Mister taylor martin t a y l e r 977538 come on in and see you oh thanks thank you how are you yeah good you yeah really good you've been working today or not yet yeah just went in got a job to do for my dad so just at 1 of his properties so I'm just there and then go back there after he keeps you busy does he yeah he does yeah yeah but yeah he's just doing a lot of my own stuff as well so okay yeah and then on wednesday so on what holiday on wednesday so where are going gran canaria oh lush like weather from my thirtieth though oh great yeah oh lovely nice yeah great who are going with just my partner great yeah she said we wanna do a quick 30 if not like not for you really yeah go to the sun yeah good idea can't believe in that nice are you going to do some stuff there like water sports yeah that was our first holiday over there we're going to they have quite a few different excursions and stuff we said we'll have to do a couple more to what I've got over there good he's a guy where we're sort of staying there's a guy that has like a thing to set up mhmm we just went to him last time so we'll go back and see if nothing new brilliant yeah I'm sure because you got everything there haven't you you got the sea you got the mountains it's just lush yeah there is a place that a partner wants to go it's like the sand dune you can like watch more sunset and all that sort of stuff that was very romantic exactly yeah fair it's a worry isn't it yeah I'd rather be having a beer in a pub when they start talking about that you've got to be worried know I'll be yeah exactly yeah how are your bowels yeah not too bad been like sometimes sort of hit and miss mhmm sort of thing but I obviously I can't remember when I got diagnosed with it but k obviously probably january I like sorted myself out basically yeah ate like as clean as possible mhmm obviously never gonna be perfect sort of thing you still have like your little enjoyments yeah of course but and there's no real evidence that big dietary modification makes much of a difference no really so obviously you know I I obviously looked up and obviously tells you ones to try and avoid but the the thing is I I looked at is that the things it was telling you to avoid are the things that you should probably avoid in general yeah the fatty foods the processed the beer yeah the fizzy drinks like you shouldn't need anyone would say you shouldn't really have it anyway because it's not good for you but yeah obviously just for us it's obviously on a bit more of a bigger level it can affect us more but yeah yeah but I I from like january I sort of lost quite a bit of weight but I've been a bit naughty over the summer with the beers and that I've gained a little bit back on mhmm yeah other than that just sort of yeah sometimes I can I was out on saturday and had a bit of a funny time my stomach was just cramping but yeah other than that try and just sort of be as good as possible yeah and but yeah not not really any some some days I wake up yeah tell me my stomach just from when I need to go toilet you can kind of tell from so you get up first thing in the morning and need to rush to the loo not all the time but my my my partner even said to me the other day she was like like I have sort of stages where I'll be like oh I need to go but it's not like oh I feel like I need to go to the toilet soon it's I need to get there I need to go now yeah but then obviously I kind of realized there's certain things that I shouldn't eat sort of thing like spicy foods is the 1 that affects me the most if I have something sparse I used to eat quite a lot of spicy food mhmm see I enjoy it and if it's spicy now tips you off yeah that's like where that's I kind of started to realize there's certain things mhmm and like beer and that I think it's just kind of it can it just gets me bloated and can feel a bit uncomfortable but yeah yeah other than that it's not been too bad just trying to laugh at myself the best I can really yeah good good can sort of sleep for a minute isn't it and how many times a day do you go for a pee all varies really I guess because like funny enough the other day I I didn't remember going for like a whole day okay but then I probably went like 3 times the other day mhmm sort of thing over the weekend so yeah I'm not like sort of I would probably average like 1 to 2 a day at least normally like on average sort of thing I'd go with yeah but yeah sometimes if I do feel it come on I'm like I need to go but not all the time sometimes like but yeah more probably than most is the sort of mhmm I need to go now yeah yeah nothing too major sort of thing okay great trying to like I say keep it under control yeah and you find like fatty foods spicy foods make things worse is it worse in the morning or not really so spicy foods the next morning the next morning you suffer mhmm it's like and the stool isn't it's not solid or nothing it's like you've proper affected my bowel yeah it's just yeah it's sort of like yeah it's just there's no there's it's mhmm no like sort of form to it it's just a mhmm rum sort of thing but that's also that's what I found the most it was the spicy food I think that's sort of like yeah like the fatty stuff and all that is it's not always just runny but it's not it's like it was it's not sort of like a nice solid sort of thing but yeah it's just like flopping in between sort of thing like but not like there's never really no like struggle to pass or anything like that okay you never get constipated it's normal not really not really sometimes like if I when I'd in like when I said in january I was like clean off of just sort of out of no alcohol just water sorted out looked aussie up and I was just eating like the sort of like chicken and sweet potatoes for like lunches and that taking in and heating it up and obviously at that? Like my stomach was like spot on mhmm so I'm trying to keep that up obviously through the week obviously I think at that. Because I was kind of like stepped away from most like no takeaways nothing obviously I felt like my best but obviously like you say it's alright but is it it's not like sort of keeping it up for a forever so it's hard to keep it up forever yeah so I think it was just as everyone does in january yeah christmas has been yeah and that's where the main reason I did it it was at christmas it was I my stomach I was really having some problems really like cramping mhmm sort of and that's when obviously my partner just sort of said well we need to just kind of give it a change yeah so then I did and now I know sort of like mhmm it's that that's alright for me mhmm just try and keep it at the best I can yeah I still obviously have the beers on the weekend if I need to like sort of I mainly actually only have anything like if I'm like I went out on saturdays with my friend's thirtieth sort of thing like it's only the occasions and if I've gone up to like watch the football I've gone on holiday sort of thing do you know what mean but other than that yeah I just try and sort of clean the cramping stay away from it as much as I can obviously 1 knows over the summertime when it's hot and you wanna sit in the garden and have a bit bit exactly but yeah other than that yeah it's not too bad the cramping yeah and stuff like you can sort of feel like in your stomach it's doesn't feel right mhmm without going to toilet sometimes then I know alright like I may have like a episode of going to the toilet but other than that yeah I can kinda try and keep it as I can so yeah good so it sounds relatively manageable doesn't it yeah for the minute yeah like like say I I have my my ups and downs on days but like sometimes I'll even not have anything that I wouldn't think would agree with me and you're still sometimes I'll still like really my stuff I don't know if that's just some but I don't know if your stomach obviously just is kind of everyone's bowels very to an extent yeah exactly and you even though like you say you might have eaten great for a week or whatever it doesn't it's not to say that your stomach's not gonna have an episode where it's uncomfortable and you don't pass like you're solid sort of thing but yeah and the when it's bad the episodes are cramping pain loose stools and urgency is that is that sort of like I was I'd say along those lines yeah I think obviously after I got diagnosed it was sort of of cutting things out but wasn't like perfect and then obviously like I said every christmas I think obviously as you know christmas time it's just there's chocolate everywhere around the house and you go around like your parents and then you wanna give your food and then so yeah it's 1 of those I think yeah in christmas time it got bad with like just sort of having beers and that because everyone wants to go out and celebrate and then I think that's when yeah sort of and obviously now I know sort of what's good yeah it was I think over christmas it's when it the cramping come on when my partner was just sort of like so actually my sister's got it as well yeah so is she on treatment for it yeah she injections or infusions or something well I don't know if she can you take is it tablet can you take tablets yeah she she had she her bowel perforated oh right so she she's had an operation yeah yeah that's well she ain't never knew she had it until then and then I think she come in in like november couldn't find it and by february yeah they had to remove part of it and right she yeah so so yeah I think she's always sort of been on medication because of it they obviously managed to reverse the and put it back and obviously she hasn't got a bag anymore so I think she sort of struggles with it more but maybe that's just because it wasn't found as obviously she went through probably the worst of it yeah whereas obviously for me obviously when I started having problems sort of like mini episodes leading up to going to the like obviously local gp like sort of thing so like I don't feel great before I would have probably not really bad night if what I would probably add something that can agree with me obviously with my sister and what she had it was like well I can't sort of like mess around a bit yeah of course if I told my mom that I a bit having stomach pains and didn't do anything she would have wanted yeah 1 she'd been livid yeah exactly so fair enough good so I guess what could be causing your symptoms is see this is your: yeah yep and this bit here the last part of the small intestine is that bit that's inflamed for you yes and it's the most common site affected by crohn's okay so this just last part where this imagine there's all this small intestine here and then leading up to your stomach this part is the bit that's inflamed and that's the case on your mri scan as well as your colonoscopy is this spot and that spot is good for lots of things 1 of the things that it does is absorb bile so when you eat something your stomach is distended and stretched and in response to that you release a substance which causes your gallbladder to contract so you've got your gallbladder sat above your liver here like a pouch for storing bile and it will release bile down your bile ducts and into your small intestine which is just next to your right and that helps you digest fat when you eat fatty food your gallbladder will contract more but that bile is very is a real laxative so when it gets into the: it's irritating and the: hates it I know and so the role of the terminal ileum the last part of the small intestine is to absorb that bile and absorb bile salts and it's really good at it but when it's inflamed it doesn't it's not so good no it stops being able to do its job and that means that some of those bile salts can sneak into the: and when they get into the: the colon's not happy you can't absorb them and it contracts spasms you get pain you get really loose urgent stools and then you pass a very loose stool yeah and often people will say the symptoms are worse when they have fatty foods that aren't very good for them yeah they're better when they have clean simple foods so there are various things you can do about that 1 is carry on a you know low fat diet mhmm which can be great some people choose to take medication for it and they say I'll have a tablet that I can take that binds bile acids so you have it once a day or twice a day usually people take it at night the symptoms usually worse in the morning yeah and overnight it binds the bile acids that are sat in your small intestine and it means that you're bummed up a little bit and bile acids don't get to that: and irritate things I'm not saying that's definitely the case for you don't have a good it sounds like it we don't have a good test for it no so we have a good treatment but we don't have a good test okay so the kind of the treatment is the test so you could try it for a few days it would have an effect instantly if it was the cause of your symptoms and if it makes your symptoms better then great you carry on taking it if it doesn't make your symptoms better you could stop it and say that's not for me and I'll just carry on my you know cleaner diet mhmm to my symptoms it may be worth a try okay yeah you can go to grand canaria and go for a meal with your partner you know have to stop your thirtieth birthday and be like today is a cheat day I'm gonna have a nice meal with my partner I have a couple of these tablets and that should stop the symptoms not something you take every day so some people take it every day and some people don't you can't take too much of it no so if you took it every day that'd be fine and some people say I'll just use it when I get particularly bad symptoms although I know I'm gonna go and have fish and chips yeah exactly yeah she's well no I'm going out for a couple days of the weekend with my friends you can you can take it right and and that might make your symptoms better I'm look I can't promise that it will though because and like I said I don't have a good test I can't tell you a 100% that's what's causing your symptoms that sounds a bit like it and it might make you feel better and it's unlikely to make you feel worse so no exactly yeah it makes sense it might be worth worth a try mhmm yeah yeah that doesn't mind you because I mean you're you're going out on your thirtieth birthday it's you don't wanna miss out on nice nice things do you just no exactly yeah so if it I was gonna say obviously if it was an option I would have just said I'll just try and be go back to strictland because you some like sometimes I'm 1 of I don't like to rely on mhmm I don't wanna so I'll take it when I need it if I know I've got something coming up but I don't like to I'd rather try and like sort of like put my mindset into I can make myself better by eating better I'm not saying I'll take a tablet so I'm not gonna go out I can I can be naughty I'll just have a tablet and I'll get takeaway every other night yeah it's obviously the only way you're gonna make you feel yeah you're gonna feel yeah and obviously you just benefit from being healthier in life in general yeah you do it's good having a good healthy diet is gonna benefit you in more than just your bowels but at the same time life's all about compromise isn't it it's about bowels so if you've got something like this that you think yeah alright I can I can be a little bit naughty today and have some beers around the pool and whatnot thing there's no reason why that like you say if you can't it's not gonna affect you so exactly and if it doesn't work within the first couple of days stop taking it because it it won't make any difference it's not the kind of thing that builds up you have it it stays in your bowel it binds the bile acids in your bowel and then you put it out so you just take 1 so yeah you the the dose is 1.25 g that's 1 tablet mhmm I've said 1.25 to 3.75 g so that's 1 tablet to 3 tablets a day can have yeah you can have that in a day if you're taking just the 1 obviously just have 1 if you're taking 2 I'd have 1 in the morning and 1 in the evening if you're taking 3 I'd have 1 in the morning 2 in the evening 2 okay but anyway yeah that's probably better more effect in the evening most people have their symptoms in the morning when because you're not eating at night so your body's bile's still coming out a little bit dribbling out and it's obviously sort there's nothing to soak up bile gets into your: that's causes terrible symptoms so it may be worth a try but I don't think the activity in your crohn's disease is causing your symptoms because it sounds so variable so dietary dependent and there wasn't significant activity on your mri scan or colonoscopy no so it's all quite reassuring given you've got crohn's disease should we check your blood test to make sure that I'm right and that inflammation isn't causing things is that okay yeah then I can get some blood tests from you today and I can just keep an eye on that to make sure you're not becoming anemic or anything like that that can sometimes happen with crohn's disease yeah and you have that amnesia like low blood counts sometimes people don't absorb things very well okay because it got better just make sure that you well yeah I I lost the weight just got like I said I was eating clean when I was going to the gym so I think I I lost like 2 and a half stone I think I was at like 15 and I dropped down to like 4 12 4 but now mhmm probably gained another stone great with just just because over the summer yeah I'm enjoying the summer it's been a good summer I've gotta enjoy it yeah and the problem is like obviously me getting to stage now everyone's getting married everyone's I'm so I know yeah it's tough oh yeah yeah it's tough it's a tough age you've got lot of weddings coming for you I'm sure yeah well like now obviously you've got your tablet good work I've got all your brothers my brother's obviously weddings on the 20 fifth okay so yeah I'll just take 1 of them hope so really do it'd be really good to get it sorted because we're aiming for perfection we just want you to feel completely normal yeah and can I ask you for a stool test as well a stool test yeah just to see what that inflammation level is like it was slightly raised last time see if it's come down at all from when you last had them in january is that alright you can just have to do it yeah yeah yeah when do I fill it with pee you can do it anytime if I'm asking you to put on on command no no no that's fine yeah what I might just give it you can give it back to your gp and they'll send it to us you can bring it to the hospital if you're nearby bring it up here or to the bottom downstairs they'll take it off you and send it to the lab okay I don't if it works for you yeah yeah amazing the goes on the pot obviously yeah yeah that's fine yeah awesome I was and you just get get me at the hospital pharmacy which is just outside the big gray acute medical building it's on-site okay I don't know if you ask at the desk I'm sure they'll be able to if I go down to the main reception they'll like tell me where to go yeah okay exactly yeah yeah yeah if you go yeah if you go to main reception they'll you where to go it's better to walk outside the main entrance of london's hall it's on the right just near a and e no okay yeah it's fine no worries alright yeah and what now I'll just sit outside and record the blood I'll show you where the blood tests martin taylor 977538 let's the gp talk to the patient have the same diagnosis symptom complex as the letter from doctor bat from july 2024 and? Number 4 possible element of bile acid malabsorption trial of treatment with colesevelam october 2025 <\n\n> Examination weight 89.15 and <\n\n> Plan number 1 trial of conesevelam 1.25 to 3.75 g per day in 2 to 3 divided doses for suspected bile acid malabsorption due to eylea crohn's disease <\n> Number 2 if not effective can stop colesevelam <\n> Number 3 follow-up in 12 months time or via the ibd helpline in the interim if worsen and number next if becomes significant symptomatic from ti grades then consider a course of budesonide <\n\n> Dear gp I had the pleasure of meeting mister taylor in gastroenterology clinic today on behalf of doctor bat full stop the consultation was face to face full stop <\n\n> His bowels have been hit and miss recently full stop he has a significant improvement in his symptoms around january when he changed his diet decreased his intake of fat and alcohol however understandably things have slipped a little since then full stop he finds that spicy foods and beer will worsen his symptoms as well as fatty foods full stop some mornings he has to rush to the toilet but other times he will open his bowels once or no times in a day full stop some days he might open 3 more times full stop he's never constipated full stop paragraph previously had some weight loss but this was intentional and is based way back up to his previous levels full stop <\n\n> He has a holiday plan soon to grand canaria for his thirtieth birthday and obviously avoiding all fatty, spicy foods and alcohol is a challenge when one's celebrating one's thirtieth birthday full stop <\n\n> I explained today that I wonder whether some of his symptoms may be driven by a bile acid malabsorption due to the low grade inflammation in the last part his small intestine full stop I've explained that sometimes these symptoms can respond to bile acid binders such as codicetilam and I've given him a prescription for a course of this today full stop I explained that if they are likely to improve his symptoms this will be relatively rapid I e within the first few days of taking them and if they're not effective then he can stop them full stop he's not taking any other medicines that might interact with this type full stop paragraph I hope that the cocephalym improves his symptoms then I'll arrange to see him again in clinic in a year's time full stop if in the meantime, if his symptoms deteriorate, then I'd encourage him to get in contact with the inflammatory bowel disease nurses or myself via the secretaries and we can see them more urgently full stop you also see anna could you add to the plan blood test today and fecal calprotectin today thank you so it's the sixth attempt 25 it's my registrar of 50 2 it's the consultant so investigations may have been treated we'll be worried about things that are happening so cp so I took a simple x-ray infusion alright have a seat archie thank you how are you feeling yeah not too bad to be fair good good luck wonderful good you feeling well yeah how you balancing yeah once once a day once a day perfect it depends what I drink for you really okay can affect it yeah I think it does for everyone really yeah curries and spicy foods and things like that and fatty food or what's along with it's fine alcohol is 1 alcohol yeah so if I have a night I'll I'll have supper the next night yeah slight curries they're okay I guess mhmm thai sweet chili crisps yeah they've gone up okay interesting so yeah certain things I just know that I can't touch so fair enough okay fine and but reassuring your recent stool well the stool test that you had from april showed there was no inflammation in your bowels then oh okay that's good and you had some blood tests at the september which showed your your level of inflammation in the blood was unresectably low okay which is brilliant as well so in terms of control of your ulcerative colitis it seems like obviously you came in very unwell yeah initially but but the treatment with infliximab and aspirin seems to be working really well that's good which is great isn't it yeah yeah that's good and you've now been in sort of stable remission as we call it for about 2 years now yeah I would say yeah that's good it's good yeah good so it seems I'm quite I'm I'm I'm quite good taking my tablets but I do struggle taking them on weekends mhmm it's just because like I'm so used because when I'm done work mhmm I forget to take them yeah of course less of a routine yeah but when I wake up in the morning the first thing I do is take my tablets regularly work yeah for the weekends I do find that a little better which I'm just taking my tablets what do you do for a living I'm a care assistant okay like at a care home or yeah in a care home yeah working with dementia so oh it must be tough yeah it's yeah really tough fair but I guess and you but you don't work shifts you work like in the week yeah I work every other weekend every other week so when I work that's hard yeah then you'll remember the 2 things tablets not on the sunday forget because I'm off sundays yeah okay fine I'm with you yeah I guess something to talk about is those tablets isn't it the antiaprine and whether you'd wanna consider stopping them or not oh okay so we know that so the infliximab is what's doing the job yeah the infusions or do you take infusions or injections I take the infusions the infusions yeah the infusions are what's doing the job to decrease the activity in your ulcerative colitis such that we've got it really well controlled okay but the problem with the infliximab is sometimes your body can develop antibodies and reaction to the infliximab it doesn't mean that you have a you feel terrible yeah yeah yeah but what can happen is the effectiveness of the infliximab can be reduced yeah to be fair like when I've gone through stages where like I'm actually going to take my tablets for 5 or 6 days in a row I'm like for example I'm taking my tablets mhmm but when I when it's the week that I have my infusion I do feel a bit ugh yeah I have my infusion without the tablets really fine so that would be it'd be best if I did continue taking the tablets it's it's completely up to you it's you know it's entirely yeah it's our our decision together about what we do about the tablets I don't wanna like not take them know gonna be getting berlin back here again yeah of course so yeah I understand the I guess the in the back of our mind the problem with infliximab is a slightly increased risk of cancer oh okay in the longer term oh okay so when people have been exposed to it for 5 to 10 years you've obviously only been exposed to it for 3 years now yeah when people are on it for 5 to 10 years we start to worry about that risk and as people get older over 55 obviously in your forties you're not there yet but when people get older we start to worry more about that risk as well oh okay because it suppresses the immune system your body's immune system is not just fighting bugs it's fighting cancer as well yeah and because you suppress your immune system your entire immune system with the acetaminophen it does increase your chance of cancer particularly blood cancer so that is the negatives of taking the tablet yeah although it works really well to dampen down the immune response to infliximab yeah so there's various things we can do about with the tablets you can carry them on for you know like you know at least you can carry them on for a year or so a couple more years if you wanted to okay but we'll keep talking about it about whether we want to take them off okay you can take them off completely and we could monitor your infliximab levels you're unlikely to have a a crash out in terms of getting your bowels as bad as they were before yeah what's more likely to happen is we start to notice that you're feeling a little bit more unwell and your bowels get a little bit worse okay and then because we're monitoring you now and we're we're keeping an eye on things when you come for your infliximab we might see you developing antibodies and at that. We can do things we can yeah I'm happy away dose change it switch to something else yeah the other option is half dose so you could have half dose of your azathioprine there's some emerging evidence that it may be okay not as good as full dose and not as dangerous yeah as full dose sort of thing so it's a middle ground option but it sounds like from what you said at the start you're obviously keen to avoid you know being as ill as you were before yeah and the safest way to avoid being as ill as you were before is to carry on as we are because I used be like 1 of the first people you'd probably ever meet mhmm but then that that up that ended up happening and I would say like I've not been 100% the same of course ever since yeah yeah that's fine because yeah I lost the ability of my legs strength as well yeah a lot of things happening with it of course I don't know if this is the side effects but since I've been on this and since I've had these tablets I've had severe backache really yeah very much that literally just on my spine like a lot yeah just above my buttocks like there and it's it's like when I get out of bed it's like oh my god I can't move and that only happened since I was getting admitted to hospital mhmm and I don't know if it's connected in a way it could be because we know that inflammatory bowel disease can cause joint inflammation at the same time okay the infliximab is usually very good for the joint inflammation associated with bowel disease but we could have a look at your back I'll chat to my colleagues in rheumatology and see what the best test is sometimes people do mri scans of the spine to look for activity and inflammation in the spine if that's the case that may be you could speak to the rheumatologists who get to that and that kind of thing yeah that would be great yeah I really I really do some of the bladder it's only been since I've ever been pearly mhmm mhmm so since you're admitted you have low back buttock pain yeah and it's worse in in in the morning when you get out of bed it's like a pretty much bed it hurts pretty much most of the day really our blood thinners doesn't hurt like I can sit down and I can lie down as soon as I get up that's when it's like god it reminds me do you mind if I answered this no that sounds yeah that sounds strange hello it's rob hi how's it going you alright I'm sure I have yes some can we put us have a look yeah is that okay per per day sorry yeah yeah he can he can titrate it yeah so you could you could yeah in an ideal world I guess you'd dispense him 3.75 but he'll know how much to titrate because he can do it to his symptoms thanks mate appreciate it cheers bye sorry about that no no sorry yeah you're saying you get your symptoms all the time the back of the symptoms yeah it's always there always there and that's why I'm just like it's I never had backache like this I I get backache sometimes because of the jaw bone the jaw bone but this one's literally just there always any rashes on your legs at all no pain in the small joints of the hands no nothing it's literally on my back speak to the rheumatologist they may want to see you in clinic or they may suggest doing an imaging test before in terms of scanning your back yeah that would be gonna let you know yeah that'd be great yeah fine great and then in terms of the act and things like that why don't we can park that if you want because that's probably a sensible thing to do especially if you've been recently poorly yeah you know it's all fresh in the mind and you're keen to avoid being overweight don't wanna get cancer of course not of course that's but like I said the risk starts to starts to come in around 5 and you're you know 2 years in 2 to 3 years in so you know the the lots of people are on it for 5 10 years have no trouble yeah yeah some you know some people who are particularly older worry when they get to 5 years but you're not in a particularly at risk age and you haven't been exposed for that long okay so I think obviously you don't get cancer but but I think at the moment I I sense from you that you're keen to have some stability yeah and that's absolutely fine okay and I'm not keen to change things okay what won't be sensible is to check your levels of antibodies when you next have your infliximab dose yeah and checking the stool test to make sure everything's still all well controlled it sounds like it is from your symptoms yeah but it'll tell us how the infliximab is whether you're developing reaction to the infliximab yeah and all that kind of stuff I think I've got an appointment this month anyway great to have the infusion yeah great it's fine months so when you go for the infusion have the levels taken before over the blood test before okay like a trough level I'll put it on the system for them to do right yeah no and then we can see that yeah and then we can take it from there and we can talk again in say 6 months time yeah does that sound good perfect we can see how you're feeling get the back stuff sorted and that may they may suggest switching to something else it might preclude all of our discussions anyway and we can see all the blood tests show yeah that'd be great doesn't it that sounds alright yeah yeah the back sounds really debilitating doesn't it yeah it is yeah I'm not a back doctor but it we do see a lot of people that have these symptoms associated with ulcerative colitis unfortunately it can cause joint problems when I started first getting the post I asked the people that it gives an infusion and they said well I don't think it's a side effect so I hope it's like it's not a side effect of the drug yeah it's an extraintestinal manifestation the ulcerative colitis can inflame other parts of the body not the: yeah so it's not that yeah so they're they're right in saying it's not a side effect but I guess it's a maybe I asked the wrong question but yeah but I guess yeah at the same time it's something to think about when you've got ulcerative colitis and back pain I'll give you another stool test is that okay I've got 1 you've got 1 yeah I've got 1 already but it's but I've come thank you for my appointment so that's great then I will if you're gonna have these blood tests done this month yeah you might as well just get them done there instead of you know what mean get it all done on the same day when you come in to get your trough levels I'll put some more some general blood tests to monitor your infliximab therapy in say getting jabbed today and then getting jabbed in the heat this time won't make any difference that sounds alright with you yeah that's fine and we've checked your cgm levels as well and we will take it from there yes which 1 did you take which infliximab are you on do you know the brand do you remember the brand name it's alright I'll start with azathioprine yeah the azathioprine is tablet and then do you know the brand name of the infusion oh I'm not sure it's okay I'll I'll look it up I can sort it out I will put them on system for me okay take them off alright oh brilliant great no thank you it's nice to meet you yeah you too you too I hope you've got some facts about I you should get an answer and yeah talk quickly yeah no thank you doctor no worries bless you bye bye you too thanks so plan number 1 copy letter to rheumatology number 2 fecal calprotectin number 3 infliximab levels antibodies and tgns at the time of next infusion as well as bloods including a crp number 3 follow-up in 6 months' time number 4 discussion regarding cessation of azathioprine