12th April 2005
Dr Wilson White
Nambour Medical Centre
PO Box 746
Dear Wilson,
Re:       Mrs June Jones
      D.O.B 08/01/1976  
Thank you for asking me to see June again regarding her gallstones.  As you know she had an episode of cholangitis around the time of her recent delivery and caesarean section in December.  Ultrasound suggested dilated biliary tree and Thomas Anderson was kind enough to perform an ERCP and release several stones from the distal common bile duct.  
Since this time June has been generally well.  She has had one episode last week where she had a similar episode of back pain which lasted 24 hours but has subsequently resolved.  This was not associated with dark urine and not associated with fevers.  
I have had long discussions with June and her husband Cipher today.  I have explained to her that she does have approximately 1% per annum of having further serious problems associated with her gallstones.  Whilst these risks are small per annum, at her age there is a highly likelihood that she will have problems at some point.  I have also explained that long term there is a small risk of carcinoma of the gallbladder associated with the presence of stones in the longer term.  
It is a difficult decision for June to commit to surgery for her gallbladder and I have not forced her hand at this point.  I am however optimistic that she will agree to cholecystectomy eventually.  Kind regards
Yours sincerely,
Dr. J Andrews MBBS, FRACS
Cc        Dr Thomas Anderson