So it's a referral for ben murphy davies alpha 2 4 1 6 9 8 investigations upper gi endoscopy 20 eighth to the fifth 20 25 moderate esophagitis with linear erythema and erosions at the lower esophageal sphincter grade 2 esophagitis anteral erythema moderate duodenitis normal ampulla mri small bowel 05/27/2025 no abnormal small bowel wall thickening enhancement and no inflammatory change no free fluid in collections oral contrast has flowed through the proximal to the mid small bowel no positive oral contrast with the distal terminal ileum that's 05/28/2025 crp '13 normal white cells and neutrophils alt a 38 from 87 blood gas normal note recent ct abdomen and pelvis 10 cm section of small bowel on the left side of the abdomen dilated up to 3.4 centimeters containing fluid gas and small volume fecalization with sudden transitional narrowing which may represent an adhesion cell stricture subsequently reviewed by georadiology he feel no abrupt transition. Or other features to suggest adhesion obstruction small foci of slightly increased attenuation of the small bowel loops in the left side of the abdomen single loop of small bowel on the left side mildly dilated leading to gradual tapering hello is it mister murphy davies yep I'm rob I'm the gastroenterologist rob hello nice how are you not too bad but fine you're mad yeah tell me more about it why have you been better well ever since I had my gallbladder out last july every couple months 6 weeks or whatever I've been vomiting and diarrhea they said after surgery and stuff your body's gonna get stages or whatever stay away from your fatty foods dairy too much dairy too much spice all that sort of stuff gone on and on and on but every like I said every so often it just got violently sick or completely opposite or a combination of both came in 4 weeks ago with the same thing sort of nothing got said they basically just said your stats are weren't enough we'll scan you later on I said well I wasn't I didn't feel like I was ready to go home they said well everything's ready we'll scan you blah blah kinda pushed pushed my hand yeah which I wasn't very happy about okay 3 weeks later I'm in again mhmm but for the last 2 weeks it's near enough I can't keep any food down whatsoever obviously I'm on a liquid diet here mhmm I'm eating a lot in myself okay I'm lactating enough more mhmm and what are you having for your liquid diet I've protein drinks myself some soup soup okay ice cream okay jelly soup yogurt clear soup soup that's like you can't see through no I've seen they give they're obviously gonna be fine so you might have like a lean potato soup vegetable chicken okay fine chicken has got some fiber in it hasn't it a little bit yeah I have lost a stone since I've been here oh alright which but I'm not complaining about that because ever since I had my gallbladder out I can't lose weight mhmm okay I've actually put on nearly 3 stones since I had my gallbladder out so within a week I know it's something to be aware of but I'm not complaining on that fucking liquid diet I'm happy about that mhmm end stage was the last time last week I had a full meal and then after I had my endoscopy they tell me to eat mhmm so I did but when when I came back they went they came back and said they didn't want you to eat mhmm so I'd already had a chicken small chicken pasty and a sandwich yep because I'll I'll be you're hungry I haven't eaten for nearly a week so I got to about 10:00 mhmm mhmm I I said I'm I got to sleep around and then I got a pain in my chest and then I'm vomiting I didn't go sleep till I wake up in the morning I'm like I've got to productive in so much pain I've gone back on liquids and that's every time you eat something solid the moment you'll have tummy pain chest pain you'll sick diarrhea but it's either 1 or the other at the moment it's constant burning I haven't really passed much stool other than when I had all the dyes and that food and I came back and it was like a chocolate fountain but for the last I'd say 8 weeks continuously it's been not like a week where I haven't been able to it doesn't matter what food like chicken salad I was on 1 day and I was vomited for 4 hours but it gets to the. Where it's just boil it's red it's urging I'm retching I'm in so much pain because over the last 8 weeks I didn't know I had that much in me it's scary how much stuff has come up yeah I guess everything you eat has been coming but then I'm like well I didn't eat for 3 days and I'm still vomiting but it's caused like I've got to that. Where I'm scared to be because you don't want be sick being sick is hard by the way yeah but it's like I said this has been ongoing since july obviously for the first couple months I took them with pintocell just like they had her out they told me there could be sickness or reactions with foods so then you would think oh I bet that have you been losing weight since the you said you've been struggling to lose weight I've struggled to lose weight but it's just over the last week since you went on a liquid diet I've stopped your weight's dropping off yeah but at home you weren't losing weight I eat I eat chicken salad scrambled eggs loads of fibrous things yeah I've tried to go on so many different things and tell me like after you eat chicken and salad what happens not much it's the it's the evenings yeah okay so it's like I can eat mhmm and then it'll get to like 09:10 o'clock at night I'm like yeah and then I'll start like I said I get a lot of gas yeah barapin throbbing a lot more barapin but like it comes up and you can feel it it's like a deep round you know when you get like a new oh that was a good 1 yeah but it's 1 2 3 okay and it's continuous but yeah I don't know where we're at you know obviously I've had the mri of the bowel and the endoscopy when I was in last time they were they had a colonoscopy booked in as well yeah they cancelled that I had a ct scan 1 medical team said I had an adhesion twisted bowel and surgeon said no you don't so I had a lot of contradiction last time and then they went well you start to bind and I was what I'm not throwing up I'm not because you I'm not eating or vice versa I wasn't happy that guy sent out because I thought well this is a recurring thing obviously 3 weeks less than 3 weeks later I'm back in because would throw it out for like 3 hours do know mean like I'm ratchet I'm stuck I was in so much pain so awful that I couldn't do it and like I said they put me on a liquid diet I had 1 eating where I had a small pasty and a chicken salad sandwich and I threw up for 3 hours so at this moment I don't want to eat solid food yeah I understand but I can't live on liquids forever of course so I get I know it's I myself a lot of times I've been in a lot of different doctors I've seen and now I don't know we don't know what we do I understand I'm not expecting miracles here but I can go on at this. Of not being able to a solid meal because said small small pasty I had and a chicken sandwich and 3 hours yeah and when did this all start when I know you feel like your diarrhea and symptoms happened after july yeah but how long have you been not able to eat anything it sounds like things are worse in hospital than they were at home is that fair to say or not no this is the same it's been like it's debilitating isn't it yes is but I left it for so long because I was like well I know people that have had the gorman I'm speaking to people with down syndrome yeah yeah you're quite a robust guy and us men tend to have cut our heads on the saturday yeah I'm not just gonna do you know what mean I've been having surgery on my leg for the last 3 years right okay I've out of hospital I've pippa chillani but very severe my specialist in london thinks I'm like 1 in 200000000 wow I still might lose my leg jeez okay so over the last 3 years I've been 2 every 6 weeks for the last 18 months since january 27 I've been having surgery every 6 weeks so I've been laid in bed for like 3 or 4 weeks at a time whilst sometimes having this sickness being in bed not being able to get up stand up throwing up on my buckets and things next to bed been a very common cause I've spent more time in hospital these last 3 years than I ever had yeah yeah awful I'm on the. Now where like this because it would only happen for like 3 or 4 days or a week ago every couple of months I've kind of gotten used to it but over these last 8 9 weeks it's now constant getting worse so the last 8 weeks it's been getting worse and worse and you said you'll eat something in the day you'll be fine then in the evening you'll get bloated gas burping and then yes or diarrhea or diarrhea or both or both and everything you've eaten that day will come up what will come up everything like gut brown stagnant stuff yeah fine that smells horrid oh smells to yeah but if it's stool based it's black and dark green but they both are can obviously you drink real bark and fire yes of course but some of the stuff that's something else yeah okay we're coming out of the that's what my stomach is doing today yeah hard it'll push the. Where I like my stomach I'm urging like it I'm throwing up but I can't bend I can't do anything when I'm like I said that's that's not my normal size so you're worrying but it gets to that. Where you can't even put it in air tilts yeah and then you'll vomit and it can stand up it goes down and then it's sort of like a shooting here then I get tense here and then I know I'm gonna be 1 or it's a surprise sometimes once 1 end starts I know that's gonna be the focus focus can I have a look at your tummy I went on holiday where'd you go turkey I've only been abroad like twice what about some turkish again just outside antalya that's lovely proposed dude congratulations thank you I assume she said yes yeah she did things were meant to be quite good afterwards but I was being sick all the on holiday where you're free of free of the day when were you in turkey from the may 9 mhmm sorry yeah bye just wanna make sure you haven't got I saw it okay fine alright sorry no no it needs to be like I said I know everyone's scratching their heads and I don't know what to do with myself like I said I feel like last time I came in I got fired off yeah I'm sorry you feel like that like I said it's so last time there was some concern about the radiology wasn't there had a cut we had a scan that was interpreted once by a musculoskeletal radiologist who was the radiologist on call yeah so they're not experts at looking at the stomach no I understand that gastro intestinal radiology is the hardest radiology so it's really complicated it's moving when they're doing the scan all the time and it's really difficult so it's challenging for anyone who isn't a gi radiologist to really say so the musculoskeletal radiologist said you've got bowel obstruction and then the gi radiologist looked at it and said no you haven't got bowel obstruction although there is an area that's a bit swollen up it doesn't look like bowel obstruction because that's quite reassuring think I've got fingernails up and said well there's adhesions and there's a twist in the exactly that's what we were thinking about and that's what the first radiologist said I understand yeah but just trying to clarify with communication and then being told all this I was told that first it wasn't 4 hours later but in between that you're going to need to do this this is the beginning so then you're mentally preparing for that the surgeon that came down was very blunt and went I don't know what he was talking about he went don't believe it it's something I've looked at it it's done yeah fine and I was like but there was plans made afterwards do you know what I mean look at whether this is gonna happen this is gonna happen from my perspective had the mri scan while you're here what do you know about the result of that not much okay it's just basically just like there's no blockages they were happy with it yeah fine so it's a poor study yeah so it's a great test but for you it wasn't very good yeah because you drank the contrast but it didn't make it all the way through your small intestine it only got through to the middle it's a nobody's talk yeah this is why I'm a specialist I guess so you can see that it got to the first half and the first half looks lush there's no problem with the first half of your small intestine but then it just stops and that could be because your gastrointestinal transit time is slow it's moving through slowly we didn't wait enough time to do the scan everyone's different or it could be that there's blockage there and we don't know you know what I mean yeah if contrast not getting there that makes me think maybe there's something blocking it you had that scan recently that showed maybe there's something blocking it and I talk to you now and you describe what sounds like a blockage in your intestine you can imagine that like you drink and eat something it wants to go out the other end it can't there's something stopping it and then so it has to come out the other way yeah do know what I mean yeah yeah so I suspect that's what's going on from talking to you I think that's what I'm worried about that's what my boss was worried about which is why we said do that upper gi camera test and do the mri scan so now is it is it all worth your range we won't get that so you've got 6 m of intestine instantly we'll get 2 m in the back end and we'll get a metre and a half in the top end but that means there's 4 metres in the middle that we can't get it in a pill cam could be an option the trouble with the pill cam is it might get stuck in it if food's not getting through the camera will get stuck and if the camera gets stuck then you need an operation to take it out so I need to speak to the gi radiologist who's the expert in it look at all the pictures again and in having spoken to you to find out what I think is going on and see what they think if they think that they'll be able to do a delayed contrast mri another mri we drink some liquid we wait longer and we make sure it comes through an option they may say that having a specialist radiologist looking with an ultrasound scan might be better or they might say no we're not going be able to do better than that in which case we'll go for a capsule endoscopy but with a patency capsule first so it's a capsule that's absorbable but it's the same size as the capsule does that make sense so if it gets stuck no drama you'll absorb it and we'll know that it gets stuck so we know we can't put the camera in but if it goes through great we'll put the camera in and we'll find out do you take lots of ibuprofen no no never take it I have paracetamol I'm on pregabalin diet heard a gold dream and what are you on them for I had 8 superficial blood clots and a small dvt I've got a phone call with my surgeon in london on the fifth I think then for eastburn to organize we need to go down and have my aka and sure that it's still so long clefts aka injections as well 1 treatment day's got lots of lot in it I had thrombosis and thrombophlebitis as well yeah I said just lucky to still be there for now yeah so so like I said everything you've said makes me doesn't make kind of sense but it makes sense yeah but is there any way of you like or someone writing that down yeah because obviously I've got a lot of balance of course todd it's just like from what you've said because family have been here when other doctors have been here what you've said doesn't match up to anything that's been said since I've been here and obviously the way we got treated last time my family are pushing to get some illicit involved oh right fine because they they're very upset about how I got treated I come home I suffer with mental health issues as well so it's my struggle if someone's saying something to me and then comes back the next person who's not there but I need it I struggle to take things in and obviously if I'm in it a lot of my own family back and all that sort of stuff of course me trying to explain stuff to them it's it's getting a bit much for me as well yeah I understand I've I've I've I've took it from what you've said mhmm and it makes sense because do you know what I mean yeah I think it makes sense but when doctors have given me nothing is what they have said might be looked at what you've said and the only thing I know I don't think I understand but I understand that obviously they're not specialists yeah yeah exactly to have a specialist mhmm like just brief like a dog yeah so there's a picture of your your collar on and your inside so this is your bum and this is your top end this is your mouth I'll probably draw a little mouth there I'm talking about a potential of a blockage in the small intestine we've looked down to about here and everything looks okay it's a little bit inflamed and it's a little inflamed but it's probably for the vomiting exactly and we could look in this way but we'd only get round to here and where the scan looks like the contrast got to so we gave you the contrast then it went all the way in here I'll hash the area where we saw it and then there was something and then it just stops so it gets the middle say that's the middle and then it just stops and that may be because it's not travelling through well or it may be because there's something blocking it and we don't know which and this is all okay because we have to look down with our ogd and that like I said was a bit inflamed but that's it so let me go and speak to the gi radiologist at 04:00 or so if I've got a bit of time to see them for an hour to go and ask them a question and see what they think if there's another investigation and then I'll come back to tell like I said it's just I don't want to because he was talking to me this morning about being chipped up yeah think we could use tests as an outpatient but I agree it's miserable to be losing weight in hospital and not have an answer it's not so much like you might agree but I got sent over there it was 10 to 12 weeks before I had an mr that's not I can't continue another 10 or 12 weeks of course so I don't want to go home and be left it'll be as and when and we're not hearing from you for 6 weeks no it's true do you know what I mean yeah in some ways it's better some tests are harder in hospital like if we wanted to do colonoscopy it'll be crap in hospital because the prep is always crap so going home would be better I understand that but I've got poid off last time I'm back in hospital this time and it's worse this time because then I went home and was still able to eat I thought because I was eating in hospital they didn't put me on a liquid diet but this time I can eat so what do I do when I go home yeah I know what you mean exactly we've got to have you eating I can't go home because I'll just then I'm going to cause myself if there is a blockage or I'm going end up causing myself more pain I'm just gonna you get into home ways and do you know what I mean for sure you know some slip I find it more difficult because if my partner's at work or anything I'm at home on my own mhmm I I love a lot of yeah of course know what I mean it's sad I've to stop my trial of medication which has helped me walk the sirolimus yeah I'd like to stop it because of this like the doctors don't want any complications spreading around or anything okay well let's try and find out what's going on yeah let me go speak to the radiologist and