Morna forbes 711824 67 year old lady show his key blood test reviewed hemoglobin 30 on the 12/17/2025 with mcv 49.6 and platelets 470 hemoglobin improving to 47 72 and 74 most recently on the december 20 with persistent microcytosis ttg tested and negative ct thorax abdomen and pelvis december 2025 no evidence of metastatic malignancy but evidence of congestive cardiac failure multilevel presumed osteoporotic vertebral fractures want me to put your feet down and be a bit more comfortable they're okay from there but you're right okay alright so everyone by way whom you brought with you paula who's this I'm laura I'm the senior carer hi laura for the care name because she's saying that hi nice to meet you hi morgan hi how are you actually would you mind if I moved into this chair of course bit more comfortable uncomfortable unfortunately give her the hand if you need it okay can ask you a while so it's not very embarrassing yeah sorry lovely well done great so I saw that you were in hospital recently yes in december tell me all about it what happened well gp suddenly contacted the care home and I was suddenly told in december suddenly get told we want you in hospital now I went into complete panic because I struggle with ocd so it's very difficult trying to cope with that sort of thing suddenly like that anyway was because my haemoglobin had dropped from what we're concerned so low it's 1 of the lowest I've ever seen really really actually yeah 30 and very low 29 at 1. Been trying to figure out why so I've been through so lots of blood transfusions by the sounds of it 12 out of blood transfusions did 12 yeah 12 4 lots of and then they did an iron infusion as well because I can't take iron tablets because yeah you had constipation or something constipation and I can't cope with that because I'm bent in the middle because of the back injury so that and then they did a ct scan mean you would think no I saw your ct scan yeah you have any symptoms at that time well felt exhausted all the time I mean it was getting worse and worse and I was breathless and it was just it was I mean the you know the few weeks just leading up to the leading up being admitted we're we're just getting worse and worse that you know so I I'd actually asked originally to see somebody in that beginning of that week I think it was a nurse to sort you know go through a few of the blood tests of course but yeah and have you noticed any bleeding from anywhere no no nothing like that this is the weird thing they're still trying to treat and figure out where what this what might be has anyone dipped your to check whether you've got blood in there sorry has anyone dipped your wee to see whether you've got blood in there we haven't at the clinic I think they probably did at the hospital I can't remember they didn't write about it but they might have remember when they did it that's fine and then I the other place that you could be bleeding from and not know is bleeding into your coo a little bit which is why you see a gastroenterologist not seen any blood clot and I was mentioned when I was in my twenties so a very very long time ago I had a bleeding stomach ulcer that's a very very long time so I'm aware of the kind of stomach pains you get with all of that because I had that for a long time and then I have black stools and you know so I'm aware of all the symptoms I'm very very aware of that and any sign of that I would immediately ask about you know yeah fine so so nothing that I found out to do fine good I'm glad you live in a in a care home obviously no yeah fine and what's led to you being in the care home because I understand at 1. You were in 2024 you were living in a house was is that right I I own a park home but my back completely collapsed a year ago I'm sorry can tell you the exact date november 9 so I went through november 5 I was taking my car to be serviced and doing shopping and moving a lot of stuff from the car first to empty the car and so I probably was triggering what was going to happen I didn't realise at that. That I already must have had back fractures from the previous injuries that we had brought up so an increasing back pain but then it just completely went just from 1 day to the next since then I've not been able to cope with them it's very horrific I can't imagine I'm sorry and you so I guess the reason I ask is is about so you had this ct scan which hasn't shown anything worrying as it caused your symptoms which is obviously good but the trouble with the gastrointestinal tract is you can bleed into it without really knowing small drips of blood over a long. Of time just gets absorbed by your poo and you don't really see them and when we scan you it's all stuck together so they're all hollow tubes but they're not full of air yeah so when you we scan you they just look like 2 things stuck together so we don't see if there's anything growing in there that might be bleeding slowly the and things I'm talking about there can be benign causes you can have blood vessels that are very close to the surface in the stomach or in the large bowel that as poo or food comes past they just brush and bleed slowly there can be precancerous things like polyps fleshy outgrowths in the bowel that can ooze slowly when poo comes past them and they can be cancers that cause things like this and we know that having low blood counts like this does put you at risk of gastrointestinal cancer and we quote the risk as around 10% so 90% of the people in your position won't turn out to have a cancer however it's not an insignificant risk and something we should investigate we've got lots of ways I'd also come across the fact that I've been on ppim for a long time because you're at higher risk it does but it also means you can't absorb iron very well so absolutely yeah so it could be a dietary thing yeah and what is your diet like obviously good care good yeah it's fine like I'm still eating you a relatively robust healthy diet mhmm I eat meat I eat fish I eat chicken I eat you know I mean know the things you sort of drink fruit and vitamin c and things like that not so much I try and get my brother to bring me alright alright so it sounds like it sounds like you're eating a reasonable amount of iron if you eat yeah red meat then you should be getting enough iron in a form that's very easily absorbed if you don't eat red meat then green leafy vegetables and vitamin c is usually sufficient to keep your iron levels up but certainly yours were quite low very low in fact we tested you for coeliac disease and you don't have that as a dietary sorry we tested you for coeliac disease in the blood test and you don't have that as a cause of a dietary deficiency of iron which brings us I guess back in a full circle back to the possibility of slow blood loss we've got lots of ways we can investigate the potential for slow blood loss the best tests are the most invasive tests and that's endoscopies we use long flexible cameras to have a look into your upper gi tract so the oesophagus stomach and the first part of the small intestine and your lower gi tract the: the large bowel and the last part of the small intestine we routinely do those tests the problem with those tests for you will be mobility both in terms of getting from your wheelchair up onto the bed and most importantly the preparation of your bowels so for colonoscopy we recommend having 5 days written off really with a low residue diet and for a few days before the test we we said to drink a very strong laxative laxative medicine that makes you go to the toilet 8 10 times or something like that back in quick succession so obviously using a wheelchair that is going to be challenging for you to manage I don't use a wheelchair in my room mhmm but I use a I use a walking frame a walking frame but it's it's getting to and from the suite in her room but obviously it's still getting there quickly of course but what you know talking to the lady I talked to you know with the phone appointment recommended just going out and laying on the loo for a while rather than trying to get back to the boys because I also struggle with ocd that makes it difficult for me to cope with things like swelling myself of course horrible and the other thing is I've got such huge pressure on my bladder because of all because it's going on with that I mean everything is pressure pressure pressure so I've gotten massively worse ability to tolerate all of this stuff when you go to the loo all the time diarrhea no wee sort of urinary frequency I mean it's massively worse than before the bat injury I see it just suddenly you know I was using much smaller pads and then all of a sudden it's like you know and I can only sort of go to bed for about 3 hours and I've got to get up well actually before I was put on the they go on the wrong we all pronounce it but before I was put on that I could only go for an hour so I couldn't go to bed at all + I was having spasms in my back that stopped me going to bed so I started taking that but then I'm actually allergic to it my skin reacted all over so I'm now on double dose effects of phenytoin to try and cope with that I've got so many different things all working against each other lot of what I'm concerned about for doing I realise if you can do an endoscopy colonoscopy I will somehow get through that but trying to cope with having to get to the loo the prep is to be the most challenging if ever I'm more worried about that than about actually the procedure no everyone who comes and has a colonoscopy tells us that the prep is the worst bit because I'm not worried about not eating certain foods can do that I've got know how to do fasting safely in the past and you know know all about that so you know so I don't have a problem of you know not eating certain things or whatever it's actually that wetting myself all the time sorting myself and trying to get cleaned up because then I've got to stand up to try and get myself cleaned up and that's where my back's really really bad so I've got all of that going on yeah of course but I'll get through it somehow you know it's the best test but there are alternative tests so you could have a scan similar to the scan you've had where we give you some very mild bowel preparation before for the 2 days before the test and you drink the mild bowel preparation before so it just tells us what's poo and what's not and then you do a scan the problem with that is the sensitivity I e our ability to detect things is reduced by that it's not as good of a test because you're not blowing air up as we will in a colonoscopy to separate everything out so that means that things that are very small like a polyp that might be bleeding and causing iron deficiency we won't detect if you've got a cancer we're more likely to detect it and it's a better test to detect a cancer than the test you had before but it's not the perfect best test so I guess it's our discussion and decision making about how you'd be able to tolerate an invasive test like colonoscopy versus the desire to detect something I think it's worth detecting something because you're young you know and you would be a candidate to have an operation to fix it and the kind of operations that are performed for bowel cancers are keyhole operations that people recover from relatively quickly so if you had a bowel cancer that was detected with our colonoscopy you'd be a good candidate to have that removed and have that treated curatively if that makes sense but I'm not saying that's definitely what's going on because as I said 90% of people in your position won't have a cancer so what do you think you think it's worth pursuing it or not it's worth pursuing it and I'd get through it somehow I don't know quite how at the moment and I'm dreading it I you know but that's just normal I can't somehow get through that fair enough I'd have to sort of not drink tea know obviously diet is completely limited I've looked up on the internet what you're supposed to eat and what you're not supposed to eat and drink and you're allowed to drink tea but I would stop drinking tea because obviously tea is going to make me go to the loo more you know just things like that have to make some adjustments and probably don't know quite what I'd do with the mirabegron you would still want to take the mirabegron if you wanted to I suggested to the lady the other day that I could maybe take it a bit because the trouble is the afternoon which is exactly when it would be done is actually my worst time for running backwards and forwards to met myself basically as simple as that so if I'd moved the merabegron forward a little bit but the trouble is I need it to get me through the night and I need it to get me through the next morning the morning as well so it's like you know and I can't take the normal dose I mean think what most people take is double the oral intake but because I'm actually allergic to it and I'm having to take more fexofenadine to balance I don't know quite how to you know or I could take more for that 1 day I don't know whether that's a possibility something you could try isn't it but you obviously don't wanna give yourself a terrible allergic reaction do you mhmm difficult but I can see so you'd see it's all scheduled for the january 15 which is good but it makes up the tenth tenth the tenth right saturday the tenth this says the fifteenth but it sometimes doesn't get updated and what you know is gonna be the best oh that's right right right bit of information tenth what I've been told was saturday I would trust with what you've been told 3 03:30 in your yeah fine I've been trust I would trust that over this which kind of makes I guess our discussion today a bit moot doesn't it because if you're already planning to have the test it sounds like you've been assessed for it it's already booked in you've had another phone call great but the lady that I spoke to the other day was querying about the bowel prep so she wanted to send it back to the consultant to see if there was something different that morna could have well I don't know who gets it rob miller is my name 1 of the gastroenterologists yeah I don't think that was the name of the person that's going to pay it for the prep to what she said to me when I had that telephone conversation with them and we've had different telephone conversations what she said to me was she was going to re refer it just to sort of check whether the tenth would work or whether it would be better to do it during the week or whatever but that's not for me to decide she just said I'm re refer it to the consultant she gave me a different name doctor summers perhaps I think he's the referring consultant anyway it's bit academic really isn't it I'm not good at remembering names but that's fine I've got it written down and what was the cons I'm trying to look for the pre assessment notes to see whether they've put it that explain with your medication at all the mubeq mubeq on or was there something else well there were just several things all the questions I'd brought up about getting the flu and about the incontinence and all of those things and my medication the fact that I'm on take that's the other thing I'm on tegretol and baclofen baclofen both of which had some sedative effects yeah right and I was concerned about you know if I'm given a sedative as well how sensitive is that you know gonna be mhmm am I gonna be again am I gonna be able to get so I'm always concerned about this because if something makes me really dopey and I fall asleep for hours then I'm going to be soaked how do I cope with all that we usually don't send people out until they're recovered from the sedative as you say and we'd only give the right amount so it doesn't last too long it doesn't last too long it can affect your higher mental functioning for 24 hours which is why we say don't drive don't make any big decisions don't work over 24 hours but people are entirely awake when they leave us so then I could then take my normal dose of tegretol that evening I might sort of reduce the amount of back pain just for that 1 evening I can't do it for too long yeah but just for that 1 evening you know I might do that yeah because you might be quite a little bit sleepy still for me because I because I don't wanna get too sleepy and then find at night I'm so if you woke up during can just cough her with all of that I don't blame you that's fine it looks like we're going to do an upper gi endoscopy at the same time which is good we get them all done in 1 go and work out what's going on and take it from there I can cope better with having a couple of things done at the same time and and and even just getting to and from hospital it's not easy it's easier than it was definitely easier than it was but but I'd rather sort of get over and done with in in 1 rather than have to come twice and you know have to go across no no completely understood yeah fine but so we've got a bit of a plan I'll speak to doctor summers I think is the person that the booking team have sort of spoken to and work out what we're gonna do about your prep and we can send you out the right stuff let me just have a look a look please feel free on I know I've got the letter with me I may have written the name on there just a sec that's a good on the right side go now and now I'm just right down there mister rick it's okay written on the other you can we should be able to work yourself shouldn't we it's I'll sort out I work very closely with the consultants and also with the endoscopy team because we're the people that do the procedures for the the lady that phoned me had the phone consultation with me on asfam there wasn't it on asfam there she she's the 1 that gave me the name of the person that would be doing it so understood yeah so she might be a person I don't know who she I don't know what I think but no it's okay I can't see that there's nothing done but but she would I'll work it out yeah alright so we've got a plan we'll have a look at those 2 tests I'll write to you with the results of the test when they come back to me if there's any biopsies or anything like that I'll let you know what the results of them are and then we can take it from there in terms of your ongoing iron replacement it's good to have a couple of iron infusions you've had you had 1 while you were in hospital about doing another 1 you know depending on blood tests doing another 1 in a couple of months it might be sensible to get some blood tests today if that's okay to see how your blood counts are doing following this iron infusion you may need a further 1 if you're still anemic to get you feeling better okay so that's something you have done here yeah you can take them we can have the blood test taken now if that's alright with you okay yeah some just down the corridor they can take them for you check this make sure we check your b 12 folate lovely so brill so blood test today + or - I'll arrange an iron infusion for you we'll see the results of your tests and I'll let you know the results of them okay okay so so we're talking about it being definitely the tens now so is that what we're I'd I'd I'd rely on whatever you've been told by the bookings team they are much more up to date with booking the endoscopies than I am so they're going be yeah if they're told to the tenth it's going be the tenth yeah so I don't have to get back to anybody that no no so if that's what they told you then it's the tenth well it's just that the late I was told the tenth then the lady on monday was querying it and saying she was re referring it to see that fine oh I understand it was the date that was the problem not the and the prep were the 2 there were 2 queries weren't I well she spoke to me after it was all you know yeah after I'd been told about the date and everything and then she she spoke because actually what happened was originally there was supposed to be a phone consultation the previous week I missed that because I'd only just got back from the hospital had a neuralgia attack hadn't found the letter in it just not there in 2 days and I hadn't had a chance to find it so I missed that appointment confirmed appointment so it was only monday that I actually spoke to her I see so at that. This is just last monday she was saying she would re refer it and it might be changed or it might not I'd really like to know of course you would you know yeah yeah it's all this to and fro that I find difficult well why don't why don't you go and have your blood test I'll call the bookings team and I'll work out what's going on that sound alright that would be great and then I can come and let you know in the blood test room would be really good that sound good yeah no today of course it would be the run that I want to do but that's just so important here of course completely understand yeah good is it still cold down there it's not as cold as when it was first thing but really cold though but when you're ready molly you have to pee down k wonderful you're waiting for again the brakes has been on thank you that's alright oops hold on I think I have to do a quick break it's alright teacher build driver the wheel yeah mhmm the wheel goose gets her done so plan bidirectional endoscopy as planned 2 blood tests today + or - further iron infusion number 3 right with the results number 4 copy letter to endoscopy dwikings team dear gp I had the pleasure of meeting miss forbes on behalf of doctor poles in ida clinic today the consultation was face to face and she was accompanied by lorna her carer paragraph I'm sorry to hear that she was admitted to hospital acutely after some routine blood tests with her gp because of in because of fatigue demonstrated a hemoglobin of 30 which was subsequently rechecked and found to be 29 she was feeling exhausted at this time but hadn't noticed any bleeding or weight loss she underwent blood transfusion as well as iron infusion during her stay in hospital and is feeling a little better she's <\n\n> She's previously been intolerant of iron supplementations from constipation and so she's been having iron infusions full stop paragraph she tells me they dipped her urine in hospital and it was normal full stop <\n\n> She's living in a care home at the moment because approximately a year ago her she experienced acute back pain when she was living in her park home and wasn't able to stand she subsequently came into hospital and was found to have had spinal chronic spinal fractures and so she was rehabilitated and then now lives in a care home <\n\n> We spoke about her diet which sounds like it's good with good sources of dietary iron <\n\n> She walks with a walking frame slowly around her room and uses a wheelchair outside of it paragraph she's already been planned for bidirectional endoscopy and we discussed her ability to tolerate the prep today which it sounds like she's going to be able to manage and I look forward to seeing the results of that she's also gonna have some blood tests today in order to ascertain whether she might be benefit from any further iron supplementation and she could be a good candidate for ferricruit given her previous intolerability of iron of other oral iron preparations I look forward to seeing the results of her test I'm alright with them yours sincerely and then dear endoscopy bookings team, <\n\n> Happy new year full stop <\n\n> I'd be grateful if you could look into this lady's upcoming endoscopy there's some confusion from her about the date as well as the preparation for the endoscopy be happy to answer any queries you might have about it many thanks <\n\n> She's a bit confused as to when it will be and would very much like confirmation of that I'd be grateful if you could call her to update her thank you