Attending court with IBS/IBS-type symptoms

[UrsusArctos]

Hello. I'm new here and I'm posting because I have an urgent and very worrying question.

My medical history is very complicated. I was diagnosed aged 2 with coeliac disease. However, the paediatrician who diagnosed me, and the GP who confirmed that diagnosis, made the diagnosis purely based on the fact that I seemed to be unwell when I ate gluten and better when I didn't. Doctors I have spoken to more recently have agreed that this was in fact completely unacceptable. At the time my parents were persuaded that it was unnecessarily unpleasant to subject a child of that age to a biopsy test. Unfortunately that decision has led to problems more recently as the gastroenterologist I am now being treated by doesn't really know how to proceed until he knows for certain whether or not I actually have coeliac disease. I was perfectly healthy for about 25 years on the gluten-free diet, but over the last five or six years I have become increasingly unwell with symptoms including diarrhoea, bloating, bleeding, and pain. If I did not take large quantities of loperamide on a regular basis I would probably have almost constant diarrhoea. I have had stool samples analysed, I have had blood tests, I have been genetically profiled, I have had abdominal and rectal examinations, I have had an OGD and colonoscopy, and I am now waiting for the results of D1 and D2 biopsies (following 7.5 weeks eating gluten). Stool samples were inconclusive as my incompetent GP didn't know that rectal bleeding causes raised calprotectin. Blood is normal. Genetic profile is positive for HLA-DQ2. Abdominal and rectal examinations were normal. OGD and colonoscopy were normal. The only thing we don't know about now is the biopsy results. I am now following the gluten-free diet again and I feel absolutely terrible, so whether or not I do have coeliac disease I obviously have something else as well. The only diagnosis I've been given so far is IBS.

Here is my present concern: next week I am due to attend the Crown Court for at least one whole day. I'll be giving evidence for about three hours before lunch and for at least two hours after lunch, with the possibility of the court sitting late or my returning the next day to continue in the morning session. The judge will be informed that I have these symptoms and that I am in the process of further investigations by a gastroenterologist. Stress seems to be a very big factor in my symptoms, and this is almost certainly going to be the most stressful thing I have ever done (and I hope the most stressful thing I will ever have to do). I visited the court last week and just seeing the courtroom was absolutely terrifying. It is just terrifying me all the more that I may or may not have symptoms while giving evidence. All I can think to do is to take a huge dose of loperamide prophylactically. I am currently due to give evidence under special measures, but I am considering declining the agreed measures, partly (though not solely) because the procedure for entering and leaving the courtroom is so lengthy and complicated, and I know that I may need to be able to leave the courtroom immediately.

I am just wondering whether there is anyone else who has ever been in a similar situation, and whether anyone has any suggestions. One idea that occurred to me was to take strong laxatives (such as Moviprep) on the day before I am due in court, so that my digestive system will be completely empty. There are two problems with this. The first is that if I'm in court having not eaten for nearly two days, probably having very little sleep, and being dehydrated, I am unlikely to be able to give evidence very effectively. The second is that if my digestive system is completely empty, and if I am drinking water to prevent dehydration and to help when I am speaking, I will have to keep leaving the courtroom to pass urine! People will probably think I am being completely ridiculous, but people who have had symptoms as severe as mine will perhaps understand just how awful it can be and how worrying it can be. I was even wondering about having a urinary catheter, which I think shows how out of my mind I am going with worry about how to get through this. It's got to the point where I am actually more worried about my bowel symptoms than I am about the trial itself.

Any suggestions gratefully appreciated!

[shirlygirly]

Oh dear, I would certainly not overdose with laxatives its not fair on you or your body. I have to take immodium freqently and they can really gum up

the works and then your body has to right itself. I have had to prepare

for an operation and you would expect that to be easy, but anything but,

with IBS you cannot empty your bowel to order. I would make it quite

clear that your need for the bathroom may be frequent, due to your

health and arrange for someone you can signal to discreetly when that

need arises. Stress would certainly be a trigger for me and most people

would understand that. Try and stay calm, Rescue Remedy works for me

you must state your needs without feeling guilty, it is not your fault.

dont lose anymore sleep, Good luck things are never as bad as you

imagine they will be. Shirley.

[val_s]

I suggest seeing your doctor and asking for something like Propranolol - it's a beta blocker that's often prescribed for performance anxiety, as a one-off for driving tests, or as needed for actors or musicians, etc.

It blocks the action of adrenaline which causes the butterflies, loose bowels, etc, so your body feels calmer - but, importantly, without affecting performance.

It's quite fast acting too, so even if you don't take it, just having it with you, and knowing you have something to take if needed, may also be helpful.

[Hidden]

Can you not ask to be excused on medical grounds , your GP could write a letter for you to the court . I do hope and pray that you will feel better soon .

[UrsusArctos]

Thank you everyone for these suggestions.

I'm certainly not looking forward to it, but I don't think that not giving evidence is going to be an option. This trial is the culmination of two and a half years' work on the part of the police and CPS. My own contribution to that investigation has been more interviews than I can remember, dozens of pages of evidence, and huge quantities of documents handed over to the police. If I don't give evidence on the day then the defendant walks, no question about it. Much as I'd like not to be in this situation, the outcome of years of hard work by police officers and lawyers hangs on my ability to speak on the day.

Yes, I think taking laxatives is probably not the way to go either! I think I'll go armed with loperamide and stress that the OIC needs to make sure that the judge understands. Unfortunately it's going to be a recorder of the Crown Court rather than a circuit judge, so I fear he won't have as much experience of dealing with difficult witnesses!

I'll look into Propranolol. The only worry for me is that I'm in court first thing Tuesday, which means I'd have to get it from a doctor on Monday and wouldn't have a trial run to see how it works. I'd be a bit worried just taking one in court without having any idea how it was going to make me feel! It could be a good thing to have lined up if I'm ever in the same situation again.

[2Chrissie4 in reply to UrsusArctos]

Try Codeine Phosphate three times a day as well as the Loperamide. I too have IBSD and sometimes have to travel over 87 miles to see the team looking after me.

I take two capsules of Loperamide every morning and night as well as two Codeine Phosphate tablets every morning, lunchtime and every evening. They help me to have some measure of control over my often liquid bowel movements. The Codeine Phosphate is a painkiller but and this is crucial, the codeine also bungs you up by hardening the stools. It is important that you take bothe the Codeine Phosphate and the Loperamide regulsrily and your bowels will settle somewhat. Even taking these you will still get urgent calls to go to the loo but the codeine will help give you time to get there without accidents.That is the best advice I can give you. Speak to your GP about adding Codeine Phosphate to all your other medication. I wouldn't be without them now. In exeptional circumstances and rarely you can afford to miss the odd dosage of codeine without any ill affects. Good Luck.

[UrsusArctos in reply to 2Chrissie4]

This is very interesting. It confirms my suspicion that the doctors I have seen so far (apart from the gastroenterologist at the hospital, who is a recent addition) have been completely useless! You say, "with all your other medication". What other medication?! The only thing my GP has gone up with is peppermint oil! An earlier GP said I should an an apple every day. That is the same GP who, when I said I was unhappy about the coeliac diagnosis, and given that I was suffering from almost constant diarrhoea, bloating, bleeding, and pain, told me that I should go away and eat a slice of wholemeal bread. If I had diarrhoea etc after eating the slice of bread then I knew I had coeliac disease! Really? Even though I have diarrhoea almost every day anyway?! My latest GP isn't any better, but she did do the one redeeming thing of referring me to the hospital, where the doctor seems to know what he's doing. My latest GP didn't know that patients with rectal bleeding may have raised calprotectin anyway, meaning that stool samples were not worth analysing for calprotectin, and she referred me for a capsule endoscopy to diagnose coeliac (not the gold standard diagnostic tool), and to make matters worse assured me, despite my pointing out that it couldn't possibly work, that I could be diagnosed with coeliac despite not having eaten gluten for over 30 years! Any medication I take (loperamide) is just something I work out myself, with no medical supervision. I don't think I will bother talking to my GP, but what I will do is mention it to the gastroenterologist when I go back to him in a few weeks, as he's the first doctor I've seen who actually seems to know what he's doing.

[Chocobella]

Hi UrsusArctos,

First off it is understandable why you are feeling so anxious. I get that all the time, particularly as my job involves a lot of Court and prison visits! What I usually do is take one Loperamide tablet the night before and take as prescribed the following morning if I have symptoms.

I know it is easier said than done but the best thing would be to try to relax by doing whatever helps you to. If anything, it is the stress and anxiety of appearing at Court that could bring on symptoms.

Whatever you do, avoid drastic measures such as large doses of laxatives or as tempting as it may be, anti-diarrhoeals. You'll probably end up feeling worse on the day and for many days after.

I wish you the best of luck!

I am going to take my own advice now, I'm nervous about having to go to an important meeting in a couple of hours!

[UrsusArctos in reply to Chocobella]

Thanks. I remember hearing a barrister saying that she is so nervous about going to court that she invariably vomits before going in to court. I just hope it doesn't come to that! So if that is a barrister, who is presumably in court quite often, and just in her professional capacity, I wonder what it's like for an ordinary member of the public who's never done this before!

You'll probably be more familiar than most that if I do take advantage of special measures then it means a very complex procedure for entering and leaving the courtroom, which may be unhelpful if I need to leave very quickly. I've sort of decided that by this stage it's unlikely that the defendant's brother is going to kill me, so I'm thinking I should be ok without standing behind a screen. The ability to leave the courtroom quickly seems more important at this stage.

[BeckP77]

I'm a Police Officer and have to give evidence at length in the witness box plus I also have aniexty IBS (d) so giving evidence is my worst fear because of the urgency of getting to the loo in stressful situations.

I would suggest eating plain food leading up to the court date so there is nothing to upset your stomach anymore than it will already be. Take an Imodium, not too much otherwise you'll be in dire straits a few days later. You did the right thing by telling the witness officer/prosecutor that you may need to leave to use the loo because they can explain to the judge and you don't have to stress about that. Wear a large pad, it just alleviates a bit of your anxiety.

Most importantly and I tell you this because I have experience in what you're asking for, the worst time will be the moment leading up to you be called into court. The gripes will be at there worst, try to wait and breath through the gripes until you to the loo just before you go on. Once you've been you can go into court, the gripes will still be there, continue to breath, once they start to ask you questions focus on them and what you're being asked. I promise you that you will slowly start to focus on giving evidence rather than you're stomach.

You can leave to use the toilet if you need too, sometimes knowing that eases the anxiety.

Keeping everything crossed for you x

[UrsusArctos]

Thanks. It's especially interesting to hear from people who attend court regularly.

There's now no urgency as the trial began yesterday and was adjourned after 36 minutes until 5 October. That is after it had already been adjourned from 13 October last year. Yes, a trial has been delayed by exactly 51 weeks. At least this means I'll have a chance to discuss with the consultant between now and then.