Transcription - 20250530T 10-31.mp3

Next patient dennis dodds alpha 4 2 1 1 0 9 past medical history g 2 p ta low grade tcc of the bladder diagnosed october 2024 open radical prostatectomy '2 thousand and '3 for gleason 2 2 + 2 prostate cancer past medical history hypertension prostate cancer erectile dysfunction type 2 diabetes mellitus current medication mirabegron 50 mg modified release once a day metformin 500 mg or 1 g twice a day senna 7.5 to 15 mg at night timolol 5 mg per mil eye drops twice per day in the right eye solofenacid 10 mg each day <\n> Linegliptin 5 mg once a atorvastatin 20 mg once a night amlodipine 5 mg once a day dapagliflozin 10 mg once day hispagliflozin 3.5 g 1 sachet daily enalapril 50 mg per day colazide 750 mg capsules 3 capsules 3 times a day allergies mercaptopurine and azathioprine diagnosis ulcerative colitis diagnosed in 1977 most recent gastroenterology letter from sunderland august 20 24 so plan number 1 routine number 2 signpost to ibd nurses number 3 bloods including using these and lfts in light of 5 asa treatment number 4 follow-up in 12 months had the pleasure of speaking to dodds on the camera phone today on behalf of doctor haywood in inflammatory bowel disease clinic full stop mr dodds was previously under our care with ulcerative colitis diagnosed in 1977 and moved up to sunderland and has moved back to plymouth to be close to family back in november 2024 full stop <\n\n> In terms of his symptoms, he has good regular bowel habits however over the last 3 weeks he has noticed some slightly increased bowel frequency and urgency and has increased his valsalazide dose and has found this to be very effective full stop he'll experience a flare like this once or twice per year full stop he usually associates his flares with stress and he's had a stressful time lately with a house move and so he reasonably attributes a lot of his symptomatology lately to that full stop <\n\n> In terms of previous medications, he's had prednisolone during flares he's also been treated with azathioprine however he had abdominal pain and reacted to this and he's also had sulfasalazine however he reacted to this as well full stop <\n\n> His most recent colonoscopy was in 2021 which was technically limited by a fixed sigmoid loop and was incomplete having only reached the ascending: full stop biopsies taken demonstrated mild active inflammation and so surveillance in 3 years was recommended which would have been due in november full stop <\n\n> In terms of his social history, he is a retired royal navy physiotherapist and his wife is a retired retired nurse from dareford hospital he does not smoke and drinks alcohol with moderation full stop <\n\n> He's reluctant to undergo further colonoscopy surveillance as he struggled with preparation previously he's found the clean prep difficult to tolerate due to taste and volume and he's had the best results results with picolex in terms of tolerability however the worst endoscopic results with this full stop <\n\n> He's not had moviprep which could be a good option to try this time and he's previously had good success with 2 weeks of laxido prior to his prep which I'll arrange for him as well full stop <\n\n> He's aware that we have an excellent iron inflammatory bowel disease nursing service at darafib which he can contact with any concerns between clinic appointments full stop I will send him out some blood tests with the letter which he can have taken at future inn or another community phlebotomy site and request a colonoscopy routinely with laxido prior and with full stop and guys I look forward to speaking to you again in 12 months' time full stop you're sincerely

Diagnosis:
Ulcerative Colitis

Other Medical Diagnoses
- Low grade TCC of the bladder (diagnosed October 2024)
- Open radical prostatectomy (2003) for Gleason 2+2 prostate cancer
- Hypertension
- Prostate cancer
- Erectile dysfunction
- Type 2 diabetes mellitus

Medications:
- Mirabegron 50mg modified-release tablets - one to be taken each day
- Metformin 500mg tablets - two tablets to be taken twice a day
- Senna 7.5mg tablets - 1-3 nocte
- Timolol 5mg/ml eye drops preservative free - bd right eye
- Solifenacin 10mg tablets - one to be taken each day
- Linagliptin 5mg tablets - one to be taken each day
- Atorvastatin 20mg tablets - one to be taken at night
- Amlodipine 5mg tablets - one to be taken each day
- Dapagliflozin 10mg tablets - one tablet to be taken daily
- Ispaghula husk 3.5g effervescent granules sachets gluten free sugar free - take one sachet daily
- Enalapril 20mg tablets - two daily (40mg daily)
- Enalapril 10mg tablets - one to be taken daily (30mg total daily dose)
- Colazide 750mg capsules - take THREE capsules THREE times daily

Investigations:
- Colonoscopy 2021: Technically limited by fixed sigmoid loop, incomplete (reached ascending colon only). Biopsies showed mild active inflammation. Surveillance in 3 years recommended (due November 2024)

Plan:
1. Routine colonoscopy appointment with moviprep and laxido BD for 1 week prior
2. Signpost to IBD nurses
3. Bloods including U&Es and LFTs in light of 5-ASA treatment - Windsor House
4. Follow-up in 12 months

I had the pleasure of speaking to Mr Dodds on the camera phone today on behalf of Dr Haywood in inflammatory bowel disease clinic. Mr Dodds was previously under our care with ulcerative colitis diagnosed in 1977 and moved up to Sunderland and has moved back to Plymouth to be close to family back in November 2024.

In terms of his symptoms, he has good regular bowel habits however over the last 3 weeks he has noticed some slightly increased bowel frequency and urgency and has increased his Colazide dose and has found this to be very effective. He'll experience a flare like this once or twice per year. He usually associates his flares with stress and he's had a stressful time lately with a house move and so he reasonably attributes a lot of his symptomatology lately to that.

In terms of previous medications, he's had prednisolone during flares. He's also been treated with azathioprine however he had abdominal pain and reacted to this and he's also had sulfasalazine however he reacted to this as well.

His most recent colonoscopy was in 2021 was technically limited by a fixed sigmoid loop and was incomplete having only reached the ascending colon. Biopsies taken demonstrated mild active inflammation and so surveillance in 3 years was recommended which would have been due in November.

In terms of his social history, he is a retired Royal Navy physiotherapist and his wife is a retired nurse from Derriford Hospital. He does not smoke and drinks alcohol with moderation.

He's reluctant to undergo further colonoscopy surveillance as he struggled with preparation previously. He's found the Klean-Prep difficult to tolerate due to taste and volume and he's had the best tolerability (but worst endoscopic results) with Picolax.

In the past, surveillance with CT colonography has been discussed with him.  However, this does not allow us to assess his disease activity in the same way that colonoscopy does and has the potential to miss flat lesions.  Therefore, I would recommend colonoscopy as opposed to CT colon.

He's aware that we have an inflammatory bowel disease nursing service at Derriford which he can contact with any concerns between clinic appointments. I will send him out some blood tests with the letter which he can have taken at Windsor House phlebotomy site and request a colonoscopy routinely with Laxido BD prior for 1 week and with Moviprep.

Summary

Investigations

Plans