- 17 hours ago
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00:01Morning 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, it's gone.
00:11Really soft, it's gone, I'm sorry.
00:13It's alright.
00:14Does it help to rub it or anything?
00:15I should leave it coming, it's hurt.
00:17I do rub it, but...
00:18Yeah.
00:19Sorry.
00:21Are you a warrior?
00:23Yes.
00:24Because I always think I'm gonna die.
00:30When you feel it, say yes.
00:32Yes.
00:34Yes.
00:41You only live up.
00:43It's still there.
00:44It's still there.
00:45It's still there.
01:00I'll be in the next video.
01:01Yes.
01:02Yeah.
01:03RICHARD CHAMBERS
01:04Good.
01:05켄
01:06You're wearing masks.
01:07Good.
01:08Good.
01:09Good.
01:10Good.
01:11Good.
01:12Good.
01:13Good.
01:14Good.
01:15Good.
01:16Good.
01:17Good.
01:18Good.
01:19Good.
01:20Good.
01:21Good.
01:22Oh, good.
01:23Good.
01:24Well, how are you?
01:25Good to see you again?
01:26Yeah, likewise.
01:27Good.
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?
01:51It'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.
02:33It 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.
02:44So normally the hydrocortisone we use is 1%, but I could try and prescribe you 0.5%, which is even weaker.
02:50And 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.
02:57See how you go with it.
02:58Yeah.
02:59Does that sound okay?
03:00Yeah.
03:01Any idea on that time frame 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.
03:19Time before.
03:20Okay.
03:21Perfect.
03:22Yeah.
03:23Any questions at all?
03:24That's it.
03:25Thank you very much.
03:26Yeah.
03:27All right.
03:28Awesome.
03:29Thank you very much.
03:30You're very welcome.
03:31Take care.
03:36Right.
03:37So you're here for your submit test.
03:39Yes.
03:40They've been trying to do it for about a year because I'm overdue.
03:42Okay.
03:43Every time they try and do it, they can't do it because I've been examined because I was on this
03:48pre-cancer pathway for a while.
03:50Okay.
03:51Okay.
03:52So you've had some abnormal smears before?
03:54I'm not overdue.
03:55Not for a while.
03:56Okay.
03:57I think they've been okay for a while.
03:59But I'm...
04:00Is it every five years?
04:01Yeah, that's right.
04:02I'm not overdue the five year one.
04:03Okay.
04:04So we are a little...
04:05Long.
04:06We've had worse.
04:07But you are...
04:08We would do it.
04:09For me I am.
04:10I'm usually really efficient about these things.
04:11We'll do it now.
04:12We'll do it today and then we can get it done.
04:13Because I've got to have another ultrasound on Friday for the pre-cancer pathway.
04:16Okay.
04:17So I just thought I can't leave it.
04:18And tell me what's happening on that pathway.
04:20It was a suspected cancer pathway.
04:22Every 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?
04:29Um...
04:30Not that we know of.
04:31Not that we know of.
04:32I mean sometimes they do but they would have told us 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...
04:56And we referred you, was it because of the womb 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 and 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.
05:39Exactly, exactly.
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.
06:15Okay.
06:16And as you know, most of the time it 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.
06:26Very occasionally they have to see you in that colposcopy clinic where they want to have a little closer look at it.
06:31Yeah.
06:32But they test it all on there.
06:33Yeah.
06:34And as you said, it's been normal a few times recently, so fingers crossed it'll be all right.
06:36Yeah.
06:37Thank you very much.
06:38Thanks, Elizabeth.
06:39Okay.
06:40Let me let you go.
06:41Good luck with your scan then on Friday.
06:43And nice to see you as always.
06:46All right.
06:47Take care.
06:48Bye.
06:49Bye.
06:50Bye.
06:51Bye.
06:52Bye.
06:53Bye.
06:54Bye.
06:55Bye.
06:56Bye.
06:57Bye.
06:58Bye.
06:59Bye.
07:00Bye.
07:01Bye.
07:02Bye.
07:03There you go.
07:04How are you?
07:05Uh, slightly sore.
07:06Oh sorry to hear that.
07:08Come to take a seat.
07:09Good to see you, how can I help today?
07:10Ahem.
07:11Ahem, what it is, I've got erm, I'm having a lot of trouble with my some.
07:17Ok.
07:18Ah, quos I've got osteo grasping spine anyway.
07:20Ahemmm.
07:21I'm not sleeping very well.
07:24Sometimes if I lay on my back or I turn on the sides,
07:26I get a sharp pain down my back.
07:28And the top of my leg's going numb.
07:30It's gone for about half an hour, and I don't know what.
07:33The problem is it's been something quite regularly.
07:36How long has the pain been as bad as this for, would you say, roughly?
07:39Every three days I get excruciating pain and got a trap nervous or something like that.
07:43Yeah, absolutely. Sounds like potentially...
07:45Quite frustrating. I'm trying to get up in the morning.
07:47I can't get up because my leg's numb.
07:49If I try and stand on it, I'm having trouble.
07:52Always on the left side?
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?
07:58Well, not since I was hit by the e-scooter, no.
08:00It's getting worse and worse than when I was wear a tear or...
08:03Yeah.
08:03Also, someone helped me sleep at night with the amortripline
08:07because I haven't got any left.
08:09Is the amortripline helping a bit?
08:10Yeah, it helps. Helps a bit.
08:12You'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, we could always consider that.
08:20How else is it affecting your life at the moment?
08:22Are you used to...
08:23Does it get out and about?
08:24Well, I get out and about, I mean, I'm playing long green balls,
08:26but it's got to the stage where I can't wind this down as far
08:31to roll the ball anymore, so it's difficult.
08:34Yeah.
08:35Trying to have a life.
08:37Francesca?
09:01Hi.
09:05Hi.
09:06Hi.
09:07How are you?
09:08I'm good, thank you.
09:09Come and take a seat.
09:10I'm pregnant again.
09:11How are you?
09:12Oh, I'm so hot.
09:14Oh, I bet you are.
09:16How many weeks are you now?
09:17I'll be 32 on Friday.
09:20Oh, exciting.
09:21I know.
09:21How's it been second time round?
09:23It's, I would say, very different.
09:26Yeah.
09:26Like, I felt I'm way bigger than I was.
09:30Yeah.
09:30And just, yeah, it's just hard with a toddler.
09:34Yeah.
09:34So Wilbur turned two a couple of weeks ago.
09:37Oh.
09:37So he's, like, really in the, you know, toddler tantrum phase.
09:41And very active, I bet, timing up everything.
09:43Oh, my God.
09:44It's really hard.
09:45And when you look back at when you were pregnant the first time, you think, oh, that was actually
09:50fine.
09:51Absolutely.
09:51Absolutely.
09:52When you're looking after another one.
09:53Yeah.
09:54But, yeah.
09:55So we're going to do RSV today and the whooping cough vaccination.
10:00Perfect.
10:00Did you have RSV for your last one?
10:02No, I don't think it was around with Wilbur.
10:03Yeah.
10:04So RSV is a respiratory virus that is responsible for sort of common colds and coughs.
10:09Yeah.
10:10However, it can lead on to pneumonia and bronchiolitis.
10:13Okay.
10:14Which is, you know, particularly bad for babies.
10:17And then the whooping cough is exactly the same as the one that you had before.
10:21Yeah, I think I had that with Wilbur.
10:22Exactly.
10:22So protecting them for their eight weeks, first eight weeks of life before they have their
10:27eight-week vaccinations.
10:28Perfect.
10:29It's very unlikely to get side effects from these other than sore arms.
10:34I'll do them both today if you're happy with that.
10:35Yeah, fine.
10:36Sore arms might be a little bit red, a little bit achy.
10:40That should subside within a day or two.
10:42Yeah.
10:43There is always a chance with all vaccinations that you might get sort of mild flu-like symptoms,
10:47a bit of an achy body, whatnot.
10:49But with these two, it is unlikely.
10:51However, if you're worried about anything, just let me know.
10:53Okay, perfect.
10:54Are you feeling well today, other than hot and pregnant?
10:57Yeah, no, I'm feeling fine.
10:59Perfect, perfect.
11:00And remind me, you don't have any allergies, do you?
11:02No, I don't, no.
11:04Lovely.
11:05Oh, it's very exciting.
11:07Yeah.
11:08Very exciting.
11:09Okay, so we will do the RSV in your left arm.
11:15So we'll start with this side of that, so okay?
11:17Sure.
11:17So just relax your arm for me, relax it down just like that.
11:20Relax from your shoulder.
11:20All right, sharp scratch.
11:29That's one done.
11:35Okay, sharp scratch.
11:40Perfect.
11:44So next time I see you, we'll be for the vaccination.
11:48That's crazy, isn't it?
11:49But if you need anything, though, in a long time, just let me know.
11:54But yeah, so much luck with everything.
11:56Thank you so much.
11:57So nice to see you.
11:58Yes, I'll be to you too.
12:00Take care.
12:00Bye.
12:01Bye.
12:05Would it be okay today just to examine you, is that all right?
12:10Yeah, sure.
12:10So whenever you're ready, if you stand up for me, I'm just going to press down the spine.
12:16So you can see how there is a bit of asymmetry there.
12:19So, you know, this shoulder is a bit lower than this one because you're compensating because
12:22you're in so much pain.
12:23That's very common to see that.
12:25A bit tender there.
12:29Yeah.
12:29So a bit of spinal tenderness.
12:31I agree.
12:31So around L2, L3, L4.
12:34Ah.
12:35Sorry.
12:36Mm.
12:37Sorry.
12:38Are you able to bend forward for me?
12:40Stop when it's painful, so only go as far as you can.
12:42Yeah, I can bend forward, yeah.
12:43Yeah.
12:43So it's, yeah, it's fine.
12:44Stop.
12:45And then if you bend back for me, yeah.
12:47So it's a very limited range of motion, isn't it?
12:49Yeah.
12:50If you slide one arm down, one leg.
12:52Yeah.
12:53And the other side for me.
12:54Yeah, very, very limited.
12:55We need to get that back really sort of mobilized and moving around.
12:59Back pain can be really debilitating.
13:01It can lead to a lot of sick days, a lot of time off work, and can cost the economy, you
13:06know, millions a year.
13:07So it's really important to manage it as best as we possibly can.
13:12And prevention is obviously far better than cure.
13:14So having good posture, strengthening core muscles, making sure that we're exercising
13:18in a safe way and are looking after our bodies is really, really important.
13:23Can I get you on the couch?
13:24Would that be okay?
13:24Yeah, sure.
13:26In Simon's case, clearly the pain was having a very big impact on his quality of life,
13:30on his abilities to sleep, et cetera.
13:31If the pain is a bit more complex, if there's pain radiating into the buttocks or into the
13:36legs with potential nerve involvement, that then might mean that we refer patients for
13:41more specialist intervention at times.
13:43A lot of the time we can still manage that in the community as well, but really understanding
13:47the impact the patient's pain is having on them is very important.
13:51And that helps us to determine whether we need to seek specialist intervention or not.
13:55how's that pain?
14:00Oh, I'm sorry.
14:02I'm just going to lift this leg up.
14:06It's okay.
14:11Tender.
14:12Ouch.
14:13Yeah.
14:13Oh, bless you.
14:14Sorry.
14:15Lift this leg up.
14:16Push me up.
14:17Good.
14:17Push me down.
14:18Good.
14:18Push me up with this one.
14:20Push me down.
14:20Yeah, yeah, yeah, yeah.
14:22It's gone numb.
14:22Really sore.
14:23It's gone numb.
14:24Sorry.
14:24It's all right.
14:25Does it help to rub it or anything?
14:27I should leave it a couple of minutes.
14:28I do rub it, but...
14:29Yeah.
14:31Sorry.
14:33Whenever you're ready, you can come back round.
14:35Take your time.
14:36Do you need a hand?
14:37Oh.
14:40Yeah, one of the main problems is, like, when I'm in lying in bed, because I lie on the left,
14:44it's getting myself up and having to sit on the bed for a while.
14:48Yeah, just to get used to it and get the sources.
14:52I should just take a seat there.
14:54Okay.
14:56What I think we should do is a few things.
14:58We can increase the amitriptyline, if you like, just for a few nights to see how you get on with it.
15:03You can definitely go up to three quite easily.
15:05If you want a little bit of cocodermol or something like that, just to, you know, for those paroxysms of pain when it's really, really bad,
15:14you can take a couple of cocodermol, not a problem at all to do that.
15:17And then I think we should refer you to the musculoskeletal team just to see if there's anything else that needs to be done.
15:23Things to look out for, if there's any complete loss of sensation between the legs, if the pain's getting worse,
15:29if there's any loss of balance, that kind of stuff, just let us know as well.
15:33All right, we'll see how you go.
15:35Okay.
15:35And we'll take it from there.
15:36Okay, thank you.
15:37I'll send the prescription to the pharmacy for you.
15:39Okay, thank you very much.
15:39Thank you, take care.
16:14Yeah.
16:14Do you drink alcohol then?
16:16Yeah.
16:16Yeah?
16:17Santiago is a young, healthy, active guy who came in for his annual diabetic health check.
16:24Santiago has type 1 diabetes.
16:27Type 1 diabetes is your body doesn't produce insulin.
16:30It's an autoimmune condition.
16:33It's classed as a chronic condition.
16:35So on average, how much do you drink a week?
16:38No, like maybe two, three pints.
16:41Big?
16:41Like after a football match, yeah.
16:43Do you play football?
16:43Yeah.
16:44Are you good?
16:46I mean, you should ask that to my friends, but I think I'd befriend myself.
16:50I think they would say yes.
16:53You're decent.
16:54Who do you support?
16:55Who do I support?
16:56You've got to be very careful now.
16:57Wrong choice.
17:00Who do you support?
17:02Chelsea?
17:03Yes.
17:03Oh, okay.
17:04Well, I suppose if you're in Fulham.
17:06If you're in Chelsea or Fulham.
17:08I've arrived quite like early or a few years ago here, but like I was, I'm from Argentina.
17:14Do your family live in Argentina?
17:16Yeah.
17:16You can relax.
17:18Sharp scratch.
17:20Do they come here at all?
17:22They came once.
17:24I also went back like twice since I moved.
17:28Okay.
17:29Pop your finger on there for me nice and hard.
17:32So do you play any other sport?
17:34So I'm trying to get into golf, but I'm not doing good.
17:39My dad's always, he says he's at the office, which means he's in the golf course, but he's rubbish.
17:46He still goes.
17:51That's perfect.
17:52Oh, God.
18:00Jeremy, see you then.
18:02Oh, is that your thing?
18:02And then you do the one.
18:04I can lose my arms in it.
18:11I do.
18:14Right, so I need to buy some more blue dresses, yeah?
18:17Oh, Bro, he's got pockets.
18:18When she's heavily pregnant, that would be more enough.
18:27Shoes off, eat up.
18:28Okay.
18:29Don't, don't get surprised with my, how do you call this?
18:33The fungal, is it fungal now?
18:36Here, here?
18:36Yeah, yeah.
18:37So next time you cut your toes, I want you to cut them and put the nails in here.
18:44Okay.
18:44And bring it in for me.
18:46Okay.
18:47But this looks like classic fungal toenail.
18:50Okay.
18:51Right, close your eyes, no treating.
18:53When you feel it, say yes.
18:54During an annual health check, we do a foot check
19:13where we check for any signs of infection
19:16and we also use a monofilament device
19:20which checks for loss of sensation or auto-sensation to the feet.
19:25We check to make sure there's no open ulcers, no wounds.
19:30Make sure that you've got feeling
19:33because if not, then we can action it.
19:36So it's really important to attend your annual diabetes check.
19:41You've got some hard skin to the bottom of your feet.
19:47So when you're in bed at night,
19:49if you put some moisturizer on the bottom of your feet.
19:53Okay.
19:54Rub it into your feet, both feet,
19:57and then put cotton socks on.
19:59Okay.
20:00That's great.
20:00You've done liver, kidney, fibres, cholesterol, diabetes, iron, the whole lot.
20:04Amazing.
20:05Okay.
20:05Okay.
20:06Sam, I appreciate it.
20:07You're welcome.
20:08Thanks so much.
20:08Take care, Sam.
20:09Have a good weekend.
20:10Best wishes for Chelsea next season.
20:12Best wishes for Fulham.
20:13A lot.
20:14Bye.
20:14Bye-bye.
20:22Come on in.
20:24Take a seat.
20:26My name is Anna McHugh.
20:27I'm one of the doctors.
20:28So what's been going on?
20:30I originally just wanted to get blood done because...
20:33Okay.
20:33I'm back home in Australia.
20:35I usually have an iron infusion,
20:37but I've noticed that it's not a normal practice here to do iron infusions.
20:41So I think it's worth just getting my blood done anyway,
20:44but I've just been like absolutely exhausted all the time.
20:48I've got a lump on my armpit that's been growing for like a year and a half.
20:51Okay.
20:52We'll definitely take a look at that.
20:53Yeah, that's good.
20:54Definitely good to know.
20:55So when did you notice on this occasion that you were feeling a little bit more tired than usual?
21:02Honestly, it's been the last maybe couple of months.
21:06Okay.
21:06And it's just progressively getting worse.
21:07It's like I'm really struggling to just get through a work day and...
21:10Okay.
21:11Yeah.
21:11Yeah.
21:12Tell me a little bit more about the lump.
21:14So is it multiple lumps?
21:16I'll examine you in a moment.
21:17It's just one here.
21:18Okay.
21:19And anywhere else?
21:20No, it's just this one.
21:21And I noticed it maybe last, last February.
21:25Okay.
21:26And has it changed?
21:27It's getting bigger.
21:28Okay.
21:28And it's becoming sore.
21:30Like even if I'm just like resting, it's like this achy pain.
21:33And is it ever red, hot or anything like that?
21:36No, not that I've noticed.
21:37Okay.
21:37And any lumps or bumps anywhere else?
21:40Not that I've noticed.
21:41Okay.
21:42My nan actually died of breast cancer.
21:43So, yeah.
21:45And is there anyone else in the family with...
21:46Well, my mum passed away from melanoma, so...
21:49Okay.
21:49I'm sorry.
21:50My cancer's just running rife in the females in my family, unfortunately.
21:54I'm sorry to hear that.
21:55No, it's okay.
22:12Good luck with the veins, so...
22:14Okay.
22:15Like a challenge.
22:17Do you have a good vein?
22:18I doubt it.
22:20Sorry.
22:21Perhaps my blood is solidifying.
22:25Okay, so I'm just pressing along the veins in the back of the leg.
22:28What, you think it might be deep vein flumbus or something awful?
22:32Because you've had varicose veins for a long, long, long, long time.
22:34Yeah.
22:35But the pressure's built up.
22:36So now we've got the sort of discoloration, which isn't going to go away.
22:40Because you did offer to sort out the varicose veins still as well.
22:42They're painful.
22:43They throb.
22:43They're sensitive to the sun.
22:45It's quite bad, actually.
22:46It did.
22:51Edward?
22:52Oh.
22:53Hello.
22:54Hold on.
22:54I've got to remember the script.
22:56Oh.
22:59Come in.
23:00Come in.
23:00Have a seat.
23:00I'm Megan.
23:01How are you?
23:02Oh, I'm, well, a number of years ago, I had trouble with varicose veins.
23:07I took one out.
23:08Okay.
23:09Doctor said, do you want to see?
23:10I said, not plenty likely.
23:11What I saw the pharmacist today about was, should I get a pair?
23:17They go right up.
23:18Oh, what stockings?
23:19Like compression stockings?
23:21Oh, sorry.
23:21DVT stockings, yeah.
23:22Yeah.
23:23I said to the pharmacist, well, are the knee ones okay?
23:27Or can I get one up the thigh?
23:30Is the main concern here about the stockings, or have you had any other symptoms?
23:33Have you had any swelling, any pain along the veins?
23:38Not really, even though you had a bit of a pain, but nothing more than the twinge.
23:42But I'm just worried that I don't want to get any worse, you know?
23:44Yeah, yeah.
23:45Can I have a feel?
23:45Is that all right?
23:46Yeah, yeah.
23:47Have a feel of your path.
23:47I've just had a shower.
23:48You're safe.
23:51Just clean my hands.
23:52You're safe as well.
23:53Warm hands, thank God.
23:55Any pain when I press along the vein?
23:58No, no.
23:58No, it's the sight of these nodules things.
24:00Any pain along here?
24:01Oh, up here sometimes, but not much.
24:03Did they ever get red or hot?
24:05Not really.
24:06These look like almost bruises, or a bit of blood where it's popped slightly.
24:10Oh, right.
24:11Because I can touch them, it feels different to the vein.
24:14Ah.
24:15You can get something called phlobitis, which is to do with inflammation in the varicose veins,
24:20and it can be quite uncomfortable and hot to touch, and painful.
24:25Now, you haven't got any of that, which is good, but people worry about DVTs.
24:29Yeah, yeah, yeah, yeah.
24:30Yeah.
24:30I mean, have you had any recent long-haul flights?
24:34I fly to Australia every year.
24:36Yeah, when did you last fly?
24:37I flew back in January.
24:39In January.
24:39Okay, so it's not relatively recent, that's six months ago.
24:42Often, for a lot of people who travel on long-haul flights, they can buy compression stockings
24:48over the counter.
24:49For this guy, he had some varicose veins, quite significant, leading all the way up to
24:53his groin.
24:54With his frequent trips abroad, his age, and the varicose veins, it puts him at a slightly
25:00higher risk of getting a DVT.
25:03Because before we would consider compression stockings, really what you should have is
25:11a Doppler.
25:12It involves, there's two ways you can do it.
25:14One way is they put two blood pressure cuffs, one on each leg and one on the arm.
25:18You lay flat for about 20 minutes, and they measure your venous return, and they measure
25:24to see if there's any what we call aphalosclerosis in the arteries, so like plat build-up.
25:30I don't think they did, well, I can't remember, so long ago now.
25:33What we don't want to do is, if you've got a big build-up, it's giving you lots of compression,
25:39and then there's an issue of you having problems with, like, venous supply, getting, blood supply
25:43getting to the legs.
25:44Yeah, that's all right.
25:46Your feet, are they often purple?
25:50Yes.
25:51Yeah, okay.
25:52I think you'd benefit from a Doppler to check how your venous supply is, okay?
25:58No, she tells me.
25:59So I'll get that sorted for you.
26:03One of the things that concerned me about this patient was that his feet were purple.
26:07This suggested to me that he probably had some venous insufficiency, which means that
26:12his vein system isn't working properly, so then he's getting pooling and discoloration.
26:17I keep walking everywhere.
26:18You're walking everywhere.
26:19Can you feel your toes okay then?
26:20Yeah.
26:20Continue doing what you're doing, because that's fantastic.
26:24And like I said, if it starts to get painful along the vein, like, hot to touch, painful
26:28when you're touching it, let us know.
26:30But if it's more deep in the calf, then I'll be a bit more concerned.
26:34Yeah.
26:34Okay?
26:35But I'll get those all sorts of food.
26:36Look after yourself.
26:37I'll have a look at referring you on to get a Doppler.
26:42Yeah, okay.
26:43To make sure your blood supply's all good.
26:46I said, I don't do that anymore.
26:47I don't know.
26:48I see my legs coming apart.
26:49Oh my God.
26:51Look after yourself.
26:52Thanks, love.
26:52Bye.
26:52Bye.
26:53Leave the door open?
26:54Oh yeah, leave it open, yeah.
26:56Take care of yourself.
26:58I will, I will.
26:58Let me know.
26:59At night time, would you notice any kind of drenching night sweats where you would have
27:05to change the sheets or the pyjamas or anything?
27:08No, no, no, no.
27:09Nothing like that.
27:10Have you noticed any change in your bowel habit?
27:13No.
27:13Any blood in the poo, black tarry steels, anything like that?
27:16No.
27:17I mean, there was a few months ago.
27:20Well, I noticed it and I was loud and it just sort of passed.
27:24Can you describe that a little bit more?
27:25Was it red when you're wiping?
27:27Well, both and then like it was, you could see that there was blood in the stool.
27:32Oh, for sure.
27:33And was it painful to pass the poo?
27:36Not like stomach wise, no.
27:38I didn't really know what to think of it.
27:40So I just, I was like, something might pass through it.
27:42Okay.
27:43Okay, 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?
27:48Yep.
27:49No worries.
27:53And if you just pop the top up.
27:55Yep.
27:55Perfect.
27:55Now my hands are freezing.
27:56That's okay.
27:57Even in the screen, just let me know if you have any discomfort.
27:59Nice.
28:05Any pain there when I press it?
28:07Not really.
28:08I've been there.
28:10Just a little bit.
28:10Yeah.
28:11Okay.
28:11And you can sit up for me.
28:14Now, I'm going to feel the lymph nodes in the neck, okay?
28:17Yeah, they have been swollen when I've been getting sick, like really big.
28:21Yeah, but.
28:28Okay, can you put your hand on my elbow?
28:30Mm-hmm.
28:31And I'm just going to feel under the armpit.
28:33Mm-hmm.
28:33Can you point to where you can feel?
28:40Okay.
28:40And relax again.
28:44Okay.
28:44And you can sit back down for me.
28:46So the tummy's nice and soft.
28:54I can feel what you're feeling under the armpit.
28:57Have you noticed any lumps or bumps in the breasts at all?
29:00I had a biopsy in my left breast for, I had fibrodinomas.
29:07Okay.
29:07And that was maybe like 20, 21.
29:11Okay.
29:11Yeah.
29:12And since then, are you good at checking your breasts for any lumps?
29:16I've got breast implants.
29:17It's really hard.
29:18Okay.
29:18But nothing that you've...
29:20Not that I've noticed.
29:21That you've noticed.
29:22Yeah.
29:22Okay.
29:22Yeah.
29:23Having breast implants doesn't put you at any higher risk of having breast cancer.
29:26And there's no particular special or different way where you should be checking your breasts
29:31if you do have implants.
29:33I think, you know, generally knowing what's normal for you.
29:36So looking for any asymmetry, pain, skin changes or puckering or nipple discharge.
29:42And obviously relating to this case, lumps under the armpits.
29:46Those are all things where you absolutely should go to your GP to check.
29:50So what I might do is bring you back in at another point just to have a full examination
29:55of the breasts because sometimes when we have a lump under the armpit, we just want to make
29:59sure that there's nothing else going on.
30:02And we can send you through to the breast team in that context.
30:07Okay.
30:08Yeah.
30:08And then with regards to the tiredness, there are a few blood tests that I'm thinking that
30:15we should do definitely.
30:16So I want to look at your iron stores to make sure that you're not anemic.
30:20I also will do a celiac screen as well to see if there's an underlying cause for having
30:25had low iron in the past and things like thyroid function as well.
30:28Yeah.
30:29Is that okay?
30:29Does that make sense?
30:30Perfect.
30:31It may well be that we then send a referral off to the breast team just to double check.
30:36Sure.
30:36Because a lump under the armpit, we just need to fully examine.
30:40Yeah.
30:41Does the same time next Thursday work for you?
30:44Yeah, it should be fine.
30:45So we'll do blood tests and then I'll examine you next week and more than likely send you
30:52to the breast team just to make sure that we're covering all our bases.
30:55Okay.
30:55Okay.
30:55Any questions for me?
30:56No, that's all.
30:57Yeah.
30:58Thank you so much.
30:59You too.
31:00Cheers.
31:00Cheers.
31:05Do you mind if I park this in here?
31:08There we go.
31:10Okay.
31:11Ready?
31:13How's it going?
31:13How's this young lady?
31:14She's all right.
31:15She's all right.
31:16A few complaints.
31:17Yeah.
31:19Yeah.
31:19Have a seat.
31:20You want to stand or sit, Maya?
31:22You want to sit on Danny's knee?
31:23Yeah.
31:25No.
31:25Stand or sit?
31:26Come up?
31:27Okay.
31:27What's been happening?
31:28So she's been complaining from about since maybe Friday night when she's peeing that it
31:34hurts.
31:34Okay.
31:35Yeah.
31:35Her pee is quite strong smelling as well.
31:38Yeah.
31:38Yeah.
31:38Okay.
31:39So yeah.
31:40So that's been going on now since.
31:41Any temperatures?
31:42Does she feel hot?
31:43No.
31:43Oh no.
31:44And it's also during the night as well where it's the most strongest for her.
31:48Yeah.
31:48So she wakes up at maybe two or three o'clock in the morning and complains.
31:51So she's out of nappies at night.
31:53Blah, blah, blah.
31:54She doesn't wear a nappy at night.
31:55She does wear a nappy at night.
31:56Yeah.
31:56Yeah.
31:56But she says it hurts.
31:58Yeah.
31:58Yeah.
31:58She says it hurts.
31:59Yeah.
31:59And then she does, you know, the typical crossing of her.
32:01Yeah.
32:02Yeah.
32:02Yeah.
32:02So it's important that we get a urine test before we start treatment.
32:08Okay.
32:08If she's unwell, we'd say put her on sort of a general antibiotic, amoxicillin, it's the
32:13usual children's one.
32:14But the result then may show that it's a different antibiotic, it might be better.
32:19Okay.
32:20How easy, what do you, this is the next question.
32:22Yeah.
32:23How easy.
32:24How easy am I going to do?
32:25Yeah, that works.
32:25That's for her.
32:26Um.
32:28Yeah, mi amor.
32:30Bye.
32:31Bye.
32:32Mi amor.
32:33The 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.
32:38Okay.
32:38That thing, but we can do all the same here.
32:43Just by label on it for me.
32:45We're going to put your pee pee in there.
32:46And then someone's going to look at it and tell me if you have something wrong.
32:52Yeah.
32:52Yeah.
32:56Do you want to choose a sticker?
32:57Oh, you want a sticker, Maya?
32:58Which one?
32:59What do you want?
32:59We've got shark, starfish, turtle, octopus.
33:02Which one do you want?
33:03You choose.
33:04You want the octopus?
33:04Okay.
33:05I suppose it's a jellyfish, daddy.
33:07Oh, sorry, jellyfish.
33:08Sorry, not the octopus.
33:09Yeah, don't look at my nose, Maya.
33:10You want that one?
33:11You want to put it on your, you want to put it on your, uh, yeah.
33:14Yeah, you can show all your, all your friends in Becker's.
33:16You've got a sticker?
33:18Daddy gets these to go.
33:19Yay.
33:20Party bags.
33:22Okay.
33:22There you go.
33:24You're welcome.
33:24Any problems, give us a call.
33:25Yes.
33:26And if I see the urine test back early, I'll give you a call.
33:29Okay, thanks.
33:30Thank you for coming.
33:31Bye.
33:32Bye.
33:33Do I get a wave?
33:34Bye.
33:35Thanks for coming.
33:35See you.
33:36If I eat anything in the morning, I immediately feel bloated and full.
33:46And if you sort of pass wind and things, does that help?
33:48I'm not able to very much, but I don't usually anyway.
33:50Do you feel like now bloated a little bit with more wind?
33:54Um, yeah, maybe a little bit.
33:56Okay.
33:57And does the pain improve after a bowel movement or passing wind?
34:00I feel like I really need to go.
34:01Yeah.
34:03What's your pain?
34:04Do you think it's because you had the latte?
34:10Mind if you're crumping up?
34:11Because you've mixed the milk and the chips and then sweets.
34:17Maria?
34:18Hello.
34:20Come on in.
34:21How are you?
34:22Not good.
34:23Not good.
34:23Oh, dear.
34:24I'm crawling in again.
34:25That's all right.
34:26I'm pleased to see you.
34:28We're in here today.
34:30That's why I'm crawling in again.
34:31Yeah.
34:32So what's happened?
34:33You know, last week I had terrible diarrhea first.
34:37Okay.
34:38And then total constipation.
34:40Bloated like this on Sunday.
34:42Okay.
34:42Nothing.
34:42And I didn't want.
34:43So I went to Chelsea in Westminster.
34:46He was rather a thing.
34:48This is all painful.
34:50Okay.
34:50He couldn't feel a blockage.
34:52Okay.
34:52He took my blood.
34:53Okay.
34:54And sent me home.
34:56Now it's again.
34:57It's constant pains here.
34:59Okay.
34:59It's like this.
35:01I sent you a copy of those, what I could copy from the test from the hospital.
35:06Yeah.
35:07Yeah.
35:07It 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?
35:14And we sent you to the sort of the urgent clinic to try and get them to find out what it was, didn't we?
35:19And didn't she run tests?
35:21She did a lot of tests.
35:22And they put cameras in and everything, didn't they?
35:24Yes, and nothing.
35:25And then the other day when I was pooping, it looked like blood.
35:29I'm just thinking of having a whole body scan, maybe.
35:33Well, you pretty much got a whole body scan before, didn't they?
35:36Just a few weeks ago.
35:37So they did a whole CT, what they call thorax, abdomen, pelvis.
35:41They did all of it from top to bottom.
35:43And here I am.
35:43From here all the way down.
35:44And here I am again.
35:46So they didn't find cancer or anything horrible,
35:48which is what we all worry about.
35:50And they've said that everything was fine, the heart, the lungs.
35:53They didn't find any swollen lymph nodes or glands.
35:56They said the liver, gallbladder, pancreas, spleen, adrenal glands, kidneys, bladder are all normal.
36:04Even bladder.
36:05Bladder, all normal.
36:06But they did say that you've got a condition, I don't know if you know about it,
36:09called diverticular disease.
36:12Our intestine sort of comes and it looks like this.
36:14And it's nice and bobbily like that.
36:16And it comes down and out and we go to the loo.
36:20So that's what it should.
36:21But with diverticular disease, we end up with these little pockets that stick out.
36:26And the poo comes up and round and out.
36:28It can get stuck in these and cause them to be inflamed and bloaty and sore and horrid.
36:34They said no other abnormality in the colon, nothing else in the pelvis.
36:37But you do have these and what I wonder happens is that some days might not be so bad.
36:43Other days might be horrible.
36:45Yeah.
36:46Do you pass a lot of wind?
36:47Do you find you're quite windy?
36:48Well, sometimes I don't.
36:49I have to take something.
36:51Okay, to help it pass.
36:52Yes.
36:52And the problem is that that's what can happen here.
36:54The sort of gas can build up and then it's stuck and it can't go around.
36:57And if gas, if the walls get stretched to the colon, it's really uncomfortable.
37:01And it can be really horrible.
37:03Why don't we start with just seeing if we can get something to help you with the one thing
37:07we know is going on, which can cause the bloating and the horribleness.
37:09Can we have a poop test?
37:10We can do a poop test and we can just check that there's nothing there.
37:13Yes, that there's no blood.
37:14Are you a worrier?
37:33Yes, because I always think I'm going to die.
37:37And what do you think?
37:38You're going to die of something horrible?
37:40Cancer or something horrible?
37:41The problem is that we all worry about things.
37:42And sometimes that worry just grows a bit, doesn't it?
37:45I think it's getting a sort of, because I've had so many friends die.
37:49I know, I'm sure.
37:50That's frightening, isn't it?
37:52But that's my age.
37:54I mean, but that's the problem, that that's going to keep on happening, isn't it?
37:57Yes.
37:57Instead of going forward.
37:58I mean, that's why I accept it.
38:00Yeah.
38:01But it's just sad.
38:02It is sad.
38:03Yeah.
38:03You know, I said, oh, can I go on holiday somewhere?
38:07Who'd you go with?
38:08Yeah.
38:09I used to always have one or two.
38:11And they're all sort of dropping off, are they, slowly?
38:13Yeah.
38:14And they're all dropping off, I mean.
38:16But that's okay.
38:16It's the problem being the fittest of a group, because then you're the one that's left standing,
38:20aren't you?
38:20Well, I'm about the only one left out of the lot that we started.
38:25What about making new friends and different things?
38:28I have lots of young friends.
38:31Anyone to go on holiday with?
38:33Well, I am.
38:35I always do.
38:36Once a year, I force them.
38:38Good.
38:38I bet you don't force them very much.
38:40I'm sure if you suggest a holiday.
38:40Well, I'm trying to Zanzibar in September.
38:43Oh, my goodness me.
38:44That's amazing.
38:44I'd like to go to Zanzibar for longer, but 10 days, that's max.
38:48Because what you get people to sort of dog sit, do you?
38:50Yes, yes, and drives my partner crazy.
38:53He's 80 and on his own with the three of them.
38:57Can he not travel with you, or does he not really like traveling?
38:59No, he doesn't.
38:59He's autistic.
39:00He doesn't move.
39:01He sits in front of the computer all day long.
39:07It's very difficult.
39:08But we get on well.
39:09I've known him for 65 years.
39:12And are you married?
39:13Is he your partner?
39:13No, he's my partner.
39:14He was always my best friend.
39:16I got married to somebody else and then got divorced and went back now.
39:20But I've been 11 years now.
39:22Oh, okay.
39:23Well, that's right.
39:24We're the best friend.
39:25We knew each other's families.
39:27We grew up in Harpenden.
39:29Oh, right.
39:29Oh, I know.
39:30So we knew each other.
39:31You know?
39:31And it works.
39:32It works.
39:33He has somebody to talk to.
39:35I have somebody to talk to.
39:36Good.
39:36We all do our own thing.
39:38Yeah, yeah.
39:39I mean, they keep you all going.
39:40I mustn't complain.
39:42I'm a bit just of a neurotic, but this makes me feel better.
39:45Well, I'll tell you what.
39:46Let's do the test and see, but then we'll discuss the result when it comes.
39:49And then we can make a plan.
39:50Right.
39:50I'm going to give you the little sample pot.
39:52Let me get it from the girls at the front.
39:54Then we can get it sorted out.
39:55It's all day.
39:56You'll see.
39:57Another fit test, please.
39:58Bring it back any time.
40:00Enjoy.
40:01Take care.
40:01All the best.
40:02Bye-bye.
40:02Bye-bye.
40:03How are you?
40:05Well, I'm all right.
40:06I mean, because I'm asked to come, not because I want to come.
40:10But you feel okay?
40:11Yeah.
40:12Yeah.
40:13I get on with it.
40:15Yeah.
40:15You know that.
40:16I know that.
40:17That's why I like seeing you, because you know me.
40:20So your sugar's okay.
40:22Your liver...
40:24It's still there.
40:26Yes.
40:26It's still there.
40:30A lot of strolls good.
40:31Is it good?
40:32Yeah.
40:32What is it?
40:34Yours is 4.4.
40:37Wonderful.
40:38I've never heard me about that.
40:40There you go.
40:41I spend my life telling people to take statins, and it's great when it works.
40:48Well, I've been taking them for so many years, it's unbelievable.
40:51I started you on them, because I'm on the same ones.
40:55There's the first of them.
40:57Yeah.
40:59But you feel okay?
41:00You don't have achy joints?
41:01Oh, I do have achy joints, but I'm 80 years old.
41:04What do you expect?
41:07I mean, even the bones here hurt.
41:09My collar bones hurt.
41:10But, you know.
41:14Tell me about the bones and aches and pains and things.
41:17Tell me about them.
41:17Well, for instance, we went to the coast, and what should have been an hour and a half's
41:23journey, because half the motor closed, did a detour, took us three hours.
41:28So, you know I've got a bad back.
41:31I've always had a bad back.
41:32So when you get out of the car, after that...
41:34Oh, not in the car.
41:35In the car.
41:35Why are you going?
41:36And my hips were hurting.
41:38Yeah, yeah.
41:38I couldn't wait to get out of the car.
41:41So, I mean, I'm used to back hurts, you know.
41:43It's all the time, isn't it?
41:45Yeah, yeah.
41:45Yeah, yeah.
41:45It's part of me.
41:47It's always the left knee.
41:49Yeah, yeah.
41:50Yeah, yeah.
41:50And usually the right hip, as I say the other day, it was both hips.
41:57Mm-hmm.
41:57But then...
41:58Yeah.
42:00Hey.
42:00Yeah.
42:01Something's got to kill me.
42:03Well, your joints are not going to kill you, but we want to make it as joyful experiences,
42:09going to the coast as possible.
42:10Sorry, too.
42:11I don't really want you in pain.
42:13Blood pressure's a wee bit high as well.
42:16That's probably because I've been sitting out there and you're late.
42:20And I'm always early.
42:22Well, I'm not happy to just leave that blood pressure as well.
42:27Well, that's it.
42:28It's happening every day.
42:29So, I would like to check your blood pressure again.
42:38Are you going your way or are you here?
42:40No, I'm here.
42:40You're here?
42:41I'm here.
42:42What I'm going to do is book you in in two weeks' time with me and Sam, if she's around.
42:49Yes.
42:50And just do a couple more blood tests.
42:52Aye.
42:53Check your blood pressure.
42:54Yeah, we'll just send it to the phone and on.
42:56Yeah, okay.
42:57I'll send it.
42:58Nice to see you anyway.
43:00And you.
43:00Yeah.
43:01It's not like coming to the doctor's, is it, when I come to see you?
43:05It's just to see Tim.
43:06Chuck.
43:07Yeah, take care.
43:08Brilliant.
43:08Yeah, all right.
43:09Take care.
43:09Cheers.
43:11Thank you very much, Dr. George.
43:13Take care.
43:14All the best to you.
43:15Bye now.
43:16Bye now.
43:17Thank you very much.
43:18See you.
43:19Bye.
43:21Bye, Emily.
43:22I'll see you next week.
43:28I'll see you next week.
43:58You've had a few of those falls recently.
44:23Oh, I've had five of them.
44:25It always happens where you can't get up because there's nothing to hold on to.
44:29Oh, gosh.
44:30From your, like, perspective, would you think I have ADHD?
44:33It's a spectrum, isn't it?
44:35We're probably all on one part of the spectrum.
44:36He just woke up one morning and wasn't all there.
44:41Look, what's the difference?
44:44You know what?
44:44Oh, God.
44:45All right.
44:50Hey, boy.
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