GPs- Behind Closed Doors (2013) Season 9 Episode 1

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GPs- Behind Closed Doors  GPs- Behind Closed Doors (2013)S09E01 GPs- Behind Closed Doors (2013) Season 9 Episode 1

Transcript

00:00Morning surgery you should have nice pointy bits at the bottom of your lungs and they're

00:12not they're full of fluid so what's going on I think in your case it might pop I'm

00:18quite helpful at making that happen so please don't force it I'm so wobbly I find it difficult

00:26to make it to the bus sounds a bit scary as well I'm very scared actually I'm just wondering what

00:34the results were on the third poo I did you still have a drink occasionally yeah every day steroids

00:48and alcohol and blood thinners it's a potentially dangerous mix

00:56good morning

01:06good morning

01:06I

01:30Danny hi. Hi. Have a seat. Well, I was in Spain

01:36About a week ago.

01:37A little dot appeared underneath there, which I think is still there, about a week ago.

01:42Yeah.

01:42And then this thing in the corner here is two or three days old.

01:47Okay.

01:47I'm waking up with gooey eye, you know, really gooey.

01:51Any kind of medication, eye drops or anything?

01:54I did a week ago, and my girlfriend got some eye drops yesterday and was cleaning it up.

01:59And when did you notice that it started kind of swelling?

02:02The swelling's only in the last 24 hours.

02:04Okay, so that's new.

02:05And the redness of the eye, that was there from the beginning?

02:07That's been getting worse the last couple of days.

02:10Okay.

02:10How is the pain?

02:12I'm beginning to feel a little bit something behind the eye.

02:16Something.

02:18Okay, and your vision?

02:20Oh, that's a good point.

02:22That's okay.

02:24Okay, let's just have a little look.

02:27So if you just look up for me.

02:29So what you've got, which you've probably seen, is quite a nasty calazium.

02:34So like a little cyst.

02:36Yeah.

02:37Just shut your eye for me.

02:38Any pain when I press here?

02:40No.

02:41But what I noticed was the one in the corner, and then if you undo the centre of it there,

02:46there's a white dot there, which is what the original problem was.

02:49Okay.

02:50So I'm wondering if that was caused by that other...

02:52So I think what it is, is a calazium.

02:54So they're also called meibomian cysts.

02:57And you've basically got a cyst, which is kind of under the eyelid, and it's got some

03:02pus in it.

03:03And then the rest of the eyes would become kind of inflamed with it.

03:06So yours is quite big.

03:09Ophthalmology, if you were to see them, sometimes drain them.

03:11But obviously we can't do that here.

03:13So what we can do is give you some antibiotic ointment and drops.

03:19The other thing I want you to do is some hot compresses.

03:22Right, just with a pad or something.

03:24So you can either buy special eye masks or just a flannel in hot water, so not that it's

03:29going to burn you.

03:30The idea of the heat is it draws the blood to the area, and then we're trying to soften

03:35the stuff in the cyst.

03:36And ideally the cyst at some point will burst.

03:39Dispates.

03:39Well, either dissipates or I think in your case it might pop.

03:43I'm quite helpful at making that happen.

03:45Yeah, so please don't force it.

03:47After about five minutes of the heat, then just try and massage it.

03:51So you're just gently rubbing along.

03:53Okay, so not squeezing it.

03:55I don't want you to get your eyelid and press it together, because the problem with that

03:57is then the infection can spread.

03:58I have done that before with what you said.

04:00Yeah, so what I'll do is I'll give you the antibiotic drops.

04:02I'm going to give you some all-antipotage just because it is quite a big cyst.

04:05And then see how things go the next 24, 48 hours.

04:08If it's getting worse, so you notice that swelling, we definitely need to see.

04:12Or if it's really severe, it would be eye casualty, which would be up at Western Eye.

04:15Oh, we don't want to go there.

04:16I really don't think that's going to happen.

04:17Hopefully it will burst and just resolve.

04:20All right, have a great afternoon.

04:21Cheerio.

04:22Bye.

04:23Okay, Emma.

04:30Hi.

04:31Let's go.

04:32Hello, Emma.

04:32How are you?

04:33Say hi.

04:34Come on in.

04:38You want to draw?

04:39Yeah.

04:40You do that.

04:40Mommy's going to tell me what's going on, okay?

04:42Okay.

04:43She's breathing really bad.

04:44How do you call it?

04:45It's like in Spain we call it apnea.

04:48Apnea.

04:48Yeah.

04:49So it's just so pauses and breathing.

04:50Yeah.

04:51Mommy, hold it.

04:52Okay, hold it.

04:52I don't think it's normal because it's really half for her.

04:56Yeah.

04:56Sometimes I have to do like this to check if she's breathing or not.

05:00Okay.

05:01How long do you think she pauses for?

05:03I don't know for how long.

05:04Yeah.

05:05But for seconds.

05:05Enough to worry.

05:06Yes.

05:07Yeah.

05:07Okay.

05:08Okay.

05:08And how often is it happening?

05:10Oh, normally.

05:11It's a, it's a, it's a, it's a baby.

05:13But like, uh, last year it's even worse.

05:17So ever since she's been a baby she's had these causes in her breathing?

05:19Yeah.

05:20Is there a family history of any respiratory problems?

05:23So, asthma?

05:24Yeah, I have asthma.

05:25You have asthma?

05:26Yeah.

05:27Okay.

05:27So let me come and have a listen to her now.

05:30Okay?

05:30Yeah.

05:31And then we'll have, we'll have a think, okay?

05:33Come.

05:34Don't be trouble.

05:35Emma.

05:35Emma, come here.

05:36And he's going to take your breathing.

05:38Okay, Emma.

05:39Tell me when you're ready.

05:41You're ready?

05:42Okay.

05:45She doesn't cough at night?

05:47No.

05:48Emma, what I'd like to do next is have a lick inside your mouth, if that's okay.

05:52Oh, you want the pencil?

05:53Okay.

05:53But you need to open now your mouth.

05:55Can you open your mouth?

05:57Negotiation.

05:57Yes, sew your mouth.

05:58Venga.

05:59Don't be silly.

06:02It's okay in your teeth.

06:03Your teeth.

06:04Okay.

06:05Emma, please.

06:06No.

06:07Do you want me, do you want mommy to show you what it looks like?

06:09No.

06:10Mira, only así, mira.

06:11No.

06:12Okay.

06:13Emma, Emma.

06:14She's not like that.

06:14Emma.

06:15Emma.

06:17So, her chest sounds clear.

06:20Yeah.

06:20I cannot hear any wheeze today.

06:22What I think you should do, Lorena, is try and get video of the apnea.

06:27Okay, yeah.

06:28In kids, their breathing patterns do vary.

06:32So, some pauses in breathing, we don't worry about.

06:35Okay.

06:36Okay, so, it would be good to have that video.

06:38Yeah, I was going to say to you.

06:39We see what you see, and we can tell you if there's something to worry about.

06:42Okay.

06:43It would be nice to see the back of her throat, just to make sure she doesn't have these giant

06:46tonsils that are making her snore, that are going to be obstructing her airway while

06:50she sleeps.

06:50Yeah, we'd love to see you face to face again, and then we'll try and lick in her throat again.

06:54Can I check my belly?

06:55Open your mouth, and he's going to check your belly.

06:58No.

06:59Okay, so, we'll have to go.

07:01Say bye.

07:03Bye, Emma.

07:04Don't forget this.

07:05Oh, yeah.

07:06Toma.

07:06Okay.

07:07You can...

07:08Venga.

07:09Let's go.

07:11See you soon.

07:12Yeah.

07:12Bye.

07:13Okay, bye.

07:14Bye.

07:15Bye.

07:16Bye.

07:17Bye.

07:18Bye.

07:19Bye.

07:20Bye.

07:21Bye.

07:22Bye.

07:23Bye.

07:25Bye.

07:25I've been lucky enough to work at the Fulham Medical Centre now for almost 22 years.

07:29You'll be registered here as long as I've been here, to be honest.

07:321990-something.

07:35And I absolutely love working there, and I love the team I work with.

07:38Do you like seeing me?

07:40Yeah, I do.

07:41I used to bring my nan in to see the doctors in the doctor's surgery.

07:45As long as you don't get fed up with me.

07:48Oh, how can I be fed up with you?

07:49Sorry.

07:50A big reason why I chose to become a GP was really because of the continuity of care,

07:55getting to know patients.

07:56Especially having been here six years now, you get to know the families, you watch the

07:59children grow up.

08:00Well, it's nice to see your family all well.

08:02Kids growing up, usual stuff.

08:03They always are.

08:04One minute you could be seeing a gynaecological problem, the next a child.

08:08That's why I like seeing you, because you know me.

08:11How long?

08:12Shh.

08:14But it's also great working in a bigger team.

08:17Every day is different.

08:19That's what makes it fun.

08:21So we work with a lot more allied health professionals now.

08:23I think we're so lucky to have this.

08:26Paramedics and dietitians, pharmacists.

08:30No, I mean it.

08:30I'm not just trying to say the right thing.

08:33The people I work with are absolutely incredible.

08:34We work really well as a team.

08:36I mean, I've been here since I was born.

08:38She's a long time.

08:39You do get the sense that you're doing something for other people, so it's rewarding in that sense.

08:44Right, give me this.

08:45If I can make them smile when they're going through maybe the most vulnerable time of their life, then it's worth it.

08:53There goes your lung.

08:54I don't think I've got nothing wrong with me lung.

08:58Despite all the challenges, it really is the best job in the world, and I honestly couldn't see myself doing anything else.

09:03So you like it here, do you?

09:05I do, yeah.

09:06I'll see if I can stay here as long as you.

09:07Well, 78 years is a bit excessive, but it's nice to meet you.

09:12Hello, I'm looking forward to you.

09:15Hi.

09:16My name's Dr Pearson.

09:17I'm the GPs.

09:18Come and have a seat.

09:19How are you?

09:20I'm all right.

09:21I've got a bit of a sore back.

09:23Yeah.

09:23Flashed chest.

09:25So what's happened?

09:26So two, maybe more than that, 200 years ago, I had a skiing accident and went into hospital, had a knee surgery, then came out and got really bad pneumonia.

09:35I didn't know about the pneumonia until it was really, really bad.

09:41And then I was admitted to hospital for like five days, I think it was.

09:44And it was all full of infection, wasn't it?

09:46Yeah, yeah.

09:46And pyema, they caused it.

09:49It took me ages to get better and it took like almost until recently where I feel like I've got my normal energy levels.

09:56Okay.

09:56And so when the pain started again, that's when I decided actually I probably should do something about it.

10:01Yeah.

10:01More quickly.

10:02Yeah.

10:03So I went to A&E where they did some blood tests and an x-ray.

10:07Okay.

10:07In the x-ray, they couldn't see anything.

10:10Okay.

10:10But I was still, I'm still in pain and I don't want to take codeine anymore.

10:14No.

10:14If I can avoid it.

10:15If I can avoid it.

10:15Yeah, yeah.

10:16So tell me about the pain and when it started and what it is this time.

10:18So it started maybe Tuesday last week, so almost a week.

10:22Okay.

10:22It felt exactly the same where I thought it was musculoskeletal.

10:26Okay.

10:26So I left it for a while.

10:28Yeah.

10:28And then the pain was getting worse and so I had to take more painkillers and can't sleep because I can't really lie down all the way on my back.

10:36How was your breathing?

10:37Fine.

10:38And was your breathing fine before as well?

10:40So all 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 sort of said the x-ray was fine and 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.

10:58Yeah.

11:10I mean, I just feel my lungs are really not operated to full capacity.

11:18Right, no.

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.

11:36Yeah.

11:37So the reason I'm listening there is just to make sure there's no fluid build up around

11:40the lungs and there isn't.

11:41So the lungs sound crystal clear.

11:43Sounds good.

11:43You do have fluid in your lung.

11:50You should have nice pointy bits at the bottom of your lungs and they're not, they're full

11:53of 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

12:20lung.

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 and it's, 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 their level again.

12:40So an empyema is when pus, basically infection cells, build up between the lungs and the

12:45wall 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 or a really nasty

12:53chest infection.

12:54If they're 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

13:00of breath.

13:01And also potentially the infection can spread in other parts of your body and potentially

13:05lead to sepsis if nothing is done about it.

13:07And I do worry that if we don't do anything, then you're going to end up feeling poorly

13:11or having a temperature in five days in hospital again, which we don't want to do.

13:15They do have at the hospital what we call it, the AEC, which is an acute assessment unit.

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.

13:27What we don't want to do is it to build up.

13:29So we need to stop it.

13:30And then we need to ask the question, why, if anything, has it come back and how can

13:34we prevent it coming back again?

13:35Do you mind having a seat in the waiting 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

13:40around.

13:41All right.

13:41Thank you very much.

13:41Have a seat.

13:42I'll call you back in two minutes.

13:48Hello.

13:48Hi.

13:48My name's Dr Pearson.

13:49I've got a 37-year-old lady.

13:52She's had a history of an empyema and I've had a look at the x-ray and it does show there

13:57is some blunting of acosophrenic angles and I'm worried that it might have escalated over

14:02the last 24, 48 hours.

14:04Okay.

14:04I'll get her to come straight away.

14:05Thank you so much.

14:06Bye.

14:10Hello.

14:11Yeah.

14:11Go straight up.

14:13Okay.

14:13You take care.

14:14Good luck today, Elena.

14:14All the best.

14:19Will I bring my coffee?

14:20You can, of course.

14:21Yeah.

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.

14:32Oh, it's farting from midnight.

14:34Oh, bless you.

14:35Poor thing.

14:36So 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?

14:45I'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.

15:03Yes, I've had so many pains and things that I thought, well, I'd better have as pure as I can blood test.

15:10Fair enough.

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.

15:29Hmm.

15:30But it could come tomorrow.

15:32Anytime, yeah.

15:33Fair enough.

15:33The 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, getting more experienced.

15:44Yeah, you're a pro now, exactly.

15:46You've known it that many times.

15:47So, since then, I've had no pain.

15:49But when it happens, I have to lie flat on my tummy, take a Panadol, and take the bucket with me into bed,

15:57because I heave a lot.

15:58Oh, bless you.

15:59And nothing comes up.

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.

16:10Yeah, 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.

16:22I can hardly walk.

16:23The pain is so severe.

16:24It's got doubled over with it.

16:25So, the first poo sample, the one that looks for microscopic evidence of blood that we don't see 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 is 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.

16:46It came back elevated on one occasion, and 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 of 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 pain 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.

17:19Well, 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 Hour.

17:28Good, okay.

17:29I'll bring this out for you, and you can finish it in the waiting room.

17:31It's not a problem at all.

17:32I'll read my book.

17:33Yeah, exactly.

17:34You've come prepared.

17:35Yeah, I'm kind of prepared.

17:36It's not your first rodeo.

17:44You all right, Millie?

17:45Hey.

17:47Oh, gosh, it is.

17:48I feel a bit sweaty.

17:49I honestly thought I was going to be late.

17:51Really?

17:51Yeah, because a train station 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 terrible symptom, and especially this is mental brain fog.

18:20Yeah, yeah.

18:21Memory relapses, so many of them are difficult to concentrate.

18:26So, well, I started this one.

18:28Yes.

18:29And that one.

18:31Yeah.

18:32And I put only one, those, one pump.

18:36Yeah.

18:37And when I tried two, I started feeling a little bit nausea.

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, yes, 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.

19:21Libido.

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 mentally 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 was 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.

20:09I think some of the data with breast cancer is not, you know, they're still studying it.

20:12Because it's quite new.

20:13We know until you're 50, you're at kind of population risk of breast cancer.

20:18So, 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.

20:52So, 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.

21:13And we'll do your testosterone 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.

21:27I'm so glad that you're feeling much better.

21:29Yeah.

21:30Me too.

21:31Not at all.

21:32Have a great afternoon.

21:33Yeah.

21:33You too.

21:34Bye.

21:35Bye.

21:36My voice sound okay?

21:44It sounds, you've got the sexy telephone voice.

21:46Not really.

21:47I think I do at night.

21:48Of course.

21:49I've been told my voice is very soothing.

21:52Of course.

21:53Yeah, I think it is.

21:54Right.

21:54It 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.

22:00You do.

22:00You sound so pot.

22:02Hello, hello.

22:02I'm calling from Philo Medical Center.

22:03It depends who I'm calling.

22:09I do put on a little sexy voice.

22:11And then someone's coming really nice on the phone.

22:12I'm like, oh, that's okay.

22:14No worries.

22:15Yeah.

22:16Oh, God.

22:20Come and have a seat.

22:21Tell me, what are we up to today?

22:23Right.

22:24I don't know about my x-ray tool.

22:27Okay.

22:28We can have a look at that.

22:29But tell me what sort of symptoms.

22:30You've still got pain and things.

22:31The pain is just getting bad.

22:34And it's also around the lower back half 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 at night.

22:46You can't sleep.

22:47I mean, the x-ray was done in April.

22:49And 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,

22:58whether they've been damaged a bit.

22:59Did you fall over or?

23:02Last 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.

23:14And 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 cell that did help me in my knees and all that.

23:25I'm sure you're absolutely right.

23:26Steroids can really help inflame joints.

23:28So there's no doubt there.

23:30The problem is it's not generally steroids that we take by mouth.

23:32We normally try and do a cortisone, a steroid injection into inflamed tendons, ligaments,

23:37things like that, to reduce it.

23:39So we target it to where the problem is rather than getting it into the whole body.

23:44The reason being is because steroids have a lot of side effects.

23:47There's a 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.

23:53Because second of all, and always more worrying, is sometimes they thin the lining of the stomach.

23:59Do 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.

24:13And this is why I worry.

24:14And I know I sound like a broken record saying this to you again.

24:17But 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.

24:27So the mixture of steroids and alcohol and blood thinners,

24:31it'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.

24:39And it's not like the blood clots are just in your legs.

24:41They're in your lungs.

24:42They'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.

24:48And 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?

24:57For you, I'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'll start it at the age of nine.

25:16You start drinking at nine?

25:18Yeah.

25:18Have 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?

26:09Mm.

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 load of painkillers, put in a bottle of fruit juice.

26:22Mm.

26:23When I feel I can't do no more, I'll just drink that.

26:26You'll take 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.

26:36Yeah, yeah.

26:38And what is it that stops you from doing it now?

26:42Because 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 and I, and I, and I, I'm not going to be burdened to nobody.

27:09Nobody.

27:10Okay.

27:11So why don't we try and help you with this pain?

27:13Try 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 tablets and the bottle and things at the time, come and see me.

27:35Okay.

27:36All right.

27:38All right, sweetener.

27:38Well, 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.

27:47All right.

27:48You take care, sweetener.

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.

28:01Okay.

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 month.

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.

28:44I was supposed to have gone yesterday, but then they had to change it.

28:47Since then, I thought it was first it was a bite.

28:50And I had a look and there's nothing there, just there's some lumps.

28:53Okay.

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, we should refer to the breast

29:22clinic for assessment.

29:24Are you all right if we have a little look?

29:25Yeah.

29:25Would that be okay?

29:27That'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.

29:32Okay, let's have a look at these lumps.

29:38So just relax your arm down.

29:41Here?

29:42Yeah.

29:43Yeah, so there is still a bit of a lump there.

29:45Do you shave the area when you...

29:46No, 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, painy, and then it didn't

29:54go so that moves the hair.

29:56Yeah, that's not the most fun.

29:59That's a bit sore?

30:00Yeah.

30:00I'm just going to check the other side if that's all right.

30:06I can't feel anything that side.

30:07I only checked the breast last time.

30:09I'm just going to really quick fill your neck if that's okay.

30:11I'm not noticing any lumps or swellings there.

30:13Stiffness recently.

30:15So especially sort of down here.

30:20And no lumps or bumps in the boing that you've noticed?

30:23No.

30:23That's fine.

30:23You can sit up and come and have a seat.

30:27The lumps...

30:28It could be a couple of things.

30:28One is it could be some lymph nodes.

30:30The other option is it was an infected cyst and 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 and we're not 100% sure

30:43what they are, I'll request an ultrasound off them.

30:47You're obviously going to be seen in the breast clinic in a couple of weeks anyway, so they'll

30:50be checking the breast, but let's put an ultrasound request through and we'll just get that done

30:55so 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 to follow up everything, but any

31:03concerns or if anything gets worse in the meantime, let's see.

31:05So three to four weeks.

31:06Yeah.

31:06Great.

31:07Okay.

31:07Thank you very much.

31:07Not at all.

31:08Bye-bye.

31:16I was going to say I can have a silly question.

31:17Post-surgery.

31:18Oh, yeah.

31:19It's done.

31:20Yes.

31:21That post-natal depression is after having a baby.

31:28Post-traumatic.

31:29Post-traumatic stress disorder.

31:39So it means after you go through traumatic experience.

31:42Huh?

31:44You're not even listening.

31:45Alex, you want to give me 10 examples of where there's post in it?

31:48The post goes in the letterbox.

31:54Come in, please.

31:56Nice 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?

32:12Um, I normally eat healthy, but with South Asians, we are dependent on rice-based food.

32:20Okay.

32:21And it's almost every day that I eat rice.

32:25All my dietitian, I've been overweight, but in the last few years I have gained, say, about 20 kilos.

32:32Okay.

32:32What do you usually have for lunch?

32:35Uh, so again, rice.

32:37Okay.

32:37With, with, uh, 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, quarter of the plates?

32:47Maybe one plate.

32:48One plate.

32:49Yeah.

32:49And what about your dinner?

32:50Similar 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,

33:43just imagine you're having half a teaspoon of sugar.

33:46In your experience, would you advise going for something like a Manjaro privately?

33:53So, Manjaro, 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 Manjaro for the rest of your life.

34:05If you don't improve your diet, then once you start taking Manjaro,

34:09you will put the weight back on.

34:12And this will actually damage your metabolism system.

34:15Yo-yo dieting, losing weight, putting on weight.

34:18But work on your diet for one month or two.

34:21Have a good weekend.

34:24Take care.

34:25Bye-bye.

34:33Come 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.

34:40Oh, 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.

34:52Inner ear.

34:53Inner ear.

34:54Okay.

34:54And I had 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 you'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 it 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 it in the past.

35:34Do you ever get any palpitations or any funny heart racing?

35:37I do.

35:37You know, it does a little bit, yes.

35:39Okay.

35:40Tell 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.

35:48You feel a bit odd and you get a funny feeling.

35:50Okay, well, 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, and 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.

36:14It's not going totally...

36:16Do you ever feel that, that your heart's beating a bit funnily?

36:18Okay, let me just have a feel of your pulse again for a minute.

36:22And then what we'll do is I can...

36:25Let 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 in the past.

36:31No.

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 have that reading of the heart, just

36:49to make sure.

36:50If 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

37:12we 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.

37:22If you have a seat, but don't run away, once you've done this, don't run away, because

37:25then I'll see you again in a minute.

37:27Thank you, George, yeah.

37:30I will see you in a few minutes, but have a seat in the waiting room again, and then I'll

37:33see 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?

37:52I've got a yeast infection.

38:06Yeah, really 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 vomited.

38:15Like, yeah, yeah, I vomited.

38:17Reassuring thing is, it's really common to feel a bit short of breath with it, so that

38:20I 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.

38:31How 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.

38:45All right?

38:46No, because it's been terrible.

38:47So what it showed is what we suspected.

38:50So 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.

38:59So it's sort of, you see, it's going and then it's a slightly smaller gap here and then

39:02there'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, I think that's why you're feeling

39:15probably 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

39:40today, you'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, are 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 before, you just give me a shout.

40:08All right?

40:08Good.

40:12Oh, I'm not on the day yet.

40:14From 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

40:24I fainted.

40:27How are you guys?

40:34Good.

40:35Oh, how are you?

40:36Gorgeous boy.

40:39How'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?

40:48Well, we went for the surgery on that a couple of weeks ago and was obviously meant to be

40:53like the most routine procedure.

40:55Yeah.

40:56And the surgery went well, but he had a really quite 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.

41:08We'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.

41:31So we'll do the Rotarix vaccine that goes in his mouth first.

41:39We should be used to this.

41:41You take lots of oral medication at home.

41:44Good boy.

41:45Well done.

41:46Good job, bud.

41:48Okay.

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?

41:59Are 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.

42:27I'm sorry.

42:28I'm sorry.

42:29I'm sorry.

42:31Shh.

42:32In a minute.

42:33I know, darling.

42:35Shh.

42:36Shh.

42:37It'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.

42:53Okay.

42:55Well done.

42:56Thank you so much.

42:57Take care.

42:58Bye.

42:58You too.

42:58Bye.

43:00Don't worry.

43:01Don'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 better just come in and have it checked.

43:08Definitely.

43:09Okay.

43:09Thanks so much.

43:10I like you.

43:10I think it really suits you.

43:12Bye.

43:13Thank you very much, Dr. George.

43:14Take care.

43:15All the best.

43:15Bye, it's a fine note.

43:24Bye.

43:25Bye.

43:45Bye.

44:15I was up a ladder, I was fitting a window, and the expanding foam tin exploded in my

44:22face.

44:22There's all these bloody hallucinations around me.

44:24There's one that's always sitting in my place.

44:26I want to change my life.

44:27I want to stop, like, the drugs in every of you.

44:45Bye.

45:08Bye.

45:10Bye.

45:11Bye.

45:13Bye.

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