Your guide to self-supported management and remote monitoring

Useful definitions: 

• Colorectal is another word for bowel, colon, or rectum.
• CEA stands for carcinoembryonic antigen, which is a protein found in the blood.
• CT scan uses X-rays and a computer to create detailed images of the inside of the body.
• Endoscopy is the term for the camera used to visualise (see inside) the gastrointestinal tract.
• Colonoscopy and flexible sigmoidoscopy are used to view the lining of the large bowel.
• Supported self-management - enables you to take a leading role in your follow-up with support from the cancer support team.
• Remote monitoring – enables you and your clinical team to monitor your health and review your plan of care without needing to do this face-to-face.

Follow-up after colorectal cancer treatment

This page explains how the Colorectal team will monitor you following your colorectal cancer treatment.

Over the next 5 years you will have CT scans, a blood test called CEA, and endoscopic assessment of the remaining large bowel at set times.

To do this North Bristol NHS Trust (NBT) uses a secure website called My Medical Record (MMR). The website will give you access to your monitoring plan, colorectal test results, useful health and wellbeing information, and the ability to message the team. Using MMR reduces the need for routine follow-up hospital appointments. 

Following your treatment, a member of the Colorectal nurse team will discuss your monitoring plan and introduce you to the website. 

Here is a short film about MMR: 

After watching this video, if you would like to use MMR we will provide you with login details. If you choose not to use MMR, your monitoring will continue with routine phone appointments. 

What tests will you have?

CEA blood test:

• For the first 3 years you will have a test every 6 months.
• For the next 2 years you will have a test once a year.

CT scan of the abdomen and pelvis (CAP):

• Once a year around the time of your surgery for the first 2 years.

Some people may also have a colonoscopy or flexible sigmoidoscopy if required.

CEA can be raised in some patients with colorectal cancer so it is monitored following treatment. However, many other conditions can increase it.

Your CEA blood tests will be taken at your GP surgery or other community setting. You will be asked to arrange the blood test yourself. MMR will show your monitoring plan which tells you when the blood tests are due.

You will be able to see your results on the website, the Colorectal team will contact you if any action is needed.

CT scans and endoscopy appointments will be arranged by the Colorectal nurse team. You will receive an appointment to attend the hospital for these tests. The results will be available to you on MMR after they have been reviewed by the Colorectal nurse team.

• If your results are normal, you will receive a letter on MMR confirming the result and the date when your next test it due.
• If your test results are abnormal and require further review, a member of your Colorectal nurse team will contact you and advise you of the next steps.

We appreciate that having undergone treatment for colorectal cancer you may have queries from time to time. During the monitoring period you can contact the Colorectal team by phone or using MMR secure messaging.

Depending on your query the Colorectal team will either give advice, find out more information, or arrange a hospital appointment.

Picture of the My Medical Record homepage

Useful information available on MMR 

Local and national information including websites, leaflets, and videos are available on MMR. They cover topics such as:

• Managing the side effects of treatment.
• Healthy lifestyle.
• Support groups.

How to contact us

Clinical Nurse Specialist and Cancer Support Worker 

0117 414 0514

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003692

Information for patients referred for an MRI arthrogram at North Bristol NHS Trust. 

What is an MRI arthrogram?

How do I prepare for an MRI arthrogram?

What are the risks?

On the day of the procedure:

What happens during the MRI scan?

Pregnancy

Claustrophobia

How long will it take?

After the procedure

How will I get the results?

© North Bristol NHS Trust. This edition published July 2024. Review due July 2027. NBT002793.

In October 2024, NBT became the first NHS Trust to sign the Concordat for the Environmental Sustainability of Research and Innovation Practice. 

Developed by the UK research and innovation sector, the voluntary concordat represents a shared ambition for the UK to continue delivering cutting-edge research, but in a more environmentally responsible and sustainable way.

Clinical trials contribute substantially to greenhouse gas emissions, with average carbon emissions generated per trial of almost 80 tonnes. This is equivalent to the average carbon footprint of one person in the UK for 13 years.

Positive actions NBT has already undertaken to drive sustainable research include:

• Research & Development (R&D) including sustainability as one of the two founding principles of its research strategy. This underpins all decision-making across R&D.
• Requiring that a Sustainability Impact Assessment (SIA) is completed for all internally funded Research grant applications. This encourages researchers and innovators to plan and carry out their activities in an environmentally sustainable manner.

• Working on overarching policy to ensure that sustainability is included in all policies and procedures.

   

Introduction

Until recently, many individuals referred for contrast scans were advised to abstain from (stop) breastfeeding for 24-48 hours after a scan. 

This advice was not based on evidence of harm to the infant and did not consider the difficulties of expressing milk for 24 hours, bottle feeding, and the risk of mastitis for the mother. 

This page provides information about new guidance for breastfeeding people undergoing contrast-enhanced MRI and CT scans.

MRI scans, MR contrast, and breastfeeding

CT scans, CT contrast, and breastfeeding

Where can I breastfeed in the hospital?

You are welcome to breastfeed anywhere on site, however if you would prefer to have a private room, dedicated breastfeeding rooms are located:

• Near every lift well in the Atrium. Rooms are next to the giant letters (A, B and C) round the right-hand side of the lift doors.
• A further room is located near the Brunel car park entrance.

What will happen if I choose not to have contrast? 

The decision to have contrast is entirely yours. It will not affect any aspect of your care within the imaging department. It may mean that your diagnosis is not quite as specific, which may potentially impact your treatment plan. Please discuss this with your referring clinician.

What if I am or think I might be pregnant?

MRI

CT

How can I prepare for a contrast enhanced scan?

The day before your scan, slightly increase your fluid intake (drink more) and continue to do this for the following 24 hours to ensure you are well hydrated.

On the day of your appointment, please refer to any specific dietary instructions which, if required, will be stated on your appointment letter.

Please contact the department prior to your scan if you have

• Reduced kidney function or diagnosed kidney failure.
• You are on or have ever been on dialysis.

What options are available to me?

1. You can decide to receive contrast and continue breastfeeding as normal.
2. Prior to your appointment - express sufficient breastmilk (and store appropriately) to bottle/cup feed the child for 12 – 24 hours. After the scan, express and dispose of breastmilk for the following 12- 24 hours.
3. You can decide to have a plain (non-contrast) scan with review to see if contrast is necessary for diagnosis. Your doctor or clinical nurse specialist will have considered the potential risks and benefits of having a scan involving contrast when referring you. (For accurate diagnosis it is not always possible to have a non-contrast scan).

What happens during a contrast scan?

Contrast is normally injected via a cannula or line which is placed in a vein, usually in your arm. The cannula will stay in your vein until your procedure has finished. You will be monitored and observed throughout and advised when the contrast is about to be injected. This could be a manual injection by a member of the team or by an injector pump. 

In MRI, you may feel a cool sensation in your arm when the injection starts. These side effects are temporary. 

In CT, you may feel a warm sensation passing around your body and a metallic taste in your mouth. These side effects are temporary.

What happens after my contrast scan?

We will ask you to remain in the department for a short period of time, to observe you and remove the cannula. We will leave the cannula in place incase we need to give you any other medication. We will check to make sure you feel well enough to leave and remove the cannula. 

Please do not leave the department with your cannula still in place unless you have another procedure requiring its use within the hospital.

Reliable sources of information

© North Bristol NHS Trust. This edition published February 2024. Review due February 2027. NBT003510.

This information is for people with loop recorders who have been sent for an MRI scan at North Bristol NHS Trust.

What is an MRI scan?

MRI stands for Magnetic Resonance Imaging. It is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

Are loop recorders safe for MRI?

Yes, it is safe for you to have an MRI scan with your loop recorder but there are some instructions you will need to follow so please read this leaflet carefully.

Will the MRI damage my loop recorder?

No, the MRI will not damage your loop recorder, but the powerful magnet may corrupt the data on your device and cause important information to be lost.

What do I need to do to prepare for the scan?

To prevent the data from being lost you will need to make sure your home monitoring system is working correctly. This could be a device next to your bed that automatically sends data to the hospital, or it might be an app on your phone.

It is recommended that you send the data to the hospital manually immediately before coming in for your MRI. If you are not sure how to do this, please contact your cardiac centre.

It is also recommended that you make a note of the time and date of the scan to pass on to your cardiac centre. This will help them to account for any interruptions to your monitoring whilst you are inside the MRI machine.

What if I don’t have a home monitoring system?

If you don’t have a home monitoring system you will need to attend the cardiac testing clinic before your MRI scan. Please contact the MRI bookings team on the number on the back of this leaflet to inform us of this and we will arrange a cardiac testing appointment alongside your MRI scan.

What if my loop recorder battery is dead?

If your loop recorder is no longer functioning, you still need to tell the MRI department you have one so you can be booked onto one of our weaker strength scanners. 

You won’t need to do anything else to prepare.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003682.

This page contains advice on how to become more active starting from your time within hospital and to continue at home.

Why is it important to exercise?

Regardless of your age or physical abilities, introducing these exercises into your daily routine will help keep you stay strong and make daily activities easier. Exercise can help you improve:

• Balance.
• Mobility.
• Flexibility.
• Circulation.
• Bone health.
• Skin health.
• Strength.
• Agility.
• Breathing.

Moving more can also improve your mood and sleep. These will help you feel better in hospital and once you are home. 

Things to consider when exercising

Don’t worry if you haven’t exercised in some time. These chair exercises are gentle and easy to understand. If you are unsure of anything, speak to our physiotherapy team.

1. First, find yourself a stable chair to sit on that doesn’t move - avoid any chairs with wheels.
2. Make sure you are in a comfortable position on the chair with feet flat on the floor. Sit upright, away from the back of the chair, and wear comfortable clothes.
3. Have some water nearby.

When to stop exercises 

It’s normal to experience muscle aching after starting new activities. As you do the exercises more often, you may notice the discomfort reduces. If you become suddenly unwell, you should stop exercising and seek medical attention. 

Seated exercises

Here is the exercise programme including warm up exercises. Follow the exercise instructions on the next few pages. Your physiotherapist will tell you which exercises you should do. Your physiotherapist may write down the number of 'reps' and 'sets'  you should do of each exercise. 

• Reps (repetitions) are the number of times you perform a specific exercise.
• Sets are groups of reps with rest time in between.

For example: if your physiotherapist asks you to complete 5 reps, and 3 sets you should:

1. Do the exercise 5 times.
2. Rest.
3. Do the exercise 5 times.
4. Rest.
5. Do the exercise 5 times.

Chest stretch

1. Sit upright in your chair.
2. Extend your arms to the side.
3. Push your chest forwards and hold for 3 seconds.
4. Return to the starting position.

Upper body twist

1. Sit upright in your chair.
2. Cross you arms, reaching for the opposite shoulders.
3. Keep your hips facing forward and turn your upper body slowly to the left and then right.
4. Return to the starting position.

Neck rotations

1. Sit upright in your chair and face forwards.
2. Slowly turn your head to the left and hold for 3 seconds.
3. Slowly return to the centre and turn your head to the right, hold for 3 seconds.

Seated marching

1. Sit upright in your chair and hold the sides of the chair if needed.
2. Start marching your legs: lift 1 leg up with your knee bend and then the other at a controlled pace.
3. Continue this for 30-45 seconds.

Knee extension

1. Sit upright in your chair.
2. Kick your foot out in front and of the floor to straighten your leg. Don’t lock your knee.
3. Slowly control your foot back towards the floor.
4. Repeat with your other leg.

Foot side taps

1. Sit upright and hold onto the sides of the chair.
2. Lift one leg to side, tapping your toe out to the side.
3. Bring it back to the centre then repeat with the other leg.
4. Add a resistance band if advised. 

Ankle flexibility

1. Sit upright and place your feet flat on the floor.
2. Lift your toes off the floor as high as you can whilst keeping your heels down.
3. Lower your toes back to the floor.
4. Keep your toes on the floor, and lift both heels.

Shoulder press

1. Sit upright and start with your hands by your side.
2. Push both arms into the air, straightening your elbows.
3. Lower them to your chest.
4. Add a pillow if advised.

Arm curl

1. Sit upright and keep your elbows at your side.
2. Lift your hand towards your shoulder by bending your elbow.
3. Lower your hand back down.
4. Add a resistance band if advised.

Reaching across

1. Sit upright, hold onto one side of the chair if needed.
2. Reach one arm across your body, try to stretch a few inches further.
3. Then do the same with the other arm. Keep your feet grounded on the floor.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003690

The Pelvic Pain Service 

NBT Pelvic Pain service involves many medical specialties because of how complex the condition can be. These include: 

• Gynaecology.  
• Urology.
• Pain medicine.
• Pain psychology and psychiatry.
• Physiotherapy.
• Occupational health.
• Pelvic pain management programme. 

About persistent pelvic pain

What causes pelvic pain?

What happens in a gynaecology clinic appointment?

How is persistent pelvic pain diagnosed?

Managing your persistent pelvic pain

How can you prepare for your clinic appointment?

More information and support

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003727

What are aminoglycosides, and what are they used for?

Aminoglycosides are a family of antibiotic medications. They are used either alone, or alongside other antibiotics, to treat serious and life-threatening bacterial infections in many different parts of the body. 

Examples of aminoglycosides used in the UK include:

• Gentamicin (most commonly used). 
• Tobramycin. 
• Amikacin.

The team looking after you have decided to give you an aminoglycoside because it will be the most effective antibiotic for your infection, or because there is a reason you cannot have other antibiotics. 

They are mostly given into a vein as a drip (through a cannula in your vein), or sometimes as an injection. The dose you are given depends on what kind of infection you have, your weight, and how well your kidneys are working.

What to tell us before starting an aminoglycoside?

Before we start you on this medication, it is important that you, or someone who knows you well, tells us about any of the following:

• Any allergies you have and what the symptoms of this are. 
• If you are or could potentially be pregnant. 
• You are breastfeeding. 
• If you have any conditions causing kidney disease or any kidney problems. 
• If you have hearing or balance problems. 
• If you have myasthenia gravis (this is a disease that causes muscle weakness). 
• If you or a relative on your mother’s side have a history of a mitochondrial genetic variant (a genetic condition) or loss of hearing or balance due to antibiotic medicines. 
• This is important for us to know because certain mitochondrial genetic variants may increase your risk of hearing loss with aminoglycosides. 
• If you have ever been told that you cannot have an aminoglycoside antibiotic.

We will also ask you about your current medications that you are taking, including any that you buy without a prescription (over the counter) or any herbal remedies. Some medications may increase the risk of side effects with aminoglycosides so it is important that you tell us. 

Sometimes, when a patient is extremely unwell due to infection (for example, patients with sepsis), antibiotics should be given within an hour of diagnosis to reduce the risk of serious complications or death. There won’t usually be time to wait until a specific type of infection has been identified, so broad spectrum antibiotics are given first. These are designed to work against a wide range of known infectious bacteria and usually cure most common infections.

If you are extremely unwell, or the above conditions aren’t documented in your medical record, the team looking after you may not be able to consider this before the aminoglycoside is given. The team will always try to confirm details with you or someone who knows you well, but sometimes this will be once your condition has stabilised. The team will then discuss the benefits and risks of continuing the aminoglycoside along with possible alternative treatments.

What side effects can aminoglycosides cause?

Like all medicines, aminoglycosides can have side effects. The following is a summary of the more serious ones. If you would like further information, please speak to the team looking after you.

Ears

Kidneys

Muscles

Allergy

How can the risk of these side effects be reduced?

If you are at increased risk of developing these side effects, we would ideally try to avoid using an aminoglycoside to treat you. However in some serious infections this may not be possible. In this situation your doctor will discuss the risks and benefits of treatment with you.

Aminoglycoside doses are carefully calculated for each individual patient to ensure you get a dose that is right for you.

The amount of aminoglycoside in your blood is measured regularly to check the dose continues to be the right one for you and adjustments made if needed.

The team looking after you will also take regular blood tests to monitor your kidney function. Based on these results the dose of the aminoglycoside, or how often you are given it, could be changed. This will reduce the risk of side effects, and make sure the medication is as effective as possible in treating your infection.

The risk of some side effects increases with longer courses of treatment, therefore the team looking after you will try to keep the course as short as is needed to treat your infection.

To reduce the risk of the aminoglycoside affecting your kidneys, you can make sure you drink plenty of water/fluids whilst you are taking the aminoglycoside.

© North Bristol NHS Trust. This edition published August 2024. Review due August 2027. NBT003703.

What is an MRI prostate scan? 

An MRI (magnetic resonance imaging) scan uses strong magnets and radio waves to create detailed pictures of your prostate. This allows us to detect or rule out potential tumour, or monitor changes in the prostate over time. It is safe and painless, and does not involve any radiation. 

How to prepare for an MRI prostate scan

It is important your bowels and bladder are empty before the scan. 

Please arrive 20 minutes before your MRI scan time. You need to empty your bowl of any stool (poo) and gas. This is important as if there is any gas or stool in your rectum, we may miss a tumour. Even if you feel like you don’t want to empty your bowels, we recommend you sit on the toilet and try. This will move any gas which could blur the images.

To make sure you have the best image quality, avoid sexual activity that leads to ejaculation for 3 days before your MRI scan. This allows the seminal vesicles (glands next to the prostate) to naturally dilate (widen) which allows them to be seen clearly so they can be reviewed for a tumour.

You can eat and drink as usual, but if possible try to avoid things that cause bloating or gas such as fizzy drinks, coffee, strong black tea, beans, onions, or broccoli for 24 hours before your appointment.

Before the scan you will fill out a questionnaire about your health. Because the scan uses strong magnets, we would like to know if you have any metal, implants, jewellery, piercings, dentures, or hearing aids. We will then ask you to change into a hospital gown and put your belongings into a locker.

What will happen during my MRI prostate scan?

The MRI will take about 30 minutes. We will ask you to like as still as possible on a table. The table will move slowly into the scanner which is shaped like a doughnut. Please tell the radiographer if you are claustrophobic so they can help you feel as comfortable as possible.

The machine won’t cause any pain but is noisy and you may feel warm. You will be able to speak to the radiographer through an intercom to let them know if you have any issues during the scan.

Before your scan we may insert a cannula (tiny plastic tube) into a vein in your arm. This allows the radiographer to inject a contrast dye to make the prostate and other organs clearer on the scan. The dye is incredibly safe, but we do want to know if you have any kidney problems, asthma, or allergies. Please tell the radiographer if you have any of these.

Hycosine butylbromide (Buscopan) 

We may give a muscle relaxant called Buscopan before starting the examination. This helps us see the prostate better by reducing bowel movement during the scan. Like all medicines this can cause side effects. Most people have none but if they do they go away quickly. If you have blurred vision, please make sure your vision has returned to normal before driving.

Very rarely Buscopan causes a type of glaucoma called acute angle closure glaucoma. If your eyes get very painful and red within 48 hours of the injection, seek urgent medical advice.

Also very rarely Buscopan can cause urine retention (inability to pass urine/pee). Please seek medical advice if this happens.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003709. 

This page is for patients who have had surgery to treat a perianal abscess at North Bristol NHS Trust. 

It has advice about what to expect after surgery, and when to seek further advice. 

After the surgery

You will not be able to drive after having a general anaesthetic and will need to have an adult take you home.

Removal of packing/review wound advice

If you have had packing inserted during the operation, this will need to be removed before you are discharged or by your GP Practice Nurse within 24-48 hours. No further packing will be needed after this is removed.

General wound care advice 

The abscess has been left open to allow drainage of infected material. Fluid and blood may leak from the wound, so wearing an absorbent pad may help this. A small amount is normal, if this does not stop, or is a large amount, please seek medical attention. 

Bathing advice 

To allowing healing, the area needs to be cleaned once or twice a day in the shower or bath. Use water to clean the area thoroughly, including inside the wound and avoid using soaps or perfumed products on the area until the wound has healed. 

Please try and insert a finger into the wound to enable full cleaning. Sometimes the skin over the abscess cavity can ‘heal too quickly.’ Finger irrigation can allow the healing to be slower but more effective. 

Pain management advice 

This procedure can be quite painful, but this will improve within a few days. You will be discharged with painkillers. It important to take these regularly if you are experiencing discomfort. Follow the instructions on the prescription. Do not take more than the prescribed dose.

Going to the toilet

You can use the toilet as normal following the procedure. You will be discharged with laxatives to soften your stools (poo). You should wash the area after passing stool (pooing).

When to see GP

Please see your GP Practice Nurse for ongoing management of your wound.

When to go to Accident and Emergency

If following the procedure, you feel unwell, are in severe pain, have high temperatures, or fast heart rate please go to your nearest Accident and Emergency department.

Returning to work and activities

This depends on what work you do and how you feel. 

You should not go swimming until the wound has healed. 

You can drive when you can sit comfortably, handle a vehicle safely, and perform an emergency stop. You should inform your insurance provider before you start driving again.

Accessing follow-up

We will not usually need to see people who undergo incision and drainage of perianal abscess again. However, we may need to see you again if it is causing ongoing issues:

• If your wound is not healing by 8-10 weeks. 
• Associated with another condition (please see below).

If this is the case, then please follow the guidance for getting an appointment with the surgical team:

• Email lowergisecretaries@nbt.nhs.uk
• Phone 0117 414 0835 or 0117 414 0838
• Available Monday to Friday, 09:00 to 16:00 

Potential complications

Most perianal abscesses are caused by a blocked gland in the anus, however in small number of individuals (10-15%), perianal abscesses can also be present with another condition called an anal fistula. This is the formation of a tunnel between the skin and inside the anus/rectum. Fistulas require further investigations and treatment. Symptoms of anal fistula include:

• Skin irritation around the anus/rectum. 
• Pain in the anus/rectum. 
• Anal discharge. 
• Pus or blood in your stool (poo).

If we suspect an anal fistula at the time of surgery, we will explain this and organise follow up for you. If your GP has concerns over an anal fistula, they can refer you to the Colorectal Outpatient Department for assessment. For more information on anal fistulas please see the NHS website Anal fistula - NHS (www.nhs.uk)

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003689.