Gastroscopy

 I read Adam Kay's book "This is Going to Hurt" a year or so ago. I thoroughly enjoyed it and laughed along with the various hilarious tales of stupid things people had done and stupid places people had put stupid things. By contrast the recently released BBC series of the book survived about 15 minutes before I had to turn it off. I'm sure it's excellent but there was a foot and I didn't like it and it turns out that I can read about icky medical things but I really don't want to see them. Along with the comedic tales, the book also has some more poignant moments. It was one such moment that made me pause and take a breath. A patient that he is reviewing in hospital begins coughing up large amounts of blood, his registrar diagnoses oesophageal varices but by the time they have managed to get a tube into the patient's throat, the patient has died. 

The reason this story got to me (other than just because it was generally horrific) is that I have oesophageal varices too. If you want more information about oesophageal varices you can try this website and see if they have any information about them- www.google.co.uk. Mine were picked up on around the time of my first transplant assessment back in Sep 2019 and I've been taking tablets for them ever since. They are found and monitored courtesy of a gastroscopy which, as a procedure, is 9th on my list of "Favourite Liver Disease Monitoring Techniques". The list in full:-

1. Ultrasound. Ultrasounds are great. It's basically a 20-30 minute lie down in a quiet, dark room. Someone pushes the thing around your torso and there's a little bit of jelly on the belly but that wipes off easily and then you're good to go. No pain involved.
2. Urine sample. This is simple. It's like one of those maths puzzles where you have to get the liquid from the 400ml container (bladder) to the 30ml container (sample pot) without getting too much on your hands and clothes. Also no pain.
3. Stool sample. Very similar to a urine sample but much trickier. You can't really see what you're doing (which I guess you wouldn't want to but it makes it challenging) and you're now dealing with a solid with dimensions a good amount larger than the sample tube. Still no pain involved unless you've got it really wrong.
4. Fibroscan. Very quick (only about a minute's lie down) and you get the scanner poked in to your ribs. Bit of a non event.
5. CT Scan. Another one where you get a decent lie down but slight pain as they have to put a canula in to administer the contrast to improve the images. When the contrast is injected it makes you feel like you have wet yourself even though you haven't which is a super, fun experience.
6. MRI scan. More lying down but this time there is no chance of getting any sleep because the machine is so noisy. Someone once mixed all of Skrillex's songs together and that's not far from the sound of an MRI scanner. Again canula insertion is the only pain involved.
7. Blood test. "Sharp scratch" is as bad as this gets. It requires a level of trust that they know how much blood to leave you with. Would be higher on the list but you don't get to lie down.
8. Colonoscopy. I'm sure I'll cover colonoscopy in more detail in the future but negative headlines would be the bowel prep and the fact that someone is feeding a hose with a camera on it through you. Cold squash and a biscuit afterwards are not sufficient reward for this heinous violation of my personal space. It amazes me that some people choose not to have sedation for this.
9. Gastroscopy. Like a colonoscopy but you start at the other end of the patient. Worse than a colonoscopy in my book because I hate having the scope down my throat- I can get by for a number of hours without using my backside but I breathe all the time so please don't block my airways with your big, fat gastroscope.
10. Endoscopic retrograde cholangiopancreatography (ERCP). This is basically a Gastroscopy extra. Down the throat then keep going until they send a smaller camera in to the bile ducts themselves. General anaesthetic required and I had a good amount of throat and shoulder pain afterwards.
11. Liver biopsy. The absolute worst. Local anaesthetic first and then a needle through the ribs in to the liver for some more anaesthetic. And finally we send in Mr Big Needle and he takes a hefty bite out of your liver. Afterwards you have to lie on your side for 6 hours to apply pressure to the wound and stop it bleeding/the rest of your liver falling out. Would not recommend.

At the moment I am having monthly gastroscopies so they can check my varices and band them (the Dr puts elastic bands round the varices to stop them bleeding and, as we saw above, varices bleeding is nonoptimal). Nothing overly exciting to report from these but I do have a new best friend and their name is Midazolam. Midazolam is given before colonoscopies and gastroscopies and it makes you sleepy, less anxious and stops you forming new memories (according to Wikipedia). Technically, Midazolam and I go back many years to my first colonoscopy in 2006 but I realised how important they were to me recently after a couple of scopes where I was quite agitated and had good memories of the procedure. I now speciifally ask the Dr to give me lots of sedation and I think the last Dr got it spot on as I not only have no memories of the procedure, I also can't recall the post-procedure urine sample I gave or the chest x-ray I had done or leaving the hospital or the shopping I did at Tesco!

Anyway, the various tests and procdeures listed above remind me that I am getting excellent medical care in all of this and I'm hugely grateful to the NHS. I've been on the trasnplant waiting list for 2 months today and my PSC symptoms fluctuate up and down but I've been really pleased to have had a good run for the last month. I was able to enjoy some time off work with my family over Easter without any great fatigue issues which was a huge blessing.

Oh and for anyone who is concerned about how "Operation Pack a Bag for Hospital" is going, I have bad news. A laundry emergency meant I have had to take the 2 pairs of pants back out of my hospital bag and my daughter wanted to do some puzzles so they puzzle book has come out too. I will absolutely get this bag packed but sadly I have not hit my (revised) target of under 2 months.