Peter kearney +1 316176 this is mister peter kearney thank you hello hello I'm with gastroenterology registrars hello mister wilson how are you very well are you itchy are you nauseated are okay not feeling depressed but fully too uncomfortable are you able to eat very no I did okay I had sausage mash with peas most greek sausages and a bit of the mash peas but just sat here just thinking they'd be putting around even a meal a few minutes I'm just not not feeling it yeah that work k I've got to get that down my neck as well mhmm and that's not good the team looking after you say that you've lost a lot of weight yes yes for most of my adult life I've been sort of done 95 97 kilos mhmm came in on friday at 18.4 good that's fine okay so 15 17 kilos over a couple of months or more than that it's couple of months couple of months mhmm when I first I first started getting good the bloating feeling give you some medicine yeah stay there and then I find that to the doctor because I was getting pain on this strat here and it was about an hour after eating it it really pained me and it would sort of progress down the stomach mhmm I'm kind of so that was done yeah but I just need to go through the went and saw him did some blood tests yeah okay I'm gonna do small blood tests and then another round of blood tests and then I was told to come down here and find and here you are yeah fine so yeah and tell me about your life more generally do you do you work for a living are you retired I retired since years what did you do I used to run a company with my electric bills mhmm alright round here or did you in dorset doesn't mean we needed a factory I haven't really seen you yet wanted to expand our stuff so we needed a factory that was 120 meters long wow sorry and we bought this machine and it was a 100 meters long right weighed 700 tons right for making big cables mhmm so so that was that wife comes from down here and inherited her girl mother's house when she passed away to do something but his wife was going down here I was looking that's terrible really mhmm commute backs and forwards to work and then down here every weekend fine lovely and then after you retired just stayed down here just came down here my son still lives in the house I think and what have you been doing with your retirement not a lot yeah what kind of things do you do on a daily basis not not not over just run the house yeah cook clean out for the cat garden garden yeah go for walks walking yeah yeah how often do you walk at least 5 miles a day fine very good and safe to say if you wanted to work if you had a job you could work it sounds like yeah yeah yeah nothing would stop alright that's good to know alright you're smoking or drinking I haven't smoked for more than 40 years so when my wife was pregnant and she was with her daughter I eat a cigarette cigarette up and she ran away mhmm that was it okay fine gave up drink wise I don't do you need to go to bed I hardly hear anything because I've got on holiday and might have a few cocktails or something mhmm but nothing crazy yeah alright okay well that's it and what's your understanding about being in hospital the tests we've done things like that has that explained anything to you or does that explain things so it's okay to say you don't know anything nobody's talked with anything or nobody's told me mhmm what is wrong with me mhmm the doctor on friday what did say had me thought of cancer can't really sort of summoned on the back of their mind it did cross my mind that the sudden was a possibility well okay but right let us know when you do wanna go back in the bed we'll get you some clean ones okay you okay that was perfect I I had about pancreatitis 10 years ago and then you have had my good blood removed after that oh I've not I haven't had I in my working life I never had a day off sick until I had a gallbladder fine never really been ill great I got to 60 and then it won't have me on yeah so you've had some some blood tests taken yes initially when you yeah first lots came they've shown raised markers of inflammation in the liver and slightly high marker of jaundice which makes us think that there might be something in and around the liver that's a bit inflamed or unhappy and there was that concern about your weight loss which led to us performing a scan and that's why the team have asked me to come and speak to you about the results of that scan right right I'm afraid it's not very good news no no would you like me to tell you about it or would you like to yeah meet to get your family and we can talk you about it you can tell me are you sure yeah okay that's fine the scan unfortunately shows a lump on your pancreas no that lump looks like pancreatic cancer mhmm I'm sorry no because I did have a what was I was told a pseudocyst on my pancreas back in about 10 years ago and went up to my mhmm was it doctor running a trial mhmm starts thin down his throat and withdrew some fluid from it obviously never heard of any results it was just a blind trial mhmm after your pancreatitis I guess that's you know cystals yeah fine well they picked they picked up the cyst on a scan they were doing scans of my gallbladder mhmm they said it was about the size of 50p a piece mhmm there's something that's a little bit larger than that now 3 to 4 centimetres in size unfortunately it has the appearances of cancer as opposed to a cyst it appears to be invading some of the area around the blood vessels which run near the pancreas it's also causing an obstruction in the bile ducts which is why your jaundice markers have gone up slightly I can't tell you for sure that's what it is because I haven't got a sample of it I don't 100% tell you but it does look like that on the pictures everyone always asks about this and it's very difficult to say at the moment with your jaundice markers on the way up sometimes we don't do anything about that the jaundice markers can get very high people can get infections around the bile ducts and that can cause people to deteriorate quite quickly however there's no sign that this cancer has spread anywhere in terms of to the liver or to anywhere else in the tummy it's obviously a good sign we haven't got a scan of your chest so we should scan your chest just to make sure there's no sign of any spread there but it would be unlikely for a pancreatic cancer to spread there so the bile duct obstruction is the number 1 thing that's a danger to you at the moment and we probably need to sort that out with another camera test similar to the camera test you had before to have the pseudocyst drained this is a camera test where we go into the bile ducts through a long camera and we can unblock them and we can also take some samples from the bile duct to see what this lump is there's no 100% certainty that those tests will be conclusive but they're the best way of getting some tissue while they're already there in that area and it will also unblock your bile ducts meaning you're less risk of getting infections in that area which can make people deteriorate in terms of prognosis from the cancer if that's what this is it's very difficult to say what will happen as I say there's no sign of spread it doesn't look incredibly advanced but we need to look at the pictures at our specialist meeting which is tomorrow lunchtime I've referred you to that and we'll speak about them with the specialist radiologists the oncologists the surgeons all together in the room to have a look at these pictures and to determine what kind of treatment we might be able to offer obviously I've given you what's probably terrible news yeah and I got a holiday booked in march this morning where are you going st vincent lovely yeah as I say it's you know it's very difficult to say there's no sign of spread there's nothing on that scan that's gonna kill you quickly is it operable that's what we that's what we need to look at tomorrow in our meeting there are operations that we can do that's the curative option in pancreatic cancer as I say there's no sinus spread which in theory makes you a candidate for that operation however there are lots of operative intricacies in terms of the proximity of the cancer to blood vessels that we need to look at and that's why the surgeons are there at the meeting tomorrow to talk about that I'm worried that this closeness of the cancer to the blood vessels makes that challenging and maybe it will not be helpful but I don't understand tomorrow obviously it's a horrible conversation to have to have for you if you'd like I can call her and tell her the news if you prefer that or I can come around tomorrow and we can have a talk about it altogether what she says I can bring 1 of my colleagues and we can chat together about it if you like and we'll have a lot more information after the meeting as well about what we're able to do in the meantime there's a few things that we can do to make you feel better we can give you some medicine which is pancreatic enzyme replacement or prion when the pancreas is blocked up by something like cancer you won't release any pancreatic enzymes which means you can't digest food which is why you've lost so much weight we can augment your pancreatic enzymes with a tablet you take alongside meals which would mean your weight loss would stabilise we'd hopefully try and getting you putting some on weight and building up your strength the ensure's can be really good for that and it's a tablet you have alongside your meal so you have 1 with a snack 2 with a main meal and 3 with a bigger meal with lots of fats I'll prescribe them for you so you can have them to try and build you up a little bit shoots my sugar levels off mhmm do you have diabetes yes I haven't they're very sugary 12:00 mhmm and now it's just 1.4 I'm do it mhmm I think often that you won't absorb anything fatty so what will happen is the sugar won't be absorbed easily but the fat won't be so it'll spike your blood sugar levels so you haven't got any more reserves because you haven't been able to have any fat absorption because of the pancreas but now we see that if you go on some pancreatic enzymes and the place for me it actually strangely will actually probably lower your blood sugars because it will stabilise your blood sugar certainly this lansoprazole that you're on we should have alongside the creon because it means that it's effective without taking the lansoprazole it will mean the creon won't work so well yeah do have any pain at all not really no good how are your bowels I go every day do you feel dizzy at all not really no good it's just the the amount of gas feeling bloated mhmm because of where the lumps on the stomach makes you feel very bloated look okay that much you're going quite away yeah it's the stomach isn't very big really considering how much we eat it rests quite small size of an orange but it massively increases in size and distend when we eat something to allow us to accommodate a meal but unfortunately when you've got a lump just next to it it isn't able to distend as much so you'll feel full very quickly so eating little and often trying to keep your strength and energy levels up is the best thing you can do both to facilitate treatments that we've got and also for your health and you know your prognosis with this I'll ask them to add on a lot of blood tests looking for weird and wonderful things that can look like pancreatic cancer on imaging I doubt very much that they'll be that'll be the case that's it's worth excluding those just to make a 100% sure and after the meeting tomorrow I can come and chat or I can come chat before the meeting if you'd like but it'll be the same conversation with that today saying I don't know exactly what to no it's but if you'd like me to speak to your family I completely understand and that makes a difficult conversation I can do that but yeah she's testing you after the procedure see this commonly she's got the max yeah there'll likely be further tests suggested in terms of a further scan and probably a decompression of the bile ducts with that camera test that we can talk more about any idea of when we can probably get it on repeat is that headache that might happen the camera test it's not an emergency because you're not very cold which is obviously a big thing your jaundice levels are not very high we don't need to rush to do that you can get out of hospital and we can give you go you know over the next few weeks while you're at home I don't know I think you'll do a bit of a heavier dose I think you'd be able to be discharged now there's no reason to keep you in hospital however it's 05:00 at night you're here in hospital it may be easier and simpler to stay for tomorrow we can have a chat with all your family all the right people are in the right place we can talk about our plan and take it from there fine that sound alright just because he's quite a big fanny now so it will be down and up mhmm so I'll leave it for a little bit I'll be back to him well it's yeah unfortunately it's my specialty so it's part of my part of my job I think it's important to meet someone who knows a bit about the kind of treatments that we can offer as opposed to the team on the ward but I am yeah I'm still really sorry alright well thanks very much for your help will come and let go to the doctor alright yep so impressions new head of pancreas nice his involvement of sma and smv no sign of metastatic spread on ct however thorax not yet scanned plan number 1 ct thorax number 2 upper gi and gt referral number 3 creon alongside meals number 4 increase ensures as tolerated number 5 analgesia number 6 antiemetics number 7 update family in tomorrow