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Crohn's Disease Forum » Surgery » Fistulas, Fissures and Abscesses » Advice on colorectal surgeon on nhs/private



06-03-2014, 12:59 PM   #1
mox123
 
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Advice on colorectal surgeon on nhs/private

I am based in the uk and have been suffering from what I believe may be an anal fistula. the symptoms are:

- constantly reoccuring abscess 2cm from anus, puss, etc.
- occurs when having an incomplete bowel movement and don't feel empty
- absolutely painful
- exact same area

been going through this pain for two years, finally saw a general surgeon and it was pitiful. he did not take it seriously and put it down to being related to a hemorrhoid which is utter nonsense. his examination lasted minutes and i was in and out bearing in mind this was the last evening appointment for the day.

is there any way i can see a colorectal surgeon on the nhs, id even consider going private if it is not too expensive.

does anyone have any information that would point me in the right direction? i dont know if i should go back to the doctor and if they can refer me to a colorectal surgeon, im not sure if i should change doctor surgery,

any advice would be appreciated.

my doctor thing its a cyst, surgeon thought it was related to hemorrhoid, and i think its a fistula,

i appreciate any advice you can offer
06-03-2014, 01:15 PM   #2
littlemissh
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Ask your GP to refer you to a colorectal surgeon. He/she just needs to write a referral letter. If you know who you want to see it can be addressed to the relevant person.

Your GP will often know the most trustworthy colorectal surgeons so it is worth asking their advice.
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06-03-2014, 01:20 PM   #3
highlandsrock
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Hi Mox

The team that performed my operation was excellent and were lead by a top man. I'll PM you with his details. I was operated on at St.Thomas' Hospital in Westminster and would wholeheartedly recommend them.
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06-03-2014, 01:46 PM   #4
highlandsrock
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For some reason I couldn't send a PM.

I was operated upon by Mr. Emin Carapetti. You'll find him on the internet with some good reviews. I know that he has since left St.Thomas' so may only be working in private practice. He specialises in the area you need.

I was referred to St.Thomas' by East Surrey Hospital as they didn't have the right faciities to manage my recovery after so complex an operation. Mr. Carapetti was ably supported by Mr. Tim Campbell-Smith who is the gastro surgeon at East Surrey.

You didn't mention which area of the UK you are in so I realise the above may not be much help if you aren't in the South East. I recorded my surgical experiences on my blog if you are interested.
06-03-2014, 01:59 PM   #5
mox123
 
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thankyou littlemissh and highlandrock for your replies so far.

i am in glasgow, scotland where i reside. just a follow up question from that highlandrock did you go through the nhs or private, if private what were the costs involved.

i will try to locate this doctor and im willing to travel if necessary, would you be able to give more info on your specific condition if you feel comfartable with this, how long was the surgery, recovery, pain levels, post surgery etc.

i will speak to my gp again to see if i can be referred to a colorectal surgeon. the general surgeon suggested i take more fibre which doesnt help me solve this problem any further. what if my gp refuses to refer me, should i change gp?
06-03-2014, 02:44 PM   #6
KayleighMeek
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I think you should see another GP if they won't refer you before being diagnosed I saw 4/5 different Drs before being refered to a GI.
You may struggle getting private cover if you have been diagnosed with crohns already as they consider it part of the same condition. I tried looking into it a few years ago for arthritis associated with crohns and I couldn't get very far.
I have seen that most nhs Drs also work in the private sector so you might see the same either way the only thing with private is you will get seen quicker
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06-03-2014, 02:53 PM   #7
highlandsrock
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I will not go privately as it is against my principles so all my care has been provided by the NHS. It has been of the highest standard. I know waiting lists can be bad in some parts of the country but if you actively take control of your treatment and appointments you can get round the log jams.
06-03-2014, 03:18 PM   #8
mox123
 
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thanks again to everyone that replied so far.

in all honesty im considering borrowing money to pay for a private consultation with a colorectal surgeon which is around 200 and see if i can get any better diagnosis that i can take back to the doctor if worst comes to worst, heck i would even pay for the surgery if it wasn't too steep,

would you know how much these sort of surgeries would cost, ive did some googling and it seems to be around the $1000-2000 mark abroad but im not sure how much it would be here for something like a seton or fistulotomy, i wouldnt think it would be any more than 3000 in total, still alot of money and i think i would need to borrow it from family

well i can try a different gp in the same practice but do you reckon its better to change the practice altogether or just different doctors within the same surgery? my practice has around 6 different doctors i could see each and every one, if i have to

ive never experiences issues like this before and im worried about all the hassle and this is causing me a great deal of stress and affecting my relationship,

i just need to convince my doctor to refer me to a colorectal surgeon im really not sure how else i can convince them,
06-03-2014, 03:40 PM   #9
Absentminded
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Hi,

I've had several major bowel operations both privately and on the NHS, all of which were done by the same Colorectal Surgeon.

I have private health insurance so don't pay directly for my care, but I do get copies of the invoices so I have some idea of how much it costs.
Just as a guide, my last colonoscopy cost 1650, which was under sedation and I was only at the hospital for 2 hours.
At the other end of the scale, the major bowel surgery that I had back in January cost over 8000. That includes the surgeon's fees, anaesthetic fee, 48 hours in HDU, and another 5 days in hospital, plus all the other sundries (drugs, dressings, etc. etc.)

What might be possible for you is to have your consultation privately and any op you may need on the NHS. My surgeon charges 150 for his consultations.


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06-03-2014, 03:55 PM   #10
Daisy123
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Hi,

I've had several major bowel operations both privately and on the NHS, all of which were done by the same Colorectal Surgeon.

I have private health insurance so don't pay directly for my care, but I do get copies of the invoices so I have some idea of how much it costs.
Just as a guide, my last colonoscopy cost 1650, which was under sedation and I was only at the hospital for 2 hours.
At the other end of the scale, the major bowel surgery that I had back in January cost over 8000. That includes the surgeon's fees, anaesthetic fee, 48 hours in HDU, and another 5 days in hospital, plus all the other sundries (drugs, dressings, etc. etc.)

What might be possible for you is to have your consultation privately and any op you may need on the NHS. My surgeon charges 150 for his consultations.
This is how I was first diagnosed. My parents paid for me to see a GI privately who then transferred me back to the NHS for treatment. He did both private and NHS work
06-03-2014, 05:25 PM   #11
valleysangel92
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Hello there

I don't have any experience with private care, but I thought I'd chip in and say that my NHS surgeon was excellent, he did a brilliant job and he put me at ease, his bed side manner was good, I got regular visits on the ward and he made a point of telling the nurses that my parents were allowed onto the ward in the morning before my op and once I got out of recovery. My nurses were all very caring and the care I got was second to none.

I know that not everyone gets good experiences with the NHS but it is possible to get care that's just as good as private. I know the waits are longer but that can't always be helped.

I was actually told that even if I wanted to go private, I wouldn't be allowed as the operation was too risky, I don't know if that's because my low weight and asthma combined with an abnormal facial alignment posed anesthetic risks but I was given the impression it was because of the operation itself..
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06-04-2014, 03:46 PM   #12
littlemissh
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You shouldn't need to convince your GP. Just say that you want a referral, thank you very much.
If he/she refuses (which is not really allowed) then see another GP and also make a complaint.

(COI Am a UK GP..in case you hadn't guessed)
06-05-2014, 05:35 PM   #13
mox123
 
Join Date: Jul 2013
thankyou everyone that has replied so far. i really appreciate your advice.

i'm in extreme pain tonight and i am going to call in an emergency tomorrow and ask to be referred to a colorectal surgeon,

im seriously considering seeing a private colorectal surgeon and pay for the initial consultation, then carry it over on the nhs,

can i just double check is it a colorectal surgeon that i need or a GI? what does GI stand for exactly?

Im desparate to get diagnosed and hopefully have a seton fitted. the symptoms are pointing to a fistula, and i feel sure that it is a fistula of some sort,

if i need to complain about a gp who can i complain to, the practice itself or elsewhere?
06-05-2014, 05:40 PM   #14
theOcean
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GI is a gastroenterologist. A surgeon would be if you're considering surgery; GI would be for IBD, and some even specialize in it.

I have a peri-anal fistula, so if you have any questions about that or setons you can always ask! We also have a section for fistulas and a support group for them.

As for complaining about a GP: you can complain to the practice, and there are also multiple websites online (ratemyMD and the like) that you can find where you can write reviews.
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06-05-2014, 06:02 PM   #15
mox123
 
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thankyou for this

what are the general steps and timescales, for example if my gp refers me to a GI / colorectal surgeon?? does that mean the initial referal i will have a colonoscopy done?
06-05-2014, 06:32 PM   #16
mox123
 
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im thinking of using a usb borescope to do a self-colonoscopy, i know this sounds ridiculous but I am desparate to show my doctor something,

if you google usb endoscope or usb borescope you will see what i mean, its similar to the colonoscopes but it can be plugged into a usb port on a laptop, its a snake type thing just like the ones the professionals use.

what do you guys think? worth a shot? i dont think i would need to go deeper than say 6 inches and i can take multiple pictures using it and record video, i will get my partner to help me

any thoughts? or am i being crazy desparate
06-05-2014, 06:41 PM   #17
theOcean
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I can't answer for timescale, since I'm from Canada and I'm not as familiar with the NHS. I'm going to tag valleysangel92 (I see she's already replied above) in the hopes she can respond to you, though.

I really, really don't think you should do a self-colonoscopy, though. You run the risk of perforating your colon if you do that, and it's really not worth the risk, though I understand your desperation.
06-05-2014, 06:59 PM   #18
valleysangel92
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Thanks for the tag .

Unfortunately there's no straight forward answer with timescales. It really depends on what the waiting lists are like in your area and if you are classed as an emergency, urgent or routine patient.

Before I had a scope I had to have an MRI scan. They prefer to start with less invasive and therefore less risky tests first if they can, but in your case they may go straight to a scope.

After I got the MRI I waited about two months for my colonoscopy, but that time included cancellations due to me reacting to the prep and the hospital having a mix up.

It's more common to be referred to a GI than a surgeon at first, and in the UK GIs can perform scopes. The sooner you get the ball rolling the sooner you'll get your appointment and tests sorted. If you do have a fistula that needs surgery then your GI can refer you to the correct surgeon, my GI directly passed my case on to a colleague when I had my resection, skipping months of paperwork and ensuring I got the best surgeon available. This route is generally better than being referred by a GP as they will write to the general department and you will just get whatever surgeon picks up your file (it would still be one from the appropriate specialism, but its still sort of pot luck) . GIs will generally have a good working relationship with the surgeons and be able to directly recommend the best one for your situation. Plus it makes it easier to get something done if there is a problem, since you can directly contact your GI about it and they can step in if needed.

Please, please don't try to scope yourself. I understand how desperate you must feel, this disease can be so horrid, but it's just too risky. As theOcean said, you risk perforating your own colon which is a medical emergency and can lead to sepsis. Plus you could give yourself an infection, you could cause internal bleeding and not to mention how uncomfortable the whole thing would be... It's far safer to wait and get it done at the hospital.

If you are really struggling then you can go to A+E to get help. But please do not try to self test and/or self diagnose.
06-05-2014, 07:11 PM   #19
mox123
 
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Im thinking of going to an A & E now, im not sure what I should do, if I go now what will happen will they simply inspect me and give me pain killers
06-05-2014, 07:17 PM   #20
valleysangel92
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Well at this time of night not much will happen if I'm honest, but they would at least get you comfortable I should imagine.

Whenever I've gone to A+E I've been admitted and given fluids and pain killers, for my shorter stays when I was undiagnosed I had basic bloods and ultrasounds. I was already diagnosed when I had my longer stays so I also had CT scans and blood work, plus a GI review of my treatment. I've never had a fistula though.

I have known people be admitted through A+E and then get scoped and diagnosed and they began treatment straight away. Again it will depend on the individual hospital, but at the very least you should get some pain relief, basic bloods, and examination (this might include a rectal exam) and xrays, plus either an ultrasound, CT or MRI. They might scope you or they might let you home and arrange a scope as a day patient.
06-05-2014, 07:23 PM   #21
mox123
 
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well I have phoned nhs24 to see what they say, the abscess has popped but its still lumpy underneath, i really cant take this, they are going to call me back, i hope they recommend I go to an a + e
06-05-2014, 07:27 PM   #22
theOcean
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If your abscess has popped, I definitely think you should go to A&E anyway. You don't want it to get infected, after all!
06-06-2014, 06:19 AM   #23
valleysangel92
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Yeah I agree, the phone service is great and all, but they are lead by nurses generally, so they probably won't have much specialized knowledge so they cant always give the best advice on things like this. If you don't go to A+E then try and get an emergency appointment at your GPs at least.
06-06-2014, 07:30 AM   #24
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Good luck. I am unfamiliar with hospitals outside of the US. If you go to A+E can you request to be seen by an on staff GI? My local hospital in the US has a GI and Colorectal surgeon that makes the rounds. Not sure if that is the case where you are. Also, be very wary of letting a general surgeon at your abscess. What you likely need is for them to put you out clean out the abscess and give you a EUA (exam under anesthesia) to check for a fistula track. If you are feverish or have been you should make sure they know so they take you more seriously. Are you on any meds? Are you diagnosed
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06-06-2014, 02:07 PM   #25
littlemissh
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It is a colorectal surgeon you need. If you see a gi he could do a colonoscopy but if it showed abscess/ fistula that required surgery he would then have to refer you on to a colorectal surgeon.

In england the guidelines are that from referral you should be seen and treated within 18 weeks. But if you were referred as urgent or when you saw the consultant he considered you urgent you would get a much quicker scope/tests.

I have been seen in clinic and had a gastroscopy that week on more than one occasion.So in short, generally, you will get quick tests and treatment if you need it. And if you are in that much pain then you should be sorted quickly.
Your GP can arrange for you to be admitted/assessed in the ED by a surgeon but it will be the on call surgeon who may not be a colorectal specialist. Unless you need to go to ED it is best to go via your GP as they can refer you to the correct person.
If you have an abscess it needs antibiotics and the oOH GP can sort that for you as your GP will be closed until monday.

Hope this helps
Best of luck.
06-07-2014, 08:20 AM   #26
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I had my fistula op at St George's, it was roughly two months from being seen to the actual op. I'd had a referral from my GP to colorectal


06-08-2014, 08:05 AM   #27
mox123
 
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thanks for everyone that replied so far.

I went to see the doc and he simply said they can't do anything if the surgeon has not recommended any further action - since the surgeon simply told me to take more fibre and that was that

i asked to see a GI or colorectal surgeon and he said they cant do that as there isnt anything that indicates i need to see them,

he also said i would see a gi or colorectal surgeon as teh general surgeons are specialists in this area or some nonsense like that

he also advised i should go to a + e when it flairs up, so im waiting for it to flare up so i can go to a+e but if they simply give me pain killers and anti-biotics its no use, i need a serious diagnosis and im really stuck

should i see someone private for a diagnosis and take this back to the gp, ive got an appointment with another gp at the surgery to find out his opinion,

this is getting ridiculous and i dont know why im not being taken seriously

i mean could it be something other than a fistula, its an abscess that reoccurs at the same spot around the time of a bowel movement, give a few hours and the lump gets larger and over the course of a day or two an abscess forms, if i dont go to the toilet for 2 days i am fine as long as i am "emptied" properly, if i havent had a full empty this is when i get the symptoms,

surely these are linked and makes sense of some sort of fistula that is causing the abscess, ive noticed a little hole where the abscess was before and continual leakage over the course of days around bowel movement which eventually healed up but slight lumpy and quite bad discolouration around the area, the discolouration is always there

im not sure what to do, should i consult with a colorectal surgeon and pay the 200 odds for a diagnosis, or change my gp surgery?
06-08-2014, 11:40 AM   #28
littlemissh
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Mox, you have mail.
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