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GPs- Behind Closed Doors (2013) Season 9 Episode 8
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00:01Good morning, surgery.
00:02I've got a lump in my armpit that's been growing for like a year and a half.
00:10Ah, yeah, yeah, yeah.
00:11Really soft.
00:12It's gone.
00:13I'm sorry.
00:14Does it help to rub it or anything?
00:15I should leave it coming.
00:16It's hard.
00:17I do rub it, but...
00:18Yeah.
00:19Sorry.
00:21Are you a warrior?
00:23Yes.
00:24Because I always think I'm going to die.
00:30When you feel it, say yes.
00:32Yes.
00:33Yes.
00:34Yes.
00:41You only live up.
00:43It's still there.
00:44It's still there.
00:45It's still there.
01:00You only live here, but...
01:01You only live here.
01:02It's still there.
01:03It's still there.
01:04I don't know.
01:05You only live here.
01:06You know.
01:22Henry, please, Mike.
01:24Mm-hmm.
01:25Hello.
01:26Hey, Harry.
01:27How are you?
01:28I'm guessing not well, otherwise you wouldn't be here, I'm so sorry.
01:31It's getting a bit bigger, isn't it?
01:33I think it probably got bigger like the couple days after I saw you and then like,
01:37it came to a head over the weekend and then on Sunday morning as I was doing the hot compress,
01:41like I noticed when I took it away there was like yellow stuff on it.
01:44So then I assumed it popped, but actually I don't think the swelling's gone down at all, the pain's gone.
01:49How's your vision at the moment, is that okay?
01:50It's actually still a bit blurry, like I literally noticed it as I walked out of the house to come here.
01:54Any other symptoms, fever, nausea, vomiting, anything like that going on?
01:57Good, so you feel otherwise well.
02:02I'm just going to lift the eyelid and pull the eyelid up a little bit.
02:05I just want to have a look on the underside really.
02:07Yeah, you can see where it's scarred over.
02:10Sorry, it's uncomfortable a bit.
02:19Good.
02:20Do you think the ointment helped that I gave you last time? Did it help a little bit? No?
02:29I don't know if it did to be honest with you.
02:30Fine.
02:31I think the infection's gone because it looks very dry, it doesn't look like there's any more sort of pus in it or anything like that, which is good.
02:36Yeah.
02:37But I think we need to try now and get on top of the inflammation for you.
02:40I'm just thinking how best to do that.
02:42What I could do is give you a very, very, very weak one.
02:45So normally the hydrocortisone we use is 1%, but I could try and prescribe you 0.5%, which is even weaker, and say just use it for a few days really just to really help bring that inflammation down.
02:56And we can give that a go, see how you go with it.
02:58Yeah.
02:59Does that sound okay?
03:00Yeah.
03:01Any idea on that timeframe as to when that's going to be better?
03:03It's so variable.
03:04So some people, unfortunately, will be troubled with this for months.
03:06I don't think that's going to be the case here.
03:08I hope such would.
03:09But other times, you know, sort of 10 days, 2 weeks, that kind of ballpark figure is sort of more common.
03:15From here onwards, I would hope it wouldn't be as long as that because we've already endured all of that time before.
03:21Okay, perfect.
03:22Yeah, here we go.
03:23Any questions at all?
03:24That's it, thank you very much, yeah.
03:25Good.
03:26All right.
03:27Awesome.
03:28Thank you very much.
03:29No pleasure, you're very welcome.
03:30Take care.
03:37Right, so, you're here for your smear test?
03:39Yes.
03:40They've been trying to do it for about a year because I'm overdue.
03:42Okay.
03:43But every time they try and do it, they can't do it because I've been examined because I was on this pre-cancer pathway for a while.
03:50Okay, okay.
03:51So you're due, so you've had some abnormal smears before?
03:54Not for a while.
03:55Okay.
03:56I think they've been okay for a while, but I'm, is it every five years?
04:00Yeah, that's right.
04:01Yeah, that's right.
04:02Long overdue the five year one.
04:03Okay, so we are a little, not long, we've had worse, but you are, we would do it.
04:08For me I am, I'm usually really efficient about using it.
04:10Well, we'll do it now.
04:11We'll do it today and then we can get it done.
04:12Because I've got to have another ultrasound on Friday for the pre-cancer pathway, so I just thought I can't leave it.
04:18And tell me, what's happening on that pathway?
04:19It was a suspected cancer pathway.
04:21Every investigation they tried to do was unsuccessful, so they took me in to give me a hysteroscopy.
04:26And they didn't do the smear there and then or anything in the hospital?
04:29Not that we know of.
04:31Not that we know of.
04:32I mean, sometimes they do, but they would have told us it had we done it.
04:35They said it looked normal.
04:37They have said.
04:38The good news is that they're not overly worried and that they've discharged you off the cancer pathway.
04:45Great.
04:46As in they don't think it's cancer.
04:47Great.
04:48So I think that's one good news.
04:49Great, great.
04:50But they still want to see you and follow up and deal with things because they need to find out what's happening.
04:53Suddenly I got another ultrasound and I thought, oh no.
04:55And I think it was, and we referred you, was it because of the wound lining?
04:59Well, I kept bleeding.
05:00Yeah.
05:01But I just decided to stop taking the HRT because I think that was causing the problem.
05:06Okay.
05:07Right, let's hop up.
05:08Would you like a chaperone?
05:09No, I'm fine.
05:10Someone else in the room just to be here.
05:11No, no, no.
05:12It's fine.
05:13Come and have a seat.
05:14Let me close this.
05:15I've put that there and you can put that across your middle.
05:17So if you've got a dress on, it's probably just as easy to either just hitch it up a little bit or whatever.
05:22Yeah, exactly, exactly.
05:23Take off from the waist down and then we all can get the bits ready.
05:26Okay.
05:27Are you ready?
05:28Yes, yes, yes.
05:29I think when you have bleeding, sweetheart, and you're sort of what we call post-menopausal,
05:31and we have some bleeding, then we've got to think, well, why?
05:34Yeah.
05:35And therefore we've got to go down the route where we start looking into it because then we can work out what it is.
05:38Exactly, exactly.
05:39Exactly.
05:40So it's really important.
05:41So it's great to get the all clear, but then we must make sure it stays the all clear and then we can see.
05:45So you just be as comfortable as you can.
05:47You'll feel a little bit of cushioning.
05:48I'm sorry it's a bit cold.
05:49It's okay.
05:50There we go.
05:51I'm sorry, sweetheart.
05:52It's okay.
05:53You all right?
05:54Yeah.
05:55Okay.
05:56There we go.
05:57It's okay.
05:58I did loads of squats at the gym this morning.
05:59They were hurting.
06:00They were hurting more than this will hurt.
06:02Right.
06:03Let me knock those off.
06:04Let me get you some tissues, sweetheart.
06:06Job done.
06:07Well, there we go.
06:08You can tick that one off your list.
06:10The results will come back to Emily and she will then contact you and let you know the results.
06:14Okay.
06:15And as you know, it will most of the time comes back normal, but sometimes if they're not 100% happy, they come back to us and very occasionally we have to repeat it.
06:25Hopefully not.
06:26Yeah.
06:27Very occasionally they have to see you in that colposcopy clinic where they want to have a little closer look at it.
06:30Yeah.
06:31But they test it all on there.
06:32Yeah.
06:33And as you said, it's been normal a few times recently, so fingers crossed it'll be all right.
06:36Thank you very much.
06:37Thanks, Elizabeth.
06:38Let me let you go.
06:39Good luck with your scan then on Friday.
06:41And nice to see you as always.
06:44Bye.
06:45Door open or closed?
06:46Leave it open.
06:47That's fine.
06:50Simon, please.
06:51Hello.
06:52Good morning.
06:53How are you?
06:54Uh, slightly sore.
06:55Oh, sorry to hear that.
06:56Come to take a seat.
06:57Good to see you.
06:58How can I help today?
06:59Um, what it is, I've got, um, I'm having a lot of trouble with my back.
07:03Okay.
07:04Uh, because I've got osteoarthritis in the spine anyway.
07:05Mm-hmm.
07:06I'm not sleeping very well.
07:07Um, sometimes if I lie on my back or I turn aside, I get a sharp pain down my back.
07:10Mm-hmm.
07:11Mm-hmm.
07:12Um, what it is, I've got, um, I'm having a lot of trouble with my back.
07:17Okay.
07:18Uh, because I've got osteoarthritis in the spine anyway.
07:19Mm-hmm.
07:20Mm-hmm.
07:21I'm not sleeping very well.
07:22Um, sometimes if I lie on my back or I turn aside, I get a sharp pain down my back.
07:28Mm-hmm.
07:29And the top of my leg's going numb.
07:30Mm-hmm.
07:31It's gone for about half an hour and I don't know what the problem is.
07:34It's been something quite regularly.
07:35Mm-hmm.
07:36How long has the pain been as bad as this for, would you say, roughly?
07:39Roughly.
07:40Every three days I get an excruciation pain and got a trap nerve or something like that.
07:43Yeah, absolutely.
07:44Sounds like potentially.
07:45Um, quite frustrating.
07:46I'm trying to get up in the morning and I can't get up because my leg's numb.
07:49Yeah.
07:50And every time I try and stand on it, I'm having trouble.
07:52Always on the left side or...?
07:53It's always on the left side, yeah.
07:55Any injuries or trauma recently that might have set it off or made it worse?
07:58Um, well, not since I got hit by the e-scooter, no.
08:00Yeah.
08:01It's getting worse and worse than when I was wearing a tear or...
08:03Yeah.
08:04Also, someone helped me sleep at night with the amitripline because I hadn't got any left.
08:08Is the amitripline helping a bit?
08:10Yeah, it helps.
08:11Helps a bit.
08:12Yeah.
08:13You're on two tablets of those, 20 milligrams.
08:14Yeah.
08:15So there is scope for that to go up a little bit if needed.
08:18Yeah, I could go a bit.
08:19We could always consider that.
08:20Um, how else is it affecting your life at the moment?
08:22Are you still able to get out and about?
08:24Well, getting out and about, I mean, I'm playing long green bowls, but it's got to the stage
08:27where, um, I can't wind this down as far to roll the ball anymore.
08:32Yeah.
08:33So it's, uh, difficult.
08:34Yeah.
08:35Trying to, um, have, have a life.
08:38Yes.
08:39Francesca?
08:40Hi.
08:41Hi.
08:42Hi.
08:43Hi.
08:44How are you?
08:45I'm good, thank you.
08:46Come and take a seat.
08:47I'm pregnant again.
08:48I'm pregnant again.
08:49How are you?
08:50Oh, I'm so hot.
08:51Oh, I bet you are.
08:52How many weeks are you now?
08:5330, I'll be 32 on Friday.
08:59Oh, we're exciting.
08:59I know.
09:00I know.
09:03How's it been two time around?
09:17Yum.
09:20Oh, big about考eno.
09:21how's it been second time around it's i would say very different like i felt
09:26i'm way bigger than i was yeah and just yeah it's just hard with the toddler yeah so we'll
09:34return two a couple of weeks ago so he's like really in the yeah you know toddler tantrum
09:40very active i bet climbing up everything oh my god it's really hard and when you look back at
09:46when you were pregnant the first time yeah you think oh that was actually fine
09:50when you're looking after another one yeah but yeah so we're going to do um rsv today and the
09:59whooping cough vaccination did you have rsv for your last one i don't think it was around with
10:03yeah so rsv is a respiratory virus that is responsible for sort of common colds and
10:09coughs yeah um however it can lead on to pneumonia and bronchiolitis um which is you know particularly
10:15bad for for babies and then the whooping cough is exactly the same as the one that you have
10:21before exactly so protecting them for their eight weeks um first eight weeks of life before they
10:27have their um eight week vaccinations perfect it's very unlikely to get side effects from these
10:31other than um uh sore arms or do them both today if you're happy with that yeah fine um sore arms um
10:38might be a little bit red a little bit achy that should subside within a day or two
10:42yeah there is always a chance with all vaccinations that you might get sort of
10:46mild flu like symptoms a bit of an achy body whatnot but with these two it is unlikely however if you're
10:51worried about anything just just let me know okay perfect are you feeling well today other than yes
10:56and pregnant yeah no i'm feeling fine perfect perfect yeah i'm reminding you don't have any allergies
11:02do you no i don't know lovely oh it's very exciting yeah very exciting okay so we will do the rsb in your
11:14left arm so we'll start with this side of that's okay sure so just relax your arms yeah relax it down
11:19just like that relax from your shoulder all right sharp scratch
11:24one done
11:31okay sharp scratch
11:36perfect
11:41so next time i see you will be for the vaccination that's crazy isn't it um but if you need anything
11:51though yeah just um just let me know but yeah so much luck with everything thank you so much so nice
11:57would it be okay today just to examine you is that all right yeah sure so whenever you're ready if you
12:11stand up for me i'm just going to press down the spine so you can see how there is a bit of asymmetry
12:18there so you know this shoulder is a bit lower than this one because you're compensating because
12:22you're doing so much pain oh yeah that's very common to see that
12:28bit tender there yeah so a bit of spinal tenderness
12:31i agree so around l2 3 l4
12:35sorry sorry
12:38are you able to bend forward for me stop when it's painful so only go as far as you can
12:42yeah i can bend forward yeah
12:43yeah so it's yeah stop and then if you bend back for me
12:47yeah so very limited range of motion isn't it
12:49yeah okay if you slide one arm down one leg
12:52yeah and the other side for me yeah very very limited we need to get that back
12:56really sort of mobilized and moving around back pain can be really debilitating um it can lead to a
13:02lot of sick days a lot of time off work and can cost the economy you know millions a year so it's
13:07really important to um manage it as best as we possibly can and prevention is obviously far better
13:13than cure uh so having good posture strengthening core muscles making sure that we're exercising in a
13:19safe way and are looking after our bodies is really really important can i get you on the couch would
13:24that be okay in simon's case clearly the pain was having a very big impact on his quality of life on
13:30his abilities to sleep etc if the pain is a bit more complex if there's pain radiating into the
13:35buttocks or into the legs with potential nerve involvement that then might mean that we refer
13:40patients for more specialist intervention at times um a lot of the time we can still manage that in the
13:45community as well but um really understanding the impact the patient's uh pain is having on them
13:50is very important and that helps us to determine whether we need to seek specialist intervention or
13:55not
14:15if this leg up push me up good to push me down good to push me out with this one push me down
14:20good yeah yeah yeah really soft big condom sorry does it help to rub it or anything no i just leave
14:27it a couple of minutes i do rub it but yeah sorry whenever you're ready you can come back round take
14:35your time do you need a hand oh yeah one of the main problems is like when i'm in lying back because
14:43i like my life is getting myself up having to sit on the bed for a while yeah just to get used to it
14:50and get sources okay what i think we should do is a few things we can increase the amitriptyline if you
15:01like just for a few nights to see how you get on with it you can definitely go up to three quite
15:05easily if you want a little bit of um cocodomol or something like that just to you know for those
15:11paroxysms of pain when it's really really bad you can take a couple of cocodomol not a problem at all
15:16to do that and then i think we should refer you to the musculoskeletal team just to see if there's
15:20anything else that needs to be done um things to look out for if there's any complete loss of
15:25sensation between the legs if the pain is getting worse um if there's any loss of balance that kind of
15:31stuff just let us know as well all right we'll see how you go okay we'll take it from there all
15:36right i'll send the prescription to the pharmacy for you okay thank you very much thank you take care
15:46and here i'll go yep ready
15:52hiya how are you doing good you i'm fine okay i'm sam so i'm gonna do your diabetes check today so i'm
16:00gonna do your bloods give you a urine test check your feet do you know how much you weigh um 80
16:07kilograms maybe do you smoke nope i mean not regularly social yeah do you drink alcohol then yeah yeah
16:17santiago is a young healthy active guy who came in for his annual diabetic health check santiago has type
16:25one diabetes type one diabetes is your body doesn't produce insulin it's an autoimmune
16:32condition it's classed as a chronic condition so on average how much do you drink a week no like
16:39maybe two three pints like after a football match yeah do you play football yeah are you good i mean you
16:46should ask that that to my friends but i think i think they would say yes i think they would say yes
16:53you're decent who do you support who do i support you've got to be very careful now wrong choice
17:00who do you support chelsea yes oh okay well i suppose if you're in fulham i've arrived quite
17:09like early or a few years ago here but like where were you from i'm from argentina do your family live
17:15in argentina yeah you can relax sharp scratch do they come here at all uh they came once i also went back
17:25like twice since i moved okay pop your finger on there for me nice and hard so do you play any other
17:33sport so i'm trying to get into golf but i'm i'm not doing i'm not doing good my dad's always he says
17:41he's at the office which means he's in the golf course but he's rubbish he still goes
17:55okay and then you do the one
18:05i can lose my arms in it
18:14right so i need to buy some more blue dresses yeah
18:16so i want you to cut them and put the nails in here okay and bring it in for me
18:46okay but this looks like classic fungal toenail okay right close your eyes no treating
18:53when you feel it say yes yes yes yes yes yes yes yes
19:10during an annual health check we do a foot check where we check for any signs of
19:16infection and we also use a monofilament device which checks for loss of sensation or auto sensation
19:23to the feet we check to make sure there's no open ulcers no wounds and make sure that you've got feeling
19:33because if not then we can action it so it's really important to attend your annual
19:39diabetes check you've got some hard skin to the bottom yeah of your feet so when you're in bed at
19:48night if you put some um moisturizer on the bottom of your feet okay rub it into your feet both feet
19:56and then put cotton socks on okay that's great you've done liver kidney fibres cholesterol diabetes
20:03iron the whole lot amazing okay okay sam i appreciate thanks so much take care
20:08have a good weekend have a good weekend best wishes for chelsea next season best wishes for fulham
20:13a lot bye bye bye
20:22come on in take a seat my name is anna mcquill i'm one of the doctors so what's been going on um i originally
20:30just wanted to get um bloods done because okay back home in australia i usually have an iron infusion
20:37but i've noticed that it's not a normal practice here yeah iron infusion um so i think it's worth
20:42just getting my bloods done anyway but i've just been like absolutely exhausted all the time i've got
20:48a lump on my armpit that's been growing for like a year and a half okay we'll definitely take a look at
20:53that yeah that's good definitely good to know yeah so um when did you notice on this occasion that you
20:59were feeling a little bit more tired than usual honestly it's been the last last maybe a couple
21:05of months okay and it's just progressively getting worse like i'm really struggling to just get through
21:09a work day and okay yeah yeah tell me a little bit more about the lump so is it multiple lumps i'll have
21:16i'll examine you in a moment it's just one here okay anywhere else no it's just this one i noticed it
21:22maybe last last february okay and has it changed it's getting bigger okay um and it's it's becoming
21:30sore like even if i'm just like resting it's like this achy pain and and is it ever red hot or anything
21:35no not that i've noticed okay and any lumps or bumps anywhere else not that i've noticed okay my nan
21:42actually died of breast cancer so yeah yeah is there anyone else in the family with well my mum passed
21:47away from melanoma so okay i'm sorry cancer's just running right from the females in my family
21:52unfortunately i'm sorry to hear that that's okay
22:01good luck with the veins okay like a challenge do you have a good vein i doubt it sorry that's my
22:22blood is solidifying okay so i'm just pressing along the the veins back of the leg what you think it
22:28might be deep vein flumbus or something awful because you've had varicose veins for a long long
22:33long long time but the pressure's built up so now we've got the sort of discoloration which isn't
22:38going to go away because he did offer to sort out the varicose veins still as well they're painful
22:43they throb they're sensitive to the sun it's quite bad actually who did
22:47edward oh hello hold on i remember the script oh
22:59come in come in have a seat i'm megan how are you oh i'm well a number of years ago i had trouble with
23:06varicose veins i took one out okay doctor said do you want to see i said not bloody likely you know
23:12what i saw the pharmacist today about was should i get a pair they go right up up oh what stockings
23:19like compression stockings yeah yeah i said the pharmacist well are the knee ones okay
23:27or can i get one up the thigh is the main concern here about the stockings or have you had any other
23:33symptoms have you had any swelling any pain along along the veins not really um maybe a bit of a pain but
23:40nothing more than the twins but i'm just worried that i don't want to get any worse you know yeah
23:45yeah can i have a feel is that right yeah yeah i've just had a shower you're safe
23:51just clean my hands you're safe as well warm hands thank god any pain when i press along the
23:57vein it's the size of these nodules things any pain along here oh up here sometimes but not much
24:03did they ever get red or hot not really these look like almost bruises or a bit of blood where it's
24:09it's popped it slightly oh right and because i can touch them it feels different to the vein ah
24:14you've not you can get something called phlobitis which is to do with inflammation in the varicose
24:20veins and it can be quite uncomfortable and hot to touch and painful now you haven't got any of that
24:26which is good but people worry about dvts yeah yeah yeah yeah yeah um i mean have you had any recent
24:33long-haul flights i fly to australia every year yeah when did you last fly uh it flew back in january
24:38in january okay so it's not relatively recent last six months ago often for a lot of people who travel
24:45on long-haul flights they can buy compression stockings over the counter for this guy he had
24:49some varicose veins quite significant leading all the way up to his growing uh with his frequent trips
24:55abroad his age and the varicose veins it puts him at a slightly higher risk of getting a dvt because
25:03before you we would consider like um compression stockings really what you should have is a doppler
25:12it involves there's two ways you can do it one way is they put two blood pressure cuffs on each
25:16one on each leg and one on the arm you lay flat for about 20 minutes and they measure your venous return
25:23oh right and they measure to see if there's any what we call aphalosclerosis in the arteries so like
25:29plaque build-up but i don't think they did well i mean i can't remember what we don't want to do
25:35is if you've got a big build-up is giving you lots of compression and then there's an issue of you
25:40having problems with like venous supply getting blood supply getting to the legs yeah that's all right
25:46your feet are they often purple yes yeah okay i think you'd benefit from a doppler to check how
25:54your venous supply is okay and that she tells me so i'll get that sorted for you one of the things
26:04that concerned me about this patient was that his feet were purple this suggested to me that he probably
26:09had some venous insufficiency which means that his vein system isn't working properly so then he's getting
26:15pooling and discoloration i keep walking everywhere you're walking everywhere can you feel your toes
26:20okay then yeah continue doing what you're doing because that's fantastic and like i said if it starts
26:25to get painful along the vein like hot to touch painful when you're touching it let us know but if
26:30it's more deep in the calf then i'll be a bit more concerned yeah okay but i'll get those all sorts of
26:36food look after yourself i'll have a look at referring you on to um get a doppler yeah okay to check make
26:44sure your your blood supply is all good yeah i said there's no juice everywhere i don't know i see me
26:48legs coming apart oh my god look after yourself okay bye bye this door open oh yeah leave it open yeah
26:56take care of yourself i will i will let me mail at night time would you notice any kind of drenching
27:04night sweats where you would have to change the sheets or the pajamas or anything no no no nothing like
27:09that um have you noticed any change in your bowel habit no any blood in the poo black tari stools
27:16anything like that no i mean there was um a few months ago well i noticed it and i was i didn't
27:22and then just sort of passed but can you describe that a little bit more was it red when you're wiping
27:27or well both and then like it was you could see that there was blood in the stool for sure and was it
27:33painful to pass the poo um not like stomach wise no i didn't really know what to think of it so i
27:40just i was like something might pass around okay okay that's definitely good to know as well though
27:45is it okay if i examine your tummy and i have a feel of that lump under your armpit yeah no worries
27:53and if you just pop the top up perfect now my hands are freezing that's okay even in this okay just
27:58let me know if you have any discomfort nice any pain they want to present um not really i've been
28:09in there just a little bit yeah okay and you can sit up for me now i'm gonna feel the lymph nodes in
28:16the neck okay yeah they they have been swollen when i've been getting sick like really big yeah but
28:28okay can you put your hand on my elbow and i'm just gonna feel under the armpit
28:35can you point to where you can feel
28:39okay and relax again
28:44okay and you can sit back down for me
28:53so the tummy's nice and soft i can feel what you're feeling under the armpit have you noticed
28:58any lumps or bumps in the breasts at all i had i've i had a biopsy in my left breast for i had
29:05fibrodinomas and that was maybe like 20 21. okay yeah and since then are you good at
29:14and checking your breasts for any i've got breast implants it's really hard okay um but nothing that
29:19you've i've not that i've noticed yeah okay yeah having breast implants doesn't put you at any higher
29:25risk of having breast cancer and there's no particular special or different way where you
29:30should be checking your breasts if you do have implants i think you know generally knowing what's
29:35normal for you so looking for any asymmetry pain skin changes or puckering or nipple discharge and
29:43obviously relating to this case lumps under the armpits and those are all things where you absolutely
29:48you should go to your gp to check so what i might do is bring you back in another point just to have
29:54a full examination of the breasts because sometimes when we have a lump under the armpit yeah we just
29:59want to make sure that there's nothing else um going on and we can send you through to the to the breast
30:05team in that okay in that context okay yeah um and then uh with regards to the tiredness um there are
30:13a few blood tests that i'm thinking that we should do definitely so i want to look at your iron stories
30:18and your um to make sure that you're not anemic i also will do a celiac screen as well to see if
30:23there's an underlying cause for having had low iron in the past and things like thyroid function as
30:28well yeah is that okay does that make sense perfect it may well be that we then send a referral off to
30:34the breast team just to double check sure because a lump under the armpit we just need to yeah yeah
30:39fully examine okay does the same time next thursday work for you yeah should be fine so we'll do blood
30:47tests and then i'll examine you next week and more than likely send you to the breast team just to
30:53make sure that we're covering all our bases okay okay any questions for me uh no that's all yeah thank
30:58you so much you too cheers do you mind if i park this in here here we go okay ready
31:13how's it going how's this young lady she's all right she's all right a few complaints but yeah
31:18yeah yeah have a seat thank you you want to sit you want to stand or sit my yeah sit on daddy's knee
31:24no stand or sit come up okay what's been happening so she's been complaining from about since maybe
31:31friday night when she's peeing that it hurts okay yeah her pee is quite strong smelling as well yeah
31:38yeah okay um so yeah so that's been going on now since any temperatures does she feel hot no no um
31:44and it's also during the night as well where it's the most strongest for her yeah so she wakes up at
31:49maybe two or three o'clock in the morning and complains that she's out of nappies at night
31:53she doesn't wear a nappy at night she does wear a nappy yeah yeah but she says it hurts yeah
31:59and then she does you know the typical crossing of yeah yeah so it's important that we get a urine test
32:05before we start treatment okay if she's unwell we'd say put her on sort of a general antibiotic amoxicin is
32:12the usual children's one but uh the result then may show that it's a different but it might be
32:19better okay okay how easy what do you yeah this is the next question yeah how easy how easy am i gonna
32:25go yeah um the other option is cotton wool you know put it down there and then when she's gone you
32:36just squeeze it out into this okay i think but we'll give you all the same here
32:43just by label on it for you we're gonna put your peepee in there and then someone's gonna look at it
32:48and tell me if you have something wrong yeah yeah
32:53you want to choose oh you want a sticker my hair which one would you want we've got shark starfish
33:01turtle octopus which one do you want you choose you want the octopus okay jellyfish daddy oh sorry
33:09yeah don't know my nose man you want that one you want to put it on your you want to put it on your
33:12uh yeah you can show all your all your friends and becas you got a sticker daddy gets these to go yay
33:19party bags okay there you go thank you you're welcome any problems give us a call yes and if i see the
33:27urine test back early i'll give you a call okay thanks thank you for coming hi hi do i get a wave hi
33:34thanks for coming see you if i eat anything in the morning i immediately feel bloated and full
33:45and if you sort of pass wind and things does that help i'm not able to very much but i don't usually
33:50anyway do you feel like now bloated a little bit with more wind um yeah maybe a little bit okay and
33:57does the pain improve after a bowel movement or passing wind i feel like i really need to go yeah
34:01actually pain
34:07do you think it's because you have the latte why not just be crumping up because you've mixed the milk
34:12and the chips and then sweets maria hello come on in how are you not good not good oh dear i'm crawling in
34:24again that's all right pleased to see you we're in here today that's why i'm crawling in again
34:31yeah so what's happened you know last week i had terrible diarrhea first okay and then total
34:39conservation bloated like this on sunday nothing and i didn't so i went to chelsea in westminster
34:46he was rather a thing this is all painful you couldn't feel a blockage okay my blood okay and sent me
34:55home now it's again it's constant pains here okay it's like this i sent you a copy of those what i
35:04could copy from the test from the hospital yeah yeah it looks like my liver and kidney is something
35:10because we've had sort of tummy upset and problems for quite a while haven't we and
35:14we sent you to the sort of the urgent clinic to try and get them to find out what it was didn't we
35:19she didn't she run tests and did a lot of tests and they put cameras in and everything didn't they
35:24nothing and then the other day when i was pooping it looked like blood i'm just thinking of having a
35:31whole body scan maybe well you pretty much got a whole body scan before didn't they just a few
35:36weeks ago so they did a whole ct what they call thorax abdomen pelvis they did all of it from top to
35:42bottom and here from here all the way down and here i am again so they didn't find cancer yeah or
35:48anything horrible which is what we all worry about yeah and they've said that everything was fine the
35:52heart the lungs they didn't find any swollen lymph nodes or glands they said the liver gallbladder pancreas
35:59spleen adrenal glands kidneys bladder are all normal even bladder bladder all normal but they did say
36:07that you've got a condition i don't know if you know about it called diverticular disease your our
36:12intestine sort of comes and it looks like this and it's nice and and bobbily like that and it comes
36:18down and out and we go to the loo so that's what it should but with diverticular disease we end up with
36:23these little pockets oh that stick out and the poo comes up and round and out it can get stuck in
36:30these and cause them to be inflamed and bloaty and sore and horrid they said no other abnormality in the
36:36colon nothing else in the pelvis but you do have these and what i wonder happens is that some days
36:42might not be so bad other days might be horrible yeah do you pass a lot of wind do you find you're quite
36:47windy well sometimes i don't i have to take something okay to help it yes and the problem is that
36:53that's what can happen here that sort of gas can build up and then it's stuck and it can't go
36:57around and if gas if the walls get stretched to the colon it's really uncomfortable and it can be
37:02really horrible why don't we start with just seeing if we can get something to help you with the one
37:06thing we know is going on which can cause the bloating and we have a poop test we can do a poop test
37:11and we can just check that there's nothing there yes that there's no blood
37:23so
37:32are you a warrior yes because i always think i'm going to die and what do you think you're going
37:38to die of something horrible some cancer or something the problem is that we all worry about
37:42this and sometimes that worry just grows a bit doesn't it i think it's getting is sort of because
37:48i've had so many friends i'm sure that's frightening isn't it but that's my age i mean but but that's
37:55the problem that that's going to keep on happening isn't it instead of going forward that's why i
37:58accepted yeah but it's just sad it is yeah you know i said oh can i go on holiday somewhere who'd you go
38:07with yeah i used to always have one or two and they're all sort of dropping off are they slowly
38:13yeah and they're all dropping off i mean but that's okay it's the problem being the fittest of a group
38:18because then you're the one that's left standing on you i'm about the only one left out of the lot
38:23that we started what about making new friends and different things i have lots of young friends
38:29anyone to go on holiday with any yeah well i am i always do once a year i force them good i bet you
38:38don't force them very much i'm sure if you suggest i'm trying to zanzibar in september oh my goodness
38:43me that's amazing i'd like to go to zanzibar for longer but 10 days that's max because what you get
38:49people to sort of dog sit yes yes and drives my partner crazy he's 80 and uh on his own with the
38:56three of them can he not travel with you or does he not really like he's autistic he doesn't move
39:01he sits in front of okay the computer all day long it's very difficult but we get on well i've known
39:09him for 65 years and are you married is he your partner no he's my part he was always my best friend
39:16i got married to somebody else and then got divorced and went back now within 11 years now okay well he does
39:24his we're the best friend we knew each other's families we grew up in harpenden so we knew each
39:30other you know it works it works he has somebody to talk to i have somebody to talk to good we all
39:37do our own thing yeah yeah i mean they keep you all going i mustn't complain i'm a bit just of a
39:43neurotic but this makes me feel better well i'll tell you what let's do the test and see but then we'll
39:47discuss the result when it comes and then we can make a plan what i'm going to give you the little sample
39:51pot let me get it from the girls at the front then we can get it sorted out it's all day another
39:57fit test please bring it back anytime thank you enjoy take care bye bye how are you well i'm all right
40:06i mean because i'm asked to come not because i want to come but you feel okay yeah yeah i get on with it
40:14yeah you know that i know that that's why i like seeing you because you know me so your sugar's okay
40:22your liver is still there yes it's still there
40:27a lot of strolls good is it good yeah what do you say yours is 4.4 wonderful there you go
40:43i spend my life telling people to take statins and it's great when it works well i've been taken
40:49because for so many years it's unbelievable i started you on them because i'm on the same ones
40:55there's the first of them yeah but you feel okay you don't have achy joints oh i do have achy joints
41:02but i'm 80 years old what do you expect i mean even the bones here hurt my collar bones hurt
41:10but you know tell me about the bones and aches and pains and things tell me about them for instance
41:19written to the coast and what should have been an hour and a half journey because half the motor
41:25clothes did a detail took us three hours so you know i've got a bad back i've always had so when you
41:32get out of the car over that in the car in the car while you're going and my hips were hurting yeah yeah
41:38i can wait to get out the car so i mean i'm used to back hurts you know it's all the time yeah yeah
41:45it's part of me it's always the left knee yeah yeah yeah and usually the right hip i say the other
41:55day it was both hips but then yeah hey yeah something's got to kill me well your joints are not
42:04going to kill you but we want to make we want to make it as joyful experiences going to the coast
42:10as possible i don't really want you in pain your blood pressure's a wee bit high as well
42:16that's probably because i've been sitting out there and you're late and i'm always early
42:21for her i'm not happy to just leave that blood pressure as well what's it now every day so i would
42:33like to check your blood pressure again are you going your way or are you here no i'm here yeah i'm
42:41here what i'm going to do is book you in in two weeks time with me and sam if she's around yes just
42:50do a couple more blood tests all right check your blood pressure yeah we'll just send it to the
42:55phone and on yeah okay i'll send it nice to see you anyway and yeah it's not like coming to the
43:03doctors is it when i come to see you yeah just to see him chuck yeah take care yeah all right take care
43:09much cheers thank you very much thank you very much thank you i'll see you next week thank you
43:33so
43:41so
43:43so
43:45so
43:47so
43:51so
43:53You've had a few
44:22of those falls recently, haven't you?
44:23Oh, I've had five of them.
44:24It always happens where you can't get up
44:27because there's nothing to hold on to.
44:29Oh, gosh.
44:30From your perspective, would you think I have ADHD?
44:33It's a spectrum, isn't it?
44:34We're probably all on one part of the spectrum.
44:37He just woke up one morning and wasn't all there.
44:52We're probably all on one part of the spectrum, isn't it?
45:08We're probably all on one part of the spectrum, isn't it?
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