Who are we? 

The Sarcoma Clinical Nurse Specialist (CNS) is a registered nurse with specialist education and experience in sarcoma. We are your key worker, which means we are your main point of contact. We can answer questions, provide support during and after your care, and act as a patient representative in the sarcoma multi-disciplinary team (MDT) meetings.

What support and information will be offered? 

• Support during your investigations and at diagnosis.
• Verbal and written information on diagnosis and treatment options.
• Answers to any questions about diagnosis, treatment, and end of treatment plan.
• Directing you to other support such as a physiotherapist, dietician, finance and welfare services, and cancer information and support services.

Cancer Support Worker (CSW) 

The Cancer Support Worker is a non-clinical member of the sarcoma support team. They have received training to provide support and information about physical, emotional, and practical concerns to help you self-manage your recovery and return to as healthy a lifestyle as possible. 

Personalised Care and Support Planning (PCSP) 

Being diagnosed with sarcoma can be a frightening and unsettling time. It can affect many areas of your life.

The sarcoma service offers each patient a PCSP at diagnosis and after finishing treatment. This involves completing a simple questionnaire that allows you to highlight your concerns and to prioritise what matters most to you.

We offer you this assessment to ensure that wherever possible, your concerns and needs are being addressed. We can discuss additional support to help you manage your diagnosis, treatment, and beyond.

Our Sarcoma Cancer Support Worker, Hannah, will contact you two weeks after your diagnosis.

Areas covered by the PCSP may include:

• Physical concerns: tiredness or fatigue, weight change, sleep, appetite.
• Practical concerns: finances, transport or parking, housing.
• Emotional concerns: uncertainty, sadness or depression, worries about the future, feeling a lack of control.
• Family or relationship concerns: partner, children, person you care for.
• Spiritual concerns: faith and spirituality.
• General information and support: exercise and activity, diet and nutrition, health and welling.

This is personal to you, it might be that now is not the right time. The option to create a care and support plan is available to you at any stage of your diagnosis and treatment pathway. We encourage you to ask for one at any time you feel you need one. 

The Sarcoma Multi-Disciplinary Team 

The MDT is a team of specialists with experience in the diagnosis and management of sarcoma. The MDT is made up of: 

• Clinical Nurse Specialists (CNS).
• Plastic surgeons.
• Oncologists.
• Radiologists.
• Histopathologists.
• Thoracic surgeons.
• Retroperitoneal surgeons.
• The MDT coordinator.
• Patient Pathway Coordinators.
• Sarcoma Cancer Support Worker (CSW).

Making decisions about your healthcare

At NBT we encourage shared decision making. This is when patients work with healthcare professionals to make decisions about their healthcare plan and treatment. This makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments base on medical evidence, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments. You are always welcome to bring someone with you such as a family member or friend to your appointments.

Some questions that might be helpful to ask:

• What are my options?
• What are the possible benefits and risks of those options?
• What support and information is available to help me make my decisions?

Shared decision-making matters to us. Tell us what matters you you. 

If you would like a PCSP or a supportive conversation sooner, please contact Hannah on 0117 414 7417.

The Sarcoma Clinical Nurse Specialist can be contacted on 0117 414 7453.

NGS Macmillan Wellbeing Centre 

We offer help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop-ins’ for coffee and a chat or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15
Phone: 0117 414 7051 

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at, or soon after the time of a cancer diagnosis.

The session provides:

• Information about cancer and related topics that help you participate in your care and recovery.
• The opportunity to meet other people with similar experiences.
• Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

Further useful information

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003719

The Gynaecological Cancer Nurses

We are Clinical Nurse Specialists experienced in the care of individuals who are undergoing investigations for suspected gynaecological cancers or those who have been diagnosed.

We understand that waiting for test results and appointments can be a worrying time and we are available to help support you from the moment of referral, until you are either discharged from our service or your care has been taken over by the Gynaecological Cancer Team at St Michael’s Hospital, UHBW.

We are here to answer queries or concerns, and provide support and information to you, your family, and carers. We are part of a multidisciplinary team and there will be several different people involved in your care. We act as a ‘link’ to improve communication between them, you, and the wider cancer team.

We aim to: 

• Meet you and your family during hospital appointments when possible, and provide advice and support.
• Visit you on the ward if you are an inpatient.
• Answer any questions you have about your illness, the tests you may need, and discuss treatment plans for you.
• Provide phone, email, and face-to-face support.
• Refer you to other services for support.
• Liaise with community healthcare teams away from the hospital, such as district nurses, GPs, etc.
• Make sure you understand what is happening at each stage of the investigation and/or treatment pathway.
• Support you with concerns about cancer and treatment, symptoms and side effects.

Service availability

Out of hours

Personalised Care and Support Planning (PCSP)

This helps people living with cancer to have a say in how their care is planned and given. This means making sure the care matches what’s important to them.

This includes:

• Having conversations to identify your concerns.
• Developing a Personalised Care and Support Plan.
• Sharing information about diet, physical activity, fatigue, practical information, emotional support, etc.
• Directing you to local support services such as benefits.

Making decisions about your healthcare

At NBT we encourage you to be a partner in your healthcare.

When patients work with healthcare professionals to make decisions about their healthcare plan and treatment, this is called shared decision making. Shared decision making makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments based on medical evidence, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments.

Some questions that may be helpful to ask:

• What are my options?
• What are the possible benefits and risks of those options?
• What support and information is available to help me make my decisions?

Shared decisions making matters to us. Tell us what matters to you. 

NGS Macmillan Wellbeing Centre 

We give help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have any concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop ins’ for coffee and a chat, or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15

Phone number: 0117 414 7051

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at or soon after the time of a cancer diagnosis.

The session provides:

• Information about cancer and related topics that help you participate in your care and recovery.
• The opportunity to meet other people with similar experiences.
• Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

© North Bristol NHS Trust. This edition published September 2024. Review due September 2027. NBT003677

Blood Transfusion

Telephone: 0117 4148350
On-Call Haematology BMS via bleep 9433

Autolab heldesk

Telephone: 0117 4148383
On-Call Haematology BMS via bleep 9433

Medical Staff

Dr A Whiteway
Consultant Haematologist
Head of Clinical and Laboratory Haematology
Via Haematology secretaries - Telephone: 0117 4148401

Dr Michelle Melly
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr M Kmonicek
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Samreen Siddiq
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Sophie Otton
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Jaroslaw Sokolowski
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Surenthini Salmon
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Kiri Dixon
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Laboratory Staff

Mrs Allison Brixey
Blood Sciences Manager
Telephone: 0117 4148416

Mrs Joanne Skingley
Blood Sciences Operations Manager
Telephone: 0117 4148498

Mr Tim Wreford-Bush
Lead BMS Blood Transfusion
Telephone: 0117 4148363

Dr Karen Mead
Specialist Practitioner of Transfusion
Telephone: 0117 4148358

Mrs Grace VanDerMee
Lead BMS Haematology
Telephone: 0117 4148356

Mrs Halina Collingbourne
Quality Manager
Telephone: 0117 4148354

Anticoagulation Monitoring Service

Please note that this service has moved to Pharmacy.

Llinos Jones
AMS@nbt.nhs.uk
Telephone 0117 4148405
Contactable from Mon-Fri 09:00 - 17:00

Secretaries Office

Telephone: 0117 4148401
Email: HaematologySecretaries@nbt.nhs.uk

All clinics are held at Gate 5, Brunel building, Southmead Hospital, Bristol, BS10 5NB.

Referrals should be made to the Consultant Haematologists.

Monday am
General Haematology Clinic
Dr S Otton, Dr J Sokolowski Dr S Siddiq and Dr K Dixon

Tuesday am
General Haematology Clinic
Dr A Whiteway
Lymphoma Clinic
Dr K Dixon

Tuesday pm
Lymphoma Clinic, 
Dr S Otton week 1,3,5, Dr J Sokolowski- every week
Thrombosis Clinic
Dr M Melly

Wednesday am
Myeloma Clinic
Drs M Kmonicek and Dr A Whiteway
General Haematology Clinic
Dr S Salmon

Friday am
General Haematology Clinic
Dr M Kmonicek and Dr M Melly
Lymphoma Clinic
Dr S Salmon, Dr S Siddiq and Dr J Sokolowski

GMC number: 7451957

Year & location of first qualification: 2014, Brighton and Sussex Medical School.

Specialty: Interventional Neuroradiology

Clinical interests: Mechanical Thrombectomy for acute stroke.

Secretary: Alex Bessant

Telephone: 0117 414 9007

The Department of Neuropathology is based in the Pathology Sciences Building on the Southmead site of North Bristol NHS Trust.

The Head of Department is Professor Kathreena Kurian.

The department provides a UKAS accredited diagnostic neuropathology service (including nerve and muscle biopsies), for the Bristol area and regional hospitals, including those from the private sector.  It also provides a referral service both nationally and internationally.

The following services are provided by the department:

• Clinical neuropathology support for neuroscience specialities.
• Neurosurgical biopsy histology, including fully integrated reports with molecular biology.
• Diagnostic pathology of muscle and nerve, including in-house biopsy facilities.
• Neuropathology autopsies.
• Macroscopic assessment of fixed brain and spinal cord specimens.
• Post-mortem neurohistology including work for H.M. Coroner and forensic service.
• Cerebrospinal fluid cytology.

Neuropathology Requesting

Neuropathology request forms are available from the Neuropathology Department and should be completed in full.

Each request received by the laboratory is considered an agreement between the requestor and laboratory for provision of Neuropathology Services.

Refer to the Neuropathology Department User Manual (below) for further details on requesting tests.

Neuropathology Reports

Reports are currently available on ICE and will be sent by secure email to the requesting Clinician. A hard copy of reports can be obtained by telephoning the departmental secretarial team.

For further information, download the User Manual

The Tertiary Neurovascular Interventional Neuroradiology Unit at North Bristol NHS Trust (NBT) is a leading centre of excellence, specialising in advanced neurovascular interventions to diagnose and treat both adult and paediatric complex conditions of the brain and spine. Our mission is to deliver cutting-edge, patient-centred care through innovative neurovascular interventions. We strive to be at the forefront of medical advancements, improving patient outcomes and quality of life.

The Neurovascular Interventional Radiology (INR) service provides the largest 24/7 Mechanical Stroke Thrombectomy service in the UK, performing over 430 Mechanical Thrombectomy's (MT) for South West England and South Wales between 2023 and 2024. 

The unit offers a comprehensive range of services, including the treatment of cerebral aneurysms, arteriovenous malformations, and acute stroke interventions. NBT was awarded neurovascular (level 5) gamma knife commission for South West England in June 2024. Our INR department covers all paediatric neurovascular intervention at Bristol Children’s Hospital. Our team is proficient in minimally invasive endovascular procedures, ensuring the highest standards of care. Our team comprises highly skilled interventional neuroradiologists, neuro intensive care and neuro anaesthesia, neurosurgeons, and specialized nursing staff, all dedicated to providing exceptional care. Each team member brings extensive experience and expertise in neurovascular interventions.

Other procedures such as cerebral angiography, myelography, carotid stenting, lumbar punctures, spinal biopsies and cement augmentation procedures are also performed. We monitor closely international developments in the published scientific literature and adopt new techniques where appropriate; one such example being the emergence of middle meningeal artery embolization for chronic subdural haemorrhage, in carefully selected patients and in collaboration with our neurosurgical colleagues. There is an increasing demand for spinal injections and other related interventions. 

The unit is actively involved in groundbreaking research and clinical trials, contributing to the advancement of neurovascular medicine. Our commitment to innovation ensures that we employ the latest techniques and technologies in patient care. There is an active academic department with close link with Bristol University Medical school. The INRs teach undergraduate medical students from Bristol Medical School, Severn Deanery radiology registrars, has pioneered an INR FY2 program and is involved in neuroscience clinical research programs. The group has collaborated on several published studies in recent years. NBT INR also trains international INR fellows, credentialing from allied specialities (neurosurgery and neurology) from USA and Australia. 

What is an OASI? 

OASI stands for obstetric anal sphincter injury, which can happen after childbirth. It is an injury to the anal sphincter that is relatively common in people who have had a vaginal delivery (it affects 1 in 5).

What is the OASI clinic? 

This is one-stop clinic where the specialist, multi-disciplinary team aims to review all patients with an OASI.

Why do I need to attend an OASI clinic?

It is not mandatory for you to attend the clinic, however it is considered best practice to make sure you receive the best possible care. It is recommended by the the Royal College of Obstetricians and Gynaecologists. By assessing your symptoms, how you are healing, and giving you advice, this will help minimise your future risk of anal incontinence (not being able to control bowel movements).

When and where will my appointment be?

It will be at Southmead Hospital, Cotswold outpatients, on a Wednesday afternoon. It will usually be 12 weeks after giving birth.

Who will I see in the clinic? 

You will see Consultant Gynaecologist Miss Sen, and Consultant Colorectal Surgeon Miss McCarthy. You may also see a physiotherapist, specialist nurses, and clinical scientists. There may be trainee doctors in clinic who are there to observe. 

What happens at my appointment? 

You will have your first consultation with the specialists. You will be asked direct questions about your recovery including wound healing, bladder and bowel function (going to the toilet), and sexual activity.

We will then ask for consent to do an intimate vaginal and rectal examination, and there will be a chaperone in the room. The two tests will take about 10 minutes.

Endo anal ultrasound scan

Anorectal manometry

These measurements give us a good idea about the function of your anal sphincters. It will help us decide if you may benefit from a course of pelvic floor physiotherapy. 

Will the examination and tests hurt? 

They may be uncomfortable but should not be painful. We won’t do the tests if it would be painful. All tests and examinations will be done with consent, and a chaperone present, and we will be guided by you. 

What will happen after the examinations and tests?

You will return to the consultation room where we will discuss the results of the tests, and the function and anatomy of your anal sphincter. We will talk about any future plans for pregnancy, and you will have plenty of opportunity to ask and questions you have.

It can be worrying for you to come to the clinic. You may have had difficulties in birth that you haven’t had a chance to process. In clinic you may also find it worrying to hear words such as anal sphincter, injury, and OASI. If there is anything you don’t understand or are concerned about, we would be happy to see you again. 

You don’t need to do any preparation before the tests. There is a small risk of injury to the rectum, and we advise you to look out for rectal bleeding after the procedure. If this happens you can phone the number on the back of this leaflet, or out of hours phone 111. 

How long will my appointment be? 

Your appointment will take around 30 minutes, and we will try to get all your tests done in one visit. Sometimes you may have to return on another day for the tests, particularly if you are in pain at the time of your appointment.

The tests in the OASI clinic are considered ‘mobile’ and are generally quick. Some patients may benefit from more thorough assessments so you may be referred for further tests either at Southmead Hospital or Bristol Royal Infirmary. These will be done on another day, and we will see you again in the clinic for a follow-up appointment after the tests. Sometimes we will offer you a follow-up in the Colorectal Clinic with Miss McCarthy if you have ongoing bowel issues.

Where can I find more information? 

MASIC Foundation 
Home - Aiming to change the lives of women injured during childbirth. (masic.org.uk)

Royal College of Obstetricians and Gynaecologists
Perineal tears and episiotomies in childbirth | RCOG 

© North Bristol NHS Trust. This edition published September 2024. Review due September 2027. NBT003413

GMC number: 7049861

Year & location of first qualification: Imperial College London 2009

Specialty: Interventional and Diagnostic Neuroradiology 

Clinical interests: Cerebral aneurysm treatment with flow diversion; endosaccular device treatment with WEB; mechanical thrombectomy; tumour and dural arteriovenous fistula embolisation using liquid embolics.

Secretary: Alex Bessant

Telephone: 0117 414 9007

This page has information for patients who have had a third and fourth degree tear during the delivery of your baby. These are called obstetric anal sphincter injuries (OASI). 

This page explains the types of tears, how to look after yourself, and follow-up care. 

What is a perineal tear? 

Many women experience tears during childbirth, as the baby stretches the vagina and perineum (skin between the opening of the birth canal and anus). In the UK around 9 in 10 women who have a vaginal birth will have some degree of perineal trauma. 

Types of perineal tear

• First degree tears are small skin-deep tears. They usually heal naturally.
• Second degree tears are deeper and affect the muscles of the perineum. They usually need stitches.
• An episiotomy is a cut made by a healthcare professional through the vaginal wall and perineum. This may be done if your baby needs to be born more quickly or if they need more space. Episiotomies can sometimes extend and become a deeper tear.
• Third degree tears extend into the muscle that controls the anus, and the anal sphincter. If this extends further into the lining of the anus or rectum this is a fourth degree tear. 
• A rectal buttonhole is a rare injury when the anal sphincter doesn’t tear but there is a hole between the anus and vagina.

Why did I get a third/fourth degree tear?

Will it cause any problems?

What about stitches?

What can I do to help recovery? 

Some simple steps can help healing and reduce the chance of developing complications. 

Keeping the area around the tear and perineum clean

Opening your bowels (avoiding constipation)

Opening your bowels should not affect your stitches. For the first few days after your tear is repaired, control of your bowels may not be as good as before you had you baby. 

• You will be given some medicine to soften your stool (poo) when you go home.
• Aim to drink at least 2 litres of water a day.
• Eat a healthy balanced diet including things like fruit, vegetables, cereals, and wholemeal bread.
• Avoid painkillers with codeine as they can cause constipation.

The best position to sit in when opening your bowels is with your feet on a stool like in the image below with your: 

• Knees higher than hips.
• Lean forwards and put your elbows on your knees.
• Bulge out your abdomen.
• Straighten your spine.
• Take your time and don’t rush.

This helps straighten your bowel. 

What can I do to help improve my bladder and bowel control? 

You can strengthen the muscles around the vagina and anus by doing pelvic floor exercises. You should start these as soon as you can after the birth, as long as you don’t have a catheter in and you’ve had your first normal wee.

The next page has a brief description of how to do pelvic floor exercises and there are links in the back of this leaflet to further resources we have put together.

Doing the pelvic floor exercises

When can I expect to return to usual activities?

When can I be intimate (have sex) with my partner again?

What follow-up arrangements should I expect?

Will I be able to have a vaginal birth again?

Useful NBT videos

Useful phone numbers

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002127