Oh that's Scott that 3 tier and 3 5 4 50 tier right now observations went hello investigations hi this is sam bell how are you hello ulcerative colitis previous colectomy and ileostomy formation and subsequent ileoanal pouch anastomosis 20 '12 pre pouch ileitis and pre pouch stricture seen on pouchoscopy december 2022 defunctioning a pouch with loop ileostomy and hesialysis 2023 previous pouchitis spondyloarthropathy under the care of rheumatology on adalimumab injections under doctor bat and then had a pouchoscopy in february 2026 a defunction pouch mild diffuse pouchitis pouch looks fibrotic and smoothly synosed proximally proceeding to the neo too high was too uncomfortable symptoms have settled down since short course of metronidazole a few weeks ago biopsies from the pouchoscopy demonstrate some inflammation consistent with pouchitis only for repeat pouchoscopy for chronic pouchitis then presents on the march 30 so 2 days ago 3 days ago increased stoma and crampy abdominal pain he described a. Of reduced stoma followed by grossly increased output of liquid bowel content no clear precipitant or surgical cause likely gastroenteritis and managed for that c diff was negative he was encouraged to use loperamide gently and doscapine and to drink electrolyte solutions his blood tests now so hemoglobin a 196 with neutrophils 8.13 and white cell count 12 lfts bilirubin 23 from 27 albumin 53 from 49 alt 52 from 46 creatinine a 167 from baseline of 96 it's aki 1 at least note creatinine was a 116 during previous admission sodium and potassium normal gfr 40 down from 62 amylase 114 from 107 crp of 1 urea of 6.2 ast of 54 feces pcr april 1 so yesterday negative c diff screen negative during previous admission tested for calcium which was normal and magnesium which was normal at that time as well he and had an x-ray of his abdomen on the march 31 which showed mildly dilated liver small bowel noted centrally in the abdomen venous blood gas on the march 30 showed a ph of 7.34 with hemoglobin a 184 and base excess - 4.3 biochemically he's very dehydrated and his observations laceration is 99% on air blood pressure 142 over 96 heart rate a 113 with blood pressure at 142 over 96 and respiratory rate at 17 the plan is iv fluid replacement add magnesium calcium phosphate to bloods + or - replace scent marks only and fluid restrict to 1.5 of scent mark's solution while in aki keeping copious iv fluids there's clear evidence of biochemical dehydration peck urinary electrolytes urinary sodium and potassium recheck stool mcns and c diff 9 am cortisol monoate thyroid function ttg limit oral intake of hypertonic fluids water tea and coffee aura dispersible leperamide and continue ppi input output monitoring strictly medications list amitriptan 10 mg at night sertraline 50 mg once a day adalimumab from rheumatology omeprazole 20 mg twice a day paracetamol 1 g 4 times a day as required past medical history cholecystectomy 20 14 as well as the ulcerative colitis and surgical management which we already know about yeah coming in tonight yeah not just yet so tell me all that I saw you come in you came in through through medical unit with increased output from your state yeah so that was on sunday sorry monday morning 02:00 in the morning literally they had a amount of going down the back so that was full yeah completely full just water like a yellow water there was nothing else in that where you can see small particles but not actually like normally I don't have any problem with firming up like I keep a good diet keep myself healthy so I've not had a problem with it and and it just went through his face they thought it might be above upstairs maybe but if it is I just don't seem to be able to get rid of it because your tests haven't shown that you've got a bug right okay it's difficult yeah have it come up but no right and you had vomiting along with it is that right and this morning I was going to see so I yesterday I think it was fantastic I felt like I wasn't a 100% don't get me wrong and the doctor comes said I'll take some of the paramyrile you can go on right but when I spoke to the nurse this morning said that it needs to be done and tell me exactly what was going on so I had a stool sample done don't know how long that takes it's come back now I think as I from yesterday anything on that 1 no it's fine it's fine but we don't like I said we don't always detect it if you have got gastroenteritis we don't always see it right okay it's not a perfect test no okay so so she said to me you're gonna have to come back in because again like literally it started the ibd nurses so it's about 04:30 this morning bit like all the time so I've been saying this before and I just felt nausea real bad even though I've been eating like I had soup soup bread plenty of ready soda chris and I was taking zinc yeah energy drinks energy gels as well like the electrolyte gels because I do a lot of cycling so I generally do 4 rides a week generally 80 to 120 ks so I ride a lot all week so hydration has never been a problem even the cycling generally when I ride my stomach doesn't do anything it's all stuck and then it's like this all the way yeah I've not experienced anything like this and then like I say and then today as soon as I woke up exactly the same as before just like every half hour just everything I was trying to put in was just coming straight back in so the most common think is just from there feeling dry so if I try and stretch like your toes or your fingers or anything they just don't completely certainly your blood pressure you're very high rate of it right yeah so when when did start it yeah which is and then palpitations no pain in your chest chest no none of that none nothing like that no literally just feel like you're a good stomach you feel like you could pass out no I wasn't yeah it was very like eddie like because when I came up pain down the leg the car park had called it caused a massive cue so I was like I just dropped me off there I'll walk up to amy and then I instantly regretted it and like I said I'm always on the bike and pretty fit but I couldn't even move like I struggled I had to stop like 4 or 5 times just coming through the cavity which was about being able get blood and did you have any fevers or other things no no fever so popping still around for vomiting yeah and then it's kinda spiraled from there gonna drink more the more you drip the more comes out yeah even if you sip though though so like today I was just going to sip in it like lit in an autumn but will not go for them so when I when I was at home yesterday I made myself up an sis 1 with the electrolyte 1 and I thought I'd just sip on that for a bit and see if that's any problem it's exactly the same just think there's something no you're very dehydrated it's like there's a bug in there or something and I can feel it you know because it's very angry and agitate the up ear at some. Yeah but I don't know what it is you had a little bit of small bowel inflammation okay at 1 time in the past yeah back in 2012 yeah I mean it could be something it could be something related to that I'm really far as remarkable like today I'm just pretty clear your markers your markers of infection are slightly raised but you can get it with infection or with activity of the inflammatory bowel disease right if your crp is 30 something usually it's high crp is normally and the h1c it's massive at the moment you're very dehydrated and you need to have lots of intravenous fluid and try to decrease the amount you're having already probably yeah I think that's like just give that a rest the trouble is the more you drink the more will come out but also what I did find with the intravenous 1 I was gonna ask is that the same even though they were giving me intravenously was just instantly going into my bag I don't know why it's like it's flushing itself for some I guess your your body is trying to get rid of water through the stomach if you've got activity then you can lose water there but the problem is then you lose all the salty oh that's right but yeah you so you just blood test show you've got a bit of a kid who hit from being dehydrated right yeah and your breast type test show that you're very dehydrated so okay I'll add on a few blood tests checking your magnesium calcium phosphate see if we need to replace that okay then I'll get on a couple of liters of intravenous fluid to try and top you up and get you feeling better yeah then in the meantime I suggest that you have anything to drink for the night so let me just pile you full of fluid and let me do the work yeah because the more you drink the more you'll have in your gut the more you'll come out okay I'll carry on you take a metformin do you I do yeah do you take are you using the laparib I tried it yesterday because I don't usually take it now but like did it come out in the back did you see it come out I did not know that's funny it's like literally because it's it's like a hot air balloon every time it's full of gas well just full of water like normally you get a hot air balloon like full of gas but this was it looked like when they filled with gas but just pour water and then literally as soon as you open it the gas yeah it's horrendous like having a leaking of the stoma on the left no you pain in the tummy around the stoma site I do get some pain there because I've got a slight peristal hernia will come out I know these crust but it's just where the where the mesh is and they come up through the mesh it like snags them out a little bit so you get a little bit snagging now and again but not they're like a pulley type but not no that's always been like that since day like I don't think there's been any change with anything other than just that I can't control it as normally I can and that's I was trying to think of things that I've done because they're like have you been mearing them with birds or anything like that and I was trying to think the last thing I do remember is we have a assessed bit at work it's like a wash down pit but it nearly ends up like a assessed pit because all the machines that get down end up being used for different green sheets and it goes away know traces for kempe and and stuff and and and stuff stuff I don't know whether it was just stagnant water and actually just kept the scabbard and stuff the only other thing I'd like was a lift provider could be a stretcher for 4 kilos even though I'm not meant it's only for the last 6 months my oldest is 34 now the youngest is 21 but no we lived in ann arbor they're listed in paints but they've got 4 businesses and they're so busy we have the kids probably 8% job yeah so we got rid of our 2 house got us down in preston on the beach so we got the beach right by the grandkids and you can just walk across the world well got it from a friend of ours pedro lives in portugal in portugal all the family's kind of I'm trying to convince my parents to live with me they don't want to terrible to live with yeah I don't know whether I'd wanna live with my mom I must be honest but but like I don't wanna have any kids anymore yeah so fuck do you drink or smoke no no nothing like that no I mean like you know I'd go out probably maybe once in a blue moon and maybe other couple of hours yeah not too really fucking hammered yeah you know I'm not lucky I drink that much allergic to anything no really that's fine and have you come off opiates lately or been on the opiate painkillers sometimes coming off those pills and like not for a long time I like the only time I've ever taken 1 is if I'm having it'd be more to do with as and then occasionally you might get like so I've got a real bad shoulder which is like attached to the tendon or whatever ligament and then I've got like a worn joint and all that so occasionally I might get up and I've got like a real bad shoulder pain on it so I might take 1 for that yeah but I I might just take 1 and then not take 1 for another yeah fine 6 months or something know I mean it's just no don't need anything I've got addicted them sorry don't worry I've addicted let's get your bogs there won't be a lot in there though I don't need anything to come out no got addicted to them when I came out of the hospital once you got addicted to them 12 blood addicted and then I went through well that like lightning type feeling you get mhmm what's that it was hard to come off of it okay but luckily I went to surgery and then come off of it when I was up on the ward because I was on other stuff and I realized then after that I'd never take too long of them just as and when but I think because when you come off them feel like you need them it's actually just your body primed up and you don't actually need it yeah don't need it you can't determine where the pain is and where your body's saying it's hard is it yeah of course I'd like to have a quick licking I just need a couple of questions of death as you can see death is the common cause of death the human body and the reason why it is so important yeah well I remember I don't know if you remember mr de france so he doesn't mention the same thing the last 1 was mr pengeles a list of friends once said to me I don't think you're ever going to go back to doing manual labour and I was determined to show him so I went back to doing what I did and then obviously he's a keen cyclist himself was doing him on the road occasionally no I've done that 1 last year I'm doing it again this year but that's not until a bit later now this is the. And fly okay so it's around somerset black yeah on the black downs black downs yeah I've done it last year as well yeah okay I got bronze on both of them last year I wanna try and improve it this year great likely I'd only been riding like 6 months when I've it just got back into it I didn't I wanted to get fit but I couldn't make little bit of a seated yeah and then swings are out but it gets a bit boring so I got back on the bike I was like I'm gonna give it a go and then I bought a real nice road bike through cycled away it's been a bit great and now I actually cycled works in the council as well work up on yeah yeah yeah I live in paintlands I ride a half a lot back yeah yeah 25 each way but what I do is I'll show you my loop great you make it take longer I work yeah so I go out to kingstown and then back to langley and then up over winter wow fine every day not every day so I try and do it 3 days a week nice I wear no do you do anything too much like in the evening yeah like cycling yeah I do like the climb man it's getting worse yeah could be you could listen to that that's normally the best part say again that's normally the best part it's the 1 good organ I got left I think it seems to be working well don't do that alright that's fine although I think it's probably dehydration there just breathe it out can you sit for it have a listen to your head because normally it's just kinda like before when I'm okay graham can I help you it's just when you like sit in a weird position I know know I can't be quick that's alright can I have a look at the camera yeah I'm trying to look I'm trying to get look that it's a little bit good right you're too weak get a hug and you've you've had a couple of times actually you had a couch yeah you had a couch and couch and then you've had your gallbladder removed for so much was that something else yeah so yeah I've had a few but yeah so the original was large: out and then and then stoma and then you have stoma on the outside of the pouch yeah and then I've had a loop well I've a loop at the moment actually so the pouch is still in because mister pengali said there's so much going on there it's probably not sucking in yeah I'm gonna have a look at I just wanna make sure it looks pink and healthy which it does yeah I mean I I changed it yesterday and it looked fine and then I took it off and then quite quite sunken it looks you just you put piney air around it not for your own well I think that's mean it's a year old right hernia just below my sternum that's where I had a hiatus hernia years ago mhmm and then I think that's when they meshed yeah both of them and would with be the I I've think only I got the left eye to see if I'm if I'm in middle of the stomach slips up into the chest I think I had it twice I think I had it twice and then can you lift your head off the bed you could be okay you can go ahead and do that you've done a really nice job I really enjoy this job what is it you do rest of your life yeah it's a combination of instagram going and instagram yeah you just been getting direct surgeons I really like him yeah I'm really disappointed because my boy is a runner he's a really good runner runs for x isn't it yeah is it x harry yeah so if you look at my boy and show him on yeah so he's 6 foot out this is my youngest 1 he's 6 foot 2 okay he's got a runny he wants to get a rope bike and I keep saying he's been down hines don't you because I'd already beaten me on his first I'm out in the car yeah I can't aim really fine probably gonna run today I would have thought so in terms of coming into hospital I suggest you bring me into hospital I did send a bag in just in case there's give you lots of intravenous fluids I'll ask them to check your electrolytes and your urine I'll add some blood tests on to make sure there's nothing else causing your stroma output to be high and we'll recheck it to see if there's any bugs in there yeah yeah and then I say try and deplete you like you're drinking oh really maximum a liter a day I would think sipping a liter a day freaking out ideally it would be something like st mark's like a electrolyte solution which would really try and because you mean like the sea water yeah the sea water is that I bet that would be horrible I know it's horrible or diorilite as well the same yeah double strength diorolite same 1 same stuff the only the only difference is that with the double strength diorolite can get it in black currant can you add you can add juice to the juice now oh maybe I'll just do that then yeah do you drink tea or coffee I do I haven't been not no no good I I normally just have a coffee if I'm out riding and I go for a coffee and a cake because I'm on a stick yeah yeah but not don't generally I do if I'm having a hot dinner with any tea yeah fine that's good I'll get you on the decaf when you're here if that's okay try to decrease the scent or any effect yeah like I said I don't really have caffeine much good that's good you you know when they're good runners when if I look at his activity run I'll tell you a little bit if you go to like so this was his last exit wrote my book look at his split track sessions yeah look at his splits there that's that was splits there yeah splits at the top that wouldn't have been his best 1 but like you must I don't know what splits they were but if you go to there was 1 where he does a run and his splits are are pretty much like 3 whatever kilometer every 3 yes yeah is this it 15 minute 5 gig on the territory I mean that's fairly accurate split isn't it amazing look at that consistency yeah that's what I mean like how the hell do you do that I don't know it's pretty because it's like it does a hard 1 light 1 hard 1 light 1 hard 1 yeah that's exactly what he's doing right yeah but it's not that light is it he's still going 3 43 40 it's not a light 1 0 so we we still need make a good like a good 1 0 yeah for sure but he's a good he looks like a runner he looks like a runner yeah yeah he loves his running he's just out all the time yeah I'm envious because I started running really late before my surgery because originally when I had to like they thought it was jogger's belly well I thought it was jogger's belly have you ever heard of it it's real thin people that run a lot oh your bowel yeah you can do I've had to run to the toilet in my runs before yeah yeah so I just thought I had a bad case of jogger's belly then they had a massive bleed if you're running jogger like this I've got a trout but yeah so I really I'd done marathons and I'd done the london trout on as well which was back in 2011 I'd done the trout and then 2009 I'd done the london trout that was last resort great I swore I'd only do 1 I didn't wanna do anything I just wanted to know that I could run and then when you set yourself challenged you just wanna I was like yeah I was like 40 30 late thirties when I run it so but I wish I'd start these actually mhmm imagine yeah yeah I need to get picky bike I shouldn't start when you give me a I'm at harvard you're on shift for like week don't I start yeah so it's a big thing when you're on 12 hours you don't for sickness just take a second take a look some medicines oh right okay feel less sick oh yeah that'd be great if you're very concerned I'll give you a bottle