How are doing hi I'm raul I'm 1 of the gastroenterology doctors nice to meet you hi sorry to see you in the hospital it's all a bit strange isn't it what so you had your problem on out in march 1 of my doctors had a surgeon mister sinner took it out yeah and then since then you've been getting lots of pain yeah how often is the pain it's been sometimes been to begin with mhmm but it's just been more and more and more and how often have you been to it now the last couple of months it's been 3 weeks ago it's oh alright good you showed it how it's been every other week and now it's the last 1 was monday and now this 1 here so it's just becoming more and more frequent I ended up going exopincki yeah on a holiday and we had to cut that short because again I got the pain rub 111 they took 2 hours to respond and that was literally in a car park I like you're just having the pain so I ended up going to newsy's hospital and running around the neck and couldn't do anything so then ended up driving back home yeah like 1 1 1 rung back and broke which is the opposite way so I was like and they couldn't do anything else because you're not in the right place camp yeah yeah so we ended up at exeter and then they sent about an mri scan yeah so I had the mri scan and who saw you in exeter was amy or went to a and e went to a and then seen a doctor and then the doctor sent us up to abbey ward oh yeah so you saw 1 of the surgeons oh yeah mhmm I don't know who that's fine yeah that's their surgical assessment tool oh okay yeah they do you know remember who it was it's alright if you don't remember do you have a letter I've got a letter on my phone that'd be great oh this is that epic thing they've got I do where you can log in and look at your letters yeah that'd be great just because so I'm sure can they because they said the same they continue to do here right this is stupid confuses yeah things called micah or something yeah we could have a look just because I and have you had any result results from that mri scan yet yeah so they said I've got an 8 mm stone I've seen the scan and then but did they tell you what they're gonna do about it so they wanted to do take it out with the camera take it out mhmm camera thing okay fine and are they gonna take it out with the camera I don't know they said they don't know whether they can do it or we can't get it done we can do it they can do it I don't really mind I that's what I was you'd have done twice I would whoever can do it the soonest yeah it's been over a week yeah because the last time I come here was august a week since you had the scan takes some time to report so no but I mean I went I come here in august mhmm for the same thing and somebody called me actually after I've been discharged doing it and I was like yes please and then I haven't there I didn't hear yeah fine from anyone and now it's like november so I was like I don't know yeah I'm sorry it's difficult isn't it sorry no it's fine but it just seems like by the like this happened at 11:00 this morning it always seems like I'm in all this pain by the gone yeah it's gone but we don't need to see you in pain we believe you and we can see what's causing the pain on our on the scan so don't worry like I've got a 7 month old and god that must be awful literally couldn't get him I'd like I can't call anyone till after it's calmed down like a thought yeah that's my I'd love to exactly thank you so it's a letter from to your gp by from mister mansfield lovely chap yeah colorectal chest pain tenderness her lefties did not show obstruction at home and back returned for an mrcp which has retained stain discussed with the gastroenteritis suggested you should refer to the gastro team for an outpatient appointment in consideration of possible ercp follow-up in gastro clinic refer to exotene and charlie feels she's lost faith and told me follow-up so what do you want to do I've got it done who else can do it the quickest yeah of because I know them statements are there I know this is gonna happen again no it will happen again without a doubt at siu mhmm yeah by that time she's like she is now on their diet it's all negative of the times I don't even make it to hospital mhmm do know I mean a lot of times happen in the middle of the night and the kids are asleep and there's nothing I can do so it happens more times than I of course in hospital with and obviously I've got kids and I work I I don't intake the paracetamol when I have a headache so yeah yeah when this happens I smash the codeine then I of course do you know what I mean because I'm not used to so what we worry about with this pain is an infection around the stones so turning yellow or having a fever is what we really worry about yeah having the pain is annoying and horrid and you can come and see us for painkillers but they are out these ercp procedures they're talking about outpatient tests so I don't mind what we do but I think it's sensible to not duplicate loads of things going on because what will happen is the gastro team will book you for an appointment and we'll book you for an appointment and blah blah blah blah yeah so I don't mind but I think you should probably pick our hospital no no no it's fine you can do whatever you want if you live up the road and want your and want things done here because it's more convenient for you then that's absolutely fine yeah yeah do is that what you want yeah yeah you sure yeah cool it's only because they said about doing it and then I was like well talkie said that in but in then I never heard anything about it yeah fine but all that hard yeah of course so it's like yeah yeah no I'm sorry if you're like yeah but but I certainly can't see that you've ever met 1 of my team the gastroenterologists and we're the people that do the camera test which is why they suggested the exeter gastroenterologists are involved so it's an annoying political political area area the bile ducts the surgeons take out the gallbladders but unfortunately often stones are retained and sometimes stones are retained from my perspective they're always maintained because I only see the people whose stones don't don't but there are probably loads of people where it doesn't I have ct can't see anything yeah we don't see them well on ct scan yeah it was the mri scan that was seen and I'm still not sure whether because they should have tested what stones they were to know whether they were ones left over or if their new 1 is full you can't make a new 1 without a gallbladder no you can't make stones without a gallbladder you can make tiny bits of grit yeah without a gallbladder but they're 8 mm in size you've got tiny the ducts in your liver are so small you can't make stones in those the bile has to sit for a while and congeal and form a stone you need a gallbladder really to make a good size stone oh okay so sometimes people still have pain after from a bit of grip traveling through the ducts but it's very uncommon yeah and the vast majority of people have no symptoms when he said there's stones I was like well how big are they and he said 6 mil and I was like oh 6 mil is quite big isn't it in your body but I didn't know that I was like that's a pathetic size to me it's a size don't worry so then you said you've got lovely stones they're a nice size makes me feel a bit better than no don't worry yeah the duct is only meant to be 4 mm in size yeah so having an 8 mm stone really does block it up yeah yeah and we can see the stones on them and that's what's causing your pain when you eat you release an enzyme which causes your gallbladder to contract and your bile ducts to contract when you haven't got a gallbladder your bile ducts still squeeze when they squeeze down on something hard it's really painful yeah because that's what makes you watch I I've been drinking soy milk mhmm I don't even like very much drinking alcohol stop drinking alcohol I'm just drinking I don't know well that's what's causing your pain in stones so let's take the out the procedure is called an ercp an endoscopic retrograde cholangiopancreatography so ercp use a long flexible camera to go over the back of your tongue through your gullet and stomach into the first part of the small intestine then we use a wire through the camera to fiddle into the bile duct then we find out where the stones are and we use a balloon to trawl them out so it's basically plumbing unblocking the ducts with a big balloon and we trawl them out often we make a cut on the inside in the bile duct you won't feel it because you can't feel your gut in order to get the stones out the procedure is very safe we do a lot of them we do them we have 2 lists a week we do them it's quite not safe it's quite a lot yeah of course so there are risks associated with the procedure some of those people get an infection in the bile duct after some of those people get inflammation in the pancreas after some of people bleed or have a tear in the bowel all those risks put together their rate of complications is probably in the region of 3 to 4% we quote an overall mortality so a death rate of the procedure of about half a% we often do this procedure for people who are really poorly with pancreatic cancer a lot of the deaths are made up with those people so I would think that your risk of mortality would be hugely lower does that make sense fine we do the procedure in our endoscopy unit you lie on your front you have some medicines when you're sleepy and then the endoscopist uses their camera and x rays to find out where they're going does that kind of all make sense reach them because was quite high up 1 of them is in the cystic duct we should be able to reach it it can be challenging yeah so I need so that's why I thought I should meet you explain what I'm going to do yeah I'm gonna send a letter to mister sinha who did your operation and I'm gonna send a letter to 1 of my gastroenterology bosses okay and get them both involved together to look at the pictures together and see whether what the best approach is here I suspect the ercp will be the best approach mhmm certainly to remove the stone that's in your main duct and try and remove the stone that's in the other duct but it may be that we can't get that other duct stone out ercp wise and we need to do another camera test but a different camera test okay so I need to get the person who does the test to look at the pictures and decide yeah so I'll get all of that sorted okay but and I'll send a letter to mister oh mister mansfield in exeter and let him know you want to carry on here is that fair to say so we're not duplicating work if you want to do everything extra that's totally fine you don't care I just but I just think 2 people doing the same thing is a waste of time yeah it's crap for you because you'll get disjointed care yeah yeah no it's fine okay that's fine I will suddenly be acute I had my operation I woke up so sore mhmm I could like it was you'd be happy to hear we we don't make any cuts on your tummy it's all we go through your mouth and we can make a small cut on the inside that you can't feel so most people have no pain after the test worried about after pain yeah of course but I mean I was I usually don't do it I'll still it I just kind of want it to know yeah yeah there's no pain afterwards so don't worry about that okay alright thank you so and but the good thing is your blood test don't show you've got an infection or inflammation on the bile ducts which is good stop because I'm like you've small stones you haven't got an infection you just want you want more do you know what I mean like something horrible happened to me I want someone to see that yeah of course no we see it don't worry we see it we believe you you've definitely got stones in your ducts and I've definitely taken was like that's really high and like mhmm but yeah got pain from other than that yeah yeah stroke alright perfect cool I'll get all of this sorted for you and you'll hear from us very soon so we do them twice a week we do a a list twice a week where we do 4 procedures obviously there are lots of other people using the procedure but obviously given your symptoms we're keen to do it as soon as possible what will slow things down is making sure that we can access them so I need to speak to the relevant people and I can do that over the next day or so mhmm then make and then we can make a plan about when it'll be it'll probably be next week or the week after perfect is that alright oh it'd be amazing yeah perfect I'll write you I'll I'll copy you into the lecture results you'll be able to go to my work all over yeah of course and you've got kids to look after him that's it like he get to look like mhmm 4 5 hours away some days so he can't get to me like that's what I'm worried about he was around today but mhmm like yeah you can always come and see us but we're not gonna do much more than tell you you need to it and it's like because sometimes it lasts half an hour sometimes it lasts 4 or 5 hours and when it lasts for a long time I'm like is there now something is it properly blocked like and then I'm actually really ill and then I'm like do I need to go to an hospital it's not gonna properly block don't worry the problem will be an infection you can do that I think you would have got that by now you just had those days in there your hands were quite yellow last week yeah they did go a bit yellow after your eyes I didn't know how I did that didn't notice the eyes usually it's in the whites of the eyes we notice it yeah mostly I think you would notice it alright today but I did I went for any color but I don't know if that's pains not pain have you tried buscaban poorly yeah I've tried that it actually made it worse did it yeah yeah sometimes they make it better yeah I've got I've got shit ton of codeine at home but it's just I don't like taking it but I if I know that's coming up do you know what I so that's charlene flynn 597202