- 5 hours ago
GPs: Behind Closed Doors - Season 9 Episode 10
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00:00morning surgery you told somebody that you're starting to struggle at home really i think
00:11people 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 working
00:32more than what i'm doing at the restaurant too busy to be here
00:36on sunday all of a sudden i had this blackout faded it just happened just just just like that
00:54with you hello come on to it it's nice to see you i've not seen you for a while
01:23no but i remember you now tell me how are you i've got doctoritis yes absolute agony yesterday
01:30i mean it's been getting bad this knee here okay about a week okay and then last night i mean i
01:36could hardly sleep oh no i rang you and i mean it still hurts but it's i can walk on it we cured it
01:42on the telephone call i mean i'm so sorry no no don't be silly don't be silly because obviously
01:47something's going on causing all that pain so no twisting or you didn't slip or bang it or anything
01:52recently not that i can remember okay and the pain describe what you were feeling the other day
01:57yesterday and things what did what did it feel well it's like a sort of two notes on the piano
02:01there was a little steady for ache and occasionally um like that okay and did it stop you doing things
02:09like was it affect you i didn't go for my daily walk okay did you do anything yesterday to make it
02:16get better did you take any medicine or strap i took i had a couple of um cocodermol or something
02:21like that yep yep good do you mind if we have a look at your knee would that be all right now we
02:25can come and sit on here let me just have a look are you all right no i'm just going to have a look
02:30at your good knee first of all if i press around any pain there at all nothing if we bend it
02:35and if i press it left has never given me trouble i'm pushing it nothing i'm just going to pull it
02:41no problems okay so that knee looks pretty sturdy well it's never been wrong never been wrong right
02:47and i'm just going to press around so tell me of any place i press there there so and is it on the
02:52inside oh sorry no no no so this is this is where it's then you can guess yeah can't or gauge if we
02:59bend it up like the other one and if i press in again it's here is it that's there yes so it is down
03:04this side is where it's sore isn't it it's not grossly swollen which some people are no i know
03:09it's it's not quite right it's doctoritis i think this might be something going on in your knee to be
03:14honest will you i think we need to look into it come and get yourself down let's put these
03:17here we go let me just you're right on that i'm fine um the thing is with knees but it's they're
03:24pretty important come and have a seat i think looking at the knee there's a bit of swelling and it
03:30was tender and it's sore on that inside and what happens if we look at the knee joint what i'm
03:34worried about is that if there's a bit of rubbing so what happens is the little bits of bone sort of
03:40end up jarring a little bit when we bend it or when we move it sometimes it can just start rubbing a bit
03:46if that is the case why doesn't it hurt straight away so you're quite right if we x-rayed you every
03:50day last week the bone hasn't changed suddenly but what's happened sometimes it can be the way we've
03:56sat or we've just moved or we've done the gardening or something's happened and then suddenly we get
04:01inflammation around it the bones are starting to get a bit worn away and then what's happened is
04:06it's all become inflamed and that's why it becomes very sore very quickly so the arthritis which i
04:11suspect this might be hasn't developed yesterday you know your bones are 76 years old this hinge has
04:17been going for 76 years there we go so 77 years almost this hinge has been bending and if you think
04:23of a door and anywhere else it's not surprising it gets a bit of wear and tear yes i'm sure do you
04:27understand the thing is is that they don't like us calling it wear and tear because wear and tear
04:30implies well don't wear it out then rest it but actually it won't get better if you rest it and
04:35it's really important you keep walking for all the other health benefits so what we ought to do is
04:40why don't we get an x-ray of your knee have a look at it that'd be great so i'll send the x-ray
04:44form which you can go down for any time and we'll ring you with the physio you're adorable thank you
04:48we'll get you sorted but keep on your feet you're not doing anything wrong you're doing it all right
04:52and i think it was quite right you came in today to get it checked you are kind well thank you very
04:55much indeed you take care nice goodbye all the best when you bye bye bye bye oops that way yeah that
05:00way yep different room uh lucas please oh hello hello how are you both fine thank you i've just been
05:11reading all about you i'm george one of the doctors lovely to meet you hi take so you make yourself
05:15comfortable how are you doing good oh bless you what happened can you tell a story we were staying
05:21with some friends in the country and they were all playing football outside and the kids were
05:25having a glass of water someone kicked a football which hit the glass which went into his um
05:33yeah so it was it was pretty deep luckily it didn't go all the way through but he had to have
05:39stitches good and they've removed all the foreign bodies nothing well they gave it a good clean
05:44but the reason i'm here is it's quite boring really uh they gave me antibiotics and um supposed
05:49to be 10 mil three times a day for five days but they only gave me 100 mils so we've now run out
05:55yeah absolutely fine but um as we're here i just wonder if you could have a look anyway and just and
05:59just see okay well let's check a few bits for you not a problem at all and then we can get that
06:03prescription uh done let's have a closer look is the pain okay is it sore or is it not too bad
06:08no oh you're brave aren't you hard as nails i love it yeah it's good it's healing nicely
06:14i'm just gonna yeah i mean they're sticking out a bit the stitches yeah that's fine i wasn't sure if
06:19i should try and snip the ends but i don't really trust myself to to do it necessarily a great job
06:25they're dissolvable ones aren't they they are yeah yeah so they all dissolve really nicely and then
06:29whatever's left over you're right you can just snip but we can do that for you yeah lovely good can you
06:33open your mouth for me i'm just going to lift this lip up a little bit just to check your gum is
06:38okay good i don't want to press too hard lovely absolutely fine are your teeth wobbly at all
06:45no but he says it hurts but i don't know if that's just the gum being yeah a bit inflamed
06:51absolutely yeah exactly i'll just quickly check your temperature and then send this so well done
06:56you are brave goodness me that's uh having stitches not not fun yeah i think it was five or six or
07:04something in the end temperature is normal as well brilliant lovely leave that with me get outsourced
07:09any problems just let us know okay perfect thank you very much take care pleasure you're very welcome all
07:13all 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 and then
07:37you have to print it off so i can check it when i come back you're going to give me a list of stuff to
07:40where you know it's just one list that everyone works on oh i see yeah yeah so maybe you're a bit
07:46controlling thanks doris hello hello mate a whole different room today
08:05right you're okay then oh so doris you're nice and early and we have a double appointment booked
08:19we have lots of time what have i not come in for oh you're not sure no okay no one told me nothing
08:26oh right okay um my understanding doris is that and but 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
08:59and now the two people that looked after me they've moved now over the other side so i've lost them
09:08sometimes i wake up and think why am i still here
09:29you've mentioned kind of feeling like what's the point going on 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 tablet for a
09:50panic attacks you do the questions i'm about to ask you doris are specifically designed to assess for any
09:56features 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
10:12oh i suppose they would really when you're on your own got no relatives no i've never even give it a
10:25thought actually no do you often get bored bored yeah bored no i don't think so i've got a habit now doing
10:37scratch cards so no i read i watch telly i've got scratch cards are you in good spirits most of the
10:45time oh yeah yeah i enjoy my own company at times good are you afraid that something bad is going to
10:52happen to you 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 well younger than me yeah
11:20i think probably there's people off that are worse off than me
11:23better off than me no 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 if it's
11:49okay is ask our social prescribers to visit you so that they can give you some help with um this
11:57feeling of loneliness oh and i've got a plan in place for that we'll see how it works okay
12:01okay my love thanks doris when talking to doris about what matters most to her having more care and
12:07more support wasn't high on her agenda would you do me a favor would you weigh me yeah you can get
12:14on to her scales she's still fiercely independent and even though some of our colleagues might have
12:19thought she would benefit from extra support she's perfectly entitled to say no thank you for that
12:23help right now and of course if anything changes we can revisit that 43 kilograms that says okay i'll
12:31convert it for you in a minute let me move that out the way 43 kilograms i can't be much slower than
12:39that i don't think i eat a lot of chocolate so this is 43 kilograms so it's just over six and a half
12:47stone six and a half i put on a bit then you are putting on a bit that's made my day do you eat meat
12:57and fish protein is important to keep your muscles strong which in older age which is the best one you
13:02get that from you get that from most meat sources and from some vegetables as well yeah and things like
13:07cheese so i eat a lot of chocolate that's good for me you got to enjoy these things all right well thank
13:17you very much thank you doris i've had this really itchy skin thing basically and where does it affect
13:25on the body i don't know if you can see but kind of small bumps under my skin last september i suddenly got
13:31the most awful eczema and itches from head to foot i keep getting like loads of just random spots on my arm
13:39what do i do about this and my hands were so so sore they felt as if i was holding thistles
13:44moisturize moisturize moisturize moisturize got this funny thing here what i do think that is
13:50is there something called an actinic keratosis okay english john yeah
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 i'm i'm one of the medical students okay
14:14hello um so can you just tell me about why you've come in today uh just a penal rash there's sort of a
14:22slight ring around the stalk of the penis is it itchy uh i'm conscious of it a feeling i wouldn't call
14:30it pain or i wouldn't call it an itch you're just aware that it's yes there okay um and have you been
14:37like seeing like seeing any discharge or anything like has it been like flaking no 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
14:59pressure right it is it's okay and if it's okay to ask um have you been having any like sexual
15:06activity recently 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
15:25any infection i guess or to see um like what the causative agent i guess is there you go i think
15:32so i'll be good yeah yeah joint uh kuleen please hello
15:45i come through take seats i'm george one of the doctors nice to you how are you i'm fine thinking
15:49yourself lovely yeah good thanks how can i help today um i have a condition called hs yep but i've
15:55got a lump under my arm and it doesn't look it's not the same characteristic so i just want to make
16:00sure hs or hydradenitis suppuritiva is a chronic skin condition it's characterized by the formation of
16:06skin tracts or sinuses that form from the surface of the skin and they migrate in they can often get
16:11infected and be very difficult to live with very painful very itchy very uncomfortable and when did you
16:17first notice it monday and then it's just getting bigger yeah yeah is it painful yes anything coming
16:23out of it any discharge no it's quite soft though in certain areas yeah fair enough and do you feel
16:28okay in yourself any fever nausea vomiting i'm sweating that hell are you yeah yeah do you think it might be
16:32related or hard to tell it's hard to tell i'd still find any infective symptoms at the moment so
16:38like coughs cords runny nose and none of that chest infection nothing like that at all and nothing in
16:42the run-up to this so last week or anything and whereabouts is it under the armpit yeah yeah fine
16:46would it be okay to have a look yeah that's all right let's see oh wow yeah it's big oh bless you
17:02sorry that's okay
17:07yeah it's got a punctum i think it's a cyst okay so it's the hs it might be the hs
17:12but it could be you know a different sort of cyst altogether so yeah it could be it might may not
17:16be related to the hydradenitis it's tricky it doesn't sort of look actively infected but i do
17:22wonder if we should just in case give you some antibiotics that's bad again i know i'm so sorry
17:28well we don't have to we could adopt a wait and see approach and say look give it a couple of days and
17:32if in in the next 48 hours or 24 hours it's regressing getting smaller getting less and less
17:38painful fine you don't need anything if however in that time frame it's getting bigger redder angrier
17:43more painful then unfortunately we probably should you know try of course antibiotics especially with
17:48your diabetes as well we need to be very very careful um before you go just to make sure that
17:52there's no sign of infection in the body can i just check your heart rate and oxygen levels is that okay
17:57and then your temperature as well
17:58so the oxygen levels are perfect 96 so that's really good just checking to watch it there ignore
18:07the beeping it does that lovely temperature 36.2 heart rate is less than 100 so absolutely fine it's
18:13really good brilliant see how you go any problems just come back all right okay thank you my pleasure
18:19you're very welcome take care you see this ring around yeah and you see the redness and inflamed yeah
18:34it's not normal to have that but yeah i can definitely see it's marked inflammation and does that irritate
18:42to you well i'm conscious of it as i said i can feel it but it's not pain and it's not
18:48an itch i don't have to scratch it yeah that sort of thing there you go good luck
18:55yep i just keep going i'll do the other bit as well good yeah it looks quite sore doesn't it
19:04hmm there we go perfect well done yep all done yes all right i would say we're going to send that
19:14away okay um but i'm going to give you some treatment anyway what treatment would you suggest
19:20um um so yes you mentioned an oral tablet treat you from the inside one-off tablet
19:40and the cream yeah two-pronged attack what is that likely to be it is a this yes yeah i
19:49Yeah, I mean, it looks like a thrush, basically.
19:52Inflammation.
19:53No funny smells or anything.
19:54You don't get any other discharges or anything like that.
19:57Excellent.
19:59So that takes a few days to get the result,
20:02but I'm sure it'll just come back showing a yeasty infection.
20:08Looking at him, what are you thinking?
20:11What's he dressed as?
20:12Oh, tennis player?
20:14Maybe.
20:15So, I mean, sports, you know, all goes with thrush, basically.
20:21Loves hot, sweaty environments.
20:23Oh, right.
20:24Yeah, so when you do...
20:25I should lead a more sedate life, is that what you're proposing?
20:28Not at all.
20:30So, you're going to get one capsule and some cream.
20:33Okay.
20:34You're going to use the cream, smearing it round the end,
20:38and it should settle down for a while,
20:41but because you enjoy the sport and stuff,
20:44it can just occur again.
20:46Always worth having the sugar test, which we do anyway.
20:50What's the correlation there between a penis and a sugar reading?
20:54So, a high sugar in your urine,
20:57which you might do if one had diabetes,
20:59allows yeast to grow.
21:01Oh, right.
21:02It feeds the yeast.
21:04So, if you...
21:04There's something today.
21:05Mm-hmm.
21:06Yeah.
21:07For you.
21:08Tim, thank you.
21:09Right.
21:09And thank you for talking to them.
21:11It really helps.
21:11Thank you very much.
21:12Thank you, ladies.
21:12You're almost there.
21:13Bye.
21:14Bye, ladies.
21:16Tim, thank you.
21:16Yeah, no problem.
21:17Take care.
21:18Bye.
21:18Bye.
21:20The men are really bad at generally coming to the GP,
21:24but John was very staunch
21:26and very game on for showing the students,
21:30which was great
21:30because they're one of the biggest trainers of doctors in London
21:34and I think they did really, really well.
21:39How did that go?
21:41That was good, yeah.
21:42Yeah.
21:43He was comfortable talking to you.
21:46You were asking all the right questions.
21:48Yeah, I thought you were brave doing the sexual history.
21:51Well done.
21:51Yeah, and your examination
21:55and taking this one, all good.
22:08So we're here today because?
22:10Because of my medications.
22:11I know.
22:12You know what I'm going to say.
22:13It's good to see you looking well.
22:14I'm absolutely fine, actually.
22:16You know that.
22:17I know.
22:17Yeah, yeah.
22:17But you were fine when you had a bit of a twinge in your chest.
22:20Yeah, exactly.
22:20But when we got you up to the hospital, you weren't actually fine.
22:23They said, oh, you have, you know, had a heart attack.
22:27Exactly.
22:28And that's the thing.
22:28So you had a heart attack,
22:29which just meant that there was a blockage there again.
22:32And you've had, obviously, how long ago was the previous heart attack?
22:3417, isn't it?
22:3516.
22:36Okay, so 16, 17.
22:37And then it was this March time sort of thing when we got you to go back up again.
22:41And it was such a mild symptom, wasn't it?
22:43Yeah.
22:44But it was a bit of a warning.
22:45So I think, I suppose, two things.
22:47One is, that's a big learning point, that if you get any funny twinges or difficult or funny,
22:52just go and get it checked.
22:53Because if they do an ECG and that blood test, and it's not your heart, they'll kick you out
22:56straight away.
22:57Yeah, exactly.
22:57But if it is your heart, you're in the right place.
23:00But what I'm worried about with your medicine, and I know, I've heard on the grapevine that
23:05you're not taking all the medicine that the hospital took.
23:08No, not the medicine which they have given, because, you know, I wasn't feeling right with
23:13them.
23:14These tablets, actually, they're not making me feel better.
23:16They're making me feel ill.
23:27Never take pills.
23:33I know.
23:33If you can avoid them, they're best avoided.
23:35But sometimes they are needed.
23:37Lordy, lordy.
23:38Look at all these.
23:39I know.
23:40Is there side effects from it, or what?
23:42Of course there are loads of side effects.
23:44Jeez, oh, yeah, absolutely.
23:45Aspirin, yes.
23:46Folic acid, yes.
23:48Stomach bone, yes.
23:49Statin, yes.
23:50Thank God for that.
23:52I've spoken to a few people, and when they tell me how many, you know, medications are on,
23:57and I went, what?
23:58Yeah, I mean, you're doing really well.
24:00I couldn't believe it, you know.
24:04Problem is, I think, that we suddenly threw loads of new tablets on you.
24:08You fell ill.
24:09We've stopped them all and gone back to what we were on before.
24:11Yeah.
24:12But what worries me a little bit is that when you had the first heart attack, the blood
24:16vessel was blocked, and they put a stent in.
24:18Yeah.
24:19And when you had the second one, when they've gone back, it's dilated.
24:22There's a bit of what they call a sort of aneurysm.
24:24There's a dilation around it, and the problem is blood sits and clots.
24:27In those dilated bits.
24:29Right.
24:29So they're worried that just one blood thinner isn't quite enough.
24:34Okay.
24:35Then they look at it and think, well, hang on, the cholesterol was part of the problem in
24:39the first place.
24:40It blocked things.
24:41And that your cholesterol was still a bit raised, despite being on the maximum dose of
24:47statin.
24:48So that's why they added in the other one as well.
24:50Okay.
24:50Now, I was thinking one option is, what about if we look at all the new tablets, prioritize
24:56which are important, and try one at a time.
24:58That's good.
24:59And then if you feel unwell, we know that that's the only change that's been done, so that is
25:04the tablet that doesn't suit you.
25:05That's fine.
25:06I know.
25:06I can't bear patience on lots and lots of tablets.
25:09But every single one of those is individually doing a really important job.
25:14And you're young, you're fit, you're healthy.
25:16You've got your wife, you've got your family, you've got your grandchildren living with you.
25:20You can't be ill.
25:22You're too busy to be ill.
25:23You've got your restaurant.
25:23I am too busy to be ill.
25:25I'm telling you, if I'm home, you know, I'm working more than what I'm doing at the restaurant
25:29because five of them are on me.
25:31I know.
25:32So I think what we need to do is think it's not ideal being on all these tablets, but I
25:37genuinely think that if we want to keep you from not having strokes, not ending up in hospital
25:43or sick or not being able to do things, or ultimately the worst thing of dying, then
25:48actually we need to look and try and get you on these tablets to try and really
25:53improve the outlook going forward.
25:56We will try, you know, whatever it is there, you know, I'll try.
26:00One more thing I want you to know.
26:02Did you get the result from the cardiogram?
26:04It was good.
26:05It's pretty good.
26:06All your heart muscle is pretty good.
26:09Yeah, they're all fine.
26:10We've got a good heart, but we need to keep it that way because reality, if you stopped
26:15all of it and didn't exercise and ate what you wanted, blah, blah, blah, pretty much
26:20you will have more heart attacks.
26:21So we don't want that to happen.
26:23So they want you to stop the aspirin now and just continue this other blood thinner,
26:27riveroxabam, with the clopidogrel.
26:29Okay.
26:30Why don't we just do that one change today?
26:32Okay.
26:33And then if you feel awful, you let us know, let me know, let my girl, we can then,
26:37we'll stop it.
26:38Yeah.
26:38Okay, that one, and we'll see if there's an alternative or a sister one or something
26:41that doesn't make you feel ill.
26:43And then we'll look at the other ones.
26:45Okay, that's fine.
26:45We'll review it, we'll see, and then we'll move on to the next one.
26:48We'll do that.
26:48Okay.
26:49And we'll get you to 100.
26:51That's the plan.
26:52All we stay together.
26:55Oh, exactly.
26:56No chance of getting away from me.
26:58And I'll keep nagging you.
26:59And any problems, if you find you haven't got the tablet or something, or you're not sure,
27:02or someone's thrown them out or something, just give me a little.
27:04No, no, we will have them.
27:05I'm sure.
27:06I'm sure.
27:06Perfect.
27:07Save you with even more boxes.
27:08All right.
27:08No worries.
27:08I'll speak to you in two weeks.
27:09Yes, we will.
27:10All right.
27:10Thanks a lot, Muhammad.
27:11Bye-bye.
27:11Bye-bye.
27:12Bye-bye.
27:12What happened to not drinking Red Bull?
27:19I know, I shouldn't.
27:22I'm actually quite concerned for you.
27:23Stop drinking it.
27:24Yeah, okay.
27:25I promise.
27:27Let's cut it down to one a week.
27:29God.
27:30All right, Mum.
27:31This is my last one.
27:32I promise on everything I love.
27:37So tell me, what's brought you in?
27:40I'm having serious problems with my ears.
27:42Okay.
27:42Originally, I thought it was tinnitus.
27:44My mother gets tinnitus.
27:46I don't think it is.
27:48I've been using a tinnitus relief spray.
27:50Nothing is helping.
27:52They suddenly just get blocked and sore, and I then can't hear properly out of this ear
27:58specifically.
27:59Okay.
28:00And then I get a headache.
28:01Okay.
28:02And I don't know what to do.
28:03Okay.
28:03So how long has this been going on for for you?
28:05For six weeks.
28:06Yeah.
28:07So you mentioned tinnitus.
28:09Are you having ringing in the ear?
28:11I mean, everything sounds really hollow and slightly just...
28:14Like you're underwater, kind of.
28:17Ish, yeah.
28:17Yeah.
28:18Okay.
28:18And any vertigo symptoms?
28:20So feeling of the world spinning around you?
28:22Occasionally, yes.
28:23Occasionally.
28:23Okay.
28:24When I stand up.
28:25Okay.
28:25And how long do those episodes last for?
28:28I stand up, I sway, and then I'm fine.
28:31Okay.
28:32So short.
28:33Any sore throat or cough?
28:35I've had a bit of a sore throat this week, but...
28:39And what about a stuffy nose?
28:41A little bit, but not...
28:42A little bit.
28:43Okay.
28:43Will we have a look?
28:45Please?
28:47Lovely.
28:48So I'm going to look in the normal ear, or the less severe ear first, if that's okay with you.
28:53No, that's fine.
28:54That is perfectly normal and very clean.
28:59I do try to keep them clean.
29:00Good.
29:03That looks fine as well, actually.
29:05There's no redness.
29:06It doesn't look inflamed or it doesn't look like it's bulging, so it doesn't look like there's an infection there.
29:11Okay.
29:11Can I have a look in your throat?
29:14So just open your mouth and say, ah.
29:18Yep.
29:19Okay, that's fine.
29:20So no swelling of the tonsils.
29:21I'm going to feel your lymph nodes in the neck.
29:27Okay.
29:27Alrighty.
29:28So what I think is going on is actually you to do with your eustachian tube.
29:32So I think that may be blocked and causing you the popping and the fullness feeling and the discomfort.
29:38So I think if I give you a nasal spray, which sounds probably odd but fine.
29:44Yes, it's worth trying.
29:46I think that actually it will really improve things for you.
29:49I will also give you a spray for your ear.
29:52You too.
29:53Just to make sure if there's any inflammation in that ear that's causing the discomfort that that's also covered.
29:58Perfect.
29:59Thank you so much.
30:00I really appreciate it right now.
30:01I'll leave now.
30:02Okay, fine.
30:02Thank you so, so much.
30:04I'll always mind yourself.
30:16Leslie, please.
30:17Hi.
30:18Come through.
30:23Take a seat.
30:24How can I help today?
30:26Are we here to take the stitch out?
30:28Yeah.
30:28Yeah.
30:28Did you put the cream on?
30:29Yes, I did.
30:30Amazing.
30:31Good.
30:31Would you like to lie down?
30:32Is that a bit easier for you?
30:33Leslie was unfortunately intubated and ventilated in ITU following a very lengthy operation of lung cancer.
30:41And they did to do a tracheostomy to help support her breathing.
30:46Tracheostomy is a surgical procedure whereby an incision is made in the neck to gain direct access to the windpipe or the trachea.
30:53Lovely.
30:54So I'm just going to bring that down a little.
30:56Oh yeah, brilliant.
30:57We get a much better look on it.
31:00Is that painful?
31:01I just hate the thought of anybody touching that.
31:06Yeah, I know.
31:08That's just a bit of cool, salty water which will just clean the area to make sure I don't introduce any bugs.
31:17Got much planned for today.
31:21No, I know what you can put later.
31:22Sorry, you're doing really well.
31:33There we go.
31:34Done.
31:35Well done.
31:36You did really well.
31:37Excellent.
31:38Brilliant.
31:39Let's just make sure that's all okay.
31:42Yep.
31:43Lovely.
31:43I was just removing the sutures from the site.
31:46They had not dissolved and we needed to just get them out, otherwise they were an infection risk.
31:53Thanks very much.
31:54My pleasure.
31:55You're very welcome.
31:56Anything else I can help with today?
31:57Do you need anything else from us or medications or anything?
32:00No.
32:00How's your breathing at the moment?
32:02All good?
32:03I've just finished a lot of antibiotics.
32:05Yeah.
32:07I have my chest rattling this moment.
32:09Oh, did you?
32:10Let's have a little listen for you.
32:11Not a problem at all.
32:12I've got another spare set of antibiotics if I need them.
32:15Sure.
32:16Yeah.
32:16Good to keep them on standby.
32:17If your sputum's changing colour, you're feeling more short of breath, particularly wheezy,
32:22obviously let us know and you can start them at that point.
32:26Let's just check a few things.
32:29Pop that on your finger.
32:36Do you mind if I just slide this under like this?
32:39Yeah.
32:44Good.
32:45Perfect.
32:52Really good.
32:57Lovely.
32:58Chest is nice and clear.
32:59Heart rate is normal.
33:00Oxygen levels are normal.
33:01So that's really good.
33:02Lovely.
33:02I don't think you need any more antibiotics for now, which is great.
33:05No, I've got a spare set.
33:05See how you go.
33:06Yeah, absolutely.
33:07I'll send the...
33:07If I can just get the report on.
33:08...for you.
33:09Oh, good job.
33:10All right.
33:11Take care.
33:11Any problems, just let us know.
33:13Thank you very much.
33:14My pleasure.
33:14You're very welcome.
33:15All right, bye now.
33:21Bye.
33:22Edward.
33:28Oh, all right.
33:29Come on through.
33:43Mm-hmm.
33:44All right, come on in.
33:48Have a seat.
33:49All right.
33:52How are you?
33:53Well, not bad at the moment, but on Sunday, all of a sudden, I had this blackout, I fainted.
34:01Just without even any, I didn't have any, I didn't have any, anything.
34:05It just happened?
34:06Just, just, just like that.
34:07Okay.
34:07Okay.
34:07Did you fall?
34:08And I was, I was, I was falling, but just happened that I was, that the rail, where you can support
34:13yourself, it was just a lot of people, it was a lot of people, but I had this blackout.
34:16It was just closed, and I just grabbed it.
34:17Okay.
34:18And I...
34:19Did you think you lost consciousness, or you felt like you were about to?
34:21About to.
34:22About to, okay.
34:23Yes, and I stayed there.
34:24Yeah.
34:25For 10 minutes, I think.
34:26Okay.
34:27Then it subsided.
34:28Okay, and what did you feel?
34:31Just like everything was moving around like that.
34:34Yeah?
34:35So you felt really lightheaded.
34:36What about any pain in the chest?
34:38I could feel the chest tightness.
34:41And so then you went to A&E yesterday.
34:44Yes.
34:45And what did they do there?
34:46And then they gave me this medication.
34:48For dizziness?
34:49Okay.
34:50Did they do any blood tests?
34:52They didn't like take the blood.
34:53They didn't take the blood.
34:54Okay.
34:55And did they do an ECG?
34:56Did they stick stickers on your chest?
34:58No, they didn't.
34:59They didn't do that.
35:00Okay.
35:01They told me that my pressure was too high.
35:03And then they told me they didn't need me to talk to your GP.
35:07Okay.
35:08And right now you feel fine?
35:09I still feel a little bit.
35:11Okay.
35:12Let's check your blood pressure today.
35:14Okay.
35:18Just pop it up.
35:20So just relax.
35:21Just a deep breath in and out for me.
35:24Okay.
35:25To deep in and deep out.
35:27Just really try and slow your breathing down for me.
35:34That's good.
35:35Just stand up for me.
35:36That's fine.
35:37You can have a seat.
35:38Okay.
35:39So your blood pressure, I mean, it's a little bit lower standing, but it's not really low.
35:51Okay.
35:52So I just want you to look straight at me.
35:57Okay.
35:58And I want you to follow with your eyes.
36:04Good.
36:05Eyes really tight.
36:06Perfect.
36:07Show me your teeth.
36:08Like that.
36:09Can you stick your tongue out?
36:10Wiggle it from side to side.
36:11Yep.
36:12Perfect.
36:13And puff your cheeks out.
36:14So just like this.
36:15That's fine.
36:16I'm just going to touch your face.
36:17You can relax it.
36:18Does it feel the same on both sides?
36:20Yeah.
36:21Okay.
36:22Okay.
36:23I'm going to have a quick listen to your heart.
36:24Okay.
36:25Have you ever been told you've got a murmur of the heart?
36:27What's that?
36:28What's that?
36:51A murmur is when we listen to your heart and we hear a sound.
37:11So normally we want it to go da-da, da-da, da-da when we hear your heart beating.
37:16So in your case today, what I hear is like a woosh-da, woosh-da, but it's quite loud.
37:21So sometimes it can mean there's an issue with the valve.
37:24Okay.
37:25Some people will always have had murmurs and sometimes it can be new.
37:30Okay.
37:31What we need is we need to get some blood tests done.
37:34Okay.
37:35We need to get an ECG done.
37:36Okay.
37:37And we need to sort out this new murmur and whether that's relevant to the dizziness that
37:42you're having.
37:43Okay.
37:44Okay.
37:45Okay.
37:46Because obviously if it's linked to the heart, we might need to get you seen by cardiology.
37:51Okay.
37:52I'll give you a blood form.
37:53Okay.
37:54And I'll call the cardiologist.
37:56Okay.
37:57Just in case they want to see you.
37:59Okay then.
38:00Yes.
38:01Yeah?
38:02Yeah, sure.
38:03Can it develop into something else?
38:05I think my concern is that you saw cardiology not that long ago and had lots and lots of
38:10investigations.
38:11Yes.
38:12And there's no mention of a murmur.
38:14So what I want to do is just make sure that it's nothing to do with the heart.
38:17Okay.
38:18Does that make sense?
38:19Yeah.
38:20Let me give you a letter and then you can take it to Chelsea A&E.
38:24Okay.
38:25Okay.
38:26Okay.
38:27Okay.
38:28Do you still feel you're dealing with a lot of stress?
38:29Yeah.
38:30I'm so sorry.
38:31I mean, you're right.
38:32Stress can cause lots of symptoms.
38:33Okay.
38:34And I think today we need to make sure it's not related to your heart.
38:37But I think once you've been seeing my heart, I think it's very important to you.
38:42Okay.
38:43I'm so sorry.
38:44I'm so sorry.
38:45I'm sorry.
38:46Because I've been going through a lot of worries and, of course, worrying about my work.
38:47Okay.
38:48Created such a terrible anxiety.
38:49I couldn't sleep.
38:50Do you still feel you're dealing with a lot of stress?
38:51Yes.
38:52Yeah.
38:53I'm so sorry.
38:54I mean, you're right.
38:55Stress can cause lots of symptoms.
38:56Okay.
38:57And I think today we need to make sure it's not related to your heart.
39:02But I think once you've been seen by A&E and we know it's nothing to worry about, then
39:06why don't you come back and we can talk about all the anxiety and the stress and things.
39:10So if you take this to A&E, so that's just me asking that they urgently assess you with
39:15the ECG and view of the history.
39:17All right.
39:18Okay.
39:20That's all right.
39:22All right.
39:23I'll have a look later once you've been up at the paperwork.
39:26Okay then.
39:27All right.
39:28Nice to see you.
39:29Nice to see you.
39:30Bye.
39:31Now how are you?
39:32What's happened?
39:33Oh dear.
39:34I can't sleep because I can't lie down.
39:35I get earache if I lie down.
39:36Last night I probably got up 20 times.
39:37Oh no.
39:38Still have a good sleep.
39:39That's actually one of the most important things for our health.
39:56It's supposed to help stop the nerve firing a bit at night.
39:59It makes you quite sleepy.
40:01You know, maybe taking it at night might be a good idea.
40:03Yeah.
40:04I could do with the sleep.
40:05Yeah, exactly.
40:06I'm tired.
40:07Tell me what's been happening.
40:12Well, I'm feeling very tired.
40:16Yeah.
40:17And sleeping is a problem.
40:21Okay.
40:22Basically, I don't have a problem falling asleep.
40:24Yeah.
40:25It's just within seconds.
40:26Yeah, yeah.
40:27But I wake up between 2 and 3 and then I can't get back to sleep again.
40:32Yeah, yeah.
40:33Okay.
40:34Which is irritating.
40:35Yeah.
40:36This all started really once I started taking beta blockers.
40:40Is that, could that be something?
40:42Beta blockers can definitely cause fatigue.
40:45Medication is very much related to it.
40:47I'll take your blood pressure now anyway, but how long do you feel it's been going on?
40:52For at least nine months.
40:55Anything else changed?
40:56You're not stressed particularly?
40:58No.
40:59Not more stressed?
41:00Yeah.
41:01And of course, between 2 and 3, I have to go to the loo.
41:03Yeah.
41:04That's sort of, you know, standard.
41:06Once.
41:07Once, yeah.
41:08Once.
41:09You don't go more than three times at night to pee.
41:11No.
41:12Generally.
41:13I've been drinking a lot, it's fine.
41:15Waking up early, that can be a sign of other things like stress, like anxiety.
41:20Do you exercise?
41:21All the time.
41:22I cycle.
41:23Yeah.
41:24I play tennis.
41:25Yeah.
41:26So with all that exercise, it sounds like you do need some sleep.
41:29Yeah.
41:30I sleep.
41:31Maybe I shouldn't.
41:32Full blood count.
41:35Normal.
41:36Good red and white cells.
41:39Liver function tests, great.
41:42Cholesterol, fabulous at 4.8.
41:45Well done.
41:46I don't know how you feel about it.
41:48If we gave you sort of maybe five sleeping tablets to try and get you out of that catch-22,
41:58because it's this happening every night.
41:59It's a routine.
42:00Yeah.
42:01See if it's, you know, got you through and stop that cycle happening.
42:06Obviously, don't take it on consecutive nights, because then, you know, you'll be...
42:13You get addicted.
42:14You get addicted, and you worry about not having it.
42:17Yes.
42:18Yeah.
42:19What I'd like you to do is take it sporadically, meaning not every Tuesday.
42:27Don't make it...
42:28Regular.
42:29Yeah.
42:30If that's not helping, you know, there are therapists out there, and we can refer you
42:35to just like talking therapy and cognitive behavioural therapy, which we can refer you
42:41to, where they're teaching you coping techniques for waking up early.
42:45Yeah.
42:46Perfect.
42:47Okay.
42:48Lovely.
42:49All right.
42:50I'll send you an appointment.
42:51Okay.
42:52All right.
42:54Thank you very much.
42:56All right.
42:57Okay.
42:58Not at all.
42:59Nice to see you.
43:00All right.
43:01Take care.
43:02All the best.
43:03Bye-bye.
43:04Take care, then.
43:05Hopefully see you again.
43:06Bye.
43:07Yes.
43:08Take care.
43:09Bye-bye.
43:10Have a good afternoon.
43:11Bye-bye.
43:12Bye.
43:13Bye.
43:14Bye.
43:15Bye.
43:16Yep.
43:18Without that.
43:19All right.
43:20Nice to see you.
43:21Take care.
43:22Bye-bye.
43:23Bye-bye.
43:24Bye-bye.
43:25Bye-bye.
43:26Bye-bye.
43:27Bye-bye.
43:28Bye-bye.
43:29Bye-bye.
43:30Bye-bye.
43:31Bye-bye.
43:32Bye-bye.
43:33Bye-bye.
43:34Bye-bye.
43:35Bye-bye.
43:36Bye-bye.
43:37Bye-bye.
43:38Bye-bye.
43:39Bye-bye.
43:40Bye-bye.
43:41Bye-bye.
43:42Bye-bye.
43:43Bye-bye.
43:44Bye-bye.
43:45Bye-bye.
43:46Bye-bye.
43:47Bye-bye.
43:48Bye-bye.
43:49Bye-bye.
43:50Bye-bye.
43:51Bye-bye.
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