What Happens During an ERCP: From Sedation to Clearing a Blocked Bile Duct

The whites of your eyes turned yellow on a Tuesday. By Thursday the itching kept you awake, your urine had darkened to the color of strong tea, and a scan had found a stone lodged where bile leaves the liver. Now a gastroenterologist is standing at the foot of the bed, using a word you have never heard before: ERCP.

Most people in that moment want one thing, which is a plain account of what happens during ERCP, from the first sedative to the moment the blockage is cleared. Not the acronym unpacked, and not a glossy reassurance. A walk-through.

This explainer follows the procedure in the order you will experience it: preparation, sedation, the path the scope takes, the tools that remove stones or hold a duct open, and the hours and days afterward. Along the way it weighs the real risks, corrects the common myths, and sets out the signs that should prompt a phone call to your team.

What happens during ERCP, step by step

ERCP stands for endoscopic retrograde cholangiopancreatography: a procedure that combines a flexible camera scope with X-ray imaging to examine and treat the ducts that drain the liver, gallbladder and pancreas. The name is long; the sequence is fairly simple.

You arrive having fasted, change into a gown, and a nurse places a small intravenous line in your arm. Monitors track your heart rhythm, blood pressure and oxygen level throughout. Most people lie on their left side or, more often for ERCP, on their stomach with the head turned, because that position gives the clearest X-ray view of the ducts.

Sedative medicine goes in through the line. Within a minute or two you feel heavy and distant, and many people remember nothing after this point. A soft mouth guard protects your teeth and the scope.

The endoscopist passes the scope through the mouth, down the esophagus, through the stomach and into the duodenum, the first part of the small intestine. There, on the inner wall, sits a small nipple-like opening called the papilla, where the bile duct and pancreatic duct empty. ERCP uses a side-viewing scope, so the camera looks sideways at the papilla rather than straight ahead.

A fine catheter, often with a soft wire inside it, is threaded through the papilla into the bile duct. Contrast dye is injected and live X-ray pictures, called fluoroscopy, light up the duct like a road map, showing stones, narrowings or leaks. Treatment follows in the same sitting: a small cut to widen the opening, a balloon or basket to pull stones out, a stent to hold a narrowed duct open.

Finally the scope is withdrawn, you are wheeled to recovery, and the sedation slowly lifts. Everything described in the sections below is a closer look at one of these steps.

Why the bile duct matters, and how it gets blocked

Think of bile as the body’s dish soap. The liver makes it continuously, the gallbladder stores and concentrates it, and after a meal it squirts down the common bile duct into the intestine to break up fat. The pancreas sends its digestive juices down a separate duct that usually joins the bile duct just before the papilla, so the two systems share a single exit.

That shared exit is where trouble concentrates. If a gallstone slips out of the gallbladder and wedges in the common bile duct, bile backs up into the liver and spills into the blood, which is why skin and eyes turn yellow (jaundice), urine darkens and stools turn pale. Stagnant bile is also a breeding ground for bacteria; infection of the blocked duct, called cholangitis, can cause fever, shaking chills and low blood pressure and is treated as an emergency. A stone at the papilla can block the pancreatic duct too, triggering gallstone pancreatitis.

Stones are the most common reason for ERCP, but not the only one. Scar tissue can narrow a duct after surgery or long-standing inflammation. Tumors of the pancreas, bile duct or papilla can squeeze the duct from outside or grow within it. A bile leak occasionally follows gallbladder removal. Some conditions of the pancreatic duct, such as stones or strictures in chronic pancreatitis, are also approached this way.

Why not simply operate? Reaching the bile duct surgically means an incision through the abdominal wall and a longer recovery. ERCP reaches the same spot from the inside, through the body’s own openings, which is why it became the standard approach for clearing duct stones and relieving obstruction, as the NIH and Mayo Clinic describe.

Who ERCP is usually for, and who is usually asked to wait

Modern ERCP is a treatment first and a diagnostic test second. That distinction shapes who gets one.

The people most likely to be offered ERCP have a problem that the procedure can fix in the same sitting: a stone already seen in the bile duct on ultrasound, CT or MRI; cholangitis, where draining infected bile quickly matters; jaundice caused by a narrowing that needs a stent; a bile leak after surgery; or certain pancreatic duct problems. In someone with gallstone pancreatitis, guideline groups reserve urgent ERCP for those who also have cholangitis or a persistently blocked duct, rather than performing it in every case.

Others are asked to wait, or are steered toward a different test. When it is uncertain whether a stone is present, clinicians increasingly use MRCP, which is an MRI scan of the ducts without any scope or contrast injection, or endoscopic ultrasound, where an ultrasound probe on a scope looks at the duct from inside the stomach. Both find stones reliably without carrying ERCP’s risk of pancreatitis. If they show a clear duct, ERCP is avoided altogether.

Some situations call for extra planning rather than cancellation. Anticoagulant or antiplatelet medicines may need to be adjusted before a sphincterotomy, a decision that belongs to the prescribing clinician, never the patient alone. Pregnancy changes how fluoroscopy is used and shielded, and how the timing is judged against the risk of leaving an infected duct in place. Previous stomach or intestinal surgery can alter the route to the papilla and may mean a specialist center or a different scope.

Very unstable patients are sometimes stabilized first, or drained through the skin by an interventional radiologist instead. None of these are rules a reader can apply at home; they are the factors your treating team weighs.

How to prepare for an ERCP

Preparation is mostly about safety under sedation and clear X-ray pictures, and the team will give you written instructions specific to your case. The broad strokes are consistent across major centers.

Fasting comes first. The NIH’s National Institute of Diabetes and Digestive and Kidney Diseases advises no food, drink, smoking or gum for about eight hours before ERCP, so that the stomach is empty and the risk of inhaling stomach contents during sedation is minimized. If you are already admitted with jaundice or infection, nurses will manage this for you and keep you hydrated through a drip.

Your medicine list gets a careful review. Blood thinners and antiplatelet drugs matter because a sphincterotomy involves cutting tissue. Diabetes medicines matter because you will be fasting. Some people are asked to pause or adjust certain tablets, others are told to continue; the point is that the decision is made by the prescribing clinician who knows why you take them. Stopping a blood thinner on your own can be more dangerous than the procedure.

Tell the team about every allergy, particularly any previous reaction to X-ray contrast dye, latex or sedatives, and mention any chance of pregnancy, lung or heart disease, sleep apnea, or previous problems with anesthesia.

Consent is a conversation, not a signature. You should hear what the procedure is for, what the team expects to find, the main risks, the alternatives, and what happens if the duct cannot be reached. Bring your questions written down; sedation tends to erase the ones you thought of at the last minute.

Practical details round it out: someone to take you home, no driving or work decisions for the rest of the day, dentures and jewelry removed, and loose clothing for afterward when you may feel bloated.

Is ERCP painful? What sedation actually feels like

People remember ERCP far less than they fear it. The procedure itself is designed to be painless, and for most patients it is.

Three levels of sedation are used, and your team chooses among them based on your health, the expected complexity, and local practice. Moderate sedation, sometimes called conscious sedation, uses intravenous medicines that make you drowsy, relaxed and largely unaware, though you may still respond to a voice. Deep sedation, usually given by an anesthesia professional, takes you further so that you are unresponsive but breathing on your own. General anesthesia, with a breathing tube, is reserved for longer or higher-risk cases, or for people who cannot lie still safely. Cleveland Clinic and Mayo Clinic both describe these options as routine.

What does it feel like? A warm heaviness spreading from the arm, the room softening at the edges, and then, for most, a blank until someone says your name in recovery. Some people recall a brief sensation of pressure or fullness as the scope passes; gagging is rare because the medicines suppress the reflex and the endoscopist advances the scope only once you are settled.

Afterward is where discomfort lives, and it is usually mild. Your throat may feel scratchy for a day or two, according to the NIH. Air or carbon dioxide used to inflate the intestine can leave you bloated and gassy for a few hours, and lying still on your stomach for an hour can make the neck or shoulders ache.

One kind of pain is not routine: deepening, persistent abdominal pain in the hours after ERCP, especially with nausea or vomiting. That pattern can signal pancreatitis, the topic of a later section, and it is exactly why recovery staff keep asking how your belly feels before letting you go.

What happens during ERCP to clear a blocked bile duct

Once the X-ray map shows where the stone sits, the endoscopist chooses from a small set of tools, all of which travel down the working channel of the scope.

The first is usually a sphincterotomy. The papilla is ringed by a muscle called the sphincter of Oddi that controls bile flow. A sphincterotome, a catheter with a fine exposed wire along its tip, is positioned in the opening and a brief electrical current cuts a few millimeters upward through the muscle. This widens the doorway so stones can pass and instruments can move freely. You feel nothing; the intestine has no pain sense for this kind of cut.

Next comes retrieval. A balloon catheter is advanced beyond the stone while deflated, inflated to the diameter of the duct, and drawn back toward the intestine, sweeping the stone ahead of it like a plunger clearing a pipe. Alternatively a wire basket is opened above the stone, closed around it and pulled out. Extracted stones drop into the intestine and leave with the stool, usually unnoticed.

Large or hard stones need extra steps. A mechanical lithotriptor is a reinforced basket that crushes the stone against a metal sheath so the fragments can be swept out. Balloon dilation stretches the opening further. In specialist centers a miniature scope can be passed into the duct itself, a technique called cholangioscopy, and the stone shattered with a laser or shock-wave probe under direct vision.

Sometimes the duct cannot be fully cleared in one session, because a stone is too large, the patient is unwell, or time under sedation is running long. The endoscopist then places a temporary stent so bile can drain past the remaining stone, and a second procedure is scheduled. That is a planned strategy, not a failure, and your team will explain it if it applies to you.

Stents, brushings and biopsies: when ERCP does more than remove stones

Not every blockage is a stone. When the duct is narrowed by scar tissue or a tumor, the aim shifts from removal to drainage, and the stent becomes the central tool.

A biliary stent is a small hollow tube, placed across the narrowing so bile flows through it. Plastic stents are inexpensive to make, easy to place and intended to be temporary; they gradually clog with bile sludge and are removed or exchanged at a later ERCP on a schedule your team sets. Metal stents are woven mesh cylinders that expand to a wider channel and stay open longer; they are often used when a tumor is causing the obstruction. Which type is chosen depends on the cause, the expected duration, and whether surgery is planned.

ERCP also gathers evidence. When a stricture looks suspicious, the endoscopist can pass a tiny brush along the narrowing to collect cells, or take small tissue samples with forceps, for a pathologist to examine. Fluid can be sent for culture if infection is suspected.

After gallbladder removal, a small leak sometimes develops from the duct stump. Placing a stent, with or without a sphincterotomy, lowers the pressure inside the duct so bile follows the path of least resistance into the intestine rather than into the abdomen, allowing the leak to seal.

Pancreatic duct work follows similar principles: stones in the pancreatic duct can be removed, narrowings stented, and fluid collections drained, though these are more specialized procedures.

One limit deserves stating plainly. ERCP treats the ducts; it does not remove the gallbladder. If stones came from a gallbladder that still contains more, most guidelines, including NHS advice on gallstones, describe gallbladder removal as a separate operation to consider afterward, on a timeline the surgical team decides.

How long does an ERCP take, start to finish?

The honest answer is that it depends on what the X-ray shows, but the range is well described. Mayo Clinic and the NIH put the procedure itself at roughly 30 minutes to two hours; a straightforward stone extraction sits toward the shorter end, while multiple large stones, a difficult papilla, a stent exchange with brushings, or cholangioscopy push toward the longer end.

Your day is longer than the procedure. Expect to arrive well before your slot for check-in, a nursing assessment, the intravenous line and the consent conversation. Afterward the NIH describes a recovery stay of about one to two hours while sedation wears off and staff check your vital signs, your swallowing and your abdomen. If you were already an inpatient because of jaundice or infection, you return to the ward and observation continues there.

Several things stretch the timeline without meaning anything has gone wrong. Reaching the bile duct opening, known as cannulation, can take patience when the papilla is small, angled or sitting in a pocket of the intestine. Previous surgery that rerouted the stomach adds distance. Bleeding after a sphincterotomy may need a few minutes of treatment with a clip or heat. A stone that will not budge may prompt the decision to place a stent and stop.

Going home the same day is common for planned outpatient ERCP once you are awake, tolerating sips, and free of concerning pain. Staying overnight is also common and is not a red flag: people who came in with cholangitis, who have other medical conditions, who had a complex intervention, or who live far away are often kept for observation. Ask the team beforehand which pattern they expect for you, and pack for the possibility of a night in.

ERCP procedure risks: what the evidence shows

ERCP carries more risk than a routine look-see gastroscopy, and honest counseling starts there. The NIH’s National Institute of Diabetes and Digestive and Kidney Diseases summarizes research finding that complications occur in about 5 to 10 percent of ERCP procedures. Most are mild and settle with observation; a small minority are serious. The table sets them out in neutral terms.

Complication	What it is	How the team watches for it
Post-ERCP pancreatitis	Inflammation of the pancreas from manipulation near its duct or contrast entering it; the most common complication	Abdominal pain and nausea in the hours after; blood tests; preventive measures during the procedure
Bleeding	Usually from the sphincterotomy cut; often minor and treated during the procedure	Black or bloody stool, vomiting blood, dizziness; blood thinner review beforehand
Infection (cholangitis)	Bacteria in a duct that is not fully drained	Fever, chills, worsening jaundice; drainage and antibiotics when needed
Perforation	A tear in the intestinal wall or duct; uncommon but the most serious	Severe pain, rigid abdomen, fever; imaging, and surgery in some cases
Sedation reactions	Breathing or blood pressure changes, allergic responses	Continuous monitoring; anesthesia support
Contrast reaction	Allergic response to X-ray dye; rare with duct injection	Allergy history taken beforehand

Two further points belong in the risk conversation. Fluoroscopy involves a small radiation dose, kept as low as possible and shielded where appropriate. And ERCP does not always succeed on the first attempt; cannulation can fail, and a repeat procedure or a different route may be needed. Your team can tell you how these general figures apply to your particular anatomy and health, which is a more useful number than any national average.

Is ERCP a serious procedure? The most common complication in perspective

Yes, it is a serious procedure, in the sense that it is a genuine intervention performed under sedation with a real, measurable complication rate. It is also one of the most established therapeutic endoscopy procedures in the world, done many thousands of times a year, and for a blocked or infected bile duct the danger of leaving the problem in place is usually greater than the danger of treating it. Both halves of that sentence are true, and good decisions hold them together.

The complication people most often experience is post-ERCP pancreatitis, named by Mayo Clinic, Cleveland Clinic and the NIH as the leading risk. The mechanism is mechanical and chemical: the pancreatic duct opens within a millimeter or two of the bile duct, and instruments, contrast dye, or swelling at the papilla can irritate it and briefly obstruct the flow of pancreatic juice. The pancreas then inflames. Symptoms typically begin within hours: a steady, boring pain in the upper abdomen that may spread to the back, with nausea or vomiting.

Most episodes are mild and are managed in hospital with intravenous fluids, pain control and a short rest from eating while the inflammation settles over a few days. A smaller number are severe and need longer care. Endoscopy teams use several measures to reduce the risk, in line with international endoscopy guidelines: minimizing attempts at the papilla, avoiding contrast in the pancreatic duct, placing a small temporary pancreatic stent in higher-risk cases, and giving an anti-inflammatory medicine of the NSAID class around the time of the procedure to blunt the inflammatory cascade. Whether any of these applies to you is a clinical judgment for your team.

The risk is also why ERCP is no longer used simply to look. When the question is only whether a stone is present, MRCP or endoscopic ultrasound answers it without touching the pancreas.

ERCP recovery time: the first hours, days and weeks

Recovery unfolds in three overlapping phases, and knowing the shape of each helps you tell ordinary from worrying.

The first hours belong to sedation. Expect to spend about one to two hours in a recovery area, as the NIH describes, drifting back to full alertness while nurses check blood pressure, oxygen and your abdomen. Bloating and burping are common as the gas used during the procedure escapes. You may feel wobbly and forgetful into the evening; this is why you should not drive, operate machinery, sign documents or care for a young child alone for the rest of the day.

The first day or two belong to the throat and stomach. A scratchy throat for one to two days is expected, per the NIH. Once your swallowing feels normal, most people are cleared for fluids and then a light diet, moving back to normal meals as comfort allows, though your team may hold food longer if they are watching for pancreatitis or if a further procedure is planned. Many people return to desk work the following day; heavier physical work depends on how you feel and any advice you were given.

The following weeks belong to the underlying problem. If jaundice was the trigger, skin and eye color fade gradually as the liver clears the backlog of bile pigment; itching often eases before the color does. If a plastic stent was placed, a date for its removal or exchange should be on your calendar before you leave, because forgotten stents clog and can cause infection. If gallstones were the cause and your gallbladder is still in place, a conversation about gallbladder surgery usually follows, on a timeline set by the surgical team. Blood tests may be repeated to confirm that liver readings are falling.

What people often get wrong about ERCP

Several misunderstandings surface again and again in clinic, and each one can lead to a worse decision or an unnecessary worry.

The first is that ERCP is a scan. It is not. It is a treatment that happens to use X-rays as a guide, and because it carries the risk of pancreatitis, guideline groups discourage using it purely to find out whether a stone exists. If you have been offered MRCP or endoscopic ultrasound instead, that is careful medicine, not a lesser option.

The second is that ERCP removes the gallbladder. It clears the ducts; the gallbladder stays, along with any stones inside it. Gallbladder removal is a separate surgical operation, and the two are often sequenced days or weeks apart.

The third is that ERCP is surgery. There are no incisions in the skin. The cut made during a sphincterotomy is inside the intestine, a few millimeters long, and heals on its own.

The fourth is that you will be awake and gagging throughout. Sedation, whether moderate, deep or general, is standard, and most people have no memory of the procedure.

The fifth is that pain afterward is simply part of the deal. Mild bloating and a sore throat are expected; deepening abdominal pain, fever or black stool are not, and they need a phone call.

The sixth is that stents are permanent. Plastic stents are temporary by design and must be removed or exchanged; leaving one in indefinitely invites blockage and infection.

The last is that a hospital stay means something went wrong. Overnight observation is routine for people who arrived with infection, had a complex procedure, or have other conditions. It reflects caution, not a complication.

Questions to ask your care team before an ERCP

Consent is your chance to shape the plan, and specific questions get specific answers. Write these down, bring them to the pre-procedure conversation, and ask a companion to take notes, because sedation will blur the details afterward.

• What exactly are you expecting to find, and what will you do about it during the procedure?
• Is a non-invasive test such as MRCP or endoscopic ultrasound an option for me first, and why or why not?
• What level of sedation do you plan, and who will be giving it?
• How long do you expect my procedure to take, and will I go home the same day or stay overnight?
• Which of my regular medicines should I take, pause or adjust, and who is making that decision?
• What steps will you take to lower my risk of pancreatitis?
• If the duct cannot be cleared in one session, what is the plan?
• If you place a stent, what kind, and when and how will it be removed or exchanged?
• Do I still need gallbladder surgery afterward, and who will arrange that conversation?
• What symptoms should make me call, and which number do I call at night or on a weekend?
• When will I get results from any biopsies or brushings, and from whom?
• What follow-up blood tests or appointments should I expect?

You are also entitled to ask how experienced the unit is with the specific intervention you need, and what alternatives exist if ERCP is not successful, such as drainage through the skin by an interventional radiologist or surgical exploration of the duct. None of these questions is confrontational; endoscopists answer them every day, and a team that welcomes them is telling you something reassuring about how it works.

Finally, ask what you personally can do to prepare well. Sometimes the answer is nothing more than fasting properly and arriving with a ride home, and hearing that from the team is its own kind of comfort.

When to call your doctor after an ERCP

Most people leave recovery with a scratchy throat, a bloated belly and a strong desire for a nap, and by the next day feel largely themselves. A minority develop a complication, and complications after ERCP tend to announce themselves within the first day or two. Knowing the signs turns a frightening evening into a prompt phone call.

Contact your endoscopy unit, your doctor, or the after-hours number you were given the same day if you notice any of the following, and do not wait to see whether it passes:

• Abdominal pain that is getting worse, is severe, or spreads to your back, particularly with nausea or vomiting; this is the typical pattern of post-ERCP pancreatitis.
• Fever, shaking chills or sweats, which may signal infection in the bile duct.
• Black, tarry or bloody stool, or vomiting blood or material that looks like coffee grounds, which may indicate bleeding from the sphincterotomy.
• Return or deepening of yellow skin or eyes, or dark urine, after they had started to improve.
• Severe throat or chest pain, difficulty swallowing, or trouble breathing.
• Feeling faint, unusually weak, or having a racing heartbeat.
• A rigid, tender abdomen that hurts to touch or when you move.

Call emergency services rather than your clinic if pain is severe and unrelenting, if you are vomiting blood, if breathing is difficult, or if you feel you might pass out. A perforation or significant bleed is uncommon, but both are time-sensitive.

Mild symptoms deserve a call too. A bit of bloating is expected; bloating with a rising fever is not. Persistent nausea a day later, an inability to keep fluids down, or pain that needs more than the simple measures you were sent home with are all reasons to check in. Your team would far rather hear from you about a false alarm than not hear from you about a real one, and every decision about what to do next belongs with them.

Frequently asked questions

Is an ERCP a serious procedure?

It is a genuine intervention with a real complication rate, so yes, it is taken seriously. The NIH reports complications in about 5 to 10 percent of ERCPs, most of them mild. Against that sits the danger of an untreated blocked or infected bile duct, which is usually greater. Your team weighs both sides for your situation, and the decision to proceed rests with them and you together.

What is the most common complication after an ERCP?

Post-ERCP pancreatitis, inflammation of the pancreas caused by irritation of its duct during the procedure, is the most common complication according to Mayo Clinic, Cleveland Clinic and the NIH. It usually shows up within hours as steady upper abdominal pain with nausea. Most cases are mild and settle in hospital with fluids and rest from eating, and teams use several techniques during the procedure to lower the risk.

How long does it take to recover from an ERCP procedure?

Most people feel largely normal within a day or two. Sedation wears off over one to two hours in recovery, per the NIH, and you should not drive for the rest of the day. A sore throat and bloating typically fade within one to two days, and eating resumes once swallowing feels normal. Recovery from the underlying problem, such as fading jaundice, takes longer and is followed with blood tests.

Is an ERCP procedure painful?

The procedure itself is not usually painful because you are sedated, often with no memory of it. Afterward, a scratchy throat and gassy bloating are common and mild. Significant or worsening abdominal pain after ERCP is not expected and can signal pancreatitis, so it should be reported to your team promptly rather than waited out.

How long does ERCP take?

The procedure typically takes between 30 minutes and two hours, according to Mayo Clinic and the NIH. Simple stone removal sits at the shorter end; multiple large stones, a difficult duct opening, stent placement with biopsies, or cholangioscopy take longer. Add time for check-in beforehand and one to two hours in recovery afterward when planning your day.

Will I be awake during an ERCP?

Almost never in any meaningful sense. ERCP is done under moderate sedation, deep sedation or general anesthesia, chosen by your team based on your health and the complexity of the procedure. Under moderate sedation you may respond to a voice but rarely remember anything; under deep sedation or general anesthesia you are fully unaware.

Can ERCP remove the gallbladder?

No. ERCP clears stones and blockages from the bile and pancreatic ducts, but the gallbladder itself stays in place along with any stones it still contains. If gallstones caused your blockage, gallbladder removal is a separate surgical operation that your team may discuss with you afterward, as NHS guidance on gallstones describes.

What can I eat after an ERCP?

Usually nothing until sedation has worn off and your swallowing feels normal, then fluids and a light meal, moving to your usual diet as comfort allows. The NIH notes you can return to your normal diet once swallowing is back to normal. Your team may hold food longer if they are watching for pancreatitis or if another procedure is planned, so follow their specific instructions.

How long does a biliary stent stay in after ERCP?

It depends on the type and the reason it was placed. Plastic stents are temporary and are removed or exchanged at a follow-up ERCP on a schedule your team sets, because they gradually clog. Metal stents are designed to stay open longer and are often used when a tumor causes the blockage. Make sure you leave with a clear plan and date for any stent follow-up.

What is the alternative to ERCP for bile duct stones?

For diagnosis, MRCP (an MRI of the ducts) or endoscopic ultrasound can show whether a stone is present without the pancreatitis risk of ERCP. For treatment, alternatives include surgical removal of the stone during gallbladder surgery, or drainage of the duct through the skin by an interventional radiologist. Which route suits you is a decision for your treating team based on your anatomy and health.

References

• Endoscopic Retrograde Cholangiopancreatography (ERCP), NIH National Institute of Diabetes and Digestive and Kidney Diseases
• ERCP, MedlinePlus Medical Encyclopedia
• ERCP (Endoscopic Retrograde Cholangiopancreatography), Cleveland Clinic
• Gallstones: Treatment, NHS

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.