Next patient catherine mitchell 7 84 +1 56 next patient catherine mitchell 7 84 15 6 have the same diagnosis symptom complex as the letter from december 2024 but we could add number 6 h pylori stool antigen negative at september 2025 fecal calprotectin undetectable september 2025 and then <\n> Number 7 ct colonoscopy virtual january 2025: attended the department however examination was not performed full stop this 1 here says you have fallen on follow-up face to face at the telephone clinic and on the back here this bit this bit belongs to that 1 I just didn't know whether you had to because that is a bit tricky because it's got face to face and toe far too tricky for me yeah so especially because I only read the stuff at time see someone shouldn't have highlighted that it says telephone and there's the bit it belongs to telephone oh thank you so yeah that last one's the face but this one's so your penultimate is telephone thank you so much alright lovely do you want to cup it to you with coffee I'd love a cup of coffee yeah think white with sugar white without sugar k thank you so much catherine mitchell's hi sorry I've got my glasses and I've left my prescription glasses it's fine it's very bright I see it's very bright in here it is yeah okay just give me that thank you I'm rob I'm 1 the gastroenterologists nice meet you nice to meet you how are you yeah not too bad good I'm glad good tell me all about it how are feeling so things have settled I had a really bad flare up on the day my daughter's my daughter got her gcses so it took me about an hour to get home was in a lot of pain when all carrying gas everything same symptoms as before yeah same symptoms bloating yeah belching belching mhmm like a cram like my chest like mhmm I would imagine it would be like a heart attack feeling mhmm that's how it felt and I couldn't actually drive my car was thrown up into the bag I actually said to my daughter thought we might have to hang an ambulance but I really didn't yeah I managed to get home and get some mebreverine in me and then that sort of eased it off this was the day they collected their gcc results that was that months ago a couple of august august time mhmm like august 21 I think something like that mhmm eating is terrible so I can't eat any foods of gluten in or dairy I you from eating those yes symptoms yeah so if I eat anything too much of gluten or dairy it makes me really sick and then I can't eat but other than that everything else is sort of similar to how it has been before doctor wright has put me forward to the cardiology team just to check my heart okay and I'm still getting pain when they took my gallbladder out really mhmm and that is quite a dull pain and I don't know whether it's something to do with the gallbladder being taken out and all because it all seemed to have happened when my gallbladder got taken out and then I had about 3 months it was amazing no pain or nothing and then after that it's all flared up again mhmm so it's just been a bit of fun shame and have we checked your fecal elastase it's a stool test just to make sure we have and what happened with this ct virtual colonoscopy I think we planned so the after looking was it okay the colonoscopy and got halfway through it so it's okay it's fine sorry oh no that's important talking sweet tea it you're well you're having a nice nude thank you thank you there you go and he's good as well you know you're this is after our doctors here in her history the colonoscopy they just got the con I couldn't handle the pain I like literally I was in so busy bad day I just said stop it the pain was horrendous and I'm very good with scans contrast I've had it all mhmm and when you had the drip of the contrast it was really painful is that what what happened or no no it was when they started putting the gas in of course and I just couldn't and that was the same pain what I get when I get the cramps okay so I think it triggered a bit of my ptsd anyway because I've got so much house stuff going on but it was horrendous yeah oh god I'm sorry that sounds awful yeah some people are very sensitive to that stretching feeling and some people are not some people's: stretch it for ages and they don't have any problems and some people are very sensitive to that sensation very well anyway yeah sorry but anyway she's right over the top of it it's fine but yeah that was horrendous and I don't I think doctor back just said to leave it then yeah he was just saying well we'll just leave it I think the chance of having anything sinister in your lower bowel is close to 0 at the age of 38 know you know the chance of it is I think there's lot of followers because of all the breast cancers that I've had mhmm so I think they were worried obviously about secondary you know all that sort of thing but everything seems to be quite settled on the cancer side yeah and then it's that's still going strong and you had a recent ct scan not just looking at the: but looking at the rest of the tummy that was fine back in september so a year ago fine and I've sent 2 stool tests off last week I don't know if they've come back yet I have seen them so you had the h pylori stool test which is looking for the bug that causes stomach inflammation that can cause your symptoms that's normal but it's not detected and the calprotectin test which is undetectably low that looks at inflammation in the bowel so you haven't got that either which is good good there's no sign of bowel inflammation or that bug causing it so I wonder if it is just down to the gallbladder mhmm and the digestion type of thing and food mhmm I don't know what it is it's hard this is why they're gonna have a look at because those flare ups are horrendous mhmm but they haven't been going on as much so since I've been on the mebeverine that has helped so much good fine I would say that has made a big impact good and how about the nortriptyline if you try I'm still taking that so I'm taking that 2 tablets every night 2 to 3 tablets because it does help me with sleep so it depends on my sleep and and that's improving things yeah fine yeah but it hasn't got the only time it got worse was back in august where I had a really big flare up and then all my other flare ups are just basically more 0 and max without the pain mhmm it's the pain that is like crippling mhmm of course but yeah I don't know what else it could be yeah of course think annoyed what you described that these stereotypical episodes that then get better with meveverine yeah associated with stressful situations like your you know like your daughter getting your gcse results and this dietary association all sounds a lot like ibs and I think that's what doctor bout was thinking as well from the letters and often the treatments like madevran and nortriptan can be really effective and just using them when your symptoms are there or using them all the time are you using them all the time I use them all the time yeah and sometimes I'll only take like 2 meverens and then if I start having a flare up I'll take another 1 and it does help so is like god's sake yeah it's not a really terrible term but it's they do just help yeah and I I mean bad pain is often bad ibs it's it the pain is is more likely to make it ibs than something else okay often people who have no pain are the people who have serious problems and very much difficulty in terms of cancer in the bowel and things like that they rarely get pain whereas people with pain we find it although it's horrible for you we find it quite reassuring because we think actually there's probably nothing serious going on here in terms of something that's gonna limit your life or anything like that I did say to doctor wright think I'll get discharged today because I don't think there's anything else really more that can be done mean there are wacky things weird and wonderful things that we don't do in the nhs that some people find helpful especially when there's an element of that ptsd in the background as you said yes things like hypnotherapy people can find to be really helpful have you tried that before I just don't think my brain's clear clear clear I just don't believe in it all and I think the thing with my ptsd because it's medical related every time I try and get into therapy and move on I have to have some calcium like february I had to have lungs taken out I've had an operation every year since february 2020 so I just it's just ugly mhmm I just think it's just I think my ptsd with my medical keeps me alive because it keeps me on track yeah okay like before the reoccurrences and the amount of times I've gone to the doctors and they've been like oh no it's nothing I'm like no you need to biopsy it and then it's come back as cancer so of course I've done therapy and that but it's mhmm it's hard isn't it and I think it's just 1 of those things mhmm especially when you're in pain because it does it heightens your stress response definitely and then the more stressed you are you think there's something awful going on and then the pain gets worse and it's a really vicious cycle definitely yeah but reassurance is really helpful yeah definitely and I think because it's settled it was really bad to the. Where I just had I couldn't keep anything down mhmm and now I've managed to learn different foods which don't trigger so like I buy everything with no gluten in and mhmm you know keeping fruit and veg and stuff like that so yeah my diet and that side is okay mhmm mhmm great fine alright brilliant I think we can I think we can discharge you as long as you're happy with that yeah that's fine yeah yeah that's brilliant thank you so much for seeing me I'll fill this out that'll give you some good reviews oh thanks especially me I knew you bye so client discharge from clinic number 1 number 2 if loose stools predominant symptom could consider trial of bile acid either eg conocephalam