refs
stringlengths 13
803
| trans
stringlengths 5
723
|
|---|---|
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 have any sort of ideas what be 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 | im a bit worried just because its been so well controlled few years now im worried that my my adalimumab stopped working or something else causing my symptoms |
or what do you think | or what do 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 | so theres few things that might be going on we need few different tests so one of them youre right it could be that the adalimumab kind of lost effectiveness which sometimes happens and we can test for that by doing a blood test to check for level of drug in your body and also um sometimes you could develop against the drug as well |
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 it ineffective so we can easily that and the other thing is that because youve had surgery in past that can sometimes affect how something called bile salts get reabsorbed um and sometimes that can cause diarrhoea if youve got high levels of bile salts in your bowel motions but quite easy to check for us well |
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 you need to also think about your disease actually flaring so the other thing well arrange to do is faecal calprotectin in which youve 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 to cheque for inflammation and the bowel so if thats high we might to look at your medication about making some |
do you have any questions about all of that quite a lot of information | do you have any about all 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 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 options so there is a medication called and infliximab which is similar to adalimumab or we might look at you know switching you a completely different drug um as well also called the biologic different works in a different way in the bodies it is called vedolizumab yeah i think first all well some up to date tests on might need to get a scan also an mri scan of your small bowel just to have a look and see theres any in the bowel that might be you know causing your |
and i had surgery before my treatment wasnt working do you think thats a possibility in the future | i had surgery before my treatment wasnt working do you think thats a possibility 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 have always keep it at the back of our mind and hopefully they you we try and out whats going on and that medically but yeah ofcourse we have to always think about is a possibility |
yeah but hopefully not | yeah but hopefully not |
yeah thats fine thank you very much for seeing me | yeah thats fine thank you very much for seeing 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 kosher 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 |
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 for quite a while theres been a bit blood in it as well have been a bit a bit so went to see my gp theyve sent 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 month |
and prior to that where you well | and prior to that where you well |
yeah ive been ive been absolutely ground before that yeah | yeah ive been ive been absolutely ground that yeah |
and how often would you say youre moving your bowels each day | and often would you say moving your bowels each day |
probably probably about three or four times i think you know | probably probably about three or times think you know |
three or four times okay has it ever been more than that | three or four times okay it ever been more than that |
it was you know it has been a couple times where its been maybe four or five or six or so | it was you know it has been a couple times where been maybe four or or six or so |
okay and is the blood mixed in or is it just on white thing would you say | okay and is blood mixed in or is it just on thing would you say |
and if you had any abdominal pain | and if you had abdominal pain |
yeah but its been yeah its been quite a kind of crampy crampy pain yeah | yeah but its been yeah its been quite kind of crampy crampy pain |
okay um any other symptoms that youve had that you can think of | okay um other symptoms youve had that you 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 noticed that my appetite have not really been eating eating well as i used to got kind of funny rash on my my shin as well |
okay when did that start | okay did that start |
so that started about a couple months ago as well | that started about a couple months as well |
and do you have rashes anywhere else | and do you have anywhere else |
no its just on my shins | no its just on my shins |
okay any other medical conditions that you have | okay other medical conditions that you have |
yeah i had ive got asthma but never really bothers me sometimes i have to take my blue inhaler | yeah i had ive got asthma but never really me sometimes i have to my inhaler |
okay and any other medications that youre taking | okay and any other medications that taking |
and have you got any family history of any significant medical conditions | and have you got any history of any significant medical conditions |
yes my my grand my grand dad had ostrich colitis | yes my my grand my grand dad had ostrich colitis |
and any other anyone else in the family with inflammatory bowel disease | and any other else in the family with inflammatory bowel disease |
no i dont think so | no dont think |
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 youve had 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 through the results with you |
no not really no | no not really no |
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 | so that we took some biopsies when we did the colonoscopy and it looks like you do have something called ulcerative colitis so were in keeping with with that condition i much you know about inflammatory bowel disease or ulcerative colitis |
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 have seen my grandma my grandfather had it i dont know i dont 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 | so its what we call a chronic condition so its something that youre going to have life unfortunately um but its a condition that we can control very well with medications in the vast majority people so to start with well start you a course of i dont think youve had from your gp yet but should help to sort of calm down the inflammation in your and then get you on some other maintenance therapies im going into details of that on at the next consultation do you questions about that just at the |
um so um yeah sorry its just lot to take in | um so um yeah sorry its just to take in |
so how long will be on these steroids for is that for lifelong | so how long will be on these steroids for that for lifelong |
so the steroids are normally just for eight to sixty eight weeks until the inflammation has has died down | so the steroids are normally just for eight 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 have it should be going back to 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 | you should know less blood if that 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 that we talked you will be on for longer term and often people are on them lifelong or certainly for years on the course 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 to arrange some surveillance colonoscopy for you as well to make sure that you develop other conditions that are with bowel disease okay |
so well arrange it to see you back in clinic in about six weeks time for a review thank you | so well arrange it to see you back clinic about six weeks time for a review thank |
hello my name is dr kosher and im one of the gastroenterology registrars at the ibd clinic can i take your name please | hello my name is kosher and im one of the gastroenterology registrars at the ibd clinic i take your name please |
yeah its john smith | yeah its john smith |
okay nice to meet you john so tell me whats been going on | okay nice to meet you john so tell me whats been going |
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 ive had crohns quite a now i was diagnosed in early early but i just its okay for a while but just ive been feeling very just very tired and more lethargic less rested a few weeks or so i have not been able to go to to call in sick ive got the bowels have been a bit more bit watery and ive been going a bit more often |
okay how often would you say youve been moving your bowels in the last few months | how often would you say youve been moving your bowels in the last few months |
probably about three or four times a day so yeah | probably about three or four times a so yeah |
okay and you said youve not noticed any blood in your bowel motions | okay and you said not noticed any blood in your motions |
no theres been no blood its just been really watery | no theres been no blood its just been really watery |
okay and does that tend to be worse at night or during the day | okay and does that tend to be worse at night or during |
i wouldnt say that much of a difference really its sometimes im up in the night but sometimes its not every night | wouldnt say of a difference really its sometimes im up 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 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 a cramping and abdominal pain its not been too bad but of often have this having 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 skin rashes at all |
and i know that youve been on fortnightly adalimumab | and i know that youve on fortnightly |
and how hows that been going | and how hows 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 its been its been fine yeah i had surgery in two thousand and fifteen and yeah been ive been okay then but yeah its just kind of recently ive not been feeling that great |
okay and any problems at the injection sites sort of skin reactions or | okay and any problems at the injection sites sort of skin reactions or |
okay and if you had any trouble with swallowing | okay and if you had any trouble with swallowing |
okay what about vomiting or feeling nauseated | okay what about or feeling nauseated |
i say i felt a wee bit a wee bit sick but ive not actually actually been sick | i say i felt a wee bit a wee bit sick but ive not actually been |
okay and have you required any steroid courses from your gp recently | okay and have you required any courses from your gp |
no not recently no | not recently no |
okay okay and any other medical conditions that you have | okay and any other medical conditions that you |
um yes ive got ive got arthritis and ive also got hay fever and asthma as well | yes ive got ive got arthritis and ive also got hay fever and asthma as well |
and any other medications that youre on other than the adalimumab | any other youre on other than the |
so i take i take some diclofenac thats for my my arthritis | so i take i take some diclofenac thats for my my arthritis |
are you taking that regularly | are you taking that regularly |
have you noticed any stomach upset with that | have you noticed any stomach upset 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 have pain in my tummy so i dont know could 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 | possibly so we do find people here on term nonsteroidal medications like that kind of upset your stomach especially if youre not taking omeprazole or a medication like that it so we need to be need to address that do you have any insight or ideas about what might be causing your symptoms preferably diarrhoea and the 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 suppose i just assumed thats crohns with that was being watery but i dont know about but do you think it could be 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 | so yeah i think theres a few different things it could be noticed that youve not a colonoscopy for quite some time in fact not said to you shortly after were diagnosed so we need to look at repeating that i think the first instance will get some blood tests off to check in inflammatory markers and we need to some samples of your stool off make sure theres no infection and also send off a stool test called fecal calprotectin and thats to look for inflammation in that might be related to the crohns disease i depending on what are well maybe decide on whether you another test up the tail end to have a look the lining the bowel so i think thats thats what we are doing just at that the moment how 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 yeah thats thats all right yeah i just yeah i didnt really think could getting all these and things quite a lot to take in |
yeah do you think i need to change my medication to something else | yeah do you think i need to change my medication to something |
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 things we can do is to check the level of the medication in your blood called the adalimumab profile or the antibodies and the level of the drug but at the moment i wouldnt change you from adalimumab just until weve got a bit information about whats going on |
okay you think i might need more surgery | you think i might 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 again it depends a little bit on the we might you know depending on what they show we might need to go on and scan of your bowel just have a look and sure there arent any other points of narrowing in the like you had time if thats the case then we might need to look at surgery but thats a lot further down line for a moment okay |
hello my names amy i am one of the gastroenterology doctors can i take your name | hello my names amy i am one of 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 you rachel so tell 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 for past three months ive had a lot of diarrhoea and sometimes quite well and scaring now |
oh and have you ever had anything like that in the past | oh and have you ever had anything like that in the past |
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 been a bit iffy and intermittently diarrhoea but its worse over the past three |
okay and that you are passing blood each time | okay and that you are passing 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 stool and sometimes i see clots and things as well |
okay have you noticed any mucus in your bowel motions | okay have you noticed any in your bowel motions |
yeah theres a lot of mucus | theres a lot of mucus |
and does that been the case for quite a few months as well | does that been case quite a few months as well |