Physician's Assistant

Refined clinic letter Thu 15 January 2026 12:11

Last Modified: 81 days ago

MRN:

Content:

Diagnosis:
Ulcerative colitis (left-sided) - ongoing management

Other Medical Diagnoses:
• Childhood squint
• Neurological symptoms under investigation (8-month history)

Current Medications:
• Mesavant - Double dose for 6 weeks
• Clipper (if required for symptoms)

Investigations:
• Full blood count (14/01/2026): Normal - Hb 135, normal platelets, normal eosinophils
• CRP (14/01/2026): 2
• MRI head (02/01/2026, reported 13/01/2026): Normal intracranial appearances
• PCR: Negative
• ZN stain: Negative
• Faecal calprotectin (05/12/2025): 781 micrograms per gram
• Previous faecal calprotectins (2022): Normal

Management Plan:
1. Continue double dose Mesavant for 6 weeks to achieve mucosal healing
2. Use Clipper suppositories if symptoms worsen or persist
3. Neurology review on Friday (next week) for ongoing neurological symptoms
4. Follow up as needed based on symptom response

I had the pleasure of speaking to Ms Stevenson in gastroenterology clinic.

Ms Stevenson is a 36-year-old veterinary surgeon with established left-sided ulcerative colitis who has been experiencing intermittent flaring over recent months. She has been struggling with compliance with suppository treatment due to the practical difficulties of daily administration. Recent blood tests show reassuring inflammatory markers with CRP of 2 and normal FBC parameters.

She has also been experiencing an 8-month history of neurological symptoms including visual disturbances, dizziness, tinnitus, and balance problems. MRI head performed recently was reported as normal. She has a neurology appointment scheduled for next Friday which is appropriate given the constellation of symptoms.

Regarding her colitis, she has responded well to double-dose Mesavant over the past few days with improvement in symptoms and reduction in blood. The plan is to continue this higher dose for 6 weeks to achieve proper mucosal healing rather than the previous pattern of symptom improvement followed by early relapse. She has Clipper available as rescue therapy if needed.

She will continue with the current management plan and follow up as required. The neurology review will be important to exclude any underlying neurological cause for her symptoms.

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Refined clinic letter Thu 15 January 2026 12:11

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