899885 no background of type 2 diabetes hypercholesterolemia stemi with pci in november 2024 and plan for dual antiplatelet therapy for a year following this moderate spherocytosis prostate cancer with bony metastasis radiation treatment for prostate cancer leading to radiation proctopathy investigations most recent flexible sigmoidoscopy december 20 24 radiation proctitis but no active bleeding seen at that time investigations hemoglobin 85 on admission with crp 94 creatinine 118 troponin 46 to 935 subsequent hemoglobin 80 and stable actually not stable just 85 to 80 flexible sigmoidoscopy may 20 20 5 moderate low new vessel formation consistent with radiation proctitis fresh blood + + lifting solution injected following followed by apc and adrenaline hi mister white hello hello hi sorry to disturb you hi I'm rob 1 of the gastroenterology doctors hi nice to meet you how are you doing I'm feeling better good a little wobbly still a bit wobbly well without cutting you still angry really why is that disgraced myself yesterday as you know really mhmm got a large bundle I'm just down the corridor to the kitchen promptly collapsed in a heap felt fine the night before had a good meal last wine mhmm lovely got up in the morning didn't feel so good daughter who was there caught me put me on a chair put a they called duvet mhmm on the alright fine and bleeding from the back passage no no you've not noticed any of that no no not I did I did overnight you did overnight yeah yes fine here yes last night yeah and then when you were at home did you notice any I was well this was this was what called o'clock it was 8 in the morning yeah so I I was in an ambulance fine so have you been bleeding over the last few weeks oh yeah you have oh fresh red blood oh yeah every day yes when you pass the bowel motion or between bowel motions do you have a khaki okay yeah both sometimes both yeah fine it generally works on a 3 day cycle okay you'll be okay for a day then bad then worse I'd be I'd be okay for a couple of days yep then we have tsunami restriction okay okay and then a couple of days tsunami and what are your stools like are they hard and difficult to pass that I I wondered if that was partly why I bled at night because the edges were hard mhmm so I started taking laxitya mhmm and that improved things okay k do you use anything around the back passage like sucralfate or any enemas ready yeah that's fine and and you had the flexible sigmoidoscopy back in may and we injected it and burnt some of that away did that make a difference darn sore yeah sorry it is sore it's very low wasn't it you usually can't feel the bowel but when it's very low close to the bum it can I've been sore ever since really I'm sorry oh well I saw it now was alright but did it make a difference to your bleeding yes it did a bit yes mhmm apparently I've got 4 weekly recurrences booked yeah but it doesn't look like it's happened does it well only because it was last week oh of course it was because it's still may isn't it yeah like it was last week of course yeah yeah yeah sorry no it's alright you've been sore for the last week no no I mean I've it made it a little better possibly but not really if it was only a week ago it probably didn't make it better did it no on the other hand it might doctor hayward said to me look the cauterization will probably fail over time yeah he's ever just gone back I'll blast it mhmm but cheers would you like us to try and blast it again or certainly have a look yeah are you ready to go no no I came back yesterday exactly I don't think you are ready to go just yet your blood counts are still quite low your hemoglobin's 80 I had a I had a unit of blood yeah last night had a unit of blood and it's yeah and it's probably we haven't seen the result yet today no but it was it dropped a fair amount it dropped half a unit yesterday to the day before yesterday to yesterday so I'd anticipate you might have lost half that unit of blood if you bled overnight well I did I I had bled a little well I went to the laboratory this morning mhmm okay I didn't pass a stool but mhmm there was a a body of congealed blood I see just coming out fine 3 inches square right that's quite significant isn't it no pain mhmm and have you had any chest pain okay sorry when does an ache become a pain you've got an ache in your chest a fair bit of the time really fine that but but not to stop me doing anything and what I've been doing if if I've been doing something and it's got little fiercer than I like it's slow down mhmm okay fine so it's worse when you're doing things but it's there a lot well it my I don't like walking up gradients when I for any time mhmm but yeah yes I I'm not in pain mhmm okay alright but it is a bit sore yes and is that sore over the last week or it's been going on for the last 2 or 3 years 2 or 3 years fine it's been stable that whole time it's not been worse in the last no because my gp said to me look if if you slow down and it doesn't stop don't bother me just dial 999 yeah but which is very sensible so it seems like the bleeding is coming from the radiation proctopathy that we know you've got actually my only gripe is that I wasn't warned at the time that it would cause this yeah the trouble is from my perspective I only see the people who have this yeah so it happens all the time yes but it probably doesn't no no but I mean it's probably quite rare on the other hand if they'd said to me there's a chance that this will happen I would still have carried on with what I wanted to exactly you needed the treatment because that treatment has been first class oh good fine I'm good so I suggest we I'll ask the endoscopist doctor heywood and see what he thought about what he did last time and whether he might want to do it again and have a look at the pictures I think that's already in the diary yeah but whether he wants to do it again sooner I mean alright okay looking at your blood test it looks like that low blood counts the anaemia has had an effect on the heart what we call a type 2 mi so when the heart doesn't get very much blood and then it becomes a bit unhappy yes it looks like your blood counts are showing that you know my previous history this year I know you've had a bad year with the heart no no but I it says I refused open heart really okay I didn't know that no I didn't oh but explained before now what I did do it was discussed with me and it was thought that breaking my chest was not a good idea at me at 85 probably quite sensible well yeah mhmm but not yet on the other hand if if if somebody said to me look unless we do it you'll die now what shall we do I'd do it yeah exactly yeah but yeah but it doesn't sound like that was the case you you're still here without it absolutely yeah actually it was a very funny afternoon it was yeah I quite enjoyed it actually good so like I say we'll try and sort this bleeding out I'll see if I can get you some enemas so they're called sucralfate they're like a thick milk of magnesia type thing that coats the inside of your: you use them a couple of times a day 4 times a day and it you can use them as much up to 4 times a day it coats the: and it means that it tries to protect the: from the stools I did ask this question is there anything I can do so that's what we can try sucralfate I'll get some for you the enemas can be sometimes difficult to get hold of however the stuff that people drink is the same stuff so we can draw it up in a syringe and blast it up there couple of times a day you need to have another blood test today if you've not had 1 already to make sure your blood counts are always vampires have been around good I'm glad because we may need to give you a bit more blood and see whether if your blood counts are low we'll I suggest transfusing you again and then I'll speak to the endoscopy team and my boss to see whether this looking at the pictures whether doctor awad would be keen to go in again or not and then I'll come and let you know about that okay is that alright yes wonderful any questions anything else can you peer into the future I wish I could yeah I feel like I spend a lot of my time trying to any idea when I go home again yeah it's hard isn't it at the moment you're quite sick you're alright your blood count's quite low you're on the border of needing transfusion which is why you had a transfusion enough so I suggest you'll probably be in for the remainder of this week I would think until monday at the at the earliest okay does that kinda okay that makes sense well yeah as long as I know where I am yeah yeah actually it was quite funny because I was on the day before yesterday I was in the shower came out and suddenly I got no bed oh god they said dear your belongings goodbye how lovely and so I had my my lunch in the quiet room yeah funny but no they had and they needed a bed urgent I I mean I didn't mind in the slightest actually yeah because yeah oh I'm sorry it sounds a bit chaotic no no no that was they were in trouble okay I I mean that's yeah my mother was a a theater sister oh right yeah and I got a daughter who worked for the nhs in north yorkshire all her working life got another 1 in london who's a psychiatric nurse oh wow okay well they it's a medical family well okay know you're in hospital oh yeah they the 1 from london's coming down to see me this afternoon oh that'd be nice and the daughter the other 1 the 1 who saved me on yesterday thank you she she lives in beer olsen as I do and she's she'll be in this morning they're gonna have to remove oh yeah good they're fantastic mark I'm glad yeah well great it was nice to meet you I'll come and let you know later thank you plan is that alright yeah no plan no just so thankful I just I just like to know where I am of course yeah yeah I'll come and let you know see you soon thank you no worries