Mick - Update and Timeline

 Friday 26/01/24

Blood taken – Full Blood Count, Haemoglobin A1c, Serum Ferritin, Vitamin B12.  Liver function tests, Lipids, Thyroid Function Test, Prostate-Specific Antigen, Bone Profile, Renal profile.

 Wednesday 31/01/24

Blood results show severe anaemia with haemoglobin of 57g/L (normal 130-170)  Go straight to nearest A&E as may require blood transfusion.

 Thursday 1/02/24

Visited A&E and admission requested with following Clinical Summary

Presented to SDEC referred by gastroenterologist for admission and under investigation by gastroenterology for anaemia and weight loss.

Weakness, lethargy, poor appetite and tiredness.  One episode of melena 2 days ago.

Given 2 units of blood and post transfusion Hb was 73 and then received 1 gm iron transfusion also.

OGD was on 3/02/24 which revealed:  Malignant tumour in distal oesophagus and GOJ junction bleeding ulcerated several biopsy’s taken.

Recommendation:  Urgent CT CAP (requested) upper GI MDM referral (given)

After OGD on the same day patient was unable to pass urine and catherterization was done.

Patient has been reviewed by the consultant and declared medically optimised for discharge.

 Plan on discharge:

-          Continue regular medications

-          - Omeprazole 40 mg BD

-          - TWOC clinic referral for catheter removal

-          - Upper GI MDM referral (done on 3.2.34)

-          - CT CAP (requested on 3.2.24)

 Friday 9/02/24

CT Scan Medway Hospital.

 Wednesday 14/02/24 – Vascular Dept, Kent & County Hospitals (at Medway)

Results of camera and scan.

Malignant Oesophagus Tumour confirmed – lower part of the food pipe.

CT scan shows that it is NOT early stage and that it had already breached the walls and was therefore NOT OPERABLE.

Some treatment may be available such as chemo and/or radio but before that a PET scan was needed to be undertaken at Maidstone and then to wait for result before deciding on any treatment.  However any treatment would be to extend the timescale to up to 2 years rather than none.

There was also fluid showing in the stomach and they were not sure yet what it was.

Diagnosis:

Cancer of oesophageal gastric junction, provisional stage T3N0M0

Osteoarthritis

Current medication:  Omeprazole.

 Investigations:

PET scan

Ultrasound guided ascetic tap.

Multi-disciplinary team reviewed the CT images and there were a few indeterminate lung nodules and an incidental finding of large infra-renal aortic aneurism, ascites and left side pleural effusion.  Surgery is not an option.

 Thursday 15/02/24

Phone call regarding shakes to be given on prescription as unable to eat anything other than soft food.

 Phone call from District nurses re delivery of catheters etc for next change (7^th May).

 Phone call from Aids helpers – did we need any aids.  Mick said I was his carer and could get him in and out of bed without aids.

 Friday 16/02/24 Vascular Dept.

Confirmation that within the stomach there is an Abdominal aortic aneurysm The left artery aorta goes to the belly button and joins the arteries.  This aneurysm is 5.5cm and usually requires major surgery.  The wall of the artery is weakened and was probably hereditary and had been growing slowly for years.  The risk of rupture up to 6cm was very small and it was best to wait for outcome of PET scan.  However Mick was very frail and surgery may not be possible.