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and any abdominal pain

on any abdominal pain

yeah i do have pain its quite mild though

yeah i do have pain its quite mild though

ive always kind of had pain throughout my life and my tummy so its its not unusual for me and kind of combination with everything else

ive always kind of had pain throughout my life and my tommy so its its not unusual for me in kind of combination with everything else

okay yeah and i know youve got a background of rheumatoid arthritis as well is that flared up recently or has that been okay

okay yeah andi i know youve got about grand of rheumatoid arthritis as well is that flared up recently are as upbeat okay

no its been okay my rheumatoids quite well controlled as well yeah

no its been ok my deltoids quite well controlled us well here on

and what medication are you taking for that

what medication are you taking for that

um just ibuprofen

and just proven

yeah just that

yeah just okay

okay and are you using that quite regularly or

using that quite regularly or no

um no as again its been okay yeah

man its been okyeah

okay and whats your weight being doing

ok and i watch your wave being doing and

um ive lost a wee bit of weight actually

better way

yeah okay

okay

and so do you have any sort of ideas what might be going on yourself or any concerns at this point

here so do you have any ideas what might be going on yourself or any concerns at this point

yeah im a bit worried just because its been so well controlled for few years now im worried that my is my adalimumab stopped working or is something else causing my symptoms

yeah right just because its been so well controlled for a few years now im worried that my is my idol um ahmad stop working or its something else causing my symptoms

or what do you think

or what do you think

yeah so theres a few things that might be going on to know we only need few different tests so one of them youre right it could be that the adalimumab kind of lost its effectiveness which sometimes happens and we can test for that by doing a blood test to check for the level of the drug in your body and also um sometimes you could develop antibodies against the drug as well

so theres a few things that might be going on to will need to do a few different tests so one of them youre right it could be that the adult mobs kind of lost its effectiveness which sometimes happens andi contest for that by doing a blood test to cheque for the level of the drug in your body and also sometimes you can develop antibodies against the drugs well

and which can make it ineffective so we can easily check that and the other thing is that because youve had surgery in the past that can sometimes affect how something called the bile salts get reabsorbed um and sometimes that can cause diarrhoea if youve got high levels of bile salts in your bowel motions but thats quite easy to check for us well

on which can make it ineffective so we can easily cheque that on and the other thing is that because youve had surgery in the past that can sometimes affect how something called the bile salts re absorbed on dh sometimes that can cause diarrhoea if if you i got high levels of bio salts and in europe emotions on but thats quite easy tio cheque for a swell on

and of course you need to also think about whether your disease is actually flaring up as well so the other thing well arrange to do is a faecal calprotectin in which youve probably done before

of course you need teo also think about whether your disease is actually floating up as well so the other thing will arrange to do is a fickle kyle protect in which you probably dont before

just a stool test to cheque for inflammation and the bowel so if thats high we might need to look at your medication and think about making some changes

just a stool test to cheque for inflammation and bow on so if thats high we might need to look at your medication and think about making some changes

do you have any questions about all of that quite a lot of information

do you have any questions about all of that got a lot of information

yeah its okay if you do need to change my medication like what would be the next step

its okay if you do need to change my medication like what would be the next step

so theres a few different options so there is a medication called and infliximab which is similar to adalimumab or we might look at you know switching you to a completely different drug um as well also also called the biologic different works in a different way in the bodies it is called vedolizumab but yeah i think first of all well get some up to date tests on first might need to get a ct scan or also an mri scan of your small bowel just to have a look and see if theres any inflammation in the bowel that might be you know causing your symptoms

so theres a few different options s so there is a medication called inflicts a map which is similar to other little mob or we might look at me you know switching you to a completely different drug ahs well also also called a biologic different works in a different way and the body its called beetle is a mob on dh but yeah i think first of all well get some up to the test on first might get a ct scan or also an m a nice kind of your small battle just to have a look and see if any on dh inflammation in the battle that might be causing your symptoms

and i had surgery before my treatment wasnt working do you think thats a possibility in the future

and i had surgery before my treatment wasnt working do you think thats a possibility in the future

so i mean its always possible we have to always keep it at the back of our mind and hopefully they you know we can try and work out whats going on and that do something medically but yeah ofcourse we have to always think about surgery is as a possibility

so i mean its always possible they have to always keep it at the back of our mind and hopefully they you know we can try and work out whats going on that do something medically but of course we have tio think about it surgery is as a possibility

yeah but hopefully not

yeah but hopefully no

yes definitely okay

yes definitely ok

is that okay

is that ok

yeah thats fine thank you very much for seeing me

yeah thats fine thank you very much for seeing me

thank you

thank you

so hello my names dr kosher im one of the gastroenterology doctors and this is the ibd clinic inflammatory bowel disease clinic can you tell me why youve been referred here today

so hello my names dr ko show im one of the gastroenterology doctors and this is the ibd clinic and find your disease clinic can you tell me why your finger found here today

yes so have been having this sort of that having diarrhoea for quite a while theres been a bit of blood in it as well have been a bit a bit concerned so went to see my gp and theyve sent me here

yes so i have been having this and that i had diarrhoea for quite a while has bean blood in it as well shaking a little bit concerned so aunt seema gp and theyve theyve sent me here

okay and how longs that been going on for

ok and how longs that been going on for

well its three months three month

every three months three months

and prior to that where you well

prior to that where you will

yeah ive been ive been absolutely ground before that yeah

yeah ive been ive been absolutely ground before

and how often would you say youre moving your bowels each day

on how often would you say youre moving your battles each day

probably probably about three or four times i think you know

and probably probably boats three or four times

three or four times okay has it ever been more than that

okay has ever been more than that

it was you know it has been a couple times where its been maybe four or five or six or so

on it was you know it has been a couple times or its bean for five or six on

okay and is the blood mixed in or is it just on white thing would you say

is the blood mixed in or does it just on white thing would you say

yeah mixed in

mexican

and if you had any abdominal pain

and if you had any abdominal pain

yeah but its been yeah its been quite a kind of crampy crampy pain yeah

yeah its bean has been quite a cram p trampy paid yet

okay um any other symptoms that youve had that you can think of

okay andi other symptoms that youve had that you can think off

um ive noticed that my appetite have not really been eating eating as well as i used to ive got kind of funny rash on my my shin as well

and i have ive noticed that my my appetite have not really been eaten eating as well as i used to ive got a funny rational machine as well

okay when did that start

ok when did that start

so that started about a couple months ago as well

s o that starts in a couple months ago as well

and do you have rashes anywhere else

and do you have rashes anyone else

no its just on my shins

no its just a machine

okay any other medical conditions that you have

okay on any other medical conditions that you have

yeah i had ive got asthma but never really bothers me sometimes i have to take my blue inhaler

yeah but ive got asthma but never really bothers me something you have to take my blue inhaler

okay and any other medications that youre taking

okay on any other medications that youre taking

no any allergies

no any allergies

um no

and no

and have you got any family history of any significant medical conditions

and if you got any family history off any significant medical conditions

yes my my grand my grand dad had ostrich colitis

yes my mom my grandma my granda and had lost of colitis

and any other anyone else in the family with inflammatory bowel disease

on any other anyone else in the family with inflammatory battle disease

no i dont think so

no i dont think so

okay so so far youve had some investigations done so weve taken some samples of your stool to make sure that theres no infection there and you also had a colonoscopy a couple of weeks ago did anyone go through the results with you

okay so so far youve had some investigations done so weve taken some samples off your stool to make sure that theres no infection there on you also had a colonoscopy a couple of weeks ago that anyone go through the results with you

no not really no

and no not really no

so that we took some biopsies when we did the colonoscopy and it looks like you do have something called ulcerative colitis okay so they were in keeping with with that condition i dont know how much you know about inflammatory bowel disease or ulcerative colitis

so that we took some biopsies when we did the colonoscopy on it looks like you do have something called ulcerative colitis okay so they were in keeping with with that condition i dont know how much you know about inflammatory bowel disease or ulcerative colitis

i know wee bit because i have seen my grandma my grandfather had it i dont know i dont know a lot

we better see my grand grand father i dont know i dont know a lot

okay so its what we call a chronic condition so its something that youre going to have life long unfortunately um but its a condition that we can control very well with medications in the vast majority of people so to start with well start you on a course of steroids i dont think youve had any from your gp yet but that should help to sort of calm down the inflammation in your bowel and then well get you started on some other maintenance therapies im going into details of that on at the next consultation do you have any questions about that just at the moment

so its its what we call a chronic condition so its something that youre going tohave lifelong unfortunately but its a condition that we can control very well with medications in the vast majority of people so to start with well start you on a course of steroids i dont think you had any from your gp yet but that should help to sort of calm down the inflammation in your bedroom and then well get you started on some other maintenance data piece on will go into details of that at the next consultation um do you have any questions about that just to the movement

um so um yeah sorry its just lot to take in

um so um yeah i just saw it well look take it

so how long will be on these steroids for is that for lifelong

so how long will be only the steroids for is that for lifelong

so the steroids are normally just for 8 to 68 weeks until the inflammation has has died down

so the standards are normally just for 6 to 8 weeks until the inflammation has stayed out on

and hopefully your bowel have it should be going back to normal

hopefully your habit should be going back to normal on

and you should know its less blood as well if that doesnt happen with the steroids then we would want to know about that in case we need to do some further investigations but in terms of maintenance therapies that we talked about you will be on those for longer term and often people are on them lifelong or certainly for years depending on the course of their disease

you should know its like blood as well and if that doesnt happen with the steroids then we would want to know about that in case we need to do some further investigations but in terms of maintenance state of peace that we talked about you will be all nose for a longer time and often people are on the lifelong or certainly for years depending on the course of their disease

okay so and well also have to arrange some surveillance colonoscopy for you as well just to make sure that you dont develop other conditions that are associated with inflammatory bowel disease okay

tio will also have todo some surveillance colonoscopy forget as well just teo make sure that you dont develop other conditions that unassociated with inflammatory bowel disease okay

so well arrange it to see you back in clinic in about six weeks time for a review thank you

so were injured to see you back in clinic in about six weeks time i think of you

hello my name is dr kosher and im one of the gastroenterology registrars at the ibd clinic can i take your name please

hello my names dr costa and one of the gastroenterology and greatest stars at the i v d clinic can i take your name please

yeah its john smith

yeah its a john smith

okay nice to meet you john so tell me whats been going on

okay nice to meet you john so tell me whats been going on

well so ive had crohns quite a while now i was diagnosed in early early twenties but i just its been its been okay for a while but its just ive been feeling very just very tired and more lethargic less rested like a few weeks or so i have not been able to go to work i had to call in sick ive got the my bowels have been a bit more bit watery and ive been going a bit more often

well so you havent croons quite a while now diagnosed early early twenties and but i just its bean is being ok for a while but its just being feeling very just very tired and mohr lethargic for last last like a few weeks or so you know ive not been able to go to work i had to call and set um ive got the look my balls are in a bit more a bit watery and ive been going a bit more often

okay how often would you say youve been moving your bowels in the last few months

okay how often would you say youve been moving your bills in the last few months

probably about three or four times a day so yeah

probably about three or four times a day

okay and you said youve not noticed any blood in your bowel motions

okay and you said youve not noticed any blood in your bio emotions

no theres been no blood its just been really watery

no theres been no blood to be really water

okay and does that tend to be worse at night or during the day

okay on dh is that does that tend to be works at night or during the day on dh

i wouldnt say that much of a difference really its sometimes im up in the night but sometimes its not every night

wouldnt see that much of a difference released sometimes im up in the night but telling sees you know every night

and have you been having any abdominal pain or cramping

and have you been having any abdominal pain or cramping

yeah wee bit of a cramping and abdominal pain its not been too bad but of often have this having abdominal pain i wouldnt say its too much different they are normal for me

yeah we better for a club bombing pain its not being too bad but of often have this kind of hoping i wouldnt say its too much different than normal for me

okay and if you noticed any skin rashes at all

okay and if you noticed any skin rash is a total

no no no nothing like that

no no no

and i know that youve been on fortnightly adalimumab

andi i know that youve been on fortnightly adelaida map

and how hows that been going

and how you had powers out going

yeah its been its been fine since yeah since i had surgery in 2015 and yeah ive been ive been okay since then but yeah its just kind of recently ive just not been feeling that great

yeah its been its been fine since yeah since i had surgery 2015 has beena been okay since then but its just gonna be simply just not feeling that great

okay and any problems at the injection sites sort of skin reactions or

okay and any problems at the injection sites skin reactions are

no thats been fine

no thats fine

okay and if you had any trouble with swallowing

okay and if you had any trouble swallowing

no no no

no calls

okay what about vomiting or feeling nauseated

okay what about vomiting are feeling nauseated

i say i felt a wee bit a wee bit sick but ive not actually actually been sick

and suddenly there you will be bet a wee bit sick but no actually not being safe

okay and have you required any steroid courses from your gp recently

okay and have you acquired any standard courses from your gp recently

no not recently no

uh no not recently no

okay okay and any other medical conditions that you have

okay okay on any other medical conditions that you have

um yes ive got ive got arthritis and ive also got hay fever and asthma as well

and yes ive got a car status and on and ive also got the fever and xmas well

and any other medications that youre on other than the adalimumab

on any other medications that you dont other than the adult adam up

so i take i take some diclofenac thats for my my arthritis

s o r take take cem cem dicle ven ac thats for mei mei like this