Jojo gilley 64524 8 9 69 year old lady investigation is carried on <\n> Hemoglobin a 118 mcv 78.8 previously mcv 84.9 at in early october and hemoglobin was a 127 at that time fit 13 micrograms per gram <\n> Transferrin saturation 7% <\n> B 12 and folate normal <\n> Ferritin 39 micrograms per liter <\n> Past medical history <\n> Borderline personality disorder <\n> Hysterectomy 1956 <\n> Bpd 2014 <\n> Osteoarthritis 2016 <\n> Type 2 diabetes mellitus <\n> Cervical spinal stenosis 2023 <\n> Schizoaffective disorder february 2024 <\n> Medications list metformin <\n> Lomeprazole <\n> Melatonin <\n> Laxido <\n> Neonophylline in tablets <\n> Prednisolone tablets 3 in the morning 15 mg <\n> Senna <\n> Bisocodyl <\n> Carbacistine <\n> Atorvastatin <\n> Crete d 3 <\n> Aspirin <\n> Cetirizine <\n> Pixelside <\n> Ibuprofen line clonazepam <\n> Codeine <\n> Prolia <\n> Salbutamol <\n> Ferrous sulfate started 11/22/2025 and welcome thank you very much I'm rob 1 of the gastroenterology registrars it's nice to meet you beth you too I'm tina hi tina I'm 1 of jo gilley's enablers oh thank you thanks for coming along pleasure thank you nice nice list of her medications super helpful thanks that's okay hi jj how are you tired diet sorry why are you tired I'm not being in pain makes you tired doesn't it yeah I like your christmasy jumper thank you I'm I'm rob I'm 1 of the gastroenterology doctors you've been referred to us because of low blood counts anemia and your blood tests what's your understanding of that has your gp explained anything to you or anything I've got covid but like from not any feces a tiny bit 13 of yours is and normal is less than 10 to get a referral for bowel cancer screening it would be a 120 so yours is only just above the line but there it is positive certainly and then your your blood tests show that you've developed a bit of an anemia low blood counts which might be what's making you feel tired can't certainly make you feel tired thinking back looking back at the november your blood counts are fine but if we look at it on a graph we can see that it's been gradually getting worse over some time yeah since our records begun in december 2024 a year ago it's just been trickling down over all that time have you noticed any bleeding from anywhere about 3 or 4 weeks ago bleeding a bit where were you bleeding from my bowel mhmm you noticed bleeding yeah and where did you notice it well I I got a commode home mhmm yeah and when it was on the paper or on the poo it was funny color as well funny color what color was it pale color mhmm and then you noticed bleeding not not not today not today but that was a couple of weeks ago you said yeah what color was the blood like dark dark like a dark reddy kind of color okay and it was on the poo or on the paper mhmm okay alright and do you strain or find the stool difficult to pass no not constipated no mhmm I was on laxido iu fine I'm not sure why you gave me your medications just so I just didn't look at it okay yeah fine so you're on laxido mhmm is that because you were constipated in the past yeah fine and I guess the codeine and all that doesn't help does it no no you're also on these steroids and some aspirin aren't you as well yeah yeah all things that can make you bleed a little tiny bit certainly irritate the irritate the stomach and the rest of you yeah and have you noticed any weight loss at all I haven't lost lately how much weight do you think you've lost I don't know head mhmm clothes are loose yeah we have pains here pains in your tummy yeah when do you get the pains in your tummy pardon when do you get those well it seems to be like nighttime I would say mhmm and what kind of stuff comes out when you poop is it very hard or is it soft softish softish okay and tell me about your life more generally you you live in summerford residential home is that right and how do you find that don't like it well why is that I just don't like it fair enough in a residential home I guess even if the staff are lovely they're not they're not mhmm why do you say that just the way they are some of them are just not as pleasant as you'd like them to be that's probably what it is maybe quite strong will aren't you yeah okay that's what I'm saying that's good yeah alright it's all in here isn't it yes isn't it yeah I can open the windows if you want yes please I might stay out there sun's coming out that'll be nice that'll be nice won't you I'm gonna get soaking wet today don't I yeah I will and do you always use wheelchair I mean it was mhmm is that because of your spinal stenosis like 47 mhmm okay I'm just not gonna say it lately I've been having sore arms and legs mhmm really yeah and that's why I just I tried to pull myself up mhmm and what happened I just fell back I'm sorry but being anemic and having low blood counts can make you feel weaker that's it being anemic slightly can make you feel quite weak generally yeah yeah and I know you've you've got copd do you smoke in the past yeah do you smoke now bad very bad right how long do you smoke for not at all I don't know if the other side is I'm not going now yeah okay I've noticed how long did you smoke for I was 10 you were 10 when you started wow it's been about 10 12 years since I smoked right then so 47 years of smoking is that fair to say or 45 years I don't smoke and how many did you smoke for that time about 4 or 10 days mhmm and how about alcohol do you drink I don't drink lovely alright thanks for telling me all of that about you I appreciate it so in terms of these low blood counts what do you want to do about it you've various options so the reason you've come to clinic is to talk about what we could do about it when you've got low blood counts we worry about slow drips of blood bleeding from somewhere and that can be in the stomach it can be in the small intestine it can be in the large intestine because I was lots of places that I had blood coming from my bowel mhmm and that's why it's come here exactly yeah so you've got low blood counts we think you're losing blood from somewhere there's and a suggestion that it's coming from your bowels there can be lots of benign things that cause slow blood loss in your bowels but there are also sinister things that can cause it cancer is a risk but I'm I'm so weak now aren't I I'm getting weaker and weaker I'm sorry it'd be good to get you some iron supplements to see if that makes you feel better I can you some so much no fair enough not many people do to be fair they're very constipated they do if you try taking it every other day yeah it can be really good for the constipation and the absorption is very similar the vegetarian as well and her diet's not very varied at the mhmm awful at that moment on my diet mhmm I did a thing a menu thing mhmm mhmm and they agree the chefs agree to do it mhmm but they don't oh I'm sorry they don't eat that mhmm and obviously being a vegetarian does limit your ability to have a huge intake of easily absorbable iron yeah you need vitamin c to absorb the iron from vegetables oh iron and green leafy vegetables are the thing that contains the most iron do you get many green leafy vegetables the only green thing I have is right they've got a good amount of iron in the sprouts sprouts but you need vitamin c alongside it so if you're not having a clementine the same day as you're having your sprouts then you won't be able to absorb it very much whereas if you were to eat steak for example it's much more easily absorbed but our vegetarians have to just keep eating a bit of fruit on the side for you looking at your numbers there's a risk of of cancer associated with these low blood counts and your risk is 2.8% so it's not crazy high but it's all about your approach to risk and what you might want to do about that so what slightly changes that risk that we can't bring into is the positive stool blood test and that changes that somewhat it probably increases the risk ever so slightly maybe I can't quantify that but maybe increases that but probably not more than 3% or 3 and a half% that's quite low james it's quite low isn't it a little bit yeah yeah it's quite low isn't it but what we could do there's various things we could do to investigate that and reassure us we've got invasive tests in terms of endoscopies colonoscopies and upper gi endoscopies I think they'd be very difficult for you not because of the camera but because of the prep you'd need to take these huge quantities of prep and then you'd be back and forth to the toilet 10 15 times in 1 evening you can get really dehydrated you can fall over you can become more poorly and that's gonna be quite an undertaking for you I think and so an alternative might be to have a ct scan of your tummy and we could include your chest given your smoking history as well and before the ct scan for 2 days you drink a dye liquid which helps coat the bowels and it tells us what's poo and what's not with that we can reassure ourselves that there's nothing sinister going on and make sure that this risk is very much closer to 0% which would be good yeah and that might be might be a way forward I would suggest would be having a scan yeah and that sound reasonable yeah sometimes we perform upper gi endoscopies alongside scans where we use it's a camera we use in the top end I think that would be quite difficult for you as well I guess because you need to be on a bed so we need to be able to transfer you from the wheelchair to the bed and then you need to have this thing shoved down your throat for 10 minutes or so so it's not the nicest thing to have done yeah and the chance of us finding anything in the top end to explain your symptoms is quite low anyway probably in the order of 2 or 3% of endoscopies that we do we find something sinister there so I think that risk is very low for you so I would think that going through that for that benefit the risk benefit probably weighs more on the risk side than the benefit side of going through an invasive upper gi test and if we include your chest then that does reassure someone that you haven't got got anything big and nasty 1 of the things that I had alright fine I didn't know about that I can't remember the last I couldn't see if you had any recent scans that's what they told me you had your chest scan in 2023 that's what year was the year 2025 2 years ago nothing worrying there but we could have a look and make sure there's nothing worrying there if you like yeah that sound good yeah and given you've had this have you managed the iron supplements or not your gp started them for you have you managed taking them or not I don't know just take what you give them your gp put them on the list but I don't know if they've been it's changed to once a day before breakfast yeah so you are taking them so that's good would you mind if we got another blood test today and you see what your blood counts are like with the iron supplements if your blood counts are normal sorry if your blood counts are normal with the iron supplements then great it means that you are iron deficient and we'll move forward with the scan but if your blood counts stay the same then maybe even better because if your blood counts don't get better with iron you're not iron deficient and it could be something else causing your anemia does that make sense yeah a lot to me so we've got a bit of a plan we'll do some blood tests today if you're iron deficient on the blood tests I e blood counts have come up with iron yeah then I'll arrange you a scan of your chest your tummy and your pelvis sound good yeah great any questions or anything I've forgotten jj for you tina any questions no I don't think so so ct scan then yeah yeah if your blood tests suggest it if they're not then great yeah so we just did the whole thing today but there was a blood test there have I've got plenty of blood in there you'll be alright well it's bloody doctors and our blood terrible to type 1 though really terrible shall I show you where the blood tests are yeah lovely it was nice to meet you jj thank you I'll get the door cleaned thank you pleasure thank you very much would you like your list ma'am or is that for a present now you can keep it well lovely merry christmas merry christmas sorry I didn't get you in and I'll wear the next time oh I'll write you a letter and it'll get you in a couple of days me we'll see you there with christmas at 1. Right yeah the blood tests are down by the blue drawing just so we can work <\n\n> Plan code on <\n> Number 1 blood test today <\n> Number 2 if blood counts have augmented with iron supplementation over the last month then for ct chest abdomen and pelvis <\n> Number next if blood counts have not improved they're most likely to be anemia of chronic disease disease <\n\n> Diagnosis code on <\n> Number 1 new most likely iron deficiency anemia for further investigation <\n\n> On examination height and weight unable to be taken as a patient is in a wheelchair <\n\n> Dear gp, <\n> I had the pleasure of meeting miss gilley in ida clinic today on behalf of doctor saunders full stop the consultation was face to face and she was accompanied by her enablement worker tina full stop <\n\n> Thank you for referring her to us with her new microcytosis and anemia since november full stop she's been feeling fatigued and weak over this time and I hope that starting some iron supplementation will make her feel better full stop has made her feel better <\n> Number 2 if blood counts are augmented with I'm sorry dear gp, <\n> I had the pleasure of meeting missing worker tina full stop <\n\n> Thank you for referring her to us with her new microcytosis and anemia since november month full stop she's been started on some iron supplementations by herself and I look forward to seeing her blood tests today full stop <\n\n> In terms of gastroenterological symptoms, she's noticed some weight loss but this is clearly quantifiable she says that her clothes are more loose but she hasn't been weighing herself regularly and wasn't able to weigh today full stop <\n\n> She reports a regular bowel habit type 4 stool once per day supported by laxido but does report that 3 to 4 weeks ago she had a few episodes of dark red blood on the poo and on the paper when she opened the bowels full stop it wasn't painful when she opened the bowels and she doesn't feel any lumps or bumps down there full stop <\n\n> She's in a wheelchair today so it was impossible for me to examine her full stop doesn't notice any further episodes of bleeding since then which is obviously reassuring full stop <\n\n> In terms of her life well generally, she lives in a residential home she's used a wheelchair to mobilize she's been feeling more weak over the last few months which I explained may well be due to her anemia full stop <\n\n> She has a 90 pack year smoking history but does not drink alcohol and currently is vaping full stop <\n\n> We discussed today that her blood counts are suggestive of benign deficiency anemia pattern and we could again we agreed that we'll have some more blood tests today in order to ascertain whether her blood counts have improved with iron supplementation full stop this is a strong indicator of iron deficiency full stop <\n\n> If her blood counts have augmented with iron then we've agreed she'll have a ct thorax abdomen and pelvis given her weight loss, significant smoking history and iron deficiency anemia with 2 days of gastroparesis prep full stop <\n\n> We did discuss upper gi endoscopy but don't think she would be a great candidate for this given her wheelchair use and physiological frailty full stop full stop <\n\n> Look forward to seeing the results of her blood tests and her ct scan new york city