Gastroenterology doctors nice to meet you how are you yes thank you I'm sorry to hear you've been opening your bowels a bit more than normal for the last few months is that right since we changed your medicine to a different 1 or a branded 1 unit yes it is rushing to the toilet or is it before to the kitchen no it was really bad what happens to me with that barbecue unless should never have happened in a million years since alright it it was somewhere on let's go 3 other all water all right hospital wait did you temperature it yeah at school and watery stool right how many times a day and if there's lots of pain already really and that is why then clearly you've got and you were still taking the colesevelam yes yeah but maybe not not enough or well it wasn't working because it wasn't working was bad and they said oh give it a try I'm not a quitter but if you start taking a tablet that you know is gonna cause you a big bigger problem into its permanent no be stupid to take it yeah fine so what yes so you stopped taking it understandably because it was making things worse you thought yes that's the only time I refused but the doctor came hey I know and any tummy pain very uncomfortable and tight too and any bleeding from the bum no no good alright no has that pneumatology the result of your ct scan no that came back because the doctor he came in and he said oh don't I I said I've I've already been that's good and and he's ordered for whatever it is I'm gonna need and then when I said to the lady about it she said if it's on that it will be ordered and you will be given it so yeah the medicine yeah yes and then has anyone told you the results of your ct scan no no your scan doesn't show anything worrying or sinister oh good good it shows that your the: the large bowel does look inflamed in a few patches yes a ct scan is not the best test to look for inflammation really no but it's does show some signs of inflammation and the markers of inflammation in the blood are also up yeah I wonder whether having a look with a limited camera test a flexible sigmoidoscopy while you're in hospital would be sensible mhmm just to make sure that the crohn's disease is effective mhmm obviously we thought we treated your crohn's disease with the operation that you had which removed the bit that's most commonly affected by crohn's disease yes but crohn's disease can do funny things and it could cause what's going on and it could cause the findings on your scan I never had a problem till I was given till we switched medicine yeah that that medication fair enough and and that is god's gospel truth yeah no I believe you didn't have a problem and I think we've switched you back yes to the other medicine now good and are things better since switching you back well because it's only been done because I asked and I've just got people haven't seen these before they're from because it you'll get it okay great don't have to get it that day so and if you but you haven't got it yet to be known no okay so we need to get you now don't we and do you take the tablets or the liquid is it the sachet you mix with water or the tablet oh no can't deal with that 1 the sachet is horrid isn't it yeah good I was gonna say I've always had the tablet good let's get you the tablet brilliant okay so let's restart your tablet and let's see what happens to your bowels if your bowels go back to normal then you don't need an inpatient camera test we can get you out of here and bring you back as an outpatient for a colonoscopy if you want to have to have that yeah and and but if your bowels don't get better with that medicine then I think we should have a look as an inpatient is that okay yes wonderful that sounds like yeah because you know to me I I I just want what's best of course and we need to talk better teeth fat or it's wonderful of course no no completely I want to make I want to make you feel yeah I've got to run away and she's definitely coughing up the age of 4 we're we're not gonna talk about that yeah I am absolutely sore okay I have to put down on to examine her she's elderly and thin sat in her chair 79 year old lady with past medical history history of age related macular degeneration copd rheumatoid arthritis osteoarthritis crohn's for which she had a right hemicelectomy and leg ulcers she still smokes once a day lives alone and a 3 times a day package of care she's quite clear that her symptoms started only after her colesevelam was changed to a branded version biles of absorption would cause these symptoms but improves rapidly the colesevelam and other binders but bile acid malabsorption did not explain her ct findings or raised fecal agrotectin the ct shows colonic activity but she's not had this before and it would be uncommon to present at this stage of life ct commonly overcools colitis due to wall thickening but increased fecal caprotection is a concern I'd suggest restock her to send her out with the bowel habit returns to her normal then she could go home I'll review the images with gi radiology to ask him whether the findings are of colitis if there are signs of widespread colitis then we'll do an outpatient: if there's only sigmoid thickening that we need to investigate associated with the diverticular segment then we'll do an outpatient flexi and if the symptoms are not improving with conocevimab then I would suggest an inpatient flexible sigmoidoscopy if she's gonna be in hospital anyway doing an inpatient flexi would be reasonable to exclude any cause for her symptoms should have it in I'm glad you say goodbye lovely to meet you I hope that you feel better great take care thank you