The specialist GI Specialist visited

He drew pictures of the stents and what he did for ERCP #2. There are multiple messages.

1. Mary is not supposed to be a hero and tough it out. She should ask for pain medicine when she feels pain.
2. The two stents, one for the left duct and one for the right duct are large enough that the constricted bile duct is being stretched dramatically. That stretching is causing this immediate pain. He said the first stent went through the constriction fairly easily. The second required a lot of effort and it cause Mary to react even under anesthesia so they had to hold her down.
3. The biopsy material from the constriction taken yesterday may or may not be enough for the pathologist to get a reading. If the reading is inconclusive, then its off to Stanford and their more advanced equipment & techniques.
4. The nature of this constriction is that it has a tough top layer which is meaningless for the biopsy. The sample needs to reach under the top layer without damaging the wall of the duct. Think of a creme brulee with a really thin custard in a bowl made of paper. The technique he has available can only determine there is sugar present. He cannot reach the underlying custard without risk of popping a hole in the paper. At Stanford, there is a technique that would get a good sample of the custard without risking perforating the paper bowl. (My interpretation of his description but he agreed--sort of--and didn't roll his eyes too much.)
5. He was also surprised to find the fluid he used on Monday to highlight the gallbladder for the ERCP was still visible in the GB for Wednesday's ERCP. A normal GB should have purged that out in less than 48 hours. GB's are known to cause pain when not functioning correctly. Bile ducts do not cause pain signals in the body. So, it may be we still haven't found the source of the original pain. But looking for it caused the docs find this constriction which is a bad thing to have and its good to find and fix early!
6. The objective now is to keep Mary comfortable while the body adjusts to the presence of the stents and re-initiates the flow of bile.

In addition, Mary went almost three hours before asking for another does of pain meds. At the end of the period when the meds had worn off, she said her maximum pain was down to about a 6 on a scale to 10. Earlier today is was a clear 9 or 10 out of ten. The doc was not surprised by the pain nor by the rate of things being less painful.

The brought a food tray and Mary ate a few spoonfuls of jello and a few sips of tea. Then she took her pain med shot and has now fallen asleep again.

That is all for now!

Pat