Wednesday, 12 November 2014

Crohn's Disease - DIARY - Endoscopy

This is the 8th endoscopy/banding session since June 2012. You'd think by now I'd be an old hand at it. Of all the tests/procedures I've undergone I'd stick this high on the list of unpleasantness.

Monday 10th November 2014 - Endoscopy Day

All my previous appointments had been early morning affairs but this one was set for the afternoon - 2:00pm. We arrived at St.Thomas' 30 minutes early, after a short walk up from Waterloo Station. The new Endoscopy Suite is on the first floor, with the waiting area overlooking the Houses of Parliament.
Arriving at St.Thomas' Endoscopy Suite
I booked in and we'd only been sitting there for a few minutes when I was called in by a nurse to run through the pre-procedure checklist -

Have you got someone with you to escort you home? Yes, my wife
Do you know what is involved in this procedure? Yes, I've had it before
When did you last eat or drink?  7 o'clock this morning
What medications are you on? Omeprazole, Propanolol, Loperamide
Are you having sedation? Yes

Answering "Yes" to the last question meant needing a cannula. The nurse chose a good vein and it was inserted without any fuss. She explained that there was one other patient ahead of me but they were having both an endoscopy and colonoscopy in one go and it would be quite a lengthy procedure. I said that I hoped the two cameras didn't meet, which I thought was quite amusing, but she replied that they are done separately and I just looked stupid. That will teach me to try and be funny.
I was shown to the waiting room and my wife was told to come back and get me in 2 hours time. She wandered off up Whitehall to the National Gallery to see some of her favourite paintings.
The Cenotaph in readiness for Remembrance Day
Back in the waiting room another nurse appeared to explain what was causing the delay to my procedure and that I would be seen shortly. He described the patient ahead of me as being "topped and tailed". He asked if I had seen a doctor yet to which I replied "No". After another few minutes the doctor duly arrived and briefly ran through the risks before asking me to sign the consent form. One thing he said, which I hadn't been told before, was that the risk of the varices bleeding was at its greatest around a week after the procedure at which point the banded section should have formed scabs.

I was then lead into the Procedure Room where three nurses were waiting and I lay down on the bed. I explained that I had one request - "please don't put the gag in until I'm about to go under". One of the nurses, who was looking at me in a strange way, asked "what gag?" I explained is was the green, plastic object which goes between your teeth to protect them and stop you biting the endoscope. "Oh the mouthguard. When you said gag... well let's not go there!"

Time for the Xylocaine spray - a local anaesthetic that tastes of burnt bananas and deadens the back of the throat.  This was the bit I was dreading as just the thought of the spray makes me want to retch. It wasn't too bad! Next the oxygen supply was positioned under my nose and I was asked to roll onto my left side.

Now the bit I was looking forward to - sedation. The doctor injected two syringes of Midazolam and Fentanyl. One of the nurses was stroking my head, telling me to concentrate on my breathing to visualise something pleasant. At this point I expected to slip away into temporary darkness....

For previous procedures I have been put out cold and then woken up in Recovery. This time I was aware of what was going on and must have been awake, although very drowsy. I managed to take a photo of the endoscope but don't remember doing it! Sad on both counts.
I spent a while in Recovery and then walked round to another waiting area where my wife joined me. A nurse removed my cannula and gave me a copy of the Endoscpy Report. They had found two large varices which had been banded. Bad news as I was hoping they had not grown any worse since last year. Worse news - I need a further procedure in 4 weeks time to see how successful this banding session was.
Endoscopy Report - but no pictures taken
We made our way back to the train station and then had a lift home. I spent most of the evening asleep. I don't know why I feel so weak this time. The whole procedure has hit me for six. I was pleased with the advice not to go to work the following day but extended it a further day as I really didn't feel up to traveling up to London to work.

It's left me wondering if the varices will continue to grow at their current pace and that the time between procedures is going to get less and less. A question for the doctor in 4 weeks time

Tuesday, 11 November 2014

Crohn's Disease - DIARY - Ultrasound

For those IBD sufferers reading this post I have a question - what's the first thing you do when waking up in the morning? Within the first few seconds is how well behaved does my digestive system feels today? From that I can work out how long I have for breakfast, how long in the bathroom and whether I'm OK to venture out onto public transport for the commute to work.

Tuesday 4th November 2014 - Ultrasound Day

In a previous post I mentioned that, a few weeks ago, I had suddenly experienced a very severe pain in my lower back. Only on the left side and bad enough to concern me. I mentioned it to my consultant when I saw him recently and he booked me in for an ultrasound scan. Today was the day.

Knowing I would be leaving work at lunchtime it only seemed fair to make the effort to get in early and make up some of the time. My waking assessment was - digestive system OK but probably wouldn't want to get delayed en route. With a little bit of effort I managed to catch the 5:40 train to London.

We made it to just outside the little, urban hamlet of Norbury and by then the train was traveling very slowly. As we pulled into the station we came to a halt. The guard announced that there was a track problem ahead and he didn't know how long we would be waiting there. I immediately felt something stir in my guts. This was crazy as I was OK until the announcement but there seems little I can do to break this reaction. I tried analysing my reaction, looking at the situation rationally but that "what if I need to get to the bathroom quickly" thought overrode everything. Whilst I was still contemplating this question and formulating a plan, the guard announced that the train would be going no further and that we should all disembark, making our way to another platform.

That was enough to distract me and we slowly made our way to the new platform. Amazingly another London bound train arrived, with empty seats and the journey continued uneventfully, I've read a number of accounts recently of Crohn's sufferers having "accidents" whilst out in public and this non-incident with the train brought home just how easy it would have been for a normal day to transform into a very confidence destroying experience. The Joy of Crohn's.......
One of my regular views on the way to work Waterloo Bridge looking NE
The instructions that came with the Ultrasound letter said drink 1 to 2 pints of water at least one hour before your appointment (2:00 pm) and arrive at the Hospital with a full bladder. Have you tried this? For the last scan, back in 2008 at East Surrey Hospital, I had been asked to arrive 1 hour early and drink 2 jugs of water there. Probably a better idea really.

Anyway, I kept drinking water from mid-morning onwards and tried to retain as much as I could. I set of on the 45 minute walk to Guy's Hospital on the basis that it would keep my mind off of my bladder. The gloomy morning had turned into a beautiful day and I made sure my route took me past St.Paul's Cathedral. So far so good. Plenty of distractions.
St.Paul's Cathedral facade
By the time I had crossed London Bridge and was approaching Guy's I was getting desperate. Full bladder + 45 minute walk may not have been such a good idea.
Guy's Hospital nestling behind The Shard
I found my way up to the 2nd Floor Ultrasound Dept. and told to take a seat in the waiting area. I felt I was going to burst so asked one of the nurses if a full bladder was really necessary for a kidney scan. She replied that it was and the doctor had just arrived so would see me shortly. If I went off to the bathroom I would then need to drink more water and wait another 30 minutes. She said that walking up and down the corridor might help. Shortly afterwards I heard her explain to the doctor that I was desperate.

He called me in and said "I'll scan your bladder first - should take 30 seconds - and then you can go to the bathroom". He did scan my bladder and complimented me on how much I had managed to hold in. Time to let it out. A huge relief.

The scan continued around my abdomen. My consultant had told me to ask about ascites (accumulation of fluid in the peritoneal cavity) so the search went a little further up. A couple of minutes later the procedure was over and the doctor revealed what he had found......"Nothing, apart from one gallstone". Half of me was relieved; the other half was disappointed that no kidney stones had shown up. It left the question of what had caused the original pain unanswered together with the bloating issue. More questions for my next GI appointment.
Ultrasound machine
As I was about to leave the scanner room I asked if I could take a picture of the machine to illustrate this blog. He very kindly called up the screen showing multiple scans and commented that he liked patients that took an active interest in their treatment.

Next stop - St.Thomas', 10th November, Endoscopy.......