Okay so I'm gonna ahead and make sure that you're having a lot of the and thing I'm ahead thing I'm gonna gonna do same thing in the corner he was in the back of his office when he was speaking to you he's wondered whether you're only having to come to the world to see us today thanks for coming up no problem andy you want to go to the doctor so I hear you talking on the phone just got me on the phone I didn't know what you said so tell me about your symptoms so basically I've problems for years on that yep in reading wasn't it diane yeah it's in reading I haven't had a flare up for a while mhmm and then 3 weeks ago I had a bad flare up okay no 4 or 5 no about 5 weeks ago actually sorry I had a bad flare up and then 3 weeks ago I had the camera yep they put me on steroids yep for 3 weeks 3 weeks I've been taking them improved really it's the same slightly improved but there's still still loose stools blood I do feel a bit better in myself okay so in after the last 3 weeks of steroids yeah then I have been eating better drinking better good for that time mhmm but in general it hasn't yeah fine your bowels haven't changed yeah and what's your bowel frequency at the moment so up until now from this morning I've probably gone 10 times okay so and what comes out mixture so this morning was like just pure red blood yeah and then it was like mixed red yeah and then it'll go brown then it'll go brown red mhmm so it's more probably 60 it would have and do you have to run to the toilet when you need to go oh yeah yeah so you've got some significant urgency any mucus I've not noticed so much mucus now as originally before so the mucus has probably calmed down a bit is it painful when you're passing the stool no no no it is it's uncomfortable it's sore because you're wiping so much yeah it's not even it's just like cramping alright I need to go and then you rush to the toilet and then it gets better yeah okay but I could drink like a pint of water and then 5 minutes later I need to go alright fine so so it's very much related to what you eat and drink is that right yeah basically fine are you cutting down the amount you eat and drink yeah so drink I try I try and drink more because obviously I'm going to the toilet a lot yep eating wise I'm just trying to stick with like rice plain stuff yeah mhmm so and do you still find you need to rush the toilet after you have any of those I I wouldn't say rush but I know when I need to go in the morning to go yeah you know what mean okay so but it's more what was I doing in the mornings I'm rushing more than what I have in the evenings mhmm so I don't know if that's because the tablets are kicking in after I take the tablets maybe maybe and then wearing they're off a little bit I don't know and you started on 40 mg of prednisolone is it 8 tablets 6 tablets 6 tablets 30 mg 6 I'm now on 4 did you have 30 for 2 weeks and then step down or did you have 30 for a week and then step down after that week week week week week week yeah fine so you 30 got milligrams for a week now you're on 25 now you're on 20 now I'm on 20 and then saturday I'll be down to 15 and were your symptoms better at the beginning of the course or are they like the same I would said okay I would have said they were better on a higher dose yeah mhmm yeah fine it just seems like now the last week maybe it's starting to mhmm mhmm like more discomfort yeah so I see fine so as the as the doses come down you've been feeling worse yeah any symptoms outside the gut any eye symptoms dry eyes painful eyes lower back pain no not at the moment like originally because I had no pain to put it down to my hip have bad bones so maybe it was a lot any rashes on your legs no no nothing like that fine and any fevers that you've noticed at home fine great alright broke and do you feel short of breath or chest pain at all no like maybe your blood counts be low no nothing like that good fine what do do for a living I work in a factory fine what kind of factory fish fish fine lovely down somewhere in plymouth yeah cap down okay for fish so okay fine quite a big factory yeah yeah I've seen their bands yeah yeah fine alright cool and what do you do there so supervisor so I basically just run the production do you work with lots of chemicals and things like that on the cleaning side so it's all fresh produce and then for the last 3 hours of my shift I then direct cleaners okay you direct them but you don't really do a lot of research fine good alright and do you have a family yeah I've grandkids kids grandkids you're a granddad I don't know what you mean fair enough great young granddad yeah fine so you have 2 grandkids and you've got 2 2 boys and a wife and your wife yeah fine and you live with all of them in a house oh no I live with my wife and my youngest yeah and then my eldest lives with his partner and his kids okay great fine and your kids well do they have yeah absolutely any family history of inflammatory bowel disease no no fine great so my mom my mom has problems of ibs and that but not inflammatory bowel disease yeah fine and do you drink or smoke nope fine allergic to anything no good can I have a look at you yeah sure looking at your hands touch your tummy yeah do mind if I can I don't know do you want me to stand up no you're fine just there for the moment yes tell her yeah let's go just let me know rubbing I think in general I think kind of why he's healthy so they've been the recent flare up that that's me that's really nice talking about what's your no no he was supposed to eat yeah but originally when the symptoms as well like I was getting a lot of leg pains yeah I know down in that yeah refined I don't know back to home and even at work right coming towards the end of my shift because I I stand a lot yeah coming towards the end of my shift it'd be like achy and I get back in the legs just in general just my thighs just in general okay but not now so I don't know if actually I was dehydrated a little bit or you can get cramps it was a matter of it it it give me a bit of a okay tell me something you would have done because it was a yeah there was a problem also score on the buccal value just easy to reduce score know the right way no of course getting there you want some heavy lifting around lots mhmm but when I'm changing your old 60 60 kg I would describe that as having everything else yeah okay but it's not often it's probably 5 6 times a night 5 6 times a night yeah yeah I would describe that as a couple wouldn't you maybe a minute it would be if it was more maybe so we haven't seen your blood test yet yeah but it looks like you had some blood tests taken yeah that was about 12:00 12:00 yeah funny isn't it it's a while ago it doesn't look like they even got to the lab so we'll follow-up who took them here I'll follow-up who took them here and make sure they got to the lab if not we might try and get some other blood tests from you because I was hoping to see you with the blood test but they're not back yet yeah that was a focus? Yeah exactly and then come here yeah so depending so with what you tell me we worry about people when they're passing more than 10 stools a day we we start to think this might be a significant flare yeah of either of a colitis and inflammation in the: and we know your crohn's disease affected the: in the past there's and looking at your previous flexible sigmoidoscopy that you had there's evidence of things being inflamed at that time yeah then my question is has that got worse and that's why your symptoms have got worse that's a drip of steroids that you have in hospital you've tried oral steroids they haven't done the ticket you're still passing a lot of stools a lot of times a day and there's a chance of becoming more systemically unwell unless we do something about it and that would be giving you a strong course of intravenous steroids in hospital for 3 days at least and then seeing how you are and over that time we'll keep a close eye on your stool charts that you're keeping for yourself we can rehydrate you with a bit of intravenous fluid if you're feeling dehydrated opening your bowels a lot when it's half day and keep a close eye on your blood tests including your markers of inflammation over that time and take it from there if you develop tummy pain we want to know so that's your job in hospitals to keep your stool track and then if you get tummy pain please tell us because we want to make sure you haven't developed a complication of inflammation in the: your last flexible sigmoidoscopy was relatively recent but I think it'd be prudent to repeat that and get some biopsies because we didn't get any biopsies at the time of your last 1 just to make sure you haven't got anything else the: and to see how bad the inflammation is at the moment which helps guide us on what kind of treatments that we've got after 3 days if things are better then great we'll switch you on some tablets get you out of here if things are better then we can talk about what we do about it and there are other treatments that we have available things like infusions and injections that modulate the immune system and bring the inflammation down does that kind of make sense have you talked about those things before and thought about them yeah fine and what do you take at the moment for your your crohn's disease nothing yeah fine fair enough looking at your pictures endoscopic pictures and the report of your last colonoscopy and the biopsies that you had before I'm not convinced a 100% convinced this is crohn's disease do you know what they said that last time did they yeah yeah no when he was looking at it was like like the actual 1 he was doing it yeah he was saying like you know I'm not actually doing it anymore yeah because of the distribution because it's just at that last part near the back passage and there was an area on the other side of the: a small patch as we call it at that time when you'd have your colonoscopy that can happen in ulcerative colitis which is a different type of inflammatory bowel disease and that will be more likely to present with the kind of symptoms that you're getting at the moment with rectal bleeding urgency and passing stools 10 times a day so it may be that that's the underlying diagnosis it is irrelevant really because the treatment the same but my. Is that some more biopsies will help us nail down which is which and it will also help us guide the treatments because if you've got ulcerative colitis then that's much more likely to respond to just tablet treatments that you take every day or suppositories that you take when you're having a flare versus strong immunomodulatory injections and things like that have you tried anything like pentazer or octotazen or nothing like that because you had green because we thought you had green skin and obviously I was I was on for a while yeah and then a couple of years ago maybe that's when I had the thing mhmm but before that it was a few years before before okay yeah alright does that kinda make sense any questions or anything like that any have you gotten do need to do anything for work so you no I'm talking to him anyway so okay that's fine alright do you obviously you've not come in maybe not expecting to come to answer yeah no because I just thought I was coming in of course or whatever so I've got my car back yeah fine is it possible to drop if you want to that's absolutely fine yeah yeah you're just so then get pain of course no no I understand yeah yeah so we can yeah we can start you on treatment now or if you need to run around for an hour or so you're more than welcome to do those things and take the car back and all that stuff or get your wife to come in and do whatever you need to do yeah we can be very flexible yeah so I can drop my car back and then come back we'll keep the bed fee it's perfect sounds good sounds like fun great alright any questions you happy great if you think of anything we're around so just cram us yeah that's cool cheers thank you see you later cheers so would I get better using that thing to plug the car back now yeah why not yeah that's fine I'll do that now I think you will end up on my projects yeah he's the kind of man who will respond to steroids and then probably go on to like 10 yeah and that one's his side preference