31 December 2009 – First Causes (Cancer and Me 4)
Much of the detail of those days in hospital is now hazy in my memory. I remember meeting one of Basingstoke hospital’s most well-respected consultants, Mr Rees, and his surgical team. His colleague, Miss Welch, reminded me of Connie from Holby City and Casualty.
Within a few days they had confirmed that I had pancreatitis and jaundice. They explained to me that these two conditions are caused when the bile duct, which allows bile to flow from both the liver and the pancreas into the duodenum (digestive tract just below the stomach), gets blocked. When that happens yellow bile then builds up, which causes jaundice, and pancreatic fluids flow back to the pancreas and cause pancreatitis.
At that stage, they had done an ultrasound scan which was to check for the second most common cause of pancreatitis, which is gall stones. The most common cause of the condition is alcoholism, but since I have never been a heavy drinker they ruled that out straight away. Gallstones can cause this apparently because the gall bladder in also connected to the same bile duct, and if the gall bladder produces little crystals called gallstones then sometimes they get stuck and block the duct. Well, they couldn’t see any of those.
That didn’t phase the doctors though. For one thing, it is possible apparently that some of the gallstones could have been so small as to be invisible on the ultrasound. I thought that unlikely, to be honest! For another, it didn’t really matter what caused the blockage, since they had a way of unblocking the duct!
That solution was a procedure they called an ERCP. It’s a type of endoscopy where not only do they thread a small camera down your throat into your stomach, but at the same time they can insert a stent (a tiny plastic sleeve) into the bile duct in order to let the fluids start flowing again.
I was told that the procedure would be painless. I would be sedated. Apparently most patients don’t even remember going through it due to the sedation.
Well, for me it was different. The sedation did knock me out for a short time, and then I can remember with great clarity the great big tube going down my throat into my very sore gut. And I can remember it being pulled around, going up and down, while I gagged and cried in pain with tears streaming down my face (although I think I had my eyes closed). I couldn’t understand why they didn’t slow down when they heard me crying out (in a muffled way obviously, as I had a tube down by throat!). I reasoned that perhaps they thought my noises were simply reflex sounds and were not conscious. But I found the whole thing pretty traumatic, and my whole gut ached for days afterwards.
I was then monitored with daily blood tests and told to stay on a ‘low fat, low residue’ diet. It had to be low fat, because they thought I had gallstones, and fat stimulates the gallbladder. And it had to be low residue (or low fibre) because my gut was still quite tender and so it needed a bit of rest from trying to push stuff through!
As my jaundice drained away and my blood results headed back towards normal, the doctors started talking about having to remove the stent with another ERCP a few weeks later, and about how they would probably recommend a gall bladder removal operation. And in terms of my hospital stay they said that I could go home once they were confident that I was keeping my food down and returning to normality.