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and any abdominal pain

and abdominal pain

yeah i do have pain its quite mild though

yeah 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 tummy so its its not unusual for me and kind of combination with everything

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

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

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

and what medication are you taking for that

and what medication are you taking for that

um just ibuprofen

um just ibuprofen

yeah just that

just that

okay and are you using that quite regularly or

okay and are you using that quite regularly or

um no as again its been okay yeah

um as again its been okay yeah

okay and whats your weight being doing

okay and whats your weight being doing

um ive lost a wee bit of weight actually

ive lost a wee bit of weight actually

yeah okay

yeah okay

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

and so you have any of ideas what might be going 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 im a bit worried just because its been so well controlled for few years now im worried that my is my adalimumab working or is 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

yeah so theres a few 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 of lost its effectiveness which sometimes happens and we can test for that by doing a blood test to check for level of the drug in your body and also um sometimes you could develop antibodies against the drug as 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

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

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

and of course you need also think whether your disease actually flaring up as well so the other well arrange to do a calprotectin in which youve probably done 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 the bowel 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 have any questions about all of that quite lot of information

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

yeah its okay if you do need to change my like 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 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 also called the different works in a different way in bodies it is called but yeah i first of get some up to date tests on first might need to a ct scan or also mri scan of your bowel just to have a and see if theres inflammation in the bowel that might be know causing your

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

i had surgery before my treatment wasnt working do you 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 we have to always keep it the of our mind you know we can try and work out whats on and that do something medically but yeah ofcourse we have to always think about surgery is as a possibility

yeah but hopefully not

yeah but not

yes definitely okay

yes definitely okay

is that okay

is that okay

yeah thats fine thank you very much for seeing me

thats fine you very much for seeing

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 my dr kosher im one of the gastroenterology doctors and this is the ibd clinic inflammatory bowel disease clinic can you tell why youve been referred 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 have been this sort of that having diarrhoea for quite a theres been a bit blood in it as well have been a bit a bit concerned so went to see my gp and theyve sent me

okay and how longs that been going on for

okay and how longs that been going on for

well its three months three month

well three months three month

and prior to that where you well

and prior to that where you well

yeah ive been ive been absolutely ground before that yeah

yeah ive been ive been absolutely before that yeah

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

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

probably probably about three or four times i think you know

probably probably about three or four times i think know

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

three or times okay has it ever more than that

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

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

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

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

yeah mixed in

yeah mixed in

and if you had any abdominal pain

and if you had any abdominal

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

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

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

okay um any symptoms that youve had that can think of

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

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

okay when did that start

when that start

so that started about a couple months ago as well

so that about a couple months ago well

and do you have rashes anywhere else

and do you have rashes anywhere else

no its just on my shins

no just on my

okay any other medical conditions that you have

okay any other medical that you have

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

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

okay and any other medications that youre taking

and medications youre taking

no any allergies

no any allergies

um no

no

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

and have you got any family history of any medical conditions

yes my my grand my grand dad had ostrich colitis

my my grand my grand dad had ostrich colitis

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

other anyone else in the family inflammatory bowel 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 had some investigations done so weve taken some samples of your stool to make sure that theres infection there and also had a colonoscopy couple of weeks ago did anyone through the results with you

no not really no

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 and it looks like you do have something called ulcerative colitis okay so they were in keeping with with that i dont know how much know about bowel disease or colitis

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

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

okay its what we call a chronic condition so its that youre going to have life long unfortunately um but a condition that we can control very well medications in the vast majority of people so to start with well start you on a course of steroids i dont 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 maintenance therapies im going into details of that on at the next consultation do you have any questions about that just at the moment

um so um yeah sorry its just lot to take in

um so um sorry its just lot to in

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

so how long will on these 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 steroids are normally just for 8 to 68 weeks until the inflammation has has down

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

and hopefully your bowel have it should be going back to

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

and you should less blood as well if that doesnt happen with the then we would to know about case we need to some further in terms of maintenance therapies 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

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

okay so and well also to arrange surveillance colonoscopy you as well to make sure that you dont develop other conditions that are associated 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 well arrange it to see you back in clinic in about six weeks time for a review thank 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 name is dr kosher and im one of the gastroenterology registrars at the ibd clinic can i take your name please

yeah its john smith

yeah its john smith

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

okay nice to meet you john so tell whats 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 ive had crohns quite i was diagnosed in early early twenties but i just its been its been okay for a while but its just ive feeling very just very tired and more lethargic less rested like a few weeks so i have not been able to go to work i had to call in sick ive got my bowels have been a bit more bit watery 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 say youve been moving your bowels in the last few months

probably about three or four times a day so yeah

probably about three or four a so yeah

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

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

no theres been no blood its just been really watery

theres been no blood its just been really watery

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

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

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

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

and have you been having any abdominal pain or cramping

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

okay and if you noticed any skin rashes at all

okay and if you noticed any skin rashes at all

no no no nothing like that

no no like that

and i know that youve been on fortnightly adalimumab

and i know that youve been on fortnightly adalimumab

and how hows that been going

and hows that been

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

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

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

no thats been fine

no thats been fine

okay and if you had any trouble with swallowing

okay and if you had any trouble with swallowing

no no no

no no

okay what about vomiting or feeling nauseated

okay what vomiting or feeling nauseated

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

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

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

okay have required any steroid courses from your gp recently

no not recently no

no recently no

okay okay and any other medical conditions that you have

okay okay and any other medical conditions that you have

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

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

and any other medications that youre on other than the adalimumab

and any other medications that youre on other than adalimumab

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

so take i take some diclofenac for my my