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okay and whats your weight being doing

okay and whats your weight being doing

and so do you have any sort of ideas what might be going on yourself or any concerns at this point

and so do you move any of ideas what that might be to going on yourself or any concerns at this point

yeah im a bit worried just because its been so well controlled for few years now im worried that my is my adalimumab stopped working or is something else causing my symptoms

yeah im api bit ad worried just because its other well controlled for few years im that my is my it stopped working or is something else causing my say

or what do you think

or what do you think

yeah so theres a few things that might be going on to know we only need few different tests so one of them youre right it could be that the adalimumab kind of lost its effectiveness which sometimes happens and we can test for that by doing a blood test to check for the level of the drug in your body and also um sometimes you could develop antibodies against the drug as well

yeah cause theres bloody things that might be going on to know is only need few m different tests so one of them youre right it and be that the adalimumab kind of lost its effectiveness m which sometimes happens and we can test for that by a blood test to check for the level of the drug in your body and bells um sometimes you could develop antibodies against the drug as well any

and which can make it ineffective so we can easily check that and the other thing is that because youve had surgery in the past that can sometimes affect how something called the bile salts get reabsorbed um and sometimes that can cause diarrhoea if youve got high levels of bile salts in your bowel motions but thats quite easy to check for us well

and which can make fickle it ineffective so we can easily check the dont thing is that because youve had surgery tabloid the past that can sometimes piece affect called the bile salts get reabsorbed um and is sometimes that can diarrhoea got high levels of bile salts in been bowel motions but thats quite tigers check for us quite collect

and of course you need to also think about whether your disease is actually flaring up as well so the other thing well arrange to do is a faecal calprotectin in which youve probably done before

and of course need to also expedient think faecal about whether your disease is actually just up stayed well of the thing well to limit do is a faecal far calprotectin in which youve probably done before

just a stool test to cheque for inflammation and the bowel so if thats high we might need to look at your medication and think about making some changes

just a stool test cheque for inflammation the bowel so if thats high outer we might need to look at your medication and city about making some greatest changes you

do you have any questions about all of that quite a lot of information

do you have any questions about of that quite a lot of information

yeah its okay if you do need to change my medication like what would be the next step

yeah its okay if you do need to change my medication like what youre be the next step

so theres a few different options so there is a medication called and infliximab which is similar to adalimumab or we might look at you know switching you to a completely different drug um as well also also called the biologic different works in a different way in the bodies it is called vedolizumab but yeah i think first of all well get some up to date tests on first might need to get a ct scan or also an mri scan of your small bowel just to have a look and see if theres any inflammation in the bowel that might be you know causing your symptoms

so theres a few different yourselves so there is a medication called and infliximab which similar adalimumab eso might look adeline you pin switching you to a completely different drug um at well also called the biologic different works in a different way in the bodies it is called vedolizumab checked yeah ah i think first of all ko p get some up barrel to date tests on first might mei need to get a ct scan or also an mri scan of your um small bowel just to have a look and see if any inflammation of in the bowel that might be you know causing your symptoms

and i had surgery before my treatment wasnt working do you think thats a possibility in the future

and i had adelaida surgery before my bell ven do you thats a possibility little in the future

so i mean its always possible we have to always keep it at the back of our mind and hopefully they you know we can try and work out whats going on and that do something medically but yeah ofcourse we have to always think about surgery is as a possibility

so i mean its always possible we have to always keep but it at the am of re and hopefully they you know cramp we can rangers and work out whats going on and that do something it medically but yeah ofcourse we have dhis water about surgery is as a

yeah but hopefully not

yeah im but hopefully not

yeah thats fine thank you very much for seeing me

yeah thats fine thank my you very for seeing or me

so hello my names dr kosher im one of the gastroenterology doctors and this is the ibd clinic inflammatory bowel disease clinic can you tell me why youve been referred here today

so hello my names dr kosher im said one and from gastroenterology doctors and this is the ibd clinic inflammatory bowel clinic can you tell me why injured kilogrammes referred here today

yes so have been having this sort of that having diarrhoea for quite a while theres been a bit of blood in it as well have been a bit a bit concerned so went to see my gp and theyve sent me here

yes so have been having this sort of that having diarrhoea youre crones quite a while theres been bit of up imperative it as well have been got bit a bit time so went to see my and theyve a todo me im here

okay and how longs that been going on for

okay and how longs that been going on for

well its three months three month

well its three months three

and prior to that where you well

and prior to that in where looser checked

yeah ive been ive been absolutely ground before that yeah

yeah ive been ive been absolutely ground before okyeah yeah

and how often would you say youre moving your bowels each day

and how often would you inflicts youre moving your deltoids each day

probably probably about three or four times i think you know

probably probably about three or man times i think you know

three or four times okay has it ever been more than that

three or four times okay has andi ever non been more than too

it was you know it has been a couple times where its been maybe four or five or six or so

it bell you know it has been croons couple times where its been maybe adam four or five or in faecal or so

okay and is the blood mixed in or is it just on white thing would you say

about and krone the blood mixed in or is it right dh high thing would say

and if you had any abdominal pain

and if you had any abdominal pain

yeah but its been yeah its been quite a kind of crampy crampy pain yeah

yeah but its been yeah its quite a parent of crampy crampy pain yeah

okay um any other symptoms that youve had that you can think of

okay um any other symptoms that youve is that outer can think of

um ive noticed that my appetite have not really been eating eating as well as i used to ive got kind of funny rash on my my shin as well

um ive alone my appetite works not really been eating eating as well youre i used to ive got kind of funny rash on my shin as well

okay when did that start

okay that start

so that started about a couple months ago as well

so that ive about a couple ad months ago well

and do you have rashes anywhere else

and do you have rashes anywhere else

no its just on my shins

no studio its just on shins ad

okay any other medical conditions that you have

okay any other medical conditions that you are does

yeah i had ive got asthma but never really bothers me sometimes i have to take my blue inhaler

yeah i had got asthma but really bothers me sometimes i have to take my blue inhaler

okay and any other medications that youre taking

okay and any other medications that youre taking

and have you got any family history of any significant medical conditions

and have you got student family history society boats any significant medical conditions

yes my my grand my grand dad had ostrich colitis

yes my battle grand my stars had ostrich

and any other anyone else in the family with inflammatory bowel disease

and any other anyone else in the family with for bowel disease

no i dont think so

it i dont think claytor

okay so so far youve had some investigations done so weve taken some samples of your stool to make sure that theres no infection there and you also had a colonoscopy a couple of weeks ago did anyone go through the results with you

okay so so far plan had some data investigations of done so weve taken in samples of your stool to taesa sure that because no infection there and you also had a colonoscopy a couple of weeks high did anyone the machine the results with you

no not really no

no not really

so that we took some biopsies when we did the colonoscopy and it looks like you do have something called ulcerative colitis okay so they were in keeping with with that condition i dont know how much you know about inflammatory bowel disease or ulcerative colitis

p my we took some biopsies cramp when we did the colonoscopy and it looks like you do something called ulcerative colitis okay us they were in keeping with with that condition i dont barrel know how r know about inflammatory um bowel or sets

i know wee bit because i have seen my grandma my grandfather had it i dont know i dont know a lot

i know wee bit because i lot have seen my grandma my locked had it i dont know i dont rash know a lot

okay so its what we call a chronic condition so its something that youre going to have life long unfortunately um but its a condition that we can control very well with medications in the vast majority of people so to start with well start you on a course of steroids i dont think youve had any from your gp yet but that should help to sort of calm down the inflammation in your bowel and then well get you started on some other maintenance therapies im going into details of that on at the next consultation do you have any questions about that just at the moment

okay so its what we a chronic so its something that it youre going here to have life long unfortunately um but its a condition that we can tabloid very well with medications in the vast iss of people so to start here with well start you on student course of steroids i dont this think youve had soon your gp yet but that should help to bet of mat down one the tommy in mom your bowel adam then look get you on some other maintenance therapies service going into details of i on at the next do you have any about that just at the moment

um so um yeah sorry its just lot to take in

um so um yeah sorry its just lot to take

so how long will be on these steroids for is that for lifelong

so how long will be on these contest for that for lifelong

so the steroids are normally just for eight to sixty eight weeks until the inflammation has has died down

so take the steroids are normally just eight to sixty eight weeks until the inflammation has has died down

and hopefully your bowel have it should be going back to normal

and hopefully your bowel have it should going back been normal

and you should know its less blood as well if that doesnt happen with the steroids then we would want to know about that in case we need to do some further investigations but in terms of maintenance therapies that we talked about you will be on those for longer term and often people are on them lifelong or certainly for years depending on the course of their disease

and mob you should know its less blood as if that doesnt happen swallowing the steroids we would want to know about that in case am need to do some further investigations but in terms of therapies that we talked about you will mom be on those for theyve longer term and often people are on them sad lifelong or certainly for years depending on the of their disease

okay so and well also have to arrange some surveillance colonoscopy for you as well just to make sure that you dont develop other conditions that are associated with inflammatory bowel disease okay

okay so well also have gonna arrange some surveillance colonoscopy for you as well just to make sure that you dont develop other conditions that diary mouthon with inflammatory how bowel disease okay are

so well arrange it to see you back in clinic in about six weeks time for a review thank you

so well finest it to see you back in clinic in about affair weeks time for a p thank you

hello my name is dr kosher and im one of the gastroenterology registrars at the ibd clinic can i take your name please

mobs my mob name is dr kosher and one floating the bodys registrars idol at the ibd dont can i your name please

yeah its john smith

yeah mom its john smith piece

okay nice to meet you john so tell me whats been going on

okay nice to meet you john status tell me been going on

well so ive had crohns quite a while now i was diagnosed in early early twenties but i just its been its been okay for a while but its just ive been feeling very just very tired and more lethargic less rested like a few weeks or so i have not been able to go to work i had to call in sick ive got the my bowels have been a bit more bit watery and ive been going a bit more often

well so well had crohns quite a while now for i starts early early twenties but i just been its ad been okay for a while but its just been feeling very just very tired and more lethargic less rested like a few weeks the or v so i have not been take able to to work had ulcerated call in sick ive got the my bowels have state been a bit more bit watery and ive infected going a bit more often

okay how often would you say youve been moving your bowels in the last few months

okay how grand often would you say youve other moving your faecal bowels in the last few months

probably about three or four times a day so yeah

probably about three but four times a day so yeah

okay and you said youve not noticed any blood in your bowel motions

okay and you said youve noticed any blood in your bowel motions

no theres been no blood its just been really watery

no theres been barely no blood its just been really watery

okay and does that tend to be worse at night or during the day

okay and iss that tend to be worse at night or during the isnt

i wouldnt say that much of a difference really its sometimes im up in the night but sometimes its not every night

i wouldnt rate say battles much of a difference trampy its sometimes im me in the night but sometimes its not every night

and have you been having any abdominal pain or cramping

and have you been having any abdominal pain know or cramping

yeah wee bit of a cramping and abdominal pain its not been too bad but of often have this having abdominal pain i wouldnt say its too much different they are normal for me

yeah wee bit wanted a cramping and abdominal pain its not been beetle bad but of often have proven having abdominal pain i wouldnt say its too much different they are normal for me

okay and if you noticed any skin rashes at all

okay and if you noticed any skin pictureandi at all

and i know that youve been on fortnightly adalimumab

suddenly i know that youve been on fortnightly

and how hows that been going

father hasnt kyle that been going

yeah its been its been fine since yeah since i had surgery in two thousand and fifteen and yeah ive been ive been okay since then but yeah its just kind of recently ive just not been feeling that great

yeah stayed been its been fine since idol yeah since i had surgery in two thousand and fifteen and yeah ive been ive been okay since then but yeah its just adeline kind of recently ive just not been feeling that great

okay and any problems at the injection sites sort of skin reactions or

okay and mine have at the injection sites sort faa ofthe reactions or

okay and if you had any trouble with swallowing

okay and if severethat rational any trouble with swallowing

okay what about vomiting or feeling nauseated

okay what about of or feeling nauseated

i say i felt a wee bit a wee bit sick but ive not actually actually been sick

have say i felt wee bit a rate wee bit sick but whyd not actually actually been sick

okay and have you required any steroid courses from your gp recently

okay and have you required mobs steroid courses from gp

no not recently no

no not recently no

okay okay and any other medical conditions that you have

okay they and any other medical conditions affair you

um yes ive got ive got arthritis and ive also got hay fever and asthma as well

um soon ive watched got ive got arthritis non and ive also got go fever and know anne as look

and any other medications that youre on other than the adalimumab

and any other medications that youre on other than the adalimumab

so i take i take some diclofenac thats for my my arthritis

so i take i take guy some barely diclofenac thats for my my sets

are you taking that regularly

are you taking that regularly

have you noticed any stomach upset with that

have you noticed any stomach far bean with that

i mean well i suppose i have to have this abdominal pain in my tummy so i dont know could that be could be connected to that

i mean well i suppose i have to this abdominal pain my so sets dont know could that be could be connected to

yeah possibly so we do find people here on long term nonsteroidal medications like diclofenac that kind of upset your stomach especially if youre not taking omeprazole or a medication like that with it so we need to be might need to address that do you have any insight or ideas about what might be causing your symptoms preferably the diarrhoea and the weight loss

yeah possibly so they because being teo here on long term nonsteroidal something diclofenac that kind of dodds upset your stomach especially if youre not taking omeprazole or a medication like that with off so we look to be might need faecal address that do you have any insight or ideas about what might be causing your symptoms preferably the diarrhoea far and the weight loss

and well i suppose i just assumed thats my crohns with that was being watery but i dont know about but do you think it could be anything else

and well i movement just assumed thats quite crampsand crohns with that mucous being watery but i dont deciding about but do you think adam it be anything else

so yeah i think theres a few different things it could be i noticed that youve not had a colonoscopy for quite some time in fact not said to you shortly after you were diagnosed so we might need to look at repeating that i think in the first instance will get some blood tests off to check in inflammatory markers and we need to send some samples of your stool off to make sure theres no infection and also send off a special stool test called fecal calprotectin and thats to look for inflammation in your bowel that might be related to the crohns disease i think depending on what those are well maybe decide on whether you need another camera test up up the tail end to have a look at the lining of the bowel so i think thats thats what we are doing just at that the moment how does that sound to you

mohr yeah think theres a few different it could be telling i map that eso not too dont colonoscopy for adult quite some time in fact not said you shortly after you diagnosed so might need to look at repeating that i think in the first instance absorbed lost some blood tests off to check in time inflammatory markers and we need to send along samples of stool off to make sure theres no infection and also send off a special stool know test called fecal end protect and thats to look for and inflammation abso your bowel that might be related to the swell disease i think depending on what those well maybe decide on whether you nice another camera watch up up the tail well to have a look at the lining this the bowel outer so i diet thats thats what we anyone doing just one show of the moment does that sound to you

yeah i mean yes yeah thats thats all right yeah i just yeah i didnt really think could be getting all these tests and things quite a lot to take in

yeah i mean yes yeah thats thats all right yeah i any just yeah i didnt really think ad could im be telling getting all these tests and two quite a lot take in

yeah do you think i need to change my medication to something else

yeah do you think i need to change piece my medication to quite something else

so one of the things we can do is to check the level of the medication in your blood called the adalimumab profile or checking the antibodies and the level of the drug but at the moment i wouldnt change you from your adalimumab just until weve got a bit more information about whats going on

so one of the wanted we can do barrel is to check the level of the medication in your blood called of got adalimumab profile pictureandi checking the antibodies and the level barely of the drug but at the moment i fighting change you mob sets your adalimumab until idea got a bit other more information about whats going on

okay you think i might need more surgery

okay you think i might a need more surgery

well again it depends a little bit on the investigations we might you know depending on what they show we might need to go on and get mri scan of your bowel just to have a look and make sure there arent any other points of narrowing in the bowel like you had last time if thats the case then we might need to look at surgery but thats a lot further down the line for a moment okay

well battles it depends a little bit on the investigations soon you know depending on what they show we might need to go on and get mri scan faa your bowel just to opinion a said and make there it arent any other points of narrowing in deciding bowel tommy you had last time doors thats are the case then we might need to beetle stewart but thats old a lot down the line for a okay

hello my names amy i am one of the gastroenterology doctors can i take your name

my names amy i am one of the gastroenterology doctors can i take your name

okay nice to meet you rachel so tell me why youve been referred to the gastroenterology clinic today

okay nice to meet you rachel so tell me why youve referred to the gastroenterology clinic today

so for the past three months ive had a lot of diarrhoea and sometimes its quite bloody as well and its scaring me now

so outside the past three knowwhat ive had harry lot of and sometimes its quite for bloody as status and its scaring me now cem

oh and have you ever had anything like that in the past

oh this have you ever had anything ko like that in the other

over the past few years id say its been a bit iffy and intermittently having diarrhoea but its been worse over the past three months

over the past few years id say its still a bets iffy and intermittently having diarrhoea you but its ko been worse over the past three months

okay and that you are passing blood each time

okay that you are blood each time

most times and its mixed with the stool and sometimes i see clots and things as well

most times and its mixed with the v stool something sometimes i see clots and things as gonna

okay have you noticed any mucus in your bowel motions

okay have rational noticed any mucus im your bowel motions

yeah theres a lot of mucus

yeah inside a wife of little

and does that been the case for quite a few months as well

does that been the case for quite a few months as well