Pulmonary fibrosis (PF) describes a variety of disorders that may lead to scarring in the lung.

What is Pleuroparenchymal Fibroelastosis (PPFE)?

Pleuroparenchymal Fibroelastosis (PPFE) is a rare form of PF that tends to affect the upper parts of the lung. The scarring tends to involve the areas just beneath the lining of the lungs (the pleura) and the lung itself (the parenchyma).

What are the symptoms?

In PPFE it can be more difficult for the lungs to transfer oxygen into the bloodstream. This means the body may not get the oxygen it needs to work properly. This can cause breathlessness and/or a cough from the irritation. Some people experience a dull pain around the lungs and feel fatigued. Weight loss and recurrent lung infections may occur.

Why does PPFE happen?

It is not entirely clear why PPFE happens. It is sometimes associated with a separate lung fibrosis condition affecting the bottom of the lungs or following previous treatment for cancer.

It is difficult to predict how the condition will develop in a person as it can vary a lot.

What tests will I have?

Your specialists will take a detailed medical history and perform a thorough physical examination. You may be asked to have the following investigations:

• Chest X-ray.
• Lung function tests. These are breathing tests which show how well your lungs are working. They are used later to monitor your lung disease, to see if it is progressing. You may also be asked to have a walk test where you will be asked to rate how breathless you are and measure your walking distance and oxygen levels.
• A series of blood tests will be done to screen for systemic inflammatory conditions.
• A CT scan of your chest will show a detailed picture of your lungs that allow your specialist to identify scarring of the lungs.
• Some people may also have a bronchoscopy, where a small flexible tube is passed down into your lungs to allow collection of cells. This may help with diagnosis and management.

What treatments are available?

Treatments may differ depending on the symptoms you have, and your specialist will discuss which treatment is right for you.

Antifibrotic medications, like nintedanib, can slow down the build-up of scar tissue in the lungs. They may be used to treat PPFE if there is evidence that it is getting worse. These treatments may reduce the rate that your lung fibrosis progresses, but they don’t stop the lung scarring completely. And they won’t get rid of any scar tissue that has already formed.

You may be prescribed an antibiotic to prevent lung infections.

Other medications and therapies are used to help relieve symptoms, such as cough and breathlessness. Your specialist will discuss options with you on an individual basis.

Pulmonary rehabilitation is a supervised exercise and education programme that can help you to learn to manage your breathlessness and remain active. The programmes are multidisciplinary, meaning that the team includes respiratory physiotherapists, nurses, dieticians, doctors and others, and can help improve your energy, strength, and quality of life.

As the lung fibrosis stops enough oxygen getting into the bloodstream, some people may need supplemental oxygen therapy. Oxygen therapy may help with breathlessness and help you to be more active. Corrected levels of oxygen in the blood are necessary for normal body functions and reducing additional health problems.

You should also discuss with your doctor if there are any clinical trials you can participate in. Clinical trials are voluntary research studies designed to answer specific questions about the safety and/or effectiveness of medications.

A small minority of patients may require assessment for and be suitable for lung transplantation.

How can I help myself?

Have your seasonal vaccinations (COVID-19 and flu) and the pneumonia vaccination (you only have this once).

You may be eligible for a variety of benefits such as Attendance Allowance or Personal Independence Payment if you need help with personal care or getting about.

Our specialist nurses run a regular Pulmonary Fibrosis Support Group which is a space for discussion with other patients with lung fibrosis. Here we also aim to have several presentations from a variety of guest speakers and charities.

Keep active and do what you enjoy!

Further information and resources

Action for pulmonary fibrosis

Asthma + Lung UK

How to contact us

• Bristol Interstitial Disease Service
  Southmead Hospital
  Bristol
  BS10 5NB
• 0117 414 7762
• ILD@nbt.nhs.uk

© North Bristol NHS Trust. This edition published June 2025. Review due June 2028. NBT003790. 

What is Organising Pneumonia (OP)?

Organising Pneumonia (OP) is a rare lung disease that causes inflammation and scarring in the small airways (bronchioles) and air sacs (alveoli) of the lung. Although OP has pneumonia in its name, it is not an infection and cannot be passed on.

What are the symptoms?

In OP it can be more difficult for the lungs to transfer oxygen into the bloodstream. As a result the body may not get the oxygen it needs to work properly. This can cause breathlessness and/or a cough from the irritation, and you may feel fatigued. Some people can have a flu-like illness, high temperatures, or lose weight.

Why does OP happen?

It some cases is not entirely clear why OP develops and this may be called idiopathic or cryptogenic disease. In rare cases it may be linked to an inflammatory condition that affects other parts of the body.

What tests will I have?

Your specialists will take a detailed medical history and perform a thorough physical examination. You may be asked to have the following investigations:

• Chest X-ray.
• Lung function tests. These are breathing tests which show how well your lungs are working. They are used later to monitor your lung disease, to see if it is progressing. You may also be asked to have a walk test where you will be asked to rate how breathless you are and measure your walking distance and oxygen levels.
• A series of blood tests will be done to screen for systemic inflammatory conditions.
• A CT scan of your chest will show a detailed picture of your lungs that allow your specialist to identify scarring of the lungs.
• Some people may also have a bronchoscopy, where a small flexible tube is passed down into your lungs to allow collection of cells. This may help with diagnosis and management.

What treatments are available?

Treatments may differ depending on the symptoms you have, and your specialist will discuss which treatment is right for you. In some mild cases, symptoms of OP may resolve without treatment and can simply be monitored and treated later if necessary.

Medications

Steroids are produced naturally in the body by the adrenal gland. Additional steroids called prednisolone can be given to try and reduce inflammation in some patients.

They are usually given in a tablet but may be given intravenously (into a vein). If you are prescribed steroid tablets long-term, you should not stop taking them suddenly. You will be given a ‘steroid emergency card’ which you should always carry with you.

The specialist may also see if you need bone protection medication and anti-reflux treatment whilst on steroids.

Immunosuppressive medication

Mycophenolate mofetil and azathioprine are medications that lower the activity of the immune system to help control the disease. Treatment with immunosuppressive medications may allow you to stop taking steroids. As a result, they are sometimes also called a ‘steroid-sparing agent’. You will require regular blood tests to monitor your response to treatment.

Other treatments

Other medications and therapies are used to help relieve symptoms, such as coughs and breathlessness. Your specialist will discuss options with you on an individual basis.

Pulmonary rehabilitation is a supervised exercise and education programme that can help you to learn to manage your breathlessness and stay active. The programmes are multidisciplinary. This means the team includes respiratory physiotherapists, nurses, dieticians, doctors and others. It can help improve your energy, strength, and quality of life.

As the lung fibrosis stops enough oxygen getting into the bloodstream, some people may need supplemental oxygen therapy. When levels of oxygen are low, oxygen therapy may help with breathlessness and enable you to be more active. Corrected levels of oxygen in the blood are necessary for normal body functions and reducing additional health problems.

You should also discuss with your physician if there are any clinical trials in which you can participate. Clinical trials are voluntary research studies, conducted in people, which are designed to answer specific questions about the safety and/or effectiveness of medications.

How can I help myself?

Have your seasonal vaccinations (COVID-19 and flu) and the pneumonia vaccination (you only have this once).

You may be eligible for a variety of benefits such as Attendance Allowance or Personal Independence Payment if you need help with personal care or getting about.

Our specialist nurses run a regular Pulmonary Fibrosis Support Group which is a space for discussion with other patients with lung fibrosis. Here we also aim to have several presentations from a variety of guest speakers and charities.

Keep active and do what you enjoy!

Further information and resources

Action for pulmonary fibrosis

Asthma + Lung UK

How to contact us

• Bristol Interstitial Disease Service
  Southmead Hospital
  Bristol
  BS10 5NB
• 0117 414 7762
• ILD@nbt.nhs.uk

© North Bristol NHS Trust. This edition published June 2025. Review due June 2028. NBT003789. 

A self-help guide for managing your blood glucose at home with insulin.

Why do I need insulin?

• Pregnancy hormones can increase your blood glucose.
• High blood glucose is associated with large babies, increasing the risk to both mum and baby.
• Insulin will help to lower you blood glucose to normal levels.

Why do I need to change my insulin dose?

Every woman needs different amounts of insulin, and as your pregnancy progresses you will need more insulin. It is important to increase the dose to keep your blood glucose within target.

Low blood glucose

If your blood glucose is 3.5 or below, with symptoms (dizziness, shaking, sweating, or irritability):

• Treat it  immediately with a carton of fruit juice or 4 dextrose tablets and reduce your insulin by 4 units that night.
• Call us to discuss your insulin dose after you have low blood glucose.
  • Monday to Friday, 08:00 to 16:30 call the diabetes midwives on 0117 414 1072.
  • Outside of these hours call the Maternity Assessment Unit on 0117 414 6906.

The flow chart below shows when to check your blood glucose and what to do if it is below 5. Please ask us if you need help understanding this. We will tell you how many units of insulin to start with. 

Flow chart written steps

Top tips

• It is common for you insulin dose to increase over time.
• There is no upper limit to insulin dose.
• You will be able to stop the insulin after birth.
• The diabetes antenatal team will be here to support you throughout your pregnancy.
• Insulin is safe to inject in pregnancy.

© North Bristol NHS Trust. This edition published December 2025. Review due December 2028. NBT003831.

Overview

Over time your Parkinson’s treatment may stop working well enough to control your symptoms. At this point other options may be considered, such as surgery or medications given as infusions or injections.

These treatments don’t cure Parkinson’s, but can help improve movement problems and quality of life, particularly for certain types of problems like:

• Motor fluctuations: this is where your tablets don’t last between doses or cause involuntary movements (known as dyskinesias).
• Tremors which are causing problems.

There are a range of different advanced treatments available. These are called device-assisted therapies (DAT). These treatments aim to provide steady flow of dopamine to help improve motor symptoms.

DAT are not suitable for everyone with Parkinson’s. The following information gives you an overview of the options. You can discuss them further with your Parkinson’s specialist or if you are referred to a specialist DAT clinic.

Currently there are five different DAT available for Parkinson’s:

• Deep brain stimulation (DBS).
• Apomorphine - an injection or infusion of a dopamine agonist under the skin.
• Duodopa - Levodopa-Carbidopa Intestinal Gel (LCIG).
• Lecigon - Levodopa-Carbidopa-Entacapone Intestinal Gel (LECIG).
• Produodopa - foslevodopa-foscarbidopa – a continuous infusion under the skin.

When thinking about starting one of these treatments, your Parkinson’s doctor will consider several things like your symptoms, other health issues, and what you prefer.

Deep Brain Stimulation surgery (DBS)

DBS is the main surgery used to treat Parkinson’s. It is a well-established treatment which has been used since the 1990’s. The DBS service for Parkinson’s was set up in Bristol 25 years ago. It is one of the largest centres in the UK, treating around 60 new patients every year.

DBS is most effective at improving motor symptoms, such as tremor, slowness of movement, stiffness and dyskinesia. DBS is not a treatment for the non-motor symptoms of Parkinson’s, but it may improve some of them, such as sleep.

How is the device implanted?

In Bristol, this is done under general anaesthesia (you are asleep) with robotic assistance.

• Your head is put in a metal frame to keep it still in the robotic arm.
• Two small holes are drilled in the front part of the skull.
• Small thin tubes called guide tubes are put through the two holes into the brain.
• Thin wires called electrodes are implanted through the guide tubes into the target area in the brain.
• The electrodes are attached to the connecting wires (extension leads). These are placed under the skin and connected to a small battery (similar to a cardiac pacemaker). This is placed beneath the collar bone in a chest pocket.

You will be discharged a day or two after the surgery and return in 4-6 weeks to have the DBS activated once you have healed.

When the pulse generator is switched on, the electrodes stimulate the targeted area in the brain. The stimulation alters signals in the brain to improve the symptoms of Parkinson’s. Over the next 2 years you will have several follow-up visits to adjust the stimulation and your medication.

DBS therapy doesn’t stop your Parkinson's progressing over time. Having DBS may mean you can reduce your Parkinson’s medication by up to 40%, although this is different for each patient. All the DAT options can be useful for people with motor fluctuations, but DBS is the only option that is helpful directly for tremor.

What are the risks?

Like all surgery, there are risks with DBS surgery which include and are not limited to:

• Small risk of infection, especially in the first month. If this happens, you may need to have the DBS removed. You may need to stay in hospital for antibiotics.
• Rare risk of bleeding in the brain.
• Problems with speech and balance, which may improve with re-programming the device.

Who can have DBS?

If you are thinking about DBS, you will have a series of tests to see if you’re suitable for this type of surgery. This may be a day-case or overnight stay and is done by a specialist team, including a Neurologist and DBS Nurse. During the assessment, surgery, and follow-up, you will need to make lots of visits to Southmead hospital. You should think about this when making your decision.

Certain people cannot have DBS, for example if you have a cardiac pacemaker or if you cannot have an MRI scan. Also if you have significant balance or memory problems, then DBS is not suitable. Instead, you may be able to have one of the other therapies on the next few pages.

Apomorphine

Apomorphine is a type of dopamine agonist, like other drugs such as ropinirole, pramipexole and rotigotine. Apomorphine is given subcutaneously (under the skin) using a small plastic cannula connected to a pump. Despite its name, apomorphine is not related to morphine and is not addictive.

Apomorphine can be given in two ways:

1. Intermittent injections or “rescue therapy” with and injector pen.
2. Continuous infusion using a pump.

Apomorphine can improve movement symptoms within 5-10 minutes. The effect of a single injection usually lasts for about an hour.

Some patients use injections every so often, whilst others need a continuous infusion. Apomorphine infusions are usually given throughout the day but can also be continued overnight in some patients. Apomorphine does not replace most other Parkinson’s medications and needs to be used with them. The infusion must be set up daily and you will be given training and ongoing support with this by a specialist nurse.

Who can have apomorphine?

If apomorphine is being considered, your Parkinson’s specialist will usually refer you to your local apomorphine nurse. You can discuss the therapy in more detail and sometimes arrange a response test. This is done to see if you respond well to the treatment and to check if you have any side effects. You will need to have an ECG and blood tests before the response test.

Your Parkinson’s specialist will not recommend apomorphine if you have problems with low blood pressure, hallucinations, or psychosis, as these can be made worse by the treatment. It may also not be recommended if you have had certain side effects from other dopamine agonists, including impulsive behaviour.

Nausea and vomiting are common side effects when starting apomorphine. An anti-sickness medication (domperidone) is prescribed at the beginning to help with this. Another common issue can be skin reactions, particularly with continuous infusions but these can usually be managed with advice from your apomorphine nurse.

Apomorphine pump

Pen for size reference. 

Apomorphine pen

Pen for size reference. 

Duodopa: Levodopa-Carbidopa Intestinal Gel (LCIG)

Duodopa is a gel form of the drug levodopa (the main treatment for Parkinson’s). It is delivered directly into the small intestine via a small pump.

This treatment is given through a tube called a gastrostomy or PEG-J tube which needs to be inserted to deliver the gel medication. Patients starting on LCIG are usually admitted to hospital for around 5 days, which allows the gastrostomy tube to be put in. The medication is then started and adjusted to control symptoms. This is overseen closely by a specialist team, including a neurologist and specialist nurse.

The treatment usually runs through the day and replaces most tablet medication for Parkinson’s, except those used overnight. The pump needs to be set up daily and often people need support with this. For some patients, an overnight pump can be added to treat symptoms at night.

We will usually only recommend Duodopa if DBS or apomorphine are not suitable.

What are the risks?

• When the PEG-J is inserted there can be infection and bleeding.
• When the treatment has started there can be:
  • Infection around the tube.
  • The tube can be blocked or move out of place which stops treatment working. This may mean you need to take tablets again until the tube is unblocked or or replaced (you may need to stay in hospital).
• You may develop a B12 deficiency when taking Duodopa. We will give you a B12 supplement to stop this. 

If you are thinking about LCIG, you will first need some tests to see if you’re suitable. This may be a day-case or overnight stay and is done by a specialist team, including a Neurologist and Specialist Nurse.

LCIG pump 

Pen for size reference.

Lecigon: Levodopa-Carbidopa-Entacapone Intestinal Gel (LECIG)

Lecigon is another form of levodopa gel treatment. It is similar to Duodopa but has an additional drug called entacapone. This makes the levodopa work for longer. Lecigon became available for the treatment of Parkinson’s in the UK in 2025, but it has been used for several years in other countries.

Like Duodopa, Lecigon requires insertion of a gastrostomy tube. This allows the gel medication to be given directly into the small intestine via a pump. Because the entacapone is added, a smaller amount of gel is needed to control symptoms. This means the pump is smaller and more portable.

What are the risks or side effects?

• Diarrhoea – this may mean you cannot use Lecigon. You may need a trial of entacapone tablets first to see if you can tolerate this,
• When the PEG-J is inserted, there can be infection and bleeding.
• When treatment has started there can be:
  • Infection around the tube.
  • The tube can be blocked or move out of place which stops treatment working. This means you may need to take tablets again until the tube is unblocked or replaced (you may need to stay in hospital).
• You may develop a B12 deficiency when taking Lecigon. We will give you a B12 supplement to stop this.

We will usually only recommend Lecigon if you are not suitable for DBS or apomorphine.

If you are thinking about Lecigon, you will first need some tests to see if you’ are suitable for this type of treatment. This may be a day-case or overnight stay and is done by a specialist team, including a neurologist and specialist nurse.

LECIG pump

Produodopa: foslevodopa-foscarbidopa

Produodopa is a new treatment for Parkinson’s and was approved by for use in the UK in 2024. Produodopa is a liquid form of levodopa (the main treatment for Parkinson’s) and is given subcutaneously (under the skin), using a pump, the same way as apomorphine.

This pump treatment runs for 24 hours a day to control motor symptoms both during the day and night. This means you will need to wear the pump day and night. Produodopa will usually replace most of your other Parkinson’s medications.

If you are thinking about Produodopa, your Parkinson’s specialist will usually refer you to a Produodopa nurse. You can discuss the therapy in more detail and they will show you how to use the pump. You will also have a series of tests to make sure you are suitable for the treatment.

The treatment can be started either during a short stay in hospital (average 2 days) or as a day-case. You will need several visits to adjust the dose after starting treatment, so it is important to be prepared to attend the hospital often in the first month.

What are the risks or side effects?

As this is a new treatment, we are still developing our understanding of the risks/ side effects and benefits of Produodopa. A common issue from clinical trials has been skin reactions, including swelling, inflammation and skin infections. These can be managed with advice and training by Produodopa nurses. Another common issue we have found is difficulty finding the right dose of medication, which is why you may need to come to hospital more often than with other DAT.

We will usually only recommend Produodopa if you are not suitable for DBS or Apomorphine.

Produodopa pump

Summary of DAT

Useful information 

Further information about advanced Parkinson's treatments and therapies from Parkinson's UK: Advanced Parkinson's treatments and therapies | Parkinson's UK

How to contact us

• 0117 414 8266
• movdiscomplextherapiesadmin@nbt.nhs.uk
• Movement Disorder Complex Therapies Service
  Bristol Brain Centre
  Elgar House
  Southmead Hospital
  Bristol
  BS10 5NB

© North Bristol NHS Trust. This edition published November 2025. Review due November 2028. NBT003813

About the Department of Cellular Pathology

The Department of Cellular Pathology provides a wide-ranging and comprehensive Histopathology, diagnostic Cytopathology and Cervical cytology screening service to both North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust, as well as GPs and other healthcare providers. The service is accredited to ISO15189:2022 with UKAS (Lab 8130) and relevant activities are licensed by the Human Tissue Authority (license 12413).  There is extensive participation in External Quality Assurance schemes.  The department is well-equipped and is housed in a purpose-designed laboratory opened in 2016.

The Department is open for service and opinion Monday to Friday, 09:00–17:00. 

Outside of these times, a renal on-call service exists and contact with on-call consultant staff can be made via switchboard. 

There is no general on-call service.

The diagnostic service in fully computerised with extensive databases. The current LIMS is Clinisys WinPath Enterprise. 

Results are all available through ICE, and all requesting can be made through ICE.

The service has implemented specialist reporting to support the wide range of services at the Trusts. 

The consultants are members of one or more specialist teams working to common standards. 

Clinical consolidation of services had brought together the work of some teams whilst in others cellular pathology has instigated this. 

A number of the consultants support referral practices and in all specialisms, consultants are core members of the multidisciplinary teams for cancer services.

The department works closely with the Bristol Genetics Laboratory for the provision of a portfolio of molecular genetics testing.

Services offered include consultation with clinical colleagues to assist in the interpretation of reports and to provide advice about the collection, handling, fixation and submissions of specimens for investigation.

A number of individuals in the department have research interests, and the department as a whole is keen to support such activity within the Trusts.

The accreditation status of our tests can be found in the Quality section of the Severn Pathology website.

This page aims to help you understand frozen shoulder. It is not a substitute for professional medical care and should be used along with treatment from your healthcare professionals. Everyone's situation is individual. You may be given specific advice that is not included in this page.

The shoulder

Your shoulder joint is a ball and socket joint (like a mortar and pestle). The ball at the top of your arm bone (the humerus) fits into the socket (the glenoid) and this is the part of the shoulder that moves. The socket is part of the shoulder blade (the scapula). 

The joint is surrounded by soft tissue forming the capsule - imagine it like a wrapper surrounding a chocolate. The shoulder gives a large range of movement which allows us to do our daily activities.

Frozen shoulder (adhesive capsulitis)

Frozen shoulder, also known as adhesive capsulitis, is where the shoulder becomes painful and stiff. It is often not obvious why this pain and stiffness has started. Normally, the soft tissue around the shoulder joint (capsule) is stretchy and elastic. This allows the joint to move. In a frozen shoulder, the capsule has become inflamed and thickened (fibrous). This leads to the pain and stiffness.

How common is it?

Symptoms

Stages

Causes

Treatments

Hydrodistension injection

This injection uses X-ray or ultrasound to guide it into the shoulder joint. Local anaesthetic and a steroid is injected into the shoulder. Extra fluid (sterile saline) is also injected into the frozen shoulder joint to try to stretch the capsule. This aims to give pain relief and improve your shoulder movement. It feels the same as a normal injection but with the added benefit of stretching the capsule.

At North Bristol NHS Trust, we do this in the Radiology (X-ray) department as an outpatient appointment. You won’t need to go to theatre or have sedation. This is a good option for people who have had their symptoms for six months or longer and has shown faster improvements in pain and movement than other injections. 

On the day of the procedure

The procedure

Risks

What happens after the injection?

Physiotherapy

This section will take you through a progressive activity programme. This is important to maximise the benefit you get from the injection (Robinson et al., 2017).

• The day of the injection (day 0) - do the exercises 2 times a day while your shoulder is still feeling numb. Once your shoulder is no longer numb, stop the exercises.
• Day 1 - no exercises (this allows the steroid to work).
• Day 2 - no exercises.
• Day 3 - start the exercises again. Do them every day from this point.

Exercises

Follow-up

The clinician who referred you for the injection should arrange a further review 6-12 weeks after the injection. Please contact them if you do not already have an appointment.

If you have already seen a physiotherapist at North Bristol NHS Trust and are on a Patient Initiated Follow-Up (PIFU) appointment please ring 0117 414 3131 to book a review with your physiotherapist.

© North Bristol NHS Trust. This edition published October 2025. Review due October 2028. NBT003791

You will receive a letter with the details of your appointment for activation (switching on) and initial programming of your stimulator. 

We recommend that you arrange for a friend, carer, or relative to come with you while you are in an “off” state to your appointment. If you are travelling to Bristol the night before, please make sure you have booked accommodation and transport to the Bristol Brain Centre in advance.

Before booking transport home, please check with your Movement Disorder Nurse Specialist what time you are likely to be able to leave hospital.

Please stop taking your Parkinson’s medication from midnight the day before your appointment so we can assess your responses accurately in an “off” state.

What to expect at your activation visit

The initial activation and programming visit may take several hours, sometimes the whole day. This can be tiring and we look to schedule a break. 

During the visit we will check how well the stimulation is working to control your symptoms and if you have any side effects. We will ask you to do some tasks (like the ones in your pre-operative assessment) and regularly ask you how you feel.

We will set the stimulator to give you the best control of your symptoms before you go home. After this you can take your Parkinson’s medications to see how they work together. This will help us adjust your medications while you have the stimulation on.

During your visit, we will show you how to use the patient programmer to adjust settings safely. You will learn how to check the battery and, if it is rechargeable, how to charge it. We will also give you printed instructions for reference.

After your first visit you may need to return to hospital at least once more so we can adjust the stimulator and review your medication. This is so we can achieve the best possible results from stimulation.

Checklist of things to bring to your appointment:

• Your medication in original packaging, and a medication list/prescription. If you take apomorphine, bring enough needles and administration lines for your whole stay.
• Patient programmer and stimulator charging equipment. Charge fully any equipment before coming in.
• Lunch and/or snacks. There are cafés on site, but you may wish to bring your own food.
• Your completed wound audit questionnaire.

How to contact us:

Advanced Treatment Service (Deep Brain Stimulation and Duodopa Therapy)
Bristol Brain Centre
Elgar House,
Southmead Hospital
BS10 5NB

Daily Nurse Clinic Line (Mondays to Fridays): 0117 414 8269

© North Bristol NHS Trust. This edition published October 2025. Review due October 2028. NBT003181.

This page gives you information and advice for when you go home. You will have had the opportunity to ask questions whilst in hospital, but we wish to support you once you are home. This leaflet should address any concerns you have.

You must never feel isolated; do not hesitate to contact your Movement Disorder Nurse Specialist to discuss any issues.

What can I expect when I first go home?

You may continue to feel tired for 6 weeks while your body is recovering from your recent surgery. It is important to keep relatively active and work towards getting back to your normal routine. But you should continue to rest from time to time.

You should not drive for 6 weeks.

It is important to stay hydrated and have regular bowel and bladder movements (going to the toilet).

You should continue with your pre-operative medications regime until your stimulator activation visit (unless we tell you otherwise).

It is important to do your neck exercises several times a day, for about 6 weeks after surgery. This will stop the leads running down your neck from becoming too tight. Rotate your neck from side-to-side, forwards and backwards, and move your ear to each shoulder.

Some people may have temporary symptoms because of mild swelling in the brain. These can include:

• Blurred vision.
• Slurred speech.
• Falls or loss of balance which is not normal for you.
• Increased involuntary movements (dyskinesia).

Please contact the Movement Disorder Nurse Specialists at Southmead or your GP out of hours if these symptoms are a worrying you, or if you feel unwell.

Your Movement Disorder Specialist will have advised you on how to care for your wounds before being discharged from hospital. You will be given a letter for your Practice Nurse advising when your stitches and steri-strips should be removed. You will also have a wound audit questionnaire to complete and bring back with you to your activation visit.

Keep your wounds dry and regularly check for signs of infection. Signs of wound infection can include, but are not limited to:

• Redness, swelling, tenderness, or pain at the wound site.
• A raised temperature.
• Any leakage from the wound. This may be brown, green, or clear.

If you have any of these symptoms, please contact your GP for advice on treatment. Also inform your Movement Disorder Nurse Specialist straight away.

It is important that you record details of any symptoms in your wound audit questionnaire.

Specific advice following DBS surgery

To become familiar with the specific safety guidance, cautions and contra-indications, please refer to the patient information booklet for your DBS system.

Here is a summary of some of the specific points:

• Inform clinicians, including dentists, that you should receive antibiotics before any invasive procedures. Your Movement Disorder Nurse Specialist can provide a letter outlining the recommendations for antibiotics if your clinician requires this.
• You are recommended to request assistance to go around security screeners like those in airport security.
• You should be careful going through theft detectors and near tag deactivators like the ones in shops and other public buildings. Make sure you go through the centre of the detector and as quickly as possible.
• When travelling in an aeroplane there is a small risk that cosmic rays could switch your stimulator off. Make sure you check it is switched on after your flight.
• If you have any further surgery, make sure the stimulator is switched off. Tell the surgeon you should only have bipolar diathermy.
• Seek advice before MRI (magnetic resonance imaging) scans as they can potentially cause significant damage to you.
• You may need to switch your stimulator off if you are having an electrocardiogram (ECG), as stimulation may interfere with the recording.
• It is important that you carry your DBS identity card and patient therapy controller with you at all times.

Checklist post-DBS surgery

• Book in to see your Practice Nurse to have your stitches and steri-strips removed through your GP Practice.
• Complete your wound audit questionnaire and bring to your stimulator activation visit.
• Please refer to your stimulator activation visit leaflet for details about this appointment.

How to contact us

Advanced Treatment Service (Deep Brain Stimulation and Duodopa Therapy)
Bristol Brain Centre
Elgar House,
Southmead Hospital
BS10 5NB

Daily Nurse Clinic Line (Mondays to Fridays): 0117 414 8269

© North Bristol NHS Trust. This edition published October 2025. Review due October 2028. NBT003183.

Head injury in adults mBIG pathway

You have been sent to this page because you are recovering from a Minor Traumatic Brain Injury (MTBI).

This page has information on:

• What is a minor traumatic brain injury?
• What to expect after you have been discharged from the Emergency Department (ED)?
• Symptoms that you are likely to experience while recovering from the MTBI?

Research has shown that if people recovering from MTBI know what to expect, they feel better and recover faster.

What is a minor traumatic brain injury?

An MTBI can happen for many reasons. For example, following a fall, an assault, sports injury, or a road traffic accident. An injury to the brain can occur even when there is no direct blow to the head.

An MTBI can happen even if you have not lost consciousness (been knocked out), or have any physical signs of a head injury. In most cases an MTBI does not lead to any form of brain injury. 

• MTBI is caused by rapid acceleration and deceleration of the brain a it moves inside the skull. This means it very quickly speeds up and slows down either from a blunt force or a sudden change of direction.
• This can cause bruising and temporary disruption to how the brain works. Because of this, the brain may not work as efficiently for a while.
• Around 50% of people that have a MTBI experience some symptoms. However, you should not be concerned as this is perfectly normal.

You have attended the Emergency Department (ED), and your doctor or nurse are happy for you to go home. What are the next steps?

You will receive two phone calls from one of the Clinical Team members to check up on you:

• The first call will be on the next day after you have been discharged from the ED.
• The second call will be between day 5 and day 7 after you have been discharged from the ED.

Please note the call may be from a Bristol-based, Plymouth-based, or an unknown number.

Do make sure you stay within easy reach of a phone and medical help.

Do notify the DVLA about your injury.  

Do not stay at home alone for the first 48 hours after leaving hospital. 

If you develop any of the following symptoms, you must return to your local Emergency Department or call 999:

• Loss of consciousness.
• Drowsiness when you would normally be awake.
• Unable to be woken from sleep.
• New deafness in one or both ears.
• Clear fluid coming out of nose or ears or at the back of your throat accompanied by a salty taste.
• Bleeding from one or both ears.
• Weakness or numbness.
• Dizziness or a lack of co-ordination.
• Vomiting (being sick).
• Increasing disorientation.
• Problems speaking or understanding what others are saying.
• Persistent blurred or double vision.
• Severe headaches that still persist after taking pain killers.
• Neck stiffness.
• If you experience fits (collapsing, passing out suddenly, epileptic seizures).

Symptoms you are likely to experience during your recovery from an MTBI:

• Mild headache.
• Dizziness.
• Feeling sick (without vomiting).
• Sensitivity to light.
• Sensitivity to noise.
• Sleep disturbance.
• Fatigue and needing to sleep more.
• Irritability.
• Confusion.
• Restlessness.
• Impulsivity and self-control problems.
• Feeling depressed, tearful or anxious.
• Difficulties with concentration.
• Memory problems.
• Difficulties thinking, planning and problem solving.

How long will symptoms last?

Most people should fully recover from an MTBI within two to three months, because any damage to the brain is minor.

You can help your recovery by getting enough rest and getting back to your normal activities gradually.

Until you feel you have fully recovered you should avoid driving, and also to avoid alcohol.

If your symptoms do not go away after two weeks, please contact your GP.

Supporting your recovery do’s and don’ts

Do:

• Remember that symptoms are a normal part of the recovery process.
• Slow down and let your brain heal.
• Have plenty of rest.
• Avoid stress where possible.
• Resume your daily activity in a gradual way.
• Stay well hydrated and take simple pain killers such as paracetamol.
• Avoid reading small text or screens such as computers, phones or TV - concentrating on these can make your symptoms worse.

Don't:

• Push yourself too hard.
• “Power on”.
• Do too much too soon.
• Become overwhelmed.
• Take any alcohol or drugs.
• Take sleeping pills, sedatives or tranquilisers unless they are given by a doctor.
• Play any contact sport (like football or rugby) for at least 3 weeks.
• Drive a car, motorbike or bicycle or operate machinery until you are fully recovered.

© North Bristol NHS Trust. This edition published November 2025. Review due November 2028. NBT003800

This is a general guide to the colposcopy service at Southmead Hospital. Please be aware not all the information will apply to you.

You will have the chance to speak to the doctor or nurse doing the colposcopy and ask any questions you have. You can also ask for further information from your GP or practice nurse.

Every year, thousands of patients miss their hospital appointments. Each missed appointment costs the NHS money, delays treatment and increases waiting times for all patients. If you are unable to attend your appointment for any reason, please contact us on the numbers below.

What is a colposcopy?

A colposcopy is where we look at the cervix (neck of the womb) using a special microscope (a colposcope). This allows the colposcopist to look more closely at your cervix than during a cervical screening test (smear test).

Why do I need a colposcopy?

Do I need to contact the colposcopy clinic before my appointment?

What is Human Papillomavirus (HPV)?

What about if I am on my period?

What happens at my appointment?

Please arrive 10 mins before your appointment time as you will be asked to fill in a questionnaire about yourself and to consent to the examination and colposcopy procedures. The colposcopist will then see you and answer any questions. They will do the colposcopy examination to see if there are any cell changes and decide what needs to be done. You are very welcome to bring someone with you to the appointment.

What might happen during your colposcopy appointment:

What will the biopsy show?

Biopsies can show several things:

1. No abnormality (normal).
2. HPV infection.
3. Inflammation.
4. Cell changes (CIN and CGIN).

Cell changes are not cervical cancer. The most common type of cell changes is called CIN. CIN stands for Cervical Intraepithelial Neoplasia. CGIN stands for Cervical Glandular Intraepithelial Neoplasia.

What is CIN?

Other findings

LLETZ Treatment

Will I be treated on my first visit?

How will you do the LLETZ treatment?

What if I have a coil (intrauterine contraceptive device)?

Is the treatment painful?

Does the treatment have any side effects?

Is there an alternative to LLETZ treatment?

Can I bring someone with me?

Can I go to work on the following day?

When and how do I get my results?

What happens next?

95% of women will have a follow-up smear test in 6 months with their GP or in colposcopy. You will then be advised how often you need tests in the future. For a few women, the cells may change again, and you may need to have a second treatment. For about 3 in every 10000 treated women, cervical cancer can still develop, and that is why it is so important to have follow-up smear tests when recalled.

How to contact us

Cotswold Inpatient Ward 

0117 414 6785

Evenings and weekends

Colposcopy Clinic 

0117 414 6791 (Option 2)

Monday to Friday 08:00 to 16:00

Further information and support

Population screening programmes - GOV.UK

BSCCP | Home

We are the leading gynaecological cancers charity - The Eve Appeal

© North Bristol NHS Trust. This edition published November 2025. Review due November 2028. NBT002311