- 5 giờ trước
GPs: Behind Closed Doors - Season 9 Episode 1
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03:31chọn so It draws blood to the area so we're trying to soften the stuff in the cyst and ideally the cyst at some point will burst
03:39either it dissipates or I think in your case it might pop
03:43I'm quite helpful at making that happen
03:46Let's avoid it so please don't force it after about five minutes of the heat, just massage it so you're just gently rubbing along
03:54So not squeezing it I don't want you to get your eyelid and press it together because the problem with that is then the infection can spread
03:58I have done that before with Wosling Say
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07:52Điều đó là vì god dân nghiệm của tên, chị đã biết trở thành người chó với giáo sĩ.
07:56Tại thường là là việc dân,bour viên cô ấy.
07:59Hãy tìm thấy bọn bọn đều, bạn có thể thấy bọn bọn đều với những tên bọn bọn đều sống.
08:02Anh có thể nhìn thấy một cách gây hợp các bạn.
08:04Chuyện một điện bàng thân đã thấy pháp thông minh cô ấy.
08:07Đó là vì tôi thích nên nhiều việc quan tâm mình.
08:11Qua từng?
08:15Cái tên là một người thân tôi đáng.
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10:40All well apart from this pain, which feels very similar to before when you had the impairment.
10:45So you quite rightly went to A&E.
10:46They said the x-ray was fine.
10:48And we've had a look at it and it shows chest x-ray.
10:51There was blunting of the angle, suggesting that you have got a slight pleural effusion.
10:55You do have fluid in your lung.
11:10I mean, I just feel my lungs are really not operated to full capacity.
11:18Can I listen to your own lungs?
11:20Yeah.
11:21Bugs love hot, wet places and the lungs are great.
11:24I'll have a listen in just to make sure the lungs are okay.
11:26Have you been to the lung function test?
11:29Yes, that's the one.
11:30Are you coughing at all?
11:31Not because I've got like a tickle in my lungs.
11:34We need to get you some new lungs and a new heart.
11:36So the reason I'm listening there is just to make sure there's no fluid buildup around the lungs.
11:41And there isn't.
11:42So the lungs sound crystal clear.
11:43Something good.
11:44Yeah, yeah, absolutely.
11:47You do have fluid in your lung.
11:50You should have nice pointy bits at the bottom of your lungs.
11:52And they're not, they're full of fluid.
11:54Okay.
11:54So what's going on?
11:55Why is it there?
11:56Can I have a listen to your lungs?
11:58Because I think we need to find out why are you getting this?
12:02And where are you getting the pain?
12:04Like bra strep area on my right side.
12:06On this right-hand side, yeah.
12:08I can just hear there's slightly reduced air entry on that right side.
12:14The oxygen's 97, 98.
12:16So that's good.
12:17The question is that that x-ray does show, come and have a seat, a bit of fluid in your lung.
12:20So your lungs, your lungs themselves can't feel the pain.
12:25Sort of the pleura, it was called, the plastic bags they sit in.
12:28That's what gets sort of inflamed.
12:29Or if there's fluid there, it's pressing on it.
12:31And it's an uncomfortable feeling.
12:33And it's horrible.
12:33And as you said before, we left it and it built up and up and up.
12:36So I'm worried.
12:38Yeah, I don't want it to get to that level again.
12:40So an empyema is when pus, basically infection cells, build up between the lungs and the wall of your chest.
12:47So it's not actually in the lungs, it's trapped there between them.
12:49It's not a common condition, but it can happen as a result of a pneumonia, a really nasty chest infection.
12:54If left untreated, an empyema can be really serious.
12:57The collection of pus can build up and that can squash your lungs and make you very short of breath.
13:01And also, potentially, the infection can spread in other parts of your body and potentially lead to sepsis if nothing is done about it.
13:07And I do worry, sweetheart, that if we don't do anything, then you're going to end up feeling poorly or having a temperature in five days in hospital again, which we don't want to do.
13:14Yeah, no, please.
13:15They do have at the hospital what we call the AEC, which is an acute assessment unit.
13:19Yeah, I've been there before.
13:20You've been there before.
13:21They are so good.
13:22They are so good.
13:22So basically, they're a sort of consultant-led, urgent thing where we can't wait weeks.
13:27Yeah.
13:27What we don't want to do is it to build up, so we need to stop it.
13:30And then we need to ask the question, why, if anything, has it come back and how can we prevent it coming back again?
13:36Do you mind having a seat in the wait room just for a few minutes?
13:38No, no, that's fine.
13:38And I'll try and get hold of them on the phone and sometimes it takes a bit of phoning around.
13:41All right.
13:41Thank you very much.
13:41Have a seat.
13:42I'll call you back in two minutes.
13:43Thank you.
13:43Okay, thank you.
13:48Hello, hi.
13:48My name is Dr Pearson.
13:49I've got a 37-year-old lady.
13:52She's had a history of an empyema.
13:55And I've had a look at the x-ray and it does show there is some blunting of acostrophrenic angles.
13:59And I'm worried that it might have escalated over the last 24, 48 hours.
14:04Okay, I'll get her to come straight away.
14:05Thank you so much.
14:06Bye-bye.
14:10Hello, no.
14:11Yeah, go straight up.
14:13Okay, you take care.
14:14Good luck today, Elena.
14:14All the best.
14:15Will I bring my coffee?
14:20You can, of course, yeah.
14:21Go for it.
14:21Why not?
14:22Can you take it?
14:23Of course I can.
14:23In case I spill it.
14:25Yeah.
14:25I've been well looked after this morning.
14:27I went on a starvation from lunchtime yesterday.
14:30Oh, no, you didn't need to do that.
14:33Oh, it's hotting from midnight.
14:34Oh, bless you.
14:35Poor thing.
14:37So I was gasping for coffee.
14:38Oh, I can imagine.
14:40I'll leave this here for a second.
14:42How have you been, though?
14:43Are you well?
14:44Well, I'm up and down a bit.
14:46Yeah.
14:47A little bit more up than down.
14:49Well, that's good.
14:50But it's, you know, I'm not 100%.
14:51I get really cross with myself, actually.
14:54Well, remember to be kind to yourself, because, you know, I think we're all our own worst critics,
14:59aren't we?
15:00Yeah.
15:01There you are.
15:02Thank you.
15:03Yes, I've had so many pains and things that I thought, well, I'd better have as pure
15:09as I can blood tests.
15:10Fair enough.
15:11Yeah.
15:11The thing is, I'm just wondering what the results were on the third poo I did.
15:19Yes.
15:20Which, you know, these pains are crucifying me when I get them, unannounced, unexpectedly.
15:27I haven't had one for a month.
15:29Mm.
15:29But it could come tomorrow.
15:32Anytime, yeah.
15:33Fair enough.
15:34The last poo that came in, that one I had more in the bottle than I had in the last two bottles.
15:40Fine.
15:40Because I was more expert, getting more experienced.
15:44Yeah, absolutely.
15:44You're a pro now, exactly.
15:46You've done it that many times.
15:47So, since then, I've had no pain.
15:49Good.
15:49But when it happens, I have to lie flat on my tummy.
15:52Yep.
15:53Take a Panadol.
15:54Yep.
15:54And take the bucket with me into bed, because I heave a lot.
15:58Oh, bless you.
15:59And nothing comes up.
16:00Mm.
16:01And an hour later, I can get out of bed, stand up, as though nothing had happened.
16:07Fine.
16:08Whereabouts in your tummy is it painful?
16:09Down here somewhere.
16:11Yeah, fair enough.
16:11And there's no pattern to the pain starting.
16:13No.
16:13It just happens spontaneously.
16:15I know when it's going to happen now.
16:16Do you?
16:17It's usually when I've done a wee.
16:18And then suddenly, I know that something happening down there, I can hardly walk.
16:23The pain is so severe.
16:24It's been doubled over with it.
16:25So, the first poo sample, the one that looks for microscopic evidence of blood that we don't
16:30see with the naked eye.
16:31Right.
16:31The good news is that's come back completely normal.
16:34Right.
16:34Which means the chances of your symptoms being due to bowel cancer is less than 1%, which
16:40is really, really good.
16:41It's a nice rule-out test, so we can safely say that.
16:43The other two, fecal calprotectin test, it's called, it came back elevated on one occasion,
16:48and then we repeated it, but we haven't given it long enough.
16:51We only repeated it a couple of weeks later, and it was still a bit high.
16:54So, the reason we do that one is to screen for something else, like an inflammatory condition
16:59of the bowel, something like colitis, Crohn's disease, that kind of stuff.
17:04And so, that has come back elevated.
17:05We should refer you to the gastroenterology doctors, and I think if you're having the abdominal
17:10pain with it, then absolutely, we should be sort of, you know, investigating that further.
17:15I'll refer you to the gastroenterologists, see what they say.
17:18Oh, that's it, that's it, then.
17:21Okay.
17:22Done.
17:23Done, done, done.
17:25Are you okay getting home?
17:26Did you order the transport?
17:27I've got Dalek hair.
17:28Good, okay.
17:29I'll bring this out for you, and you can finish it in the waiting room.
17:31Not a problem at all.
17:32I'll read my book.
17:33Yeah, exactly.
17:34You've come prepared.
17:35Yeah, I came prepared.
17:36It's not your first rodeo.
17:41Oh.
17:44You all right, Millie?
17:45Hey.
17:46Oh, gosh, it is, I feel a bit sweaty.
17:49I honestly thought I was going to be late.
17:51Really?
17:52Yeah, because the train station there, near my area was closed.
17:56I had to go all the way to another one.
17:58I'd take a bus.
17:59It was so annoying.
18:01Morning surgery.
18:04How are you?
18:05Well, totally different.
18:09In a good way?
18:10Yeah, in a good way.
18:11Great.
18:11But I would like to discuss those.
18:14Okay.
18:14I had a perimenobal symptom, and especially this is mental brain fog and memory relapses,
18:22so many of them are difficult to concentrate.
18:26So, well, I started this one.
18:28Yes.
18:29And that one.
18:31Yeah.
18:31And I put only one dose, one pump.
18:34Okay.
18:35Pump.
18:35Pump.
18:36Yeah.
18:37And when I tried two, I started feeling a little bit nauseous.
18:42Okay.
18:42Is it fine?
18:43And I stopped the second.
18:45Okay, so you went back to one.
18:46Yes.
18:47Okay.
18:47So, yeah, so this is the estrogen.
18:49And estrogen, I suppose, sometimes can give some side effects.
18:53So, yes, some people might feel a bit nauseous when they increase the dose.
18:56Some people get things like breast tenderness.
18:59In most cases, you get used to the dose, and those symptoms go away.
19:03Okay.
19:03How do you feel on one pump?
19:06Fine.
19:07Like, I'm still like myself.
19:10Good.
19:11Maybe my libido, not the 100% as it was.
19:14I wonder, is it for the whole my life?
19:17It will be lower libido?
19:19For the libido.
19:20Okay.
19:21Libidium.
19:21Have you noticed any change in the libido with estrogen?
19:24It improved.
19:25Okay.
19:26But, like, not 100%.
19:28If we take the libido out of it, how much better do you feel on one pump?
19:33After two weeks, I noticed the difference in my body and mental especially.
19:38I got a new job.
19:40I passed an interview.
19:41Oh, well done.
19:42Yeah, it was an intensive period, but thanks to these things.
19:47Good.
19:48I'm glad it's a miracle.
19:49Yeah.
19:50I mean, I definitely noticed a difference in your positivity today.
19:52Oh, really?
19:53It's really nice to see.
19:54Because I know you were a bit nervous about going on it, weren't you?
19:57Yeah.
19:57So, I read a lot.
19:59I spoke with many people about connection with breast cancer and so on.
20:06I was worried about this a lot.
20:08I think some of the data with breast cancer is not, you know, they're still studying it.
20:12Because it's quite new.
20:14We know until you're 50, you're at kind of population risk of breast cancer.
20:18Oh.
20:19So, it doesn't matter.
20:20Not until you're 50.
20:21So, we know that for women between age 50 and 59, if we put 1,000 women on HRT, there
20:27would be four additional cases of breast cancer.
20:30However, there's lots of other factors that increase breast cancer.
20:32So, smoking, alcohol, being overweight, lack of exercise.
20:36So, when looking at risks of HRT with a woman, we need to look at their family history.
20:42And we also need to look at those lifestyle factors.
20:44For the libido, we know that the estrogen can help.
20:48But I think last time you asked about testosterone as well.
20:51Yeah.
20:51Yeah.
20:52So, we can give testosterone.
20:54Okay.
20:55It's more how you feel.
20:56We want to do the best for your symptoms.
20:58I would like to try testosterone.
21:00What we'll do is, why don't you try two pumps and see if it makes you feel any better.
21:05Uh-huh.
21:06If, after a couple of weeks, you think, or even a week, if you think two pumps is not
21:09for me, stay at one pump and then come in and have your bloods checked and we'll do your
21:14testosterone level and everything.
21:16Okay.
21:16Yeah.
21:16And then I'll see you and we can talk about adding in the testosterone if the bloods are
21:21fine.
21:22All right.
21:22Yeah.
21:23Perfect.
21:24All right.
21:24So, any worries in the meantime, come in.
21:27Okay.
21:27Okay.
21:28I'm so glad that you're feeling much better.
21:29Yeah, me too.
21:30Thank you.
21:31Not at all.
21:32Have a great afternoon.
21:33Yeah, you too.
21:34Bye.
21:34Bye.
21:35Bye.
21:36Bye.
21:42My voice sound okay?
21:44It sounds, you've got the sexy telephone voice.
21:46Not really.
21:47I think I do at night.
21:48Oh, toss.
21:49I've been told my voice is very soothing.
21:52Oh.
21:53Yeah, I think it is.
21:54Right.
21:54Oh.
21:55It is.
21:55I've got a soothing voice.
21:56You too as well.
21:58And me, I've got a sexy telephone voice.
21:59She's got the sexy telephone voice.
22:00Oh, you do.
22:01You sound so pot.
22:02Hello, hello.
22:02I'm calling from the medical centre.
22:04It depends who I'm calling.
22:09I do put on a little sexy voice and then someone's sound really nice on the phone.
22:12I'm like, oh, that's okay.
22:14No worries.
22:14Come and have a seat.
22:21Tell me, what are we up to today?
22:22Right.
22:23I don't know about my x-ray tool.
22:27Okay, we can have a look at that.
22:29But tell me what sort of symptoms you've still got pain and things.
22:32The pain is just getting bad.
22:34And it's also around the lower back for some reason.
22:39Because it's both my left and my right.
22:42Okay.
22:42But the right is so bad I can't sleep properly.
22:46You can't sleep.
22:47I mean, the x-ray was done in April and they're saying that actually the bones look quite strong.
22:52But there is a bit of narrowing.
22:54They're wondering if the tendons and sort of things that hold our bones in place, whether they've been damaged a bit.
22:59Did you fall over or?
23:01Last year, I moved an elderly gentleman.
23:07I had to pull him from his kitchen to the front room.
23:10Oh dear.
23:11And then saw my back.
23:12You hurt your back.
23:13And I think then you requested some prednisolone, some steroid tablets.
23:18So I was put on that for a few months.
23:21But it helped the shoulders.
23:22It did help me in my knees and all that.
23:25You're absolutely right.
23:26Steroids can really help inflame joints.
23:28So there's no doubt there.
23:29The problem is it's not generally steroids that we take by mouth.
23:33We normally try and do a cortisone, a steroid injection into inflamed tendons, ligaments, things like that to reduce it.
23:39So we target it to where the problem is rather than getting into the whole body.
23:44The reason being is because steroids have a lot of side effects.
23:47A couple of the side effects that are very relevant here where we have to be careful.
23:49One is it can actually thin bones and do damage to bone.
23:52So we don't want to make that worse.
23:54Second of all, and always more worrying, is sometimes they thin the lining of the stomach.
23:58Do you still have a drink occasionally?
24:01Yeah, every day.
24:03Every day.
24:04And how much do you drink every day, Stero?
24:06Oh, it's gone up to about two, four cans a day and the whiskey again.
24:12And this is why I worry, and I know I sound like a broken record saying this to you again, but I worry, Peter, that that amount of alcohol, it's not great for your stomach lining.
24:23And when you're on a blood thinner, which you have to be because you've had these blooming blood clots.
24:26So the mixture of steroids and alcohol and blood thinners, it's a potentially dangerous mix that could then make you bleed and get really poorly.
24:36And you've already had how many blood clots?
24:38Three.
24:38And it's not like the blood clots are just in your legs, they're in your lungs, they're in the dangerous place.
24:43And if we don't treat them and they fly off, they go up to the brain.
24:46If we have a blood clot in the brain, that's a stroke, and we don't want that.
24:48So we've got to do everything we can to avoid causing harm and problems.
24:54And alcohol, I mean, do you want any help with that at all?
24:57I've done that, what, five times, seven months, gone to the places.
25:03Seven months, that's a long time to have given up for.
25:06I know.
25:06So what's made you go back to the drinking?
25:09I just want it.
25:11You like it?
25:12I just want it.
25:13Yeah, I started at the age of nine.
25:16You started drinking at nine?
25:18Yeah.
25:27Have you been to Turning Point?
25:40Is that who you've been to before?
25:42No.
25:43So they're our current provider of alcohol services.
25:47They are really, really, really good.
25:49I'm going to send you how to contact Turning Point if you choose to do it.
25:52I genuinely think it is never, ever too late.
25:55Nobody will be cross that you've done it before and relapse.
25:57That's the nature of alcohol sometimes.
25:58So as far as the shoulder, can I get you a steroid injection into it?
26:04Can I get the steroid in but do it locally rather than into the whole system?
26:10Around this point around the back, it's getting really bad.
26:15And the thing is, I'll tell you the truth, I will get a lot of painkillers put in a bottle of fruit juice.
26:23When I feel I can't do no more, I'll just drink that.
26:26Take the lot.
26:27Yeah.
26:27Have you bought all the tablets to do that or anything like that?
26:30Not yet.
26:31Not yet.
26:32Do you feel you're getting towards that point?
26:34Yeah, I'm feeling that, yeah.
26:38And what is it that stops you from doing it now?
26:40Because I can move about.
26:46I still can move and I still can look after people.
26:49Okay.
26:50And I've got my two cats.
26:52I love the cats.
26:53That's good.
26:54But you're saying when the pain gets such that you can't move and you can't do things for yourself, you don't want to be here.
26:59I don't want to be where it's going to be bad if the pain's going to be bad.
27:05And I hear you.
27:06And I'm not going to be burdened to nobody.
27:10So why don't we try and help you with this pain, try and work out what's causing the pain.
27:15Give me a chance to go through and see what you've had done.
27:18I'll just get a referral sorted out for the next people for the steroid and things like that.
27:21But I'll then try and find out exactly for the back and everything, where we're at, what we're doing.
27:25We'll move on and we'll make some progress.
27:27And let's keep in touch a bit more, Peter.
27:29And if ever things get so overwhelming that you feel that maybe the tablet's in the bottle and things at the time, come and see me.
27:35Okay.
27:36All right.
27:38All right, sweetheart.
27:39Well, listen, lovely to see you today.
27:40Come on.
27:40Let's get you sorted out.
27:41And you know where we are if you need us.
27:44All right.
27:45I'm going to get it sorted.
27:46All right.
27:47Thank you.
27:48All right.
27:48You take care, sweetheart.
27:49Look after yourself.
27:50You too.
27:50Yes.
27:50All right.
27:51Bye-bye, Peter.
27:51Bye-bye.
27:52Bye-bye.
27:57Tell me what's been going on.
28:02Okay.
28:03I have a lump.
28:04Almost seems to be getting bigger.
28:06I've noticed a lump here on the neck and I wanted to check it.
28:10I've got a lump on my armpit.
28:11It's getting bigger.
28:12Many, many years ago, I did get a lump on the side here.
28:16And tell me a bit about it when you noticed it.
28:18I just noticed it today, this morning in the mirror.
28:21It's underneath, so it's tender, isn't it?
28:25Yeah.
28:25It's just sitting there, isn't it?
28:27Yes.
28:28And it moves around a little bit, which is a good sign.
28:31It was 40, 50 years ago.
28:33But actually, it's gone down, that lump.
28:40So what can I do for you?
28:41Well, we met before.
28:42Yeah.
28:43My breasts.
28:43I was going to the breast clinic.
28:45I was supposed to have gone yesterday, but then they had to change it.
28:47Since then, I thought at first it was a bite.
28:50And I had a look, and there's nothing there, just there's some lumps.
28:53OK.
28:54And it's quite swollen and hurt.
28:56And I just thought I should come and see you and see if there's anything going on.
28:58Did you say you have an appointment at the breast clinic tomorrow?
29:01No, I had one yesterday, which they had to change.
29:03I think now it's in about two weeks' time.
29:04Well, have you been seen since I referred you?
29:06No.
29:07No, because that was back in May, wasn't it?
29:08Yeah.
29:09Marla was referred to the breast clinic for breast pain.
29:12So she'd actually been having breast pain for around five months.
29:15She is on HRT, which definitely could be a cause of her breast pain.
29:18But the guidelines suggest that breast pain over three months,
29:21we should refer to the breast clinic for assessment.
29:24Are you all right if we have a little look?
29:25Yeah.
29:25Would that be OK?
29:26OK, that's fine.
29:28You can lift the top up or just lift it off if that's easier.
29:31I'm just going to grab some gloves.
29:36OK, let's have a look at these lumps.
29:38So just relax your arm down.
29:41Here?
29:42Yeah.
29:42Mm-hmm.
29:43Yeah, so there is still a bit of a lump there.
29:45Do you shave the area when you...
29:47No, I don't.
29:49So I thought it might be an ingrat.
29:50I sort of...
29:51I thought it was a bite because it felt small and sort of itchy, pain,
29:54and then it didn't go, so that moves the hair.
29:56But that's...
29:57Yeah, that's not the most fun.
29:59That's a bit sore.
30:00Yeah.
30:02I'm just going to check the other side if that's all right.
30:06I can't feel anything that side.
30:07I only rechecked the breast last time.
30:09I'm just going to really quickly fill up your neck if that's OK.
30:11Not notice any lumps or swellings there.
30:13Stiffness recently.
30:14So it's especially sort of down here.
30:20And no lumps or bumps in the groin that you've noticed?
30:22Not a work in your neck, no.
30:23That's fine.
30:23You can sit up.
30:24Thank you.
30:24Come and have a seat.
30:27The lumps, it could be a couple of things.
30:28One is it could be some lymph nodes.
30:30The other option is it is sort of was an infected cyst.
30:33Yeah.
30:34And now it's getting better.
30:35Was it ever red and hot or just quite tender?
30:39No, not red.
30:40I think because there's lumps there and they've been there three weeks
30:42and we're not 100% sure what they are,
30:44we'll request an ultrasound off them.
30:47You're obviously going to be seen in the breast clinic
30:48in a couple of weeks anyway.
30:50So they'll be checking the breast.
30:51But let's put an ultrasound request through
30:53and we'll just get that done so that we know exactly what they are.
30:57Does that sound all right?
30:58All right.
30:59Not at all.
30:59And then we'll see you probably in three or four weeks
31:02to follow up everything.
31:02but any concerns or if anything gets worse in the meantime?
31:05So three to four weeks.
31:06Yeah.
31:06Great.
31:07Okay.
31:07Thank you very much.
31:07Thank you.
31:08Bye-bye.
31:08Bye.
31:08Bye.
31:09Bye.
31:09Bye.
31:09Bye.
31:15I was going to say I can have a silly question.
31:17Post-surgal catheter.
31:18Oh, yeah.
31:19Yes.
31:21That post-natal depression is after having a baby.
31:25Post-traumatic stress disorder.
31:39So it means after you go through traumatic experience.
31:42Huh?
31:44You're not even listening.
31:45I asked you one question.
31:46You want to give me 10 examples of where there's post in it?
31:48The post goes in the letterbox.
31:50Which post?
31:54Come in, please.
31:55Nice to meet you.
31:57Please have a seat.
31:58My name is Nilou.
32:00I'm the dietitian and you are referred to me regarding weight management.
32:05That's right.
32:05Yeah?
32:06You have tried to work on your diet.
32:08Yeah?
32:09What changes have you made in your diet?
32:12I normally eat healthy.
32:14But with South Asians, we are dependent on rice-based food.
32:21And it's almost every day that I eat rice.
32:25All my dietitian, I've been overweight.
32:28But in the last few years, I have gained, say, about 20 kilos.
32:32Okay.
32:33What do you usually have for lunch?
32:35So, again, rice with lamb or chicken.
32:41Curry.
32:42Is that a curry?
32:42Yeah.
32:43Okay.
32:43Yeah.
32:43How much rice would that be?
32:45Half a plate?
32:46Quarter of the plate?
32:47Maybe one plate.
32:48One plate.
32:49Yeah.
32:49And what about your dinner?
32:51Similar to my lunch.
32:52What would be the biggest problem in your diet?
32:55If you wanted to give me...
32:56Portion size.
32:57Portion size.
32:58So, this is a picture, like, with half of the plate rice.
33:02So, this plate has 1,200 kilocalories.
33:07As a man, it's usually between 1,800 to 2,000 kilocalories per day.
33:13So, imagine, one plate will definitely be 1,500, 600.
33:19Then, if you repeat that for dinner, that would be 3,000.
33:24Then, for the breakfast, snacks, another 1,000.
33:28You get something between 4,000 to 5,000 kilocalories per day.
33:33That's why you're not able to shift the weight.
33:36How flexible are you, like, in changing your diet?
33:40Whenever you're having one tablespoon of rice,
33:44just imagine you're having half a teaspoon of sugar.
33:47In your experience, would you advise going for something like a monjaro privately?
33:53So, a monjaro, I recommend to the patients who have tried everything and no good results.
34:01Because you're not going to be able to be on monjaro for the rest of your life.
34:04If you don't improve your diet, then once you start taking monjaro,
34:09you will put the weight back on, and this will actually damage your metabolism system.
34:15You're your dieting, losing weight, putting on weight.
34:18But work on your diet for one month or two.
34:21Okay.
34:22Thank you.
34:23Have a good weekend.
34:24Take care.
34:25Bye-bye.
34:25Come and have a seat.
34:34Hello.
34:35I haven't seen you for about 20 years.
34:37You haven't changed.
34:38I could never get an appointment with you.
34:41Oh, I know.
34:42Well, it's always difficult to get appointments, isn't it?
34:44I'm sorry.
34:44I know it's busy.
34:45How are you doing today?
34:46Right, okay.
34:47About 12 years ago, a virus attacked my middle ear.
34:52Oh, dear.
34:53Inner ear, inner ear.
34:54Okay.
34:54And my head balance problems.
34:55But the balance problems have sort of come back.
34:58Oh, okay.
34:59So it's got quite bad.
35:01You know, the 414, we've only got one bus.
35:04Yeah.
35:04And sometimes we've got to wait like 20 minutes, half an hour for the 40.
35:08And there's no seat there at all.
35:08And there's no seat.
35:09Oh, dear.
35:10When the bus comes, I'm so wobbly that I find it difficult to make it to the bus.
35:15That sounds a bit scary as well.
35:17I'm very scared, actually, yes.
35:19Yeah.
35:19And have you had any falls at all?
35:21Yeah.
35:22But I tripped over two weeks ago.
35:24I was on the way to physio.
35:26Oh, dear.
35:26Yes.
35:27I saw Albert.
35:27You have bashed it, haven't you?
35:28Yeah.
35:29Oh, dear.
35:30Good job you didn't break anything or harm yourself.
35:32Yeah.
35:32Well, I have done in the past.
35:34Do you ever get any palpitations or any funny heart racing?
35:37You know, it does a little bit, yes.
35:39Tell me a little bit about the heart when you're getting the palpitations.
35:44You know, I can just be sitting somewhere and suddenly, oh, you know.
35:48You feel a bit odd and it gets a funny feeling.
35:50Well, I stewarded it now a bit.
35:53Is it?
35:54Yeah.
35:54Let's just have a listen.
35:55Let's just have a listen.
35:56A tiny bit.
35:57Okay.
35:59That's okay.
36:00And we'll just see if we can pick anything up.
36:07Tell you what I'll do.
36:08It sounds good.
36:09You've got a strong heart, which is good.
36:11It's just going slightly irregularly.
36:15It's not going totally.
36:16Do you ever feel that, that your heart is beating a bit funnily?
36:19Let me just have a feel of your pulse again for a minute.
36:22And then what we'll do is I can, let me just see what Sam's up to.
36:27You don't have any heart problems or anything that you know of?
36:30I've never had it in the past.
36:32No.
36:33I wonder.
36:33I'm 73 now.
36:35Okay.
36:35You're still young.
36:36Still got another 30 years to go, my friend.
36:38We need to get you an ECG is what we need to do to get to, to, to, to have that reading
36:48of the heart, just to make sure.
36:49If the part is beating irregularly, what happens is that it does a few in a row, then it pauses
36:54just for a few seconds and then it does a few more and it pauses.
36:57And it's during the little pauses is that sometimes the blood might sit like it does
37:03if you cut your skin, the blood comes out and then it clots.
37:05And then if it forms a little clot in your heart and then it starts beating again, it
37:09might send that clot up somewhere and that causes sometimes things like strokes, which
37:13we want to avoid.
37:13So we need to get the ECG just to confirm.
37:17Is that all right?
37:18Yeah.
37:19Come on through to Sam and then I'll have you back again with the ECG in a few minutes.
37:22Thank you.
37:22If you have a seat, but don't run away.
37:24Once you've done this, don't run away.
37:25Cause then I'll see you again in a minute.
37:30I will see you in a few minutes, but have a seat in the way to the room again and then
37:33I'll see you.
37:33Do not run away.
37:34No.
37:35All right.
37:35Okay.
37:36Thank you, Sam.
37:38I'm just scared.
37:40Why are you scared?
37:40I'm scared.
37:42Don't get upset.
37:44Okay.
37:54I've got a yeast infection.
38:06Yeah.
38:06Really common, unfortunately, with all that.
38:08But at this moment in time, there's nothing I'm worried about.
38:11Good.
38:11Is if it being anything more sinister.
38:13Good.
38:14I literally threw up.
38:15Oh, you've vomited.
38:15Like, yeah, yeah, I vomited.
38:17Reassuring thing is, it's really common to feel a bit short of breath with it.
38:20So that, I wouldn't worry too much.
38:21What do you think about stress?
38:22Can stress bring out skin conditions?
38:24Sometimes you can get the stress.
38:25Very, very common.
38:26Very, very common.
38:27Our skin is absolutely representing often what's going on inside.
38:30How are you with having your blood taken?
38:32I, unlike my husband, can't stand the sight of needles.
38:36It is very common.
38:37In men?
38:38Yeah.
38:41Come on back in.
38:42Right.
38:43We've found what's going on.
38:45Thank you.
38:45All right.
38:46Yeah, because it's been terrible.
38:47So what it's shown is what we suspected.
38:51So it's this funny condition.
38:52So your heart, look at this, it's going really lovely.
38:55That's great.
38:56But it does have this atrial fibrillation.
38:58So it's sort of, you see, it's going and then it's a slightly smaller gap here.
39:02And then there's a longer gap here and a smaller gap here.
39:04So it's never going to stop.
39:06This isn't life-threatening in that I'm worried about your heart.
39:09It's just what happens.
39:10It's really common.
39:11Because your heart rate was going quite fast and things,
39:14I think that's why you're feeling probably tired of dizzy and a bit odd.
39:17And we can slow it down.
39:19That's easy.
39:20It is with a tablet.
39:21But I honestly think, Maria, the tablet will make you feel a bit better.
39:24It's a very low amount of what we call a beta blocker.
39:27It just calms things down a little bit.
39:29But we do have to take a blood thinner as well.
39:31Just because of these little pauses here, we don't want a blood clot.
39:35So actually, if you take this, so from today, we can go to the chemist and get hold of it today.
39:40You're going to be absolutely fine.
39:42It's keeping your heart and your brain and stopping.
39:45It reduces the chance of stroke, which is what we want.
39:48You're far too busy to have a stroke and be ill.
39:49Let me send it through to Boots here.
39:52So you can just nip next door to Boots.
39:54And then we'll catch up on Friday and see how you're feeling.
39:57Okay.
39:57Well, look.
39:58Are you all going to be all right to get to Boots and get back?
40:00Oh, absolutely.
40:01I feel so much better already.
40:03Thank you so much.
40:04All right.
40:04Not at all.
40:04I'll see you on Friday.
40:06And if there's any problem for you, just give me a shout.
40:08All right?
40:08Good.
40:08Oh, I'm not on the day yet.
40:15From yesterday?
40:15Yeah.
40:16That always happens to me.
40:18I become so dramatic after getting an injection.
40:21I remember at my old school, I got one and they had to put a thing down on the floor because
40:25I fainted.
40:32How are you guys?
40:34Good.
40:35Oh, how are you?
40:36Gorgeous boy.
40:38How's everything been going?
40:40We've had a few weeks of it.
40:42It must be sad.
40:43Do you remember last time I came in, I said he had a hernia in his groin?
40:48We went for the surgery on that a couple of weeks ago and was obviously meant to be like
40:53the most routine procedure.
40:55And the surgery went well, but he had a really quite a nasty turn afterwards and ended up needing
41:01two blood transfusions.
41:02Oh, gosh.
41:03So that was just obviously like the last thing we needed.
41:07Absolutely.
41:07So we'll aim to do all of the 12-week vaccinations.
41:11Yeah.
41:11So that will be the six in one.
41:13Yeah.
41:13So that will cover him for diphtheria, tetanus, whooping cough, polio, haemophilus influenzae,
41:18B and hepatitis B.
41:19Yeah.
41:19And then the second one is the pneumococcal vaccination.
41:23Okay.
41:24What does that protect against?
41:26So pneumonia.
41:27Come on then.
41:28Hello, bubba.
41:30Oh, my boy.
41:32So we'll do the Rotarix vaccine that goes in his mouth first.
41:37We should be used to this.
41:41You take lots of oral medication at home.
41:44Good boy.
41:45Oh, darn.
41:46Good job, bud.
41:47Okay.
41:49So we'll do one leg, turn him around, do the other leg, and then cuddles afterwards.
41:54Okay.
41:55Mummy doesn't like this.
41:57You don't know what's coming, do you?
42:00Are you going to be a brave boy?
42:02I'm sorry.
42:03If I can get you to lift that hand.
42:06Just here.
42:07Okay.
42:07Ready.
42:09Okay, bubby.
42:10I know.
42:12Oh, darling.
42:13I'm sorry.
42:14I'm sorry.
42:15Oh, sweet boy.
42:17It's okay.
42:19I know.
42:19It's horrible.
42:21Come on, darling.
42:22I'm so sorry.
42:24Oh.
42:25It's okay.
42:26Mummy's here.
42:27It's okay.
42:28I'm sorry.
42:29I'm sorry.
42:30Shh.
42:31I know, darling.
42:35Shh.
42:36Shh.
42:36It's okay.
42:38Mummy's here.
42:38Mummy's got you.
42:39You might find that his legs are a little bit red, a little bit raised.
42:44There might even be a little bit of a bruise.
42:46That's all completely normal.
42:48I will see you in four weeks' time.
42:50Yeah.
42:51Perfect.
42:51And that will be the last one for a while.
42:53Thank you.
42:55Well done.
42:56Thank you so much.
42:57Take care.
42:58Bye.
42:58Thank you, you too.
42:58Bye.
43:00Don't worry.
43:01Thank you so much.
43:02Nice to see you, Mr. George.
43:03Take care.
43:03Bye-bye.
43:05Great.
43:05Thanks, Kate.
43:06I just thought I'd better just come in and have it checked.
43:08Definitely.
43:09Okay.
43:09Thanks so much.
43:10I like it.
43:10It really suits you.
43:11Thank you.
43:12Bye.
43:12Bye.
43:13Thank you very much, Dr. George.
43:14Take care.
43:15All the best to you, too.
43:16Bye now.
43:24Bye.
43:25Bye.
43:25Bye.
43:25Bye.
43:26Bye.
43:26Bye.
43:26Bye.
43:26Bye.
43:26Bye.
43:27Bye.
43:27Bye.
43:27Bye.
43:27Bye.
43:27Bye.
43:27Bye.
43:28Bye.
43:28Bye.
43:28Bye.
43:29Bye.
43:29Bye.
43:30Bye.
43:30Bye.
43:31Bye.
43:32Bye.
43:33Bye.
43:34Bye.
43:35Bye.
43:36Bye.
43:37Bye.
43:38Bye.
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43:40Bye.
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43:42Bye.
43:43Bye.
43:44Bye.
43:45Bye.
43:46Bye.
43:47Bye.
43:48Bye.
43:49Bye.
43:50Bye.
43:51Bye.
43:52Bye.
43:53Bye.
43:54Bye.
43:55Bye.
43:56Bye.
43:57Bye.
43:58Bye.
43:59Bye.
44:00Bye.
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