- 6 hours ago
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00:00Morning surgery you told somebody that you're starting to struggle at home really I think
00:16people put things in my mouth at times do you feel okay in yourself I'm sweating like hell
00:24do you have any other medical conditions how long have you got you can't be you're too busy to be
00:34here you've got your restaurant if I'm home you know I'm working more than what I'm doing at the
00:39restaurant too busy to be here on Sunday all of a sudden I had this blackout faded it just happened
00:48just just just like that
01:03Morning.
01:05Morning.
01:23With you?
01:24Hello.
01:25Come on through.
01:26It's nice to see you.
01:26I've not seen you for a while.
01:28No, but I remember you.
01:30Now tell me, how are you?
01:31I've got doctoritis.
01:33It was absolute agony yesterday.
01:36I mean, it's been getting bad, this knee here.
01:38Okay.
01:39For about a week.
01:40Okay.
01:40And then last night, I mean, I could hardly sleep.
01:42Oh, no.
01:43And I rang you.
01:44And, I mean, it still hurts, but it's, I can walk on it.
01:47We cured it on the telephone call.
01:48I mean, how do I do?
01:50I'm so sorry.
01:51No, no, no, don't be silly, don't be silly.
01:52Because obviously something's going on causing all that pain.
01:54So, no twisting or you didn't slip or bang it or anything recently.
01:57Not that I can remember.
01:58Okay.
01:59Okay.
01:59And the pain, describe what you were feeling the other day, yesterday.
02:03And things, what does it feel like?
02:04Well, it's like a sort of two notes on the piano that was all steady to ache.
02:08Okay.
02:09And then occasionally, like that.
02:12Okay.
02:13And did it stop you doing things?
02:14Like, was it affecting you?
02:16I didn't go for my daily walk.
02:18Okay.
02:19Did you do anything yesterday to make it get better?
02:21Did you take any medicine or strap it up?
02:23I had a couple of cocodomol or something like that.
02:27Yep.
02:27Yep.
02:27Good.
02:28Do you mind if we have a look at your knee?
02:29Absolutely not.
02:29Would that be all right?
02:30Now, we can come and sit on here.
02:31Let me just have a look.
02:33Are you all right?
02:34Yep.
02:34I'm just going to have a look at your good knee, first of all.
02:36If I press round, any pain there at all?
02:38No, none at all.
02:39Nothing.
02:39If we bend it.
02:41And if I press it.
02:42No, no.
02:42The left has never given me trouble.
02:44I'm pushing it.
02:45Nothing.
02:45I'm just going to pull it.
02:47No problems.
02:48Okay.
02:48So that knee looks pretty sturdy.
02:50Well, it's never been wrong.
02:51Never been wrong.
02:52Right.
02:53And I'm just going to press round.
02:54So tell me of any place I press.
02:55There.
02:56That one.
02:56There.
02:56So, and is it on the inside?
02:58Yeah.
02:58Oh, sorry.
02:59No, no, no.
02:59So this is where it's been.
03:01Then you can guess.
03:02Yeah.
03:03Or gauge.
03:04If we bend it up like the other one.
03:05And if I press in again, it's here, is it?
03:07That's there, yes.
03:08So it is down this side is where it's sore, isn't it?
03:11It's not grossly swollen, which some people are.
03:13No, no.
03:14But it's not quite right.
03:15It's doctoritis.
03:17I think there might be something going on in your knee, to be honest, William.
03:20I think we need to look into it.
03:21Come and get yourself down.
03:22Let's put these.
03:22Come on.
03:23Here we go.
03:24Let me just.
03:24Are you all right on there?
03:25Let me just wash my hands.
03:25I'm fine.
03:26The thing is with knees.
03:28But it's.
03:29They're pretty important.
03:31Come and have a seat.
03:32I think looking at the knee, there's a bit of swelling and it was tender and it sore on that inside.
03:37And what happens if we look at the knee joint, what I'm worried about is that if there's a bit of rubbing.
03:42So what happens is the little bits of bone sort of end up jarring a little bit.
03:47When we bend it or when we move it, sometimes it can just start rubbing a bit.
03:51If that is the case, why didn't it hurt straight away?
03:54So you're quite right.
03:54If we x-rayed you every day last week, the bone hasn't changed suddenly.
03:58But what's happened, sometimes it can be the way we've sat or we've just moved or we've done the gardening or something's happened.
04:05And then suddenly we get inflammation around it.
04:07The bones are starting to get a bit worn away.
04:10And then what's happened is it's all become inflamed.
04:12And that's why it becomes very sore very quickly.
04:14So the arthritis, which I suspect this might be, hasn't developed yesterday.
04:18You know, your bones are 76 years old.
04:21This hinge has been going for 76 years.
04:23Almost 77.
04:24There we go.
04:25So 77 years almost this hinge has been bending.
04:27And if you think of a door and anywhere else, it's not surprising it gets a bit of wear and tear.
04:31Yes, I'm sure.
04:32Do you understand that?
04:33The thing is, is that they don't like us calling it wear and tear because wear and tear implies, well, don't wear it out then, rest it.
04:38But actually, it won't get better if you rest it.
04:40And it's really important you keep walking for all the other health benefits.
04:43So what we ought to do is, why don't we get an x-ray of your knee, have a look at it.
04:47Sure, that'd be great.
04:48So I'll send the x-ray form, which you can go down for any time.
04:51And we'll ring you with the physio.
04:52You're adorable.
04:53Thank you so much.
04:54We'll get you sorted.
04:54But keep on your feet.
04:55You're not doing anything wrong.
04:56You're doing it all right.
04:57And I think it was quite right you came in today to get it checked.
04:59Oh, you are kind.
05:00Well, thank you very much indeed.
05:01You take care.
05:02Nice to see.
05:02All the best.
05:03Bye-bye, Strut.
05:03Bye-bye.
05:04Oh, it's that way there.
05:04Yeah, that way, yep.
05:05Different room.
05:09Lucas, please.
05:10Oh.
05:11Hello.
05:11Hello.
05:13How are you both?
05:14Fine, thank you.
05:15I've just been reading all about you.
05:17I'm George, one of the doctors.
05:18Lovely to meet you.
05:18Hi.
05:19Take, see if you make yourself comfortable.
05:20How are you doing?
05:21Good.
05:22Oh, bless you.
05:22What happened?
05:24Can you tell a story?
05:25We were staying with some friends in the country, and they were all playing football outside.
05:29And the kids were having a glass of water.
05:31Someone kicked a football, which hit the glass, which went into his, yeah, so it was pretty
05:39deep.
05:40Luckily, it didn't go all the way through, but he had to have stitches.
05:44Good.
05:45And they've removed all the foreign bodies, nothing.
05:47Well, they gave it a good clean.
05:49But the reason I'm here is it's quite boring, really.
05:51They gave him antibiotics, and it's supposed to be 10 mils three times a day for five days,
05:56but they only gave me 100 mils.
05:57A little bit more.
05:58So we've now run out.
06:00Yeah, absolutely fine.
06:00But as we're here, I just wonder if you could have a look anyway, and just see.
06:05Okay, well, let's check a few bits for you.
06:06Not a problem at all, and then we can get that prescription done.
06:10Let's have a closer look.
06:11Is the pain okay?
06:12Is it sore, or is it not too bad?
06:13No.
06:14Oh, you're brave, aren't you?
06:15Hard as nails.
06:16I love it.
06:17Yeah, it's good.
06:18It's healing nicely.
06:19I'm just going to...
06:20Yeah.
06:21I mean, they're sticking out a bit, the stitches.
06:23Yeah, that's fine.
06:24I wasn't sure if I should try and snip the ends, but I don't really trust myself to do
06:28it necessarily a great job.
06:30They're dissolvable ones, aren't they?
06:32They are, yeah.
06:33Yeah, so they all dissolve really nicely, and then whatever's left over, you're right,
06:36you can just snip, but we can do that for you.
06:37Yeah.
06:37Lovely, good.
06:38Can you open your mouth for me?
06:40I'm just going to lift this lip up a little bit, just to check your gum is okay.
06:44Good.
06:44I don't want to press too hard.
06:47Lovely.
06:47Absolutely fine.
06:48Are your teeth wobbly at all?
06:50No, but he says it hurts, and he touches it, but I don't know if that's just the gum
06:54being bruised.
06:55Yeah, a bit inflamed, absolutely.
06:56Yeah, exactly.
06:58I'll just quickly check your temperature, and then send this.
07:00So, well done.
07:01You are brave.
07:01Goodness me, that's...
07:03I'm in stitches.
07:04Not fun.
07:07Yeah, I think it was five or six or something in the end.
07:11Temperature's normal as well.
07:12Brilliant, lovely.
07:13Leave that with me.
07:14Get that sorted.
07:14Any problems, just let us know.
07:15Okay, perfect.
07:16Thank you very much.
07:17Take care.
07:17Pleasure.
07:17You're very welcome.
07:18Bye.
07:18All the best.
07:31I've got so much anxiety about going away.
07:33I always get like this before I go, but you should see me.
07:35What I do is, before I go away, I have a to-do list.
07:38You know, like, referrals need to be done a certain way, and then you have to print it
07:42off so I can check it when I come back.
07:44Are you going to give me a list of stuff to do?
07:45No, it's just one list that everyone works on.
07:48Oh, I see.
07:50Yeah.
07:50Yeah, so maybe you're a bit controlling.
07:54Thanks.
07:54Doris.
08:02Hello.
08:03Pardon me.
08:09Oh, different room today.
08:14Right.
08:17You okay, then?
08:18So, Doris, you're nice and early, and we have a double appointment booked.
08:24We have lots of time.
08:25What have I got coming for?
08:27Oh, you're not sure?
08:28No.
08:29Okay.
08:29No, one's told me nothing.
08:31Oh, right.
08:32Okay.
08:33My understanding, Doris, is that you told somebody that you're starting to struggle at home.
08:39Well, not really.
08:41I think people put things in my mouth at times.
08:45I mean, I don't say I struggle.
08:51I get in and out of bed okay on me own.
08:54I've got one of those little other things.
08:57Yeah.
08:58The worst part for me is loneliness.
09:01Loneliness?
09:02Yeah.
09:02Yeah, because I'm on my own, and now the two people that looked after me, they've moved
09:09now over the other side, so I've lost them.
09:13Yeah.
09:13Sometimes I wake up and think, why am I still here?
09:17Yeah.
09:32You've mentioned kind of feeling, like, what's the point going on?
09:39Oh.
09:39I want to explore that a little bit more, and I have some specific questions that I want
09:44to ask you, and I notice that you do take an antidepressant medication.
09:49You take a very, very low dose of sertraline.
09:53I also take tablets for a panic attack.
09:56You do.
09:57The questions I'm about to ask you, Doris, are specifically designed to assess for any
10:01features of depression in people who are older.
10:05So, over the past week, do you feel that you are basically satisfied with your life?
10:12Yes.
10:13Good.
10:15Over the past week, have you felt like your life is empty?
10:19Oh, I suppose there's more to me, like, when you're on your own.
10:22No, I've never even given it a thought, actually.
10:31No.
10:32Do you often get bored?
10:35Bored?
10:36Yeah, bored.
10:37No, I don't think so.
10:39I've got a habit now, doing scratch cards.
10:44No, I read, I watch telly, I've got scratch cards.
10:48Are you in good spirits most of the time?
10:50Oh, yeah, yeah, I enjoy my own company at times.
10:54Good.
10:55Are you afraid that something bad is going to happen to you?
10:59No.
11:00Good.
11:00No, not really, I don't think about it.
11:02Great.
11:03Do you feel happy most of the time?
11:05Most of the time.
11:06Do you often feel helpless?
11:09No.
11:11Do you feel that your situation, Doris, is hopeless?
11:14Oh, no.
11:15Good, good.
11:16And do you think that most people are better off than you?
11:21Well, younger than me, yeah.
11:24I think probably there's people that are worse off than me.
11:28Hmm.
11:30Better off than me.
11:31I wouldn't like to answer that one.
11:33Okay, that's fine.
11:34It's actually quite nice to hear you, some of those answers to that question.
11:37I think that one of the things that you said matters most to you and is your priority is this loneliness.
11:44I think so, really.
11:46For now, we won't do anything with regards to getting...
11:49No, if there's anything desperate, I will...
11:52What I do want to do, if it's okay, is ask our social prescribers to visit you so that they can give you some help with this feeling of loneliness.
12:03Oh.
12:03And I've got a plan in place for that. We'll see how it works.
12:06Okay, well, I'll...
12:07Thanks, Doris.
12:08When talking to Doris about what matters most to her, having more care and more support wasn't high on her agenda.
12:14Would you do me a favour?
12:16Would you weigh me?
12:18Yeah, you can get onto her scales.
12:20She's still fiercely independent, and even though some of our colleagues might have thought she would benefit from extra support,
12:26she's perfectly entitled to say no, thank you for that help right now.
12:29And, of course, if anything changes, we can revisit that.
12:3343 kilograms, that says.
12:35What's that?
12:36I'll convert it for you in a minute.
12:38Let me move that out of the way.
12:4043 kilograms.
12:42I can't be much slower than that, I don't think.
12:45I eat a lot of chocolate.
12:47So, this is 43 kilograms, so it's just over six and a half stone.
12:54Six and a half?
12:56I put on a bit then.
12:58You are putting on a bit.
12:59That's made my day.
13:01Do you eat meat and fish?
13:02Protein is important to keep your muscles strong in older age.
13:06Which is the best one?
13:07You get that from most meat sources.
13:09Meat.
13:10And from some vegetables as well.
13:11Yeah, and meat and vegetables.
13:12And things like cheese.
13:13So, I eat a lot of chocolate.
13:17That's good for me, isn't it?
13:19You've got to enjoy these things.
13:21All right, my lover.
13:22Thank you very much.
13:22Thank you, Doris.
13:23I've had this really itchy skin thing, basically.
13:29And where does it affect you on the body?
13:31I don't know if you can see, but kind of small bumps under my skin.
13:34Last September, I suddenly got the most awful eczema and itches from head to foot.
13:41I keep getting loads of just random spots on my arm.
13:44What do I do about this?
13:45And my hands were so, so sore.
13:47They felt as if I was holding thistles.
13:50Moisturize, moisturize, moisturize.
13:51Got this funny thing here.
13:54What I do think that is, is something called an actinic keratosis.
13:57Okay, English.
14:01John?
14:02Yep.
14:05So, they're going to run the show today.
14:07Are they?
14:07If that's okay, does that work for you?
14:10I'm going to be here listening.
14:11Okay.
14:12Have a seat.
14:14So, hello there.
14:16My name is Sharomi.
14:17I'm one of the medical students.
14:19Okay.
14:19Hello.
14:20So, can you just tell me about why you've come in today?
14:23Just a penile rash.
14:26There's sort of a slight ring around the stalk of the penis.
14:30Is it itchy?
14:31I'm conscious of it, a feeling.
14:34I wouldn't call it pain or I wouldn't call it an itch.
14:37You're just aware that it's there.
14:39Yes.
14:39There, okay.
14:41And have you been seeing any discharge?
14:43No.
14:44Or anything?
14:44Like, has it been, like, flaking?
14:47No.
14:47It's just red?
14:49Yes.
14:50Okay.
14:51Do you have any other medical conditions?
14:53How long have you got?
14:54I have the typical medication of someone of my age for cholesterol and blood pressure.
15:02Blood pressure.
15:03And that's for high blood pressure, right?
15:05It is.
15:06That's okay.
15:07And if it's okay to ask, have you been having any, like, sexual activity recently?
15:13No.
15:13No?
15:13No, okay.
15:15Yeah, okay.
15:15So I think that's it for me.
15:18How did she do?
15:20Terrific.
15:22So what are you going to do, doctor?
15:24So I think we're going to do a swab just to see if there is any infection, I guess, or
15:31to see, like, what the causative agent, I guess, is.
15:35There you go.
15:36I think so.
15:37We'll be doing it.
15:38Yes.
15:39Joint.
15:43Culeen, please.
15:45Hello.
15:45Hi.
15:45I come through, take a seat.
15:51I'm George, one of the doctors.
15:52Nice to meet you.
15:52How are you?
15:53I'm fine, thank you.
15:54And yourself?
15:54Lovely.
15:55Yeah, good, thanks.
15:55How can I help today?
15:57I have a condition called HS.
15:59Yep.
15:59But I've got a lump under my arm, and it doesn't look, it's not the same characteristic, so I
16:04just want to make sure.
16:06HS, or hydradonitis suppurativa, is a chronic skin condition.
16:09It's characterised by the formation of skin tracts or sinuses that form from the surface
16:14of the skin and they migrate in.
16:15They can often get infected and be very difficult to live with, very painful, very itchy, very
16:20uncomfortable.
16:22And when did you first notice it?
16:23Monday.
16:24And then it's just...
16:24Getting bigger.
16:25Yeah.
16:26Yeah, is it painful?
16:26Yes, it is.
16:27Anything coming out of it?
16:28Any discharge?
16:29No, it's quite soft, though, in certain areas.
16:32Yeah, fair enough.
16:32And do you feel okay in yourself?
16:34Any fever, nausea, vomiting?
16:35I'm sweating like hell.
16:36Are you?
16:36Yeah.
16:37Do you think it might be related or hard to tell?
16:39It's hard to tell.
16:40Hard to tell.
16:40Fine.
16:40Any infective symptoms at the moment?
16:42So, like, coughs, colds, runny nose, and another chest infection, nothing like that
16:46at all.
16:46And nothing in the run-up to this, so last week or anything.
16:49And whereabouts?
16:49Is it under the armpit?
16:50Yeah, just under the armpit.
16:51Yeah, fine.
16:51Would it be okay to have a look?
16:52Yeah, that's right.
16:53Is that all right?
16:54Look, let's see.
17:01Oh, wow, yeah, it's big.
17:03Oh, bless you.
17:07Sorry.
17:08Quite a bit.
17:09Yeah, it's got a punctum.
17:13I think it's a cyst.
17:14Okay, so it's the HS.
17:16It might be the HS, but it could be, you know, a different sort of cyst altogether.
17:20So, yeah, it could be, it may not be related to the hydrodonitis.
17:23It's tricky.
17:23It doesn't sort of look actively infected.
17:26But I do wonder if we should, just in case, give you some antibiotics.
17:30That word again.
17:32I know, I'm so sorry.
17:33Well, we don't have to.
17:34We could adopt a wait-and-see approach and say, look, give it a couple of days.
17:37And if in the next 48 hours or 24 hours, it's regressing, getting smaller, getting less
17:43and less painful, fine, you don't need anything.
17:44If, however, in that time frame, it's getting bigger, redder, angrier, more painful, then
17:49unfortunately, we probably should, you know, try a course of antipasics, especially with
17:53your diabetes as well.
17:54We need to be very, very careful.
17:56Before you go, just to make sure that there's no sign of infection in the body, can I just
17:59check your heart rate and oxygen levels?
18:01Is that okay?
18:01And then your temperature as well.
18:07So, the oxygen levels are perfect, 96%.
18:09So, that's really good.
18:11Just checking the temperature there.
18:12Ignore the beeping, it does that.
18:15Lovely.
18:15Temperature 36.2, heart rate is less than 100, so absolutely fine.
18:18It's perfect.
18:18It's really good.
18:19Brilliant.
18:20See how you go.
18:20Any problems, just come back.
18:22All right.
18:23My pleasure.
18:24You're very welcome.
18:24Take care.
18:25Perfect.
18:34You see this ring around there, and you see the redness under there.
18:38Inflamed, isn't it?
18:39Yeah.
18:39It's not normal to have that.
18:42I can definitely see it's marked inflammation.
18:46And does that irritate you?
18:49Well, I'm conscious of it.
18:50As I said, I can feel it, but it's not pain, and it's not an itch.
18:54I don't have to scratch it, that sort of thing.
18:57There you go.
18:58Good luck.
19:00Yep.
19:01I'll just keep going.
19:03I'll do the other bit as well.
19:06Good.
19:06Yeah, it looks quite sore, doesn't it?
19:09There we go.
19:12Perfect.
19:12Well done.
19:13Yep.
19:14All done?
19:14All done.
19:15Yes.
19:16All right.
19:17So we're going to send that away.
19:19Okay.
19:20But I'm going to give you some treatment anyway.
19:22What treatment would you suggest?
19:29You mentioned.
19:30Oh, caniston, or the oral flu.
19:33Fluor.
19:34Mm-hmm.
19:35Fluornazole, that's it.
19:36Perfect.
19:37So, yeah, she mentioned an oral tablet.
19:42Treat you from the inside.
19:44One-off tablet, and the cream.
19:47Yeah.
19:48Two-pronged attack.
19:49What is that likely to be?
19:51It is a...
19:52This?
19:53Yes.
19:53Yeah, I mean, it looks like a thrush, basically.
19:56Inflammation.
19:58No funny smells or anything.
19:59No.
19:59You don't get any other discharges or anything like that.
20:01No.
20:02Excellent.
20:04So, that takes a few days to get the result, but I'm sure it'll be, you know,
20:09I'm sure it'll just come back showing a yeasty infection.
20:13Looking at him, what are you thinking?
20:16What's he dressed as?
20:17Oh, tennis player?
20:19Maybe.
20:21So, I mean, sports, you know, all goes with thrush, basically.
20:26Loves hot, sweaty environments.
20:28Oh, right.
20:29Yeah.
20:29So when you do...
20:30I should lead a more sedate life, is that what you're proposing?
20:33Not at all.
20:35So, you're going to get one capsule and some cream.
20:38Okay.
20:39You're going to use the cream, smearing it round the end, and it should settle down for a while.
20:46But because you enjoy the sport and stuff, it can just occur again.
20:51Always worth having the sugar test, which we do anyway.
20:55What's the correlation there between a penis and a sugar reading?
20:59So, a high sugar in your urine, which you might do if one had diabetes, allows yeast to grow.
21:06Oh, right.
21:07It feeds the yeast.
21:07So, if you put...
21:09Like something to do?
21:10Mm-hmm.
21:11Yeah.
21:12For you.
21:13Tim, thank you.
21:14Right.
21:14And thank you for talking to them.
21:15It really helps.
21:16Thank you very much.
21:17Thank you, ladies.
21:17Almost there.
21:18Bye.
21:19Bye, ladies.
21:21Tim, thank you.
21:21Yeah, no problem.
21:22Take care.
21:23Bye.
21:25The men are really bad at generally coming to the GP, but John was very staunch and very
21:33game on for showing the students, which was great because they're one of the biggest trainers
21:37of doctors in London.
21:39And I think they did really, really well.
21:44How did that go?
21:46That was good, yeah.
21:47Yeah.
21:48He was comfortable talking to you.
21:51You were asking all the right questions.
21:53Yeah, I thought you were brave doing the sexual history.
21:56Well done.
21:58Yeah.
21:59Yeah, and your examination and taking this all good.
22:02So we're here today because?
22:15Because of my medication.
22:16I know.
22:16You know what I'm going to say.
22:18It's good to see you looking well.
22:19I'm absolutely fine, actually.
22:21You know that.
22:21I know.
22:21Yeah, yeah.
22:22But you were fine when you had a bit of a twinge in your chest.
22:25Yeah, exactly.
22:25But when we got you up to the hospital, you weren't actually fine.
22:28They said, oh, you have, you know, had a heart attack.
22:32Yeah, exactly.
22:32And that's the thing.
22:33So you had a heart attack, which just meant that there was a blockage there again.
22:37And you had, obviously, how long ago was the previous heart attack?
22:3917, isn't it?
22:4016, 17.
22:41Okay, so 16, 17.
22:42And then it was this March time sort of thing when we got you to go back up again.
22:46And it was such a mild symptom, wasn't it?
22:49It was a bit of a warning.
22:50So I think, I suppose, two things.
22:52One is, that's a big learning point, that if you get any funny twinges or difficult or funny,
22:57just go and get it checked.
22:58Because if they do an ECG and that blood test and it's not your heart, they'll kick you
23:01out straight away.
23:02Yeah, exactly.
23:02But if it is your heart, you're in the right place.
23:05But what I'm worried about with your medicine, and I know I've heard on the grapevine that
23:10you're not taking all the medicine at the hospital.
23:13No, not the medicine which they have given because, you know, I wasn't feeling right with
23:18them.
23:18These tablets, actually, they're not making me feel better.
23:21They're making me feel ill.
23:22Never take pills.
23:38I know.
23:38If you can avoid them, they're best avoided.
23:40But sometimes they are needed.
23:42Lordy, dordy.
23:43Look at all these.
23:44I know.
23:45Is there side effects from it, or what?
23:47Of course there are loads of side effects.
23:48Jeez, oh, yeah, absolutely.
23:50Aspirin, yes.
23:51Folic acid, yes.
23:53Stomach bone, yes.
23:54Statin, yes.
23:55Thank God for that.
23:57I've spoken to a few people, and when they tell me how many, you know, medications are
24:02on, I went, what?
24:03Yeah.
24:04I mean, you're doing really well.
24:05I couldn't believe it, you know.
24:09Problem is, I think, that we suddenly threw loads of new tablets on you.
24:13You fell ill.
24:14We've stopped them all and gone back to what we were on before.
24:16Yeah.
24:17But what worries me a little bit is that when you had the first heart attack, the blood
24:21vessel was blocked, and they put a stent in.
24:23Yeah.
24:24And when you had the second one, when they've gone back, it's dilated.
24:27There's a bit of what they call a sort of aneurysm.
24:29There's a dilation around it, and the problem is blood sits and clots in those dilated bits.
24:34Right.
24:34So, they're worried that just one blood thinner isn't quite enough.
24:39Okay.
24:40Then they look out and think, well, hang on, the cholesterol was part of the problem in
24:44the first place.
24:45It blocked things.
24:46And that your cholesterol was still a bit raised, despite being on the maximum dose of
24:52statin.
24:53So, that's why they added in the other one as well.
24:55Okay.
24:55Now, I was thinking one option is, what about if we look at all the new tablets, prioritise
25:01which are important, and try one at a time.
25:03That's good.
25:04And then, if you feel unwell, we know that that's the only change that's been done, so
25:08that is the tablet that doesn't suit you.
25:10That's fine.
25:11And I know, I can't bear patience on lots and lots of tablets, but every single one
25:16of those is individually doing a really important job.
25:19And you're young, you're fit, you're healthy, you've got your wife, you've got your family,
25:24you've got your grandchildren living with you.
25:25You can't be ill.
25:27You're too busy to be ill.
25:27You've got your restaurant.
25:28Yes, I am too busy to be ill.
25:30I'm telling you, if I'm home, you know, I'm working more than what I'm doing at the
25:34restaurant, because five of them are on me.
25:36I know.
25:37So I think what we need to do is think, it's not ideal being on all these tablets, but
25:42I genuinely think that if we want to keep you from not having strokes, not ending up
25:47in hospital or sick, or not being able to do things, or ultimately the worst thing of
25:52dying, then actually we need to look and try and get you on these tablets to try and really
25:58improve the outlook going forward.
26:01We will try, you know, whatever it is there, you know, I'll try.
26:05But one more thing I want you to know, did you get the result from the cardiogram?
26:09It was good.
26:10It's pretty good.
26:11All your heart muscle is pretty good.
26:14Yeah, they're all fine.
26:15We've got a good heart, but we need to keep it that way, because reality, if you stopped
26:20all of it and didn't exercise and ate what you wanted, blah, blah, blah, pretty much you
26:25will have more heart attacks, so we don't want that to happen.
26:28So they want you to stop the aspirin now and just continue this other blood thinner,
26:32rivaroxabam, with the clopidogrel.
26:34Okay.
26:34Okay.
26:35Why don't we just do that one change today?
26:37Okay.
26:38And then if you feel awful, you let us know, let me know, let me go.
26:41We can then, we'll stop it.
26:43Yeah.
26:43Okay, that one, and we'll see if there's an alternative or a sister one or something
26:46that doesn't make you feel ill, and then we'll look at the other ones.
26:50Okay, that's fine.
26:50We'll review it, we'll see, and then we'll move on to the next one.
26:53We'll do that.
26:53Okay, and we'll get you to 100.
26:56That's the plan.
26:58That's the plan.
26:59All, all, all we stay together.
27:00Oh, exactly.
27:01No chance of getting away from me, and I'll keep nagging you.
27:04And any problems, if you find you haven't got the tabletopal,
27:06or you're not sure, or someone's thrown them out or something,
27:08just give me low, and I'll put them straight.
27:09No, no, we will have them, I'm sure, I'm sure.
27:11Okay, perfect.
27:12Save you with more boxes.
27:12Thank you so much.
27:13All right, no worries, I'll speak to you in two weeks.
27:14Yes, we will.
27:15All right, thanks a lot, Muhammad.
27:16Bye-bye, Zita.
27:16Bye-bye, bye.
27:17Bye-bye, bye.
27:19What happened to not drinking?
27:23Red Bull.
27:24Ha, I know, I shouldn't.
27:26I'm actually quite concerned for you.
27:28Stop drinking it.
27:29Yeah, okay, I promise.
27:32Let's cut it down to one a week.
27:34God.
27:35All right, Mum.
27:36This is my last one, I promise, on everything I love.
27:42So tell me, what's brought you in?
27:44I'm having serious problems with my ears.
27:47Okay.
27:47Originally, I thought it was tinnitus.
27:49My mother gets tinnitus.
27:51I don't think it is.
27:53I've been using a tinnitus relief spray.
27:55Nothing is helping.
27:57They suddenly just get blocked and sore, and I then can't hear properly out of this ear
28:03specifically.
28:04Okay.
28:05And then I get a headache.
28:06Okay.
28:07And I don't know what to do.
28:08Okay, so how long has this been going on for, for you?
28:10For six weeks.
28:11Yeah.
28:11So, you mentioned tinnitus.
28:14Are you having ringing in the ear?
28:16I mean, everything sounds really hollow and slightly just...
28:19Like you're underwater, kind of?
28:21Ish, yeah.
28:22Yeah.
28:23Okay.
28:23And any vertigo symptoms?
28:25So feeling of the world spinning around you?
28:27Occasionally, yes.
28:28Occasionally.
28:28Okay.
28:29Because you're my stand-up.
28:30Okay.
28:30And how long do those episodes last for?
28:33I stand up, I sway, and then I'm fine.
28:36Okay.
28:37So, short.
28:38Any sore throat or cough?
28:40I've had a bit of a sore throat this week, but...
28:44And what about a stuffy nose?
28:46A little bit, but not...
28:47A little bit.
28:48Okay.
28:48Will we have a look?
28:50Please?
28:52Lovely.
28:53So, I'm going to look in the normal ear, or the less severe ear first, if that's okay with you?
28:58No, that's fine.
28:59That is perfectly normal and very clean.
29:04I do try to keep them clean.
29:05Good.
29:08That looks fine as well, actually.
29:10There's no redness.
29:11It doesn't look inflamed, or it doesn't look like it's bulging, so it doesn't look like there's an infection there.
29:16Okay.
29:17Can I have a look in your throat?
29:19So, just open your mouth and say, ah.
29:23Yep.
29:24Okay, that's fine.
29:25So, no swelling of the tonsils.
29:26I'm going to feel your lymph nodes in the neck.
29:31Okay.
29:32Alrighty.
29:33So, what I think is going on is actually you to do with your eustachian tube.
29:37So, I think that may be blocked and causing you the popping and the fullness feeling and the discomfort.
29:43So, I think if I give you a nasal spray, which sounds probably...
29:48Odd, but fine.
29:49Yes.
29:50It's worth trying.
29:51I think that actually it will really improve things for you.
29:54I will also give you a spray for your ear, just to make sure if there's any inflammation in that ear that's causing the discomfort, that that's also covered.
30:03Perfect.
30:04Thank you so much.
30:05I really appreciate it right now.
30:06I'll leave now.
30:07Fine.
30:08Thank you so, so much.
30:09No worries.
30:09Mind yourself.
30:09Thank you so much.
31:12Yeah.
31:12I know.
31:13That's just a bit of cool salty water, which will just clean the area to make sure I don't introduce any bugs.
31:22Got much planned for today.
31:25You know, I'm not going to cut late now.
31:34Sorry.
31:35Doing really well.
31:35there we go done well done you did really well excellent brilliant let's just make sure that's
31:46okay yep lovely i was just removing the sutures from the site they had not dissolved and um yeah
31:55we needed to just get them out uh otherwise they were an infection risk thanks very much
31:59my pleasure you're very welcome anything else i can help with today do you need anything else
32:02from us or medications or anything no how uh how's your breathing at the moment all good
32:08i've just finished a lot of antibiotics yeah i have my chest rattling this moment oh did you let's
32:15have a little listen for you not a problem at all i've got another spare set of antibiotics if i need
32:20them sure yeah good good to keep them on standby if your sputum's changing color you're feeling more
32:25short of breath particularly wheezy yeah obviously let us know and you can start them at that point
32:30let's just check a few things pop that on your finger thank you
32:36do you mind if i just slide this under like this thank you
32:44good perfect really good
32:58lovely chest is nice and clear heart rate is normal oxygen levels are normal so that's really good
33:06so i don't think you need any more antibiotics for now which is great
33:09no i've got to see how you go yeah absolutely i'll send the um for you all right take care any
33:16problems just let us know thank you very much you're very welcome and thank you for taking that
33:21my pleasure you're very welcome
33:22all right bye now bye
33:27edward oh all right come on through
33:48hi come on in have a seat
33:54how are you well um not bad at the moment but on sunday all of a sudden i had this blackout of
34:05faint i fainted just without even any i didn't have any anything it just happened just just just like
34:12that okay did you fall i was falling but just happened that i was that the rail yeah where you
34:18can support yourself it was just closed and i just grabbed it okay did you think you lost
34:23consciousness or you felt like you were about to about to about to yes and i stayed there yeah for
34:2910 minutes i think okay then it subsided okay and what did you feel
34:35just like everything was yeah so you felt really lightheaded what about um any pain in the chest
34:43i could feel the chest tightness and and so then you went to a and e yesterday yes what did they do
34:50there and then they they gave me this medication uh but for dizziness okay did they do any blood tests
34:57they didn't like take the blood they didn't take the blood okay and did they do an ecg did they stick
35:02stickers on your no chest they didn't they didn't do that okay they told me that my pressure was too
35:07high and then they told that they don't eat me to talk to your gippy okay and right now you feel
35:14fine i still feel a little bit okay um let's check your blood pressure today okay
35:20uh just pop it on so just relax from just a deep breath in and out for me okay
35:30deep in deep in deep out just really try and slow your breathing down for me
35:34that's good just stand up for me
35:41that's fine you can have a seat
35:49so your blood pressure i mean it's a little bit lower standing but it's it's not really low
35:56okay so i just want you to look straight at me
36:05okay and i want you to follow with your eyes
36:13good eyes really tight perfect show me your teeth like that can you stick your tongue out wiggle it from
36:20side to side yeah perfect and puff your cheeks out so just like this that's fine i'm just going to
36:28touch your face you can relax it does it feel the same on both sides yeah okay okay i'm going to have a
36:35quick listen to your heart okay
36:49have you ever been told you've got a murmur of the heart what's that
37:05a murmur is when we listen to your heart and we hear a sound so normally we wanted to go
37:18duh duh duh duh duh duh when we hear your heart beating so in your case today what i hear is like a
37:24whoosh duh whoosh duh but it's it's quite loud so sometimes it can mean there's a issue with the valve
37:29um some people will always have had murmurs and sometimes it can be new okay what we need is we
37:37need to get some blood tests done we need to get an ecg done okay um and we need to sort out this new
37:45murmur and whether that's relevant to the dizziness that you're having okay okay because obviously if
37:51it's linked to the heart we might need to to get you seen by cardiology i'll give you a blood form
37:59okay um and i'll call the cardiologist okay just in case they want to see you okay then yes yeah yeah
38:07sure can it develop into something else i think my concern is that you saw cardiology not that long
38:13ago and had lots and lots of investigations and there's no mention of a murmur so what i want to do is
38:20just make sure that it's nothing that to do with the heart okay does that make sense let me give you
38:26a letter and then you can take it to chelsea a and e sometimes when you're stressed yeah it can be one
38:35of the reason why i went here going through some uh because i've been going through a lot of uh
38:40worries and of course worrying about my work okay created such a terrible anxiety i couldn't sleep do
38:53you still feel you're dealing with a lot of stress yeah i'm so sorry i mean you're right stress can
38:59cause lots of symptoms okay um i think today we need to make sure it's not related to your your heart
39:07but i think once once you've been seen by a and e and we know it's nothing to worry about
39:11then why don't you come back and and we can talk about all the anxiety and the stress and things
39:15so if you take this to to a and e so that's just me asking that they urgently assess you with the ecg and
39:21view of the history all right okay thank you that's all right oh thank you all right i'll have a look
39:29later once you've been up at the paperwork okay then all right nice to see you nice to see you bye
39:43now how are you what's happened oh dear i can't sleep because i can't lie down
39:48i get earache if i lay down last night i probably got up 20 times oh no still have a good sleep
39:56that's actually one of the most important thing for our health it's supposed to help stop the nerve
40:03firing a bit at night it makes you quite sleepy you know maybe taking it and i might be a good idea
40:08yeah i could do with the sleep yeah exactly i'm tired tell me what's been happening well
40:20i'm feeling very tired yeah and sleeping is a problem okay basically i don't have a problem
40:28falling asleep yeah it's just within seconds yeah yeah but i wake up between two and three
40:35and then i can't get back to sleep again yeah yeah okay which is irritating yeah this all started
40:42really once i started taking beta blockers is that could that be something beta blockers can definitely
40:49cause fatigue medication is very much related to i'll check your blood pressure now anyway but
40:54how long do you feel is it's been going on for at least uh nine months anything else changed you
41:02not stressed particularly not more stressed and of course between two and three i have to go to the
41:08loo yeah that's sort of you know yeah standard once once yes you get you don't go more than three
41:15times at night to pee no generally without you haven't been drinking a lot it's fine waking up early
41:21that um you know it can be a sign of other things like stress like anxiety would you exercise all the
41:27time i cycle yeah i play tennis yeah so with all that exercise sounds like you do need some sleep
41:39full blood count normal good red and white cells liver function tests great
41:46cholesterol fabulous at 4.8 well done um i don't know how you feel about it if we gave you sort of
41:55maybe five sleeping tablets to try and get you out of that catch 22 because is this it's a routine
42:05that's right yeah see if it's you know got you through and stop that cycle happening obviously don't take
42:13it on consecutive nights because then you know you'll be you get addicted you get addicted and you
42:21worry about not having it yes yeah what i'd like you to do is take it um sporadically meaning not every
42:31tuesday don't make it regular yeah okay if that's not helping you know there are therapists out there and
42:39we can refer you just like talking therapy and cognitive behavioral therapy which we can refer
42:46you to where they're teaching you coping techniques for waking up early yeah perfect okay lovely all
42:52right well i'll send you an appointment okay all right nice to see you take care have a good day take care
42:57thank you
43:02thank you
43:09thank you very much
43:09all right okay not at all nice to see you all right take care all the best bye-bye
43:14take care hopefully see you again bye take care bye-bye
43:18have a good afternoon bye-bye
43:19bye
43:20yeah yeah don't go without that all right nice to see you take care thank you bye
43:26bye
43:38bye
43:40bye
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