You feel like you're on the he would have been a 113 that then increased to a 120 to 1 and she had a month of iron before that yeah her ferritin was 37 transferred sats were 7% those numbers were pre iron pre iron yeah exactly yeah and then subsequent iron yeah so I think it got like 70 something okay okay we also had a recent investigation she had an ogd september 2022 was a: in march 2022 both normal but obviously she's young 4 5 5 6 2 1 sorry what are you saying no no that's fine so I mean I think I think I've probably been saying this over the phone but you know her blood tests are within the fluctuations of what might be considered normal fluctuations anyway if it was a 140 then maybe it would be a big response line you mean or yeah so she's not theoretically you're supposed to increment by 2 g in 2 weeks basically so she's she's not not that threshold and you know her ferritin has gone up a bit but not massively so they're they're I guess what I'm saying is even if she hadn't had iron those blood tests could be within the realms of what you might get just from natural fluctuations because how close they are to the previous ones great and she's also reassuring she had a colonoscopy relatively recently and a normal fit a normal fit so I don't I don't think there's particular concerning features or clear evidence of iron deficiency I guess well understand lots of tests yeah yeah doctor zasiga but she hasn't made any comment to say that the colonoscopy was spectacular seems like a good. So would you like to quit for the iva and to submit a biopsy guess you could set it you know if if you really wanted to have another oud we could do but it's almost certainly gonna be normal given that it's not even clearly ida yeah and she's had 1 not that long ago 2 ga oh it or the ga she's the 1 that I've tried on the station she's tried again for that yeah that's it that's the same day and so what I would say what I would say is our suggestion would be mhmm stop the iron and keep an eye on her what do we say then hemoglobin and ferritin and if she had clear clear future iga then let us know and we could revisit that but given the investigations you've had and the fact we don't think we've got obvious evidence of our efficiency we're not we're not enough it's not good enough to put it through further ga related procedures yes for a very low yield at this time so yeah obviously bit has she ever been iron deficient not I think she was on it I think she was is that why it was done before as well yeah it's just the colonoscopy and the hiv is high that's true she has lots of symptoms it could have been the symptoms as well 4 5 5 6 2 low normal but never had a low low ferritin and her so yeah I think I would just say there aren't okay anything ever to find deficiency based on the other tests and that we're not we wouldn't pose anything else but if you know maybe we would want to keep an eye and if she did develop it develop it then we would we would do that and change yeah alright that's pretty helpful thanks it's easy yeah doctor I'm go mhmm I'm go to the gonna I'm I'm to I'm to the doctor I'm go doctor make sure that's all you're doing I'm gonna go do that okay I'm gonna go ahead yeah do yeah I've had seen yeah yeah I've seen I've people taking within the right direction so I've people I've seen in more than 10 it's nice yeah it's nice there is the als is 90 increase but also definitely yeah the baby she might have like stool is blocked and with when she came in she have pain you should say epicardial pain great we're all there yeah sure thank you alright have a nice day alright we're talking about the rhythm that's the word we're discussing from the november 30 trevor cornish she's the first patient this chap's 38 he has small bowel crohn's disease he was the plan was his death plan was made back in november oh yeah yeah holiday and the plan was to restart so I just followed your plan and said we need to restart the infection reinducing him aren't we we are we are yeah that's fine he's had a caliper which is a 141 he's had some blood tests for a premium logic screen because I couldn't see he'd had 1 on our system does he he hasn't had a: does he need a: I don't he's I'll just have him see him in 6 months that's fine you sure yeah okay I said you might need to go to hospital here why does he need a colonoscopy he's not I can't see he's had 1 I just staged his disease but I might be wrong that's true I couldn't see it on ears okay yep so susan hello when she came for endoscopy back in oh I'm years yeah and then since he was 60 years old he must have had 1 computer it is oh I know she'll be problems in abscess abdominal pain auscultate mri scan neuroception diagnose him on it's late september 20 22 yeah she wants to go to the and she's it must be just maybe somewhere else okay so she's got any pain we might have diagnosed her by that aphasia there's no dysplasia it's swallow is that mhmm but sure would have had the solid before we started on things like incorrect I guess so in in some time so this it goes back before records again records began and then I'll discuss it with them when I see them I think it's 6 months for me mhmm sounds good we haven't done that for the last 5 years so yeah copy that back yeah it's true okay the next 1 vicky vicky are all follow ups mhmm that's fine thank you so you got vicky and your this number is your patient what is your appointment at the hospital patient number is 59481 oh there she is watery diarrhea since hemi collect bit of ulceration and anastomosis couldn't get in reactive so not again we met her first in january in february shortly I'm sorry put on I was gonna treat her back because she's at risk isn't she I've not previously been able to get it for and if not effective for creole because she has had low elastase but I suspect it could be dilutional sphincter of dysfunction where oh here yeah she was having some intermittent abdominal pain right upper quadrant abdominal pain which I wouldn't I'd be very careful painting anyone with that diagnosis no no it's okay once you've like she's she's got plenty of reasons to have symptoms doesn't she mhmm she's got right upper quadrant epigastric pain but she has had a head so shoulder blade seems to be scapular an anastomosis will be in her right upper quadrant it's a inflamed it's a bit inflamed I don't had that flexed pain on the back I wasn't trying to enable just was no trying to no I gave her some blood tests to say wouldn't have k in terms of her oh okay yeah yeah yeah I would just say guess I've I've asked you to get blood tests during an attack I was fine because once you no no I didn't no of course the diagnosis that you be trying to you'll be revisiting it so now we'll just go back to the time please mhmm the next time you have a severe attack please get blood tests and give them a prescription for the medical school or something like that generic is that okay yeah I can do that okay but how long are then 70 okay sorry and she only follow-up of course yeah when would you like to see her again maybe 4 months okay fine you can do you wanna edit that now or would you like to write it on her yep and this 1 is 6 months this 1 is 4 months is that okay cool and robert beard is on record beard website so I don't recognize all these names but I they're all follow ups so yeah I think you you probably will yeah robert beard is 03/2003 sorry it was a while ago so it's a bit my memory is not good on these ones can't tell you that here's his little spider so she looks like he's ulcerative colitis so he's doing well on veto assessment of the: being fine as well it's okay I was like we'd have a look mhmm this is of evidence have you previously failed to respond 6 or 1 p 8 6 6 to I can't let's do a little little of nice a letter yeah so you can see on the screen oh yeah yeah yeah a she very interesting case when she was there when she was on oh yeah yeah yeah in fact I remember she said that I sent the writers first and she'd write her up we got great pictures histology endoscopic pictures ct scan surgical specimens if you're looking for a case trial they didn't do it but she did present and we've got a bit more time now I've read 1 or 2 case reports about this similar thing but I agree if and you and the other edges wanted to write up we could just ask her permission so she came in she was on secukinumab and she came in with a very unusual segmental colitis or sigmoid endoscopically it looked weird it looked very beefy and red okay and the histology matched with the occasional case reports in the literature and she was extremely unwell so she had a sigmoid colectomy and then she did very well but since then she a few months maybe a year later she presented with ulcerative colitis there's a I've story to be told never seen that in any of the cases so it's a little twist on so if you and the other regist I'm not saying you have to but if you wanted to did though yeah I did look out for yeah it's an interesting case interesting case so by this. She looked like typical ulcerative colitis just see are the pictures there from her very first test there olivia endoscopic case notes report that's right it's a severely colitis oh yeah yeah so it's good pictures right it looks close to the foundation as opposed to devils yeah yeah sort of all it's an unusual there you go those were the pictures it's an unusual severe with an abrupt cutoff of bulb and flow did not look like ibd at all and then we have the full histology report from the excisional biopsy of course yeah and then we have the spinal so you know so it's a great case report because we love this what's the diagnosis so as you're saying there interrupt you guys want to club together and do a nice nice case report yeah we have a few years follow-up on this lady now she had secukinumab induced segmental colitis which is reported in the literature there's very few cases endoscopic pictures were weird histology was weird but in keeping with the existing literature but ultimately had a sigmoid colectomy so we've got the full surgical specimen and the next twist is that a few years later she presented with very typical ulcerative colitis and end of the case report doing well on upadacycline brilliant yeah great and doing well on upadacycline yeah so ckm for rheumatoid thing she's on for x bond x bond isn't it yeah so if you guys wanna write a nice little yeah case report a good way of being maybe a little short 1 with a few pictures for frontline or something like that let me know yeah inside view isn't that what it's called something like that yep and there there'll be there'll be a ct scan there as well brilliant with nice juicy sigmoid on it that's that's very impressive she's doing well she's a bit constipated she's opening her bowels once to twice a week passing her 5 1 stools draining at it I've given her some gentle laxatives right some some you know laxida golden linseeds kind of thing yep gotcha checked her fecal calpro which she hasn't returned yet she was slightly anemic on her last blood test but I've rechecked them and she's now normal her abdomen's normalized and she's not iron deficient do we see her in a year's time given she's doing so much or would you like to see her a year's time yep okay that's fine same for mister b he's doing well yep thank you erin and then erin valko our patient number is ready 1180213 thank you oh this lady I tried to call her but she didn't pick up but essentially I don't know if we need to talk to her she's got a polyposis condition with multiple serial sessile serrated adenomas from 2022 she had 9 polyps all had a plastic 1 adenoma excised previously and she's waiting another call waiting for a coma in g 26 and I'll request it for her is that okay lovely job yeah +1 238558 thank you crohn's disease 20 19 89 operatively managed oxymfleximab anti thyroid intolerance and on human being yeah how's she doing she is doing mhmm somebody stalls 6 times a day yeah she's a you talked to her about bile talked to her about bile because she yeah has had right hemophilectomies and I and she said blood test levels fetal calves and her tummy we talked a lot about but she wasn't keen she wasn't keen because her bloods are a bit irregular I suppose and her antibodies are still negative that's great levels and she's got good drug levels and the calpro is less than 26 this is an activity isn't it okay she's got a little she said she gets a lump on the side of her abdomen I was gonna ultrasound that I don't think it's gonna come with anything and quite a bit so okay that's perfect thank you for your time let me just move on andrew patient number is 1 35 time zone 9 013 9013 yes he has time zone and so there's a medical symptoms he is a gp he's a gp trainee he's living back in malta now oh really okay yeah I phoned him in malta had a lovely chat with him he was in malta and I'm waking the guest back to the uk oh gibraltar sorry you're in gibraltar I've never seen territory so there's information on on him he's never less time yeah he's he had actually mild to moderate changes in the: and the ileum he's yeah a gp trainee he's not on any treatment okay we have we need to scope him again this year when he's back okay yeah that's fine yeah he's in his schedule a monthly intermittent festival 9 18 months ago I was there with my wife and kids who came from ann arbor and we had a nice little chat and then he approached me we were going he said could I get a lift home with you guys and I said a we're not going home and b it's me my wife our 3 children I can't lie unless you wanna come in the rest of the holiday with us what was the festival that music festival yeah I did family yeah friendly wasn't it oh nice patient number is 663 yeah 547 emma lewis has been referred to us don't know if you met her before oh you did vomiting so yeah you may have a catamenial oh didn't turn up you were managing her for cyclical vomiting syndrome yeah exactly but then it was mostly around her the dka. So it does and there is a there is a thing yeah just a little bit she has seen some people from gynecology unfortunately she turned up she was in terrible pain she turned up she was lying on the floor of the waiting room oh no we carried her into the dining room saw her head oh wow oh gosh she's been back and forth for 8 years I'm sure you can see in november 3 times had less yeah with abdominal pain big intestinal which I mean the only organic pathology we've seen is this fluid filled cyst with possible hemorrhagic clots and I guess I wonder whether it maybe relates to her kidney because she's got something gynecological wrong yeah so I spoke to gynecology and asked whether they wanted to admit her they didn't want to admit her but they saw her acutely in 1 of their clinics and did another scan yeah alright yeah so I messaged you on my side was happy to she came in to the hospital to the country she's got space by now she's they gave her methenamine gas and she was upset about her ppi and then discharged a lot of pain when I saw her yeah course but it's essentially I don't I don't think she's got maybe she's got severe vomiting syndrome but her pain seems to be predominant practice as opposed to vomiting it seems as though she got pain and then vomiting as opposed to vice versa so she's been in done blood they examined her they put her on some mace she's had a tv uss which didn't show that it was an organising hemorrhagic cyst on ultrasound and they started on some guidance on treatment so hopefully it'll be effective but she did look yeah like she was in a lot of pain when she's why you write her put her on top just no only today so 6 months later I'm not talking yeah mhmm yeah or with the if it were I I hear what you're saying but it's kind of a long term problem difficult to understand exactly do you wanna send her because just you're allowed to say that so was I've been drinking yes mhmm reassuring bloods etcetera yeah actually it was on call of course that says positive reassuring bloods piffing 74736 I'm gonna start can can we see everything you got access to my birth plan yeah okay I'm actually going to see him but let's talk about might have a good if he wasn't on the clinic they would have taken him off the screen you so wouldn't do the measurement I said you were in cardiology ward to catch up that mild left sided ulcerative colitis so you wrote in for a follow-up so I said fine follow-up routinely when you're feeling better I hope that's alright +1 91 +1 91 what a great number justin doctor edna carstow oh this is the fisherman from bricksen from bricksen were talking he was seen by you initially obviously you were concerned about inflammatory bowel disease and crohn's disease this guy I remember seeing him in clinic like on 4 occasions and saying you need to come in for surgery and he was literally sitting there going no no I'm fine I've got a big job tomorrow you know and his wife was looking at him going mhmm and then he ultimately comes in and cancer poor child anyway yeah so he's under cancer follow-up with doctor he's in with doctor ross I think he was referred back to clinic to talk about the underlying possible diagnosis of crohn's disease because some of the biopsies from the resection show chronic inflammation in areas not affected by malignancy but I think if you've got a malignancy in your terminal ileum you're to have some inflammation that's right this is crohn's disease worry I mean people are going have to think of it cancer we don't think so poor fellow yeah poor fellow alright he's gonna sell his boat to the sadly he's I'll do can't do the fishing anymore but he's gonna see out the past season he says a lot of his that's true yeah poor man what are the chances of that 6 1 8 3 7 6 and all the clinic letters from oncology are just dealing with all this uncertainty that would basically the impression you get from the clinic is that they've never managed this before they haven't really had any data any drugs no idea no molecular markers no other choice ticrohn's 2022 the fco bloods mri follow-up in 6 months so yeah yeah robin she's got ticrohn's from 10/2022 she's currently managed with infliximab and and azathioprine she is doing well in terms of her bowels once every day every other day but she tried to increase her fiber and she got pain after eating oh okay so she did bread they down again yeah I told her to dial it back down she had an mri in 2022 and she had some possible stricturing active inflammatory disease mild stricturing without pre synaptic dilatation true just wanna make sure that she's still there don't know no fair enough I think that's she's she hasn't had a scope for 3 years mhmm that's true active disease around the time of diagnosis and I guess it'd be nice to prove even if we don't think she had we're restage her restage her yeah so that's rather nasty so and she hasn't submitted her fcat then so + thank you that's really helpful yeah that's really great thank you karen gregory +1 28128 3364 3364 okay so let's write your last letter mhmm last time egi symptoms it's regarding this lady's got patient initiated this is the lady with the long covid it's a huge number of symptoms we've got all the wrong with that yeah those you know usually they don't say I can't have sugar and there's sucrose in the coating of the pill I don't know what you do with that it doesn't really hard yeah really hard victoria gray instead 744166 looking for salivation and you saw her I see he said she's been under service an issue for her hypersalivation yeah some bowel symptoms build her business she's she's the 1 that owns the care homes she's having a really stressful time she's very intense okay and she is she's got upper gi symptoms with the obstetricians yeah she's got variable bowel she's got ibs given her some ibs I suppose leo newman is the guy there was a bit of traffic about him wasn't there doctor exactly right leo's young isn't he he's 20 maybe doctor yeah his number is 766465 he's young actually he was having a combination of upper gi symptoms and lower gi symptoms with loose and urgent stools with occasional blood and vomiting subsequently emailed to me and said he's very symptomatic mhmm so I said get nausea and coloscopy and you said I tried to get him to do that mhmm and I think fern he he phoned I was at clinic there yesterday fern said he's on the phone again said he's crawling around the place in pain let's do that then and I said to fern I'll tell him that we can't start that out over the phone you have to go to hospital know oh actually he was booked into a hot clinic we'll see fine so have a look there you may have been seen a hot clinic subsequent to that review endoscopy currently oh no twentieth of the twelfth so he's coming in into endoscopy on the twentieth of the twelfth and then he came in on the sixteenth of the twelfth he's coming in for you've seen it come in possible on the tenth of the twelfth good so he's finally come around perhaps yeah yeah good so your honor if you just want if you can add a note onto there and do that so he's subsequently come back so just just about the end to say subsequently symptoms worsened he was seen in a hot clinic and endoscopy has been arranged or something so he seemed like he was really struggling but I there's no matter I could do to convince him unfortunately think he'd had some previous ones on the ga he's only 21 and he really really really didn't wanna have it done as an urgent basis had the scopes the his notes will be fired up to me again to look at the ocular care okay okay anne evans it's at 541 yeah 539 39 2 inside go inside open so I could see if I can connect okay some constipation yes pelvic floor does probably mean irrigating getting bleeding after that and you were concerned about aerophagia okay so she's on the right side her symptoms are unchanged essentially she gets upper abdominal and lower abdominal pain a constructing pain when she opens her bowels it's temporary I think but then it occurs 5 minutes after she's variable bowels brain injury type 1 or type 6 within a week when she eats deep she finds her symptoms are worse reflecting her full chest pain so I think there was concern about constipation and pelvic floor dysfunction there's also concern about aerophagia and anxiety so again I can see she's had she went to derephed in 2024 and had celiac artery stenting for celiac axis stenosis oh really okay and then she her symptoms recurred the year after mhmm and she had a ct effect showing no cause for her symptoms but I she's got a stent in her celiac axis and she's getting in pain after eating I guess it makes me consider whether she could be having a recurrence of coeliac plexus I think it's unlikely sounds like the well helped temporarily then just over a year later she had a recurrence of these upper abdominal pain symptoms after eating they said they're not doing anything it was all pain and working and they had no problem with the stent at that time I must admit I had my real lack of knowledge about this in terms of what happens she's had her stenting done with my ir at darafid write back to darafid and just say that her symptoms are worsening and she's worried that she might have that the that the stent could might be issues with the stent it would be great that you could see her is it is worth imaging because that's what she's you're going to get a ct for starting let's this wait for the ct report I haven't booked it yet but I was considering doing that's fine go ahead and book the then we can make a plan yes please I'll book your own key then has constipation she is not responding to normal length to usual laxative 6 monocort she's got a skin on the face glycerin support mhmm it might be a good candidate for for the candidate she's still got a variable doubt I take but the question I had is about the background attack at sibo cardiomyopathy been investigating for ischemic heart disease awaiting ct coronary angiogram I think it's okay she said yeah yeah I would go ahead great anne evans or something as she said earlier okay I don't know I vaguely remember her from like 2 years ago yeah so if you so is can you your balloon / have you fallen out yeah we'll wait ct ct start putting it down brilliant and would you okay it's fine my signature picked that up no was gonna send you the copy of that letter for me to track the my section of the card yeah and when I stop it if it'll if I request it come back to me as well so okay great yeah so we can basically write it down I'll take the policy here oh sorry the same thing the same thing on the gown no can't make sure you're unsure symptoms of it's usually it's difficult can't 0 9 use the thyroid a sense he will have it but I think sleep restrictions can be helpful so this gentleman a nice man he's he came to the end of my clinic he's an editor he's very young he's very intelligent he's a new patient that I met him at the time of a bowel cancer screening and doc oh yeah so I I I said before so he had incidental finding of pileitis yeah so said he's 61 time he had a pile of 6 ulcers in the distal ti measuring up to the morning he had a neck ti sometimes he took some biopsies which showed large high blood pressure other areas of the brain which causes inflammation lots of stuff out there with tenderness yeah and you could see me with crohn's colitis yeah so right doesn't want it to recur doesn't want to see anything else I'm concerned about bowel cancer I said I would start of managing the hygienic or we could prefer it and so I could this is mister sutton isn't it so I would do f renal calc and then yeah that work yeah then do an mri or or I'm doing a colonoscopy we can reach it that's true you know yeah + or - colonoscopy thank you is what I would go for I can do that is that okay of course thank you and because we can reach the area so if the mri comes like if we just didn't I don't know not good the mri's normal it might be reassuring but he's very symptomatic so my next question is symptomatic oh really no he's got no symptoms sorry I should have said he's okay he's fine just do an f cal yeah he's got no symptoms yeah do the f cal and if the f cal is elevated mhmm then we need to find out well is it crohn's disease mhmm so I would therefore go for colonoscopy so we can get tissue yeah yeah fine and also we can reach the area mhmm you know there's a other possibilities then would be an mri scan would be useful he doesn't have any symptoms at the moment we're looking for subclinical disease well and if we if we ultimately confirm he has crohn's disease we might get a routine mri just to help stage it out fully mhmm but we get not very bad yeah and then if we if then if his so let's say his f cal is dilated he has ulcers in his ti but the biopsies don't show crohn's disease mhmm still work on crohn's disease usually we don't then I guess we've got 2 options we could do an mri scan which will shows either any skipped lesions are there any typical appearances for crohn's disease then we could review the mri and the 2 endoscopies that look at mdt and so to the consensus here is this early crohn's should we start neuroblastoma or if we have a raised fecal count to withhold the I guess the other test because it's a small yeah so if we were trying to build a case that this crohn's disease sorry sometimes you know a capsule we have criteria for making a capsule diagnosis of crohn's disease so if he had a capsule analgesia that he's got like extensive enteritis chronic enteritis that looks like crohn's would probably get a start on treatment then yeah great but I would start with fecal plan sounds good thank you yeah that's good to do the last 1 feel up for it yeah let's go yep yeah the first 1 on this list is call bennett is it 952931 no problem bennett thank you are you okay prabh that yeah I'm still gonna do that so benner has it come through already so mister benner has chronic so I think he's chronic abdominal pain enormous this is 1 of doctor bat's patients okay I just put him in as an extra 1 when he's on when he's in clinic already yeah he'd rather not be 324265 erica heartburn gourd dysmotility sjogren's dry mouth heartburn symptoms despite 40 mg twice a day and chest pain about barrett's I'm sorry about barrett's let me have a look at the pictures again and the biopsies were normal so I reassured her yes she just did not have barrett's and she had write that on ph studies yeah I reassured her again and then she has had a year now she says of yellow foul smelling oily floating diarrhea she had a colonoscopy which excluded microscopic colitis last days which is unusual 7 3 just low yeah but she has had excellent symptomatic response to crion therapy have we given her a she that's a good question identify the new diagnosis of pancreatic exudus yeah we should make sure she doesn't have some fib march oh yeah great she said pancreas pancreas or prickle no focal pancake think she's concentrated and she's had good symptomatic improvement to her creole does she need a prophylactic effect well I don't think she does does she want another 1 more thing well she's honking at so I told her she doesn't have barrett's mhmm but she gets this oh yeah you have a look she gets volume reflux booked her for a gastroscopy she has yeah she yeah it's fine I just got it yeah sorry yeah it's fine no she gets lots of volume reflux she gets heartburn you know anyway next patient it's steve terlickowski steve terlickowski yeah 486094 48609 he's a lady yeah think I remember steve who had a different she has ah yes this lady she's got chronic constipation since 2014 she's had multiple laclopride so she tried linaclotide in july 2024 I was gonna try prucalopride I mean similar I guess the beauty of prucalopride is you can uptitrate a bit more so she said she feels constipated over time doesn't have to last for a week or more and then also she said she pushes on her stomach to try and drive stool downwards then she has to rush to the toilet the moment it drops into her to her blood she says blow down she feels it drop blow down she has 2 children she had her pityostomy instrumentation I guess I wonder whether there could pelvic floor dysfunction or dyssynergic I usually refer those patients over to the pelvic physiotherapists in the first instance and let them decide if they think a dpg would be and and pifu then is that yeah that sounds reasonable okay yeah I can roll 1 again oh gosh you met christie christie good or bad let's find out that's 1 370-3030 christie you fix 1 thing something else happens I hope I haven't tried to fix her then I see extremely I doubt it very well so you didn't attend that clinic with you but then came clinic and dialysis director's done yes so yeah she has got so many symptoms yeah she just sat down and just shouted symptoms at me says this constellation of symptoms which is my way of saying just was nonstop symptoms yeah 2 to 3 months sweating sweating itching fatigue dry mouth can't get bloated she's so tired seems all the discomfort so joe it's interesting with with percy so she has some children single mom mhmm and she would always come under all these awful symptoms not be judging her mhmm then she had an operation then she came back to a new partner she came back and she'd lost a little bit of weight botoxed hair dyed you know I mean she looked like a completely different person wow looked like she'd on like extreme makeover and she was what you know with with the new partner and then they wake up you know I don't know well maybe they did but I remember because for years she was like this I could never fix her and then she comes to a different person so she'd always sit in the chair and go oh I'm so terrible and then she walked into this like a clinic like she owned the place you know to which sat up told me about her symptoms doing great no problems she went it was like how interesting like a different person you know so so I guess there's the there's the mitrait stuff I mean I guess I just did some standard so I'll just refer back to them to ask them to see her again this twisting feeling around her stoma okay so routine bloods stoma nurse review she was having nausea and heartburn had an ogd had an ogd okay and she's continuing to use lupidofacial cannabis for the rectal stump sure perfect I think a lot of christy's symptoms are driven by stress and anxiety yeah right the feeling that her life should be okay yeah I'm sure alright jackson okay 704731 okay I would have sought nigel in the past where he's been managed with a nightmare history of watery diarrhea the consistency can change usually mushy at that time it's 3 to% query post from infectious ibs for possible weight loss or possible ibs he's got another scope he was trying the probiotics that he recommended and he found those that maybe that he recommended and he found them transformative he said he tried some probiotics and I don't think he recommended sorry I think nigel recommended some probiotics and he found those transformative his symptoms were much much better but then following his colonoscopy think he wrote to him and said see that you've started on probiotics wasting money your stools don't float I don't recommend taking probiotics you just discontinue it no it's not worse you've made it worse you're public enemy number 1 I'm just going to go back down to bromide I've said you take them if you want I don't mind I don't think we have any evidence they work but if they work he's been great and then I said we discussed a repeat colonoscopy but I think I don't think we need to do it at the moment and we've altered the bowel preparation so it's so too he's going to go back on the probiotic he feels better I don't know which probiotic recommended to be useful there there is a few probiotics that can be helpful yeah there's a mutaflor for ulcerative colitis proven really yeah very effective mutaflor what's called isil 0 1 6 7 I think mutaflor m u t a f l o r mutaflor thank you yeah e coli nissl 1 9 1 7 hard to get it's only made by 1 company in germany wow you have to order it from there but they've done several good studies full roll streptomyitis amazing yeah oh yeah yeah but but you don't think much sorry it's very specific probiotic so apparently as effective as mesalazine in in rcts but she was a there's another probiotic that has got some good evidence for histamine intolerance but it's very difficult to prove histamine intolerance I've had a few patients tell me that they've gone with this prolactin intolerance and their symptoms which may look at your histamine tolerance got a lot better good so I don't know if nigel recommended that doctor just mention the histamine intolerance there and think that's yeah some calories history intolerance is a whole other discussion to have 1 day that's fine dan jackson so he's going to go back in his probiotic I think he broke his probiotic I think he's got post infective ibs he went see me in the legs and the leg district he had a fecal pout 108 and it was normal again yep and yep I broke him back so I'd say is there any danger with I mean I think he will go I tried to discharge him but it was really keen to see us cool so I'm just gonna book him back again and I think at that. He should be discharged is that okay right could I just give you again I don't mind well look you've already told him I know he was really keen yeah I tried to discharge him I didn't think he could have ibs so the next thorogood thorogood mhmm 652749 susan thorogood so various problems yeah previous investigations you've been doing bowel still suffering with your bowels urgent and soft bowel movements in 45 minutes of open meals you've said you've tried colesevelam she has got a variable bowel habit 2 months she's still regurgitation and somewhere and a bad week 10 times a day passing types of stools significant leakage it's about 3 to 8 times per day normally passing loose but sometimes heart and stool she has a lot of urgency and she's using imodium but actually I think looking at her scan is she's very loaded mhmm I I think you can look at the pictures if you like that and she's had a previous operative management she had hartmann's before she had a fistula and perforated got a palpitations actually I had a vaginal fistula when she was in spain so we don't have any documentation about it but unfortunately but that was the documentation okay so you guys to me it looks be yeah like a transition. Me see let has she had barium barium swallow looking at her swallow let's see maybe I'll probably do this as well and most likely of it it's also what recommendation her endoscopy there's loads of right sided stool yep and then they had so she had deep transverse loaded as well then over on the left there's some loading but then and it just stops about 1.5 fluid or secretion and then it looks quite decompressed down to our rectum yep and we scoped her before she had had an endoscopy it was a clear stricture that was done by doctor bat pangular articulosis no fistula cutaneous instability but look at the pictures what about this look at this this is the anastomosis okay it's a bit blurry alright yeah okay and I wonder whether an anastomotic stricture could be causing a kind of pseudo obstruction type picture yep and causing constipation I was gonna chat to the x-ray meeting about that yeah let's do that look at the pictures they didn't feel that suitable then maybe I don't know I don't really know what you do about anastamotic stricture can you dilate it endoscopically yeah we've got how long ago was that scope she thought that was about 10/23 so we why went don't we look at the organs so x-ray ndt + or - repeat repeat scale structure yep and she had a full colonoscopy last time at the right bit so mhmm helen scheperson schmidt scheperson k so that was the recommendation here at ogd so there is a suggestion of clearance for and gg is normal so suggestion of clearance for oh sorry we're on a 9538 symptoms only related to severe rash 68 5 a lady with ibd is awaiting sodium docusate so for and stuff so she crohn's disease from the age of 22 I resected my hand collecting in 1992 and then she had a ga using senna t and it's changed her life I think she comes in her wheeled wheelchair she loves senna tea she's fantastic I've never had it before but it sounds great will use it can I have cup of senna tea she has 1 cup of 9 and just sorts it out who doesn't like a nice cup and eyelid eyeliditis on an mri do do endoscopy no evidence of iodine endoscopic image 2025 eye and lasting prophylaxis is completely normal so I've got eyes I get an increasing population of patients who are eyeliditis I know me too in the last few clinics what's causing it to retrial arthritis I'm gonna look the gynecologist in plymouth with terrible endometriosis for which he's awaiting a is that ileitis 's on mri actually just a little bit of endometriosis adhering to the ileum causing a thick oh no could maybe yeah all could be in need 1 2 3 colonoscopies yep procedure relatively normal mild and nonspecific ulceration in 2021 the other was normal you have a caliper as a normal she opens the bowels yeah 2 to 4 times some days with pain and when she opens the bowels it improves her pain she feels full bloated sometimes they're type 7 but other times they're type 1 and 2 okay symptoms can be she's constipated and she's got bit of overflow she's got some right upper quadrant pain looking at the imaging I think she looked at it constantly well she like problem she doesn't quite fit have you thought about taking tea very good it feels like diverticula to me it was so hard reports and then I had I talked about any laxatives or stool softeners or she's right earlier before sarah the decapeptal reduced to slow down her heavy periods but you didn't I didn't think there was discussion about how to have it at that time maybe she didn't offer it so we're going to take a gentle approach a bit of soluble fiber a of soluble fiber fiber gel adequate hydration is important too + or - senna too I said I've got the senna game oh yeah gone for senna completely I think I was just on the senna roll fine that's fine fine too and I was gonna take me out of the same place because I don't think I don't think about you don't think you can manage it be convincingly demonstrating any evidence of if she doesn't respond to simple laxatives why don't you please if you a if if you would like a routine routine appointment appointment to to your clinic the patient is contact for a second because they don't know whether to work for them urgently or routinely nice job what a role appreciate it how's the referral physiotomy of 10 to that's 10 to 10 about your fingers for some reason thanks doctor have a nice weekend you too very good thanks so I'm that so I'm gonna add more information what was I I I do speak because I say you know I do speak like 5 to 10 minutes okay I have also this is all clear you can that I need to in the patients who don't have ibd yeah is of the most option yeah it's a very professional it's part of the simple approach that's a fucking idea I couldn't believe it every single patient resolves to find a gel okay it's like a little bit of stretch we're making it so that I suppose thank you is that right there that's what you're talking about so you can set the language so you're looking for yeah do you need to say too heavy so she she was defunctioned she she she doesn't really remember she was having a problem okay good then I'll arrange to the sack of those savings it's a watery boy into your sleep really feels as good no no I just this is the watery boy hospital number +1 356249 date of birth 06/21/1953 <\n\n> Cocktail letter to patient gp <\n\n> Dear mister dan, <\n\n> Booked a colonoscopy for you as we were concerned that you recently stopped your vidolizumab and your calprotectin levels would show inflammation in your: came back as slightly raised full stop from our? Of view we think this is a good test to look for any signs of inflammation and whether you need to be treated again for your inflammatory bowel disease full stop I can see that you're hesitant to proceed with the colonoscopy full stop I can also see from my previous lecture that you were relatively asymptomatic in terms of gi symptoms full stop think it's reasonable if you do not want to proceed with the colonoscopy at last for in time for us to see you in clinic and then we can discuss it at the time full stop paragraph I have arranged a follow-up for you in doctor braxton's clinic hopefully over the next few months full stop thank you kind regards doctor golpip you quit mate what it's it's have to be quick when it's done oh fuck did I put like all sorts of shit in your desk I did like colonoscopy for 1 of his id patients or something like it's the letter or the reports the colonoscopy report is a little confusing I think it was confusing I mention that exactly I mentioned that that was a 1 mm polyp a 3 mm polyp and then another 3 mm and 1 of the polyps that was talking about wasn't polyp because it was a mucosal prolapse and then the other polyp was a tubular adenoma and then there was no histology for that 1 it's okay let me click on this button I even printed all this like in literally of the whole clinic I just wanted to see 1 patient he's actually gone he's actually gone