Trevor wall 339470 80 year old man now fourth presentation of pain and difficulty in swallowing associated with his esophageal stent which was inserted on the 12/29/2025 sounds like the stent insertion was challenging with this distal esophageal tumor with nodular mucosal disease intraluminally and ct has demonstrated epigastric lymphadenopathy on ct and pet which has meant that this esophageal cancer is not curable and therefore he is going to see the oncologist on the january 14 to consider undertaking some chemotherapy blood test he was recently on allerton and discharged on the january 5 during his admission he underwent a chest x-ray which showed stents still in situ with no changes associated with it bloods demonstrated some raised inflammatory markers crp was 86 but then the subsequent I should say crp was a 177 which subsequently improved down to 86 with no intervention full blood count demonstrated neutrophils of 8.49 but normal white cell counts on discharge lft is normal mildly raised creatinine during admission up to a 123 which improved down to 82 during at the. Of discharge medications list mometasone nasal spray lanzoxyl 30 mg twice aspirin 75 mg once a day or aleve mouth gel as able hydroxycobalamin injections laxido as required viscotib as required atenolol 25 mg once per day past medical history t 4 n 3 m 1 esophageal poorly differentiated adenocarcinoma involving esophagus stomach with metastatic nodal disease in the above and below the diaphragm on pet scan subsequent ct thorax and abdomen december 2025 due to pain after stent insertion no evidence of complication progressive supraclavicular mediastinal lymphadenopathy as described subsequently had a chest x-ray on the january 4 because of his raised inflammatory markers showed no interval change urine mcns during the admission showed no bacterial growth either other past medical history monoclonal gammopathy of uncertain significance october 2025 tia april 2025 rosacea june 2023 angioedema balanitis hypertension 2014 gout 2014 note gp record january 6 patient wife called at her wit's end cannot deal with patient no eating or drinking recent discharge from hospital wants to go back in ambulance is on the way I did discuss with the team the ambulance team when he was with the patient around 06:00 this morning and they were planning to send leave him at home but it appears that this did not happen mister walt hello I'm robert 1 of the gastroenterology doctors nice to see you again how are you not good well I'm alright pain wise mhmm good I can't swallow very well at all like I eat a chicken sorry it's a nightmare the stent isn't it you've had so much trouble with it I assume but because I found it yesterday obviously yesterday I think I actually had 9 with the ice creams in sort of a day sounds good yeah sounds a good day I couldn't I couldn't I couldn't yeah the ice cream did I yeah I couldn't I couldn't drink anything mhmm very well anyway so ice cream goes down but water doesn't oh yeah that is strange isn't it yeah today there's virtually nothing going on yeah I I was trying I was trying to look and what so is has anything gone gone out today no nothing 0 pops come out nothing gone no no just wee I did manage good I don't how much I think just be oh I think I've had protein drinks I've had a couple of sips of them yeah a couple of sips yeah yeah yeah so then and what happens if you have more than sips I get it brings across the pain oh yeah big trap well I'm a huge trap but trap pain so there's a tell me about it what describe it to me you nothing on you have a sip of drink and then what happens I get I get pain here you get pain in your upper tummy lower chest that's called my tummy back and how bad is the pain not bad not bad the last time it goes very good but you're not able to have more than a sip no why I don't know the swallowing's even worse I I was trying to have a tablet I and yet I have to give up with it didn't even have to get the tablet down oh even the orymorphs has struggled we've tried to do orymorph every 4 hours yeah yeah we swapping and swapping with cow pulp so they can connect to us and even back to being struggling to take it as well because of pain is that why yeah that and fear it's like now I've moved now as soon as I move I've brought something here having a stent in your oesophagus is no fun it's no fun for anyone but it's particularly not fun for you it's a big rigid metal tube that just sits in your esophagus so it's incredibly uncomfortable the worry is not getting the water down his weeing I'm weeing every hour bought a drink yesterday it was a week away from I've been dehydrated 1 going back in yeah so they put in a you know another drip in big shot have you had a drip since you've been here no you had some with the paramedics did you no no nothing okay I've done the I've done the jig all day oh sorry very very few sticks of water what can I get you to eat now then should I get you to some ice cream as well today aren't you yeah you can try with it ashley I'm not not hungry I'm being I I am trying trying to mix healthy yeah yeah but got some water up there what have I did I mean so we got plenty of fat we've got warm in his mouth mhmm but I can't swallow it weird that is strange and what happens if you try to swallow it you choke choke well it goes down the wrong way I can't even swallow it's like no I can't swallow I'll try to swallow can't swallow he also suffers from dry throat eating some artificial saliva I saw on your gp I've got a spray the spray seems to go away but it doesn't help I've picked up the touch I'm sorry and how's your weight pains at going alright it's alright not too bad well good I went down from 12 4 2 to 8 12 with all of this I'm staying 8 12 right still staying good what I need is really to be able to get the career to be you know intravenous you know yeah just to make sure that's what your kid is riding out yeah of course we don't need that yeah but in the longer term if you think very short term really because you're gonna see the oncologist aren't you a week's time that's right I mean for them they want to see a man who's eating and drinking who stays out of hospital because they can't give you chemotherapy if you're in hospital no and who is well at home and able to deal with that whole sort of treatment if that's what you want to have yeah so we need to get this sorted out for you don't we I don't with all the tests you've had over the last few weeks the chest x-ray hasn't shown the stent has moved the ct scan hasn't shown a complication related to the stent they had some slightly high markers of infection and inflammation while you're in hospital but they got better by themselves yeah without any treatment or anything like that which obviously could it there could be lots of things causing this and it we should look into what's causing them another chest x-ray to make sure the stent hasn't moved I doubt very much I have no no I'll figure out he doesn't yeah and but I do think that I don't I'm not gonna have a magic wand to make it better no unfortunately having a stent in your esophagus is part of my french shit right it's not it's not good at all yeah it's it's unpleasant it's uncomfortable every time you eat you get reflux because you can't keep any acid in your stomach because you've got a stent bypassing all of that it so will be uncomfortable for you it is going to be painful think for you not for everyone but for you it is to be painful there is all sorts of fear there isn't there oh yes from the anxiety a fear of what choking is what it is yeah and I've got dry scalp now mhmm I've got a really really dry mouth I've even put I've got eye ointment there dry eyes as well I washed the eyes earlier it's a bit flail here but the eye biscuity helping the eyes a lot eyes you've got some of that saliva stuff for your mouth do you yeah you use that yeah I've I've had some early well you you do look dry yeah I'm sorry it's just a quest really if somebody could bother to walk the groin and can it feed me intravenously you couldn't have intravenous feeding with while you're on chemotherapy person no we'd rather than you'd do mhmm well I can put you on intravenous feeding but it won't fix the underlying problem I can't intravenously feed you forever no you need to be able to eat don't you yeah and if I've not got anything that I'm going to be able to to make you eat more then I don't know what the role for that is to be I think some intravenous fluid is good to rehydrate you to get you feeling better that's fine you can try an ice cream yeah and I think trying an ice cream is a very good idea yeah yeah it's I don't think you need to be eating a beautiful plate of vegetables think as long as you're eating calories yeah lots of calories really it matter what you're eating I've got protein drinks I can I can I can take that kind of and obviously protein drinks are thin aren't they yeah as compared to ice cream gosh gosh often people will say to me that they struggle with liquid things but find solid things better is that what's that what's that like for you you're to eat olive opposite you can't make anything solid no yeah don't tried anything solid what I'm thinking that's a day I don't tried anything since you've been in with your solid yeah I never tried sausage yeah oh you didn't I tell you what I did had a bit of rhubarb and yeah a a probably half a teaspoon yeah hit that yesterday and what happened I was alright with that mhmm because objectively from our perspective we've got a camera that's 11 millimeters in size yeah a normal esophagus is 18 millimeters in diameter and our camera went through just fine after the stent right yeah so from our perspective when we look with our camera it's all open and there should be nothing stopping you from eating solids from the oesophageal cancer everything doesn't move well because of the cancer and because of the stent and it is uncomfortable I'm sorry sounds a bit younger than be anything structurally yeah stopping things from going down I think exploring how your swallow is by seeing the speech and language team will be helpful if you're worried about choking they might be able to provide some reassurance that there's nothing that would make you choke and try you on some thickened fluids to see if that makes you feel better because sometimes as I say thickened things can be better for an initial phase of the swallow where it's in the back of your mouth if you're worried about choking that can be helpful well I'll start trying to ask you if it went down okay then yeah great well I'll do it yeah but when I'm at home I've tried to cover the pits and I went down this morning but I haven't tried them since and what's the difference you think between ice cream here and ice cream at home what nothing nothing so so it's not solid it's a bit melty here yeah it's nice yeah fine get you some there's some next door I'm trying to chip you please not actually this I think might be yeah guess you've had difficulty in swallowing for a bit of time before all of this happened and so maybe 1 gets slightly used to not being able it started when he had this dry throat he's on yeah yeah nothing nothing extravagant I'm still getting you okay that was my elbow alright go to the doctor I'm getting you in bed as well I can't breathe in as deep as what you're you're doing it's alright I'm just listening to you I'll have a quick listen to your back if you don't mind yeah thank you other pain that got there earlier on pain and nerves and yeah big breast mobility so I can't do a good stretch anymore great you can get back if you like that's alright let you pull it before I came out I went to the toilet I'd been for 10 days I worked for toilet 9 times 9 times wowzer so it should be fairly clear clear to settle out I've also liquid ones can I leave your tongue do you mind fine thank you that's lovely thanks very much I think you've got infection in your throat a candidal infection looks like it sometimes when the esophagus isn't able to close and move well because of a stent you can get fungus growing in the throat it's a bit weird oh that could easily cause the symptoms you're describing let me get you some antifungal mouthwash and some antifungal tablets we should say that I've got some blood clots to go for through the thing yeah what mouthwash have you got colgate fax alright I'll get you some special antifungal stuff called nystatin it can cause you to feel like you can't swallow things down I don't think that's going to be causing the pain in your oesophagus but it could be causing as you say the difficulty in swallowing I think that'll make things a lot better doctor wells have much pain today he's the pain a bit because he's on his on or or on and paracetamol which he wasn't taking can I tell but his son's been holding him down and washing it down the skull no I've got a liquid 1 caprol or something caprol for kids yeah for kids mhmm that's that's controlled the pain today hasn't it good it would be this what would you call whole form of I've the carry not been too bad for pain at all not today it's just the fact that it's so dry you won't believe it so let's get I'll get rid of a bag of fluid get a chest x-ray make sure the stent's in the right place I'm sure it is yeah I'll sure sure it is I'll get you some ice cream I'll try that some antifungal mouthwash and some antifungal treatment the antifungal treatment is 2 worth and the antifungal mouthwash you can use for 10 days we did all those things we were trying to out of here couldn't we yeah yeah that's why I went to all I thought if we go on we went there I thought ah I can't monitor how much liquid I'm getting mhmm and I could get sore just to to drink anything mhmm of course or the occasional little sip of monday water which I'm very spickered but most of the time I can't even swallow of course well let's get this antifungal stuff I really think that will make a big difference and if you're a lot better alright okay great I'll be in this case any questions for you anything I forgot liz please ask me yeah you're keeping him in now I will say oh no let's yeah well you can be here you be here that's alright it's not very nice but it's no it's not a problem for us not too bad is it I'll get you all those things so I'd I'd like to try and avoid keeping you in hospital not because I don't wanna keep people in hospital it's great for me I don't like but I think it's not very nice for you and also it's not good when you've got incoming oncology to be in and out of hospital a lot I think they look at that and think this man's not going to cope well with chemotherapy if he comes in hospital 6 times you know what I mean which is when they should get in and of I thought I'd be eating big at home yeah and then I forgot I've no I've no way of monitoring me I've still got his toilet? At 12:00 I'll bet everyone get it mhmm right we'll get you a drip of fluid to rehydrate you we'll get you some some food I think if you've had the drip you can have some ice cream if you're able to get ice cream down and you can have some antifungal treatment to go away with with to make things better over the next few days go and that'll be a really good step does that sound alright I don't think taking you to ward is going to add very much you're going send me over again after a few hours I think that's the right thing to do that's why I don't don't mind to what I'm thinking I can take you up to aalton and that's absolutely fine I don't mind but I don't know what else will add do you know what I mean with staying in hospital if you feel like you can't go home that's totally fine happy to I like I can't monitor it I don't want to get dehydrated having your kidneys or liver or so I understand I understand I don't don't really no idea I think the key from my perspective is getting you eating and drinking something yeah and I think from I think I know what the cause of your trouble eating and drinking is I think it's this fungal infection in your throat I think treating that will make things better I don't have a magic treatment that will make it better instantaneously it'll take a day or so for it to get better I'm obviously worried about my cancer because nobody's told me yet I must have terminal cancer we've oesophageal cancer on your ct scan what do you understand about the results of your pet scan nothing nobody's told me anything alright you saw doctor summers in clinic after you had your pet scan I I understand got 6 months to live you know that's right think that's right yeah so we keep you in this position alright no we've talked about fishing in this position alright I think that's what I read in the letter that you said I I see the letter oh fine but I think he met you in clinic and said that to you but you're some girls that was just well I've not actually seen he's not an oncologist he's not an oncologist no no alright so I don't know what the treatment would be but the prognosis would be with and without chemotherapy yeah we choose to prescribe that and I can't answer that question unfortunately because I don't do those things but I am a gastroenterologist and we yes I think that prognosis is accurate and unfortunately when the softgel cancer is spread it's it's it's not curable I I nobody's told me that before okay I'm sorry I almost told you that before alright let's get some liquid in you yeah yeah okay let's get you cleaned up okay I'll come back with you okay you alright thank you so thank you bit yeah the reason we've dropped back in there thank you missus william because she's movement was way down the direction the shoulder was going actually the stress of the worry that was going through of course the family of all I'm sorry at 6 months on old I'm not saying I'm happy but you know what I mean yeah yeah you're accepted yeah he's not accepted now you've told him he might mhmm nothing worse about it sounds completely understandable yeah but the the the mood swings he's going through are phenomenal it's even worse he's not fine enough towards us okay but it's just the nurses will back up as well how we can be and how those mood swings right none of us can talk you around drinking taste it eating to take things we're also the same as you guys let's just stop you from swallowing okay and you can't tell us you just say it's acid reflux well as you say you're gonna have acid reflux let me stents open it's all going come straight if it is possible just for your mum's sanity to keep them on our tongue hopefully there is space on our lips there's no space but you can make sense yeah if you could do that it would it would make even maybe she's for a couple of days yeah because she's been in touch with social services and she's been trying to get some sort on that for me which is now gonna be granddaughter again I would expect you to go and know tomorrow evening so her husband's gonna leave her with her and had tia was 2 years ago I'm just worried that he's gonna get better and then we're end up with the 2 yeah last thing yeah that's that's actually funny yeah yeah I've not spoken to you but if you can get him on our website he's he has said to us he's always itching to get out and get out and get out he's having discharge so I'm okay I know just over time and when I met an appointment he's really keen to not be in hospital yeah which very different he's wanted to be back in and wants to be here and wants to get hydrated and wants to be monitored the idea yeah that's it I'm glad you said what you just said to him it's hard it's done everything you need it's done I've no so impression multifactorial poor oral intake secondary to psychological difficulties around swallowing number 2 stent related pain and discomfort number 3 oropharyngeal and possible esophageal candidiasis number next and then social concerns from family regarding patient managing at home with wife and poor oral intake plan number 1 chest x-ray number 2 blood test number 3 iv access and iv fluid number next nystatin and of course a fluconazole number next brief admission primarily for social reasons number next elder ward ideally