Wednesday Morning

The Crowne Plaza thing was strange, I arrived early and met Janine (I think) an acting practice manager from Birkenhead. We were then joined by Ron Bob and Paul from Hammy House. The lunch looked mediocre, sort of hot buffet, I surprised myself by assertively asking for liquidised soup. It was produced and drank about half of it. Had a good natter with Bob, poor Janine must have been bored solid.The presentation was very slick it was by a company called Cerner. Basically they want all the hospitals and GP's to have the same system and thus accomplish shared records with a stroke. Seemed very good but the culture change required overawed me. I also had nightmares about the size of GP's inboxes after the change. Even if we said yes tomorrow then it would take 33 months to implement so not an immediate worry. The interesting bit is how we get from here to there. The presentation team was international and the schmooze was flowing.
I got home around five - exhausted. We were in such a rush that Jean went to the chipshop, I had four chips and some chicken foo yung. They were delicious and I didn't barf. A quick visit to the mother in laws preceded my visit to the out patients at Aintree to see Mr Kerrigan.
I arrived at ten to eight (appt at 8), the 7.30 had DNA'd. Got weighed only about 300g difference from the gym scales. Got into see him at 8.15. Took him some pictures of me to put in my case notes and showed him my exercise routine (a printout not the real thing). He was made up with the weight loss and gym progress. We had a long talk about the vomiting and what to do. The fact it has subsided in the last four days has persuaded me to do nothing but he imparted some good information and practical advice. The opening from my new pouch is 1.4cm diameter, and we talked about food likely to block it, chicken, steak, broccoli. We also talked about when it gets blocked you get vomiting, which if frequent can lead to the "ring" becoming oedematous and you barfing even fluids. Which looking back has happened a couple of times he said the trick is to rest the pouch by taking fluids to maintain hydration, but resting the pouch. So 5mls of water every 10 minutes for 2 days followed by two days of clear fluids, then 2 days post op diet and something else giving your belly a rest for a week. (I'll have to check the details with Jean) . Seems practical but totally undesirable. The other options he offered were a barium swallow and gastroscopy to assess if the outlet had become too small, and leading to dilatation with a balloon if this was the case. Given the last four days we agreed that - I would continue as is, use the 5ml regime if things went bad again and contact his secretary Lorraine for fast tracking for swallow and scope. Seems a good plan to me and I always feel better with a plan and a way out if it goes wrong. He has read the blog a few times and said it opened his eyes to what a bad time people could have. He is still keen to press on with the website for patient information which I said I would help him develop.. He took blood for the usual things plus magnesium, zinc, fat soluble vitamins and will let me know if we need to to do anything. Blood was difficult to get and he ended up doing it. It turns out I used to work with his wife many moons ago when I was a charge nurse in Psychiatry at the Royal - small world. I left at 9.25 feeling heaps better - so did Jean, but Ally who was waiting outside was not best pleased.