Next patient joanne lavner 285438 kevin how hello I'm welcome to the gastroenterologist trust nice to meet you yeah how are you I'm good thank you what do you do at the trust work at maternity down at the maternity oh cool yeah and you just snuck away yes that's good how are you feeling you alright yeah not too bad yeah yeah I'm okay good I'm glad your bowel's doing okay right the only thing tell me I'm still noticing is I'm bleeding lots and and I bleed I mean we're talking lots not just spotting at all mhmm which is fine I think it's probably internal hemorrhoids I'm bleeding but okay we're talking about a lot how about like a cup have you got pictures I haven't got pictures at I've got pictures because I wasn't so worried about that because I still do think it's probably hemp okay I know I shouldn't be self but I've got pictures of blobs that I now see sometimes so so I've that no it's fine I have people bring me tupperwares don't worry I've got them hidden because every time I sort of like so I've done a few over the last month just to show what it what let's do it alright so this is 1 of them I'm sorry that's so these are over the last month so that wasn't so bad with yeah I don't that was again this 1 wasn't that was just I think gunk whatever this is more recently and it's always on the paper do see it in the toilet as well well the toilet's just full of red yeah yeah this is this is the last 1 this was a few days ago oh no that's the last 1 a few that's just that is enlarged by the way it wasn't nothing I was just trying to get at the of course so yeah so yeah it's fine and how long has that been going on for well it's the bleeding probably bleed more than I don't I think the last time was saturday mhmm months now 6 months or on and off with yeah yep yep mhmm but I can have weeks a week 2 weeks without it and then all of a sudden it'll come back mhmm and so I'm like but I have had this on and off before mhmm it's those bits that I'm thinking yes yeah what what is that more I don't know it could be stool I'm guessing from internal part yeah it could be it certainly looks like bits of stool but coated in in blood doesn't it and but most of it is just some of it isn't stool it's just the blobby mucus kind of yeah stuff yeah yeah that's it yeah and do rush to the toilet no no I mean I do have to go to the toilet but that's more about diet and what I eat if I eat too much fiber it's not good for me I eat eggs sometimes I need to like go within 20 minutes mhmm and that sort of thing but I'm that's normal for me like that's normal for you yeah mhmm I haven't felt I felt that I'm just I'm tired but then I'm eating quite a lot so probably mhmm but I'm not yeah I'm not too worried about I don't think I did have a test recently did you yeah and of course it came back with bleeding mhmm so I did come in to see the nurse did you see yeah mhmm and I spoke about it and I went yeah it will be bleeding because there's blood in my brain constantly so we decided not to go with a another colonoscopy mhmm and that was when you saw the nurse here when was that in december or I can't remember october this year february was it february yeah fine okay february 24 okay and my sorry go on no please my biggest concern is my my more weight than my cancer my worry concern probably a bit saturated is so I wasn't well this time last year was feeling quite bad and I had a polyp in my duodenum which they took out at plymouth yes and they said oh it won't be fine we're gonna take it out just because it couldn't grow but it wasn't growing for years blah blah blah but it had grown quite substantial from when I had it stand here mhmm from 1.5 and then in 4 months it had gone to 2.2 mhmm which I thought was quite a lot is that are we are we comparing the findings on the imaging well I know that's what they just told me it was 1.5 and when I fine but but they're not gonna which is fine I don't and it was fine it wasn't cancerous or anything which is great he took it out fine mhmm yeah and I was and my symptoms are gone since then but they're not there's no follow-up so it was an incidental finding so I'm thinking and all of this in the last couple weeks I've started burping again which was 1 of the things I had horrendously last year when I wasn't well and it's not normal for me the burping mhmm but that's so that's more my concern than the bleeding fine okay I think and what did your you had an upper endoscopy is this another colonoscopy mhmm what's yours it's doing quite well to be fair and do you have it taken out under general anesthetic or do they just yes yes yes that's nice it's quite nice isn't it and then do you add and he said and I just thought they would perhaps follow it up okay I know Google isn't your friend I do work in this department yeah he does I've stopped doing Google no take it but they sort of they say that if it's growing that quickly then they would expect you then to have follow ups mhmm mhmm and because of the original size of it and that and and it's no like follow ups goodbye sort of thing which is fine if that's there's obviously a reason why there's no follow ups and it's fine but I'm just thinking okay so how do I know if it does come because they're quite comfortable about that I think so it's it's difficult for me to say concretely and give you a huge amount of reassurance because I don't have the histology from derek and I don't have the sample that they took off but doc I'm I was working with doctor cochrane a couple of weeks ago and he would usually take a very big margin so he he takes a lot of these off that's his specialty yeah and he seemed so it was 15 millimeters when we looked at it yeah but to be honest when we measure things I'm sure as you know you know we're looking through a camera we don't have a t measure it might get quite a bit we have a look at it and we think well it's about 15 mil right but it's entirely based on this more than we don't have a tape measure now so it could have been there for years 22 for the whole time okay that's that that it's changed that rapidly because it is slow growing and I don't have the histology to oh a tubular adenoma with low grade dysplasia and it was taken off with emr so so what he what he did is inject underneath it yeah to lift it up yeah and then slice the whole thing off with a margin and you can and there there's no high risk features and there's a good margin with with what he's told us in this letter so it's been completely removed right and we would normally follow-up single polyps with a good margin with low grade dysplasia that's fair and I as I said I think that the 22 mil 15 mil thing think is just what the difference between someone in a laboratory with a tape measure looking at this sample that they've sent to them and saying that's 22 millimeters because I've put it on a tape measure yeah versus us with a camera saying that's about 15 mil yeah does that kinda make sense that's not yeah total sense yeah yeah so and and like I say we wouldn't normally follow these up and no you know there it was unlikely to cause you any problem but we'd see it so we yeah would take it off yeah that's a sensible thing to do and you had a ct yes entrogram didn't you I did which was a ct scan with contrast where we looked at your small bowel and we didn't see any other polyps there which is really good so I think all of that from my perspective is very reassuring that's okay and I think if it were me I wouldn't go and have another endoscopy just to make sure there wasn't anything growing there because I think we could all have them and they might not cause us any trouble a b you don't have any because you've seen it on the ct scan and c it was completely removed with a good margin and there was nothing sinister in it so I think I hope that's reassuring and then in terms of the bleeding and the lower bowel symptoms what should we do about it I don't know yeah fine have you had any weight loss no mhmm fine nothing at all your weight's static good do you have a little sticker did it when I spot 1 got sticker thank you a sticker then you go great so we can have a look at that but then so you haven't had any weight loss no but you're bleeding more often than not yes and good volumes of blood by the sounds of it yeah mhmm have you got an itchiness down there or anything like that no fine do you feel anything on the outside when you're wiping there might be no I have some skin tags but I think I've had them for quite a while yeah yeah fine so I I guess the sense this is the prudent thing to do is to look isn't it you last had a colonoscopy in december 2023 2 years ago you we didn't wouldn't necessarily have to do a full colonoscopy we could if you it would reassure you but we could have a look at a limited camera test where you can have an enema before you would need to have the whole and low residue diet diet thing okay that you normally would not have to do for a colonoscopy we could have a look with a flexible sigmoidoscopy just at that left hand side of the: okay it only takes 15 minutes or so okay and then we could make sure that there's nothing else there that's bleeding yeah in terms of another pulse there in term would they see if I had that yeah internal pulse we would see exactly which would also reassure us exactly why I had 1 last time but they couldn't come back saying they'd seen anything mhmm it was it was in the caravan that they watched it yeah but that it was so painful I've I've had 3 now and my god I never fainted oh I'm sorry no it was okay maybe it wasn't there but the only part I'm sure it wasn't because it was in the caravan but it wasn't it doesn't help though doesn't it the caravan it wasn't the best no it definitely it's not the worst situation I didn't think you did them in the caravan anymore but you know it was so painful when you were passing out which is weird did you have any treat any you had some midazolam and some fentanyl no I was oh yeah I really was well I was really sick I I went all a bit weird mhmm okay sorry we can like I say it doesn't have to be a full prep and we could be a bit more gentle oh yeah no no don't worry about that not doing the camera most importantly yeah it is what it is it's just really weird that the other 2 I've been dreading especially the first 1 mhmm and I hardly felt a thing was it was say lovely but it was lovely compared to what I was expecting yeah of course and then that 1 was like oh my god mhmm but they never came back and said whether or not there was internal piles no and I think a lot I mean a lot of what we what we see and what we look for is what the indication is you know in this in this situation we did say we did say there was rectal bleeding but we have no comment upon a cause for rectal bleeding they had some we had some biopsies for everywhere we took off this polyp polyp in the ascending: all the way over here it's not gonna cause fresh blood to come out down here right so that's not the cause of of your bleeding and I think it'll be good to find out what it is because if you had big hemorrhoids we could treat it you know you could have it handed or injected or something like that which would improve your symptoms yeah and if you're feeling fatigued from blood loss yeah it'd be nice to get it sorted wouldn't it shall we have some blood tests today as well and make sure you haven't become anemic with with this bleeding does that that sound alright that sounds fine yep anything I've forgotten or anything any other symptoms no no good so I'll check your iron levels and I'll check your b 12 and folate as well while we're here just to make sure that there's no other causes you're anemic and then are you taking the mesalazine yeah still fine are you finding that helpful yeah yeah I've just yeah I might just take it just take it I always yeah I've got a friend who's really really poorly with this so I always feel that I'm fine mhmm do you know I mean what does your friend tell oh she had crohn's she's she's had her bowel removed 20 years ago so she had infusions every 5 5 days a week now wow so okay so she's when I see her I think yeah mhmm you feel yeah I feel like this is not I'm yeah the only thing this does is put my health insurance up when I'm on all day like the other time yeah I'm not more busy but that's fine I I'll I'll put up with that yeah no so I I don't feel mhmm apart from the urgency sometimes to go and that but I'm used to that I don't yeah mhmm okay alright and then have you had some stool tests looking for inflammation recently if your bleeding is going to change oh yeah back in may 2024 they've had 2 tests that were that was okay that's yeah no that's when I was in trouble and I really did feel felt poorly back then oh yeah in february it looks like it was quite high yes and then got dramatically better yes that's good sure yeah great so I think we're investigating the bleeding with a back of a sigmoidoscopy some blood tests today to look for a cause whether you're anemic yeah and if you are what the cause of that is and in terms of the colitis the inflammation which was on the right hand side of your: which we saw previously previously yeah it's you know you've had those 2 stool tests that are negative if you are having some urgency it would be sensible to check again to see whether there is any inflammation that looks at inflammation in the whole: not just you know the bit that we're gonna look at with our flexible sigmoidoscopy yeah so we could have a look at that with the stool test and see if there's any activity in your colitis no and I guess if that stool test came back raised it may be proven to do a full colonoscopy but why don't we cross that bridge when we come to it does that sound alright yeah don't let me go ask you at the medicine medicine is just helpful so yeah the medicine I really did you really last time you you just run it yeah the bowel prep oh yeah it's everyone says it's the worst thought I was not I'm not keeping down if I'm doing the idea but mhmm everyone says it's the worst better I think there's a I don't know when you last last had it a couple of years ago we have changed our prep have you we I don't know if you remember the flavor the orange you've repressed the more yeah the orange yeah we were using the orange for a while but we've stopped using the orange and we're now using mango uh-huh or something like that apparently it's people prefer it the first 1 I had I didn't feel was that bad okay and I think they've changed it from then the next 2 I did I think you're right yeah and I will we've been going through a few lately started and it was like oh no alright but hopefully we can avoid it we'll do a so what sort of time scale is the well list is it anything like that well have you got any trips planned yes when are you going away weeks tomorrow 2 weeks tomorrow fine okay I was gonna if you're having rectal bleeding I was gonna book it for you 2 week wait right so we would hopefully get it done within 2 weeks if you wanted to get it sorted before or I can say you're away for 2 weeks and book it after that might be the worst right I'll book a 2 week wait and then when are you away again I would go 2 weeks on october on the october 21 for how long for 2 weeks great I'll let them know go on take your your stats shall I go and have a glass of I mean have you gotten there any questions and if I have to need taken for blood smoke no no I've sent no thank I'm gonna fill this in and bring it back up I've read it back to the notes alright thank you so much good this 1 that we do blood tests on yeah