Dr Hall has a holistic, physician style approach to patients. The initial consultation involves a thorough review of the concerns and symptoms of the patient. A complete review of the medical history and detailed review of lifestyle factors including diet, stress levels and exercise patterns is undertaken. A plan for any investigation and the management of the symptoms is formulated with the patient’s needs in mind. The patient’s GP has often already arranged less involved screening tests and some treatments will have been tried. It is important to bring any previous scans and blood test results to the initial appointment. Further investigation with Dr Hall would often involve gastroscopy or colonoscopy but could include CT scan, ultra sound and more specialised blood tests.
Gastroscopy (also termed “Endoscopy”) is a half day procedure at a local private or public hospital. It is performed under a light general anaesthetic given by a specialist anaesthetist. There is usually no experience or memory of the test and it is very low risk. Gastroscopy is used to investigate upper abdominal symptoms such as pain, bloating, fullness and anaemia. If a cause isn’t found, Dr Hall may arrange further investigation for example a CT scan, to look at structures not shown during gastroscopy to image the liver and pancreas.
Colonoscopy is a half day procedure at a local public or private hospital. It is performed under a light general anaesthetic given by a specialist anaesthetist. There is usually no experience of the test and it is very low risk. Colonoscopy is used to investigate abdominal symptoms such as pain, constipation or diarrhoea, and bleeding from the bowel. It is also used as surveillance for bowel cancer and the precursor bowel polyps in patients at risk; such as in those with a family history of bowel cancer or people over 50 years old.
Preparation for colonoscopy
The bowel needs to be fully empty so the lining can be examined. This involves day 3 and 2 before the test not consuming seeds or nuts (including wholemeal or multigrain bread). The day before the test the patient can only have clear fluids such as water, mineral water, sports drinks, cordial, soft drinks, juices (apple,grape) jellies and clear soups. As close as possible to the time of the test, a “bowel prep” is taken-the two halves are taken 6-8 hours apart. This is a very salty solution and larger volume-1500ml. Having the solution ice cold, drinking it through a straw and with extra sweet flavouring such as cordials can help. There are smaller volume/less salty preparations which can be discussed with Dr Hall.
Pillcam (or capsule endoscopy) is a test to investigate the possibility of small intestinal disorders. It is used when standard endoscopy with gastroscopy and colonoscopy haven’t revealed an explanation for anaemia, bleeding, abdominal pain or diarrhoea. The test is done as an office procedure and doesn’t require sedation. Although the PIllcam seems large almost all patients can easily swallow it. The Pillcam transmits pictures to an over the shoulder recorder, which is worn for the rest of the day. These images are then loaded onto a computer and reviewed. The Pillcam doesn’t need to be retrieved and is flushed out to sea! There is a “mini” bowel prep the night before. Medicare has specific criteria for funding, otherwise the cost is covered by the patient.
After gastroscopy or colonoscopy
You won’t be able to drive for 24 hours following the anaesthetic and therefore you will need to make arrangements for a friend or family to pick you up and it is requested that you be with someone for those 24 hours in case of unexpected events following the procedure. Although adverse events are rare, early recognition is important. Dr Hall will discuss the results of the test with you and family following the procedure, a written report is given and any later available results are usually sent be email or post. Following the anaesthetic, to discuss further your memory might not be clear. If this is the case, it is encouraged that you make a further appointment with Dr Hall or your GP.
A common symptom is “dysphagia” or the sensation of food getting stuck on the way down. This is an uncomfortable and distressing symptom and has a number of possible causes. These include reflux oesophagitis and food allergies. At the time of the gastroscopy to investigate the oesophagus, plastic dilators can be introduced to widen the oesophagus, which is frequently very helpful. Dr Hall will discuss the aspects of this procedure at the initial consultation.
Haemorrhoids rubber band ligation
Haemorrhoids and dilated blood vessels around or within the anus can swell or breakdown leading to bright red rectal bleeding, anal pain or itch. Simple measures such as increasing fibre and water intake, and ointments can be helpful. Usually a colonoscopy is necessary to identify other possible causes of these symptoms. If there are persistent haemorrhoidal symptoms, Dr Hall can arrange further treatment with rubber band ligation done at the time of the colonoscopy. This is effective in approximately 80% of patients.
Anal fissure Botox injection
Anal fissure is a split in the lining of the anus which leads to marked pain when passing motion, often associated with bright red rectal bleeding. Simple measures such as increasing fibre and water intake, and ointments can be helpful. Usually a colonoscopy is necessary to identify other possible causes of these symptoms. If there are persistent anal fissure symptoms, Dr Hall can arrange further treatment with Botox injection to the anal muscle which is in spasm in patients with anal fissure. Botox is approximately 80% effective for anal fissure and minimises the risk of long term continence issues associated with surgical treatment.