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00:00morning surgery you told somebody that you're starting to struggle at home really i think
00:12people put things in my mouth at times do you feel okay in yourself i'm sweating like hell
00:19do you have any other medical conditions how long have you got
00:24you can't be in you're too busy to be in you've got your restaurant if i'm home you know i'm
00:32working more than what i'm doing at the restaurant too busy to be here
00:38on sunday all of a sudden i had this blackout faded it just happened just just just like that
00:54morning
01:18will you hello
01:20come on to it it's nice to see you i've not seen you for a while no but i remember you now tell me
01:25how are you i've got doctoritis yes absolute agony yesterday i mean it's been getting bad this knee
01:33here okay about a week okay and then last night i mean i could hardly sleep oh no i ring you
01:39and i mean it still hurts but it's i can walk on we cured it on the telephone call i mean
01:43marvelous i'm so sorry no no don't be silly because obviously something's going on causing
01:48all that pain so no twisting or you didn't slip or bang it or anything recently not that i can
01:53remember okay and the pain describe what you were feeling the other day yesterday and things
01:58where did it what does it feel well it's like a sort of two notes on the piano that was all steady
02:03for ache and occasionally um like that okay and did it stop you doing things like was it
02:10affect you i didn't go for my daily walk okay did you do anything yesterday to make it get better did
02:16you take any medicine or strap it i had a couple of um cocodermol or something like that yeah yeah
02:22good do you mind if we have a look at your knee would that be all right now we can come and sit
02:26on here let me just have a look are you all right no i'm just going to have a look at your good knee
02:31first of all if i press around any pain there at all nothing if we bend it and if i press it left
02:37has never given me trouble i'm pushing it nothing i'm just going to pull it no problems okay so that
02:44knee looks pretty sturdy well it's never been wrong never been wrong right and i'm just going to
02:48press around so tell me of any place i press there there so and is it on the inside oh sorry no no no
02:54so this is this is where it's then you can guess yeah can't or gauge if we bend it up like the other
03:00one and if i press in again it's here is it that's there yes so it is down this side is where it's sore
03:06isn't it it's not grossly swollen which some people are no i know it's it's not quite right it's doctoritis
03:12i think this might be something going on in your knee to be honest will you i think we need to
03:15look into it come and get yourself down let's put these here we go let me just you're right on there
03:20let me just wash i'm fine um the thing is with knees but it's they're pretty important come and
03:26have a seat i think looking at the knee there's a bit of swelling and it was tender and it saw on
03:31that inside and what happens if we look at the knee joint what i'm worried about is that if there's a bit
03:37of rubbing so what happens is the little bits of bone sort of end up jarring a little bit
03:42when we bend it or when we move it sometimes it can just start rubbing a bit if that is the case
03:47why didn't it hurt straight away so you're quite right if we x-rayed you every day last week the
03:51bone hasn't changed suddenly but what's happened sometimes it can be the way we've sat or we've just
03:57moved or we've done the gardening or something's happened and then suddenly we get inflammation around
04:02it's the bones are starting to get a bit worn away and then what's happened is it's all become
04:06inflamed and that's why it becomes very sore very quickly so the arthritis which i suspect this might
04:11be hasn't developed yesterday you know your bones are 76 years old this hinge has been going for 76
04:18years there we go so 77 years almost this hinge has been bending and if you think of a door and anywhere
04:23else it's not surprising it gets a bit of wear and tear yes i'm sure so do you understand that the
04:28thing is is that they don't like us calling it wear and tear because wear and tear implies well don't
04:31wear it out then rest it but actually it won't get better if you rest it and it's really important
04:36you keep walking for all the other health benefits so what we ought to do is why don't we get an x-ray
04:41of your knee have a look sure that'd be great so i'll send the x-ray form which you can go down for
04:45any time and we'll ring you with the physio you're adorable thank you so much we'll get you sorted but
04:49keep on your feet you're not doing anything wrong you're doing all right and i think it was quite
04:53right you came in today to get it checked you are kind well thank you very much indeed you take care
04:57nice goodbye all the best when you bye bye bye bye oops that way yeah that way yep different room
05:04uh lucas please oh hello hello how are you both fine thank you i've just been reading all about
05:12you i'm george one of the doctors lovely to meet you hi take so you make stuff comfortable how are
05:15you doing good oh bless you what happened you tell the story we were staying with friends in the country
05:22and they were all playing football outside and the kids were having a glass of water someone
05:27kicked a football which hit the glass which went into his um yeah so it was it was pretty deep luckily
05:35it didn't go all the way through but he had to have stitches good and they've removed all the foreign
05:41bodies nothing well they gave it a good clean but the reason i'm here is it's quite boring really uh they
05:47gave me antirotix and um supposed to be 10 ml three times a day for five days but they only gave me 100
05:52mils so we've now run out yeah absolutely but um as we're here i just wonder if you could have
05:58yeah anyway and just and just see okay well let's check a few bits for you not a problem at all and then
06:03we can get that prescription uh done let's have a closer look is the pain okay is it sore or is it not
06:08too bad oh you're brave aren't you hard as nails i love it yeah it's good it's healing nicely
06:13i'm just gonna yeah i mean they're sticking out a bit the stitches yeah that's fine i wasn't sure
06:19if i should try and snip the ends but i didn't really trust myself to to do it necessarily a great
06:24job the they're dissolvable ones aren't they they are yeah yeah so they all dissolve really nicely
06:29and then whatever's left over you're right you can just snip but we can do that for you yeah
06:33lovely good can you open your mouth for me i'm just going to lift this lip up a little bit just
06:37to check your gum is okay good i don't want to press too hard lovely absolutely fine and your teeth
06:43wobbly at all no but he says it hurts but i don't know if that's just the gum being
06:50yeah a bit inflamed absolutely yeah exactly i'll just quickly check your temperature and then send
06:54this so well done you are brave goodness me that's uh in stitches not not fun
07:02i think it was five or six or something in the end temperature is normal as well brilliant lovely
07:08leave that with me get outsourced any problems just let us know okay perfect thank you very much take care
07:12pleasure you're very welcome all the best
07:26i've got so much anxiety about going away i always get like this you should see me what i do is before
07:31i go away as i i have a to-do list you know like referrals need to be done a certain way like and then
07:37you have to print it off so i can check when i come back you're gonna give me a list of stuff to do
07:40i know it's just one list that everyone works on oh i see yeah so maybe you're a bit controlling thanks
07:49doris doris hello good mate
08:04oh different one today
08:09all right
08:12you're okay then oh
08:14so doris you're nice and early and we have a double appointment booked we have lots of time
08:20what have i got coming for oh you're not sure no okay no one told me nothing
08:26oh right okay um my understanding doris is that and that you told somebody that you're starting to
08:33struggle at home oh really i think people put things in my mouth at times i mean i i don't say i
08:43struggle um i get in and out of bed okay on my own i've got one of those little other things yeah
08:53the worst part for me is loneliness loneliness yeah because i'm on my own and now the two people
09:01that looked after me they've moved now over the other side so i've lost them yeah sometimes i wake up
09:10and see why must you live
09:29you've mentioned kind of feeling like what's the point going on well i want to explore that a little bit
09:36more and i have some specific questions that i want to ask you and i notice that you do take an
09:42antidepressant medication you take a very very low dose of sertraline um okay i also take tablets for
09:49a panic attack you do the questions i'm about to ask you doris are specifically designed to assess for
09:55any features of depression in in people who are older so over the past week do you feel that you are
10:05basically satisfied with your life yes good over the past week have you felt like your life is empty
10:14oh i suppose they would really when you're on your own
10:20got no relatives
10:23no i've never even given it a thought actually no
10:26do you often get bored bored yeah bored no i don't think so i've got a habit now doing scratch
10:37cards so no i'll read i watch telly i've got scratch cards are you in good spirits most of the time
10:46oh yeah yeah i enjoy my own company at times good are you afraid that something bad is going to happen to
10:52you no good not really i don't think about it great do you feel happy most of the time
10:59most of the time do you often feel helpless no do you feel that your situation doris is hopeless
11:09oh no good good and do you think that most people are better off than you
11:14well younger than me yeah i think probably there's people off that are worse off than me
11:24better off than me and i wouldn't like to answer that one okay that's fine it's actually quite nice
11:30to hear you some of those answers to that question um i think that one of the things that you said
11:35matters most to you and is your priority is is this loneliness so i think so really for now we won't
11:42do anything with regards to getting no if there's anything desperate i will what i do want to do
11:49if it's okay is ask our social prescribers to visit you so that they can give you some help with
11:56this feeling of loneliness oh and i've got a plan in place for that we'll see how it works okay well
12:02thanks doris when talking to doris about what matters most to her having more care and more support
12:08wasn't high on her agenda would you do me a favor why me yeah you can get onto her scales she's still
12:15fiercely independent and even though some of our colleagues might have thought she would benefit
12:20from extra support she's perfectly entitled to say no thank you for that help right now and of course
12:24if anything changes we can revisit that 43 kilograms that says okay i'll convert it for you in a minute
12:32let me move that out of the way 43 kilograms i can't be much slower than that i don't think
12:41i eat a lot of chocolate so this is 43 kilograms so it's just over six and a half stone
12:49six and a half i put on a brick then you are putting on a brick that's made my day
12:55do you do you eat meat and fish protein is important to keep your muscles strong which is
13:00an older age which is the best one you get that from you get that from most and from some vegetables
13:05as well yeah and things like cheese so i eat a lot of chocolate that's good for me you've got to enjoy
13:14these things all right well thank you very much thank you doris
13:18i've had this really itchy skin thing basically and where does it affect on the body i don't know if
13:25you can see but kind of small bumps under my skin last september i suddenly got the most awful eczema
13:33and itches from head to foot i keep getting like loads of just random spots on my arm what do i do
13:39about this and my hands were so so sore they felt as if i was holding thistles moisturize moisturize
13:45moisturize got this funny thing here what i do think that is is something called an actinic keratosis
13:51okay english
13:56john yep
14:00so they're going to run the show today if that's okay does that work for you i'm going to be here
14:05listening okay have a seat so hello there my name is shiromi um i'm one of the medical students okay
14:13hello um so can you tell me about why you've come in today uh just a penal rash there's sort of a
14:21slight ring around the stalk of the penis is it itchy uh i'm conscious of it a feeling i wouldn't call
14:29it pain or i wouldn't call it an itch you're just aware that it's yes there okay um and have you been
14:36like seeing any discharge or anything like has it been like flaking no thing it's just red yes
14:45do you have any other medical conditions how long have you got i have the typical medication of
14:53someone of my age for cholesterol yeah and blood pressure blood pressure and that's for high blood
14:58pressure right it is okay and if it's okay to ask um have you been having any like sexual activity
15:06recently no no okay yeah okay so i think that's it for me how did she do terrific
15:17so what are you going to do doctor um so i think we're gonna do a swab just to see if there is
15:24any infection i guess or to see um like what the causative agent i guess is there you go i think
15:31so we'll be doing yeah
15:37uh kuleen please hello
15:44i come through take seats i'm george one of the doctors nice to meet you how are you i'm fine
15:48thank you and yourself lovely yeah good thanks how can i help today um i have a condition called hs
15:53yep but i've got a lump under my arm and it doesn't look it's not the same characteristic so i just want
15:58to make sure hs or hydradenitis suppuritiva is a chronic skin condition it's characterized by the
16:04formation of skin tracts or sinuses that form from the surface of the skin and they migrate in
16:10they can often get infected and be very difficult to live with very painful very itchy very uncomfortable
16:16and when did you first notice it monday and then it's just getting bigger yeah yeah is it painful
16:21yes it is anything coming out of it any discharge no it's quite soft though in certain areas yeah fair
16:26enough and do you feel okay in yourself any fever nausea vomiting i'm sweating that hell are you yeah
16:31do you think it might be related or hard to tell it's hard to tell it's so fun any infective symptoms
16:36at the moment so like coughs cords runny nose and you know that chest infection nothing like that at all
16:41and nothing in the run-up to this so last week or anything and whereabouts is it under the armpit yeah
16:45yeah fine would it be okay to have a look yeah that's all right let me see
16:56oh wow yeah it's big oh bless you
16:58yeah it's got a punctum i think it's a cyst okay so it's the hs it might be the hs but it could be
17:12you know a different sort of cyst altogether so yeah it could be it might may not be related to
17:16the hydradenitis it's tricky it doesn't sort of look actively infected but i do wonder if we should
17:23just in case give you some antibiotics that's bad again i know i'm so sorry well we don't have to we
17:28we could adopt a wait and see approach and say look give it a couple of days and if in in the
17:32next 48 hours or 24 hours it's regressing getting smaller getting less and less painful fine you don't
17:38need anything if however in that time frame it's getting bigger redder angrier more painful then
17:44unfortunately we probably should you know try a course of antibiotics especially with your diabetes
17:48as well we need to be very very careful um before you go just to make sure that there's no
17:52sign of infection in the body can i just check your heart rate and oxygen levels is that okay
17:56and then your temperature as well
18:01so the oxygen levels are perfect 96 so that's really good
18:06ignore the beeping it does that lovely temperature 36.2 heart rate is less than 100 so absolutely fine
18:13it's really good brilliant see how you go any problems just come back all right okay thank you
18:18my pleasure you're very welcome take care
18:27you see this ring around there and you see the redness under there inflamed isn't it yeah it's not
18:34normal to have that but yeah you can definitely see it's marked inflammation and does that irritate you
18:42well i'm conscious of it as i said i can feel it but it's not pain and it's not an itch i don't
18:48have to scratch it yeah that sort of thing there you go good luck yep i just keep going i do the other
18:58bit as well good yeah that's quite sore isn't it there we go perfect well done yep all done yes all right
19:10okay so we're going to send that away okay um but i'm going to give you some treatment anyway what
19:17treatment would you suggest
19:23um oh caniston or the oral flu
19:31perfect um so yes you mentioned an oral tablet treat you from the inside
19:37one off tablet and the cream yeah two-pronged attack what is that likely to be so it is a
19:47this yes yeah i mean it looks like a thrush basically inflammation inflammation no funny smells or
19:53anything you know any other discharges or anything like that no excellent
19:57so that takes a few days to get the result but i'm sure okay it'll be you know i'm sure it'll just
20:05come back showing a yeasty infection looking at him what do you what are you thinking what's he
20:11dressed as tennis player maybe so i mean sports uh you know all goes with thrush basically
20:21loves hot sweaty environments oh right yeah so when you do i should lead a more sedate life is that
20:27what you're proposing not at all so you're going to get one capsule and some cream okay you're going
20:33to use the cream smearing it around yeah end and um should settle down for a while but because you enjoy
20:41the sport and stuff that can just occur again always worth having the sugar test which we do anyway
20:48what's the correlation everything a penis and the sugar reading so a high sugar in your urine which
20:55you might do if one had diabetes yeah allows yeast to grow oh right feeds the yeast so if you like
21:03something today yeah for you tim thank you all right and thank you for talking to them it really
21:09helps thank you very much thank you thank you all right thank you tim thank you no problem take care
21:16bye the men are really bad at generally coming to the gp but john was very staunch and very game on
21:27for showing the students which was great because they're one of the biggest trainers of doctors in
21:33in london and i think they did really really well how did that go that was good yeah yeah he was
21:42comfortable yeah talking to you you're asking all the right questions yeah i thought you were brave
21:48doing the sexual history well done um yeah and your examination and um taking this one all good
22:07so we're here today because because of my medication i know you know what i'm going to say
22:11it's good to see you're looking well i'm i'm absolutely fine actually you know that yeah yeah but
22:16you were fine when you had a bit of a twinge in your chest exactly but when we got you up to the
22:20hospital you weren't actually fine they said they said oh you have uh you know had a heart attack
22:25so exactly and that's the thing so you had a heart attack which which just meant that there was
22:29a blockage there again and you've had obviously how long ago was the previous heart attack 17
22:33isn't it 16 okay so 16 17 and then it was this march time sort of thing when we got you to go
22:39back up again and it was such a mild symptom wasn't it it was a bit of a warning so i think
22:45i suppose two things one is that's a big learning point that if you get any funny twinges or difficult
22:50or funny just go and get it checked because if they do an ecg and that blood test and it's not your
22:54heart they'll kick you out straight away exactly but if it is your heart you're in the right place
22:58but what i'm what i'm worried about with your medicine and i know i've heard on the grapevine that
23:03you're not taking all the medicine that the hospital no no the medicine which they have given because the
23:08you know i wasn't feeling right with them these tablets actually they're not making me feel better
23:15they're making me feel in
23:29never take pills i know if you can avoid them they're best avoided but sometimes they are needed
23:36lordy lordy look at all these i know is the side effects from it or what of course there are loads
23:41of side effects geez oh yeah absolutely aspirin yes folic acid yes stomach yes statin yes thank
23:49god for that i've spoken to a few people and when they tell me how many you know medications are
23:55on i went what yeah i mean you're doing really well i couldn't believe it you know
24:02problem is i think that we suddenly threw loads of new tablets on you you fell ill we've stopped
24:08them all and gone back to what we were on before but what worries me a little bit is that you when
24:12you had the first heart attack the blood vessel was blocked and they put a stent in yeah and when
24:18you have the second one when they've gone back it's dilated there's a bit of what they call a sort of
24:22aneurysm there's a dilation around it and the problem is blood sits and clots in those dilated bits
24:27right so they're worried that just one blood thinner isn't quite enough okay then they look at
24:35and think well hang on the cholesterol was part of the problem in the first place it blocked things
24:40and that your cholesterol was still a bit raised despite being on the maximum dose of statin so
24:46that's why they added in the other one as well okay now i was thinking one option is what about if we
24:52look at all the new tablets prioritize which are important and try one at a time that's good and then
24:58if you feel unwell we know that that's the only change that's been done so that is the tablet that
25:03doesn't suit you that's fine i know i can't bear patience on lots and lots of tablets
25:08but every single one of those is individually doing a really important job and you're young
25:14you're fit you're healthy you've got your wife you've got your family you've got your grandchildren
25:18living with you you are you can't be in you're too busy to be in yes i am too too busy to be i'm
25:23telling you if i'm home you know i'm working more than what i'm doing at the restaurant because
25:28five of them are on me all so i think what we need to do is think it's not ideal being on all
25:35these tablets but i genuinely think that if we want to keep you from not having strokes not ending up
25:41in hospital or sick or not being able to do things or ultimately the worst thing of dying then actually
25:48we need to look and try and get you on these tablets to try and really improve the the outlook
25:53going forward we will try you know maybe whatever whatever it is there you know i'll try one more
25:59thing i want you to know if did you get the result from the cardiogram it was good it's pretty good
26:04all your your heart muscle is pretty good yeah they're all fine we've got a good heart but we need
26:11to keep it that way because reality if you stopped all of it and didn't exercise and ate what you wanted
26:16blah blah pretty much you will have more heart attacks things so we don't want that to happen so they
26:22want you to stop the aspirin now and just continue this other blood thinner river oxabam with the
26:27clopidogrel okay why don't we just do that one change today and then if you feel awful you let us
26:33know let me know let me go we can then we'll stop it yeah okay that one and we'll see if there's an
26:38alternative or a sister one or something that doesn't make you feel ill and then we'll look at the
26:42other ones one that's fine we'll review it we'll see and then we'll move on to the next one okay and
26:47we'll get you to 100 that's the plan that's all all we stay together oh exactly no chance of getting
26:55away from me and i'll keep nagging you um and any problems if you find you haven't got the tablet
27:00same or you're not sure or someone's throwing them out or something just you know no no we will have
27:03them i'm sure i'm sure perfect save you thank you so much all right no worries i'll speak to you in two
27:07weeks yes maybe all right thanks a lot what happened to not drinking red bull ha i know i shouldn't
27:20i'm actually quite concerned for you stop drinking it yeah okay i i i i promise thank you let's cut it
27:26down to one a week of course all right mom this is my last one i promise on everything i love
27:32so tell me what's worked you in i'm having serious problems with my ears okay originally i
27:41thought it's tinnitus my mother gets tinnitus i don't think it is um i've been using a tinnitus
27:48relief spray nothing is helping they suddenly just get blocked and sore and i then can't hear properly
27:56out of this ear specifically okay and i get a headache okay and i don't know what to do okay
28:02so how long has this been going on for for you for six weeks yeah so you mentioned tinnitus are you
28:08having ringing in the ear i mean everything sounds really hollow and slightly just like you're
28:14underwater kind of ish yeah yeah okay and any vert vertigo symptoms so feeling of the world spinning
28:19around you occasionally yes occasionally okay okay and how long do those episodes last for
28:26uh i stand up i sway and then i'm fine okay so short any sore throat or cough uh i've had a bit of
28:35a sore throat this week but and what about a stuffy nose a little bit but a little bit okay will we have
28:42a look please okay so i'm gonna look in the normal ear or the less severe ear first if that's okay with you
28:51that's fine that is perfectly normal and very clean thank you i do try to keep them clean good
29:02that looks fine as well actually there's no redness it doesn't look inflamed or it doesn't
29:06look like it's bulging so this doesn't look like there's an infection there okay um can i have a look
29:11in your throat so just open your mouth and say ah yep okay that's fine so no swelling of the tonsils i'm
29:19gonna feel your um lymph nodes in the neck
29:25okay all righty so what i think is going on is actually you to do with your eustachian tube so i
29:31think that may be blocked and causing you the popping and the fullness feeling and the discomfort
29:37so i think if i give you a nasal spray which sounds probably odd but fine yes it's worth trying i
29:45think that actually it will really improve things for you i will also give you a spray for your ear
29:50um just to make sure if there's any inflammation in that ear that's causing the discomfort that that's
29:56also covered perfect thank you so much i really appreciate it right now thank you so so much
30:07um
30:12uh leslie please come through
30:21take a seat how can i help today
30:24are we here to take the stitch out yeah yeah did you put the cream on yes i did amazing good would
30:30you like to lie down is that a bit easier for you leslie was unfortunately uh intubated and ventilated
30:35an ITU following a very lengthy operation of lung cancer and they need to do a tracheostomy
30:41to help support her breathing. Tracheostomy is a surgical procedure whereby an incision
30:47is made in the neck to gain direct access to the windpipe or the trachea. Lovely. So
30:52I'm just going to bring that down a little. Oh yeah, brilliant. We get a much better look
30:57on it. Is that painful? I just hate the way anybody touched me. Yeah, I know. That's
31:07just a bit of cool, salty water which will just clean the area to make sure I don't introduce
31:13any bugs. Got much planned for today. I'm going to run into that later. Good.
31:27Sorry, you're doing really well. There we go. Done. Well done. You did really well.
31:36Excellent. Brilliant. Let's just make sure that's all okay. Yep. Lovely. I was just removing
31:43the sutures from the site. They had not dissolved and yeah, we needed to just get them out otherwise
31:50they were an infection risk. Thanks very much. My pleasure. You're very welcome. Anything
31:54else I can help with today? Do you need anything else from us or medications or anything? No.
31:59How is your breathing at the moment? All good? I've just finished a lot of antibiotics.
32:04Yeah. I had my chest rattling this moment. Oh, did you? Let's have a little listen for
32:09you. Not a problem at all. I've got another spare set of antibiotics if I need them. Sure.
32:14Yeah, good to keep them on standby. If your sputum's changing colour, you're feeling more
32:18short of breath, particularly wheezy. Obviously, let us know and you can start them at that
32:23point. Let's just take a few things. Pop that on your finger. Thank you.
32:35Do you mind if I just slide this under like this? Yeah. Thank you.
32:38Good. Perfect. Really good. Lovely. Chest is nice and clear. Heart rate is normal. Oxygen levels
32:59are normal. So that's really good. So I don't think you need any more antibiotics for now,
33:02which is great. No, I've got a spare set. See how you go. Yeah, absolutely. I'll send
33:06the... If I can just get the microphone. All right. Take care. Any problems, just let
33:11us know. Thank you very much. My pleasure. You're very welcome. Thank you for taking that.
33:15My pleasure. You're very welcome. All right. Bye now. Bye.
33:32Edward. Come on through. Hi. Come on in. Have a seat. How are you? Well, not bad at the
33:54moment, but on Sunday, all of a sudden, I had this blackout. I fainted. I fainted just without
34:01even any... I didn't have any anything. It just happened? Just like that. Okay. Did
34:06you fall? I was falling, but it just happened that I was at the rail where you can't support
34:12yourself. It was just closed and I just grabbed it. Okay. Did you think you lost consciousness
34:17or you felt like you were about to? About to. About to. Okay. Yes. And I stayed there for
34:2310 minutes, I think. Okay. Then it subsided. Okay. And what did you feel? Just like everything
34:31was... Yeah. So you felt really lightheaded. What about any pain in the chest? I could feel
34:37the chest tightness. And so then you went to A&E yesterday. Yes. What did they do there?
34:44Yeah. And then they gave me this medication. But... For dizziness? Okay. Did they do any
34:50blood tests? They didn't, like, take the blood. They didn't take the blood. Okay. And did
34:53they do an ECG? Did they stick stickers on your chest? No. They didn't. They didn't do
34:58that. Okay. They told me that my pressure was too high and then they told me to talk to your
35:05GP. Okay. And right now you feel fine? I still feel a little bit... Okay. Let's check your
35:12blood pressure today. Okay. Just pop it on. So just relax. Just a deep breath in and out
35:22for me. Okay. Deep in and deep out. Just really try and slow your breathing down for me. That's
35:33good. Just stand up for me. That's fine. You can have a seat. Okay. So your blood pressure,
35:46I mean, it's a little bit lower standing, but it's not really low. Okay. So I just want you
35:52to look straight at me. Okay. And I want you to follow with your eyes. Good. Eyes really
36:07tight. Perfect. Shimmer your teeth. Like that. Can you stick your tongue out? Wiggle it from
36:14side to side to side. Yeah. Perfect. And puff your cheeks out. So just like this. That's
36:21fine. I'm just going to touch your face. You can relax it. Does it feel the same on both
36:24sides? Yeah. Okay. Okay. I'm going to have a quick listen to your heart. Okay. Have you ever been told you've got a
36:44murmur of the heart? What's that? A murmur is when we listen to your heart and we hear a sound. So
37:10normally we want it to go da, da, da, da, da, da, when we hear your heart beating. So in your case
37:16today, what I hear is like a whoosh, da, whoosh, da. But it's quite loud. So sometimes it can mean
37:21there's an issue with the valve. Okay. Some people will always have had murmurs. And sometimes it can
37:27be new. Okay. What we need is we need to get some blood tests done. We need to get an ECG done. Okay.
37:35And we need to sort out this new murmur and whether that's relevant to the dizziness that
37:41you're having. Okay. Okay. Because obviously if it's linked to the heart, we might need to
37:47get you seen by cardiology. Okay. I'll give you a blood form. Okay. And I'll call the cardiologist.
37:55Okay. Just in case they want to see you. Okay then. Yes. Yeah. Yeah, sure. Can it develop into
38:03something else? I think my concern is that you saw cardiology not that long ago and had lots and
38:08lots of investigations and there's no mention of a murmur. So what I want to do is just make sure
38:14that it's nothing that to do with the heart. Okay. Does that make sense? Yeah. Let me give you a letter
38:20and then you can take it to Chelsea A&E. Sometimes when you're stressed. Yeah. It can be one of the
38:29reasons why I've been here going through some, because I've been going through a lot of worries
38:37and of course worrying about my work. Okay. Created such a terrible anxiety. I couldn't sleep. Do you still feel you're dealing with a lot of issues?
38:48Yeah. I'm so sorry. I mean, you're right. Stress can cause lots of symptoms. Okay. And I think today we need to
38:57make sure it's not related to your, your heart. But I think once, once you've been seen by A&E and we know
39:03it's nothing to worry about, then why don't you come back and we can talk about all the anxiety and the stress
39:08and things. So if you take this to, to A&E, so that's just me asking that they urgently assess you with the ECG
39:14and view of the history. All right. Okay. Thank you. That's all right. Thank you. All right. I'll have a
39:23look later once you've been up at the paperwork. Okay then. All right. Nice to see you. Nice to see you. Bye. Bye.
39:29Bye. Now how are you? What's happened? Oh dear. I can't sleep because I can't lie down. I get ear
39:43raked if I lie down. Last night I probably got up 20 times. Oh no. To have a good sleep. That's actually
39:51one of the most important things for our health. It's supposed to help stop the nerve firing a bit
39:57at night. It makes you quite sleepy. You know, maybe taking it at night might be a good idea. Yeah.
40:02I could do the sleep. Yeah, exactly. I'm tired. Tell me what's been happening. Well,
40:11I'm feeling very tired. Yeah. And sleeping is a problem. Okay. Basically I don't have a problem
40:22falling asleep. Yeah. It's just within seconds. Yeah. Yeah. But I wake up between two and three
40:28and then I can't get back to sleep again. Yeah. Yeah. Okay. Which is irritating. Yeah. This all started
40:36really once I started taking beta blockers. Is that, could that be something? Beta blockers can
40:41definitely cause fatigue. Medication is very much related to it. I'll check your blood pressure
40:47now anyway. But how long do you feel it's been going on? For at least nine months. Anything else
40:54changed? You're not stressed particularly? Not more stressed? And of course between two and three
41:00I have to go to the loo. Yeah. That's sort of, you know, standard. Once. Once. Once. You get,
41:07you don't go more than three times at night to pee. No. Generally. Without. No. If you haven't been
41:12drinking a lot, it's fine. Waking up early, that, you know, can be a sign of other things like stress,
41:18like anxiety. Do you exercise? All the time. I cycle. Yeah. I play tennis. Yeah. So with all that exercise,
41:26sounds like you do need some sleep. I see. Maybe I shouldn't. Full blood count, normal. Good red and
41:36white cells. Liver function tests, great. Cholesterol fabulous at 4.8. Well done. Um, I don't know how you
41:46feel about it. If we gave you sort of maybe five sleeping tablets to try and get you out of that
41:56couch 22. Because is this happening? It's a routine. That's it. Yeah. See if it's, you know, got you
42:02through and stop that cycle happening. Obviously don't take it on consecutive nights because then,
42:10you know, you get addicted and you worry about not having it. Yes. Yeah. What I'd like you to do is
42:20take it, um, sporadically, meaning not every Tuesday. Don't make it regular. Yeah. Okay. If that's not
42:30helping, you know, there are therapists out there and we can refer you to just like talking therapy and
42:35cognitive behavioral therapy, which we can refer you to where they're teaching you coping techniques
42:42for waking up early. Yeah. Perfect. Okay. Lovely. All right. I'll send you in a point. Okay. All right.
42:47Nice to see you. Take care. Have a good day. Take care. Thanks.
42:56Thank you very much. Okay. Not at all. Nice to see you. All right. Take care. All the best. Bye-bye.
43:07Take care then. We'll see you again. Bye. Take care. Bye-bye.
43:11Have a good afternoon. Bye-bye. Bye.
43:16Yep. Don't go without that. All right. Nice to see you. Take care. All the best. Thank you. Bye-bye.
43:20Bye-bye.
43:20Bye-bye.
43:26Bye-bye.
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