Thursday 6th January 2011
Derriford doctors clear more than their diaries in the name of science
Several Derriford specialists recently showed their commitment to their patients by having their bowels cleared out in the name of medical science. The doctors, seven colorectal surgeons or anaesthetists, along with colleagues from other hospital departments volunteered to take part in a research project which looked at how different ways of preparing patients for major operations might affect their ability to recover from the effects of the surgery. Each participant had to cycle a stationary bike to the point of exhaustion on three separate occasions, most memorably after taking Picolax, a medication which cleans out the bowels by inducing diarrhoea.
The project, “Picopex” led by Consultant Anaesthetists Richard Struthers & Gary Minto and Colorectal Surgeon Chris Challand is the first to be supported by Bowel Cancer West, a Peninsula based charity dedicated to improving the experience of local patients by promoting education and research. Mark Coleman, Colorectal surgeon, and Director of Bowel Cancer West was one of the volunteers.
The investigators have been trying to work out whether Picolax and other medications which prepare the bowels for surgery can actually have a negative effect on recovery. In some ways having surgery is like exercising: in both situations the body`s energy requirements go up. As Dr Minto explains, “when you undergo a big operation, your surgeon removes diseased or cancerous tissue, but it is your own body that immediately starts the work of healing by laying down new tissue around the framework of stitches that the surgeon has placed. Your body also sends inflammatory cells to the healing area to fight off infection and make sure that everything knits back together properly. All these new cells have a need for oxygen and fuel so your lungs and heart have to work a bit harder all the time that the healing process goes on. It`s like getting up now and going for a light jog that lasts non-stop for several days. ”
Up to 3 in every 100 patients having major operations for bowel cancer will die within a month of that operation. For many years it has been common practice for patients having bowel surgery to be given medications to clean the bowels out just prior to surgery in an attempt to decrease the risk of infection. Since 2005, Dr Struthers and anaesthetist colleagues at Derriford have been performing exercise tests prior to major operations in order to assess patients` fitness, particularly to pick out less fit patients who may require extra support and monitoring during and immediately after their operations. They wondered if the “good effects” of the bowel prep might be outweighed by bad effects such as dehydration and energy depletion which decrease fitness and designed the Picopex study as a preliminary investigation into this.
The completion of the project, run over the past 3 months represents an early success for Bowel Cancer West which was launched in March 2010. The results of this study will shortly be available on the web site at www.bowelcancerwest.org.uk. The Bowel Cancer West team look forward to working with professional colleagues and supporting a range of further projects in 2011.
Photo Left to Right: Consultant Tom Edwards, Consultant Richard Struthers, Consultant and BCW Director Mark Coleman, Consultant Gary Minto and BCW Director, Junior Doctor Chee Lai