Here his story's a bit complicated okay this a 60 year old chap who has a likely distal esophageal tumor okay shown on his ct scan now he's presented with a stroke called sudden onset expressive and receptive dysphagia he's a 60 year old chap with a previous diagnosis of odp1a3 gene mutation so it's got dysphagia cerebri ataxia sensorineural hearing loss wow okay I've never heard of this but I think we're right so with neurology was presented as a coronary stroke he's had a ct head a cta which was negative but showed both meds advised and dilated fluid filled esophagus advised on the ct tab so he's done the ct tab for psa and the primary findings is possible and indeterminate right renal lesion and a possible right sided bladder thickening I will also try and get a hold of urology as well enjoy that yeah multiple bony meds yeah so he's trying to get history from his very heart apparently he was supposed to have had an endoscopy a couple of days ago but didn't attend okay but now he's talking a little bit better he's saying he can drink small amounts but he's not able to eat and it's been on that worsening for about 6 months he's got 2 stone weight loss okay and so ultimately he's not really eating I think with his speech and language you're currently gonna see him now and then I think they've said basically they're gonna do they're gonna do a swallow assessment but I think it's very sort of small and vulnerable nurses yeah so well yes I have seen yes he can't eat at oh he can't eat at all yeah yeah it's it's a common so from a speech and language. Of view let's just see and I suppose like he probably needs a well he definitely needs an ogj I'm not sure good it's exactly what he needs yeah and possibly a stent but I know obviously it's do you want in terms of making that happen mhmm obviously you'll need an ogd for yes and discussion and would we need anything else or do does you just notice essentially we need to have an ogd and then to some to look what it looks like and get some histology because the findings that we find on that on the ct may be probably are what's going on but it's important to make sure there's nothing else going on yeah so you know should have an ogd and at that time I guess we could consider placement of a feeding tube so that he'd have some nutrition while we're going through this. What do you think about feeding him is that the right thing to do or the wrong thing to do james I think it's the right thing to do I mean he's a 62 year old chap who's living at home independently I I think it'd be he does he's he's pretty he he he has quite a high alcohol intake but yeah he's he's got a good quality of yeah baseline but on flip side he has a metastatic esophageal cancer which will be incurable yeah yeah so that's the other flip side yeah of of thinking about the decision to feed him but under but it's good to know about it that his baseline is good and that he and and I think while we're going through this diagnostic. I think it's reasonable to give him some nutrition because I guess well I mean he's got metastatic cancer so it's gonna be incurable regardless of whether it's coming from his kidney or coming from his esophagus but I guess if he had a prostate cancer that responded well to immunotherapy as a concomitant thing to his esophageal cancer then that might be a different story mightn't it yeah definitely so I think I think yeah if you refer him for an ogd we can have a look we can take some histology which will be the most important thing to get him in front of someone who could give him some treatment for this cancer if it if this is a cancer and then we try and see what it looks like and we could consider placing a feeding tube at that time we could do that on friday afternoon on our gastroenterologist of the day list where we do all the nonbleeding inpatients so we do that on friday perfect and then if you refer if you put in a form for us I'm sure we'll be able to do it and then the you need to be referred to the upper gi and gt with the results of that histology and then we can take it from there essentially and then I guess doing the things that you're doing in the background with his other cancers to work out what's going on with them and whether they're important or related at all to what's going on with his esophagus and in terms of the upper gi mdt referral is that is that something you guys would do as part of the ogd thing or is that something if you white slip half then and say for upper gi mdt then we'll pick that up and put him through the mdt but essentially yeah we we don't necessarily have enough time to get all the information we might need at the time of an ogd so if you tell us about his functional state and all that kind of stuff which is helpful when we're thinking about cancer in your white slip referral then we can discuss them at the mdt and what does he know at the moment so he so I haven't we he knows that we're doing a scan for for some we're trying to find out with what what's going on and he knows he's due to have an ogd an endoscopy he knows he needs to have an endoscopy that's fine go and have a chat with him unfortunately he wants his brother to be here but he's not allowed to come in till 7pm okay but I'm gonna go and have another chat with him and say and see what he wants to do yeah that's yeah it's understandable that he wants his brother there isn't it because I think he I'm sure he knows it's not gonna be good news with what's going on so so that's fine isn't it but but agreed it's you can't wait till 07:00 to tell him john because of how things work in the hospital but yeah so we've got a bit of a plan you'll do a referral for an endoscopy you'll do a referral for upper gi mdt with a white septal gastro we'll scope him on friday take some biopsies + or - place a feeding tube and then we will take it from there fantastic that's really helpful thank you for that thanks guys ben to you miss cheers bye bye look it's not problem what a happened good cloth on it so it had black oh it was yeah we didn't treat it yes because once you moved there god knows what's happening there and there was a psychiatrist oh she's shut the door that he's the hemosporin I know he was the date is the blanket I know it's same but alright the details thank you you yourself doctor thank you so let's finish up in your second year with at auburn hospital just to inform you about the procedure that you're coming for on the january 8 I'm going to need you to stop