Ambulatory Services

Internal Medicine Rapid Access Clinic (IMRAC)

The Internal Medicine Rapid Access Clinic (IMRAC) provides improved access to internal medicine expertise for patients with complex and complicated medical issues. If you are referred to IMRAC, you will be seen by internal medicine physicians at IMRAC one or two times to manage you acute medical issues.

When you are referred, you will be contacted with more information regarding your appointment. It is our goal to see all IMRAC patients within 3 business days of their referral. Patient appointment handout.

Gastroscopy

A gastroscopy is a procedure to look inside the esophagus, stomach and the first part of the small bowel. A small tube with a video camera on the end is inserted through your mouth to look at your throat and stomach.

Indications for Gastroscopy:

There are many indications for a gastroscopy which include heartburn, regurgitation, difficulty swallowing, anemia, abdominal pain, unexplained weight loss, etc.

Sedation is used for this procedure, so all patients must ensure that they have someone to take them home.

Colonoscopy

A Colonoscopy is a procedure to look inside your large bowel or colon. The doctor uses an instrument called a colonoscope. This is a long flexible tube with a camera and a light at the end of it.

Colonoscopies are done for many reasons such as screening purposes for patients 50 years of age and older, due to a family history of colon cancer or a positive Fecal Occult Blood Test. We also do colonoscopies for patients experiencing symptoms like rectal bleeding, constipation, diarrhea, change in bowel habits, abdominal pain, weight loss, or anemia.

About the procedure

You will be instructed regarding cleaning your bowel in the days before your procedure. Follow the instructions that correspond to the prescription given to you by the doctor. Sedation is used for these procedures so you will need someone to take you home.

Please arrive 1 hour prior to your scheduled appointment time in order to get IV in and paperwork done. The procedure takes about 20 to 30 minutes, but you will be in our facility for approximately 3 hours, which includes your procedure and recovery time.

After a colonoscopy, a nurse observes you and reviews post op instructions. Download the instructions here. Expected time in recovery is 30 minutes.

Cystoscopy

Flexible cystoscopy is a diagnostic procedure to examine the inside of your bladder. It can also be used to take biopsies from your bladder, remove ureteric stents or administer Botox injections into your bladder. It is usually performed as an outpatient under local freezing.

If possible, arrive 30 minutes before your procedure. You will be asked to change into a hospital gown before entering the examination room. This procedure is short and you will go home quickly after your examination.

Mild burning on passing urine is common after the procedure but side effects are rare.

Minor Procedures

A plastic surgeon or general surgeon performs the Minor Surgery. Patients must first be seen by a GP or family physician, and, if suitable, they will be asked to make an appointment for Minor Surgery. We have a fully equipped operating area where we aim to provide a rapid access, local service with minimum inconvenience to our patients.

Before your operation

• Please have a shower or bath before coming to your appointment.
• You can have your meals as normal beforehand, although a light lunch may be more comfortable for you than a large meal.
• It helps to wear loose fitting clothing. You will not be required to undress completely and we typically only need to expose the affected area of your body.

We aim to make the procedure as pain free as possible. You will be awake throughout and no sedation is required. The operation will be conducted under local anaesthetic (an injection with a very fine needle to make the area go numb). You will feel a mild discomfort for a few seconds as the freezing is administered but should feel no pain at all after that. Have a light breakfast prior to procedure.

Apart from parents and carers, we are not able to accommodate companions in the minor surgery room but they are welcome to sit in the waiting room whilst you are having your operation.

What to expect 

Before your surgery the doctor will explain exactly what procedure is being done and why. You will have the opportunity to ask any questions about the procedure being performed and/or any alternative treatments - including what would result if you decided not to have surgery. 

Women's Health Clinic: Rh Negative

The BCHS Women's Health Clinic offers compassionate care for women and their families. We provide a variety of specialty services for women throughout the life stages, in the fields of general obstetrics, gynecology, and uro-gynecology.

Rh negative and pregnancy

Being Rh negative means that you do not have Rh proteins on your red blood cells. If your baby is Rh positive and you get a small amount of your baby’s blood into your bloodstream when you are pregnant or when you give birth, your body can make antibodies that hurt and kill red blood cells that are Rh positive. The most likely time that you would be exposed to your baby’s blood is when you give birth. Being Rh negative will not harm your baby during your first pregnancy.

In subsequent pregnancies, the antibodies that you made when you were exposed to Rh-positive blood at your first birth can cross the placenta and attack the Rh-positive red blood cells, if your next baby has Rh-positive blood. This is called Rh sensitization. Rh sensitization can cause fetal anemia (low iron in the blood), miscarriage, stillbirth, or a serious illness in the baby that is called hemolytic disease of the newborn.

Fortunately, Rh sensitization is very rare because women who are Rh negative can get a shot that stops their body from making antibodies to Rh-positive blood. 

RhoGAM

RhoGAM is a medicine that stops your blood from making antibodies that attack Rh-positive blood cells. RhoGAM is a sterilized solution made from human blood that contains a very small amount of Rh-positive proteins. These proteins keep your immune system from making permanent antibodies to Rh-positive blood. They do not hurt your baby. RhoGAM is given as an injection.

When do I get RhoGAM?

The chance of your blood and your baby’s blood mixing is the highest at the time of birth, although that possibility is rare. However, blood mixing can also happen during the last trimester of your pregnancy, when your placenta is growing and the membranes that separate your blood from your baby’s blood are very thin. For this reason, RhoGAM is given at 28 weeks of pregnancy to protect you for the rest of your pregnancy.

RhoGAM works for about 13 weeks. Soon after you give birth, your baby’s blood will be tested for Rh. If your baby has Rh-positive blood, you will get another dose of RhoGAM within 72 hours after you give birth. If your baby’s blood is Rh negative, you will not need the second RhoGAM dose.

Colposcopy

The Colposcopy Clinic is a specialized service for adults who have an abnormal pap test, an abnormal exam of the genitalia by a health care professional, or who need treatment for genital warts and vulvar lesions.

How long will my appointment be? 

A typical appointment runs approximately 30-45 minutes, but this can vary.

Will I have to come back more than once? 

In most cases, patients in colposcopy have 1 or more follow-up appointments, until the patient has a normal pap result.

Does a referral mean I have cancer?

In most cases, no. A common reason for referral is for dysplasia of the cervix. Dysplasia is not cancer, but does require further treatment so that it does not become cancer.

LEEP

Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue in a woman’s lower genital tract. It is used as part of the diagnosis and treatment for abnormal or cancerous conditions.

The lower genital tract includes the cervix and vagina. The cervix is the lower, narrow part of the uterus and the vagina connects the cervix and the vulva.

With LEEP, an electric current passes through the fine wire loop to cut away a thin layer of abnormal tissue. This tissue will be sent to the lab for testing. LEEP can also remove abnormal cells to allow healthy tissue to grow.

LEEP may be done when cervical or vaginal problems are found during a pelvic exam, or abnormal cells are found during a Pap test. LEEP is also done to detect cancer of the cervix or vagina.

Cells that appear to be abnormal, but are not yet cancerous, may be called precancerous. These abnormal cells may be the first evidence of cancer that could develop years later.

Your healthcare provider may have other reasons to recommend LEEP.

Generally, LEEP follows this process: 

1. Have a light breakfast at home before coming to the hospital.
2. Once you arrive and register, you will be asked to undress completely or from the waist down and put on a hospital gown.
3. You will be instructed to empty your bladder before the procedure.
4. You will lie on an exam table, with your feet and legs supported as for a pelvic exam.
5. Your healthcare provider will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
6. Often, the healthcare provider will use a colposcope, an instrument with a special lens similar to a microscope, to magnify the tissues. The colposcope will be placed at the opening of your vagina but does not enter your vagina.
7. Your healthcare provider will look through the colposcope to locate any areas for treatment on the cervix or in the vagina. Photographs with the colposcope or sketches of the areas on your cervix may be made for your healthcare record.
8. Your cervix may be cleaned and soaked with a vinegar solution, also called acetic acid solution. This helps make the abnormal tissues turn white and become more visible. You may feel a mild burning sensation. An iodine solution is sometimes used to coat the cervix, called the Schiller test.
9. The healthcare provider will numb the area using a small needle to inject medicine.
10. You will hear humming and/or blowing sounds from the equipment.
11. The LEEP wire will be inserted through the speculum and passed through the abnormal tissues. One or more passes may be needed. You may feel pressure or a slight cramping.
12. Some women feel faint during the procedure. Tell your healthcare provider or the nurse if you have this feeling.
13. It is very important that you lie still during the procedure
14. The amount and location of tissue removed depends on the whether LEEP is being used as a diagnostic tool, or to remove abnormal tissue. LEEP wires come in different sizes and shapes.
15. The electrical current will seal the blood vessels, so usually there is very little bleeding. Any bleeding from the LEEP site may be treated with a paste-like topical medicine.
16. The tissue will be sent to a lab for further testing.