So the next patient is peter chevin c h e v I n foxtrot059930 45 year old gentleman extensive colitis 02/2005 let's go to investigations most recent colonoscopy november 2022 circumferential mucosal inflammation in the proximal transverse: with erythema and edematous mucosa 1 times 3 mm sessile polyp removed histology 3 x 2 x 2 mm tubular adenoma with low grade dysplasia colonic biopsies diffuse moderate active chronic inflammation with neutrophilic cryptitis crypt abscesses and an increase in chronic inflammatory cells within the lamina propria no granulomas crypt architecture distortion from the ascending: the rest of the biopsy show normal large bowel mucosa most recent blood tests july 2023 using his normal crp 2 full blood count normal most recent hop sorry in the diagnosis we've got extensive colitis ibd - u diagnosed 02/2005 most recent hospital admission 2017 requiring iv steroids most recent colonoscopy november 2022 azathioprine from 2007 to 2032 intermittently used appendicectomy june 2020 other medical problems none medications list amitriptyline 10 mg at night delete that it's not that salafelt 3 g modified release granules 1 sachet each day hi is that mister peter chevin hi there mister chevin I'm doctor miller I'm 1 of the gastroenterology registrars here at dareford how are you have I caught you at a reasonable time ish good I'm glad I I've seen you you haven't seen us in clinic for a while I yeah it has great oh brilliant so your symptoms have been well controlled fantastic great so when's the last time you had a flare up mhmm okay mhmm and that was back in 2017 that was a while ago okay okay great well that's really good news so you haven't really had any trouble in terms of needing hospital admission or anything since then and what are your bowels like okay okay mhmm fine and what kind of stuff comes out great fine mhmm great that's brilliant and you're taking your cellophag fair enough yeah fair okay so you just use it when you're flaring and you don't use it the rest of the time and how often will you will you want to take it once a year fine and you take the 1 the 1 sachet the 3 g okay good fine and how do you feel in yourself generally do you have any eye problems rashes on your legs low back pain anything like that nothing like that brilliant great and tell me about your life more generally what do you do for a living okay yeah I bet fine so you you just finished work today or wow okay good fine have you always done that or yeah fine are you a big kind of clubber is that your is that why you you like it or is it fair enough fair enough great and do you have a family do you live with anyone at home fine and are are your kids well have they got any signs of colitis or anything like that no issues fantastic yeah that is great mhmm mhmm great did he have surgery for that alright great and do you take any other regular medicines or nothing and any other health problems great brilliant fine so I I guess you got the letter from doctor fung back in april saying that they that he would request colonoscopy for you have have you got any thoughts about that mhmm I think so yeah you're an old hand yeah fine okay good fine alright so yeah you're you're used to it and we've we've got some knee prep that we're trying that most people find a lot better there's plenty of stuff I don't know if you've had that before that yeah most people are finding a lot better so hopefully that will that will even be improved so as I I mean doctor fung's writing that we wanna keep an eye on your even when your bowels are well and you feel well we wanna keep an eye to make sure that you're not developing polyps or growths which we know you're at increased risk of with the ulcerative colitis exactly as you get older and with your family history and things like that so that's 1 thing we can do to decrease your risk of anything sinister in the future the other thing that's proven to decrease your risk of sinister things in the future is that salivary so we know that it works well for symptoms but we also know that it massively decreases your risk of cancer cancer if you take it every day because we know that even when people don't have symptoms they might have a low level inflammation in the: and certainly your last colonoscopy showed that you had inflammation in your: even though you felt well so the biopsies showed inflammation throughout your: so dampening that inflammation down means the cells don't turn over so quickly and when you've got less cell turnover you've got less chance of 1 of them going off on their own and developing into a cancer so I think I understand why you might think I don't want to take it but he is really good at that at decreasing your cancer risk and often we continue it even when we've got other medicines that really work well for ulcerative colitis we've got big activity in their disease we carry on those salafouts to say that's just as a cancer preventer so I think that would be worth considering certainly so so I would yeah I would suggest carrying them on and if you need I can write it on the letter to ask your gp to provide for you and you can have a think about that yeah fine fair enough not many people say their gp is fantastic to be honest with you so so yeah so I'll I'll ask your gp to add them on your list I'll and I'll I'll make sure the colonoscopy is booked for you and we'll see you then and then if you're if you're well I'll put you in to see either the nurses next or us depending on who's able to see first and we'll take it from there but you know where we are if you're flaring if you're having symptoms that you're you know that you're not sure if they're a flare just get in contact with the ibd nurses they can contact you in contact with the secretaries and I'll give you a call anytime and we can work out what to do that sound like a reasonable plan anything I've forgotten any questions great k fair enough I think that's a good choice that's why I would do it for you alright brill nice to talk to you have a lovely day get some sleep you must be exhausted bye mate cheers bye bye so plan number 1 restart salafalk granules number 2 colonoscopy for surveillance as planned number 3 ibd nurse or ibd consultant follow-up in 12 months number 5 if flaring double dose of salafalk and use for 6 weeks and contact inflammatory bowel disease nurses dear gp had the pleasure of speaking on the telephone to mister chevin today in gastroenterology clinic on behalf of doctor klimova which is k l I m o v a full stop <\n\n> Mister chevin has a diagnosis of extensive colitis the biopsies are more indicative of ulcerative colitis but the distribution is not typical which is why we've classified him as inflammatory bowel disease unspecified <\n\n> I'm happy to hear that his bowels are bowel frequency is good 1 to 2 times a day passing a formed stool and he doesn't experience bladder mucus he might experience 1 flare per year where he'll use his salafel but hasn't been using it the rest of the time paragraph he's otherwise fit and well and takes no other regular medicines in his wider social in his life more generally he works as a nightclub manager always working nights he has a wife and 3 children and reassuringly all of his children are well with no signs of colitis there full stop <\n\n> He did tell me that his father has been ill over the last 3 years with bowel cancer for which he needed operative management but reassuringly he's now in remission full stop <\n\n> We discussed his own risk of bowel cancer which is increased because of his ulcerative colitis he's going to attend a surveillance colonoscopy to keep an eye on his: and to assess the activity in his inflammatory bowel disease and I've also encouraged him to go back onto the salafate granules which we know have a positive effect in decreasing his cancer risk in the future full stop <\n\n> I look forward to seeing him back in clinic in a year's time but if he has any queries or concerns or if he's flaring he's more than welcome to get in contact with us sooner yours sincerely