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["okay and so just tell me i know you are on adalimumab and how it has been for you ","okay and me i know you are on how it has been for you"]
["so initially i felt that the adalimumab really made a big improvement kind of get my life back yeah now its i think its wearing off ","so initially i that the adalimumab really made big improvement of get life back yeah now i its wearing off"]
["okay and are you pretty good at taking it ","and are you pretty good taking"]
["yeah im good at taking it  i always take it at every fortnight ","yeah good at taking it i it at every"]
["okay and any abdominal pain ","and any pain"]
["yeah i do get some pain but ive had that for quite a long time now ","do get some pain ive that quite a long time now"]
["its been getting any worse recently ","its been any recently"]
["okay and any other medical conditions that you have ","okay and any other medical that you have"]
["so ive got arthritis and hay fever and asthma as well ","so ive hay fever and as well"]
["okay and are you on any medications for those things ","and are you on any medications those things"]
["just ansaid for my arthritis ","just ansaid arthritis"]
["okay are you taking those regularly or ","okay are you taking those regularly"]
["just kind of as when i need them i dont really like taking them ","just of as when i need them i dont really like taking them"]
["sure okay and do you have any sort of questions at the moment as to what might be going on or ","and have sort of the moment to what might going on or"]
["what do you think is causing my symptoms of the moment ","you think is causing my symptoms of"]
["so theres a few different things that could be going on one of them could be that as you sort of alluded to yourself that you might be coming your bodys not responding as well to the adalimumab so one of the things that well do today is check the levels of the drug in your body to make sure that your body is handling it as it should be it could also be that your crohns disease is a bit more active than usual so one of the things that we can do for that is check up fecal calprotectin which you will probably have had done before ","so theres a few different things that could going on one of them could be as you sort of to yourself that you coming bodys responding as well to the adalimumab so one of the things that well do is check the levels of drug in your body to make sure your handling as should be it could also your crohns disease a bit more active than so one of the can do for that is up will have had done before"]
["and thats just a stool test to check the inflammation we also need to send some samples off to make sure theres no infection there as well and well do some bloods to make sure you are not a knee make or needing any sort of a placement of your electrolytes okay what how does that sound to you ","and thats just a test check we also need send some samples off make sure theres infection there as and well do some make sure you are a or any of your electrolytes does that sound you"]
["you know that sounds fine im just worried that ill need to change my medication and ive been getting on quite well with the adalimumab ","you sounds im just worried that need to change medication ive been getting on well with adalimumab"]
["so just a bit worried about that ","a bit worried about that"]
["must be a bit disappointing when its been working so well ","must be a bit disappointing when its well"]
["okay i think well first of all get these basic investigations off it might be that we need to go on and get some more imaging of your abdomen in terms of mri scans or ct scans and also do a camera test or a colonoscopy to have a look at the tail end but well start with the basic investigations first and then we can decide about medication after does that sound okay ","i think first of all basic investigations it might we need to go on and some imaging abdomen in mri scans ct and also a test a to have a at the tail end but start with the investigations first and then can medication does that sound"]
["yeah that sounds fine just also worried that i might need more surgery again ","that sounds fine just also i might need more surgery"]
["okay what what makes you worried about needing surgery in particular ","okay what you worried about in particular"]
["just took me quite a long time to recover last time ","just took me quite a to last time"]
["i just dont want more surgery ","i want surgery"]
["well it usually is a last resort for the people with inflammatory bowel disease so well do what we can with medication and hopefully you respond there are things we can do with your adalimumab to increase its dose or increase the frequency as well so there there are definitely other options other than surgery at the moment ","well it is resort for the people with inflammatory bowel disease well do what we can with and you respond there are things we with your to increase its dose or increase the frequency so there are definitely other options other than at the moment"]
["yeah that sounds fine thank you ","yeah that sounds you"]