- 3 weeks ago
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00:00When I had my blackout faceplant, I just go boom. I've had 38 surgeries in 25 years.
00:23I haven't had my period in seven months. Okay, that's a whole nother story.
00:30How much higher is it? Your blood pressure at the moment was 172 over 111.
00:36Jesus. Exactly.
00:40Do you mind if I draw on your face? No, I don't.
00:52I'm not liking the look of this. I'm a little bit worried.
00:55Good morning.
01:11Good morning.
01:31Stephen.
01:32Doctor.
01:33Hello.
01:38Can I have a seat?
01:40My arthritis at the moment, Doctor, has gone on another scale.
01:47Yeah.
01:48Really has, yeah.
01:49I've got arthritis in my right knee.
01:51Yeah.
01:52I've got arthritis in my left knee.
01:53So I'm struggling walking, both of my wrists.
01:56I'm having this mental health issue again because of the way I'm feeling.
02:02I want to be active, but I can't be.
02:04Because something's hurting?
02:06Yeah, the bottom of my feet are hurting.
02:08Can I have a look at your feet, please?
02:10Is that all right if you just pop your shoes off?
02:11Yeah.
02:18Can you feel that touch?
02:19Yeah.
02:20Yeah.
02:21Mm.
02:22Ticklish.
02:23Yeah.
02:24Is there any tenderness around pressing?
02:25There.
02:26So here?
02:27There.
02:28So a lot of pain around this area can be caused by a condition called plantar fasciitis, which
02:32is inflammation of the soft tissue on the bottom of the foot.
02:36That may be what's giving you this grief, actually.
02:39Yeah, so what do you take to manage the arthritis?
02:42Nothing.
02:43I've never been prescribed anything for my arthritis.
02:46Can I ask you about alcohol?
02:48No, I don't drink.
02:49Fifteen months now.
02:50Well done.
02:51Okay.
02:52Since I've quit drinking, I have put on a little bit of weight, you see, because I'm
02:57no longer going for the drink.
02:59I'm going for something else, maybe a snack or something.
03:03Yeah.
03:04And what kind of snacks?
03:05Sweet.
03:06So a lot of these kind of ultra-processed snacks do actually trigger inflammation in
03:12the body.
03:13And then, like I said, other things like, you don't smoke, do you?
03:16A few.
03:17Okay.
03:18Not many.
03:19Even smoking as well has an inflammatory effect on the body, and cutting that down,
03:23stopping, could help as well.
03:25There is the option of going for a topical treatment, so a cream that you put on.
03:29You ever use Volterol gel?
03:30No, no, no.
03:31So it's anti-inflammatory medication, so really good at reducing inflammation in joints,
03:36improving pain, and you just put it on the area.
03:39And just let me know how you get on with it, okay?
03:42I'm going to send something to you now.
03:44There's good evidence that physical activity is beneficial for people with joint problems,
03:48whether it's arthritis or something else.
03:50So, yeah, if we can get your pain well-managed, I would like you to be being active,
03:57because the long-term benefits are net positive for you, okay?
04:02And do you know what it's really good for especially?
04:04Mental health.
04:05Yeah, yeah, yeah.
04:06But I do think that whilst it might be hard now, putting that effort in now may pay dividends
04:15in the future, and it would become easier.
04:17Even whilst you're talking to me and explaining this to me, it's kind of like making me feel better.
04:23You've had a little nudge.
04:25That's what you need, Doctor, sometimes, you know?
04:27You get stuck in the spot, and you don't want to move from it, you know?
04:31Yeah.
04:32Okay.
04:33Can we circle back in a couple of weeks and just let me know if anything has changed, hopefully for the better?
04:39We are only giving you a cream for this pain, and I want to know that it is actually helping.
04:44So, two weeks' time then.
04:45Can we agree on 10.45?
04:47Fantastic.
04:48Fantastic.
04:49That'll be on the 14th, Tuesday.
04:50Fantastic.
04:5110.45.
04:52You'll get a text message.
04:54Okay, then.
04:55Well done, Doctor.
04:56Thanks.
04:57Josie?
04:58Oh, yes, that's me.
05:00Hi there.
05:01Come on through.
05:02Nice.
05:03So, take a seat.
05:04Oh, thank you.
05:05You came with a bundle of letters.
05:07Yes.
05:08Some of them are NHS.
05:09Some of them are from DC.
05:10Okay.
05:11What's brought you in here today?
05:12I just moved, so I need a new GP, and I have Crohn's disease, so I need someone to help
05:24take care of that.
05:25Absolutely.
05:26I'm happy to do that.
05:27Crohn's disease is a chronic disease, and it essentially is caused when anywhere from
05:34the digestive tract from the mouth to the anus becomes inflamed.
05:39So, essentially, that manifests with tummy pain and diarrhoea, sometimes blood in the diarrhoea.
05:45How old are you?
05:4617.
05:47How was it diagnosed?
05:48I was complaining of a stomach ache for about three months, and then I lost the ability
05:53to digest food and end up in the hospital for 10 days.
05:55Okay.
05:56Okay.
05:57So, that must have been quite scary.
05:58I was very out of it during the entire period.
06:00Fair enough.
06:01So, since you were 17, so you're 23 now, have you had many flares of your Crohn's disease?
06:08It's been pretty decently managed.
06:09I basically just take care of it, not to anger it.
06:13And are there specific things that you've noticed that are triggers for it?
06:18Whole nuts, seeds, and raw greens.
06:20How is your tummy?
06:21Do you have any pain in the tummy?
06:23At the moment, I'm pretty decently managed.
06:25I'm in the middle-ish of my cycle.
06:28Okay.
06:29So, I'm due for an infusion in about four weeks.
06:31So, you're on infliximab infusions?
06:32Yes.
06:33And do you have that infusion sorted?
06:36I think so.
06:37Okay.
06:38Well, that's good.
06:39Yes.
06:40Okay.
06:41And any other issues?
06:42Any rashes?
06:43I haven't had my period in seven months.
06:44Okay.
06:45That's a whole other story.
06:47Yes.
06:48I know that's a whole other story.
06:49Okay.
06:50And I am not sexually active.
06:52Okay.
06:53And are you on any contraception?
06:56No.
06:57No.
06:58And have they been regular up until that point?
07:00Absolutely not.
07:01Not regular.
07:02Well, they were regular, then I got Crohn's disease, and then they became chaos.
07:05Okay.
07:06So, this isn't unusual for you?
07:07Yes, but seven months.
07:09Seven months is a long time.
07:10Missing like a cycle or two isn't unusual, but...
07:13Over kind of that six-month period, we tend to look into it a little bit more.
07:17Yeah.
07:18So, if you're happy for me to organize a blood test looking at hormonal levels, and we can do an ultrasound scan.
07:24If we're still in a position where in, you know, coming up on a year, you haven't seen any periods, then definitely we'll be sending you through to the gynecologist.
07:33Yeah.
07:34Don't get me wrong, I'm pretty delighted about it for just the not wrecking underwear reasons, but it's also kind of concerning.
07:40Yes.
07:41You should be having a period, you know, at least every three months.
07:45Obviously, when you have a significant illness, it definitely impacts our hormonal balance and things like that, but, you know, you are kind of six years into this, and it's worth looking into.
07:54Yeah.
07:55So, if you drop these to reception, book in a blood test.
07:58Okay.
07:59I'll make a referral for an ultrasound scan of your pelvis to see if there's anything going on in the ovaries or within the womb itself.
08:06You should be hearing from the gastroenterology.
08:08Great, and if I'm pregnant, I get to start a new religion.
08:11Well, just let us know if that's the case as well.
08:14Yes, if that's the case, we have bigger problems.
08:16Yeah.
08:17Okay, Juicy, it was nice to meet you.
08:19Nice to meet you too.
08:20Bye.
08:21Hello.
08:22Bye now.
08:33Let's fill this up somewhere.
08:35Do you have water?
08:36Do you want me to get, I can get you some.
08:38Is that okay?
08:39Yeah.
08:44Thank you so much.
08:45There you go.
08:46Sorry, I dropped the link.
08:48It's okay.
08:49I'm Dr. Dungeon.
08:50Nice to meet you.
08:51Nice to meet you.
08:52So, what can we do for you?
08:53I need to get another search and repeat prescription.
08:57Okay.
08:58I went travelling to Asia and then Australia in January 20, 24.
09:03Yeah.
09:04So, basically just before I went, my GP, this was in Devon, where I used to live, prescribed
09:14me six months.
09:15Yeah.
09:16Of a hundred milligrams.
09:17Okay.
09:18So, it would last me.
09:19Yeah.
09:20I see.
09:21So, you've just been on 50 though.
09:22So, how are you feeling on the 50?
09:23Yeah, fine.
09:24I had, like, maybe four or five days where I just, like, didn't take it because I, like,
09:30didn't have it.
09:31It was weird.
09:33Okay.
09:34So, you sort of noticed.
09:35Yeah.
09:36Yeah.
09:37My head was, like, doing that, like, tingly thing and I felt really dizzy and I was, like,
09:41profusely sweating and I was, like...
09:44For the first, like, two days I was, like, oh, like, whatever, maybe I'll just, like,
10:06see if I can actually just wean myself off because I'm very aware that it probably needs
10:10to happen at some point.
10:11We do know you shouldn't stop it suddenly.
10:13Okay.
10:14So, some of that might have been that you, kind of, just stopped abruptly rather than
10:18the fact that you wouldn't be able to manage without it.
10:20There's also no need to come off it.
10:22Yeah.
10:23So, if you feel good on it, there's no rush.
10:24Yeah.
10:25Like, honestly, when I'm...
10:26I don't know why I'm going to cry.
10:27I feel so much better.
10:28Good.
10:29I'm just like...
10:30I don't mean to be able to sit in here.
10:31I literally just cried at everything.
10:34But you say on it your mood feels good.
10:36Mm.
10:37Yeah.
10:38I'm a very emotional person and I still feel, like, everything like that.
10:42But it's not, like, a constant overwhelming.
10:45Yeah.
10:46It just completely eliminates that.
10:48And I feel the things that I feel a normal amount of anxiety.
10:51Yeah.
10:52As opposed to, like, a complete consumption of life, which is horrible and I don't want
10:58that.
10:59So, was it more of anxiety you went on it?
11:01Yeah.
11:02Yeah.
11:03Yeah, I, like, went through, like, a two-year bout of...
11:05I'm sorry.
11:06I want to say that anxiety-based depression.
11:08Yeah.
11:09Obviously, some people go on medication and then really want to come off it.
11:11Mm.
11:12And some people actually think, well, actually, I feel great on it.
11:14Yeah.
11:15I'd rather stay on it.
11:16I would.
11:17I would rather stay on it.
11:18At some point, you feel, actually, you'd like to try without it.
11:21And we can support you through that as well.
11:23But don't do what you did last time and just suddenly stop it.
11:25Yeah.
11:26Because that is when you can get, kind of, withdrawal side effects and things.
11:28Yeah.
11:29Did you have talking therapy and things in the past?
11:31Oh, I've literally tried everything.
11:32You tried everything.
11:33I mean, we can always increase the dose and the medication.
11:35Yeah.
11:36Talking therapies will always be there.
11:37Yeah.
11:38But I suppose it's what you feel would be helpful for you.
11:41I do.
11:42I don't really want to increase because I don't want to become.
11:44I know, obviously, right now, I'm not addicted to them, but I'm reliant on them.
11:49It would be nice to, like, see an exit.
11:52Okay.
11:53But I think I'll just be on them.
11:55You mean about, you mean see an exit as in coming off them?
11:58Yeah.
11:59There is no need to come off them.
12:00I wouldn't put that kind of pressure on you.
12:02Yeah.
12:03You know, if you end up on them for years and years, that's okay.
12:04They're not addictive in that sense.
12:06Mm-mm.
12:07What talking therapies do you guys have?
12:10So back on track, and they would assess you, and then they can kind of decide whether
12:14it's counselling, CBT.
12:16Mm-mm.
12:17So you can do that at any point.
12:18Yeah.
12:19But if anything gets worse in the mood, or you feel actually you're struggling a bit
12:22more, especially going into winter having been in...
12:24Yeah.
12:25Have you been in Australia?
12:26Yeah.
12:27Yeah, so...
12:28A massive change.
12:29A slight change with the weather.
12:31But, you know, some people, and some people do find that really hard.
12:35You know, British winters are something, a quiet taste.
12:39So miserable.
12:40So yeah, so if you find that that's sort of triggering things, having spent a couple
12:43of years in Australia and lovely sunshine, then we'd rather you came in sooner.
12:47Okay?
12:48And we're here to help.
12:49Cool.
12:50Perfect.
12:51Good to see you.
12:52Oh.
12:54Have a good afternoon.
12:55Bye.
13:00David.
13:05How are you?
13:06Good.
13:07Yeah.
13:08I can't see you yet until I get...
13:10We're going to go this way.
13:11Is that all right?
13:12A yard in front.
13:13Yep.
13:14Come have a seat here.
13:16I'm actually nervous.
13:17Why are you nervous?
13:18Well, because I got a phone call this morning saying I was going to be having a small operation.
13:24Ooh.
13:25That's not true, is it?
13:26I think I was just going to have a look at your...
13:28What was...
13:29Oh, I know you're going to look at that, but you're not going to operate today, are you?
13:31I'm not going to operate today, no.
13:32No.
13:33Or tomorrow, or next year.
13:35Because the thing is, there's no pain at all.
13:38Right.
13:39Does it ever not go back in?
13:41No, it doesn't go back in.
13:43Mmm.
13:44Well, have a look.
13:45Yeah.
13:46Do you want me to take my shoes off?
13:47No.
13:48No.
13:49We can leave them on.
13:50No, I'm not overweight.
13:52Yeah.
13:53And I'm not ready for a nursing.
13:55Yeah.
13:56Perfect.
13:57Yes.
13:58And you relax back.
14:00This is what you're worried about, this bit.
14:03It's not painful, no?
14:05No.
14:06No, no.
14:07So this is the bottom of your sternum, there.
14:10And your ribs all go into it, yeah?
14:12And you may have damaged a rib which...
14:14The joint which connects to the bottom of the breast bone.
14:18Right.
14:19And that's why it's swollen up a wee bit to heal as it gets better.
14:22Yes.
14:23I'm going to help you to get up slowly if you can.
14:25I just want to see your muscles as you get up, yeah.
14:28So they don't protrude or anything there.
14:30No, you see.
14:31And there's no pain at all.
14:32Yeah.
14:33You all right getting off, Don?
14:34Oh yes, I'm sure I'll be fine.
14:36I thought it was going to be hernia, but it isn't.
14:39Well that's what I thought it was.
14:40Yeah.
14:41You probably damaged it somehow.
14:42Yes.
14:43With one of your falls.
14:44Yeah.
14:45I don't think you need to do anything about this, so no operations today.
14:51No.
14:52And hopefully...
14:53But hopefully it will get better.
14:54Yeah, I think it will just calm down.
14:55Yes.
14:56As long as it's not causing you any pain.
14:58No, I think if I was...
14:59No breathing problems, nothing you see.
15:01Nothing like that, no.
15:02Yeah, yeah.
15:03Well you're very...
15:04I couldn't have a better doctor.
15:05Because I feel as if I'm being spoiled.
15:07Well...
15:08And I appreciate it.
15:09You deserve it.
15:10Yeah, yeah.
15:11I'm glad.
15:12Don't leave.
15:13Don't worry.
15:14Not that I know of anyway.
15:15Don't leave till I've gone to the other planet.
15:17I couldn't...
15:18I wouldn't wish to be with anybody else.
15:20Oh.
15:21Can you manage?
15:22All right, David.
15:23Lovely to see you.
15:24You take care.
15:25I am very appreciative.
15:26All the best.
15:27Thanks a lot.
15:28Take care.
15:29Bye.
15:32Caitlin.
15:33Hello.
15:34Yes.
15:35Nice to see you.
15:36How are you?
15:37I'm good.
15:38You're looking good.
15:39Thank you very much.
15:40Well, so are you.
15:41Come and have a seat.
15:42So what are we up to today?
15:43I'm 42.
15:44Yep.
15:45I'm starting to feel perimetopausal symptoms.
15:46Okay.
15:47So tell me, what sort of things are you getting?
15:48Mainly I'd say brain fog and memory lapses.
15:51Yeah.
15:52Extreme fatigue.
15:53Okay.
15:54You know, one day I'll be okay and the next day it'll just hit me at 6 o'clock in the afternoon
15:58and I'm like, I have to go take a nap.
15:59And that's really unlike you, is it, to be a sort of...
16:02Yeah.
16:03And you're 42 now.
16:04Yes.
16:05So it is completely normal.
16:06So perimenopause, we often say we get symptoms up to 10 years before the menopause happens,
16:11which we sort of say is around 50, but it could be 45 to sort of 55 almost.
16:14So it's very normal to feel them now.
16:15And all those symptoms you were describing, brain fog and that sort of, tiredness, can
16:19absolutely...
16:20Sometimes I think my brain just doesn't work.
16:22Yeah.
16:23It's very strange.
16:24But then other times I'm quite on it.
16:25You're on it.
16:26And so I don't...
16:27Yes.
16:28Yeah.
16:29Yeah.
16:30Okay.
16:31And is that going okay?
16:32Or are you finding it's interfering with work or anything like that?
16:33It's interfering with work.
16:34Yeah.
16:35I'm kind of in between things, but still doing some consulting.
16:36And so sometimes I feel like it interferes and I just sit there going, oh my God, I know
16:40the answer to this.
16:41And it's not coming.
16:42I just had this conversation with this person and it's just not coming.
16:44And that's really frustrating, isn't it?
16:45Yes.
16:46Yes.
16:47What about your sort of mood in yourself?
16:49Are you feeling okay in yourself?
16:50Some people find they feel a bit down, a bit frustrated.
16:53Do you ever find that?
16:54I mean, I do feel, I guess, sometimes more frustrated with how my body feels and how my
17:01brain feels and then get a bit down.
17:03Okay.
17:04I mean, I wouldn't go as far as to call it anything quite like depression.
17:07Okay.
17:08But it is...
17:09Okay.
17:10Right.
17:11And some days are better and I feel like perkier and happier and I don't want to, you
17:13know, smash the wall or strangle my husband.
17:15Yeah.
17:16But there were times when...
17:17But there are other times where I'm like, oh.
17:19So I suppose the question is that, is this perimenopause, which it does fit lots of the
17:24criteria.
17:25Yes.
17:26There is also things like thyroid problems that can sort of happen at this age as well.
17:29Right.
17:30I've read about that.
17:31And these are things that creep in.
17:32Sometimes we're a bit anemic or the blood's a bit abnormal and that can cause some symptoms.
17:34So I'm quite a fan of having a screen just to make sure that we're not missing something
17:41else.
17:42Okay.
17:43But it would be silly to go down one route and actually your thyroid's become underactive
17:47and actually we could have replaced that very easily and you'd have felt a lot better
17:50and it might, you know, and we don't want to give you HRT and it doesn't make any difference
17:53because we're treating the wrong thing.
17:54How do you feel about HRT?
17:56If it's necessary and it will help improve my symptoms, I'm all for it.
18:00Well then why don't we do the test and test it for everything and then have a look and then we can
18:04make a plan going forward.
18:05Okay.
18:06Is that okay?
18:07That would be great.
18:09We'll see you for that blood test and then we'll catch on.
18:10Thank you so much.
18:11Okay.
18:12Nice to see you.
18:13Take care.
18:14Bye.
18:15Bye-bye.
18:16Bye-bye.
18:17It looks really sore.
18:18It looks really tender.
18:19Yeah, so we've got a good amount of swelling at the back of the ankle there and redness
18:24and there's heat.
18:25I've got like a swollen eyelid.
18:27You can see the swelling there, it's a bit red and inflamed.
18:29Straight away we can see that foot's a bit bigger than that foot, isn't it?
18:32A bit more swollen.
18:33Yeah, you can see exactly where it is.
18:37What I can see on the outside is a sort of dome-shaped lump.
18:41Lift your eyelid up and try and look in, I can see the same thing there, so it's like
18:44a decent size.
18:45This hurts up here, this hurts obviously.
18:48I mean, I said to the guys at work, you know, I could look like the elephant man, but
18:51as long as it didn't hurt, I wouldn't mind.
18:53Mr Volpe?
18:56Hello, Doctor.
19:01First time I see you.
19:04I know, I've spoken to you on the phone lots.
19:07Anyway, Doctor.
19:08Yeah, today.
19:09This worries me.
19:10OK.
19:11What is it?
19:12I thought there was a hole coming out, you know.
19:14How long has it been like that?
19:16About seven, eight days ago.
19:18OK.
19:19And before that, no swelling, nothing?
19:21No.
19:22I felt this.
19:23So I say it's the primbers, you know, you get them everywhere and there.
19:27Yeah.
19:28Then it gradually get them big and big.
19:30I squeezed again, my pink blood, you know.
19:33Mm.
19:34Now all this, it's all red.
19:36Mm.
19:37Any pain here?
19:39Not there.
19:40The only pain I get here, where you see, on the ear.
19:45Mm.
19:46Yeah.
19:47And here, you feel swollen.
19:48Look, a lot swollen.
19:49My concern is that it's quite red and swollen now, isn't it?
19:53Red, yeah.
19:54That is what I found you today.
19:56You see on TV this insect.
19:58I say, could it be one of that here?
20:00I think it possibly might have started out as a bite.
20:03I'm just concerned the infections coming onto your face.
20:06Yeah, up to the eye.
20:07You see the heat, you feel it.
20:09And it's weather giving you all antibiotics is going to be enough.
20:13You do feel a bit in the head, you know.
20:16You feel a bit, you know, like you're too much.
20:19Yeah.
20:20You hear too much, you know.
20:21What I'm going to do is I'm just going to call the ambulatory unit.
20:24Do you want to just have a seat on the chair outside for a minute?
20:27Yes.
20:28And I'll call them.
20:29All right, and I'll call you back in in one second.
20:30Okay, sir.
20:36My name's Dr. Dutch and I'm a local GP.
20:38I just wanted to call you about a 78-year-old gentleman.
20:41So he had a possible insect bite, I think it was around Friday.
20:45And then Saturday it started sort of pussing.
20:47And since yesterday he's had sort of spreading cellulitis.
20:50But it's almost up to his eye and there's a bit of redness below his eye.
20:54And it's really hot and warm to touch and significantly swollen
20:57on the left above his ear.
20:59Okay, so it would be A and E.
21:02Okay.
21:20So just open wide for me.
21:22Say ah.
21:23Ah.
21:24Ah.
21:25Ah.
21:26Ah.
21:27Wow.
21:28That is spectacular.
21:29Stick your tongue out.
21:30Oh, even better.
21:31Ah.
21:32Ah.
21:33Ah.
21:34Ah.
21:35See, that's quite red, but then you've been coughing quite a lot, haven't you?
21:37Oops, sorry.
21:38You all right?
21:39I'm just going to press the tongue down.
21:40Yeah, that will...
21:41Sorry.
21:42No, don't worry.
21:43I don't like it either.
21:44Oscar?
21:47Good morning.
21:48How are we doing?
21:49Good morning.
21:50How are we doing?
21:51Good morning.
21:52Good morning.
21:53How are we doing?
21:54Good morning.
21:55My name is Anna McHugh.
21:56Nice to meet you, Doctor.
21:57It's nice to meet you.
21:58So, Oscar, what's been going on?
22:00I've got a quite a sore throat.
22:02I've been getting some headaches on this area of my head.
22:05So how long has that been going on for?
22:07It started a year yesterday.
22:09Okay.
22:10And have you ever had anything like this before?
22:12Yeah, I had something with my throat around it.
22:16The strep?
22:17Yeah.
22:18Yeah, the streptococcus.
22:19Okay.
22:20So it's kind of been in the last 24 hours that you're feeling like you have a sore throat
22:24and a headache, is that right?
22:25Is it okay if I examine you?
22:26Yeah.
22:27Okay.
22:28Now, if you open your mouth as wide as you can and say, ah, and say, ah, well done.
22:33So there are a small amount of white dots there that you can see.
22:38You can relax.
22:39I'm just feeling for any lymph nodes.
22:40Is it painful when I'm pressing there?
22:43No.
22:44I'm going to take your temperature as well, okay?
22:49Did you check his temperature yesterday?
22:51I checked it yesterday.
22:52I haven't checked it today.
22:53It didn't feel hot this morning.
22:55It was more the white dots that were concerning, but we did some kind of saltwater gargling.
22:59Yeah, that's a good idea.
23:00Absolutely.
23:01Last night.
23:02Was it worse?
23:03A little bit worse yesterday?
23:04It was a bit worse yesterday.
23:06Okay.
23:07Okay, so no temperature.
23:09So the main thing really that we're looking at is tonsillitis.
23:14More often than not, these are viral.
23:16So he is meeting the criteria to give him an antibiotic.
23:20I think we should do that for five days.
23:22Obviously, if he's getting worse or not improving, please come back and see us.
23:26But I would imagine that this will improve for him.
23:29The other thing just to mention is if he's having tonsillitis frequently.
23:33So, you know, seven episodes needing antibiotics in a year.
23:37It would be kind of a point to maybe have a think about whether we need to talk to the specialists.
23:45Absolutely not at this point in time.
23:47We're not there yet.
23:48But just so you have it in the back of your mind.
23:50Sure.
23:51Okay?
23:52Do you have any questions for me?
23:53No.
23:54Okay.
23:55All right.
23:56So we'll go for that.
23:57Okay, great.
23:58All right.
23:59Nice to meet you, Oscar.
24:00And we can pick those up now, can we?
24:01Yes.
24:02Okay.
24:03Amazing.
24:04Thank you very much.
24:05Thank you so much, Doctor.
24:06Thank you so much.
24:07Bye.
24:08Come back through.
24:09Okay.
24:10Have a seat.
24:24So I had a quick chat with the medical team at the hospital.
24:28And they're happy that we start you on oral antibiotics initially.
24:31Mm-hmm.
24:32What they want us to do is review you in 24 hours.
24:35Okay.
24:36And if it's getting any worse, then we need to refer you up to the hospital.
24:40Do you mind if I draw on your face?
24:42No.
24:43Just a little bit.
24:44So I'm just going to mark the area a little bit.
24:48So where I've marked is the kind of deep red bit.
24:51So if over the next 24 hours you see it's spreading a lot or getting worse, go straight to A&E.
24:57But I'm going to give you an appointment for tomorrow afternoon anyway.
25:00I want you to come to it so we can review how you're doing.
25:03Yeah.
25:04Yeah.
25:05Your temperature's fine at the moment.
25:06But if tonight you get a high fever and feel very unwell, please go to A&E.
25:09Okay.
25:10And then we'll see you tomorrow to see how it's doing.
25:11Yeah.
25:12Okay.
25:13Three o'clock.
25:14Yeah.
25:15Thank you, Doctor.
25:16Not at all.
25:17Nice to see you.
25:18You've done a lot for me.
25:20All right.
25:21Bye, Mr. Volpe.
25:22Bye.
25:23Bye.
25:24We're in here today.
25:25Come and have a seat.
25:26How are you?
25:27Yeah, good, good.
25:29Good to see you.
25:30Now, what are we up to today?
25:31I actually made notes.
25:32Okay, good.
25:33The pains that I'm experiencing, they're now on the shin, both legs.
25:43They're so uncomfortable that they do keep me awake at night and they do wake me up.
25:48So both thighs, the sensation would be a sudden cramp and trapped nerve all in one.
25:54So if I'm walking.
25:55Yeah.
25:56It halts me.
25:57I have to stop.
25:58Okay.
25:59And I can't move.
26:00And what halts you?
26:01The pain?
26:02The pain.
26:03In both legs?
26:04In both legs.
26:05Okay.
26:06Before it was on the right, if you remember, that's what I was reporting.
26:08Yeah.
26:09Now it's happening on both.
26:10Okay.
26:11It's painful enough that it brings tears to my eyes.
26:13So really bad.
26:14You know, the level.
26:15And stopping you.
26:16And do you just wait a few minutes and then set off again?
26:18I'll tell you what I do, Doctor.
26:20I jog or I just kick just so I can keep moving because I've got a train to catch.
26:27Oh, I see.
26:28So you've just got to keep moving so you can't just stand still.
26:30Yeah, yeah.
26:31I can't just.
26:32And sometimes obviously I would stand still.
26:33Yeah.
26:34Or I find that if I just sit down.
26:37Yeah.
26:38And rest up, then I'm fine.
26:42So it's almost like waiting.
26:43It sounds like it's escalating a bit more.
26:46Do you know what?
26:47It's escalated in the sense it's now affected my left side.
26:49I wanted to discuss also with you about the blood test results because I did receive a notification.
26:54The rheumatoid factor on the blood test has come back.
26:58She said it's not rheumatoid.
27:00What the rheumatologists have said, however, is they've said physiotherapy is what we need to do.
27:05And chronic pain team if the pain continues.
27:08I haven't heard from them.
27:10Yeah.
27:11So I can, I can chase all that up.
27:14She's told, she's put in the note.
27:16Yeah.
27:17That they talked about, uh, cocodomol.
27:19I don't want to rely on the medicated.
27:21I know.
27:22I know.
27:23I need to find out what else, what other options do I have.
27:26Okay.
27:27Which is good.
27:28And I think you're quite right.
27:29Because they did all the, so they did all the scans.
27:31They looked at the MRI of your lumbar spine.
27:33They'd done all of this to check that there wasn't any sort of critical sort of nerve compression
27:38or anything we need to worry about.
27:40There isn't, but it's not completely normal.
27:42Although it's not life threatening.
27:43It's nothing awful that we need to jump up and down about.
27:46It is pressing on nerves.
27:47So the rheumatologist feels this isn't an active rheumatoid arthritis picture,
27:52but you clearly have disc problems and onset of musculoskeletal problems that we need to learn to manage better.
28:00And we need to help you with that.
28:02Can we try and get the pain clinic to try and have a look at this?
28:06Yeah, they've not.
28:07They've not.
28:08I'll chase them.
28:09We'll try and get them involved.
28:10Because I think your regimen that you're doing with the painkillers is brilliant.
28:13Yeah.
28:14But it's not helping.
28:15But I think the fact that it's stopping you walking, it's stopping you doing things,
28:17we've still got a long way to go, haven't we?
28:19So we're not there yet.
28:20Yeah.
28:21I understand.
28:22I've got a list of medicine that I need.
28:25Okay.
28:26Codidremol.
28:27Codidremol.
28:28The patches, you know, the HRT.
28:31The HRT.
28:32The HRT one.
28:33I mean, one option with the patches actually.
28:35You're only on 50, you're on a reasonably low dose.
28:38We could go up to the 75 just this month.
28:40Then we can meet up again in a month's time or so and see if it's made any difference.
28:43Yeah.
28:44So I'll send those through to Boots.
28:46The pain clinic referral.
28:47And then you and I catch up again in a month and see how you're doing.
28:50Okay.
28:51All right.
28:52Thank you very much.
28:53Well, listen, good luck with things.
28:54Nice to see you.
28:55And why don't we book?
28:56If we speak to the girls at the front desk, if you could book it again for say four weeks'
28:57time, something like that.
28:58Four weeks' time, I'll do that now.
29:01You take care.
29:02Nice to see you.
29:03All the best to talk.
29:04Bye-bye.
29:05Bye.
29:06Mr. West Seidling?
29:07Yes.
29:08Come on in.
29:09Have a seat.
29:10I'm Dr. Dudgeon.
29:11We've met before.
29:12A while ago.
29:13Yeah.
29:14Oh, a urine.
29:15Perfect.
29:16I've just been three months in Denmark.
29:19Oh, amazing.
29:20I saw a doctor friend of mine and I had some tests taken.
29:23Okay.
29:24Of course I have a kidney patient.
29:25Yeah.
29:26He looked at my figures and he said, you should just check for urine infection.
29:31Okay.
29:32Have you got any symptoms of a urine infection?
29:34Yes, I go to the toilet a lot.
29:36Mm-hmm.
29:37I think it's a little painful.
29:38Okay.
29:39And is that a new symptom?
29:40Yeah.
29:41I would say, yeah, I've had it a couple of weeks.
29:45Does it burn or sting?
29:47Yeah, a little bit of burn.
29:50And you saw the kidney team this week, is that right?
29:53Yes, that's correct.
29:54Would you let them know about the symptoms?
29:55No, I didn't.
29:56So they feel your kidneys are sort of stable?
29:59Yeah.
30:00Okay.
30:01How long time do you think they'll remain stable?
30:03The function of the kidneys, they call it EGFR, so your estimated filtration rate.
30:08So yours is 14 at the moment.
30:10Yeah.
30:112024, you were about 16.
30:13I think it's very slowly getting a bit worse.
30:18Have you got pain in the tummy at all?
30:19No.
30:20No?
30:21No fevers?
30:22Okay.
30:23But you wouldn't say you're always needing to go or it always burns?
30:26No.
30:27No, just sometimes.
30:28Okay.
30:29Let me dip it and we'll send it to the lab as well.
30:32Yeah.
30:33Okay.
30:34Do you notice the symptoms are worse if you don't drink much or?
30:38No.
30:39I mean, I start the day by drinking a big glass of water.
30:43Good.
30:44There's a tiny trace of blood and a tiny trace of white cells.
30:49The urine.
30:50The urine.
30:51We're definitely going to send it to the lab and that will tell us whether or not there's an infection or not.
30:54Yeah.
30:55If the symptoms are very mild and they've been there a few weeks.
30:57Okay.
30:58Especially with the kidney symptoms, let's wait the results and then decide whether or not to treat you once we know whether or not there is an infection.
31:05Sounds good.
31:06If over the next couple of days the symptoms get worse, call us and we can always give some antibiotics.
31:11Okay.
31:12Very good.
31:13Thank you very much.
31:14All right.
31:15Not at all.
31:16Tell me, is Dr. Pearson still here?
31:17Dr. Pearson still here, yeah.
31:18Yeah, she is.
31:19Yeah.
31:20Because she looked after me for the last 25 years.
31:21Oh.
31:22I'll send her your love.
31:23All right.
31:24Have a good afternoon.
31:26Bye.
31:28Would you rather only buy all your underwear secondhand or all your toothbrushes you have to buy secondhand?
31:36Underwear because you could wash them.
31:38No.
31:39Someone else's bits have been in your underwear.
31:41Yeah, but you wash them, you can bleach them.
31:43George said underwear.
31:44Max, what did you choose out of the underwear or the toothpaste?
31:46I said I'd just go Phil Commander.
31:48Maggie does that anyways.
31:51Yeah.
31:52Pamela.
31:53Yes.
31:54How are you?
31:55My ankles are swollen, my legs are swollen, I can hardly walk and I feel sick.
32:04Let's hopefully sort you out.
32:06Yes, please.
32:07You know, I've never had swollen feet before.
32:10Take a seat, make yourself comfortable.
32:13So leg swelling, both sides, three days, one leg is worse than the other.
32:18Yeah, the right leg is terrible.
32:20Shall we have a look at your legs?
32:21You can have a look at this one in particular.
32:24Are they worse at night and better in the morning?
32:26No.
32:27Can I just press on your leg?
32:28Yeah, that's a bit sore.
32:30It's not pitting, so that's good.
32:31It doesn't look like there's any fluid there, so that's really good.
32:34Really?
32:35Yeah.
32:36This one isn't quite as bad.
32:38Sorry, is this painful?
32:40No, but you can feel that it's swollen.
32:42Yeah.
32:43Right, let's measure them.
32:44Ten centimetres down and measure.
32:47And no periods of lying in bed for days on end recently.
32:50I'm sleeping a lot during the day.
32:52If I sit down to watch television, the news or anything, I go to sleep.
32:56That's not me.
32:57It's not usually you.
32:58Good.
32:59They're exactly the same, 35 on both sides.
33:01Really?
33:02Really, really good, yeah.
33:03I agree with you.
33:04At the sort of bottom, near the ankle, this does look more swollen than this one.
33:07That's terrible.
33:08Yeah.
33:09I think I've got arthritis in there, actually.
33:10Yeah, I would agree.
33:11Look at that fat.
33:12Yeah, it is arthritis.
33:13So what I think is going on is what we call venous insufficiency, which basically means
33:18the blood vessels in the legs are just not quite working as well as we'd like them to.
33:23And so blood is getting down to the legs, but it's not going back up towards the heart as efficiently as it once did.
33:29And that's really just age-related changes and various other bits like that.
33:33Can I have a little listen to your heart?
33:35Yes, you can.
33:36I feel there's so much going wrong with me.
33:38I've never had this before, this feeling, even when I came out of hospital with a stroke.
33:52Pamela, I can hear a bit of a murmur in your heart, so I wonder if there might be either
33:57a bit of a narrowing of one of the valves or if one of them is a little bit leaky.
34:01So I think we should do some more tests for you.
34:04I'll see if the girls can do an ECG now for you to save you having to come back.
34:08Please don't panic, but I think there's a few things we should do just to make sure.
34:12Is that all right?
34:13Any questions?
34:14That's a lot of information.
34:16Well, my worry is my heart.
34:19I mean, it's always been fine.
34:21Let's hope it stays fine.
34:24You know?
34:25Yeah.
34:26Oh, God.
34:27We'll sort you out.
34:28Don't worry.
34:29We'll get it sorted.
34:30Thanks.
34:47If I could ask you to just pop both your feet flat on there, thank you.
34:51I should know the rules by now.
34:52Why do you look scared?
34:53Do I?
34:54No, I'm not scared.
34:55Well, did you just zone out for a second?
34:56I just zone out, yeah.
34:57Perfect blood pressure.
34:58129 over 76.
34:59Gorgeous.
35:00That's really good.
35:01Andrew?
35:02Yep.
35:03Andrew?
35:04Yep.
35:05How are you?
35:06Yep.
35:07How are you?
35:08Yeah.
35:09How are you?
35:10Oh, I'm fine.
35:11Pop your bag on the chair.
35:12So we're going to do your blood pressure.
35:13I've not seen you for a while, so that's a good thing.
35:14It's a year.
35:15Is it a year?
35:16Yeah.
35:17So it's going to be every year.
35:18Yeah.
35:19Yeah.
35:20So it's going to be every year.
35:21Yeah.
35:22When you're on medication, we do like to keep an eye on you.
35:23Right.
35:24You look fit.
35:25Well, yeah.
35:26So I mean, I sort of cycle every day.
35:27Yeah.
35:28So I do about 150 miles a week.
35:29That's amazing.
35:30Relax.
35:31I walk everywhere.
35:32And I eat healthily.
35:33But I do smoke.
35:34Okay.
35:35Yeah.
35:36Yeah.
35:37Little skinny ones.
35:38Well, when you want to give up, come and see us.
35:39I don't want to give up.
35:40Okay.
35:41Fair enough.
35:42I'm 76 years old.
35:43You're amazing.
35:44Yeah.
35:45Yeah.
35:46Yeah.
35:47Yeah.
35:48Yeah.
35:49Yeah.
35:50Yeah.
35:51Yeah.
35:52Yeah.
35:53Yeah.
35:54Yeah.
35:55Yeah.
35:56Yeah.
35:57Yeah.
35:58Yeah.
35:59Yeah.
36:00I'm 76 years old.
36:01You're amazing.
36:02And I can run a little bit.
36:03I remember your mum.
36:04So.
36:05Right.
36:06You are.
36:07You're amazing.
36:08Okay.
36:09Relax.
36:10And no talking.
36:11From now.
36:17It's high.
36:18I remember we had this before, didn't we?
36:21Is it that much higher?
36:22It is high.
36:23But don't stress about it because it'll make it go up even more.
36:26Right.
36:27Okay.
36:28Great.
36:29Happy place.
36:30Happy place.
36:31Happy place.
36:32Happy place.
36:33Hmm.
36:34Happy place.
36:36Sounds like a rusty old moped, doesn't it?
36:42It is too high.
36:44Too high?
36:45Yes.
36:46Right.
36:47Ideally, we would want another 24 hour offer you.
36:51You know, the 24 hour monitor that you had before.
36:54How much higher is it?
36:55How much higher is it?
36:56We would ideally want you to be under 140 and under 85.
37:01Right.
37:02Your blood pressure at the moment is, the lowest one was 172 over 111.
37:09Jesus.
37:10Exactly.
37:12And he's not helping.
37:14Not today anyway.
37:16You can see a doctor at four o'clock today.
37:22Okay.
37:23So let's tackle you today.
37:24Is that okay?
37:25Yes.
37:26What would be causing the higher blood pressure?
37:27It can be family history.
37:30But it's not running in the family.
37:32If I had an answer for it.
37:33Yeah, you wouldn't be sitting here, you'd be sitting in Monte Carlo, I know.
37:36Exactly that.
37:37Yeah, quite.
37:39All right.
37:40Thank you very much.
37:41Bye.
37:48So, we're doing your ECG.
37:49Yeah.
37:50I'm such short-legged.
37:51Okay.
37:53Luckily, this is one of those beds that moves up and down for you.
37:56Yeah.
37:57Do we need to move them a bit more over?
37:59Yeah.
38:00I'm going to have to put two on your legs.
38:01Is that okay?
38:02I'm just going to pop it on top.
38:05Two go on your wrists.
38:07Okay.
38:08I'm just going to pop it between your legs and then I'm going to run the ECG.
38:14Let's have a look.
38:24Okay.
38:25So, I'm going to pass the ECG back over to Dr. George, who will have a look at it.
38:33Okay.
38:34That's all done for you.
38:35Do you need help?
38:36Yes.
38:37There we go.
38:39So, that's...
38:40It's okay.
38:41Lovely.
38:43All done.
38:45That's okay.
38:46We'll wait in the waiting room and I'll speak to Dr. George.
38:48Yes, okay.
38:49Lovely.
38:51You're welcome.
38:52Is that real?
38:54No, it's not.
38:55No.
38:56You're welcome, doesn't it?
38:57I know.
39:01Let's have a look at this.
39:02So, baseline's a bit messy, but that's okay.
39:06No ST elevation.
39:08Progressive lengthening.
39:10I'm not liking the look of this.
39:11I'm a little bit worried.
39:12She can go home.
39:13I don't think we're doing anything acute.
39:14There's nothing to suggest that.
39:15I'll go and tell her.
39:16That's absolutely fine.
39:17You can go home.
39:18Not a problem at all.
39:19Just to let you know, the ECG is okay.
39:20I'm going to run it by a cardiologist though, just for reassurance.
39:22Any problems at all, just give us a call.
39:23All right?
39:24My pleasure.
39:25You're very welcome.
39:26All right.
39:27Take care.
39:28I feel like I'm cutting a fever, you know.
39:29You people have made me sick.
39:30I'm going to go home.
39:31I'm going to go home.
39:32I'm going to go home.
39:33I'm going to go home.
39:34I'm going to go home.
39:35I'm going to go home.
39:36I'm going to go home.
39:37You can go home.
39:38Not a problem at all.
39:39Just to let you know, the ECG is okay.
39:41I'm going to run it by a cardiologist though, just for reassurance.
39:42Any problems at all, just give us a call.
39:43All right?
39:44My pleasure.
39:45You're very welcome.
39:46All right.
39:47Take care.
39:48I think I'm going through it.
39:49Is that a tricky?
39:50I have a bad one.
39:51I feel like I'm cutting a fever, you know.
39:54You people have made me sick.
39:58David.
40:01Hello.
40:02Morning.
40:03How are you?
40:04I'm good.
40:05How are you?
40:06I'm okay.
40:07Come on in.
40:10How are you doing?
40:11Okay.
40:12When I had my last blackout faceplant, my family is now saying I should get my hearing checked.
40:19Okay.
40:20Maybe the best thing to do is see if I got wax first and then see if...
40:24And then go and do something.
40:25Yeah.
40:26So very sensible.
40:27When you collapsed last time sort of thing and you faceplanted.
40:30Yeah.
40:31Do they know why you're having those collapses?
40:32Well, I've been poked and prodded.
40:34I know.
40:35Considerably.
40:36So two neurologists and a neurosurgeon later.
40:38And the cardiologist.
40:39Yeah.
40:40Yeah.
40:41We've added that in the mix as well.
40:42I know you've seen so many different consultants.
40:44It's a combination of, you know, AFib.
40:46So your pulse suddenly speeds right up, does it?
40:48Well, I just go boom.
40:49Okay.
40:50After 38 surgeries in 25 years, I should write a book.
40:57So poor David has skin and joint problems and has had multiple knee replacements, knee operations,
41:02shoulder operations, etc.
41:04He's enjoyed some quite extreme sports and he's very active.
41:07And as a result with his skiing and things, he's often had other accidents as well that have then resulted in him having 35 surgeries in total.
41:14Can I feel your pulse now?
41:15Let's see.
41:16Are you in fibrillation at the moment?
41:17Can you feel?
41:18Right now I feel fine.
41:19Okay.
41:20It just, um, it's just odd.
41:22It's the last month, I mean, that it's so high and so low.
41:25So it's going sort of fairly steadily at the moment.
41:27And just remind me, your medication, you're on blood thinners.
41:30Yes.
41:31Yeah, good.
41:32You have to be on them.
41:33And I have bisiprol.
41:34So they're all helping your heart.
41:35But of course the blood thinners, if you're crashing and falling and breaking things, we don't
41:36want you on blood thinners, but you have to be on the blood thinners for the heart.
41:39So your ears, we're worried that they're going to continue to.
41:42Okay.
41:43You know, let's, let's, let's tell me that they just got wax in them and then.
41:46That would be the easiest of the problems to solve, wouldn't it?
41:48All our balance is actually controlled inside our inner ear.
41:51So in David's case, it's probably quite complex that it might be a combination of potentially
41:55a heart rhythm problem, as well as the balance problems with his ear that are causing him
42:00to collapse, which in itself is also very dangerous.
42:02So we'll have a look at this side.
42:03It tickles a bit, I'm afraid.
42:04Yeah.
42:05Is there any pain in your ears?
42:06Uh, no.
42:07All right.
42:08Well, there's no wax in that at all.
42:09David and the eardrum looks absolutely perfect.
42:11So that ear looks perfect.
42:12So we've got a one to compare it to, which is good.
42:14Right.
42:15Let's just have a look this side.
42:16There's absolutely no wax at all.
42:18Not a drop.
42:19David's clear as a whistle.
42:20And the eardrum looks healthy.
42:23Good.
42:24Which, and so obviously the ear wax is the, well, I mean, that would be, if it had been
42:28ear wax, that would have been a simple fix, wouldn't it?
42:30But it's never quite that simple.
42:31Yeah.
42:32It means it's not the outer ear.
42:33The middle ear is sort of represented a bit by the drum, which looks healthy on both
42:37sides, which means it might be that the transmission of sound through is the problem.
42:42The little bones will have to sort of oscillate next to each other.
42:45But nothing in the middle of you.
42:46Nothing.
42:47Yeah.
42:48Nothing in the middle between there and there.
42:49I think it's worth doing a hearing test.
42:50Yeah.
42:51There's certainly not a reason not to, because if you, if you're not hearing right, it's
42:54not going to be helping with the balance issues and everything else that we've got.
42:57I'll refer you for the hearing test.
42:59Let's get that done.
43:00We can see if we can help with that side of it.
43:02Right.
43:03Good luck, David.
43:04Oh, let's get the hearing sorted out.
43:05Thanks.
43:06You take care.
43:07You take care.
43:08Look after yourself.
43:09Bye-bye, David.
43:10Take care.
43:12And enjoy your 20 more holidays.
43:14See you later.
43:15Bye.
43:16Good to see you again.
43:17Yeah, good to see you soon.
43:18Thank you, Doctor.
43:19So you take care and we'll give you a phone call.
43:21No, no problem.
43:23Bye.
43:24Perfect.
43:25It was lovely to meet you.
43:56So I've been suffering from very severe pain, like a sharp knife.
43:57First thing, I'm coughing a lot.
43:58So I've been suffering from very severe pain, like a sharp knife.
43:59First thing, I'm coughing a lot.
44:00Second thing, I have blood.
44:01When I cough and doesn't want to stop.
44:02I'm coughing a lot.
44:03Second thing, I have blood when I cough and doesn't want to stop.
44:04Well, I have to confess, I actually sterilized a needle.
44:05Oh dear God.
44:06No.
44:07Okay.
44:08I have to go.
44:09Oh dear God.
44:10Thank you very much.
44:11I've been outflow a lot.
44:12Oh, dear God.
44:13So I've been suffering from very severe pain, like a sharp knife.
44:17I'm coughing a lot.
44:18I have blood when I cough and doesn't want to stop.
44:22from very severe pain, like a sharp knife.
44:26First thing, I'm coughing a lot.
44:27Second thing, I have blood when I cough
44:30and doesn't want to stop.
44:31Well, I have to confess, I actually sterilized a needle.
44:34Oh, dear God.
44:35And then the past eyes are coming out.
44:37It's odd, I've not seen that before,
44:39if I'm honest with you.
44:39I've not seen somebody who's on four high-dose
44:42blood pressure tablets still have a blood pressure
44:44as high as yours.
44:52.
44:59.
45:04.
45:09.
45:10.
45:13.
45:15.
45:17.
45:19.
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