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02:15No, no, no, no, no, no.
02:45No, no, no, no, no, no.
03:15No, no, no, no, no, no, no, no, no.
03:17No, no, no, no, no, no.
03:19No, no, no.
03:21No, no, no, no.
03:23No, no, no, no.
03:25Okay.
03:26Perfect.
03:27Yeah.
03:27Here we go.
03:27Any questions at all?
03:29That's it.
03:29Thank you very much.
03:30Yeah.
03:30Good.
03:30Okay.
03:30All right.
03:31Awesome.
03:31Thank you very much.
03:32Thank you.
03:32No, no, no.
03:32You're very welcome.
03:33Take care.
03:33Thank you very much.
03:41Right.
03:42So, you're here for your smear test.
03:43Yes.
03:44They've been trying to do it for about a year because I'm overdue.
03:47Okay.
03:48But every time they try and do it, they can't do it because I've been examined because I was
03:52on this pre-cancer pathway for a while.
03:54Okay.
03:55Okay.
03:56So, you're due.
03:56So, you've had some abnormal smears before?
04:00Not for a while.
04:01Okay.
04:01I think they've been okay for a while, but I'm, is it every five years?
04:06Yeah.
04:06That's right.
04:06Yeah.
04:06I'm not overdue the five-year one.
04:08So, we are a little, not long, we've had worse, but you are, we were due it.
04:13For me, I am.
04:13I'm usually really efficient about these things.
04:15We'll do it now.
04:15We'll do it today and then we can get it done.
04:17Because I've got to have another ultrasound on Friday for the pre-cancer pathway.
04:21Okay.
04:21So, I just thought I can't leave it.
04:23And tell me, what's happening on that pathway?
04:24It was a suspected cancer pathway.
04:27Every investigation they tried to do was unsuccessful, so they took me in to give me a hysteroscopy.
04:31And they didn't do the smear there and then or anything in the hospital?
04:34Um, not that we know of.
04:36Not that we know of.
04:37I mean, sometimes they do, but they would have told us it had we done it.
04:40They said it looked normal.
04:42They have said.
04:43The good news is that they're not overly worried and that they've discharged you off the cancer pathway.
04:50Great.
04:50As in, they don't think it's cancer.
04:52Great.
04:52So, I think that's one good news.
04:53Great, great.
04:54But they still want to see you and follow up and deal with things because they need to find out what's happening.
04:57Suddenly, I got another ultrasound and I thought, oh no.
05:00And I think it was, and we referred you, was it because of the wound lining?
05:04Well, I kept bleeding.
05:05Yeah.
05:06But I just decided to stop taking the HRT because I think that was causing the problem.
05:11Okay.
05:12Right, let's hop up.
05:13Would you like a chaperone?
05:14No, I'm fine.
05:15Someone else in the room just to be here.
05:16No, no, no.
05:16It's fine.
05:17No, you're all right.
05:18Sorry.
05:18Come on, have a seat.
05:19Let me close this.
05:19So, I've put that there and you can put that across your middle.
05:22So, if you've got a dress on, it's probably just as easy to either just hitch it up a little bit or whatever.
05:27Take off from the waist down and then we all can get the bits ready.
05:31Okay.
05:31Are you ready?
05:32Yes, yes, yes.
05:32I think when you have bleeding, sweetheart, and you're sort of what we call post-menopausal and we have some bleeding,
05:37then we've got to think, well, why?
05:39Yeah.
05:39And therefore, we've got to go down the route where we start looking into it because then we can work out what it is.
05:43Exactly, exactly.
05:44So, it's really important.
05:46So, it's great to get the all clear, but then we must make sure it stays the all clear and then we can see.
05:49So, you just be as comfortable as you can.
05:52You'll feel a little bit of cushioning.
05:53I'm sorry it's a bit cold.
05:54It's okay.
05:55There we go.
05:56I'm sorry, sweetheart.
05:57It's okay.
05:58You all right?
05:59Yeah.
06:00Okay.
06:00There we go.
06:01It's okay.
06:02I did loads of squats at the gym this morning.
06:04They were hurting.
06:04They were hurting more than this will hurt.
06:07Right, let me knock those off.
06:08Let me get you some tissue, sweetheart.
06:11Job done.
06:11Well, there we go.
06:12You can tick that one off your list.
06:15The results will come back to Emily and she will then contact you and let you know the results.
06:19Okay.
06:20And as you know, it will most of the time comes back normal, but sometimes if they're not 100%
06:26happy, they come back to us and very occasionally, we have to repeat it, hopefully not.
06:30Yeah.
06:31Very occasionally, they have to see you in that colposcopy clinic where they want to have
06:34a little closer look at it.
06:35Yeah.
06:36But they test it all on there.
06:37Yeah.
06:37And as you said, it's been normal a few times recently, so fingers crossed.
06:40Yeah.
06:40It'll be all right.
06:41Thank you very much.
06:42Thanks, Elizabeth.
06:42Good luck with your scan then on Friday.
06:45Thank you.
06:45And nice to see you as always.
06:47Thank you.
06:47Thank you.
06:48Take care.
06:48All the best.
06:49Bye-bye, Stratt.
06:49Bye-bye.
06:49Door open or closed?
06:50Leave it open.
06:51That's fine.
06:52Thank you.
06:52Thank you.
06:56Simon, please.
06:57Hello.
07:04Good morning.
07:06How are you?
07:07Er, slightly sore.
07:09Oh, sorry to hear that.
07:10Come to take a seat.
07:12Good to see you.
07:13How can I help today?
07:16Um, what it is, I've got, um, I'm having a lot of trouble with my back.
07:22Okay.
07:22Uh, because I've got osteoarthritis in the spine anyway.
07:24Mm-hmm.
07:26I'm not sleeping very well.
07:27Um, sometimes if I lay on my back or I turn my sides, I get a sharp pain down my back.
07:33Mm-hmm.
07:34And the top of my leg's going numb.
07:35Mm-hmm.
07:36It's gone for about half an hour and I don't know what the problem is.
07:38It's been something quite regularly.
07:40Mm-hmm.
07:41How long has the pain been as bad as this for, would you say, roughly?
07:44Every three days I get excruciating pain and I've got a trap nervous or something like that.
07:48Yeah, absolutely.
07:49Sounds like potentially.
07:50Quite frustrating.
07:51I'm trying to get up in the morning and I can't get up because my leg's numb.
07:54Yeah.
07:54And every time I try and stand on it, I'm having trouble.
07:57Always on the left side?
07:58It's always on the left side, yeah.
07:59Any injuries or trauma recently that might have set it off or made it worse?
08:03Um, well, not since I was hit by the e-scooter, no.
08:05Yeah.
08:06It's getting worse and worse than when I was wearing a tear or...
08:08Yeah.
08:08Also, someone helped me sleep at night with the amitripline because I haven't got any left.
08:14Is the amitripline helping a bit?
08:15Yeah, it helps.
08:16Helps a bit.
08:16Yeah, you're on two tablets of those, 20 milligrams, yeah.
08:20So there is scope for that to go up a little bit if needed.
08:23Yeah, I could do it.
08:23We can always consider that.
08:25How else is it affecting your life at the moment?
08:27Are you used to get out and about?
08:29Well, I get out and about, I mean, I play long green balls, but it's got to the stage
08:32where I can't wind this down as far to roll the ball anymore, so it's difficult.
08:38Yeah.
08:39Trying to have a life.
08:42Francesca?
09:06Hi.
09:07Hi.
09:10Hi.
09:11How are you?
09:13I'm good, thank you.
09:14Come and take a seat.
09:15I'm pregnant again.
09:16How are you?
09:17Oh, I'm so hot.
09:19Oh, I bet you are.
09:20How many weeks are you now?
09:22I'll be 32 on Friday.
09:25Oh, exciting.
09:26I know.
09:26How's it been second time around?
09:28It's, I would say, very different.
09:31Yeah.
09:31Like, I felt I'm way bigger than I was.
09:35Yeah.
09:35And just, yeah, it's just hard with a toddler.
09:39Yeah.
09:39So Wilbur turned two a couple of weeks ago.
09:42So he's, like, really in the, you know, toddler tantrum phase.
09:46And very active, I bet, climbing up everything.
09:48Oh, my God.
09:49It's really hard.
09:50And when you look back at when you were pregnant the first time, you think, oh, that was actually
09:55fine.
09:56Absolutely.
09:56Yeah, absolutely.
09:57When you're looking after another one.
09:58Yeah.
09:59But, yeah.
10:00So we're going to do RSV today.
10:03And the whoop and cough vaccination.
10:05Perfect.
10:05Did you have RSV for your last one?
10:07No, I don't think it was around with Wilbur.
10:09Yeah.
10:09So RSV is a respiratory virus that is responsible for sort of common colds and coughs.
10:14Yeah.
10:15However, it can lead on to pneumonia and bronchiolitis.
10:18Okay.
10:19Which is, you know, particularly bad for babies.
10:22And then the whoop and cough is exactly the same as the one that you had before.
10:26I think I had that with Wilbur.
10:27Exactly.
10:27So protecting them for their eight weeks, first eight weeks of life before they have their
10:32eight-week vaccinations.
10:33Perfect.
10:34It's very unlikely to get side effects from these.
10:36Other than sore arms.
10:39Oh, do them both today if you're happy with that.
10:40Yeah, fine.
10:41Sore arms.
10:42It might be a little bit red, a little bit achy.
10:45That should subside within a day or two.
10:47Yeah.
10:48There is always a chance with all vaccinations that you might get sort of mild flu-like symptoms,
10:52a bit of an achy body, whatnot.
10:54But with these two, it is unlikely.
10:56However, if you're worried about anything, just let me know.
10:58Okay, perfect.
10:59Are you feeling well today, other than hot and pregnant?
11:02Yeah, no, I'm feeling fine.
11:04Perfect, perfect.
11:05And remind me, you don't have any allergies, do you?
11:07No, I don't, no.
11:09Lovely.
11:10Oh, it's very exciting.
11:12Yeah.
11:13Very exciting.
11:13Okay, so we will do the RSV in your left arm.
11:20So we'll start with this side, if that's okay?
11:22Sure.
11:22So just relax your arm for me, relax it down just like that, relax from your shoulder.
11:27All right, sharp scratch.
11:34That's one done.
11:40Okay, sharp scratch.
11:43So next time I see you, we'll be for the vaccination.
11:53That's crazy, isn't it?
11:55But if you need anything, though, in a long time, just let me know.
11:59But yeah, so much luck with everything.
12:01Thank you so much.
12:02So nice to see you.
12:03Yes, I'll be to you too.
12:04Thank you.
12:05Take care.
12:05Bye.
12:06Bye.
12:06Bye.
12:06Would it be okay today just to examine you?
12:14Is that all right?
12:15Yeah, sure.
12:15So whenever you're ready, if you stand up for me, I'm just going to press down the spine.
12:20So you can see how there is a bit of asymmetry there.
12:24So, you know, this shoulder is a bit lower than this one because you're compensating because
12:27you're in so much pain.
12:28Oh, yeah.
12:28That's very common to see that.
12:30A bit tender there, so a bit of spinal tenderness.
12:36I agree, sort of around L2, L3, L4.
12:39Ah.
12:40Sorry.
12:42Sorry.
12:43Are you able to bend forward for me?
12:45Stop when it's painful, so only go as far as you can.
12:47Yeah, I can bend forward, yeah.
12:48Yeah, so it's fine, stop.
12:50And then if you bend back for me, yeah.
12:52So it's a very limited range of motion, isn't it?
12:54Yeah.
12:55If you slide one arm down, one leg.
12:57Yeah, and the other side for me.
12:59Yeah, very, very limited.
13:00We need to get that back really sort of mobilised and moving around.
13:04Back pain can be really debilitating.
13:06It can lead to a lot of sick days, a lot of time off work, and can cost the economy, you
13:11know, millions a year.
13:12So it's really important to manage it as best as we possibly can.
13:17And prevention is obviously far better than cure.
13:19So having good posture, strengthening core muscles, making sure that we're exercising
13:23in a safe way and are looking after our bodies is really, really important.
13:27Can I get you on the couch?
13:29Would that be okay?
13:29Yeah, sure.
13:31In Simon's case, clearly the pain was having a very big impact on his quality of life,
13:35on his abilities to sleep, etc.
13:36If the pain is a bit more complex, if there's pain radiating into the buttocks or into the
13:41legs with potential nerve involvement, that then might mean that we refer patients for more
13:46specialist intervention at times.
13:47A lot of the time we can still manage that in the community as well, but really understanding
13:52the impact the patient's pain is having on them is very important, and that helps us
13:57to determine whether we need to seek specialist intervention or not.
14:00How's that?
14:04Painful.
14:06Oh, I'm sorry.
14:07I'm just going to lift this leg up.
14:11Is that okay?
14:16Tender.
14:17Ouch.
14:18Yeah.
14:18Oh, bless you.
14:19Sorry.
14:20Lift this leg up.
14:21Push me up.
14:22Good.
14:22Push me down.
14:23Good.
14:23Push me up with this one.
14:25Push me down.
14:26Good.
14:26Ay, ay, ay, ay.
14:27It's gone down now.
14:27Really sore.
14:28It's gone down.
14:29I'm sorry.
14:29It's all right.
14:30Does it help to rub it or anything, no?
14:32I should leave it a couple of minutes.
14:33I do rub it, but...
14:34Yeah.
14:36Sorry.
14:38Whenever you're ready, you can come back round.
14:40Take your time.
14:41Do you need a hand?
14:42Oh.
14:45Yeah, one of the main problems is, like, when I'm in the lying bed, because I lie on the
14:49left, is getting myself up and having to sit on the bed for a while.
14:53Yeah, just to get used to it and get a saucer.
14:57Just take a good seat there.
14:59Okay.
15:01What I think we should do is a few things.
15:03We can increase the amitriptyline, if you like, just for a few nights to see how you
15:08get on with it.
15:08You can definitely go up to three quite easily.
15:11If you want a little bit of cocodomol or something like that, just to, you know, for
15:15those paroxysms of pain when it's really, really bad, you can take a couple of cocodomol.
15:20Not a problem at all to do that.
15:21And then I think we should refer you to the musculoskeletal team, just to see if there's
15:25anything else that needs to be done.
15:28Things to look out for.
15:29If there's any complete loss of sensation between the legs, if the pain's getting worse,
15:34if there's any loss of balance, that kind of stuff.
15:36Just let us know as well.
15:38All right.
15:38We'll see how you go.
15:40Okay.
15:40And we'll take it from there.
15:41Okay.
15:41All right.
15:42I'll send the prescription to the pharmacy for you.
15:44Okay.
15:44Thank you very much.
15:44Thank you.
15:45Take care.
15:51Santiago?
15:53Yep.
15:53Ready?
15:57Hiya.
15:58How are you doing?
15:58Good.
15:59You?
15:59I'm fine.
16:01Okay.
16:02I'm Sam.
16:03So I'm going to do your diabetes check today.
16:05So I'm going to do your bloods, give you a urine test, check your feet.
16:09Do you know how much you weigh?
16:1180 kilograms, maybe.
16:13Do you smoke?
16:15Nope.
16:16I mean, not regularly.
16:18Social?
16:18Yeah.
16:19Do you drink alcohol then?
16:21Yeah.
16:21Yeah?
16:22Santiago is a young, healthy, active guy who came in for his annual diabetic health check.
16:29Santiago has type 1 diabetes.
16:32Type 1 diabetes is your body doesn't produce insulin.
16:35It's an autoimmune condition.
16:38It's classed as a chronic condition.
16:40So on average, how much do you drink a week?
16:42No, like maybe two, three pints.
16:46Big?
16:46Like after a football match, yeah.
16:48Do you play football?
16:48Yeah.
16:49Are you good?
16:51I mean, you should ask that to my friends.
16:53But I think I'm different than myself.
16:55I think they would say yes.
16:58You're decent.
16:59Who do you support?
17:00Who do I support?
17:01You've got to be very careful now.
17:04Wrong choice.
17:05Who do you support?
17:07Chelsea?
17:08Yes.
17:08Oh, okay.
17:09Well, I suppose if you're in Fulham.
17:11If you're in Chelsea or Fulham.
17:13I've arrived quite like early or a few years ago here.
17:16Where were you from?
17:18I'm from Argentina.
17:19Do your family live in Argentina?
17:21Yeah.
17:21You can relax.
17:23Sharp scratch.
17:25Do they come here at all?
17:27They came once.
17:29I also went back like twice since I moved.
17:33Okay.
17:34Pop your finger on there for me nice and hard.
17:37So do you play any other sport?
17:39So I'm trying to get into golf, but I'm not doing good.
17:45My dad's always, he says he's at the office,
17:47which means he's in the golf course, but he's rubbish.
17:50He still goes.
17:52And then you do the one.
18:14I can lose my arms in it.
18:19Right, so I need to like some more blue dresses, yeah?
18:21Same.
18:22He's got pockets.
18:23When she's heavily pregnant.
18:24He's got pockets.
18:25Yeah, he's got pockets.
18:26Heavily pregnant.
18:27Every day, Mona.
18:28Yeah.
18:32Choose our feet up.
18:33Okay.
18:34Don't, don't get surprised with my, how do you call this?
18:38The fungal.
18:39Is it fungal now?
18:40Here?
18:41Here?
18:42Yeah, yeah.
18:43So next time you cut your toes.
18:44Yeah.
18:45I want you to cut them and put the nails in here.
18:49Okay.
18:50Bring it in for me.
18:51Okay.
18:52But this looks like classic fungal toenail.
18:54Okay.
18:55Right, close your eyes, no treating.
18:57When you feel it, say yes.
18:59Yes.
19:00Yes.
19:01Yes.
19:02Yes.
19:03Yes.
19:04Yes.
19:05Yes.
19:06Yes.
19:07Yes.
19:08Yes.
19:09Yes.
19:10Yes.
19:11Yes.
19:12During an annual health check, we do a foot check, where we check for any signs of infection,
19:21and we also use a monofilament device, which checks for loss of sensation or auto sensation
19:28to the feet.
19:29We check to make sure there's no open ulcers, no wounds.
19:34And make sure that you've got feeling, because if not, then we can action it.
19:41So it's really important to attend your annual diabetes check.
19:46You've got some hard skin to the bottom of your feet.
19:51So when you're in bed at night, if you put some moisturizer on the bottom of your feet.
19:57Okay.
19:58Rub it into your feet, both feet, and then put cotton socks on.
20:03Okay.
20:04That's great.
20:05You've done liver, kidney, fibres, cholesterol, diabetes, iron, the whole lot.
20:09Amazing.
20:10Okay?
20:11Okay.
20:12Sam, I appreciate.
20:13You're welcome.
20:14Take care, Sam.
20:15Have a good weekend.
20:16Best wishes for Chelsea next season.
20:17Best wishes for Philip.
20:18A lot.
20:19Bye.
20:20Bye-bye.
20:28Come on in.
20:30Take a seat.
20:31My name is Anna McHugh.
20:32I'm one of the doctors.
20:33So what's been going on?
20:34I originally just wanted to get bloods done because I'm back home in Australia.
20:40I usually have an iron infusion, but I've noticed that it's not a normal practice here
20:44to do iron infusions.
20:45Yeah.
20:46So I think it's worth just getting my bloods done anyway, but I've just been like absolutely
20:51exhausted all the time.
20:53I've got a lump on my armpit that's been growing for like a year and a half.
20:56Okay.
20:57We'll definitely take a look at that.
20:58Yeah, that's good.
20:59Definitely good to know.
21:00Yeah.
21:01When did you notice on this occasion that you were feeling a little bit more tired than usual?
21:07Honestly, it's been the last maybe couple of months.
21:11Okay.
21:12And it's just progressively getting worse.
21:13I'm really struggling to just get through a work day.
21:15Okay.
21:16Yeah.
21:17Yeah.
21:18Tell me a little bit more about the lump.
21:19So is it multiple lumps?
21:20I'll have, I'll examine you in a moment.
21:22It's just one here.
21:23Okay.
21:24Anywhere else?
21:25No, it's just this one.
21:26I noticed it maybe last, last February.
21:29Okay.
21:30And has it changed?
21:31It's getting bigger.
21:32Okay.
21:33And it's, it's becoming sore.
21:35Like even if I'm just like resting, it's like this achy pain.
21:38And is it ever red, hot or anything?
21:40No, not that I've noticed.
21:41Okay.
21:42And any lumps or bumps anywhere else?
21:44Not that I've noticed.
21:45Okay.
21:46Okay.
21:47My Nan actually died of breast cancer, so.
21:49Yeah.
21:50Yeah.
21:51And is there anyone else in the family with?
21:52Well, my mum passed away from melanoma, so.
21:54Okay.
21:55I'm sorry.
21:56Cancer's just running right from the females in my family, unfortunately.
21:58Yeah.
21:59I'm sorry to hear that.
22:00No, it's okay.
22:16Good luck with the veins, so.
22:19Okay.
22:20Like a challenge.
22:22Do you have a good vein?
22:23I doubt it.
22:25Sorry.
22:26Perhaps my blood is solidifying.
22:30Okay, so I'm just pressing along the veins in the back of the leg.
22:33What, you think it might be deep vein flumbus or something awful?
22:36Because you've had varicose veins for a long, long, long, long time.
22:39Yeah.
22:40But the pressure's built up, so now we've got the sort of discoloration which isn't going to go away.
22:44Because he did offer to sort out the varicose veins still as well.
22:47They're painful.
22:48They throb.
22:49They're sensitive to the sun.
22:50It's quite bad, actually.
22:51Who did?
22:56Edward?
22:57Oh.
22:58Hello.
22:59Hold on.
23:00I've got to remember the script.
23:01Oh.
23:04Come in.
23:05Come in, have a seat.
23:06I'm Megan.
23:07How are you?
23:08Oh, I'm, well.
23:09A number of years ago, I had trouble with varicose veins.
23:12They took one out.
23:13Okay.
23:14Doctor said, do you want to see?
23:15I said, not plenty likely, you know.
23:17What I saw the pharmacist today about was, should I get a pair?
23:21They go right up, up.
23:23Oh, what stockings?
23:24Like compression stockings?
23:25Oh sorry, DVT stockings, yeah.
23:26Yeah.
23:27And I said to the pharmacist, well, are the knee ones okay?
23:31Hmm.
23:32Or can I get one up the thigh?
23:34Is the main concern here about the stockings, or have you had any other symptoms?
23:38Have you had any swelling, any pain along the veins?
23:42Not really.
23:43Even though you had a bit of a pain, but nothing more than the twins.
23:47But I'm just worried that I don't want to get any worse, you know.
23:49Yeah, yeah.
23:50Can I have a feel?
23:51Is that right?
23:52Yeah, yeah.
23:53Have a feel of your path.
23:54I've just had a shower, you're safe.
23:55Just clean my hands, you're safe as well.
23:58Warm hands, there you go.
23:59Any pain when I press along the vein?
24:02No, no.
24:03It's the size of these nodules things.
24:04Any pain along here?
24:06Oh, up here sometimes, but not much.
24:08Did they ever get red or hot?
24:10Not really.
24:11These look like almost bruises, or a bit of blood where it's popped slightly.
24:15Oh, right.
24:16Because I can touch them, it feels different to the vein.
24:19Ah.
24:20You can get something called phlobitis, which is to do with inflammation in the varicose veins,
24:25and it can be quite uncomfortable and hot to touch, and painful.
24:29Now, you haven't got any of that which is good, but people worry about DVTs.
24:34Yeah, yeah, yeah, yeah.
24:35Yeah.
24:36I mean, have you had any recent long-haul flights?
24:39I fly to Australia every year.
24:41Yeah, when did you last fly?
24:42I flew back in January.
24:43In January.
24:44Okay, so it's not relatively recent, that's six months ago.
24:47No, okay.
24:48Often, for a lot of people who travel on long-haul flights, they can buy compression stockings
24:53over the counter.
24:54For this guy, he had some varicose veins.
24:56Quite significant, leading all the way up to his groin.
24:59With his frequent trips abroad, his age, and the varicose veins, it puts him at a slightly
25:05higher risk of getting a DVT.
25:08Because before we would consider, like, compression stockings, really what you should have is a Doppler.
25:17It involves, there's two ways you can do it.
25:19One way is they put two blood pressure cuffs on each, like, one on each leg and one on the arm.
25:22Right.
25:23You lay flat for about 20 minutes, and they measure your venous return.
25:28Oh, right.
25:29And they measure to see if there's any, what we call, atherosclerosis in the arteries.
25:33Yeah, yeah.
25:34So, like, plat build-up.
25:35I don't think they did, well, I can't remember, so long ago now.
25:38No, but what we don't want to do is, if you've got a big build-up, it's giving you lots of compression,
25:44and then there's an issue of you having problems with, like, venous supply getting, blood supply getting to the legs.
25:49Yeah, yeah.
25:50That's all right.
25:51That's all right.
25:52Your feet, are they often purple?
25:54Yes.
25:55Yeah.
25:56Okay.
25:57I think you'd benefit from a Doppler to check how your venous supply is.
26:01Okay.
26:02No, she tells me.
26:04So, I'll get that sorted for you.
26:07One of the things that concerned me about this patient was that his feet were purple.
26:12This suggested to me that he probably had some venous insufficiency,
26:16which means that his vein system isn't working properly, so then he's getting pooling and discolouration.
26:21I keep walking everywhere.
26:22You're walking everywhere.
26:23Can you feel your toes okay then?
26:25Yeah.
26:26Continue doing what you're doing, because that's fantastic.
26:28And like I said, if it starts to get painful along the vein, like, hot to touch, painful when you're touching it, let us know.
26:34But if it's more deep in the calf, then I'll be a bit more concerned.
26:39Yeah.
26:40Okay.
26:41But I'll get those all sorts of things.
26:42Look after yourself.
26:43I'll have a look at referring you on to get a Doppler.
26:47Yeah.
26:48Okay.
26:49To make sure your blood supply is all good.
26:51Yeah.
26:52I see my legs coming apart.
26:54Oh, my God.
26:55Thanks again.
26:56Look after yourself.
26:57Bye.
26:58Leave the door open?
26:59Oh, yeah.
27:00Leave it open, yeah.
27:01Take care of yourself.
27:02I will.
27:03I will.
27:04Leave your mouth open.
27:06At night time, would you notice any kind of drenching night sweats where you would have to change the sheets or the pyjamas or anything?
27:12No.
27:13No, no, no.
27:14Nothing like that.
27:15Have you noticed any change in your bowel habit?
27:17No.
27:18No, not really.
27:19Any blood in the poo, black tarry steels, anything like that?
27:21No.
27:22I mean, there was a few months ago.
27:25Well, I noticed it and I was like, I didn't, and it just sort of passed.
27:28But...
27:29Can you describe that a little bit more?
27:30Was it red when you're wiping or...?
27:32Yeah.
27:33Well, both.
27:34And then, like, it was, you could see that there was blood in the stool.
27:37Oh, for sure.
27:38Yeah.
27:39And was it painful to pass the poo?
27:40Um, not, like, stomach-wise, no.
27:43I didn't really know what to think of it, so I just, I was like, something might pass through it.
27:47Okay.
27:48I don't know.
27:49Okay, that's definitely good to know as well, though.
27:50Is it okay if I examine your tummy and I have a feel of that lump under your armpit?
27:53Yep.
27:54Yep.
27:55No worries.
27:56Oh.
27:58And if you just pop the top up?
27:59Yep.
28:00Perfect.
28:01Now my hands are freezing.
28:02That's okay.
28:03Just let me know if you have any discomfort.
28:04Nice.
28:10Any pain there when I press it?
28:11Uh, not really.
28:12I've been there.
28:14Just a little bit.
28:15Yeah.
28:16Okay.
28:17And you can sit up for me.
28:19Now, I'm gonna feel the lymph nodes in the neck, okay?
28:22Yeah, they have been swollen when I've been getting sick, like, really big.
28:26Yeah.
28:27But...
28:33Okay.
28:34Can you put your hand on my elbow?
28:35Mm-hmm.
28:36And I'm just gonna feel under the armpit.
28:37Mm-hmm.
28:38Can you point to where you can feel?
28:42Mm-hmm.
28:43Okay.
28:44And relax again.
28:46Okay.
28:47And you can sit back down for me.
28:50So, the tummy's nice and soft.
28:59I can feel what you're feeling under the armpit.
29:02Have you noticed any lumps or bumps in the breasts at all?
29:05I had...
29:06I've...
29:07I had a biopsy in my left breast for...
29:10I had fibrodinomas.
29:11Okay.
29:12And that was maybe, like, 20...
29:1521.
29:16Okay.
29:17Yeah.
29:18And since then, are you good at checking your breasts for any lumps?
29:21I've got breast implants.
29:22It's really hard.
29:23Okay.
29:24But nothing that you've...
29:25Not that I've noticed.
29:26That you've noticed.
29:27Yeah.
29:28Okay.
29:29It doesn't put you at any higher risk of having breast cancer.
29:32And there's no particular special or different way where you should be checking your breasts
29:36if you do have implants.
29:38I think, you know, generally knowing what's normal for you.
29:41So, looking for any asymmetry, pain, skin changes or puckering or nipple discharge.
29:47And, obviously, relating to this case, lumps under the armpits.
29:51And those are all things where you absolutely should go to your GP to check.
29:55So, what I might do is bring you back in at another point just to have a full examination of the breasts.
30:00Sure.
30:01Because sometimes when we have a lump under the armpit, we just want to make sure that there's nothing else going on.
30:07And we can send you through to the breast team in that context.
30:12Okay.
30:13And then, with regards to the tiredness, there are a few blood tests that I'm thinking that we should do definitely.
30:21So, I want to look at your iron stores to make sure that you're not anemic.
30:25I also will do a celiac screen as well to see if there's an underlying cause for having had low iron in the past.
30:31And things like thyroid function as well.
30:33Yeah.
30:34Is that okay?
30:35Does that make sense?
30:36It may well be that we then send a referral off to the breast team just to double check.
30:41Sure.
30:42Because a lump under the armpit, we just need to fully examine.
30:45Yeah.
30:46Does the same time next Thursday work for you?
30:49Yeah, it should be fine.
30:51So, we'll do blood tests and then I'll examine you next week and more than likely send you to the breast team just to make sure that we're covering all our bases.
30:59Okay.
31:00Okay.
31:01Any questions for me?
31:02No, that's all.
31:03Thank you so much.
31:04You too.
31:05Do you mind if I park this in here?
31:12Yeah.
31:13There we go.
31:14Okay.
31:15Ready?
31:17How's it going?
31:18How's this young lady?
31:19She's all right.
31:20She's all right.
31:21A few complaints.
31:22Yeah.
31:23Yeah.
31:24Have a seat.
31:25Thank you.
31:26You want to stand or sit, Maya?
31:27Yeah.
31:28Sit on Danny's knee.
31:29Yeah.
31:30No.
31:31Stand or sit?
31:32Come up?
31:33Okay.
31:34She's been complaining from about since maybe Friday night when she's peeing that it hurts.
31:39Okay.
31:40Yeah.
31:41Her pee is quite strong smelling as well.
31:42Yeah.
31:43Yeah.
31:44Okay.
31:45So that's been going on now since.
31:46Any temperatures?
31:47Does she feel hot?
31:48No.
31:49No.
31:50And it's also during the night as well where it's the most strongest for her.
31:53Yeah.
31:54She wakes up at maybe two or three o'clock in the morning and complains.
31:56So she's out of nappies at night, blah, blah, blah.
31:58She doesn't wear a nappy at night.
31:59She does wear a nappy at night.
32:00Yeah.
32:01Yeah.
32:02But she says it hurts.
32:03Yeah.
32:04And then she does, you know, the typical crossing of her.
32:06Yeah.
32:07Yeah.
32:08So it's important that we get a urine test before we start treatment.
32:12Okay.
32:13Okay.
32:14If she's unwell, we'd say put her on sort of a general antibiotic.
32:17Amoxicillin is the usual children's one.
32:19Okay.
32:20But the result then may show that it's a different antibiotic.
32:23It might be better.
32:24Okay.
32:25How easy what do you...
32:26Yeah.
32:27This is the next question.
32:28Yeah.
32:29How easy.
32:30How easy am I going to go?
32:31Yeah.
32:32No worries.
32:33Yeah.
32:34Mi amor.
32:36Mi amor.
32:37The other option is cotton wool.
32:39You know, put it down there and then when she's gone you just squeeze it out into this.
32:42Okay.
32:43Right thing, but we keep you all the same here.
32:45Just put a label on it for me.
32:48We're going to put your pee pee in there.
32:51And then someone's going to look at it and tell me if you have something wrong.
32:56Yeah?
32:57Yeah.
32:58Do you want to choose a sticker?
33:01Oh, you want a sticker on my hair?
33:02Which one?
33:03What do you want?
33:04We've got shark, starfish, turtle, octopus.
33:07Which one do you want?
33:08You choose.
33:09You want the octopus?
33:10I was in a jellyfish, Daddy.
33:12Oh, sorry, jellyfish.
33:13Sorry, not there.
33:14Yeah, don't look my nose, mate.
33:15You want that one?
33:16You want to put it on your...
33:17You want to put it on your...
33:18Yeah!
33:19You can show all your friends in Becca's.
33:21Have you got a sticker?
33:22Daddy gets these to go.
33:24Yay!
33:25Party bags.
33:26Okay.
33:27There you go.
33:28Thank you.
33:29Well, can many problems give us a call?
33:30Yes.
33:31And if I see the urine test back early, I'll give you a call.
33:34Okay, thanks.
33:35Thank you for coming.
33:36Bye.
33:37Bye.
33:38Do I get a wave?
33:39Bye, thanks for coming.
33:40See you.
33:41If I eat anything in the morning, I immediately feel bloated and full.
33:50And if you sort of pass wind and things, does that help?
33:52I'm not able to very much, but I don't usually anyway.
33:55Do you feel like now bloated a little bit with more wind?
33:59Um...
34:00Yeah, maybe.
34:01A little bit.
34:02Okay.
34:03Does the pain improve after a bowel movement or passing wind?
34:05I feel like I really need to go.
34:06Yeah.
34:08What's your pain?
34:13Do you think it's because you had the latte?
34:14Why would you just be cramping up?
34:16Because you've mixed the milk and the chips and then the sweets.
34:22Maria?
34:23Hello.
34:25Come on in.
34:26How are you?
34:27Not good.
34:28Not good.
34:29Oh dear.
34:30That's why I'm crawling in again.
34:31That's all right.
34:32Pleased to see you.
34:33We're in here today.
34:35That's why I'm crawling in again.
34:36Yeah.
34:37So what's happened?
34:38You know, last week I had terrible diarrhea first.
34:42Okay.
34:43And then total conspiration.
34:45Bloated like this on Sunday, nothing.
34:47Okay.
34:48So I went to Chelsea in Westminster.
34:51So he was rather a thing.
34:53This is all painful.
34:55Okay.
34:56You couldn't feel a blockage.
34:57Okay.
34:58So he took my blood.
34:59Okay.
35:00And sent me home.
35:01Now it's again, it's constant pains here.
35:04Okay.
35:05It's like this.
35:06I sent you a copy of those, what I could copy from the test from the hospital.
35:11Yeah.
35:12Yeah.
35:13It looks like my liver and kidney is something.
35:15Because we've had sort of tummy upset and problems for quite a while, haven't we?
35:18Yeah.
35:19And we sent you to the sort of the urgent clinic to try and get them to find out what it was,
35:23didn't we?
35:24Yeah.
35:25Didn't she run tests?
35:26She did a lot of tests and they put cameras in and everything, didn't they?
35:29Yes.
35:30And nothing.
35:31Yeah.
35:32And then the other day when I was pooping, it looked like blood.
35:34I'm just thinking of having a whole body scan maybe.
35:37Well, you pretty much got a whole body scan before, didn't they?
35:40Yes.
35:41Just a few weeks ago.
35:42So they did a whole CT, what they call thorax, abdomen, pelvis.
35:45They did all of it from top to bottom.
35:47And here.
35:48From here all the way down.
35:49And here I am again.
35:50So they didn't find cancer or anything horrible, which is what we all worry about.
35:55And they've said that everything was fine, the heart, the lungs, they didn't find any swollen
36:00lymph nodes or glands.
36:01They said the liver, gallbladder, pancreas, spleen, adrenal glands, kidneys, bladder are all
36:08normal.
36:09Even bladder.
36:10Bladder, all normal.
36:11But they did say that you've got a condition, I don't know if you know about it, called diverticular
36:15disease.
36:16Our intestine sort of comes and it looks like this and it's nice and bobbly like
36:21that.
36:22And it comes down and out and we go to the loo.
36:25So that's what it should.
36:26But with diverticular disease, we end up with these little pockets that stick out and the
36:31poo comes up and round and out.
36:33It can get stuck in these and cause them to be inflamed and bloaty and sore and horrid.
36:39They said no other abnormality in the colon, nothing else in the pelvis, but you do have
36:44these and what I wonder happens is that some days might not be so bad, other days might
36:49be horrible.
36:50Yeah.
36:51Do you pass a lot of wind?
36:52Do you find you're quite windy?
36:53Well, sometimes I don't.
36:54I have to take something.
36:55Okay.
36:56To help it pass.
36:57Yes.
36:58And the problem is that that's what can happen here.
36:59The sort of gas can build up and then it's stuck and it can't go around.
37:02And if gas, if the walls get stretched to the colon, it's really uncomfortable and it
37:06can be really horrible.
37:07Why don't we start with just seeing if we can get something to help you with the one thing
37:12we know is going on which can cause the bloating and the horrible illness.
37:14Can we have a poop test?
37:15We can do a poop test and we can just check that there's nothing there.
37:18Yes, that there's no blood.
37:19Are you a warrior?
37:38Yes.
37:39Because I always think I'm going to die.
37:42And what do you think you're going to die of something horrible?
37:44Cancer or something?
37:45The problem is that we all worry about things and sometimes that worry just grows.
37:48Yeah.
37:49Doesn't it?
37:50I think it's getting a sort of, because I've had so many friends die.
37:54I know.
37:55I'm sure.
37:56That's frightening, isn't it?
37:57But that's my age.
37:58I mean, but that's the problem that that's going to keep on happening, isn't it?
38:02Yes.
38:03Instead of going forward.
38:04I mean, that's why I accept it.
38:05Yeah.
38:06But it's just sad.
38:07It is sad.
38:08Yeah.
38:09You know, I said, oh, can I go on holiday somewhere?
38:11Who'd you go with?
38:13Yeah.
38:14I used to always have one or two.
38:16And they're all sort of dropping off, are they, slowly?
38:18Yeah.
38:19And they're all dropping off.
38:20But that's okay.
38:21It's the problem being the fittest of a group, because then you're the one that's left standing,
38:24aren't you?
38:25Well, I'm about the only one left out of the lot that we started.
38:29What about making new friends and different things?
38:32I have lots of young friends.
38:36Anyone to go on holiday with?
38:38Well, I am.
38:39Good.
38:40I always do.
38:41Once a year, I force them.
38:42Good.
38:43I bet you don't force them very much.
38:44I'm sure if you suggest a holiday.
38:45Well, I'm trying to Zanzibar in September.
38:48Oh, my goodness me.
38:49That's amazing.
38:50You go to Zanzibar for longer, but 10 days, that's max.
38:53Because what, you get people to sort of dog-sit, do you?
38:55Yes, yes.
38:56And drives my partner crazy.
38:58He's 80, and on his own with the three of them.
39:02Can he not travel with you, or does he not really travel?
39:04No, he doesn't.
39:05He's autistic.
39:06He doesn't move.
39:07He sits in front of the computer all day long.
39:11It's very difficult.
39:13But we get on well.
39:14I've known him for 65 years.
39:16And are you married?
39:17Is he your partner?
39:18No, he's my partner.
39:19He was always my best friend.
39:21I got married to somebody else, and then got divorced, and went back now.
39:24But I've been 11 years now.
39:27Oh, okay.
39:28Well, that's right.
39:29We're the best of friends.
39:30We knew each other's families.
39:32We grew up in Harpenden.
39:33Oh, right.
39:34Oh, I know.
39:35So we knew each other.
39:36You know?
39:37It works.
39:38It works.
39:39He has somebody to talk to.
39:40I have somebody to talk to.
39:41Good.
39:42We all do our own thing.
39:43Yeah, yeah.
39:44I mean, they keep you all going.
39:45I mustn't complain.
39:46I'm a bit just of a neurotic, but this makes me feel better.
39:50Well, I'll tell you what.
39:51Let's do the test and see.
39:52But then we'll discuss the result when it comes, and then we can make a plan.
39:55Right.
39:56I'm going to give you the little sample pot.
39:57Let me get it from the girls at the front.
39:59Then we can get it sorted out.
40:00It's old age.
40:01You'll see.
40:02Another fit test, please.
40:03Bring it back any time.
40:04Thank you.
40:05Enjoy.
40:06All right.
40:07Take care.
40:08Bye-bye.
40:09What are you?
40:10Well, I'm all right.
40:11I mean, because I'm asked to come, not because I want to come.
40:14But you feel okay?
40:16Yeah.
40:17Yeah.
40:18I get on with it.
40:19Yeah.
40:20You know that.
40:21I know that.
40:22That's why I like seeing you, because you know me.
40:25So your sugar's okay.
40:27Your liver...
40:29It's still there.
40:30¿Es still there?
40:31Sí, es still there.
40:35¿Verdad a strolls good?
40:36¿Es it good?
40:37Sí.
40:37¿Qué es?
40:39¿Y yours es 4.4?
40:42¡Wonderful! ¿No es nada más de nada?
40:45¡There you go!
40:48I spend my life telling people to take statins,
40:51and it's great when it works.
40:53¡Well, I've been taking them for so many years!
40:55¡It's unbelievable!
40:56I started you on them.
40:58Because I'm on the same ones.
41:00I disperse of them.
41:02Yeah.
41:03But you feel okay.
41:05You don't have achy joints.
41:06Oh, I do have achy joints.
41:08But then, who doesn't?
41:08I'm 80 years old.
41:09What do you expect?
41:12I mean, even the bones here hurt.
41:14My collar bones hurt.
41:16Yeah.
41:17You know.
41:18Tell me about the bones and aches and pains and things.
41:22Tell me about them.
41:22Well, for instance, we went to the coast,
41:27and what should have been an hour and a half's journey,
41:29because half the bones were closed, did a detour,
41:31took us three hours.
41:33So, you know I've got a bad back.
41:36I've always had a bad back.
41:37So, when you get out of the car, after that.
41:39In the car.
41:40In the car.
41:40Why are you going?
41:41And my hips were hurting.
41:43Yeah, yeah.
41:43I can't wait to get out of the car.
41:46So, I mean, I'm used to back hurts, you know.
41:48It's all the time, isn't it?
41:50Yeah, yeah.
41:50Yeah, yeah.
41:50It's part of me.
41:52Mm.
41:52It's always the left knee.
41:54Yeah, yeah.
41:55Yeah, yeah.
41:55And usually the right hip, as I said, the other day,
42:00it was both hips.
42:02Mm-hmm.
42:03But then...
42:03Yeah.
42:05Hey.
42:05Yeah.
42:06Something's got to kill me.
42:08Well, your joints are not going to kill you,
42:10but we want to make it as joyful experiences
42:13going to the coast as possible.
42:15Sorry, too.
42:16I don't really want you in pain.
42:18Your blood pressure's a wee bit high as well.
42:21That's probably because I've been sitting out there
42:23and you're late.
42:25And I'm always early.
42:27Well, I'm not happy to just leave that blood pressure as well.
42:32Well, that's it.
42:33It's happening every day.
42:36So, I would like to check your blood pressure again.
42:43Are you going your way or are you here?
42:45No, I'm here.
42:45You're here?
42:46I'm here.
42:47What I'm going to do is book you in in two weeks' time
42:50with me and Sam, if she's around.
42:54Yes.
42:55We'll just do a couple more blood tests.
42:57Aye.
42:58Check your blood pressure.
42:59Yeah, we'll just send it to the phone and all.
43:01Yeah, OK, I'll send it.
43:03Nice to see you, anyway.
43:05And you.
43:05Yeah.
43:06It's not like coming to the doctors, is it,
43:09when I come to see you.
43:10It's just to see Tim.
43:11Chat.
43:12Yeah, take care.
43:13Brilliant.
43:13Yeah, all right, take care.
43:14Cheers.
43:16Thank you very much, Dr. George.
43:18Take care.
43:19All the best to you, Tim.
43:20Bye.
43:20Bye, no.
43:22Thank you very much.
43:23See you.
43:24Thank you.
43:24Bye-bye.
43:26Bye, Emily.
43:27I'll see you next week.
43:28Thank you.
43:29Bye.
43:30Bye.
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