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GPs Behind Closed Doors Season 9 Episode 1
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FunTranscript
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
01:30Jamie hi
01:33Have a seat
01:35Well, I was in Spain about a week ago a little dots appeared underneath there
01:39I think still there about a week ago. Yeah, and then this thing in the in the corner here
01:44Is a two or three days old. Okay. I'm waking up with gooey eye
01:49You know really gooey after
01:51Any kind of medication? I dropped so I did a week ago
01:55And we did and my girlfriend got some eye drops yesterday and was cleaning out
01:59And when did you notice that it started kind of swelling the swellings only in the last 24 hours?
02:03Okay, so that's new and and the redness of the eye that was there
02:08Been getting worse the last couple of days. Okay, and how is the pain?
02:12I'm beginning to feel a bit of a little bit something behind the eye
02:16something
02:18Okay, and your vision is
02:20That's a good point. That's okay
02:23Okay, let's just have a
02:25Look so if you just look up for me
02:29So what you've got which you've probably seen is quite a nasty
02:33Calasian so like a little cyst
02:37Just shut your eye for me any pain when I press here no no, but what I noticed was the one in the corner
02:43And then there's if you undo the center of the there. There's a white dot there, which is what the original problem was
02:49Okay, so I'm wondering if that was caused by that other so I think what it is is is a calasian
02:54So they're also called my boemian cysts and and you've basically got a cyst
02:59Which is kind of under the the eyelid and and it's got some pus in it
03:02And then the rest of the eyes would become kind of inflamed with it
03:06so
03:07Yours it is quite big ophthalmology if you were to see them sometimes drain them
03:11But obviously we can't do that here. So what we can do is give you some
03:17Antibiotic ointment and drops the other thing I want you to do is some hot compresses
03:22So just with a pad or something you can either buy like special eye masks and or just like a flannel in hot water
03:29So not that's gonna burn you the idea of the heat is it draws the blood to the area
03:33And and then we're trying to soften the stuff in the cyst and ideally the cyst at some point will
03:38Just dissipate you know, well either dissipates or I think in your case it might pop and
03:43I'm quite helpful at making that happen. Yeah, so don't say please don't force it after about five minutes of kind of the heat
03:49Then just try and massage it. So you're just gently rubbing along okay, so not squeezing it
03:54I don't need to get your eyelid and press it together because the problem with that is then the I have done that before with wasn't he said yeah
04:00So what I'll do is I'll and I'll give you the answer to drops
04:02I'm gonna give you some all-antibiotic just because it is quite a big
04:05Cyst and then see how things go the next 24 48 hours if it's getting worse
04:09So you notice that swelling we definitely need to see or if it's you know really severe it would be eye casualty
04:14Which would be up we don't want to go there. I really don't think that's gonna happen. Hopefully it'll burst and just resolve
04:19Thank you. All right. Have a great afternoon. Cheerio. Bye
04:22Okay, Emma hi
04:30Let's go. Hello, Emma. How are you? Say hi?
04:34Come on in
04:38You want to draw? Yeah, you do that mommy's gonna tell me what's going on. Okay, I can't she's breathing really bad
04:44How do you call it? It's like in a spain we call it we call I'm near apnea. Yeah, so pauses and breathing. Yeah
04:51Okay, hold it. I don't finish no matter because you really have for her
04:56Sometimes I have to do like this
04:58To take a busy breathing. I know okay. How long do you think she pauses for? I?
05:03Enough how long yeah for seconds enough to worry
05:06Yes
05:08And how often is that happening? Oh, no, my is saying say most and she's baby, but like
05:14Last year it's even worse
05:16So ever since she's been a baby. She's had these yeah, yeah, yeah, is there family history of any respiratory problems?
05:23So ask me God yeah, I have asthma. Yeah, yeah
05:27So let me come and have a listen to her now. Okay, yeah, then we'll have it we'll have a thing cooking
05:33Come don't be trouble Emma Emma. Ven aquí anda
05:36He's gonna take your breathing. Okay, tell me when you're ready. You ready?
05:42Okay
05:45She doesn't cough at night
05:47No, I know what I'd like to do next is have a look inside your mouth if that's okay. Oh, you want the pencil?
05:53Okay, but you need to open now your mouth. Can you open your mouth?
06:01So in your teeth your teeth
06:03Okay, Emma, please
06:05No
06:06Do you want me? Do you want me to show you what it looks like?
06:09No
06:09No
06:10No
06:10Look, only like this
06:11No
06:12Emma, Emma
06:13Emma
06:14Emma
06:15So
06:17So, her chest sounds clear. Yeah
06:19I cannot hear any wheeze today. What I think you should do, Lorena, is try and get video of the apnea. Yeah, okay, yeah
06:26Okay, yeah
06:28In kids, their breathing patterns do vary. So, some pauses in breathing, we don't worry about. Okay
06:35So, it'd be good to have that video. Yeah, we'd love to see what you see. Yeah
06:40And we can tell you if there's something to worry about. Okay.
06:42It would be nice to see the back of her throat just to make sure she doesn't have these giant tonsils that are making her snore
06:47that are gonna be obstructing her airway while she sleeps. Yeah, we'd love to see you face to face again and then we'll try and lick in her throat again. Yeah, me too. Can I check my belly?
06:55Open your mouth and he's gonna check your belly. No! Okay, so we'll have to go. Say bye, thank you. Bye, Emma. Don't forget this.
07:04Oh, yeah. Toma. Okay. You can... Venga. Let's go. See you soon. Yeah. Okay, bye.
07:14I've been lucky enough to work at the Fuller Medical Center now for almost 22 years.
07:28You'll be registered here as long as I've been here, to be honest.
07:311990-something. And I absolutely love working there and I love the team that I work with.
07:37Do you like seeing me? Yeah, I do.
07:40I used to bring my Nan in to see the doctors in the doctor's surgery.
07:44As long as you don't get fed up with me.
07:47Oh, how can I be fed up with you? Sorry.
07:49A big reason why I chose to become a GP was really because of the continuity of care, getting to know patients.
07:55Especially having been here six years now, you get to know the families, you watch the children grow up.
07:59Will it look nice to see your family all well?
08:01Kids growing up, usual stuff. Oh, they always are.
08:03One minute you could be seeing a gynaecological problem, the next a child.
08:07That's why I like seeing you, because you know me.
08:10For how long?
08:12Shhh.
08:14But it's also great working in a bigger team.
08:16Every day is different. That's what makes it fun.
08:19So we work with a lot more allied health professionals now.
08:22I think we're so lucky to have this.
08:25Paramedics and dietitians, pharmacists.
08:28No, I mean it. I'm not just trying to say the right thing.
08:31The people I work with are absolutely incredible. We work really well as a team.
08:35I've been here since I was born. She's a long time.
08:38You do get the sense that you're doing something for other people, so it's rewarding in that sense.
08:43Right, give me this.
08:44If I can make them smile when they're going through maybe the most vulnerable time of their life, then it's worth it.
08:52There goes your lung.
08:53I don't think I've got nothing wrong with me lung.
08:57Despite all the challenges, it really is the best job in the world, and I honestly couldn't see myself doing anything else.
09:02So you like it here, do you?
09:04I do, yeah. I'll see if I can stay here as long as you.
09:06Well, 78 years is a bit excessive, but it's nice to meet you, thank you.
09:11Hello, I'm looking to come on to you. Hi.
09:15My name's Dr Pearson, I'm the GP's. Come and have a seat. How are you?
09:19I'm alright. I've got a bit of a sore back.
09:22Yes.
09:23Flashed chest.
09:24So what's happened?
09:25So two, maybe more than that, 200 years ago I had a skiing accident and went into hospital, had a knee surgery,
09:32then came out and got really bad pneumonia.
09:35I didn't know about the pneumonia until it was really, really bad.
09:40And then I was admitted to hospital for like five days, I think it was.
09:43And it was all full of infection, wasn't it?
09:45Yeah, yeah, of course.
09:46And pyema they caused it.
09:48It took me ages to get better.
09:49I can imagine.
09:50And it took like almost until recently where I feel like I've got my normal energy levels.
09:55Okay.
09:56And so when the pain started again, that's when I decided actually I probably should do something about it.
10:00Yeah.
10:01More quickly.
10:02Yeah.
10:03So I went to A&E where they did some blood tests and an x-ray.
10:06Okay.
10:07In the x-ray they couldn't see anything.
10:09Okay.
10:10I'm still in pain and I don't want to take codeine anymore.
10:13No.
10:14If 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.
10:21Okay.
10:22It felt exactly the same where I thought it was musculoskeletal.
10:25Okay.
10:26So I left it for a while.
10:27Yeah.
10:28And then the pain was getting worse and I had to take more painkillers and can't sleep because I can't really lie down all the way on my back.
10:35How was your breathing?
10:36Fine.
10:37And was your breathing fine before as well?
10:39So all well apart from this pain which feels very similar to before when you had the impairment.
10:44Yeah.
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.
10:50There was blunting of the angle suggesting that you have got a slight pleural effusion.
10:54You do have fluid in your lung.
10:57Yeah.
11:09Yeah.
11:10I mean I just feel my lungs are really not operated to full capacity.
11:13Right.
11:14Can I listen to your own lungs?
11:15Yeah.
11:16Yeah.
11:17Yeah.
11:18Bugs love hot wet places and the lungs are great.
11:19I'll have a listen in just to make sure the lungs are okay.
11:20Have you been to the lung function test?
11:21Yes, that's the one.
11:22Are you coughing at all?
11:23Not because I've got like a tickle in my lungs.
11:24We need to get you some new lungs and a new heart.
11:25Yeah.
11:26So the reason I'm listening there is just to make sure there's no fluid build up around
11:27the lungs and there isn't.
11:28So the lungs sound crystal clear.
11:29Something good.
11:30Yeah, yeah.
11:31Absolutely.
11:32You do have fluid in your lung.
11:33Yeah.
11:34You should have nice pointy bits at the bottom of your lungs and they're not.
11:35They're full of fluid.
11:36Okay.
11:37So what do you do?
11:38Okay.
11:39Okay.
11:40Okay.
11:41Okay.
11:42Okay.
11:43Okay.
11:44Okay.
11:45Okay.
11:46Okay.
11:47Okay.
11:48Okay.
11:49Okay.
11:50Okay.
11:51Okay.
11:52Okay.
11:53Okay.
11:54So what's going on?
11:55Yeah.
11:56Why is it there?
11:57Can I have a listen to your lungs?
11:58Sure, sure, sure.
11:59Because I think we need to find out why are you getting this?
12:01And where are you getting the pain?
12:03Like brow strep area on my right side.
12:05On this right hand side, yeah.
12:07I can just hear there's slightly reduced air entry on that right side.
12:13The oxygen's 97, 98.
12:15So that's good.
12:16The question is that that x-ray does show, come have a see, a bit of fluid in your lung.
12:20So your lungs, your lungs themselves can't feel the pain.
12:24Sort of the pleura it was called, the plastic bags they sit in.
12:27That's what gets sort of inflamed.
12:28Or if there's fluid there, it's pressing on it and it's an uncomfortable feeling and 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.
12:37Yeah, I don't want it to get to that level again.
12:39So an empyema is when pus, basically infection cells, build up between the lungs and the wall of your chest.
12:46So 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 chest infection.
12:54If left untreated, an empyema can be really serious.
12:56The collection of pus can build up and that can squash your lungs and make you very short of breath.
13:00And 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 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.
13:14Yeah, no, please.
13:15They do have at the hospital what we call the AEC, which is an acute assessment unit.
13:18Yeah, I've been there before.
13:19You've been there before.
13:20They are so good.
13:21They are so good.
13:22So basically they're a sort of consultant-led, urgent thing where we can't wait weeks.
13:26Yeah.
13:27What we don't want to do is it to build up, so we need to stop it.
13:29And then we need to ask the question, why, if anything, has it come back?
13:32And how can we prevent it coming back again?
13:34Do you mind having a seat in the waiting room just for a few minutes?
13:36No, no, that's fine.
13:37And I'll try and get hold of them on the phone and sometimes it takes a bit of phoning around.
13:39Yeah, yeah, no problem.
13:40All right.
13:41Have a seat.
13:42I'll call you back in two minutes.
13:43Thank you so much.
13:44OK, thank you.
13:46Hello.
13:47Hi.
13:48My name's Dr Pearson.
13:49I've got a 37-year-old lady.
13:52She's had a history of an empyema.
13:54And I've had a look at the x-ray and it does show there is some blunting of acosophrenic angles.
13:58And I'm worried that it might have escalated over the last 24, 48 hours.
14:02OK, I'll get her to come straight away.
14:04Thank you so much.
14:05Bye-bye.
14:09Elena.
14:10Yeah, go straight up.
14:11OK, you take care.
14:12Good luck today, Elena.
14:13All the best.
14:14Will I bring my coffee?
14:15You can, of course, yeah.
14:16Go for it.
14:17Why not?
14:18Can you take it?
14:19Of course I can.
14:20In case I spill it.
14:21Yeah.
14:22I've been well looked after this morning.
14:23I went on a starvation from lunchtime yesterday.
14:25Oh, no, you didn't need to do that.
14:26Oh, it's farting from midnight.
14:27Oh, bless you.
14:28Poor thing.
14:29So I was gasping for coffee.
14:30Oh, I can imagine.
14:31I'll leave this here for a second.
14:32How have you been though?
14:33Are you well?
14:34I'm up and down a bit.
14:35Yeah.
14:36A little bit more up than down.
14:37Oh, that's good.
14:38But it's, you know, I'm not 100%.
14:39I get really cross with myself actually.
14:40Well, 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.
15:04I've had so many pains and things that I thought, well, I better have as pure as I can blood test.
15:09Fair enough.
15:10Yeah.
15:11The thing is, I'm just wondering what the results were on the third poo I did.
15:18Yes.
15:19Which, you know, these pains are crucifying me when I get them unannounced unexpectedly.
15:26I haven't had one for a month, but it could come tomorrow.
15:32Yeah.
15:33Yeah.
15:34Fair enough.
15:35The last poo that came in, that one I had more in the bottle than I had in the last two
15:39bottles.
15:40Because I was getting more experienced.
15:41Yeah.
15:42Absolutely.
15:43You're a pro now.
15:44Exactly.
15:45You've done it that many times.
15:46Yeah.
15:47So, since then, I've had no pain.
15:48Good.
15:49But when it happens, I have to lie flat on my tummy.
15:52Yep.
15:53And take the bucket with me into bed, because I heave a lot.
15:57Oh, bless you.
15:58And nothing comes up.
16:00And 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.
16:11Fair enough.
16:12No.
16:13It just happens spontaneously.
16:14No.
16:15It just happens.
16:16I know when it's going to happen now.
16:17Do you?
16:18It's usually when I've done a wee.
16:19And then suddenly, I know that something happening down there.
16:21I can hardly walk.
16:22The pain is so severe.
16:23It'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
16:30see with the naked eye.
16:31Right.
16:32The good news is that's come back completely normal.
16:34Right.
16:35Which means the chances of your symptoms being due to bowel cancer is less than 1%.
16:39Oh, good.
16:40Which is really, really good.
16:41It's a nice rule out test.
16:42So, we can safely say that.
16:43The other two, fecal calprotectin test it's called, it came back elevated on one occasion,
16:49and 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.
17:00Something 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.
17:18Well, that's it, that's it then.
17:21Okay.
17:22Done.
17:23Done, done, done.
17:24Are you okay getting home?
17:25Did you order the transport?
17:27I've got Dalekau coming.
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 came prepared.
17:36It's not your first rodeo.
17:37You all right, Millie?
17:49Hey.
17:50Oh gosh, it is.
17:51I feel a bit sweaty.
17:52Yeah, because the 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.
18:00Good morning surgery.
18:01Good morning surgery.
18:02How are you?
18:04Well, totally different.
18:07In a good way?
18:08Yeah, in a good way.
18:10Great.
18:11But I would like to discuss those.
18:13Okay.
18:14I had perimenobal symptoms, and especially this is mental brain fog, and memory relapses.
18:21So many of them are difficult to concentrate.
18:25So, well, I started this one.
18:27Yes.
18:28And that one.
18:30Yeah.
18:31And I put only one, those one pump.
18:35Yeah.
18:36And when I tried two, I started feeling a little bit nausea.
18:41Okay.
18:42Is it fine?
18:43Yeah.
18:44I stopped the second.
18:45Okay.
18:46So you went back to one?
18:47Yes.
18:48Okay.
18:49So, yes.
18:50So this is the estrogen.
18:51And estrogen, I suppose, sometimes can give some side effects.
18:52So, yes, some people might feel a bit nauseous when they increase the dose.
18:56Some people get things like breast tenderness.
18:58In most cases, you get used to the dose, and those symptoms go away.
19:02Okay.
19:03How do you feel on one pump?
19:05Fine.
19:06Like, I'm still like myself.
19:09Good.
19:10Maybe my libido, not the 100% as it was.
19:13Okay.
19:14I wonder, is it for the whole my life?
19:16It will be lower libido?
19:18For the libido.
19:19Okay.
19:20Libido.
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.
19:39I passed an interview.
19:40Oh, well done.
19:41Yeah.
19:42It was an intensive period, but thanks to these things.
19:46Good.
19:47I'm glad it's a miracle.
19:48Yeah.
19:49I 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?
19:56Yeah, so 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,
20:11because it's quite new.
20:13We know until you're 50, you're at kind of population risk of breast cancer.
20:17Oh, so it doesn't matter.
20:19Not until you're 50.
20:21So we know that for women between age 50 and 59,
20:24if we put a thousand women on HRT, there would be four additional cases of breast cancer.
20:29However, 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
20:41and we also need to look at those lifestyle factors.
20:44For the libido, we know that the estrogen can help.
20:47Mm-hmm.
20:48But I think last time you asked about testosterone as well.
20:50Yeah.
20:51Yeah.
20:52We can give testosterone.
20:53Okay.
20:54It's more how you feel.
20:55We want to do the best for your symptoms.
20:57I would like to try testosterone.
20:59What 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 for me,
21:09stay at one pump and then come in and have your bloods checked and we'll do your testosterone level and everything.
21:15Okay.
21:16Yeah.
21:17And then I'll see you and we can talk about adding in the testosterone if the bloods are fine.
21:21All right.
21:22Yeah.
21:23Perfect.
21:24All right.
21:25So any worries in the meantime, come in.
21:26Okay.
21:27Okay.
21:28I'm so glad that you're feeling much better.
21:29Yeah, me too.
21:31Not at all.
21:32Have a great afternoon.
21:33Yeah, you too.
21:34Bye.
21:35Bye.
21:42My voice sound okay?
21:43It sounds...
21:44You'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.
21:51Of course.
21:52Yeah, I think it is.
21:53Right.
21:54It is.
21:55I've got a soothing voice.
21:56You too as well.
21:57And me.
21:58I've got a sexy telephone voice.
21:59She's got the sexy telephone voice.
22:00You do.
22:01You sound so pot.
22:02Hello, hello.
22:03It depends who I'm calling.
22:04I do put on a little sexy voice.
22:05And then someone's coming really nice on the phone.
22:06I'm like...
22:07Oh, that's okay.
22:08No worries.
22:09Yeah.
22:10Oh, God.
22:11Come and have a seat.
22:12Tell me.
22:13What are we up to today?
22:14Right.
22:15I don't know about my x-ray tools.
22:16Okay.
22:17We can have a look at that.
22:18But tell me what's the symptoms.
22:19You've still got pain and things.
22:20The pain is just getting...
22:21I don't know about my x-ray tools.
22:22Okay.
22:23We can have a look at that.
22:24But tell me what's the symptoms.
22:25You've still got pain and things.
22:26Are you?
22:27The pain is just getting...
22:28I don't know about my x-ray tools.
22:29What sort of symptoms?
22:30You've still got pain and things, have you?
22:31The pain is just getting bad.
22:33And it's also around the lower back.
22:37Okay.
22:38For some reason.
22:39It's both my left and my right.
22:41Okay.
22:42But the right is so bad I can't sleep properly.
22:45You can't sleep.
22:46I mean, the x-ray was done in April.
22:48And they're saying that actually the bones look quite strong.
22:51But there is a bit of narrowing.
22:53They're wondering if the tendons and sort of things that hold our bones in place.
22:57Whether they've been damaged a bit.
22:59Did you fall over or?
23:01Last year, I moved an elderly gentleman.
23:06I had to pull him from his kitchen to the front room.
23:09Oh dear.
23:10And then saw my back.
23:12You hurt your back.
23:13And I think then you requested some prednisolone, some steroid tablets.
23:17So I was put on that for a few months.
23:20But it helped the shoulders.
23:22It did help me in my knees and all that.
23:24I'm sure.
23:25You're absolutely right.
23:26Steroids can really help inflamed joints.
23:27So there's no doubt there.
23:29The 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,
23:36things like that, to reduce it.
23:38So we target it to where the problem is rather than getting it into the whole body.
23:43The reason being is because steroids have a lot of side effects.
23:46A 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.
23:51So we don't want to make that worse.
23:53Second of all, and always more worrying, is sometimes they thin the lining of the stomach.
23:58Do you still have a drink occasionally?
24:00Yeah, every day.
24:02Every day.
24:03And how much do you drink every day, Steroids?
24:05Oh, it's gone up to about two, four cans a day and the whisky again.
24:12And this is why I worry, and 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.
24:22And when you're on a blood thinner, which you have to be because you've had these blooming blood clots.
24:25Yeah.
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.
24:39And it's not like the blood clots are just in your legs, they're in your lungs, they're in the dangerous place.
24:42No.
24:43And if we don't treat them and they fly off, they go up to the brain.
24:45And if 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.
24:53And 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.
25:02Seven months, that's a long time to have given up for.
25:05I know.
25:06So what's made you go back to the drinking?
25:09I just want it.
25:10You like it?
25:11I just want it.
25:12Yeah, I'll start it at the age of nine.
25:15You start drinking at nine?
25:17Yeah.
25:36Have you been to Turning Point? Is that who you've been to before?
25:41No.
25:42So they're our current provider of alcohol services.
25:46They are really, really, really good.
25:48I'm going to send you how to contact Turning Point if you choose to do it.
25:51I genuinely think it is never, ever too late.
25:54Nobody will be crossed that you've done it before and relapse.
25:56That's the nature of alcohol sometimes.
25:58So as far as the shoulder, can I get you a steroid injection into it?
26:03Can I get the steroid in but do it locally rather than into the whole system?
26:08Mm.
26:09Round this point around the back, it's getting really bad.
26:14Okay.
26:15And the thing is, I'll tell you the truth, I will get a load of painkillers put in a bottle
26:20of fruit juice.
26:21Mm.
26:22When I feel I can't do no more, I'll just drink that.
26:25You take the lot?
26:26Yeah.
26:27Have you bought all the tablets to do that or anything like that?
26:29Not yet.
26:30Not yet.
26:31Do you feel you're getting towards that point?
26:33Yeah, I'm feeling that, yeah.
26:36Yeah.
26:37And what is it that stops you from doing it now?
26:40Um, because I can move about.
26:45I still can move and I still can look after people.
26:48Okay.
26:49And I've got my two cats.
26:51I love the cats, that's good.
26:53But you're saying when the pain gets sexual that you can't move and you can't do things
26:57for yourself, you don't want to be here.
26:58I 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, and I...
27:07I'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, try and work out what's causing the pain.
27:15Give me a chance to go through and see what you've had done.
27:17I'll just get a referral sorted out for the next people for the steroid and things like
27:21I'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
27:33and things at the time, come and see me.
27:35Okay.
27:36All right.
27:37Yeah.
27:38All right, sweetheart.
27:39Well, listen, lovely to see you today.
27:40Come on.
27:41Let's get you sorted out and you know where we are if you need us.
27:44All right.
27:45I'm going to get it sorted.
27:46All right.
27:48All right.
27:49Bye-bye, Peter.
27:50Bye-bye.
27:51Bye-bye.
27:58Tell me what's been going on.
28:00Okay.
28:01I have a lump.
28:03Almost seems to be getting bigger.
28:05I've noticed a lump here on the neck and I wanted to check it.
28:09I've got a lump on my armpit.
28:10It's getting bigger.
28:11Many, many years ago I did get a lump on the side here.
28:15And tell me a bit about it when you noticed it.
28:17I just noticed it today, this morning in the mirror.
28:20Okay.
28:21It's underneath, so it's tender, isn't it?
28:24Yeah.
28:25It's just sitting there, isn't it?
28:26Yes.
28:27And it moves around a little bit, which is a good sign.
28:30It was 40, 50 years ago, but actually it's gone down that month.
28:39So what can I do for you?
28:40Well, we met before.
28:41Yeah.
28:42My 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 to look and there's nothing there, just there's some lumps.
28:53Okay.
28:54And it's quite swollen and hurt.
28:55And I just thought I should come and see you and see what's going on.
28:58Did you say you have an appointment at the breast clinic tomorrow?
29:00Yeah.
29:01No, I had one yesterday, which they had to change.
29:02I think now it's in about two weeks' time.
29:03Well, have you been seen since I referred you?
29:05No.
29:06No, because that was back in May, wasn't it?
29:07Yeah.
29:08Marla was referred to the breast clinic for breast pain.
29:11So she'd actually been having breast pain for around five months.
29:14She is on HRT, which definitely could be a cause of her breast pain.
29:17But the guidelines suggest that breast pain over three months,
29:20we should refer to the breast clinic for assessment.
29:22Are you all right if we have a little look?
29:24Yeah.
29:25Would that be okay?
29:26That's fine.
29:27You can lift the top up or just lift it off if that's easier.
29:30I'm just going to grab some gloves.
29:36Okay, let's have a look at these lumps.
29:38So just relax your arm down.
29:40Here?
29:41Yeah.
29:42Yeah, so there is still a bit of a lump there.
29:44Do you shave the area one thing?
29:46No.
29:47I don't.
29:48So I thought it might be an ingrat.
29:49I thought it was a bite because it felt small and itchy pain,
29:53and then it didn't go, so that moves the hair.
29:55Yeah, that's not the most fun.
29:58That's a bit sore.
29:59Yeah.
30:00I'm just going to check the other side if that's all right.
30:03I can't feel anything that side.
30:06I only re-checked the breast last time.
30:08I'm just going to really quickly fill your neck if that's okay.
30:10Not notice any lumps or swellings there.
30:12Stiffless recently.
30:13Especially sort of down here.
30:16And no lumps or bumps in the groin that you've noticed?
30:21No.
30:22That's fine.
30:23You can sit up and come and have a seat.
30:25The lumps, it could be a couple of things.
30:27One is it could be some lymph nodes.
30:29The other option is it was an infected cyst and now it's getting better.
30:34Was it ever red and hot or just quite tender?
30:38No, not red.
30:39I think because there's lumps there and they've been there three weeks and we're not 100% sure what they are,
30:43I'll request an ultrasound off them.
30:46You're obviously going to be seen in the breast clinic in a couple of weeks anyway,
30:49so they'll be checking the breasts, but let's put an ultrasound request through
30:53and we'll just get that done so that we know exactly what they are.
30:56Good.
30:57All right.
30:58Not at all.
30:59And then we'll see you probably in three or four weeks to follow up everything,
31:02but any concerns or if anything gets worse in the meantime.
31:04So three to four weeks.
31:05Yeah.
31:06Great.
31:07Thank you very much.
31:08All right.
31:09Not at all.
31:10Bye.
31:11Bye.
31:12I was going to say I can just say a question.
31:17Post-surgery.
31:18Oh, yeah.
31:19Yes.
31:20That post-natal depression is after having a baby.
31:25Post-traumatic.
31:28Was it PTSD?
31:32Post-traumatic.
31:33PTSD.
31:34Post-traumatic stress disorder.
31:38So it means after you go through traumatic experience.
31:41Huh?
31:42You're not even listening.
31:44Alex, you want to give me 10 examples of where there's post in it?
31:47The post goes in the letterbox.
31:49Come in, please.
31:54Nice to meet you.
31:56Please have a seat.
31:57Hi.
31:59My name is Nilou.
32:00I'm the dietitian and you are referred to me regarding weight management.
32:04That's right.
32:05Yeah.
32:06You have tried to work on your diet.
32:08Yeah.
32:09What changes have you made in your diet?
32:11I normally eat healthy, but with South Asians, we are dependent on rice-based food.
32:19Okay.
32:20And it's almost every day that I eat rice.
32:24All my dietitian, I've been overweight.
32:27But in the last few years, I have gained, say, about 20 kilos.
32:31Okay.
32:32What do you usually have for lunch?
32:34So, again, rice.
32:36Okay.
32:37With lamb or chicken.
32:40Curry.
32:41Is that a curry?
32:42Yeah.
32:43Okay.
32:44Would that be half a plate, quarter of the plate?
32:47Maybe one plate.
32:48One plate.
32:49Yeah.
32:50And 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 portion size.
32:57So, this is a picture, like, with half of the plate rice.
33:01So, this plate has 1,200 kilocalories.
33:06As a man, it's usually between 1,800 to 2,000 kilocalories per day.
33:12So, imagine, one plate will definitely be 1,500, 600.
33:18Then, if you repeat that for dinner, that would be 3,000.
33:23Then, 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 monjaro privately?
33:52So, monjaro, I recommend to the patients who have tried everything and no good results.
34:00Because 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 stop taking monjaro,
34:08you will put the weight back on, and this will actually damage your metabolism system.
34:14You're dieting, losing weight, putting on weight.
34:17But work on your diet for one month or two.
34:20Okay?
34:23Have a good weekend.
34:24Take care.
34:25Bye-bye.
34:26Come and have a seat. Hello.
34:34I haven't seen you for about 20 years.
34:36You haven't changed.
34:37Oh, well...
34:38I could never get an appointment with you.
34:40Oh, it's...
34:41I know.
34:42Well, it's always difficult to get appointments, isn't it?
34:43I'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.
34:51Oh, dear.
34:52Inner ear, inner ear.
34:53Okay, okay.
34:54And my head balance problems, but the balance problems have sort of come back.
34:57Ah, okay.
34:58Yeah, so it's got quite bad.
35:00You know, the 414, we've only got one bus.
35:03Yeah.
35:04And sometimes you've got to wait like 20 minutes, half an hour for the 40.
35:07And 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, isn't it?
35:16I'm very scared, actually, yes.
35:17Oh, good.
35:18Yeah.
35:19And have you had any falls at all?
35:20Yeah.
35:21Okay.
35:22But I tripped over it two weeks ago.
35:23I was on the way to physio.
35:25Oh, dear, yes.
35:26I 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.
35:31Yeah, well, I have done in the past.
35:33Do you ever get any palpitations or any funny heart racing?
35:36I 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.
35:43You know, I can just be sitting somewhere and suddenly, oh.
35:47You feel a bit odd and you get a funny feeling.
35:50Well, I stewarded it now a bit.
35:52Is it?
35:53Yeah.
35:54Let's just have a listen.
35:55Let's just have a listen.
35:56A tiny bit.
35:57Okay.
35:58That's okay.
35:59And we'll just see if we can pick anything up.
36:05Tell you what I'll do.
36:07It sounds good.
36:08You've got a strong heart, which is good.
36:10It's just going slightly irregularly.
36:13It's not going totally...
36:15Do you ever feel that, that your heart's beating a bit funnily?
36:17Yes.
36:18Let me just have a feel of your pulse again for a minute.
36:21And then what we'll do is I can...
36:24Let me just see what Sam's up to.
36:27You don't have any heart problems or anything?
36:29I've never had in the past.
36:31No.
36:32I wonder.
36:33I'm 73 now.
36:34Okay.
36:35You're still young.
36:36Still got another 30 years to go, my friend.
36:43We need to get you an ECG, is what we need to do.
36:46To have that reading of the heart, just to make sure.
36:49If the part is beating irregularly, what happens is that it does a few in a row,
36:53then it pauses just 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
37:02if you cut your skin, the blood comes out and then it clots.
37:04Yes.
37:05And then if it forms a little clot in your heart and then it starts beating again,
37:08it might send that clot up somewhere and that causes sometimes things like strokes,
37:12which we want to avoid.
37:13So we need to get the ECG just to confirm.
37:16Is that all right?
37:17Yeah.
37:18Come on through to Sam and then I'll have you back again with the ECG in a few minutes.
37:21All right, thank you.
37:22If you have a seat, but don't run away once you've done this.
37:24Don't run away because then I'll see you again in a minute.
37:26I will see you in a few minutes, but have a seat in the waiting room again,
37:31and then I'll see you.
37:32Do not run away.
37:33No.
37:34All right.
37:35Okay.
37:36Thank you, Sam.
37:37I'm scared.
37:38Why are you scared?
37:39I'm scared.
37:40Don't get upset.
37:43Okay?
37:44I've got a yeast infection.
37:45Yeah, really common, unfortunately, with all that.
37:59But at this moment in time, there's nothing I'm worried about.
38:00Good.
38:01Is if it being anything more sinister.
38:02Good.
38:03I literally threw up, like, yeah, yeah, yeah, I vomited.
38:04The reassuring thing is, it's really common to feel a bit short of breath with it, so
38:06that I wouldn't worry too much.
38:07Okay.
38:08What do you think about stress?
38:09Can stress bring out skin conditions?
38:10Sometimes you can get this crisp.
38:11Very, very common.
38:12Very, very common.
38:13Our skin is absolutely representing often what's going on inside.
38:16Yeah.
38:17How are you with having your blood taken?
38:18I, unlike my husband, can't stand the sight of needles.
38:19It is very common.
38:20In men?
38:21Yeah.
38:22Yeah.
38:23Come on back in.
38:24Right.
38:25We've found what's going on.
38:27All right.
38:29All right.
38:30Yeah.
38:31Yeah.
38:32Yeah.
38:33Yeah.
38:34Yeah.
38:35Yeah.
38:36Yeah.
38:37Yeah.
38:38Yeah.
38:39Yeah.
38:40Yeah.
38:41Yeah.
38:42Yeah.
38:43Yeah.
38:44Yeah.
38:45Yeah.
38:46Because 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.
38:54That's great.
38:55But 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 and then
39:02there's a longer gap here and a smaller gap here.
39:04So it's never going to stop.
39:05This isn't life threatening in that I'm worried about your heart.
39:08It's just what happens.
39:09It's really common.
39:10Because your heart rate was going quite fast and things, I think that's why you're feeling
39:14probably tired of dizzy and a bit odd and we can slow it down.
39:18That's easy.
39:19It is with a tablet, but I honestly think the tablet will make you feel a bit better.
39:23It's a very low amount of it called a beta blocker.
39:26It just calms things down a little bit, but 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.
39:34Okay.
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.
39:41It's keeping your heart and your brain and stopping.
39:44It reduces the chance of stroke, which is what we want.
39:46Yeah.
39:47You're far too busy to have a stroke and be ill.
39:49Let me send it through to Boots here so you can just nip next door to Boots.
39:53Mm-hmm.
39:54And then we'll catch up on Friday and see how you're feeling.
39:56Brilliant.
39:57Okay.
39:58Well, 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.
40:02Thank you so much.
40:03All right.
40:04Not at all.
40:05Look, I'll see you on Friday and if there's any problem before, you just give me a shout.
40:07All right.
40:08Good.
40:09Yeah.
40:10Oh, come on.
40:11It's aching.
40:12From yesterday?
40:13Yeah.
40:14That always happens to me.
40:17I become so dramatic after getting an injection.
40:20I remember at my old school I got one and they had to put a thing down on the floor because I fainted.
40:32How are you guys?
40:33Good.
40:34Oh, hi.
40:35Gorgeous boy.
40:37How's everything been going?
40:40We've had a few weeks of it.
40:41It must be sad.
40:42Do you remember last time I came in I said he had a hernia in his groin?
40:47Yeah.
40:48We went for the surgery on that a couple of weeks ago and was obviously meant to be like the most routine procedure.
40:54Yeah.
40:55And the surgery went well but he had a really quite nasty turn afterwards and ended up needing two blood transfusions.
41:01Oh, gosh.
41:02So that was just obviously like the last thing we needed.
41:06Absolutely.
41:07We'll aim to do all of the 12 week vaccinations.
41:10Yeah.
41:11So that will be the six in one.
41:12Yeah.
41:13So that will cover him for diphtheria, tetanus, whooping cough, polio, haemophilius influenza B and hepatitis B.
41:18Yeah.
41:19And then the second one is the pneumococcal vaccination.
41:22Okay.
41:23Um.
41:24What does that protect against?
41:25Um, so pneumonia.
41:26Come on then.
41:27Hello, bubba.
41:28Oh, my boy.
41:30So we'll do the Rotarix vaccine that goes in his mouth first.
41:39We should be used to this.
41:40You take lots of oral medication at home.
41:43Good boy.
41:44Well done.
41:45Good job, bud.
41:46Okay.
41:47So we'll do one leg, turn him around, do the other leg and then cuddles afterwards.
41:53Okay.
41:54Mommy doesn't like this.
41:56You don't know what's coming, do you?
41:59Are you going to be a brave boy?
42:01I'm sorry.
42:02If I can get you to lift that hand.
42:05Just here.
42:06Okay.
42:07Ready.
42:08Okay, bubby.
42:09I know.
42:10Oh, darling.
42:11I'm sorry.
42:12I'm sorry.
42:13Oh, sweet boy.
42:16It's okay.
42:17I know.
42:18It's horrible.
42:19Come on, darling.
42:20I'm so sorry.
42:21Oh.
42:22It's okay.
42:23Mummy's here.
42:24It's okay.
42:25I'm sorry.
42:26I'm sorry.
42:27I'm sorry.
42:28Shhh.
42:29I know, darling.
42:30Shhh.
42:31Shhh.
42:32Shhh.
42:33It's okay.
42:34Mummy's here.
42:35Mummy's got you.
42:36You might find that his legs are a little bit red, a little bit raised.
42:40There might even be a little bit of a bruise.
42:41That's all completely normal.
42:42I will see you in the next week.
42:43Bye.
42:44Bye.
42:45Bye.
42:46Bye.
42:47I will see you in four weeks' time.
42:49Yeah.
42:50Perfect.
42:51And that will be the last one for a while.
42:52Okay.
42:54Well done.
42:55Thank you so much.
42:56Take care.
42:57Bye.
42:58Bye.
42:59Don't worry.
43:00Don't worry.
43:01Thank you so much.
43:02Nice to see Mr. George.
43:03Take care.
43:04Bye-bye.
43:05Great.
43:06Thanks, Kate.
43:07I just thought I better come in and have it checked.
43:08Definitely.
43:09Okay.
43:10Thanks so much.
43:12Bye.
43:13Bye.
43:14Thank you very much, Dr. George.
43:15Take care.
43:16Bye.
43:46Bye.
43:47Bye.
43:48Bye.
43:49Bye.
43:50Bye.
43:51Bye.
43:52I was up a ladder, I was fitting a window and the expanding foam tin exploded in my face.
44:22There's all these bloody illustrations around me, there's one that's always sitting in my
44:26place.
44:27I want to change my life, I want to stop the drugs and everything.
44:52I want to change my life, I want to change my life.
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