Good morning doctor jobson full stop <\n\n> I hope you managed to get home at a reasonable time yesterday full stop <\n\n> I went to see this chap on the ward this morning who has had the achalasia for the last 30 years full stop he last had a botox injection in december and did have excellent symptomatic improvement from this with finally he was able to eat and drink immediately following the test full <\n\n> He's had 2 stone of weight loss combined with intermittent difficulty in swallowing solids over the last few months and this has come to a head over the last 3 days where he struggled with solids and liquids full stop <\n\n> His nutrition is essentially 0 in hospital as he's only keeping down very small amounts of fluid and occasional mashed potato which he sometimes vomits up full stop <\n\n> It does seem as though a botox injection would be quite sensible for him given the excellent symptomatic improvement he had previously and I wonder whether it might be possible to undertake this on the inpatient list today? Thank you very much