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GPs Behind Closed Doors Season 9 Episode 5
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FunTranscript
00:00Hello, Sudri.
00:14Oh, wait, this is freaking me out.
00:16Yeah. Pulse is really low.
00:21Well, I'm a bit of a guinea pig at the moment.
00:24They're testing me out with chemo tablets, and that's daily.
00:26I have a lot of ulcers, and my mum counted 13 by now.
00:3313 ulcers?
00:37I do apologize. I know this is quite the same.
00:44Oh, God, I could cry again now.
00:45Oh, bless you. What you went through is absolutely horrific.
00:48Yeah. I just can't believe I can live again now.
00:56Paul, come on through.
01:25Hi, Christine. Hi.
01:27We're in this room today.
01:29Right, you're all right. There we go, Christine.
01:31If you sit there, I'll get the door.
01:33Now, how have you been?
01:35Up and down with a few little bits and pieces, knees, hips.
01:38Yeah. How's everything else going?
01:41I'm just going to get you to have a look inside my ears.
01:44Okay.
01:45Because I've had my ears, my left ear's been, where I've been, feel as if it's, I can't hear out of it properly.
01:52Okay, okay.
01:52So, that was me. I put eye drops in instead of ear drops.
01:56What, into his ear?
01:57Yeah.
01:58We've got eye drops instead of...
01:59Pussy! I didn't have my glasses.
02:02Well, we must make sure we put them in your eye, not your ear.
02:04I mean, joking aside...
02:05It was just a pure accident.
02:07I didn't have my glasses, and I see E, and I see drops.
02:11So, you shoved them in his ear, but they were meant for his eye.
02:13Whoopsie.
02:14Right, so it's this one that's dodgy.
02:15Right, I'm going to joint it.
02:16Should I come round, Paul?
02:17That might be easier.
02:17Whatever.
02:18Yeah, it's absolutely blocked with wax, Paul.
02:21So, it's not...
02:21It doesn't look red, angry or infected.
02:23It's just totally blocked all the way around.
02:25Can't see anything.
02:25So, it's what we call impacted.
02:26So, there's a big blob of wax.
02:28We need to clear that out.
02:29Right.
02:29Okay.
02:30So, but we need it soft.
02:31Can I just check the other one?
02:32Yeah, of course.
02:33Because if we need to put drops in, we might need to do both.
02:36No.
02:37Clear as a whistle, this one.
02:37Not a drop.
02:39It's funny, isn't it, how the body does that?
02:41We need some drops to soften it, because the problem with ear wax is it will build up,
02:44and it's just A, blocking the sound getting in,
02:47and B, it starts causing pressure on the ear canal a bit,
02:50and starts causing a bit of pain or a bit of discomfort.
02:52All right.
02:53Do you have any ear drops or anything?
02:54No, it was eye.
02:55The only eye drops, right, don't put those in.
02:57But I can give you something to help you with that,
02:58because it's got a little dropper attached to it.
03:00But, yeah, not in the eye.
03:04You can put it in up to twice a day,
03:05but most people, especially at night time,
03:07put it in minimum 10 days before you even stop it.
03:11And then you can always knit back,
03:12and we can have another look and just check it's gone.
03:14All right, okay.
03:15Okay.
03:17Right, got there in the end, all right?
03:19Okay, speak to you later.
03:20Okay, take care.
03:21All the best, Paul.
03:21Bye-bye.
03:22Bye-bye.
03:22Bye-bye.
03:24I'm not that scary.
03:52Come on.
03:53Come through.
03:53Lovely to see you.
03:54On the stickers as well.
03:55Would you like a sticker?
03:56I love stickers.
03:57Let's take a seat.
03:58Let's see how we can help.
03:59Lovely to meet you all.
04:00Lovely to meet you.
04:01Lovely.
04:01How can I help today?
04:02So, I have a burp.
04:06It's got really, really big tonsils,
04:08and I don't think it's from tonsillitis or anything,
04:11because I only really see them when he's laughing
04:13or I'm hanging upside down or something.
04:15Yeah, apparently.
04:16But I've noticed it on and off for quite a long time.
04:20But the first time I saw it,
04:21I assumed it was just an inflammation or cough.
04:23Yeah, yeah, yeah.
04:23Still seems to have them.
04:25It doesn't affect his mood or energy or anything,
04:27but he snores ridiculously.
04:29I mean, in children, tonsils can be quite large,
04:31and then as we get older, they do get smaller and smaller.
04:33Oh, OK.
04:34So, they're, you know,
04:35really important part of the immune system.
04:37And, yeah, those and the adenoids as well,
04:39which we can't see with the naked eye,
04:41sort of get further up,
04:42they can sometimes be quite enlarged.
04:44Sometimes if they are touching,
04:45it can look really quite scary,
04:46and if the uvula is sort of inflamed,
04:48the little dangly bit,
04:49if it's inflamed and touching it,
04:50you can think, well, gosh, what's going on here?
04:51Sure, sure.
04:52I think, yeah, let's check a few things.
04:54Right, let's do the fun bit.
04:55Sorry.
04:56Can you open your mouth really wide for me?
04:58Can you say, ah, Henry?
04:59I'm just going to shine a torch here.
05:00Can you say, ah, Henry, please?
05:02Ah, yes.
05:04Yeah, they are big, aren't they?
05:05Jeez, yeah.
05:06You did.
05:07They're really large, aren't they?
05:08Yeah, yeah, yeah.
05:09No, you're not.
05:09You're absolutely right.
05:11They're decent.
05:12Yeah, he's got good-going tonsils, absolutely.
05:15So, what's that mean?
05:16I think it's just normal for him.
05:18Oh, OK.
05:18Yeah, nothing to be worried about at all,
05:21but please do keep an eye on things.
05:22If he thinks things are getting worse,
05:23if his breathing is labored,
05:25if he's sort of, if it's starting to interrupt his sleep,
05:28then obviously let us know.
05:29Can I get a high five?
05:30It was amazing.
05:31You did such a good job.
05:32Well done.
05:34So, thank you, Dr. George.
05:35I love it.
05:35Yeah, stand on tiptoe so you're a bit taller.
05:38It is, I do.
05:38That's what I do as well.
05:40Don't tell anyone.
05:41Let's go, let's go.
05:43All right, silly.
05:43Thank you, bye-bye.
05:45All the best.
05:45Say bye-bye, Henry, bye-bye.
05:46Bye-bye, Henry.
05:47See you, bye-bye.
05:55Let's go look at this.
05:57Look.
05:57You know.
06:01Natalie.
06:02Hi, good morning.
06:06Good morning, Doc.
06:11Hi, come on in.
06:12I'm Dr Prestowich.
06:14How can I help?
06:15Of recent, I've been having this, like, sharp,
06:19I have some chest pains,
06:21and it happened, it was happening last night,
06:22and I was having palpitations with it,
06:25and I was worried, like,
06:26is there something wrong with my heart?
06:29Is there something not okay with my heart?
06:32And I sometimes feel, like, a stabbing, like, pain,
06:36just below my abdomen area, like a stabbing pain.
06:41And sometimes across my chest, I feel the same pain.
06:44Hmm.
06:45So I was like, I'm a little bit worried about it,
06:47because I don't know why it's happening.
06:49Have you been having these pains for a long time?
06:51Three, four months or so.
06:52And how often are you getting these pains?
06:54Like, kind of...
06:56daily.
06:58It comes and goes.
06:59Are there any other symptoms with the pain?
07:01Sometimes I sweat.
07:03I don't...
07:03Yeah, and I breathe a little bit.
07:05Your shortness, slight shortness of breath.
07:07Any family history of heart disease?
07:10Erm, my mum passed away in 2016.
07:14She had, like...
07:14She died of, like, a heart attack, I'm guessing.
07:17Did she?
07:17Something along with it.
07:18It had something to do with her heart.
07:19Her heart wasn't very good.
07:20How old was she when...
07:2153.
07:22Hi, good morning.
07:43Sorry for the wait.
07:44I do apologise.
07:45I am overslept my alarm for the first time.
08:02I can't remember.
08:03Oh, no.
08:04And I miss my reform of Pilates class.
08:05Oh, no.
08:06Which I'm very sad about.
08:08Oh, no.
08:08Oh, no.
08:15Sorry about the wait, Doris.
08:24It's all right, darling.
08:25It's my time.
08:26I've got nothing.
08:28How are you today?
08:30I feel right.
08:31My back is better.
08:32Oh, no.
08:33Oh, God.
08:34Take it slow.
08:34It is like it's up setting me at the moment.
08:37I bet it is.
08:39Right, come on through.
08:42Do you know what?
08:42As we've got your eye drops out, I'm going to...
08:44Let's sit on the bed and I'll do your eye drops straight away.
08:47Right.
08:51This one first.
08:53Yeah.
08:56Well done.
08:57Blink, blink, blink, blink, blink.
08:58I feel all right?
08:59Yeah.
08:59The other one.
09:01Sorry.
09:02That's it.
09:02Blink, blink, blink, blink, blink.
09:03Sorry.
09:05Oh, God.
09:07Feel better?
09:10They do feel better.
09:11Yeah.
09:11I've got them done.
09:12Yeah, definitely.
09:13Doris is amazing.
09:14She is 94 years old.
09:16She comes to see us twice a week,
09:18but we generally see her once a day
09:20because she'll pop in and just have a chat.
09:22You'll find a tissue in there
09:23because they're a bit big.
09:25Oh.
09:26I've got to get some of them.
09:29What do you call them?
09:30What do you put in shoes?
09:32Oh, inner soles.
09:32Yeah.
09:33Yeah.
09:33This looks new.
09:36This looks new.
09:36Is it?
09:37I look at my body and think now,
09:43how did I do that?
09:44I know.
09:45Do you know what, though?
09:46It's easily done.
09:48Doris's leg wounds started off from just a knock,
09:51but because of her age and bad circulation,
09:55unfortunately, these wounds can turn into ulcers,
09:58so it's really important that patients like these
10:01come to see us on a regular basis
10:03so we can dress the wounds,
10:05check the signs of infection
10:06and just keep them clean
10:07and getting better as quick as possible.
10:10How have you been, Doris?
10:12I've been OK.
10:14Yeah?
10:14I've been OK.
10:15Just this pain in my back.
10:17Last night, it drove me mad.
10:20When I'm walking, I don't get no pain.
10:24When I'm walking.
10:26I try to walk to Sainsbury's every day.
10:29That's very good.
10:30A little bit of exercise.
10:31Yeah, absolutely.
10:33Otherwise, I've been housebound.
10:36I don't want that.
10:38I think you're doing amazingly, Doris.
10:43It's looking good, Doris.
10:45I can say, do you think it's looking good?
10:47It is.
10:49We're not putting any of the gel
10:51on this big one.
10:55We're just going to put two dressings on,
10:58so hopefully it won't be as oozy.
11:02Lovely.
11:03Yeah?
11:03Let's get your shoes in.
11:05You want to see me when I get in bed,
11:06or not?
11:07Oh, I think you are doing amazingly, Doris.
11:12That's it.
11:13That's it.
11:14OK.
11:15I won't be going out today now.
11:17I've had me walk.
11:19All right, my lovies.
11:20Well, it's lovely to see you, as always.
11:23Yeah.
11:23All done.
11:24All done.
11:25Well done, Doris.
11:26OK, my lovies.
11:27See you next week.
11:29Yeah.
11:29Bye.
11:30Bye.
11:32Bye, ladies.
11:33Bye, Doris.
11:34Bye.
11:34Bye.
11:38What I'd like to do now is examine you.
11:41Yeah.
11:42I was nervous if I needed to see, like, a heart doctor.
11:44So I sometimes kind of overthink things.
11:47I don't know if I have to see a heart doctor and a cardiologist
11:49or something like that.
11:50Well, especially if your mum has had serious heart problems.
11:54Yeah, she did.
11:54At a young age.
11:56So what I would like to do, do your blood pressure,
11:58or listen to your chest.
11:59And then we'll think about the rest of the plan once all that's been done.
12:02OK.
12:03Yeah.
12:11Not bad.
12:12Bottom number's a little bit high.
12:13Mm.
12:21Great.
12:22In terms of the chest pain, and is it related to the heart as well,
12:26it's not the classical picture of, you know,
12:28angina, where it's a very intense kind of heavy pressure on the chest
12:33with kind of profuse sweating, breathlessness.
12:37Yeah, that's the textbook kind of syndrome.
12:41Is it possible to have cardiac chest pain that doesn't look like that?
12:45Yes, of course.
12:45And we have to be wary of it, particularly of a family history.
12:49Although I'd still say that the probability of this being heart-related
12:52is on the lower side, OK?
12:55But, yeah, we should still probably consider referring you to a chest pain clinic,
13:00especially with a family history, OK?
13:02Yeah.
13:02And that's, yeah, if you do get severe central chest pain,
13:06like sweating, breathlessness,
13:08feeling like you can't, you know, light-headed.
13:10So let's get you booked in for that ECG, OK?
13:12Cheers, Doc.
13:13I could even do it this week.
13:15That'd be great, actually.
13:16Yeah?
13:16So, four o'clock on Friday.
13:19Yeah, yeah, yeah.
13:20Cheers, Doc.
13:21Thank you very much, yeah?
13:23Have a nice day.
13:24Hi, Dean.
13:36Hi, Dean.
13:37You're looking as lovely as ever.
13:39Oh, thank you.
13:40How are you?
13:40I'm fine.
13:41How are you?
13:42Ify.
13:42Good day is a bird.
13:44Yeah.
13:44I've got an appointment.
13:45Hello.
13:46Hello.
13:46How are you?
13:48Ify.
13:48Your appointment is with me?
13:49Great.
13:49What time?
13:50Now.
13:51Oh, my God.
13:52Lovely to see you.
13:53It's been a while.
13:53Hello.
13:57Hello.
13:57Hi.
13:58Right.
13:59Come on through.
14:00Hello, Teddy.
14:00Come and have a seat.
14:01You get the special seat today.
14:02Let's get a chair up for Mum.
14:04Right.
14:05Hello, my friend.
14:06So, what's brought you in to see us today?
14:09Well, I have a lot of ulcers and my mum counted 13 by now.
14:1313 ulcers.
14:14Horrible.
14:15And how long have they been there for?
14:16It started her like three or two days ago.
14:18OK.
14:19OK.
14:20She only has one ulcer and I have a lot.
14:22OK.
14:23Well, you're a family of ulcers.
14:24This is not great, is it?
14:25He's suffered quite a lot.
14:26When he gets the flare-up, they are spread everywhere.
14:30He's got them down the back of his throat.
14:31Oh, dear.
14:32But why are you getting them, I suppose, that's the question, isn't it?
14:34Well, I mean, it's a bit of a family history.
14:37OK.
14:37My sister suffered with them when she was younger, like, horrifically.
14:42He's exactly the same.
14:43He'll have a few good weeks and then he'll have a flare-up where it's, he wakes up swollen
14:48from it.
14:49And do you think his diet is quite good, sort of, relatively, or have we got a bit of a
14:53sweet tooth, or...?
14:54I wouldn't say it's bad, no.
14:56And what about things like brushing your teeth and things like that?
14:58How good are you at that?
15:00Well, I'm not that good, but I can sometimes handle it.
15:04OK.
15:04And do you, how many times a day do you brush your teeth?
15:06Twice.
15:07Good boy.
15:08I mean, there are various reasons, and sometimes it's because people are never brushing their
15:11teeth, sometimes it's because the food they're eating is all wrong, but it doesn't sound
15:14like that's the case here.
15:16Do you ever get tummy pain?
15:17Does it ever hurt when you eat?
15:19Well, I don't get it usually, but when my tummy just randomly acts up sometimes, that's
15:25hurt.
15:26You do say your tummy hurts quite a lot.
15:28And when you say it acts up, what does it feel like?
15:30Sometimes it just feels like a needle.
15:33OK, so sharp pain.
15:34Yeah.
15:35And whereabouts, if you were to point, where do you feel the sharp pain?
15:38Well, like around this area.
15:39OK.
15:40Can I just have a feel of your tummy, and then we can have a look in your mouth?
15:42Is that OK?
15:44You get to lie on my bed.
15:45Look at this.
15:45I've got the world's biggest toilet roll.
15:46Look.
15:47See, it's actually attached.
15:49Come on, look at that.
15:49Do I just sit on that?
15:50Yeah.
15:51So then you just sit on here, like you're sunbathing, on a lounger.
15:53Yep.
15:54Right.
15:55Can I have a look in your mouth, sweetheart?
15:56So where are the bad ones at the moment?
15:59Well, most of them are just white under my tongue.
16:01OK.
16:01Do you want to know the lip?
16:02Yeah, the lip, too.
16:04They are huge, sweetheart.
16:05Pull your lip down a little bit.
16:06They're big ones, yeah.
16:07Can I just touch it gently?
16:08Mm.
16:09And if you close your mouth, look at those.
16:10Look at those.
16:11That's it.
16:12And just let me pull the lip down and open it a little bit.
16:15Look at the size of those.
16:16Mm.
16:17Sweetheart, you poor thing.
16:18And open wide.
16:20Let's have a look.
16:20And lift your tongue up.
16:22Good boy.
16:23Good boy.
16:23So there are some there and there.
16:25He has a lot, doesn't he?
16:27Yeah.
16:28Poor chap.
16:29Right, can I feel your tummy?
16:30You know when you get that sharp pain sometimes?
16:32Where do you feel it a little bit if you're lying here?
16:34Right in the middle.
16:35Right in the middle here.
16:36OK.
16:37And does that hurt at all?
16:39Yeah.
16:40A bit uncomfortable.
16:41We all have acid in our stomach.
16:43Oh, no.
16:43And sometimes that can come up and it can cause discomfort.
16:45And sometimes that can come into the mouth and trigger ulcers and things.
16:48Come and have a seat for me.
16:49Come and sit back down, sweetheart.
16:50You all right?
16:50Well done.
16:51So I just wonder whether we try something to help a little bit.
16:57So for the ulcers, what do you use for those at the moment?
17:00So we've tried all the gels, Bungela, Ambysol.
17:03Yeah.
17:04I would say it's like the slightest bit of relief and then it's still really painful.
17:08I just wonder whether we look into whether we could try something, whether it's to do
17:13with anything to do with digestion and acid a little bit.
17:17And there's one of the first things I'd like to do is test, weird, this is weird, it's
17:21going to sound weird, but is do a poo test.
17:23Because sometimes people have a bug in their stomach that can cause excess acid and other
17:27problems that can then cause dental problems and other things.
17:30So why don't we do the test first?
17:32Because if that's positive, that's easy to treat and that may solve a lot of the problems.
17:35Here we go.
17:36You can take that to any chemist.
17:38There we go.
17:39And drop in the poo and then we'll have a chat and we'll work out a plan.
17:41All right?
17:43Don't forget your school bag, is that?
17:45The poo thing is still weird.
17:47You still think it's weird?
17:48I agree it's still a bit weird.
17:49I agree it's still a bit weird.
17:50We haven't completely come to the answers yet, but we're going to work on it, all right?
17:54Okay.
17:54All right.
17:54Well, thank you for coming.
17:55All the best, guys.
17:56Bye-bye.
17:57Bye-bye.
17:57Bye-bye.
17:57Hello.
17:58Hello, surgery.
18:05And that's...
18:05Is it...
18:07Sorry, did you say it's your tea?
18:08You'll have to go to a dentist.
18:10Oh, man called the wrong surgery.
18:16He thought he was a dentist.
18:21Shall we go through?
18:23How are you? You're looking well.
18:26It's not people keep telling me.
18:27You're looking very trim.
18:30Take a seat. Lovely to see you. How can I help today?
18:33I keep feeling dizzy.
18:35Oh, no.
18:36I keep feeling dizzy and really nonplussed.
18:40Yeah. How long has it been going on for, do you think?
18:42It's been going on for pretty much most of this week.
18:45But it's just got really bad today.
18:47Okay. And is it a rotational dizziness,
18:50as if the room is spinning, or just more unsteady on your feet?
18:53A bit of both. And I kind of feel...
18:55I'm not shaking, but I kind of feel shaking inside, if that makes sense.
18:59Yeah, absolutely.
19:00Any associated chest pain with it at all?
19:03No, it's just this real yucky feeling.
19:06Yeah, absolutely.
19:07And any pain in your ears, or hearing loss, or ringing in the ears?
19:11No.
19:11Good.
19:12No hearing loss, or symptoms like that.
19:14Perfect.
19:15Any shortness of breath with it, or palpitations?
19:18Oh, like, whereas I'm here now, it is, like, shortness of breath.
19:22You feel a bit short of breath.
19:23Yeah.
19:23Yeah.
19:24Wait, this is freaking me out.
19:26Let's check a few things for you.
19:28Can I feel your pulse manually?
19:30Is that okay?
19:30Because I feel really yuck right now.
19:33Yeah.
19:34I can feel my heart thumping in my chest right now.
19:38Yeah, your heart rate's a bit irregular.
19:42So your pulse is a bit on the low side, in the high 50s.
19:47Oxygen levels are normal.
19:48Pulse is really low, though.
19:50Bear with me, I'll be two seconds.
19:57Sorry, I need someone to do an urgent ECG for me.
19:59Do an urgent ECG for a wheelchair.
20:02He's just quite unwell.
20:03He's got under regular pulse.
20:04I'm just worried about AF.
20:05So you're going to be around?
20:06Oh, she's going home.
20:07I'm not feeling the way I'd like to feel like.
20:31I'm slightly dizzy.
20:33Right.
20:35Sometimes I feel like I'm going to pass out.
20:36Just, you know, just fall over.
20:39What did you feel?
20:40It's just like everything was coming around.
20:44I keep feeling like my heart's really racing.
20:47I just feel a little bit wobbly when I extend out.
20:51Okay.
20:51Yeah.
20:52Do you feel you're falling to one side?
20:54Yeah, a little bit.
20:55I go completely what I'd call woozy.
20:58Yeah.
20:58I just feel really unwell.
21:01Horace, can you pop in this room for me and I'll do the ECG myself?
21:04Is that okay?
21:05Just come through.
21:09Yeah.
21:10If you just lie there for me, you're able to take your T-shirt off for me.
21:15Oh, it's lying down again.
21:17It's just, everything's just spinning.
21:19Yeah.
21:20Sometimes if you're unwell, the heart can go in a funny rhythm, but then it goes back to normal.
21:23So, I'm sure it's nothing, but it's better to be safe than sorry, I think.
21:27So, I'm going to talk to you.
21:29Yeah, I see what you're doing here, actually.
21:31Hi.
21:32My name is Tracy.
21:33So, I'm a pharmacist here.
21:34Okay.
21:35Yeah.
21:35You're coming for an asthma review today.
21:36That's right.
21:37That's correct.
21:38Yeah.
21:38Okay, okay.
21:39How are you feeling about your asthma?
21:42It's been very bad lately.
21:43Very bad.
21:44Very bad.
21:44I've been using my inhaler most days.
21:47I do the steroid ones most morning, but with the hot weather, it was absolutely terrible.
21:54I've been wheezing.
21:56It's just like you're swimming against the tide all the time, but sometimes you just need a little bit of help.
22:02Pharmacists are moving more towards like a clinical role to help patients in GP and in the community.
22:09We've done a four-year degree.
22:10I mean, we're fully trained in terms of the with medication and how to manage long-term medication.
22:17So, obviously, that's safe of GP's time.
22:19Patients can have easier access to pharmacists.
22:22So, it's benefit for both the NHS and also the patient.
22:27Right.
22:27Okay.
22:29Ah, the old peak flow test.
22:31Yeah.
22:31Do you know what's your normal reading?
22:33No, I really don't.
22:34Let's have a look.
22:34I can just remember my name these days.
22:38Right.
22:38The highest one was 500.
22:42That's good.
22:43That was in 2018.
22:45Yes.
22:46Do that.
22:46Let's try that.
22:48Okay.
22:51Oh, that's not bad, is it?
22:54That's 270.
22:56So, hopefully, you can get at least up to 350, which was the reading in 2023.
23:04I told you.
23:05There you are.
23:08It's a bit more.
23:10I really gave it.
23:11Yeah.
23:11Give it some willy then.
23:12320.
23:13Yeah, that's the best.
23:14I see on here that we suggest to use Fulcet as a preventer and also a reliever to you before.
23:21Oh, right.
23:22The difference between Fulcet and the Ventolin is the Ventolin opens up your airway for maybe
23:28roughly about two hours or so.
23:30Fulcet is like a longer-acting one, so it will open up your airway for a bit longer of times.
23:36It's a steroid-based, isn't it?
23:38It is a steroid-based.
23:39Steroid, yeah.
23:40I wonder if I was growing a beard.
23:42No, I'm sorry.
23:43I do apologise.
23:47I know this is quite serious.
23:48It's all right.
23:49My apologies there, Tracy.
23:50That's all right.
23:52There are sort of two ways to manage asthma.
23:54Traditionally, there is a preventer inhaler which contains steroid and also a subutimal inhaler,
24:01commonly known as Ventolin.
24:03However, asthma management sort of moves towards a combination inhaler which you can use as a
24:09preventer and reliever, which is easier for patients to use because they only have one
24:14inhaler and that is their only inhaler.
24:17So, I think we previously suggest to try the Fulcet one puff morning, one puff at night.
24:23Whenever you feel breathless, you can top up with an extra puff.
24:27What I'm going to do is I'm going to give you a call in three weeks' time.
24:31Okay.
24:31And then you can let me know how you're getting on with it.
24:35Yes, so what if I give you a call maybe on the 21st?
24:40No, my son's getting married on the 23rd.
24:43I have the phone ringing up in the middle of the church.
24:46Yeah, exactly.
24:47Oh, hello.
24:49Especially with my ringtone, it's the Muppet Show.
24:55That would go down well with a vicar.
24:58So, I'll make sure I'm not calling you on the 23rd then, yeah.
25:01Okay, thank you.
25:04That is absolutely fantastic.
25:06You take care now.
25:07You take care.
25:07I'll see you in three weeks.
25:09Bye-bye.
25:13Thank you, ladies.
25:15I lived and fight another day.
25:17I know.
25:23Come through.
25:24Take a seat.
25:27Lovely.
25:28Thanks for that.
25:28Sorry about that.
25:29Good.
25:29So, your ECG is completely normal.
25:31There's nothing going on with the heart.
25:32Everything's looking good.
25:34Your pulse is just a bit on the slow side, but actually, it seems to be normalizing, which
25:38is great.
25:39I think it's this condition called BPPV, whereby the crystals in the ear are just a little bit
25:43dislodged.
25:44And that's what's causing that dizziness, that vertigo, that spinning sensation.
25:48So, there's a really common condition called BPPV.
25:51It's a benign paroxysmal positional vertigo.
25:53So, in your inner ear, there are semi-circular canals, which help us to maintain balance and
25:58to sort of know where we are in space.
26:01And suspended in that fluid are little crystals.
26:03In this condition, BPPV, those crystals can become dislodged, and that can be really uncomfortable.
26:07I'm going to give you some exercise, like a manoeuvre that you can do at home, and that
26:12will help relocate them.
26:13For the nausea and the sort of feeling really rotten with it, I'll give you a little bit
26:16of cyclizine just to help with that.
26:18You can take that three times a day if needed, and that should hopefully improve things for
26:22you.
26:23If it doesn't, or the symptoms are getting worse or changing in any way, obviously, just
26:26come back and let us know.
26:28Is that all right?
26:28Okay.
26:29Great.
26:30Take care.
26:30Cheers.
26:31Keep us posted.
26:33All right.
26:35Yeah, so you get nice and stow.
26:36That's it.
26:37And keep while hydrating as well.
26:40All right.
26:40Cheers.
26:41Take care.
26:54I'm sweating.
26:55You too.
26:57Yeah.
27:00Amelia?
27:01Yeah.
27:01Good morning.
27:02Bye.
27:04Hi.
27:05Come on in.
27:06Have a seat.
27:08I'm Dr. Dutch, and nice to meet you.
27:10Nice to meet you too.
27:10What can I do for you today?
27:12So I've been in before for suspected endometriosis.
27:16I think they found on the ultrasound.
27:18Yeah.
27:18Let me have a look.
27:19Okay.
27:20I've been kind of getting pain before and after bowel movements, not during.
27:26Pain during and after urination.
27:30And then also my hips and my legs have been getting quite sore.
27:34Okay.
27:34To the point where it's actually starting to impact my mobility.
27:36Okay.
27:37And when you get the pain, what does it feel like?
27:40Kind of like tearing around here.
27:43Yeah.
27:44And then also kind of sharp pains at the back as well and around the hips.
27:48Okay.
27:48So you had the scan back in February.
27:52So this ultrasound that you showed showed adenomyosis.
27:56So it was when the womb lining kind of goes into the muscle of the womb.
27:59But we can't really diagnose endometriosis by an ultrasound.
28:03It just doesn't tend to take it out.
28:04Yeah.
28:05And let me have a really quick feel of your tummy just with those new pains.
28:08Endometriosis is a condition which is estimated to affect around 10 to 15% of women of child-bearing age.
28:16It's where cells similar to those that line the womb, so your uterus, grow outside the uterus.
28:22So they might grow around the ovaries, the fallopian tubes, or around other pelvic organs.
28:27Just give it a quick feel.
28:29Where do you feel the pain's worse?
28:31Usually about down here.
28:34And no burning or stinging when you pass urine?
28:36No.
28:37Nothing like that.
28:42And no new partners or risk of sexually transmitted infections?
28:46No.
28:46No.
28:46Okay.
28:47Because I know you've had lots of, you've had all those kind of tests in the past.
28:50Yeah.
28:52What our days are, I think you've had, I mean, you've had all the gynae tests.
28:55And it does sound, your history sounds quite classic of endometriosis, but quite severe endometriosis.
28:59So I think we need to get that sorted for you.
29:01But I really think seeing gynecology is the right next step.
29:05Yeah.
29:05So they would talk about other treatment options, kind of surgical options, and kind of go all through that with you.
29:10The main treatment is hormonal treatments.
29:12So in the case of Amelia, she had a Moina coil in situ, which is a hormonal coil.
29:18But things like the combined oral contraceptive pill can also be used.
29:21For patients with more severe symptoms, treatment often can be surgical.
29:26And this involves removing the endometrial tissue to improve patient symptoms.
29:30So we should probably just try and make sure you've got enough pain relief and things for the next month or two.
29:36And if anything gets worse, if the gynae symptoms, you get anything new or something you think,
29:40actually, this seems really different, then come in.
29:42Okay.
29:42Yeah.
29:43Thank you so much.
29:44All right.
29:44Have a good day.
29:45Thanks.
29:45You too.
29:53Where did you get that time thingy?
29:56It's brilliant.
29:58It is.
29:59I have to say, though, it does remind me of The Wizard of Oz, which is one of my favorite films ever.
30:05Yeah, it was two hours, ten minutes long.
30:08Is it?
30:08Yeah.
30:09Wow.
30:09I timed it on my first day.
30:12So we are having a look at your toes today.
30:17Mm-hmm.
30:18Um, so they were dressed...
30:22Last week.
30:24Last week?
30:25Mm-hmm.
30:25Fine.
30:26And what was it, what was it from?
30:28I'm having chemo at the mast.
30:30Yeah.
30:30Yeah.
30:31And the side effects as such include issues with both toenails and fingernails.
30:40Fine.
30:40Okay.
30:41I see.
30:41I see.
30:42Okay.
30:42Okay.
30:42Okay.
30:42What I'm going to ask you to do...
30:44Yeah.
30:44...is sit on the bed, if it's okay.
30:48And if it's easier, taking off your shoes first, whatever it is.
30:52Yeah.
30:52Okay.
30:53So how often are you having your chemotherapy?
30:59Well, I'm a bit of a guinea pig at the moment.
31:01They're testing me out with chemo tablets.
31:04Okay.
31:04And that's daily.
31:06Okay.
31:06And how are you finding the side effects other than the nails?
31:10Well, I've been on some form of chemo or radiation now for the best part of two years.
31:15So side effects such as you lose your taste buds, shortage of breath.
31:22I don't know whether that's it.
31:24Sometimes that can affect me.
31:26I've had some issues with nosebleeds, that kind of thing.
31:29Okay.
31:31Toenails, fingernails, definitely.
31:34Okay.
31:34By and large, I've got away quite lightly, I think.
31:37Yeah.
31:39Okay.
31:41Right.
31:41If this is uncomfortable or painful at any point, just let me know.
31:46I do have sensitive feet, I'm sorry.
31:49I was going to say, you can't have tickly feet doing this.
31:57That one looks great.
32:00No signs of infection.
32:02Looks very dry.
32:04Okay.
32:05Looks good.
32:06Are you doing anything nice for the rest of your day?
32:08I've been ordered to go and get some shopping by her ladyship, so I've got to get one of
32:14my granddaughter's birthday cards.
32:15How old is she turning?
32:17She'll be 11 going on 18.
32:19Oh.
32:20Already got the present through her mother.
32:24Briefed me on what she wanted.
32:25What has she requested?
32:26Something in fashion at the moment, a white fox t-shirt, whatever.
32:31Oh.
32:32My children are a bit younger, so we're still at the Peppa Pig stage, which I'm fine with.
32:39Yeah, absolutely.
32:40Okay, you're all done.
32:42Great.
32:46Okay, so, can we bring you back in on Monday, and then we'll see you Mondays and Thursdays?
32:53Okay.
32:55Lovely.
32:56Thank you very much.
32:57Lovely to meet you.
32:57You too.
32:58Any problems, let us know.
33:01Bye.
33:01Bye-bye.
33:01Juliette, hello.
33:18Can you manage?
33:19Do you want a hand?
33:19Yep.
33:20Yep, no, I'm fine.
33:21You sure?
33:21Is that yours as well?
33:22It is.
33:23Let me take that one for you.
33:25What is in that?
33:26That is hefty.
33:29I'll take you in.
33:29We're in this room today.
33:30Right, I'll tell you what.
33:31Let me put it there so we don't fall over it.
33:33There we go.
33:34Let me have a sit down.
33:35All right.
33:39What are we up to today, Juliette?
33:40How are you?
33:41Well, I've got loads of questions for you.
33:43Okay.
33:44Fire away.
33:45My UTI.
33:47Yep.
33:48I'm 99.9% certain it's still there.
33:53Oh, no.
33:54Okay.
33:55Oh, dear.
33:56Because, I mean, that doesn't look too bad, but this morning it was dark red.
34:01Was it?
34:02I mean, when do you last think you were free of symptoms from your bladder?
34:05About a year ago.
34:06Okay.
34:07I was throwing up yesterday.
34:08Oh, no.
34:10But not today.
34:11But today you've been a bit better, not vomiting.
34:14Yeah, not vomiting.
34:16You've eaten something.
34:17Still feeling.
34:18Are you?
34:19I think that's the problem, isn't it, Juliette?
34:21I think that you've got all these constant symptoms.
34:23And because, A, having a catheter in is horrible, having enormous kidney stones, which we're waiting
34:28to get sorted out, and the kidney problem, you've got all of these reasons why you have
34:32the symptoms.
34:33And we wrote to the urology people and said, look, we're just getting all these infections
34:36and these symptoms, and the kidneys don't not...
34:39I just need a date, you know, because at the moment I'm in limbo.
34:47And it is intolerable, isn't it?
34:47And it's killing me.
34:49Yeah.
34:49It's absolutely killing me.
34:51You're getting really fed up with it all.
35:10Absolutely.
35:12So your latest urine test that we got back on the 8th, a few days ago.
35:17Yeah.
35:17I mean, that was all, that had some white cells in it, but no growth, no bacteria grew.
35:23Yeah.
35:23Do you think we can send off another catheter sample and see what it shows?
35:27I think so.
35:28It's just horrible for you, so it's hard to know when it's infection and when it's not.
35:31Exactly.
35:32Next thing.
35:33Mm-hmm.
35:35Ankle.
35:36Yes.
35:37So the last time we were talking about how the brace was sort of rubbing on the ankle a
35:43bit, and it had caused a problem with the skin.
35:45Yes, it's healed.
35:47Okay.
35:48But I went up to A&E.
35:51Okay.
35:52Oh, dear.
35:53Last week, because I was in so much pain.
35:55Oh, no.
35:56Would it be easier to come and lie on the bed, do you think, Julia?
35:58Okay.
35:59Do you want me to help you across?
36:00Let me put some paper down.
36:02Let me help you, because I think it might be easier to see it for you as well.
36:05Can you manage?
36:06Blimey.
36:07I've got it.
36:07Okay.
36:09Let me help you boot off.
36:10So it's here on the side.
36:17Yeah.
36:17I can see it is quite sore here, but it's because it's rubbing right across the nobble
36:22of the bone, isn't it?
36:23Exactly.
36:24Exactly.
36:25And we talked last time about getting in touch with the appliances people.
36:29And anything?
36:31Nothing.
36:32Okay.
36:33So I'm going to try as well, then.
36:34Would it help if we put a patch of sort of material, like, you know, like gauze and sort
36:40of taped it on?
36:41Okay.
36:41I mean, why don't we at least try that for now?
36:43I mean, my ankle, ever since I damaged it 12 years ago, it's always been really painful
36:50because I've got nerve damage.
36:52Okay.
36:53But this is beyond.
36:56Yeah.
36:58Never mind.
36:59I'm still alive.
37:00I'm going to get your stick as well because I think you're better with that.
37:02Oh, yes.
37:03I need that.
37:05Brilliant.
37:07Right on the edge.
37:08Feet are down.
37:09Yeah, we're up.
37:09Yeah, I'm fine.
37:10Okay.
37:12Fabulous.
37:12You're in sample.
37:13The girls have got a pot and a form ready for you.
37:15Don't go without sending that.
37:16I think that's really important.
37:18Sorry.
37:18All right.
37:19Well, I hope that helps your ankle a little bit.
37:21I'll chase up appliances.
37:22Brilliant.
37:23All right.
37:24Just take care, sweetheart.
37:25You all right?
37:25Yeah, yeah, yeah.
37:26Look after yourself.
37:27Well done.
37:27Wrong direction.
37:28Bye-bye, sweetheart.
37:29Bye-bye.
37:33I keep getting, like, loads of just random spots on my arm.
37:37So you are very frackley, though, aren't you?
37:39Yeah.
37:39You've got the sort of type one skin, haven't you?
37:41And then you've got some bits.
37:42Two ginger grannies on both sides.
37:45Okay, okay.
37:46You've got that.
37:47We've got those jeans sort of thing.
37:50I think it's only rough because I've been scratching it so much, though.
37:54That's not worrying at all.
37:56Oh, thank God.
37:57I've got a mole on my back.
38:06It's been there for a while.
38:07Yeah.
38:08We've kind of tracked it for a while.
38:09Yeah.
38:09Taken a few pictures of it.
38:10But at the moment, it's, like, a little bit itchy and a little bit, like, sometimes painful.
38:16Yeah.
38:16Yeah.
38:16And then it's also kind of changed shape.
38:19Okay.
38:19And, like, it's raised as well.
38:22Yeah.
38:22Okay.
38:22Yeah.
38:23You've got some pictures.
38:23Yeah.
38:24Yeah.
38:24Yeah.
38:24This was it, like, probably last year.
38:27Yeah.
38:27This is, like, it's only small.
38:31And then this was it sort of, like, today-ish.
38:33Yeah.
38:33It's very similar.
38:34Okay.
38:35But it's just, it's more of, like, the itchy and the pain.
38:38That was it today, did you say?
38:39That's today, yeah.
38:40Yeah.
38:40But, yeah, let's have a look.
38:41I see what you mean, that it is different from the others, but it's strange how it's
38:50changed as well.
38:51I see, you know, what the concern is, because the others look completely flat.
38:57Normal, yeah.
38:59With that information, I would say we would normally send the pictures to the dermatology
39:04department and they would decide what to do, whether you need a biopsy or not.
39:08Okay.
39:08So, we'll get you assessed anyway.
39:10I'm only slightly concerned.
39:13You're incredibly young to get anything like that.
39:16Yeah, I just wanted to get a check.
39:16So, it's incredibly unlikely that it's going to be anything nasty.
39:19But we'll get it assessed anyway.
39:20Okay, thank you.
39:21Thank you so much.
39:21Yeah, no worries.
39:22Take care.
39:31Surgeries.
39:33How are you?
39:34Good to see you.
39:34Hey, Dr. George.
39:35It's been a while.
39:36You're looking very well.
39:37Oh, thank you.
39:38Come through.
39:38Take a seat.
39:39Lovely to see you.
39:40Lovely to see you.
39:40Thank you, too.
39:41How can I help today?
39:44So, I'm here for something else today.
39:49I don't want to get emotional.
39:50But I've made the decision now, Dr. George, to relocate.
39:53Oh, okay.
39:54Yeah.
39:54Oh, where are you going?
39:55Back home to my family.
39:56Amazing.
39:57To my home country.
39:57Oh, good for you.
39:59And obviously, I didn't want to leave.
40:01I'm going to cry again now.
40:02Oh, bless you.
40:03Well, there's some tissues there, so help yourself.
40:04But, oh, you've been through so much, honestly.
40:06Like, you've been an absolute trooper throughout.
40:09Thank you, Dr.
40:09Kept a very positive attitude.
40:11You know, what you went through is absolutely horrific.
40:13Yeah.
40:13The car with the accident and stuff on the bike and the surgeries that you had.
40:17And, I mean, you've made an incredible recovery.
40:19She was out for a run one day and, unfortunately, was run over.
40:23She was a victim of a road traffic collision and sustained many, many injuries and was in
40:27hospital for a very long time.
40:29To complicate matters, this all happened during COVID and her family live in Sweden, so we're
40:35unable to come and be with her and support her through arguably the most difficult time
40:39in her life.
40:40Obviously, when I got my diagnosis of PTSD and we had to wait for the referral and you
40:45told me that you can come and see me here every Friday.
40:47And, oh, God, it really made a difference for me.
40:53Yeah, I mean, you know, what you went through is absolutely horrific.
40:55Yeah.
40:55You just sort of, you've never hoped anything like that happened to anyone.
40:58I just can't believe I can live again now.
41:00Like, you know, I sacrificed all this year just to recover physically, emotionally and
41:05mentally.
41:06And the therapy that you sent, the therapist you sent me to was life-changing.
41:09Amazing, good.
41:11Of course, I have symptoms still, but I now have the tools on how to, you know, how to
41:17get back, which I've learned that I've got something for you.
41:21Oh, you shouldn't have, honestly.
41:22Oh, that's so sweet.
41:23So it's only just a book and some Swedish chocolate and a card for you.
41:26Oh, thank you.
41:26That's so kind.
41:27Oh, thank you so much.
41:28Honestly, that's so kind of you.
41:30I really appreciate that.
41:32Oh, I love it.
41:32You have a big impact on me.
41:33I've heard of this book, actually.
41:34I've been meaning to read it for a long time.
41:36So, yeah, that's amazing.
41:37Thank you so much.
41:38That's really kind.
41:39Yeah, you deserve it.
41:39Honestly, you've been an absolute pleasure to work with because no matter how difficult
41:43it's been, you've always sort of, you know, pushed through and persevered, makes it so
41:48much easier.
41:49And I haven't done anything.
41:50You've done it all yourself.
41:52I've just been there to sort of listen and guide you and do a few referrals.
41:56And that's pretty much it.
41:57But that changed my life.
41:59It changed my life.
42:00It's the least I can do.
42:01I think well done.
42:02Honestly, you've been incredible.
42:03Yeah, I just feel so much gratitude, you know, from, for just being able to breathe again.
42:09So it's very sweet.
42:10Often patients just, you know, go and we don't see them again.
42:14And, you know, you wonder how they're getting on.
42:16But it was nice to have a bit of closure and sort of see her come full circle from when
42:23I first met her to now.
42:25It's been an absolute pleasure.
42:26Thank you, Dr. George.
42:27Just to sort of see you on this part.
42:28It has meant a lot to me and I didn't want to live without.
42:30Oh, that's very kind.
42:31Letting you know that you have had a very big impact to me.
42:34You and my surgeons in Sacmaris have, I don't know, I will never forget you guys.
42:38Oh, bless you.
42:39Well, I'll never forget you.
42:40You're, you know, one in a million type of patients.
42:42So I'm really pleased you're doing so well.
42:43So well done.
42:44Brilliant.
42:44Take care.
42:45All the best.
42:45Look after yourself.
42:46Bye.
42:46Bye.
42:46Bye.
42:55Thanks so much.
42:59Bye.
42:59Have a lovely rest of your day.
43:02Bye.
43:03Bye.
43:03See you, buddy.
43:05Okay.
43:06Thank you so much.
43:07Bye.
43:09Bye.
43:09Bye.
43:10Thanks so much.
43:13We'll speak before the weekend.
43:15You take care.
43:16All the best.
43:17Bye-bye.
43:17Uh-oh.
43:35Bye.
43:47Bye.
44:17I think then it might be a good idea to take him up to the hospital.
44:47Bye.
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