A fantastic £17,643.25 raised for The Eve Appeal & Jo’s Trust

We are delighted to present The Eve Appeal and Jo’s Trust jointly with a cheque for £17,643.  Funds were raised by Consultant Gynaecologist Narendra Pisal running and completing the world’s oldest and largest marathon, the Comrades Ultra Marathon in South Africa in June.  Over the summer many patients and friends of London Gynaecology generously donated and sent messages of support and London Gynaecology matched the first £5000 raised.

The amount raised will be split between both charities and joining us on the day to collect the funds was Dan Joyce from Jo’s Trust and Becky Griffiths from The Eve Appeal.

Robert Music CEO of Jo’s Cervical Cancer Trust said, “We’re so grateful for Dr Narendra’s commitment to supporting Jo’s over the years, continually taking on incredible feats to raise money. Jo’s Cervical Cancer Trust is funded almost entirely by donations, so we rely on the generosity and enthusiasm of people like Dr Narendra.

The money raised will go a long way to ensuring we are able to support more people affected by cervical cancer and cell changes and be there when they need us most.”

Athena Lamnisos Chief Executive of The Eve Appeal said, “We are hugely grateful to Dr Pisal for taking on this incredible challenge and for raising over £18,000 for The Eve Appeal and Jo’s Cervical Cancer Trust. We would also like to extend a huge thank you to his colleagues, friends and patients who donated so generously.

The money that Dr Pisal has raised will enable us to continue to fund research into the prevention and earlier detection of gynaecological cancers, bringing us closer to our vision of a world where less women develop and more women survive these cancers.”

To find out more about how we support The Eve Appeal and Jo’s Trust along with the vital work they do, click here.

Trends & Statistics: Pregnancy over the age of 35

More women than ever recorded are having children over the age of 45 and those deciding to have children after the age of 35 are considered having a ‘geriatric’ pregnancy. Consultant Gynaecologist Narendra Pisal shares his knowledge and reveals the true statistics and potential risks surrounding pregnancy in older age.

Read the full article featured on Yahoo here.

Quick, easy and simple pelvic floor exercises to know

Finding time for pelvic floor exercise can be troublesome with hectic lifestyles. Consultant Gynaecologist Narendra Pisal reveals the most effective pelvic floor exercises you can do if you’re pressed for time. 

Read the full article featured in The Mirror here. 

Consultant Gynaecologist Saurabh Phadnis Joins The Team

We are delighted to announce that Mr Saurabh Phadnis is joining the London Gynaecology team. 

Mr Phadnis is a Consultant Gynaecologist at The Royal London Hospital (Bartshealth NHS Trust), London. He completed his general gynaecology training in busy hospitals in the East of England and his subspecialty training in gynaecological oncology at Barts Gynaecological Cancer Centre.

His research included investigations into association of pregnancy related complications following treatment of precancer of cervix. He has won several prizes in national and international conferences. He was awarded the RCOG-Bernhard Baron Travelling fellowship to visit centre of excellence in Germany to expand his expertise in ovarian cancer surgery.

He is an expert in complex minimally invasive and open abdominal surgery. His particular interests include fertility preservation in gynaecological cancer, counselling and management of familial gynaecological cancer and advanced stage ovarian cancer cytoreduction surgery. He is an experienced hysteroscopic surgeon. He has more than 10 years of experience as a colposcopist and is an accredited trainer with the BSCCP.

Mr Phadnis believes in holistic and individualised approach to patient care.

If you would like to book an appointment with Mr Phadnis, please call 0207 10 11 700 or email [email protected].

Fertility, Pregnancy, IBD and Surgery

When it comes to Irritable Bowel Disease (IBD) and fertility/pregnancy,  possible complications lie in the medication more so than the disease itself. Although pregnancy will affect everyone differently, women with IBD who are pregnant are defined as ‘high risk’. Read what Consultant Gynaecologist Meg Wilson has to say on the topic in this piece by Trust Your Gut.

Maternity Fitness Clothes

Whether you prefer yoga, swimming, spinning, or just a run round the block, the health benefits linked to exercising while you are pregnant are innumerable. Our fitness ambassador Ellie Baker comments on the importance of exercising while pregnant in this article for The Evening Standard on the best clothing for fitness in pregnancy.

Mr Pisal’s Comrades Ultra Marathon Story

On Sunday, Consultant Gynaecologist Narendra Pisal ran the Comrades Ultra Marathon in South Africa in aid of The Eve Appeal and Jo’s Cervical Cancer Trust. So far, he has raised over £13,000 thanks to the incredibly grateful donations of family, friends, patients and colleagues. It is still possible to donate, and if you would like to, please click here.

Below, Mr Pisal recounts his full Comrades experience from start to finish, explaining his sources of motivation and how he kept going during the most difficult parts of the race:

Runners are often trying to find the next challenge. While driving to work one day, I was listening to Marathon Talk podcast presenter Tom Williams and his 73yr old dad Brian doing the Comrades this year and then was chatting the same day to Simpi, my surgical assistant whose brother in law was doing it for the 30th time this year! It was the same day the entries were opening up and I thought the serendipity of all that was pointing towards me doing this ultimate human race.

When I told Karen Weir (of runwithkaren), she was not phased. She had done Comrades in the infamous 2013 race and knew exactly what to do.

We started training with back to back long runs and I was astonished to get a 8min30sec PB (3:43) in Manchester Marathon in April which was only a training B-race. My foot kept hurting after that and I was sadly diagnosed with a stress fracture in cuboid bone of right foot. We were seven weeks from the start of Comrades. This was a devastating blow and I thought my challenge was over before it had started.

I was fortunate enough to get some very sensible orthopaedic advice from my mate and ace foot and ankle surgeon, Mr Pinak Ray. He said no impact, but ok to cross train. Karen chalked out a cross training plan for me which included rowing, spinning and use of a cross trainer. At this stage I still didn’t know if I was going to do it.

19th May was a Sunday when most other Comrades runners were starting their taper. I had missed a 4weeks chunk of running and started tentatively with a half marathon in Hackney (Thank you Julia Henderson). I ran that at a sensible pace chatting to Amara Hughes and was relatively pain-free in my foot (in runner speak it means ‘hurts like hell, but a morphine shot was not needed’). We then decided to go for it and Karen gave me double weekend workouts with long run-walks on Saturday followed by epic long walks on Sunday. Pradnya my wife would cycle around Regents Park (she is training for London-Surrey 100mile bike race) to accompany my walks at 5am! Simon Tanner joined me last Sunday and we had a great walk talking about life, work and politics!

Marta Solova who is an amazing sports massage therapist and Darran Marshalleck my personal trainer also kept me in reasonable shape when I was off my feet. I was so fortunate to be supported by these expert professionals in Karen, Marta and Darran. Couldn’t have done it without you guys! Your experience of working with injured athletes and still getting them race ready in time was so instrumental.

Meanwhile, Emma Orman and Florence were getting a campaign ready for using this as a platform for raising much needed money for cancer. We selected two charities that are doing amazing work in the field of women’s cancers (Jo’s Cervical Cancer Trust and Eve Appeal). The response from my friends, colleagues and patients was simple astounding. My private practice (London-Gynaecology.com) also decided to put in 5000£ and to date we have raised over 13000£. I am so amazed and indebted by the kindness and generosity of so many people. Really humbled. Thank you so much, it means a lot!

We arrived in Durban with hope rather than confidence. We knew that ‘DNF’ (did not finish) was a real possibility but we thought it was better than ‘DNS’ (did not start). I was constantly chatting to Rob and Mike who between them have done 12 Comrades and their experience, advice and detailed race strategy was enormously helpful on the race day. I also spoke at length to my son Rohit who has successfully completed two Ironmans in very challenging circumstances and he gave me some very useful tips about mental strength. He said sometimes in a race, you have to have a word with yourself and tell yourself why you are there and stop feeling sorry for yourself. It is always a choice and quitters don’t win. That advice was needed in the first 10k itself of this 87k ultramarathon where I had to have a very strong word with myself.

In South Africa, I met so many legends! I met the above-mentioned Tom and Brian Williams. Tom has been a legendary celebrity in my eyes as he along with Martin Yelling has done nearly 500 marathon talk podcasts and I have listened to them regularly over last 3-4 years. I met Bruce Fordyce who won the Comrades nine times in the 80s and I was fortunate enough to go on his bus tour of the route and benefit from his advice. I met Coach Parry whose Comrades podcasts I have been listening to and benefitted from his advice too. Finally I also met Jamie, co-founder of Runderwear, who is doing so much to make life easy for us long distance runners. I also met Isaac, Simpi’s iconic brother in law who was doing his 30th Comrades (triple green number).

On the race day, we got up at 3:15am, had a jungle-oats porridge at the hotel and walked 10 minutes to the start. The start of this race is spectacular and I was really pumped up after listening to Shosholoza, Chariots of fire and Cockerel followed by the gunshot. The race had started! I was in D-pen having qualified with a marathon time of 3:43 but was soon overtaken by EFGH runners as I was planning to start very conservatively.

The up run is famous for the hills. You have to climb more elevation than when you go up Ben Navis and the hills hit you right from the beginning. For some reason my (fractured) right foot went completely numb and I had to resort to walking in the first few km itself as I could not feel the foot landing and was afraid of falling. I then started getting shin pains and had to stop and massage those out. That was the first time I had to have a strong word with myself. I decided to go even slower than my planned pace and follow my plan C. This was to run at a pace just below the cut off pace. This was a dicey plan but I could not have sustained a faster pace.

In Comrades, there are six cut offs and you have to get to those points before a certain time. The time allowed is gun to gun 12 hours to finish this iconic 87km race with over 2000m of elevation. I made all the cut offs (obviously) but only by a few minutes and ended up giving palpitations to all my friends and family who were live-tracking me.

I decided (was forced) to walk all the hills and run all the flats and down-hills. This was again a risky strategy as the downhills come in the second half of the race and I had never run more than 42k even in training (I ended up missing all those long runs post-marathon). But I felt I had no other choice on the day. I had also suffered from flu in the week of the race and my strength must have taken a battering.

During the race, I was so excited to see Pradnya and Rohit five times! They carried a helium balloon with them and I could spot them from a long distance away. I talked to them, received my drinks and nutrition and also got much-needed motivation. One thing I got right in this race was nutrition and hydration and I could keep the cramps away (mostly). One time I was troubled by calf cramps, there was a spectator just there ready with a deep heat spray!

The atmosphere and spectator support throughout the 87k was nothing short of amazing. The whole population of South Africa appeared to be on the route of Comrades singing, shouting names, offering all sorts of food from boiled salted potatoes to barbecued meat to crisps and sandwiches. Water was provided in plastic sachets which meant I could drink from a corner but also use it as my personal hand-held shower! When I needed some Vaseline (don’t ask why), a lady took out one of the biggest tubs of Vaseline I have ever seen! There was coke, cream-soda and ice-cream! It was one long street party!! Thank you South Africa for making it so special.

Meanwhile, my running was going steady. I got into my rhythm and kept going. I was warned about the cats eyes but ended up tripping badly in the early part of the race. This was rather lucky as my aching muscles suddenly stopped hurting as the grazed knee and hands were hurting more!

My Garmin watch was amazing! I was tracking my average race-pace and keeping it as close to 8km/hr as possible. This gave me a 15sec/km cushion for the cut offs. This cushion was much needed in the latter part of the race. Thanks to a technician in the Garmin stand at the expo who had kindly switched off all nonessential functions such as heart rate monitor to vibrating alerts, the battery lasted the whole distance. It could have been a disaster otherwise.

About 15km from the finish-line I was woken up from my slumber when I was overtaken by the 12-hour bus. Buses are groups of runners following an experienced pacer who keeps them motivated and gets them to the finish line. Being overtaken by a bus at 12hr pace meant that I was going to be swept off at the next cut off on top of a nasty hill called Polly’s Short. That’s when I had to have another strong word with myself and get my act together. I made the cut off with just a few minutes to spare. Luckily it’s all downhill from there and I was so excited to see Pradnya and Rohit 2km from finish line. I hugged them and said ‘I have got this!’. I then had the luxury of high-fiving pretty much every spectator in the impressive stadium finish. I had tears in my eyes as I completed this ultimate human race 11:53 with just 7 minutes to spare. I didn’t think it was possible before the race and at so many times during the race. Your mind is stronger than your body and this was an example of my mind carrying my broken body over the finish line.

During the race, I was thinking of my cancer patients. The challenge they face is much much greater than mine. I ask them to focus on the next step and trust the process. Good nutrition, good hydration and positive mental attitude in addition to professional help and strong support from family, friends and colleagues is what you need. I had all of the above on the day and for that I am eternally grateful. This was one of the hardest but also one of the best days of my life.

Mr Pisal Runs The Comrades Ultra Marathon

Giving back is at the core of what we do at London Gynaecology. We have a firm commitment to fundraising throughout the year, particularly for women’s health charities. With our first-hand perspective on the ways gynaecological conditions can affect women’s lives, we see huge value in raising money to help fund research, care and support.

London Gynaecology’s Consultant Gynaecologist Narendra Pisal is a keen runner with 12 marathons under his belt. Last year, he ran the London Marathon in aid of The Whittington Hospital NHS Trust raising over £14,000 for new equipment for better endometrial cancer diagnosis at the hospital.  This amazing achievement was only possible through kind donations from friends & colleagues, patients and London Gynaecology who also donated £5,000.

2019 will see Mr Pisal’s biggest challenge yet. On June 9th, he will run the Comrades Ultra Marathon in South Africa. Comrades is the world’s oldest and largest ultra-marathon, at a massive 87km long with 2000m of elevation gain, starting in Durban and finishing in Pietermaritzburg. All entrants have to finish in 12 hours.

Mr Pisal has chosen to run the Comrades Marathon for a cause very close to his heart; he will be raising money to support the charities Jo’s Cervical Cancer Trust and Eve Appeal.

Mr Pisal says: “I have chosen to support Jo’s Trust and Eve Appeal. I am passionate about women’s health but sadly as a gynaecologist I see many patients who have been affected by a gynaecological cancer. Every day in the UK, 58 women are diagnosed with a gynaecological cancer and 21 will die. There is still a lot of work to do in raising the awareness, discovering new treatments and ultimately supporting women and their families through these diseases. These two charities are doing great work to bring gynaecological cancers to the forefront, onto the agenda and support groundbreaking research.” 

As part of his training for Comrades, Mr Pisal has participated in other marathons and training events; earlier this year, he ran the Manchester Marathon, achieving a time of 3:43:11 – beating his previous PB by 8 minutes. We’re excited to keep you up to date with his progress on our social media in these last few crucial weeks of training.

As ever, Mr Pisal’s goal in completing this huge challenge is to raise as much money as possible for these fantastic gynaecological cancer charities. If you would like to donate, please click here.

At London Gynaecology we’re also extremely pleased to support Mr Pisal’s effort and will match the funds raised up to £5000.

If you want to keep up to date with Mr Pisal’s progress and journey or more information on women’s health, please follow us on:

Instagram:   @LondonGynaecology

Facebook:  London Gynaecology  

Twitter:  @LondonGynae

Molar Pregnancy

Consultant Gynaecologist Narendra Pisal defines molar pregnancy, explaining its symptoms, treatment and risk factors. 

Molar pregnancy is a rare complication of pregnancy where the fetus and placenta do not develop normally and leads to a non-viable pregnancy. It occurs in around 1 in 600 to 1 in 1000 pregnancies. It is also known as Hydatidiform Mole or Gestational Trophoblastic Disease. Molar pregnancy can be partial or complete. Partial molar pregnancy is where there is a fetus with abnormal placentation where as in complete molar pregnancy, there is no fetus, just abnormal placental tissue.

Signs and symptoms 

Many molar pregnancies are asymptomatic and are diagnosed during a routine early pregnancy ultrasound scan. The placenta is seen to be abnormal with or without a non-viable fetus on ultrasound scan. Sometimes, diagnosis is only made when tissue is sent for analysis after a miscarriage. Common symptoms include morning sickness, abdominal pain and vaginal bleeding. The uterus is also more enlarged than expected gestational age. Excessive morning sickness is caused by higher levels of pregnancy hormones (beta hCG). Abdominal pain is caused by rapidly expanding uterus and sometimes a cyst of pregnancy (luteal cyst of ovary). Vaginal bleeding can be a sign of miscarriage.

Causes and risk factors

Molar pregnancy is caused by faulty fertilisation process. Complete molar pregnancy occurs when an empty egg (no chromosomes) is fertilised by two sperms. Thus two paternal sets of chromosomes are seen in a complete mole. Partial mole occurs when a normal egg follicle is fertilised by two sperms thus leading to three sets of chromosomes (triploidy). The risk factors include extremes of ages (teenage mothers or women over 45 years of age), Asian ethnicity and previous history of molar pregnancy.

Treatment

Molar pregnancy is treated by surgical evacuation of pregnancy under ultrasound guidance. It is important to register all molar pregnancies with specialist centres in London, Sheffield or Dundee. In London, the centre is located in Charing Cross Hospital.

Monitoring of beta hCG (pregnancy hormone) levels for six months after surgical evacuation is important to ensure that it does not develop into persistent trophoblastic disease (also known as GTN or Gestational Trophoblastic Neoplasia). The specialist centres would usually do this by inviting women to send urine samples by post.

Sometimes a repeat ultrasound scan and repeat surgical evacuation may be needed if there is persistent pregnancy tissue. Very rarely, this tissue can have malignant potential or indeed become malignant and may need to be treated by chemotherapy.

Sex, contraception and pregnancy after molar pregnancy 

It is important to avoid further conception for at least six months. Best contraception often is barrier contraception (condoms) as hormonal contraception and IUDs are relatively contraindicated. In future pregnancies, an early ultrasound scan and beta hCG levels are necessary as the risk is slightly higher (around 1 in 100). Beta hCG monitoring needs to continue for six months after delivery and is organised by the specialist centres.

Connection to abnormal (or cancerous) cells 

In a small proportion of molar pregnancies, the pregnancy tissue can become persistent and sometimes cancerous. This type of cancer is called as Choriocarcinoma. This cancer is however very sensitive to chemotherapy and the prognosis is often very good. Monitoring of beta hCG levels is therefore critical for six months after a molar pregnancy.

World Pre-Eclampsia Day

On World Pre-eclampsia Day, Consultant Gynaecologist Pradnya Pisal offers an insight into this pregnancy complication.

Pre-eclampsia is a pregnancy complication where the mother develops high blood pressure, swelling and protein in the urine. It commonly occurs in the third trimester of pregnancy, more so around and after 34 weeks. It can also occur close to delivery and after delivery.

Some mothers will have no symptoms at all except for swelling of the lower legs, which can be a symptom of normal pregnancy. The high blood pressure can cause headaches, vision disturbances such as flashing lights, vomiting, upper abdominal pain. Some women will experience a reduction in the amount of urine they are passing and the swelling may not be limited just to the lower legs. Their urine will show significant amount of protein. In severe cases, mothers can become very unwell and have a seizure. 

First-time pregnant mothers, older women and very young women, women who have pre-existing hypertension and diabetes and women who have medical conditions such as lupus are most at risk. Women who are overweight and who have family history of hypertension or have developed pre-eclampsia in previous pregnancies are also at risk. Women with twins can develop pre-eclampsia earlier in pregnancy and some women with a pregnancy abnormality called molar pregnancy will also develop this in the second trimester.

Babies of mothers with pre-eclampsia can be affected by growth restriction and may need earlier delivery or preterm delivery. When the condition develops in early pregnancy the baby is monitored with regular scans to check this. When delivery occurs early, the baby will have to be admitted to neonatal intensive care. There is a higher chance of these mothers needing induction of labour and increased chance of caesarean delivery.

Eating healthily, avoiding being overweight and controlling weight gain in pregnancy and after delivery are very important when it comes to avoiding pre-eclampsia. Women who are at high risk are prescribed low dose aspirin.

If women are experiencing symptoms of pre-eclampsia, they should urgently contact their midwife, see their GP or attend the maternity pregnancy assessment unit that is open usually during day time hours. Out of hours, they should contact the number for obstetric triage or the labour ward.