Patient is oscar clarksons 773509 diagnosis list as before can we change chronic hepatitis b infection too actually as is before plan number 1 today blood test blood test today hepatitis b serology hepatitis d serology and hepatitis e antigen status number 2 with blood tests recalculation of page b scoring to guide hcc surveillance number 3 follow-up in 12 months time positive was nice to meet you I'm gonna go my stage just if I got you from work before you yeah yeah yeah sorry yeah no just locally so that's alright yeah fine fair enough so can okay so you can sort of top tap out for a minute and then come back what do you do for a living fitting bathrooms and kitchens okay fine fair hard work well when you're getting older it's more physically getting feel different than the other oh my god that's why I keep going to the gym yeah exactly yeah and what do you understand about it coming to liver clinic yeah I mean normally started with doctor george he's he's gone part time or semi retired yeah they're called doctor neil doctor neil that you met last time yeah I haven't seen them of course the whole situation and everything doctor george quite recommended a lot of tests mhmm but as soon as doctor neil has gone a bit more fine but yeah so unless the first 1 I think in the yeah in a year yeah august I think it was last 1 yeah think it's yeah fine yeah yeah well and have you been in that year yeah good yeah I mean I just take my every day have I missed any days I've got 1 or 2 yeah oops I take someone off I don't remember now and I take them in the morning instead so yeah so I'll take them how many times a week might that happen not often not often and in terms of your liver tests you haven't had any in a while no last ones we had I think were a year ago oh no you had some yeah august so over a year ago at that time your viral load was undetectably low which is obviously where we want yeah I think it's important to keep rolling with those tests every year we know that sometimes hepatitis b can become if you're taking it every day it's unlikely yeah but it's always good to keep an eye on those things so yes we get some blood tests today if that's alright yeah yeah monitor your viral load yeah you haven't had you haven't ever been tested for hepatitis d which only ever infects people who have hepatitis b and we should test everyone who has hepatitis b to make it right I think it's very unlikely that you've got that because your liver tests are normal but it's always worth excluding that and I'll add on another test to look for which type of hepatitis b you have whether you have it's a bit academic but it tells us your chance of the liver inflammation continuing or not a few more tests that we haven't yet done today if that's alright yeah yeah that's fine I've got more and more of course delayed work as well but I well then again I do usually intagamate is very well tolerated most yeah very few people tell me that they are are particularly fatigued it may be indicative of as low grade inflammation continuing in the liver which we can pass on to yeah we're just adding on some other blood tests that for other reasons people might be fatigued things like thyroid function vitamin d things like that which is going and all that yeah yeah I I think it's also sport because I I swim about 6 times a week and drink it 3 times a that would tire anyone out I think yeah I'll probably of course but I think it's good to stay active isn't it and yes yes I do my best yeah I that's think good and if we can facilitate you if there's something to correct that can keep you active then that's the important thing the last thing we want is you to stop going to the gym and swimming yes because of your time yes I mean the swimming is now is well my my big really nice I used to love swimming when I was at school but I haven't really done it since then it's a shame yeah no it's not I mean I still swim in the sea not this week because of the they've been brain is terrible isn't it they're just all well you're in torquay you go down the painting yeah no I go to toowebi so I swim out to the boy I go quite far out I do about a mile swim like 5 5 month boy or something yeah yeah yeah because then the if they're polluted it's generally mainly where it's in the center so I'm basically this is toowabee and here where they pollute us I'm gonna go in there to the buoy cross the buoy along the about the pee and then back in so we've got the last chance to avoid the froth yeah I'm with you yeah yeah very good it's nice it's about mild swim so it's really nice yeah nice warm at the moment hasn't it yeah I was to a. That it it's too warm it's nice to put a pedal in but when you do a proper mhmm warmer 18 degrees or something it was last time I was in there it's it's like a bath you know I like the cold though I like the cold we're nearly to the end of so I'll probably stop november and november mhmm yeah fine and then go back to the pool yeah fine b levels hepatitis b antibodies I can sort all of these things out if you like I'll put all the blood tests on the computer for you for you they'll grab them for you in the waiting room and then if you do I'll write you with the laptop with everything we've spoken about today yes we're happy to see you more regularly yeah yeah well well we don't have to we don't have to but exactly I I don't know if we need to because everything's so well controlled yeah so it's still good now that's great exactly if things change then we should see you more regularly but I don't think we need to but we're always here so if things change just get in contact with secretary's letters numbers at the top of letter and we can call you and bring you in to see us yeah all these things we're here unlucky enough to be in I'll focus on my letter but there's nothing else oh you're only 47 don't say that yeah 40 no 47 a bit over now 49 49 that's correct okay fine yeah are you do you need more intaclix sorry do you need more intaclix or does your gp supply it to you on the repeats normally I have to phone up doctor neil's assistant and phone a prescription I think I still got 2 months left good I so we'll see your blood test and then I can send you out a prescription with the blood test good yeah great great thank you anything I want any questions no I'm not happy really good thank you you know where to go for blood test I get the link that you need as well I wanted get a good blood pressure for that I'm going to give you an empty to 30 seconds plan we've all discussed so number 2 with blood tests recalculation of page please go ahead and guide hcc so let me follow-up in 12 months' time so number 4 blood test today addition of vitamin d and thyroid function lighter I had the pleasure of meeting mister carson's in hepatology clinic today on behalf of doctor neil full stop the consultation was face to face full stop <\n\n> He's feeling well and compliant with his entecavir therapy for hepatitis b full stop <\n\n> Reassuring that his most recent viral load in august 2024 was undetectable in his liver toxin tests so normal full stop <\n\n> He's very active and fit swimming several 6 times a week and going to the gym full stop he works in a physical job as a kitchen and bathroom fitter full stop <\n\n> Ecavir therapy seems to be going well and keeping his lfts under control we should recheck these today and he's gonna have some blood tests to recheck viral load as well as hepatitis b e antigen as I can't see we've tested this before full stop additionally, he should have hepatitis delta test also full stop <\n\n> With this with these blood tests we can recalculate the scoring system to guide whether he should be undergoing hcc surveillance full stop <\n\n> Additionally, he complains of fatigue and a balanced test on short acting this also look forward to writing with the results full stop <\n\n> We'll see him in clinic in 12 months time but he's always welcome to get in contact with us sooner if things change full stop yours sincerely