Valerie harvey 209490 february 1944 81 year old lady investigations alp 342 eosinase normal with creatinine 71 which is at baseline for patient sodium and potassium normal liver function test alt 349 previously normal and alp 342 previously normal total protein 55 albumin 37 and bilirubin 21 crp of 50 when was previously normal in october less than 1 <\n> Urea 4.8 phosphate normal magnesium normal full blood count revealing low red cell counts but no anemia no neutrophilia venous blood gas revealing ph 7.41 sodium a 131 potassium 3.2 lactate nought 0.6 note recent ct thorax abdomen and pelvis for fullness on small meals and weight loss scan undertaken on the 12/20/2025 a report date on the january 8 several unchanged lung nodules and intrapulmonary lymph nodes stable small hepatic cyst but no new liver lesions no significant abnormality of biliary tree grossly normal appearance of the upper part bowel with moderate fecal loading with constipation / slow transit no evidence of malignancy so an 81 year old lady so note has been seeing gp since the january 6 with diarrhea and vomiting severe diarrhea on the january 3 with abdominal cramps reduced oral intake associated with nausea retching with production of mites mucus thick white mucus and constant abdominal pain no fever rigors or systemic illness 3 courses of antibiotics for uti with nitrofurantoin recently and was given treatment with metronidazole for antibiotic associated diarrhea as well as buscofen and leperamide diurilite and antiemetic by the gp and then saw the gp today with bowels not open for 4 days no vomiting but every time she eats or drinks feels spasms and cramps all over her abdomen no further bud or mucus passed pain in the abdomen all the time but worsened very much after eating feeling dizzy and weak taking antibiotics for presumed c difficile and looked hydrated with the gp she'd lost over 10 pounds since the onset of her illness at that time wow good listen dark in here can I turn the light on yes is this it's gonna be ever so bright yeah it's the top 1 no it's the bottom 1 I think it's quite difficult to see wowza is it valerie harvey yeah is I'm rob I'm 1 of the gastroenterology doctors and the medical registrar on call this evening hello sorry you've been waiting such a long time to see us I understand you're busy but I was gonna go I'm sorry if you're still ill tell me all about it what's been happening can you hear me okay with these plugs here they don't work yeah was gonna say you probably can't find it work so if I sit down I'm all live that'd be nice I mean I'm not I'm not done in the ears but I just feel really bad I had some sort of infection in my bowel I'm not eating for a week I've lost nearly a stone in weight and I've gotten really thin and dehydrated I can't sleep I can't eat although I'm managing to drink now because every time I drank or ate something I would start spasming again when I say spasming it was like having a baby and all if I didn't eat or drink it didn't hurt so much anyway my daughter made me go to the doctors and she said you've got to go to the hospital I'm on antibiotics anti sickness tablets and I was being sick all the time and she said I couldn't give them a poo sample because I'd had so much diarrhoea but I've not been since I had the diarrhoea said I'd a poo sample so I felt really ill and she said you're really hydrated you've got to go to the hospital and get a nice and I came about 06:00 and because I'm very arthritic as well I've been sat in those hard chairs all night and I I'm a not going to be sick because I'm on the tablets but I just feel horrible I don't think anyone's going to see me because I know what it's like you get busy yeah it's okay though don't worry catherine's husband's a doctor in london in st thomas' and I know how busy it is I just thought I can't cope anymore so it all started I understand last saturday you had some recent course of antibiotics with nitrofurantoin for urinary tract infections before that they don't know whether it was a urinary infection because when they did the test they'd already put me on antibiotics and they said the test came back negative they wanted to do another 1 then the doctor said oh we'll do another 1 and then put you on more antibiotics and he said the second test came back negative alright but to me it felt like a symptoms did you have tummy pain no it was like a severe cystitis burning pain when you pass yeah but whether it was all part of this coming on don't know because sometimes you don't know whether it's your bowel or your bladder yeah of course the pain it just goes all the way up know sometimes you think it's coming from here you know it's just so severe but I just feel so washed out and tired I've lost such a lot of weight and how many times a day have you been going well since I've had the all night diarrhoea for 2 nights that if I got up in the morning and didn't eat nothing then on the second day I thought well I'd be alright today and I got up and I took it easy had a little tiny bit of food then later on then it all started again and then after that they said we want a sample well of course I was completely empty and I'm not eating so I won't fill up for a while so I can't give them a poo sample are you using laparamide that the gp prescribed you the imodium that your gp prescribed you tell me what it's for and I'll tell you it bungs you up no no not imodium or leperamide no I'm going to take that fine your gp said that they prescribed it to you but they have stopped you no taking no no said only take it if you need it yeah good I wouldn't have took the antispasms if I didn't have to I don't like taking anything I'm a health freak but I thought I've got to take the anti sickness and the antispasms and I've had such a lot of antibiotics I think that's probably what's done it all maybe it's certainly possible to get diarrhoea associated antibiotics if you're not eating anything a little bit should come out still I don't think there was anything left in me I was passing clear fluid and blood at the end and there nothing to come and I was getting the feeling to go again and just all that was coming out was white and then it got pink and then it got red and I thought it's time to see the doctor now so you had the course of antibiotics for the urinary tract infection after the third course of antibiotics you had all night diarrhea yeah and then it progressed about a day after okay yeah and then it progressed for 2 days where you felt better in the day then it got worse again when you ate something yeah and then after that you had bleeding associated with the diarrhea fresh red blood when I say all night it was probably 12 hours oh that just sat on the loo and that well you know you probably never had it but you probably haven't I'm sure it's not been as bad as this but yeah I'm sure I think everyone has had a bit of diarrhoea just got some baby it was terrible and this is abdominal pain you're having as well as the bleeding and the diarrhoea when I hurt I hurt all the way up okay yeah from your tummy into your chest yeah isn't there a nerve that goes up here that there is it's true the vagus nerve has to link everything but I don't think and because I'm I'm hungry really deep down I'm hungry but I know I can't eat because if I eat I don't want have those spasms again yeah of course but I have started and I've got away with that I get the gripes a little bit but the doctor said you're very hydrated but you see think I look worse than I am because I've suddenly lost such a lot of weight I used to weigh 10 and a half stone oh wow fine and over the few urine infections I'm now eight-nine and we've never found out that you convincingly had a urine infection really no and again it was somebody's fault because the first doctor did a urine test and said I'm not positive about this she said I'm going send 1 up to the hospital but it was saturday I can't remember exactly and she said take a sample and she said I'll dress it with some of preservative and then I'll start you on the antibiotics straight away and I took it to the doctors and it was spilled and it never got sent up they forgot to tell me they hadn't sent it so I went another week and by that time as far as I know the 2 tests and the 1 that my doctor did yesterday there's no urine infection fine okay and I was getting to me I was burning all the way up only when you went for a wee or all the time well sometimes it was usually after I'd had a wee maybe up to an hour afterwards that's fine and I was buying everything in the chemist that you can buy you know to try and help it yeah of course but I feel really washed out this time I'm sorry can I say having lost so much weight so quickly at my age know it's gonna be hard to put it back on again yeah I'm sorry let me just call these people back that are trying to talk to you and I'll just be back with them is that alright no wait yeah I'll be back with them thanks sorry sorry the only other thing that I thought I've got a hiatus hernia mhmm and but the doctor said he didn't think that was connected to it but I do get acidy sometimes do you yeah and I that might upset me I doubt it very much do you take any medicines for the acid yeah take no meds oh that's his oral 1 yeah she's told me to stop taking leptozol sometimes that can cause diarrhoea I know everything causes something usually it's diarrhoea any fevers at all no anyone else falling no who do you live with at home myself my oldest daughter's home it's been coming there every day oh that's nice you live in a house or a flat it's a bundle bundle yeah lovely lovely sounds good do you drink or smoke I don't smoke yeah clean living as you said you're a health freak so yeah fine yeah allergic to anything no I've got your medicines list from your gp so I can have a look at all the back I've got half half of those medicines on there I've never taken sometimes you go to the doctor and say I think you should take this and you look at it and think I'm not going to take that.' and you ask them to take it off your prescription list and they never take it off I would say a good third in my prescription list I don't take doctor fine what do you take do you know doctor take thyroxine how much the dose that's prescribed on your gp website are they confused yeah do know I take furnace acid because I take methotrexate for my arthritis rheumatoid arthritis seriatric they're the 3 main ones that the doctor's given me and you take methotrexate sorry sorry they're the 3 main methotrexate once a week every sunday every sunday 6 tablets I'm on a low dose apparently that is a low dose although it takes all the pain away it does its job I also take not a statin it's a rosuvastatin a super statin something like that yeah I also get gaviscon on prescription they're the main things that I get whenever I send a prescription request in I black out what I shouldn't be taking but they never take it off if I become senile or demented they think oh she takes all this and they'd be making me angry lot of medicines true and I couldn't examine you do you mind yeah definitely examine lay down examining yourself just have a look at your hands then and then I might ask you to lay down a few for me is that alright k tiny bit of your psoriatic arthritis changes can't we ever so slightly swollen oh my hands have gone horrible but it's I don't really look at them anymore only this is slightly on that right hand side I've always had bony fingers though oh really yeah but no nail signs of arthritis so that's good it's better than it was actually I've been sipping all the time I've been on water no yeah was just pointing to your water bottle oh yeah yeah let's have a quick listen to your heart doing that sounds nice you're moving I could listen to your back I also take an inhaler for asthma what do you which I almost don't use it anymore they gave me a small nebuliser and I used that for about a month and it cleared me up completely oh great and I keep it there for an emergency now fine okay yeah but your chest feels alright at the moment yeah yeah I've had bronchitis about 3 times in my life oh okay which you know is just a sight I think your last couple of sight was old age really you but I've I've not I had covid but not badly good not very badly you've a glass of clay down at your feet glass of water where's the most tender in the pouch oh no that was the soreest bit yeah that left lower part yeah that's that's often sore mhmm that's supposed to be some part of the bowel that does a lot of work mhmm is it sore all the time I can't yeah it it's quite often sore but not spasming sore just a bit tenderly sore that that side's probably sore today bit sore today yeah so nothing coming out over the last 3 days nothing at all I've tried mhmm it feels like there's something that wants to come out no it doesn't I I know how much I passed in the toilet that night mhmm the first night and the second night was worse mhmm and I thought I'm not I'm gonna go to you for weeks I think or days you know yeah well actually I'm not gonna listen to you too much I'm you don't understand me the afternoon that sounds interesting great I'll come to the side of the top which is good so you recently had a ct scan didn't you I saw the result of that as an outpatient from 1 of the uptown surgical team who saw you because of weight loss and difficult and only able to eat small meals is that right and then you had a ct scan that was all to do with the hiatus hernia which I've checked every so often because when they checked it they said it used to be small now it's large but not large enough to worry about but then 1 of the doctors there I didn't understand what he was saying because they're good at accents and apparently he'd said he wrote on the bottom of it to refer me to see somebody and when I went to see them they said we don't think it's bad enough to do anything to is a cc scan where they put it down your throat that's an endoscopy that's what they gave me for the and then you went into a tunnel and had a scan in the on the december 21 yeah was that was that was and I was getting all this bladder pain but when they couldn't work out whether I had an infection they didn't know why I was getting they bladder said well apparently she said I got a phone call saying your doctor's asked for an emergency bladder scan so I went to the scan shop and is there a way we can scan all of you yes which they did so I thought well that's good so I think the upper gi surgeon who met you at the time of your endoscopy you told them that you were only able to eat small meals that you'd had a bit of weight loss yeah and so they did a scan of your tummy and your pelvis yeah that's right and the doctor I saw he said people when people get old sometimes you have to swallow slowly because the little flippy bit yeah yeah the lower oesophageal sphincter I think it was what he meant yeah because they say words you don't know what they're talking about didn't you but I understood what he was saying but I can't he remember what they're said you're gonna have to eat small meals and he gave me these awful drinks to drink alright because you were losing weight so much I can't drink them they're so sweet they're like drinking liquid sugar I couldn't drink them it's all very strange so so it seems what what the reason I say is because it sounds like before all of this went on with the diarrhea you were losing weight yeah but since since the diarrhea I've gone from 9 stone 3 mhmm to 8 stone and just since the diarrhoea since last saturday that week I weighed and I was 8 stone 3 9 stone 3 and I said to the doctor today how much do I weigh and she said the stones I said well how much is that and I looked it up and she said you're 8 stone 9 so that's what you're trying to eat for you no it is that's just going to the and not eating and had you been losing weight before that yeah only only because sometimes when you go to swallow you can't swallow it and that's why you had the upper gi endoscopy yeah because of problems as he still said I don't think there's anything to worry about you know I think he I was old he said there's nothing surgical that can be done he more or less said there's nothing that can be done have mash food and I'll give you some drinks well they sent these 2 great big bags of drinks with the delivery people well I don't know what you have to be to drink them it's like drinking syrup it's like drinking cream with syrup there's a lot of calories in them but too much sugar I can't drink it so I thought well what I'll do once I get over this I'm gonna go to mark's and get loads of good little bits of food and tend to myself because if if I think oh it's gonna make me ill I won't bother to eat it yeah of course and what did you do for a living oh I've done lots of things I was a nurse at 1 time oh fine but what kind of nurse were you I was on ainsley ward fine yeah orthopedics yeah yeah lovely fine and you should have said I didn't know I was speaking to another medical professional no not that medical I didn't have my heart in it really what makes you say that I was not a good nurse because I used to get too upset emotionally attached I used to come to work early to see sure someone was alright and that the other girls had looked after them you trained nurse registered nurse yes and then I became a barmaid on and off when I was at the hospital I used to get jobs at the casino because the boss never paid you they won they give you a chip the boss let you keep it and if it was a £50 chip you could cash it for £50 most casinos have got a limit on what they give the staff for the chips fine anyway then we from there where did we go oh bought a small hotel okay I ran a hotel and then I bought a little farm great some horses and then I bought some holiday flats in torquay okay fine and then run those and then when I made this you you've got to set your mind as to how much you're going to make what the value of the house what I wanted I sold that and retired early and did a bit of community care on a sunday because I was a bit lonely going to look after old people because I never thought I was old no you're still not you're being 5 I'm still a bit old at the minute but I'll get young again yeah you will yeah it'll make you feel better so your scan didn't show anything worrying which is obviously what it was here to explain I thought oh it's terrible if my eyes got bigger and I've this but the doctor says nothing there's nothing that can be done anyway you said so just at your endoscopy but you subsequently had a scan to the apex oh I've never known what the scan was at the the scan result was reported this very morning oh because no 1 ever told so was it all it's fine yeah nothing to worry about on your ct scan that you had so all I've got to do really is be careful what I eat the scan didn't show anything worrying as I say it didn't show we were the reason that the scan was done was to exclude the cancer as a cause for your weight loss difficulty in swallowing and not able to have large volumes of food there's nothing worrying there causing this I used to be a big eater I could eat a great big roast dinner and then eat apple pie you know I suppose it's old age you've to accept it haven't you the scan did show you're very constipated I might have been at that time I might have been at that time fair enough obviously don't think you're up at the moment as you say because you've had lots of I'm not all the time constipated but everyone gets it it might have been at that particular time I was constipated it looked like it was a constipation that had built up over a fair amount of time oh really your the entirety of the: was full of poo oh not just having a little pooing near your back passage there was a good amount of poo which I go every day yeah fine perhaps I don't do enough every day well it's it's difficult to say as you say might have been something transient that we picked up on our scan but it might also be that the the long standing intermittent left pain that you have yeah can be related to constipation quite commonly is that the way the poo goes in for you yes that's why the: goes all the way around the outside of your bowels and the you had poo all the way around but the tightest part is on the left and that can often be uncomfortable when food comes through that bit well it's possible because I thought I would I'd go to toilet every day and I wasn't wasn't I mean doing a little bit yeah maybe and what kind of stuff came out every day before this well a few little bits not diarrhoea not hard just easy a few little bits before all of this yeah I wasn't doing anything big and then with all of this has any solid food come out or has it always been water diarrhea was only water only water yeah well I didn't actually look it was foul smelling and I could feel it coming out I suppose it might have been like a thin porridge coming out associated with bad cramps and things yeah I couldn't have cared what it was like if you said to me you'll die if you don't look at it I couldn't move to look when it got a bit better and I thought I know they've got nothing left and I could feel something coming out and I looked and saw it was red so I thought oh I'll go and tell the doctor now you know yeah fine fair enough also perhaps I've got to be a bit more careful with my fibre intake yeah guess there's lots of things that could be going on to there the first is that as your gp thinks that you've had an infection that you've got infectious gastroenteritis often people will have vomiting associated with that and I don't think you did did you vomit I didn't bring anything up because I didn't start to vomit until after I had the diarrhea I retched several times in the sink and I brought out thick white mucus mucus thick it stuck to you and it was white like sputum almost yeah it wasn't clear it was white and I took pick it off yeah yeah okay yeah so no real large volume of vomiting no no which often goes yeah big burps often that will happen with gastroenteritis that we get vomiting so that goes against that yeah often people will have fevers and that goes against that yeah often people will have very raised markers of infection and inflammation in the blood you do have raised markers of inflammation is that from this test from the blood test you had yeah I didn't know she did have blood I always go like that I hate needles always hated needles right yeah so your blood test does show your crp is quite high about 50 something oh okay yeah in keeping with infection or inflammation but the rest of your blood tests kidney function liver function are all fine so there's no any dehydration associated with it this hasn't affected your kidneys in any way which is obviously good the other potential is whether this is an overflow diarrhea certainly do see people in clinic who have yeah who have tummy pain associated with watery stuff coming out yeah and no solid stuff coming out and your recent ct scan which showed that you were quite constipated it's always the potential that this is an overflow diet yeah yeah obviously the management of those will be very different I guess 1 test that might help us determine between the 2 is an internal examination if I can feel lots of poo inside then that will make it much more likely that this is an overflow diarrhea as opposed to an infective diarrhea yeah so that'll help us determine what to do do you mind if we do that is that alright no I've got to the stage where you do whatever you like now I think that'll help in terms of working out what's going on yeah is that okay still even though I'm on antibiotics I've still got an infection so yeah your markers of infection inflammation erased yeah that can happen with an overflow diarrhea sometimes when the when the bowels are can become inflamed I was always constipated as a child and I put it down to the poor diet that we had mhmm you know sort of like bread yeah fine fair and do you eat lots of fiber now well I practically live on vegetables oh good I don't eat meat at all yeah fair I eat a little fish mhmm and I eat some cheese and and and about half a dozen eggs a week and I eat broccoli I don't like it but I make myself eat the vegetables and in the summer I just have salad with a jacket potato but I was told when I was very young things come back bowel and it does look like your ct scan shows slow transit constipation an x-ray of your tummy would also be helpful wouldn't it it would tell us whether you're constipated maybe better than a finger test to be fair okay and and it it will would also also tell tell us us whether there's any potential complication associated with infected diarrhea so probably that's a better test okay yeah should we do that it's also less invasive so it'll be a bit nicer probably for you yeah that sound good so we'll get an x-ray of your of your tummy and see whether you're either constipated or whether you've any problems associated with an infective diarrhea we'll get you some iv fluid certainly your blood tests don't look worrying in terms of dehydration but we'll try and make it feel better okay we'll get a culture of any poo that comes out to make sure it's not infected I've been carrying it the doctor gave me a little jar and I've been carrying it with me mhmm but just haven't made anything that I can go but because I'm not the only would be strange as guess that not opening your bowels for 3 days fits a bit more with an overflow diarrhea as well okay in that you know if you had an infected diarrhea I would expect you to keep having lots of loose stools yeah yeah as opposed to as opposed to it suddenly stopping yeah yeah you know what I mean so worth thinking about that and I think and we can do some tests and work out which one's which so would that be today yeah oh okay yeah that sound alright that's lovely and and I'm not gonna have fluid put in here now I'll give you some iv fluid oh you're gonna have fluid yeah I might not feel better to go through it'd be a big bag yeah a liter of 4 hours or something like that lovely yeah that sound okay lovely good luck to you oh thank you very much it's a pleasure bye bye bye bye see you later can we just turn the lights on to your psc again it's no I've not been tested yet I'm gonna and get some rest it's 06:00 now yeah alright do want me to turn it off yeah before I actually get x-ray I'll make sure I go every week or will they let me know in advance yeah they'll let you know get me so alerted yeah yeah bye bye thank you bye bye bye