Physician's Assistant

Patient Details

Clinic letter (311 days ago 09:59)

Clinic letter Fri 30 May 2025 09:59

Last Modified: 283 days ago

MRN:

Content:

Diagnosis:
Ulcerative Colitis

Other Medical Diagnoses
- Low grade TCC of the bladder (diagnosed October 2024)
- Open radical prostatectomy (2003) for Gleason 2+2 prostate cancer
- Hypertension
- Prostate cancer
- Erectile dysfunction
- Type 2 diabetes mellitus

Medications:
- Mirabegron 50mg modified-release tablets - one to be taken each day
- Metformin 500mg tablets - two tablets to be taken twice a day
- Senna 7.5mg tablets - 1-3 nocte
- Timolol 5mg/ml eye drops preservative free - bd right eye
- Solifenacin 10mg tablets - one to be taken each day
- Linagliptin 5mg tablets - one to be taken each day
- Atorvastatin 20mg tablets - one to be taken at night
- Amlodipine 5mg tablets - one to be taken each day
- Dapagliflozin 10mg tablets - one tablet to be taken daily
- Ispaghula husk 3.5g effervescent granules sachets gluten free sugar free - take one sachet daily
- Enalapril 20mg tablets - two daily (40mg daily)
- Enalapril 10mg tablets - one to be taken daily (30mg total daily dose)
- Colazide 750mg capsules - take THREE capsules THREE times daily

Investigations:
- Colonoscopy 2021: Technically limited by fixed sigmoid loop, incomplete (reached ascending colon only). Biopsies showed mild active inflammation. Surveillance in 3 years recommended (due November 2024)

Plan:
1. Routine colonoscopy appointment with moviprep and laxido BD for 1 week prior
2. Signpost to IBD nurses
3. Bloods including U&Es and LFTs in light of 5-ASA treatment - Windsor House
4. Follow-up in 12 months

I had the pleasure of speaking to Mr Dodds on the camera phone today on behalf of Dr Haywood in inflammatory bowel disease clinic. Mr Dodds was previously under our care with ulcerative colitis diagnosed in 1977 and moved up to Sunderland and has moved back to Plymouth to be close to family back in November 2024.

In terms of his symptoms, he has good regular bowel habits however over the last 3 weeks he has noticed some slightly increased bowel frequency and urgency and has increased his Colazide dose and has found this to be very effective. He'll experience a flare like this once or twice per year. He usually associates his flares with stress and he's had a stressful time lately with a house move and so he reasonably attributes a lot of his symptomatology lately to that.

In terms of previous medications, he's had prednisolone during flares. He's also been treated with azathioprine however he had abdominal pain and reacted to this and he's also had sulfasalazine however he reacted to this as well.

His most recent colonoscopy was in 2021 was technically limited by a fixed sigmoid loop and was incomplete having only reached the ascending colon. Biopsies taken demonstrated mild active inflammation and so surveillance in 3 years was recommended which would have been due in November.

In terms of his social history, he is a retired Royal Navy physiotherapist and his wife is a retired nurse from Derriford Hospital. He does not smoke and drinks alcohol with moderation.

He's reluctant to undergo further colonoscopy surveillance as he struggled with preparation previously. He's found the Klean-Prep difficult to tolerate due to taste and volume and he's had the best tolerability (but worst endoscopic results) with Picolax.

In the past, surveillance with CT colonography has been discussed with him.  However, this does not allow us to assess his disease activity in the same way that colonoscopy does and has the potential to miss flat lesions.  Therefore, I would recommend colonoscopy as opposed to CT colon.

He's aware that we have an inflammatory bowel disease nursing service at Derriford which he can contact with any concerns between clinic appointments. I will send him out some blood tests with the letter which he can have taken at Windsor House phlebotomy site and request a colonoscopy routinely with Laxido BD prior for 1 week and with Moviprep.

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Refined results letter (283 days ago 07:45)

Refined results letter Fri 27 June 2025 07:45

Last Modified: 283 days ago

MRN:

Content:

Plan:
1. Follow up colonoscopy results when available
2. Continue monitoring kidney and liver function due to Colazide use
3. No immediate action required for current blood results

Dear Mr Dodds,

I am writing to follow up the results of your recent blood tests. Many thanks for having these performed.

We are performing these tests in order to keep an eye on your kidney and liver function in light of your use of Colazide. Reassuringly, there are no worrying changes in the function of your liver or your kidneys.

Your kidney function remains normal with a creatinine level of 63. There is a borderline low potassium level at 3.4, but this is not concerning at present. Your liver function tests are normal, as is your lipid profile. Your HbA1c is 61. Your white cell count is slightly elevated at 11.5 with lymphocytes at 5.7, but your haemoglobin level is normal.

I look forward to seeing the results of your colonoscopy, which I will write to you about separately.

If you have any questions or concerns about these results, please do not hesitate to contact us.

Yours sincerely

Summary of Results:
Creatinine: 63 (normal)
Potassium: 3.4 (borderline low)
LFTs: Normal
Lipid profile: Normal
HbA1c: 61
White cells: 11.5 (elevated)
Lymphocytes: 5.7
Haemoglobin: Normal

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