NHS first as surgeons use 3D-printed replica to help remove cancerous prostate


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Surgeons have become the first in the NHS to use a 3D-printed copy of a patient’s prostate to help them remove the cancerous gland.

They held the replica prostate in their hands as they used a £2 million robot to cut it free, ensuring they excised all the tumour but minimised the risk of causing impotence and incontinence.

The pioneering procedure is the latest to be performed at Guy’s and St Thomas’ NHS trust using 3D printing. Last November, another team of doctors relied on the technique to transplant the kidney of a father into his sick three-year-old daughter.

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Professor Dasgupta in theatre at Guy’s hospital, holding the 3D print of his patient’s cancerous prostate gland. Picture by Mark Hakansson

Professor Prokar Dasgupta, who performed the prostate operation at Guy’s hospital in London Bridge, said it had the potential to revolutionise prostate removal.

The hospital performs about 300 such operations a year with its da Vinci X1 robots. While this avoids the need for “open” surgery it means that surgeons lose their sense of touch.

Profesor Dasgupta said the plastic replica was “very realistic” and “remarkably accurate”. He told the Standard: “This retains the sense of touch. I can ‘feel’ the tumour without putting my hand inside the patient.”

He added: “How about having the patient’s prostate in my hand, before it has been removed? On the front of it, everything looks OK. But when you look at the back, there is a very big tumour. This tumour is also very close to the muscle that keeps the man dry [the sphincter], so I know exactly where to cut.

“It shows you the power of MRI, it shows you the power of this software, it shows you the power of 3D printing. If it proves to be as useful as it seems at face value, I think it has a great future.”

Professor Dasgupta with removed prostate and 3D model

“Remarkably accurate”: Professor Dasgupta compares the removed prostate to the 3D replica. Picture by Mark Hakansson

The replica was created in a laboratory at St Thomas’s hospital and relied upon measurements of the prostate from an MRI scan. It took 12 hours to produce the model, at a cost of about £150 to £200.

The model highlighted that the patient’s prostate was smooth on one side, helping Professor Dasgupta to spare one of the nerve bundles. “These bundles are important to the patient,” he said. “They go to the penis and help with the recovery of erections.

“Using this 3D model, we can plan surgery better, we can counsel the patient better and we hope to be able to remove the cancer successfully. This would hopefully allow me to do a finer operation than not having this. If I didn’t have this, there would be an element of guesswork.”

The patient, a 65-year-old GP who asked not to be named, had no symptoms and only discovered he had a large tumour on his prostate when he underwent a CT scan in India.

“He had absolutely no idea this thing was growing inside him,” Professor Dasgupta said.

Fellow surgeon Ben Challacombe said: “This man has high competing needs. He wants to be fully continent and potent but there’s no point in doing the operation if we can’t get the cancer out.”

See here as Mr Challacombe uses the robot to remove a patient’s cancerous kidney.

Bariatric surgery hailed as biggest potential breakthrough in diabetes care since insulin


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Doctors today called for surgery to become a standard treatment for diabetes in what was hailed as the biggest global advance since the discovery of insulin a century ago.

The demand from experts in the UK, USA, China and India came after clinical trials found that gastric-bypass surgery put type-2 diabetes into remission for at least five years in half of patients.

They said surgery was a life-saving option for patients unable to control their diabetes through diet and medication and could help to reduce the £10 billion annual cost to the NHS – a tenth of its total budget – of managing the obesity-fuelled epidemic.

Professor Francesco Rubino, of King’s College London, who led the research, told the Standard: “Surgery introduces a new type of outcome that was not even considered possible in diabetes before.

“With surgery, for the first time at least some patients can experience and enjoy remission of the disease that can last quite long. This is probably the most radical change ever since the discovery of insulin.

“The evidence is now robust that says this should be offered to patients. It doesn’t mean a cure for diabetes for everybody but it does show very clearly that diabetes is not invincible.”

Gastric-bypass surgery, which removes part of the stomach or re-routes the small intestine, is already offered as a treatment for obesity. Today’s call would designate bariatric surgery as a treatment option for diabetes.

It would be considered for type-2 diabetics with a BMI (body mass index) of 40 and above (morbidly obese), regardless of their blood glucose control, and those with a BMI of 30 and above (obese) whose blood glucose levels are inadequately controlled by lifestyle and medication. Thresholds for Asian people with type-2 diabetes would be lower as they develop diabetes at lower BMI rates.

Simon O’Neill, of charity Diabetes UK, said: “We strongly support the call for obesity surgery to be fully recognised as an active treatment option for type-2 diabetes alongside established forms of type-2 diabetes treatments, such as lifestyle changes, and blood glucose lowering medications.”

The Diabetes UK news release is here.

Professor Rubino, also a consultant surgeon at King’s College Hospital, said 11 clinical trials had shown that the role of the gut was key to finding a cure for diabetes. Many of the patients on trials had seen their blood glucose levels fall so low that they no longer required medication.

He said: “I think this will create fresh impetus to the search for a cure for diabetes. In the 20th century we have always been saying we can live with diabetes. In the 21st century, as we face an epidemic of diabetes, we have to find a solution. We have to prevent it. We have to treat it and potentially cure it. What surgery offers is an insight into potentially vulnerable targets to address diabetes.”

The joint statement, from Diabetes UK, the American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society, and Diabetes India, was published today in the journal Diabetes Care. Professor Rubino has written an accompanying article in Nature.

New fast-response cars for Dame Helen Mirren’s London volunteer lifesavers


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Freemasons LAS fast response cars

London Ambulance Service hopes a donation of five new fast-response cars will help it to recruit 30 more volunteer medics able to respond to life-saving emergencies.

A charity set up by actress Dame Helen Mirren four years ago has seen 145 people with medical training sign up as voluntary responders, rushing to patients suffering heart attack or cardiac arrest at the same time as frontline LAS crews.

They will be given use of the fully equipped blue-light Volkswagen Tiguan vehicles, which have been donated to LAS by the London Freemasons. The volunteers provide about 900 hours of cover a month and attend serious medical and trauma calls.

The vehicles will be based in Croydon, Ilford, Hillingdon, Isleworth and Friern Barnet.

LAS chief executive Dr Fionna Moore said: “The donation is a tremendous gesture of support to the work of the London Ambulance Service.

“The vehicles are a welcome addition to our current fleet. They will help our highly dedicated emergency response staff to deliver first class emergency assistance to the people of London.”

The Freemasons’ metropolitan grand master, Sir Michael Snyder, said: “The donation of these five rapid response ambulance cars is another fine example of London Freemasons’ care and support for the London community.”

By royal appointment! Duke of Cambridge turns VIP photographer during visit to Royal Marsden hospital


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Prince Wiliam turns cameraman at Royal Marsden

The Duke of Cambridge was called into action  as an amateur photographer during a visit to the Royal Marsden hospital today.

Prince William, the Marsden’s president, was asked by a patient to take a picture on her phone of her meeting fashion designer Ralph Lauren. William and Mr Lauren were opening the Ralph Lauren Centre for Breast Cancer Research.

The Marsden is on the verge of a ground-breaking advance by using DNA tests to determine whether breast cancer patients can be treated without chemotherapy.

Trials have shown that the blood tests – dubbed “liquid biopsies” – have reduced by a quarter the number of women requiring chemotherapy after having a tumour removed surgically.

The project, which could be more widely introduced within three years, is among several being pioneered at the Royal Marsden hospital that the Duke of Cambridge was being told about today as he opened the £4 million research centre on its Chelsea site.

Experts compared the breakthrough to the use of the PSA test for prostate cancer, which measures the level of protein in blood, and hoped it would eventually be able to detect breast cancer in undiagnosed patients.

Professor Mitch Dowsett, head of the centre, which sees about 1,000 patients a year, said between 50 to 100 patients with early breast cancer had already benefited. “I think it could radically change the management of patients if it all comes good,” he said.

The DNA test searches for “circulating tumours” in the blood and provides an “early warning” of whether the cancer, which would be undetectable on hospital scans, is still present after surgery, has returned or the patient is at risk of relapse.

The treatment is relevant for the 80 per cent of patients who have oestrogen receptor (ER)-positive breast cancer and gives clinicians greater certainty in recommending hormone therapy rather than chemotherapy, especially in those “intermediate” cases where the choice is not obvious.

“They go forward with the hormonal treatment without having the deleterious effects of chemotherapy – the hair loss, the nausea,” Professor Dowsett said.

Breast cancer is the UK’s most common cancer and kills more than 10,000 people a year. The number diagnosed has increased from 25,000 a year in 1988 to 53,000 in 2014. This is largely due to screening, and a growing and ageing population, but women having children later in life is also a factor.

Professor Dowsett decided to focus on the area after learning of concerns among doctors that research was failing to identify cancer patients who could safely avoid chemotherapy.
“Clinicians realised they were over-treating a number of patients unnecessarily. There is a cost issue, there is a time issue and, in particular, there is a patient toxicity and tolerability issue.

“Introducing these tests has reduced the use of chemotherapy in this particular centre by 25 per cent. It’s saved the hospital £100,000 to £125,000 a year on drugs.”

The Marsden’s research underlines the importance of aromatase inhibitors in the treatment of (ER)-positive breast cancer in post-menopausal women where they reduce risk of death from breast cancer by 40 per cent, 10 points more than the older hormonal treatment Tamoxifen.

William said as he unveiled a plaque to mark the centre’s opening: “I’m delighted to be back here at The Royal Marsden – it is always a place which gives me so much hope and inspiration, and a place which clearly means so much to so many people.

“I am unbelievably proud to be President of The Royal Marsden – every time I visit I see groundbreaking work carried out with extraordinary professionalism and compassion.

“Seeing the courage and spirit of the patients I met today, it would be hard not to feel positive about the work being done here, and the real difference it makes. A difference which I know extends beyond the four walls of this hospital, to cancer patients across the U.K. and internationally.

“So much of the work at The Royal Marsden would not be possible without the support of The Royal Marsden Cancer Charity and people like Ralph Lauren and Don McCarthy whose generosity has enabled the creation of these wonderful facilities.

“Speaking to the clinicians and researchers earlier this morning, I’m confident the Ralph Lauren Centre for Breast Cancer Research will set a new benchmark for breast cancer research. Their work is already having an extraordinary impact and the patients I met today are testament to that.

“The Centre will be a wonderful addition to this world-leading hospital, enabling The Royal Marsden to continue its pioneering work, so it gives me great pleasure to declare the Ralph Lauren Centre for Breast Cancer Research officially open.”

Property industry tackles mental illness after suicide of former airports developer


An initiative to tackle the stigma of mental illness among professional men was launched today after the suicide of a top property executive.

Former colleagues of John O’Halloran were marking mental health awareness week by holding a symposium to debate how to encourage people, often in high-powered jobs, to seek help when they experience a crisis in their personal life.

John O'Halloran 1

Mr O’Halloran, 63, above, a retired former managing director of commercial airport developer BAA Lynton, privately suffered depression for years and took his own life in March last year after being unable to overcome the grief of his wife Linda’s death.

His son Rob, 36, a banking policy manager, told the Standard: “It was a tragedy losing my dad. I think it’s fair to say he had a lifelong battle with depression, probably even before the days depression was acknowledged as a disease, as it’s rightly seen today.

“Very sadly we all lost my mum in 2012. She was the pillar of support that allowed him to get through some of his darker periods of depression. My hope for the symposium is that some good comes out of what was a terrible personal tragedy.”

The event is backed by property consultants CBRE, the British Property Federation and the Royal Institution of Chartered Surveyors’ charity as well as many of the UK’s biggest property firms.

It aims to promote best practice in spotting and treating mental illness and ensure problems are recognised to improve acess to care and prevent others suffering in silence.

Organiser Howard Morgan, who worked with Mr O’Halloran, for 15 years, said: “The property industry has some particular characteristics. It’s predominantly a male-dominated industry, though less so than it was. Figures show that three-quarters of suicides are men.

“Men find it more difficult to talk about private matters. I was totally unaware that John had had mental health problems all the time we worked together. It wasn’t the culture to talk about these things. I think John was like many highly professional, highly competent people and was internally bottling up the sorts of internal challenges we just didn’t know about.”

Full details of hospital’s objection to cycle lane on Westminster bridge


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St thomas bus stopGuy’s and St Thomas‘ NHS Trust today released full details of its objections to Transport for London proposals to build segregated cycle lanes on either side of Westminster bridge.

The concerns focus on the use of “floating” bus stops and the fear that this will cause collisions between cyclists and patients as they board and alight from the bus.

My story appears in today’s Evening Standard and can be found on our website here: http://www.standard.co.uk/news/london/hospital-angers-londons-cyclists-by-trying-to-block-westminster-bridge-bike-lane-a3247071.html

TfL was unable to respond fully but indicated that 75 per cent of respondents to a consultation backed the cycle lanes. It said the stewards at Elephant & Castle, where floating bus stops were introduced last month, were only used until May 4 and said there had been no reported problems (though I witnessed a couple of near misses when I passed through the area recently).

Update: Cyclists in the City says that TfL reports no incidents at the floating bus stop on the CS2 cycle superhighway outside the Royal London hospital in Whitechapel.

westminster bridge

See here for my story in March about TfL’s plans for Westminster bridge – the fourth Thames crossing to get segregated cycle lanes: http://www.standard.co.uk/news/london/westminster-bridge-to-have-segregated-cycle-superhighway-a3206481.html

Here is the press release issued today by the Guy’s and St Thomas’s NHS trust:

PRESS RELEASE                           Issue date: Friday 13 May 2016

Petition launched to challenge ‘dangerous’ bus stop outside hospital

A petition calling on Transport for London (TfL) to rethink proposals for a ‘floating’ bus stop outside St Thomas’ Hospital is being backed by groups representing patients, people affected by sight loss, and pensioners.

They are concerned that TfL’s plans for new cycle lanes and bus stops on Westminster Bridge Road are dangerous. Hospital patients, visitors and staff getting off buses would have to cross a busy cycle lane to reach the hospital.

Sir Hugh Taylor, Chairman of Guy’s and St Thomas’ NHS Foundation Trust, says: “We support cycling as part of our commitment to promoting healthier travel to work and reducing environmental pollution, for example by enabling staff to buy bikes as a tax-free benefit through a salary sacrifice scheme.

“However, we believe that TfL’s plans for cycle lanes and so-called ‘floating’ bus stops on Westminster Bridge pose risks to both pedestrians and cyclists.

“We are particularly concerned about the impact on patients and carers, especially the elderly, disabled, and families with children in buggies and wheelchairs coming to Evelina London Children’s Hospital at St Thomas’.”

Guy’s and St Thomas’ launched an online petition on Monday (9 May) which has already been signed by more than 400 people.

The petition is being supported by Vauxhall MP Kate Hoey, whose constituency includes St Thomas’ Hospital. She is calling on the newly elected Mayor of London, Sadiq Khan, to intervene personally.

She warns: “TfL’s plans for so-called ‘floating’ bus stops are potentially dangerous. Every day thousands of patients – many of them elderly, pregnant or with sick children – use the bus stop outside St Thomas’.

 “The present plans ignore this vulnerable population and I do not believe that adequate thought has been given to their needs. The new Mayor must step in to stop TfL ignoring the hospital, patients and the local community.”

 Ellen Lebethe, Chairman of Lambeth Pensioners Action Group, agrees: “All Londoners, especially the most vulnerable, have the right to safety on the roads and not to have their safety and lives compromised.

 “Older people visiting St Thomas’ as patients or as visitors should have the same confidence when crossing the roads as they do in their healthcare.”

Marsha de Cordova, Engagement and Advocacy Director of Thomas Pocklington Trust – a national charity which supports people affected by sight loss – adds: “TfL’s plans for a cycle superhighway and ‘floating’ bus stop at the south end of Westminster Bridge will be dangerous to pedestrians, particularly blind and partially sighted people.”

Professor John Porter is Lead Governor of Guy’s and St Thomas’ Council of Governors which includes elected representatives of patients, members of the public and staff.

Professor Porter says: “We are very concerned that having to cross a busy, uncontrolled cycle lane will put often vulnerable people at considerable risk.”

Smartphone app helps medics to detect hereditary cancers



Dr Anju Kulkarni and Kenisha McGregor

Dr Anju Kulkarni, left, and patient Kenisha McGregor

A smartphone app is helping GPs and hospital doctors and nurses to rapidly identify patients at risk of Angelina Jolie-style family cancers.

It enables people at risk of hereditary cancers, such as breast, ovarian and bowel cancer, to be quickly referred for potentially lifesaving treatment.

Others with a history of cancer in their family can be told that they are not at risk of it being inherited. This can offer speedy reassurance to parents as about one in 10 childhood cancers are inherited.

The Cancer Genetics app, developed by the clinical genetics team at Guy’s and St Thomas’ NHS Trust and technology firm UBQO, uses personal, family and medical history to assess the risk of inherited cancer.

It links to the latest NHS guidance and peer-reviewed articles in medical journals on about 30 cancers to ensure frontline healthcare professionals have the most up-to-date information at their fingertips.

Dr Anju Kulkarni, consultant clinical geneticist at Guy’s and St Thomas’, said it was difficult for doctors to keep abreast of “rapidly evolving” advice as inherited cancers, which are caused by gene mutations, accounted for about five per cent of all cancers.

“Spotting those patients who are at risk can be tricky if you don’t have the up-to-date guidance at hand,” she said. “It’s hard enough to keep abreast of everything, for GPs in particular. Every aspect of cancer work is rapidly evolving, particularly in cancer genetics, where there have been huge advances in the last few years.”

Anjelina Jolie’s announcement three years ago that she had undergone a preventative double mastectomy and subsequent removal of her ovaries after discovering that she inherited the defective BRCA1 gene that killed her mother saw a doubling of referrals to the breast cancer clinic at Guys. Referrals are still a third higher than before her announcement. The service receives more than 1,800 referrals a year.

Mother-of-two Kenisha McGregor, 37, from Lewisham, was found to carry the BRCA1 mutation when she was referred to Guy’s Hospital after being diagnosed with breast cancer in 2013. She went on to have a double mastectomy.

“I’d been told that I could have an elevated risk of cancer due to my family history after my first scare, but I wasn’t given a definitive answer,” she said. “I was left wondering until I found a second lump in my armpit and was diagnosed.

“The use of this app could save families from similar uncertainty and help them to receive specialist genetic testing if necessary. I have a son and a daughter and, although it will be difficult for me to accept the results, I’d encourage them both to go for testing when they are older so that together we can be either reassured, or make informed decisions about prevention if they do carry the gene.

The app has already been downloaded by health professionals almost 1,000 times in 36 countries across the world. Life sciences minister George Freeman MP said: “This app highlights the ground-breaking role that new digital technology can play in supporting NHS patients and clinicians with better diagnosis and treatment.

“Not only will it help to inform people about the risks of inherited cancers but it can put the minds of many at ease, and allow the NHS to refer patients directly to specialist cancer genetics services.”

Uber cabs able to carry wheelchair passengers in London for first time



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Disability charities today welcomed the launch of a new Uber app that allows wheelchair-users to use its cut-price taxis for the first time.

The online cab-booking service had been criticised by campaigners for being inaccessible to all Londoners – unlike black cabs, which can carry wheelchairs.

This afternoon [4pm] it started offering a new Uber WAV (wheelchair accessible vehicle) option on its app to enable passengers to book one of 55 adapted vehicles.

An investment in excess of £1 million has seen the vehicles – a mix of Peugeot Partner, Ford Connect and Citroen Berlingo – fitted with a rear-entry ramp, winch and restraint. They can also transport a carer or friend at the same time.

The vehicles are owned by their drivers but Uber is effectively subsising the new scheme by allowing them to retain a bigger share of the fare, which will be the same as paid by other Uber passengers. Uber says its fares are about 30 per cent cheaper than a black cab.

Uber aims to increase the size of its wheelchair-accessible fleet to reduce waiting times, which it predicts will be about 25 minutes in central London and 40 minutes in the suburbs.

Wheelchair-users face challenges travelling in London as only one in four Tube stations are step-free. The new app was created with backing from Scope, Whizz-Kidz and Transport for All charities.

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Lexi Porter, 18, an ambassador for Whizz-Kidz, which provides mobility equipment for young people, said the availability of Uber vehicles to get her to and from home in Lewisham would make a huge difference.

Lexi, who is on a gap year before starting a media studies degree at Worcester university, had her first trip in an adapted vehicle yesterday. “It was cool,” she said. “It was easy to get in and the driver was very courteous. It was really convenient for my wheelchair. Safety was all in order.”

She said it would make it much easier to attend festivals and concerts. “It makes it a lot easier to travel longer distances,” she said. “I get more of an opportunity to go out and live my life.”

Whizz-Kidz chief executive Ruth Owen said: “It brings affordability and choice to young people and their families, and more accessible transport. Uber’s new service is a step in the right direction that other providers would be wise to follow.”

Tom Elvidge, general manager of Uber in London, said: “We’re proud to be making one of the biggest-ever investments in accessible private hire in London and will be working hard to keep waiting times as low as possible.”

London Marathon novices help doctors to tackle mystery of endurance events on heart

Young runners who recently completed their first London Marathon are helping doctors to attempt to solve the mystery of whether mass-participation endurance races weaken the heart.

Concerns about the physical impact of running a marathon were reignited when Army captain David Seath, 31, suffered cardiac arrest and died in hospital after collapsing three miles from the finish line during last month’s event.

Researchers are carrying out extensive tests on 120 novice runners aged 18 to 35 to see how their training programme and race-day experience affected their cardiac strength.

Athletes are known to develop larger and thicker hearts, while the main pumping chamber can become “spongy”. Researchers at St George’s, University of London want to know whether this sponginess is merely temporary or a sign of a rare condition, known as left ventricular non-compaction cardiomyopathy.

They have been given access to two of the MRI scanners at the new Barts Heart Centre and are putting the 60 men and 60 women through four hours of tests, comparing their heart health now to tests done when they were selected for the marathon six months ago.

Dr Andrew D’Silva, clinical research fellow at St George’s, said improvements in heart-scanning machines allowed a breakthrough in understanding whether an individual’s “sponginess” levels were normal or increased by high-intensity exercise. The sponginess can cause the blood to clot, increasing the risk of heart attack or stroke.

“To have a lot of heart muscle sponginess does not necessarily mean there is a problem. It’s a clue,” he said. “I would like to think we will be able to give a crystal clear story of what happens in both genders with heart muscle changes: can mass participation endurance exercises harm the heart?”

He said that deaths from marathon-running were “very rare” and often difficult to link directly to the race. Exercise in general was “overwhelmingly good” for the heart, he said.

“It’s unlikely we are going to find any messages to tell people who are considering signing up for a marathon or mass participation event that they shouldn’t do it,” he said. “But hopefully we will understand better what is going to happen to their body and heart at the end of all the training they have done.”

Josh Bryan marathon runner

Josh Bryan: novice marathon runner who took part in the tests

One runner, Josh Bryan, 26, above, a City insurance underwriter from Clapham, achieved his target time of 3 hours 30 minutes after training five times a week for 16 weeks.

He was motivated to take part in the study after a former classmate and a friend of his brother both died from sudden adult death syndrome.

Mr Bryan said: “When you hear of stuff like that – people who are your age who basically drop dead without it being anticipated, who just went to sleep at night and didn’t wake up – it’s quite scary.

“Because all the studies they were doing were so extensive – taking my blood pressure and measuring my heart – I thought if anything was wrong with me, I’m in the best place: on a heart ward in hospital.”

Paralympian’s adrenaline-rush camps to aid rehabilitation of people with spine injuries


Jane Sowerby London marathon

A woman who broke her back in a freak fall is helping other wheelchair-users to take part in “adrenaline-rush” sports.

Jane Sowerby, 41, above, was left paralysed from the waist down and unable to see how she would enjoy life again after falling 13ft from the edge of stairs.

Last month she completed her first London Marathon, 13 years to the day since her accident, raising more than £3,000 for Access Adventures, which she founded with two friends.

It has sent more than 50 people on residential camps where they can experience specially-adapted challenges, from water skiing to kayaking and scuba diving, but needs more money to help others. All camps are oversubscribed and there is a demand for more sessions.

Ms Sowerby, from Ampthill, Bedfordshire, said: “If it’s the first thing you have done with other people with disabilities, it’s incredible what a boost to your confidence that can make.

“I went to Stoke Mandeville hospital’s spinal unit. They do offer some sports as part of the rehabilitation and it does give you a taster, but they are not extreme adventure sports. There isn’t that adrenaline rush there, and as soon as you leave it stops.”

The former music programmer at MTV in Camden took up sit-skiing and went on to become a Paralympic skier, competing in the 2010 Winter Games in Vancouver.

“Adaptive sports are a powerful rehabilitation tool but there’s no real funding. The military do have long-term rehabilitation funding. There get to go water-skiing on a weekly basis and hand-cycling and ski trips.

“If there was a huge pot of cash , it would be great if civilians could get that on the NHS as well. When you leave the rehab unit that is when it get tough. The support ends. 

“To find a sport you can throw yourself into, for a lot of people it’s exactly what they need to prevent them spiralling into depression.

If you have been recently paralysed and told you will never walk again, you have such a sense of achievement if you reach the end of the camp and you have been out skiing for the weekend.” 


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