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GPs- Behind Closed Doors (2013) Season 9 Episode 8
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Short filmTranscript
00:00Morning surgery.
00:07I've got a lump in my armpit that's been growing for like a year and a half.
00:15Yeah, yeah, yeah.
00:16Really soft.
00:17I'm sorry.
00:18Does it help to rub it or anything?
00:20I should leave it calm and it's hurt.
00:22I do rub it, but...
00:23Yeah.
00:24Sorry.
00:26Are you a warrior?
00:28Yes.
00:29Because I always think I'm going to die.
00:35When you feel it, say yes.
00:37Yes.
00:39Yes.
00:46Yellow liver.
00:48It's still there.
00:49It's still there.
00:50It's still there.
00:59It's still there.
01:00It's still there.
01:17Cool.
01:18uh henry please mike hello hey how are you good to see you again yeah likewise how are you doing
01:33i'm guessing not well otherwise you wouldn't be here i'm so sorry i just think it's getting a bit
01:37bigger isn't it i think it i think it probably got bigger like a couple days after i saw you
01:41and like it um it came to a head over the weekend and then on sunday morning as i was doing the hot
01:46compress like i noticed when i took it away there was like yellow stuff on it so then i assumed it
01:50popped but actually i don't think the swelling's gone down at all the pain's gone how's your vision
01:54at the moment is that okay it's actually still a bit blurry like i literally noticed it as i walked
01:58out of the house to come here any other symptoms fever nausea vomiting yeah i don't know how that
02:02going off next good so you feel otherwise well i'm just going to lift the eyelid and pull the eyelid
02:09up a little bit i just want to have a look on the underside really yeah you can see where it's scarred
02:14over sorry this is uncomfortable a bit all right good do you uh do you think the uh ointment helped
02:32that i gave you last time did it help a little bit no i don't know if it did to be honest with you
02:35fine i think the infection's gone because it looks very dry it doesn't look like there's any more sort
02:40of pus in it or anything like that which is good yeah but i think we need to try now and get on top
02:44of the inflammation for you i'm just thinking how best to do that what i could do is give you a very
02:48very very weak one so normally the hydrocortisone we use is one percent but i could try and prescribe
02:530.5 percent which is even weaker and say just use it for a few days really just to really help
02:59get bring that inflammation down and we can give that a go see how you go with it yeah that sound
03:04okay yeah yeah any idea on that time frame so when it's going to be better it's so variable so
03:08some people unfortunately will be troubled with this for months i don't think that's going to be
03:12the case here i hope such would uh but other times you know sort of 10 days two weeks that kind of
03:17ballpark figure is is sort of most more common uh from from here onwards i would hope it wouldn't be
03:22as long as that because you've already endured all of that time before okay perfect yeah here we go
03:27any questions at all that's it thank you very much yeah okay all right awesome thank you very much
03:32right so you're here for your smear test yes they've been trying to do it for about a year
03:46because i'm overdue okay every time they try and do it they can't do it because i've been examined
03:51because i was on this pre-cancer pathway for a while okay okay so you're due so you've had
03:57some abnormal smears before um not for a while i think i think they've been okay for a while but
04:04i'm it's is it every five years yeah that's right that's right okay so we are a little not long we've
04:10had worse but you are you are we would do it i am i'm usually really efficient about we're gonna we'll
04:15do it now we'll do it today and then we can get it because i've got to have another ultrasound on
04:18friday for the pre-cancer pathway so i just thought i can't leave it and tell me what's happening on
04:24that pathway it was a suspected cancer pathway every investigation they tried to do was unsuccessful
04:29so they took me in to give me a hysteroscopy and they didn't do the smear there and then or anything
04:33in the hospital um not that we know of not that we know of sometimes they do but they would have told
04:39us it had we done it um they said it looked normal they have said the good news is that they're not
04:46overly worried and that they've discharged you off the cancer pathway great as in they don't think
04:51it's cancer great so i think that's one good news great great but they still want to see you and
04:55follow up and deal with things because they need to find out what's happening i got another ultra
04:58scan and i thought oh no and i think it was and we referred you was it because of the wound lining
05:03well i kept bleeding yeah but um i just decided to stop taking the hrt because i think that was
05:10causing the problem okay right let's hop up would you like a chaperone no i'm fine someone else in
05:15the room just to be here let me close this i've put that there and you can put that across your
05:22middle so if you've got a dress on it's probably just as easy to to either just hitch it up a little
05:26bit or whatever exactly take off from the waist down and then we all can get the bits ready okay
05:31are you ready yes yes i think when you have bleeding sweetheart and you're sort of what we
05:35call post-menopausal and we have some bleeding then we've got to think well why yeah and therefore
05:40we've got to go down the route where we start looking into it because then we can work out exactly
05:43exactly so it's really important so it's great to get the all clear but then we must make sure
05:47it stays the all clear and then we can see so you just be as comfortable as you can you'll feel a
05:52little bit of cushion i'm sorry it's a bit cold it's okay there we go i'm sorry sweetheart it's okay
05:58you all right yeah okay there we go it's okay i did loads of squats at the gym this morning they
06:04were hurting they were hurting more than this will hurt right let me knock those off let me get you
06:08some tissues we turn job done well there we go you can tick that one off your list the results will
06:16come back to emily and she will then contact you and let you know the results okay and as you know
06:21it will most of the time comes back normal but sometimes if they're not a hundred percent happy
06:26they come back to us and very occasionally we have to repeat it hopefully not yeah very occasionally
06:31they have to see you in that colposcopy clinic where they want to have a little closer look at it
06:35yeah but they test it all on there and yeah and as you said it's been normal few times recently so
06:39fingers crossed it'll be all right thank you very much thanks elizabeth okay let me let you go
06:43anybody good luck with your scan then on friday thank you and nice to see you as always thank you
06:47thank you all right take care all the best bye bye bye door open or closed leave it open that's fine
06:52thank you thank you
06:53hello good morning how are you uh slightly slow oh sorry to hear that come through take a seat
07:11good to see you how can i help today um what it is i've got um
07:18i'm having a lot of trouble with my back okay because i've got osteoarthritis in the spine anyway
07:24i'm not sleeping very well um sometimes if i lay on my back or i'll turn aside i get a sharp pain
07:32down my back and the top of my legs coming numb and it's coming for about half an hour and i don't
07:37know what the problem is it's happening quite regularly how long has the pain been as bad as this for
07:43what do you say roughly every three days i get excruciating pain and i've got a trap nervous
07:47or something like that yeah absolutely sounds like potentially quite frustrating trying to get
07:52up in the morning i can't get up because my legs numb and i try and stand on it i'm having trouble
07:56always on the left side it's always on the left side yeah any injuries or trauma recently that might
08:01have set it off or made it worse um well not since when i hit by the e-scooter no yeah it's getting
08:06worse and worse than when i was wear a tear or yeah also someone helped me sleep at night
08:11with the amitripline because i haven't got any left is the amitripline helping a bit yeah it helps
08:16helps a bit you want two tablets of those 20 milligrams yeah so there is scope for that to go
08:21up a little bit if needed yeah we could always consider that um how else is it affecting your
08:26life at the moment are you still able to get out and about well get out and about i mean i'm playing
08:30longer in bowls but it's got to the stage where um i can't find this down as far to roll the
08:37war anymore so it's uh difficult yeah trying to um have a life
08:42francesca hi
09:07how are you how are you i'm good thank you come and take a seat
09:15i'm pregnant again how are you oh i'm so hot oh i bet you are how many weeks are you now
09:22i'll be 32 on friday oh exciting how's it been second time around it's i would say very different
09:30like i felt i'm way bigger than i was yeah and just yeah it's just hard with the toddler
09:39so wilbur turned two a couple of weeks ago so he's like really in there yeah you know
09:45toddler tantrum very active i bet climbing up everything oh my god it's really hard
09:50when you look back at when you were pregnant the first time yeah you think oh that was actually
09:55fine absolutely absolutely when you're looking after another one yeah but yeah so we're going to
10:00do um rsv today and the hoop and cough vaccination did you have rsv for your last one i don't think it
10:07was around with will but yeah so rsv is a respiratory virus that is responsible for sort of common colds
10:14and coughs yeah um however it can lead on to pneumonia and bronchiolitis um which is you know
10:20particularly bad for for babies and then the hoop and cough is exactly the same as the one that you
10:25have before exactly so protecting them for their eight weeks um first eight weeks of life before
10:32they have their um eight week vaccinations perfect it's very unlikely to get side effects from these
10:36other than um uh sore arms or do them both today if you're happy with that yeah fine um sore arms um
10:43might be a little bit red a little bit achy that should subside within a day or two
10:47yeah there 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 but with these two it is unlikely however if you're worried about
10:57anything just just let me know okay perfect are you feeling well today other than yes and pregnant
11:02yeah no i'm feeling fine perfect perfect yeah i'm reminding you don't have any allergies do you
11:08no i don't know lovely oh it's very exciting yeah very exciting okay so we will do the rsd in your
11:19left arm so we'll start with this side of that's okay sure so just relax your arms yeah relax it down
11:24just like that relax from your shoulder all right sharp scratch
11:29that's one done
11:36okay sharp scratch
11:42perfect
11:46so next time i see you will be for the vaccination that's crazy isn't it um but if you need anything
11:56though in the long time just um just let me know but yeah so much luck with everything thank you so
12:01would it be okay today just to examine you is that all right yeah sure so whenever you're ready
12:16if you stand up for me i'm just going to press down the spine so you can see how there is a bit of a
12:23symmetry there so you know this shoulder is a bit lower than this one because you're compensating
12:27because you're in so much pain yeah that's very common to see that
12:30a bit tender there a bit of spinal tenderness i agree sort of around l2 three l4
12:39sorry sorry are you able to bend forward for me stop when it's painful so only go as far as you can
12:47yeah so it's yes that's fine stop and then if you bend back for me yeah so it's a very limited range
12:53of motion isn't it yeah okay if you slide one arm down one leg yeah and the other side for me yeah
12:59very very limited we need to get that back really sort of mobilized and moving around back pain can
13:05be really debilitating um it can lead to a lot of sick days a lot of time off work and can cost the
13:10economy you know millions a year so it's really important to um manage it as best as we possibly
13:16can and prevention is obviously far better than cure uh so having good posture strengthening core
13:22muscles making sure that we're exercising in a safe way and are looking after our bodies is really
13:27really important can i get you on the couch would that be okay in simon's case clearly the pain was
13:33having a very big impact on his quality of life on his abilities to sleep etc if the pain is a bit
13:38more complex if there's pain radiating into the buttocks or into the legs with potential nerve
13:42involvement that then might mean that we refer patients for more specialist intervention at times
13:47um a lot of the time we can still manage that in the community as well but um really understanding
13:52the impact the patient's uh pain is having on them is very important and that helps us to determine
13:58whether we need to seek specialist intervention or not
14:01how's that pain oh i'm sorry i'm just gonna lift this leg up
14:08is that okay
14:12tender
14:17ouch
14:18yeah oh bless you sorry lift this leg up push me up good push me down
14:22good push me out with this one push me down
14:25kiss
14:26ah yeah yeah yeah it's gone numb
14:27really soft it's gone numb sorry
14:29mm it's alright
14:30does it help to rub it or anything no
14:32no i should leave it a couple of minutes i do rub it but
14:34yeah sorry
14:36whenever you're ready you can come back round take your time do you need a hand
14:41oh yeah one of the main problems is like
14:47when i'm in lying back because i lie on the left is
14:49getting myself up
14:51having to sit on the bed for a while
14:53yeah just to get you to do it get sources
14:56just take a seat there
14:59okay
15:00what i think we should do is a few things
15:03we can increase the amitriptyline if you like
15:06just for a few nights to see how you get on with it
15:08you can definitely go up to three quite easily
15:10if you want a little bit of um
15:13cocodermol or something like that
15:14just to you know for those paroxysms of pain when it's really really bad
15:19you can take a couple of cocodermol
15:20not a problem at all to do that and then i think we should refer you to
15:23the musculoskeletal team just to see if there's anything else that needs to be done
15:26things to look out for if there's any complete loss of sensation between the legs
15:31if the pain is getting worse
15:33if there's any loss of balance that kind of stuff just let us know as well
15:37all right we'll see how you go
15:39okay we'll take it from there
15:40all right
15:41i'll send the prescription to the pharmacy for you
15:43okay thank you very much thank you take care
15:47can't here i'll go
15:53yep ready
15:54hiya how are you doing good you i'm fine
16:00okay i'm sam so i'm gonna do your diabetes check today so i'm gonna do your bloods
16:06give you a urine test check your feet
16:08okay
16:09do you know how much you weigh
16:10um 80 kilograms maybe
16:13do you smoke
16:14nope
16:15i mean not regularly
16:17social
16:18yeah
16:19do you drink alcohol then
16:20yeah
16:21yeah
16:21Santiago is a young healthy active guy who came in for his annual diabetic health check
16:28Santiago has type 1 diabetes
16:31type 1 diabetes is your body doesn't produce insulin it's an autoimmune condition
16:38it's classed as a chronic condition
16:40so on average how much do you drink a week
16:43no like maybe two three pints
16:45like after a football match yeah
16:47do you play football
16:48yeah
16:49are you good
16:50i mean you should ask that to my friends but i think
16:54i think they would say yes
16:57you're decent
16:58who do you support
17:00who do i support
17:01you've got to be very careful now
17:02wrong choice
17:04who do you support
17:06chelsea
17:07yes
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
17:16but like
17:16where were you from
17:17i'm from argentina
17:19do your family live in argentina
17:21yeah
17:21you can relax
17:22sharp scratch
17:24do they come here at all
17:26uh they came once
17:28i also went back like twice since i moved
17:33okay
17:34pop your finger on there for me nice and hard
17:36so do you play any other sport
17:38so i'm trying to get into golf but i'm i'm not doing i'm not doing good
17:45my dad's always he says he's at the office which means he's in the golf course but he's rubbish
17:50he still goes
17:52oh god
17:58oh god
17:58oh god
17:59oh god
18:06so is that you see them
18:07oh it's like that
18:07and then you do the one
18:09I can lose my arms in it
18:16Right, so I need to buy some more blue dresses, yeah
18:21Oh bro, he's got pockets
18:23When she's heavily pregnant
18:27That would be more enough
18:28Yeah
18:29Shoes or feet up
18:33Okay
18:33Don't get surprised with my
18:36How do you call this
18:38The fungal, is it fungal now?
18:41Here, here?
18:42Yeah, yeah
18:42So next time you cut your toes
18:44Yeah
18:44I want you to cut them and put the nails in here
18:49Okay
18:49And bring it in for me
18:51Okay
18:51But this looks like classic fungal toenail
18:55Okay
18:55Right, close your eyes, no treating
18:57When you feel it, say yes
18:59Yes
19:01Yes
19:03Yes
19:04Yes
19:07Yes
19:08Yes
19:09Yes
19:11Yes
19:11During an annual health check
19:17We do a foot check
19:18Where we check for any signs of infection
19:21And we also use a monofilament device
19:25Which checks for loss of sensation
19:27Or auto sensation to the feet
19:29We check to make sure there's no open ulcers
19:34No wounds
19:35And make sure that you've got feeling
19:38Because if not, then we can action it
19:41So it's really important
19:42To attend your annual diabetes check
19:46You've got some hard skin to the bottom
19:49Yeah
19:50Of your feet
19:51So when you're in bed at night
19:54If you put some moisturiser on the bottom of your feet
19:58Okay
19:58Rub it into your feet, both feet
20:01And then put cotton socks on
20:03Okay
20:04That's great
20:05You've done liver, kidney, fibres, cholesterol, diabetes, iron
20:08The whole lot
20:09Amazing
20:10Okay
20:10Okay
20:10Okay
20:11Sam, I appreciate
20:12You're welcome
20:13Thanks so much
20:13Take care, Sam
20:14Have a good weekend
20:14Best wishes for Chelsea next season
20:16Best wishes for Fulham
20:18Not
20:18Bye
20:19Bye-bye
20:20Come on in
20:28Take a seat
20:30My name is Anna McHugh
20:32I'm one of the doctors
20:33So what's been going on?
20:35I originally just wanted to get blood done
20:38Because back home in Australia
20:40I usually have an iron infusion
20:42But I've noticed that it's not a normal practice here
20:44To do iron infusion
20:45So I think it's worth just getting my blood done anyway
20:49But I've just been like absolutely exhausted all the time
20:52I've got a lump on my armpit that's been growing for like a year and a half
20:56Okay, we'll definitely take a look at that
20:58Yeah, that's good, definitely good to know
21:00Yeah
21:00So when did you notice on this occasion
21:03That you were feeling a little bit more tired than usual?
21:07Honestly, it's been the last, last maybe couple of months
21:11Okay
21:11And it's just progressively getting worse
21:12Like I'm really struggling to just get through a work day
21:15Okay
21:15Yeah
21:16Yeah
21:16Tell me a little bit more about the lump
21:19So is it multiple lumps?
21:21I'll examine you in a moment
21:22It's just one here
21:23Okay
21:24And anywhere else?
21:25No, it's just this one
21:26I noticed it maybe last February
21:30Okay
21:31And has it changed?
21:32It's getting bigger
21:33Okay
21:33And it's becoming sore
21:35Like even if I'm just like resting
21:37It's like this achy pain
21:38And has it ever red, hot or anything?
21:41No, not that I've noticed
21:42Okay
21:42And any lumps or bumps anywhere else?
21:45Not that I've noticed
21:46Okay
21:46My nan actually died of breast cancer
21:48So
21:49Yeah
21:49And is there anyone else in the family with?
21:51Well my mum passed away from melanoma
21:53So
21:54Okay, I'm sorry
21:55Cancer's just running right from the females in my family
21:58Unfortunately
21:58I'm sorry to hear that
22:00No, it's okay
22:01Good luck with the veins
22:19Okay
22:19Like a challenge
22:21Do you have a good vein?
22:23I doubt it
22:24Sorry
22:26That's my blood is solidifying
22:28Okay
22:30So I'm just pressing along the veins
22:32In the back of the leg
22:33What, you think it might be deep vein flumbens
22:35Or something awful?
22:37Because you've had varicose veins
22:38For a long, long, long time
22:39But the pressure's built up
22:41So now we've got the sort of discoloration
22:43Which 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
22:48They're sensitive to the sun
22:50It's quite bad actually
22:51It did
22:52Edward?
22:57Oh
22:58Hello
22:58Hold on, I've got to remember the script
23:00Oh
23:01Come in, come in, have a seat
23:05I'm Megan, how are you?
23:07Oh, I'm, well
23:09A number of years ago
23:10I had trouble with varicose veins
23:12I took one out
23:13Okay
23:13Doctor said, do you want to see?
23:15I said, not bloody likely
23:16What I saw the pharmacist today about was
23:19Should I get a pair?
23:22They go right up
23:22Oh, what stockings?
23:24Like compression stockings?
23:26Oh sorry, DVT stockings, yeah
23:26Yeah
23:27And I said to the pharmacist
23:28Well, are the knee ones okay?
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?
23:43Not really, even though you have a bit of a pain, but nothing more than the twinge
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, is that right?
23:51Yeah, yeah
23:52I've just had a shower, you're safe
23:54Just clean my hands, you're safe as well
23:58A warm hand, thank God
23:59Any pain when I press along the vein?
24:03It's the size of these nodule things
24:05Any 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
24:19You can get something called phlebitis, 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
24:35Yeah
24:35I mean, have you had any recent long-haul flights?
24:39I've flown Australia every year
24:41Yeah, when did you last fly?
24:42I flew back in January
24:43In January, okay, so it's not relatively recent, that's the six months ago
24:47No, okay
24:47Often, for a lot of people who travel on long-haul flights, they can buy compression stockings over the counter
24:53For this guy, he had some varicose veins
24:55Quite significant, leading all the way up to his groin
24:58With his frequent trips abroad, his age and the varicose veins
25:05It puts him at a slightly higher risk of getting a DVT
25:08Because before you, we would consider like compression stockings
25:14Really, 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, one on each leg and one on the arm
25:22You lay flat for about 20 minutes and they measure your venous return
25:28And they measure to see if there's any, what we call atherosclerosis in the arteries
25:33So like plaque build-up
25:35I don't think they did, I can't remember
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
25:43And then there's an issue of you having problems with like venous supply getting, blood supply getting to the legs
25:49Yeah, that's all right
25:51Your feet, are they often purple?
25:55Yes
25:56Yeah, okay, I think you'd benefit from a Doppler to check how your venous supply is
26:01Okay
26:02Now 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
26:19So then he's getting pooling and discolouration
26:21I keep walking everywhere
26:23You're walking everywhere, can 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
26:32Like hot to touch, painful when you're touching it, let us know
26:35But if it's more deep in the calf, then I'll be a bit more concerned
26:39Yeah
26:39Okay, but I'll get those all sorts of things
26:41Look after yourself, I'll have a look at referring you on to get a Doppler
26:47Yeah, okay
26:48To make sure your blood supply is all good
26:51I said, there's no juice everywhere
26:52I see my legs coming apart, oh my god
26:55Look after yourself, okay
26:57Bye
26:57Bye
26:58Is this door open?
26:59Oh yeah, leave it open, yeah
27:01Take care of yourself
27:02I will, I will
27:03Live your mouth
27:04At night time, would you notice any kind of drenching night sweats
27:09Where you would have to change the sheets or the pyjamas or anything?
27:13No, no, no, no, nothing like that
27:15Have you noticed any change in your bowel habit?
27:18No
27:18Any blood in the poo, black tarry stools, anything like that?
27:21No, I mean, there was a few months ago
27:25Well, I noticed it and I was like, I didn't, and then it just sort of passed
27:28But can you describe that a little bit more?
27:30Was it red when you're wiping?
27:32Yeah, well both, and then like it was, you could see that there was blood in the stool
27:37Oh for sure
27:38And was it painful to pass the poo?
27:40Um, not like stomach-wise, no
27:42I didn't really know what to think of it
27:45So I just, I was like, something might pass through it
27:47I'm not, I don't know
27:48Okay, 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, no worries
27:54And if you just pop the top up
28:00Perfect, now my hands are freezing
28:01That's okay
28:02Even in this, okay, just let me know if you have any discomfort
28:04Nice
28:05Any pain there when I press it?
28:11Um, not really, I've been in there
28:14Just a little bit
28:15Yeah
28:16Okay, and you can sit up for me
28:18Now, I'm going to feel the lymph nodes in the neck, okay?
28:23Yeah, they have been swollen when I've been getting sick, like really big
28:26Yeah
28:27Okay, can you put your hand on my elbow?
28:35And I'm just going to feel under the armpit
28:37Can you point to where you can feel?
28:44Okay, and relax again
28:48Okay, and you can sit back down for me
28:51So 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, I've, I had a biopsy in my left breast for, I had fibrodynamas
29:11And that was maybe like 20, 21
29:15Okay
29:16Yeah
29:17And since then, are you good at checking your breasts for any longer?
29:21I've got breast implants, it's really hard
29:23Okay
29:23Um, but nothing that you've
29:25Not that I've noticed
29:26That you've noticed, yeah
29:27Okay
29:27Yeah
29:28Having breast implants doesn't put you at any higher risk of having breast cancer
29:31And there's no particular special or different way where you should be checking your breasts
29:37If 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
29:51Those are all things where you absolutely should go to your GP to check
29:54So 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
30:03Yeah
30:04We 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
30:13Yeah, yeah
30:13And then with regards to the tiredness
30:17There 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?
30:34Does that make sense?
30:35Perfect
30:35It may well be that we then send a referral off to the breast team just to double check
30:41Sure
30:41Because a lump under the armpit we just need to
30:43Yeah
30:43Yeah
30:44Fully examine
30:45Yeah
30:45Does the same time next Thursday work for you?
30:49Yeah, it should be fine
30:50So we'll do blood tests and then I'll examine you next week
30:55And more than likely send you to the breast team just to make sure that we're covering all our bases
30:59Okay
31:00Okay, any questions for me?
31:02No, that's all
31:02Yeah, thank you so much
31:04You too
31:04Bye
31:05Do you mind if I park this in here?
31:13Yeah
31:13There we go
31:14Okay
31:15Ready?
31:18How's it going?
31:18How's this young lady?
31:19She's alright, she's alright
31:21A few complaints
31:22Yeah
31:23Yeah
31:23Have a seat
31:25Thank you
31:25Do you want to stand or sit my
31:27Sit on Danny's knee?
31:28Yeah
31:29No
31:30Stand or sit?
31:31Come up?
31:31Okay, come on
31:32What's been happening
31:33So she's been complaining from about since maybe Friday night
31:37When she's peeing, when she's peeing, that it hurts
31:39Okay
31:40Yeah
31:40Her pee is quite strong smelling as well
31:42Yeah
31:43Okay
31:43Um, so yeah, so that's been going on now since
31:46Any temperatures?
31:47Does she feel hot?
31:48No
31:48Um, and it's also during the night as well where it's the most strongest for her
31:53So she wakes up at maybe 2 or 3 o'clock in the morning and complains that
31:56She's out of nappies at night, she doesn't wear a nappy at night
32:00She does wear a nappy at night
32:01Yeah, yeah, but she says it hurts
32:03Yeah, she says it hurts
32:04Yeah
32:04And then she does, you know, the typical crossing of her
32:06Yep, yep
32:07So it's important that we get a urine test before we start treatment
32:12Okay
32:13If she's unwell, we'd say put her on sort of a general antibiotic, amoxicillin is the usual children's one
32:19But, uh, the result then may show that it's a different, but it might be better
32:24Okay
32:24How easy, what do you, this is the next question
32:28Yeah, how easy
32:29How easy am I going to go at this for a while
32:30Um
32:32Yeah, uh, mi amor
32:34The other option is cotton wool, you know, put it down there
32:40And then when she's gone, you just squeeze it out into this
32:42Okay
32:43That thing, but we'll give you all this, Amy
32:45I'll just put a label on it for me
32:49We're going to put your pee-pee in there
32:51And then someone's going to look at it
32:53And tell me if you have something wrong
32:56Yeah, yeah
32:58Do you want to choose a sticker?
33:02Oh, you want a sticker, Maya?
33:03Which one?
33:04What do you want?
33:04We've got shark, starfish, turtle, octopus
33:07Which one do you want?
33:08You choose
33:08You want the octopus?
33:09Okay
33:10Or is it a jellyfish, Daddy?
33:12Oh, sorry, jellyfish
33:13Sorry, not the octopus
33:13Yeah, don't look at my nose, Maya
33:15You want that one?
33:16You want to put it on your, you want to put it on your, uh
33:18Yeah
33:19You can show all your friends in Becca's
33:22You got a sticker?
33:23Daddy gets these to go
33:24Yay
33:24Party bag
33:25Okay
33:27There you go
33:28Thank you
33:28Well, 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
33:37Do 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 this, does that help?
33:53I'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?
34:00Yeah, maybe a little bit
34:01Okay
34:02Does the pain improve after a bowel movement or passing wind?
34:05I feel like I really need to go
34:06Yeah
34:07It's actually the pain
34:09Do you think it's because you had the latte?
34:15Why don't you just be cramping up?
34:16Because you've mixed the milk and the chips and then sweets
34:19Maria
34:22Hello
34:24Come on in, how are you?
34:27Not good
34:28Not good?
34:28Oh dear
34:29Crawling in again
34:30That's all right
34:31I'm pleased to see you
34:32We're in here today
34:34That's why I'm crawling in again
34:36Yeah, so what's happened?
34:38You know, last week I had terrible diarrhea first
34:42Okay
34:43And then total constipation
34:44Bloated like this on Sunday
34:47Nothing
34:47And I didn't want
34:48So I went to Chelsea in Westminster
34:51So he was rather a thing
34:53This is all painful
34:55He couldn't feel a blockage
34:57Okay
34:57He took my blood
34:58Okay
34:59And sent me home
35:01Now it's again
35:02It's constant pains here
35:04Okay
35:05It's like this
35:06I sent you a copy of those
35:09What I could copy from the test from the hospital
35:11Yeah
35:12Yeah
35:12It looks like my liver and kidney is something
35:15Because we've had sort of tummy upset
35:17And problems for quite a while, haven't we?
35:19And we sent you to the sort of
35:20The urgent clinic to try and get them to find out what it was, didn't we?
35:24Didn't she run tests?
35:26She did a lot of tests
35:27And they put cameras in and everything
35:29And nothing, didn't they?
35:29Nothing
35:30And then the other day when I was pooping
35:33It looked like blood
35:34I'm just thinking of having a whole body scan maybe
35:38Well, you pretty much got a whole body scan before, didn't they?
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
35:53Which is what we all worry about
35:55And they've said that everything was fine
35:57In the heart, the lungs
35:58They didn't find any swollen lymph nodes or glands
36:01They said the liver, gallbladder, pancreas, spleen, adrenal glands, kidneys, bladder
36:07Are all normal
36:09Even bladder?
36:10Bladder, all normal
36:11But they did say that you've got a condition
36:13I don't know if you know about it
36:14Called diverticular disease
36:16Our intestine sort of comes and it looks like this
36:19And it's nice and bobbly like that
36:21And it comes down and out
36:24And we go to the loo
36:25So that's what it should
36:26But with diverticular disease
36:28We end up with these little pockets
36:29Oh, okay
36:30That stick out
36:31And the poo comes up and round and out
36:33It can get stuck in these
36:35And cause them to be inflamed
36:37And bloaty and sore and horrid
36:39They said no other abnormality in the colon
36:41Nothing else in the pelvis
36:43But you do have these
36:44And what I wonder happens
36:45Is that some days might not be so bad
36:48Other days might be horrible
36:50Yeah
36:50Do 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, to help it pass
36:57Yes
36:57And the problem is that that's what can happen here
36:59That sort of gas can build up
37:01And then it's stuck
37:01And it can't go around
37:02And if gas
37:03If the walls get stretched
37:04To the colon
37:05It's really uncomfortable
37:06Oh, okay
37:06And it can be really horrible
37:07Why don't we start
37:09With just seeing
37:10If we can get something to help you
37:11With the one thing we know is going on
37:13Which can cause the bloating
37:14And the horrid
37:14Can we have a poop test?
37:15We can do a poop test
37:16And we can just check
37:17That there's nothing there
37:18Yes, that there's no blood
37:32Are you a warrior?
37:38Yes
37:39Because I always think I'm going to die
37:41And what do you think?
37:43You're going to die of something horrible
37:44Some cancer or something
37:46The problem is that we all worry about this
37:48And sometimes that worry just grows a bit
37:49Doesn't it?
37:50I think it's getting a sort of
37:52Because I've had so many friends
37:54I know, I'm sure
37:55That's frightening, isn't it?
37:57But that's my age
37:58I mean, but that's the problem
38:00That that's going to keep on happening
38:02Isn't it?
38:02Yes
38:02Instead of going forward
38:03I mean, that's why I accept it
38:04Yeah
38:05But it's just sad
38:07It is sad
38:08Yeah
38:08You know, I said
38:09Oh, can I go on holiday somewhere?
38:12Who'd you go with?
38:13Yeah
38:13I used to always have one or two
38:16And they're all sort of dropping off
38:18Are they, slowly?
38:18Yeah
38:19And they're all dropping off
38:20But that's okay
38:21The problem being the fittest of a group
38:23Because then you're the one
38:24That's left standing, aren't you?
38:25I'm about the only one left
38:27Out of the lot that we started
38:29What about making new friends
38:32And different things
38:33I have lots of young friends
38:34Anyone to go on holiday with?
38:38Well, I am
38:39I always do
38:40Once a year, I force them
38:42Good
38:43I bet you don't force them very much
38:45I'm sure if you suggest a holiday
38:45I'm trying to Zanzibar in September
38:48Oh my goodness me
38:49That's amazing
38:49I'd like to go to Zanzibar for longer
38:51But ten days, that's max
38:53Because what, you get people to sort of dog sit
38:55Yes, yes
38:56And drives my partner crazy
38:58He's 80
38:59And on his own with the three of them
39:02Can he not travel with you
39:03Or does he not really like travel?
39:04No, he doesn't
39:04He's autistic
39:05He doesn't move
39:06He sits in front of
39:08Okay
39:08Yeah
39:10Computer all day long
39:12It's very difficult
39:12But we get on well
39:14I've known him for 65 years
39:16And are you married?
39:18Is he your partner?
39:18No, he's my partner
39:19He was always my best friend
39:21I got married to somebody else
39:22And then got divorced
39:23And went back now
39:24With him
39:25But I've been 11 years now
39:27Oh, okay
39:28Well, that's right
39:29He does his
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
39:36And it works
39:37It works
39:38He has somebody to talk to
39:40I have somebody to talk to
39:41Yeah, good
39:41We all do our own thing
39:43Yeah, yeah
39:44I mean, they keep you all going
39:45I mustn't complain
39:47I'm a bit just of a neurotic
39:49But 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
39:53When it comes
39:54And then we can make a plan
39:55Right, I'm going to give you
39:56The little sample pot
39:57Let me get it from the girls
39:58At the front
39:58Then we can get it sorted out
40:00It's all day
40:01You'll see
40:02Another fit test, please
40:03Bring it back anytime
40:05Thank you
40:05Enjoy
40:06All right, take care
40:06All the best
40:07Bye-bye
40:07How are you?
40:10Well, I'm all right
40:11I mean, because I'm asked to come
40:12Not because I want to come
40:14Do you feel okay?
40:16Yeah
40:17I get on with it
40:19Yeah
40:20You know that
40:21I know that
40:22That's why I like seeing you
40:24Because you know me
40:25So your sugar's okay
40:27Your liver
40:28It's still there
40:31Yes, it's still there
40:32Got a straw that's good
40:36Is it good?
40:37Yeah
40:37What is it?
40:39Yours is 4.4
40:42Wonderful
40:42I've never even had that
40:44There you go
40:46Thanks
40:48I spend my life telling people to take statins
40:51And it's great when it works
40:53Well, I've been taking them for so many years
40:55It's unbelievable
40:56I started you on them
40:57Because I'm on the same ones
41:00Dispers of them
41:01Yeah
41:02But you feel okay
41:05You don't have achy joints
41:06Oh, I do have achy joints
41:07But I'm 80 years old
41:09What do you expect?
41:10I mean, even the bones here hurt
41:14My collar bones hurt
41:15Yeah
41:16You know
41:17Tell me about the bones and aches and pains and things
41:22Tell me about them
41:23For instance
41:25We went to the coast
41:26And what should have been an hour and a half's journey
41:29Because half the bones were closed
41:30Did a detour
41:31It took us three hours
41:32So
41:33You know I've got a bad back
41:36I've always had a bad back
41:37So when you get out of the car
41:38After that
41:39Oh, not in the car
41:40In the car
41:40While you're going
41:41And my hips were hurting
41:43Yeah, yeah
41:43I couldn't wait to get out of the car
41:46So I mean, I'm used to back hurting
41:48It's all the time, don't it?
41:50Yeah, yeah
41:50It's part of me
41:51It's always the left knee
41:54Yeah, yeah
41:54Yeah, yeah
41:55And usually the right hip
41:59I say the other day
42:00It was both hips
42:02But then
42:03Yeah
42:04Hey
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
42:11We want to make it as joyful experiences
42:14Going to the coast as possible
42:15I don't really want you in pain
42:17Blood pressure's a wee bit high as well
42:21That's probably because I've been sitting out there
42:23And you're late
42:24And I'm always early
42:26I'm not happy to just leave that blood pressure as well
42:31Well, that's it
42:33Now that you're in
42:34Every day
42:34Mm
42:35So I would like to
42:40Check 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
42:46What I'm going to do
42:48Is book you in
42:49In two weeks time
42:50With me and
42:52Sam if she's around
42:54Yes
42:55And just do a couple more blood tests
42:57All right
42:57Check your blood pressure
42:59Yeah, we'll just send it to the phone and all
43:01Yeah, okay
43:02I'll send it
43:03Nice to see you anyway
43:05And you
43:05Yeah
43:06It's not like going to the doctor
43:08Is it when I come to see you
43:10It's just to see Tim
43:11Check
43:12Yeah, take care
43:13Brilliant
43:13Yeah, all right
43:14Take care
43:14Cheers
43:15Thank you very much
43:17Thank you very much
43:23Thank you
43:24Bye
43:25Bye
43:25Bye, Emily
43:27I'll see you next week
43:28Thank you
43:58You've had a few of those falls recently
44:28Oh, I've had five of them
44:30It always happens where you can't get up
44:32Because there's nothing to hold on to
44:34Oh, gosh
44:35From your, like, perspective
44:36Yeah
44:37Would you think I have ADHD?
44:38It's a spectrum, isn't it?
44:40We're probably all on one part of the spectrum
44:42He just woke up one morning
44:44And it wasn't all there
44:46Thank you
44:47Thank you
45:03Transcription by CastingWords
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