Whip It Out?

St.Thomas’ Hospital – Outpatients’ waiting area in Gassiott House

Friday 10th November 2017 – St.Thomas’ Hospital

My second appointment with the Upper GI surgeon to discuss a cholecystectomy. For some reason I was convinced it was at 10:40am and had arranged to be in Whitechapel at 1:00pm. When the text message reminder came through it showed the appointment was actually booked for 11:40am. If the clinic was running late then it could be a rush to get the other side of London on time.

I arrived early at St.Thomas’ so that I could drop off a sample at the path lab for calprotectin testing and to call into the Endoscopy Unit to ask why they had written to me about booking a procedure when I had already done so the previous week.

When I arrived at the Outpatients Waiting Area I had it in mind that as long as the clinic was running within 30 minutes of the alloted times I should be OK. The large screen showed the clinic was indeed running “approx 30 minutes late”. My definition of “approx 30 minutes late” does not stretch to over an hour, which is when my name finally appeared telling me which room to go to.

The surgeon apologised for the delay and for facing away from me as he read my notes on his PC. He asked how I was feeling. I explained that I was still getting the pain/ache on my right hand side but I believed it to be from scar tissue/adhesions after my ileostomy reversal. He asked if it the pain was worse when my bowels were full. I confirmed that it was and he replied that this tie in with my theory.

He ran through the results of the recent MRI Pancreas scan. It showed that no further gallstones had made their way into my biliary duct and that there was slight thickening of the gallbladder wall. More worryingly varices had grown around the gallbladder. He explained that this was to be expected due to the blockage of my portal vein and the blood flow needing to find alternative routes. The presence of these veins would make potential surgery more hazardous.

They had discussed my case in their Multi Disciplinary Meeting at St.Thomas’ but there was no clear cut decision on whether surgery should go ahead. He wanted to further discuss my case at a meeting with his liver specialist colleagues at Kings College Hospital.

I explained that I wasn’t against surgery, per se, but whilst I was feeling fit and generally well I would rather postpone it until absolutely necessary. We went on to discuss the risks of waiting. The major one being a further blockage of the biliary duct which could lead to pancreatitis (serious).

He stated that in a “normal” patient, with no other complications, the usual treatment would be removal of the gallbladder by keyhole surgery. Because of my concurrent conditions and previous surgery it would not be possible to use keyhole techniques. The choices therefore were to operate now to prevent a problem in the future “that might never happen” or to postpone the decision and review again in 6 months time. He was minded to go with this second option and that was also my preference.

I asked if, in the meantime, there were any measures I should take such as the adoption of a special diet. He replied that this would be appropriate if I was overweight but that was clearly not the case. I also asked about whether I should be avoiding alcohol. He said that he didn’t see any need for this providing I did everything in moderation, after all “life is for living!”

He handed me a 6 month follow-up request form to hand into reception but said if I needed to see him sooner then not to hestitate to call their senior nurse co-ordinator who would make the necessary arrangements. With that the consultation was over. He shook my hand and said goodbye

I left St.Thomas’ at exactly 1:00pm. Big Ben was chiming the hour as I made my way towards Westminster Bridge. 35 minutes later I arrived at my meeting which proved fascinating and enlightening.

When I thought back to my appointment I realised there were a number of questions that I had intended to ask. I will put them in an email to the co-ordinator :

How long is the waiting time for elective surgery?

How long is likely recovery/recuperation time from open surgery?

Please could I have a copy of the MRI Pancreas scan report?

Was the appointment that had recently come through from the Haemophilia Unit as a result of the Multi Disciplinary Meeting?

Next visit to St.Thomas’ – 19th December 2017 for my pre-Christmas esophageal varices check up. This will be my tenth endoscopy since late 2012. The taste of the burnt banana spray doesn’t get any easier to bear