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Short filmTranscript
00:11When I had my blackout faceplant, I just go boom.
00:17I've had 38 surgeries in 25 years.
00:23I haven't had my period in seven months.
00:25Okay, that's a whole other story.
00:30How much higher is it?
00:31Your blood pressure at the moment was 172 over 111.
00:36Jesus.
00:37Exactly.
00:40Do you mind if I draw on your face?
00:42No, I don't.
00:52I'm not liking the look of this.
00:54I'm a little bit worried.
01:10Morning!
01:11Morning!
01:12Good morning!
01:31Stephen. Doctor. Hello.
01:37Can I have a seat?
01:40My arthritis at the moment, Doctor,
01:43has gone on another scale.
01:48Really, yes, yeah.
01:49I've got arthritis in my right knee.
01:51I've got arthritis in my left knee.
01:53I'm struggling walking both of my wrists.
01:56I'm having this mental health issue again
01:58because 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.
02:23Ticklish.
02:23Yeah.
02:24Is there any tenderness around pressing?
02:26No.
02:26So here?
02:27No.
02:28So a lot of pain around this area
02:30can be caused by a condition called plantar fasciitis,
02:32which is inflammation of the soft tissue
02:34on the bottom of the foot.
02:36Mm-hmm.
02:36That may be what's giving you this grief, actually.
02:39Yeah, so what do you take to manage the arthritis?
02:42Nothing.
02:43Right.
02:44I'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.
02:51Well done.
02:51Okay.
02:51Since I've quit drinking,
02:53I have put on a little bit of weight, you see,
02:56because I'm no longer going for the drink.
03:00Mm-hmm.
03:00I'm going for something else,
03:01maybe a snack or something, right, you know?
03:04Yeah.
03:04And what kind of snacks?
03:05Sweet.
03:06So a lot of these kind of ultra-processed snacks
03:10do actually trigger inflammation in the body.
03:12Mm-hmm.
03:13And then, like I said, other things like,
03:15you don't smoke, do you?
03:16A few.
03:16Okay.
03:17Not many.
03:18Even smoking as well has an inflammatory effect on the body,
03:21and cutting that down, stopping, could help as well.
03:25There is the option of going for a topical treatment.
03:27Mm-hmm.
03:28So a cream that you put on.
03:29You ever use Volterol gel?
03:30No, no, no.
03:31So it's anti-inflammatory medication,
03:33so 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.
03:43There's good evidence that physical activity is beneficial
03:46for people with joint problems,
03:48whether it's arthritis or something else.
03:50So, yeah, if we can get your pain well-managed,
03:53I would like you to be being active,
03:56because the long-term benefits are a 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,
04:12putting that effort in now may pay dividends in the future,
04:16and it would become easier.
04:17Even whilst you're talking to me and explaining this to me,
04:20it's kind of like making me feel better, you know?
04:24You've had a little nudge.
04:25That's what you need, doctor, sometimes, you know?
04:28You know, you get stuck in the spot, like, you know,
04:30and you don't want to move from it, like, you know?
04:32Yeah.
04:33Okay.
04:33Can we circle back in a couple of weeks
04:35and just let me know if anything has changed,
04:38hopefully for the better?
04:39We are only giving you a cream for this pain
04:43and I want to know that it is actually helping.
04:44So, two weeks' time, then.
04:46Can we agree on 10.45?
04:48Fantastic.
04:49That'll be on the 14th, Tuesday.
04:50Fantastic.
04:5010.45.
04:51You'll get a text message.
04:53Okay, then.
04:54Well done, doctor.
04:55Thanks.
05:02Josie?
05:02Oh, yes.
05:03That's me.
05:04Hi there.
05:05Come on through.
05:06Nice.
05:07So, take a seat.
05:07Oh, thank you.
05:09You came with a bundle of letters.
05:11Oh, yes.
05:12Some of them are NHS, some of them are from DC.
05:15Okay.
05:16What's brought you in here today?
05:17I just moved, so I need a new GP.
05:20Yeah.
05:21And I have Crohn's disease, so I need someone to help take care of that.
05:25Absolutely.
05:25We're 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.
05:46How old are you?
05:4717.
05:48How was it diagnosed?
05:49I was complaining of a stomachache for about three months, and then I lost the ability
05:53to digest food and end up in the hospital for 10 days.
05:56Okay.
05:56Okay, so 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.
06:05Yes.
06:05Have you had many flares of your Crohn's disease?
06:08It's been pretty decently managed.
06:10I basically just take care of it, not to anger it.
06:14And are there specific things that you've noticed that are triggers for it?
06:18Whole nuts, seeds, and raw greens.
06:21How is your tummy?
06:22Do you have any pain in the tummy?
06:24At the moment, I'm pretty decently managed.
06:26I'm in the middle-ish of my cycle.
06:29Okay.
06:29So, I'm due for an infusion in about four weeks.
06:32So, you're on infliximab infusions?
06:33Yes.
06:34And do you have that infusion sorted?
06:36I think so.
06:37Okay.
06:38Well, that's good.
06:39Yes.
06:39Okay.
06:39And any other issues?
06:41Any rashes, or...?
06:43I haven't had my period in seven months.
06:45Okay.
06:46That's a whole nother story.
06:47Yes.
06:48I know that's a whole nother story.
06:49Okay.
06:50So...
06:50And I am not sexually active.
06:52Okay.
06:52And 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...
07:14Over 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
07:23do an ultrasound scan, if we're still in a position where in, you know, coming up on
07:28a year, you haven't seen any periods, then definitely we'll be sending you through to
07:32the gynecologist.
07:33Yeah.
07:34Don't get me wrong.
07:34I'm pretty delighted about it for just the not-wrecking-underwear reasons, but it's also
07:39kind of concerning.
07:40Yes, you 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
07:49and things like that, but, you know, you are kind of six years into this, and it's worth
07:53looking into.
07:54Yeah.
07:55So, if you drop these to reception, book in a blood test.
07:59Okay.
07:59I'll make a referral for an ultrasound scan of your pelvis to see if there's anything
08:04going on in the ovaries or within the womb itself.
08:07You should be hearing from the gastroenterology team.
08:09Great.
08:09And if I'm pregnant, I get to start a new religion.
08:13Well, just let us know if that's the case as well.
08:15Yes, if that's the case, we have bigger problems.
08:17Yeah.
08:17Okay, Juicy.
08:18It 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 a water?
08:37Do you want me to get, I can get you some.
08:38Is that okay?
08:39Yeah.
08:49Thank you so much.
08:51Sorry I dropped the link.
08:53It's okay.
08:54I'm Dr. Dungeon.
08:55Nice to meet you.
08:56Nice to meet you.
08:56So what can we do for you?
08:57I need to get another search and repeat prescription.
09:02Okay.
09:02I went travelling to Asia and then Australia in January 20, 24.
09:08Yeah.
09:09So basically just before I went, my GP, this was in Devon, where I used to live,
09:14prescribed me six months of 100 milligrams so it would last me.
09:20Yeah.
09:20I see.
09:20So you've just been on 50 though.
09:22So how are you feeling on the 50?
09:24Yeah, fine.
09:24I had like maybe four or five days where I just like didn't take it because I like didn't
09:31have it.
09:32It was weird.
09:34Okay.
09:35So you sort of noticed.
09:36Yeah.
09:36Yeah.
09:36My head was like doing that like tingly thing.
09:39And I felt really dizzy and I was like profusely sweating.
09:43And I was like.
10:02For the first like two days I was like, oh, like whatever.
10:05Maybe I'll just like see if I can actually just wean myself off because I'm very aware
10:10that it probably needs to happen at some point.
10:12We do know you shouldn't stop it suddenly.
10:14Okay.
10:14So some of that might have been that you kind of just stopped abruptly rather than the
10:19fact that you wouldn't be able to manage without it.
10:21There's also no need to come off it.
10:22Yeah.
10:22So if you feel good on it, there's no rush.
10:24Yeah.
10:25Like honestly when I'm, I don't know when I'm going to cry, I feel so much better.
10:29Good.
10:29I'm just like, I don't mean to be upset with you.
10:31I literally just cried at everything.
10:34But you say on it your mood feels good.
10:37Yeah.
10:37I'm a very emotional person and I still feel like everything like that.
10:43But it's not like a constant overwhelming.
10:47It just completely eliminates that.
10:48And I feel the things that I feel a normal amount of anxiety as opposed to like a complete
10:56consumption of life, which is horrible.
10:58And I don't want that.
11:00Was it more for anxiety you went on it?
11:02Yeah.
11:02Yeah.
11:02I like went through like a two year bout of, I want to say that anxiety based depression.
11:08Yeah.
11:09Obviously some people go on medication and they really want to come off it.
11:12And some people actually think, well, actually I feel great on it.
11:14I'd rather stay on it.
11:16I would.
11:16I would rather stay on it.
11:16And that's fine.
11:17And it may be that at some point you feel actually you'd like to try without it.
11:22And we can support you through that as well.
11:23But don't do what you did last time and just suddenly stop it.
11:26Because that is when you can get kind of withdrawal side effects and things.
11:29Did you have talking therapy and things in the past?
11:31Oh, I've literally tried everything.
11:33I mean, we can always increase the dose in the medication.
11:35Yeah.
11:36Talking therapies will always be there.
11:38Yeah.
11:38But I suppose it's what you feel would be helpful for you.
11:41I don't really want to increase because I don't want to become, I know obviously right now
11:46I'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.
11:56You mean about, you mean see an exit as then coming off them?
11:58Yeah.
11:58Yeah.
11:59There is no need to come off them.
12:00I wouldn't put that kind of pressure on you.
12:02Yeah.
12:02You know, if you end up on them for years and years, that's okay.
12:05They're not addictive in that sense.
12:07Mm-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 it's
12:14counselling, CBT.
12:16Mm-mm.
12:17So you can do that at any point.
12:18Yeah.
12:18But if anything gets worse in the mood or you feel actually you're struggling a bit more,
12:23especially going into winter having been in Australia.
12:25Yeah.
12:25Have you been in Australia?
12:29Slight change for the weather.
12:32But you know, some people and some people do find that really hard.
12:35You know, British winters are something, a quiet taste.
12:39So yeah.
12:40So if you find that that's sort of triggering things, having spent a couple of years in
12:44Australia and lovely sunshine, then we'd rather you came in sooner.
12:48Okay.
12:48And we're here to help.
12:50Cool.
12:50Perfect.
12:50All right.
12:51Nice to see you.
12:54Have a good afternoon.
12:55Bye.
13:01David.
13:05How are you?
13:06Good.
13:07Yeah.
13:08I can't see you yet until I get up.
13:10We're going to go this way.
13:11Is that all right?
13:12A yard in front.
13:14Yeah.
13:15Come have a seat here.
13:16I'm actually nervous.
13:18Why are you nervous?
13:19Well, because I got a phone call this morning saying I was going to be having a small operation.
13:25Ooh.
13:26That's not true, is it?
13:27I think I was just going to have a look at your, what was...
13:29Oh, I know you're going to look at that, but you're not going to operate today, are you?
13:32I'm not going to operate today, no.
13:33No, or tomorrow, or next year.
13:36Because the thing is, there's no pain at all.
13:39Right.
13:39Does it ever not go back in?
13:42No, it doesn't go back in.
13:43Hmm.
13:44Well, have a look.
13:45Yeah.
13:45Do you want me to take my shoes off?
13:46No.
13:47No, we can leave them on.
13:51No, I'm not overweight.
13:53Yeah.
13:53And I'm not ready for a nursing.
13:55Ah ha ha.
13:56Yeah, perfect.
13:58Yeah.
13:59And you relax back.
14:01This is what you're worried about, this bit.
14:05It's not painful, no?
14:06No.
14:06No, no.
14:07So this is your bottom of your sternum, there.
14:10And your ribs all go into it, yeah?
14:12And you may have damaged a rib which, the joint which connects to the bottom of the breastbone.
14:19Right.
14:19And that's why it's swollen up a wee bit to heal as it gets better.
14:23Yes.
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.
14:31Ah, okay.
14:31And there's no pain at all.
14:33You all right in the off door into four?
14:34Oh yes, I'm sure I'll be fine.
14:37I thought it was going to be hernia, but it isn't.
14:39Well, that's what I thought it was.
14:41Yeah.
14:41You probably damaged it somehow.
14:43Yes.
14:43With one of your falls.
14:47I 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 a little bit.
14:56As long as it's not causing you any pain.
14:58No, I think if I was...
15:00No breathing problems, nothing, you see.
15:01Nothing like that, no.
15:02Yeah, yeah.
15:03Well, you're very...
15:03I couldn't have a better doctor.
15:05Because I feel as if I'm being spoiled.
15:09Well...
15:09And I appreciate it.
15:10You deserve it.
15:11Yeah, yeah, I'm glad.
15:12Don't leave.
15:13I'm not, don't worry.
15:14Not that I know of, anyway.
15:15Don't leave till I've gone to the other planet.
15:17I wouldn't wish to be with anybody else.
15:20Oh.
15:21Can you manage?
15:23All right, David.
15:23Lovely to see you.
15:24You take care.
15:25I'm very appreciative.
15:27All the best.
15:27Thanks a lot.
15:29Bye.
15:32Caitlin.
15:33Hello.
15:34Yes.
15:35Nice to see you in here today.
15:37I'm good.
15:38You're looking good.
15:38Thank you very much.
15:39Well, so are you.
15:40Come and have a seat.
15:41So what are we up to today?
15:42I'm 42.
15:43Yep.
15:43I'm starting to feel perimetopausal symptoms.
15:46Yeah, yeah, yeah.
15:46Okay.
15:46So tell me, what sort of things are you getting?
15:48Mainly I'd say brain fog and memory lapses.
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
15:57the afternoon and I'm like, I'll have to go take a nap.
15:59Yeah.
16:00And that's really unlike you, is it, to be a sort of...
16:02Yeah.
16:03And you're 42 now.
16:04Yes.
16:04So it is completely normal.
16:06So perimenopause, we often say we get symptoms up to 10 years before the menopause happens.
16:11Right.
16:11Which we sort of say is around 50, but it could be 45 to sort of 55 almost.
16:15So it's very normal to feel them now.
16:16And all those symptoms you were describing, brain fog and that sort of...
16:19Tiredness can absolutely...
16:21Sometimes I think my brain just doesn't work.
16:23Yeah.
16:23It's very strange.
16:24But then other times I'm quite on it.
16:26You're on it.
16:26And so I don't...
16:27Yeah.
16:27Because you're still working and...
16:28Yes.
16:29Yeah.
16:29Okay.
16:30And is that going okay?
16:31Or are you finding it's interfering with work or anything like that?
16:33It's interfering with work.
16:34Yeah.
16:34I'm kind of in between things, but still doing some consulting.
16:37And so sometimes I feel like it interferes and I just sit there going, oh my God, I know
16:40the answer to this.
16:42And it's not coming.
16:42I just had this conversation with this person and it's just not coming.
16:45And that's really frustrating, isn't it?
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 brain feels
17:02and then get a bit down.
17:04I mean, I wouldn't go as far as to call it anything quite like depression.
17:08Okay.
17:08But it is...
17:09Okay.
17:09Right.
17:10And some days are better and I feel like perkier and happier and I don't want to, you know,
17:13smash the wall or strangle my husband, you know?
17:15Yeah.
17:16But there were times...
17:17But there are other times where I'm like, oh.
17:19So I suppose the question is, is this perimenopause, which it does fit lots of the criteria.
17:25Yes.
17:25There is also things like thyroid problems that can sort of happen at this age as well.
17:29Right.
17:29I've read about that.
17:29And these are things that creep in.
17:31Sometimes 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 else.
17:42Okay.
17:42Because your symptoms totally fit in with that.
17:44But it would be silly to go down one route and actually your thyroid's become underactive
17:48and actually we could have replaced that very easily and you'd have felt a lot better.
17:51And it might, you know, and we don't want to give you HRT
17:53and it doesn't make any difference because we're treating the wrong thing.
17:55How do you feel about HRT?
17:57If it's necessary and it will help improve my symptoms, I'm all for it.
18:01Well, then why don't we do the test and test it for everything
18:03and then have a look and then we can make a plan going forward.
18:06Okay.
18:07Is that okay?
18:07That would be great.
18:09We'll see you for that blood test and then we'll catch up.
18:11Thank you so much.
18:11Okay.
18:11Nice to see you.
18:12Bye-bye.
18:17It looks really sore.
18:19It looks really tender.
18:21Yeah, so we've got a good amount of swelling at the back of the ankle there and redness
18:25and there is heat.
18:26I've got like a swollen eyelid.
18:28You can see the swelling there.
18:29It's a bit red and inflamed.
18:30Straight away we can see that foot's a bit bigger than that foot, isn't it?
18:33A bit more swollen.
18:35Yeah, 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.
18:44So it's like a decent size.
18:46This hurts up here.
18:47This hurts, obviously.
18:48I mean, I said to the guys at work, you know, I could look like the elephant man,
18:51but as long as it didn't hurt, I wouldn't mind.
18:56Mr Volpe?
19:01Hello, doctor.
19:02Have a seat.
19:03Have a seat.
19:04Good to see you.
19:04I know, I've spoken to you on the phone lots.
19:07Anyway, doctor.
19:08Yeah.
19:09Today.
19:09This worries me.
19:11Okay.
19:12What is it?
19:13I thought there was a hole coming out, you know.
19:15How long has it been like that?
19:17About seven, eight days ago.
19:19Okay.
19:19And before that, no swelling, nothing?
19:22No.
19:22I felt this.
19:23So I say it's a premature, you know.
19:25You get them everywhere.
19:27Yeah.
19:28Then it gradually get them big and big.
19:30I squeezed again, my pink blood, you know.
19:33Now, all this is all red.
19:38Any pain here?
19:39Not there.
19:40The only pain I get here, where you see, on the ear.
19:47And here, you feel swollen.
19:49Look, a lot swollen.
19:51My concern is that it's quite red and swollen now, isn't it?
19:54Red, yeah.
19:55That is what I found you today.
19:57You see on TV this insect.
19:59I said, could it be one of that here?
20:01I think it possibly might have started out as a bite.
20:04I'm just concerned the infections coming onto your face.
20:07Yeah, up to the eye.
20:08You see the heat, you feel it.
20:10And it's weather giving you all antibiotics is going to be enough.
20:14You do feel a bit in the head, you know.
20:17You feel a bit, you know, like you're too much.
20:20Yeah.
20:20You hear too much, you know.
20:21What I'm going to do is I'm just going to call the ambulatory unit.
20:25Do you want to just have a seat on the chair outside for a minute?
20:28Yes.
20:28And I'll call them.
20:29All right, and I'll call you back in one second.
20:31Okay, 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.
20:46And then Saturday it started sort of pussing.
20:48And since yesterday he's had sort of spreading cellulitis.
20:51But it's almost up to his eye and there's a bit of redness below his eye.
20:55And it's really hot and warm to touch and significantly swollen on the left above his ear.
20:59Yeah?
21:00Okay, so it would be A and E.
21:03Yeah.
21:04Okay.
21:20Did you just open wide for me?
21:22Say ah.
21:23Ah.
21:24Ah.
21:25Ah.
21:26Wow.
21:28That is spectacular.
21:29Let's take your tongue out.
21:30Oh, even better.
21:32Ah.
21:33Ah.
21:34Ah.
21:34Ah.
21:34You see, 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...
21:42No, don't worry.
21:43I don't like it either.
21:43Ah, ah, ah, ah, ah, ah.
21:47Ahem.
21:48Ahem.
21:52Good morning.
21:53How are you?
21:54How are we doing?
21:55No, my name is Anna McHugh.
21:57It's nice to meet you.
21:58Nice to meet you, Doctor.
21:58So, Oscar, what's been going on?
22:01Yeah.
22:01I've got a quite a sore throat.
22:03I've been getting some headaches on this area of my head.
22:06So, how long has that been going on for you?
22:08It started a year yesterday.
22:10Okay.
22:11And have you ever had anything like this before?
22:13Uh, yeah, I had something with my throat around it.
22:17A strep?
22:18Yeah.
22:18Yeah, streptococcus.
22:19Okay.
22:20Um, so, it's kind of been in the last 24 hours that you're feeling like you have a sore throat
22:25and a headache, is that right?
22:26Is it okay if I examine you?
22:27Yeah.
22:28Okay.
22:28Now, if you open your mouth as wide as you can and say, ah, and say, ah.
22:33Well done.
22:34So, there are a small amount of white dots there that you can see.
22:39You can relax.
22:39I'm just feeling for any lymph nodes.
22:41Is 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?
23:05It was a bit worse yesterday.
23:07Okay.
23:08Okay, 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, but I would imagine
23:27that this will improve for him.
23:29The other thing just to mention is if he's having tonsillitis frequently, so, you know,
23:35seven episodes needing antibiotics in a year, it would be kind of a point to maybe have a think about
23:42whether,
23:42you know, we need to talk to the specialists.
23:46Absolutely not at this point in time.
23:48We're not there yet.
23:49But just so you have it in the back of your mind.
23:51Sure.
23:52Okay?
23:52Do you have any questions for me?
23:54No.
23:55Okay.
23:56All right.
23:56So, we'll go for that.
23:57Okay, great.
23:58All right.
23:58Nice to meet you, Oscar.
23:59And we can pick those up now, can we?
24:00Yes.
24:01Okay.
24:01Amazing.
24:02No worries.
24:02Thank you very much.
24:03Thank you so much, Doctor.
24:05Thank you so much.
24:06Bye.
24:15Come back through.
24:16Okay.
24:23Have a seat.
24:25So, I had a quick chat with the medical team at the hospital.
24:27And they're happy that we start you on oral antibiotics initially.
24:32Mm-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?
24:42Not at all.
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 spreading a lot or getting worse,
24:55go 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.
25:03See our hospital set to check.
25:04Yeah, yeah.
25:04Your temperature's fine at the moment.
25:05But if tonight you get a high fever and feel very unwell,
25:08please go to A&E.
25:09Okay?
25:10And then we'll see you tomorrow to see how it's doing.
25:11Yeah.
25:12Okay.
25:12Three o'clock is well.
25:13Three o'clock, yeah.
25:14Thank you, Doctor.
25:15Not at all.
25:15Nice to see you.
25:16You've done a lot for me.
25:18All right.
25:18Bye, Mr. Volpe.
25:19Bye.
25:20Bye.
25:28We're in here today.
25:29Come and have a seat.
25:30How are you?
25:31Yeah, good, good, thank you.
25:32Good to see you.
25:33Now, what are we up to today?
25:35I actually made notes.
25:36Okay, good.
25:37The pains that I'm experiencing, they're now on the shin, both legs.
25:44They're so uncomfortable that they do keep me awake at night and they do wake me up.
25:48So both thighs.
25:50Okay.
25:50The sensation would be a sudden cramp and trapped nerve all in one.
25:54So if I'm walking, it halts me.
25:57I have to stop and I can't move.
26:01And what halts you?
26:01The pain?
26:02The pain.
26:03In both legs?
26:04In both legs.
26:05Okay.
26:05Before it was on the right, if you remember, that's what I was reporting.
26:09Now it's happening on both.
26:10Okay.
26:10It's painful enough that it brings tears to my eyes.
26:13So really bad.
26:14You know, the level.
26:15And stopping it.
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.
26:30I can't just.
26:31And sometimes, obviously, I would stand still.
26:34Yeah.
26:34Or I find that if I just sit down.
26:38Yeah.
26:38And rest up, then I'm fine.
26:42So it's almost like waiting.
26:44It 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.
26:50I 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.
27:09I haven't heard from them.
27:11So I can, I can chase all that up.
27:15She's told, she's put in the note that they've talked about cocodomol.
27:19I don't want to rely on a medicated route.
27:22I know.
27:23I need to find out what else, what other options do I have.
27:27Okay, which is good.
27:28And I think you're quite right.
27:29Because they did all the scans.
27:32They looked at the MRI of your lumbar spine.
27:34They've done all of this to check that there wasn't any sort of critical sort of nerve compression or anything
27:39we need to worry about.
27:40There isn't, but it's not completely normal.
27:42Although it's not life threatening.
27:44It's nothing awful that we need to jump up and down about.
27:46It is pressing on nerves.
27:48So the rheumatologist feels this isn't an active rheumatoid arthritis picture.
27:53But you clearly have disc problems and onset of musculoskeletal problems that we need to learn to manage better.
28:01And we need to help you with that.
28:02Can we try and get the pain clinic to try and have a look at this?
28:07They'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.
28:14Yeah.
28:15But it's not helping.
28:15But I think the fact that it's stopping you walking, it's stopping you doing things, we've
28:18still got a long way to go, haven't we?
28:19Yeah.
28:19So we're not there yet.
28:21Yeah.
28:22I understand.
28:23I've got a list of medicine that I need.
28:26Okay.
28:27Codidramol.
28:27Codidramol.
28:28The patches, you know, the HRT.
28:32The HRT one.
28:33I mean, one option with the patches actually, you're only on 50, you're on a reasonably low
28:37dose.
28:38We could go up to the 75 just this month.
28:41Then we can meet up again in a month's time or so and see if it's made any difference.
28:44So I'll send those through to Boots.
28:46I'll do a pain clinic referral.
28:49And then you and I catch up again in a month and see how you're doing.
28:51Okay.
28:51All right.
28:52All 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, if we speak to the girls at the front desk, if you could book it
28:57again for, say, four weeks time, something like that.
28:59Four weeks time, I'll do that now.
28:59All right.
29:00You take care.
29:01Nice to see you.
29:01And you.
29:02All the best, sweetheart.
29:02Bye-bye.
29:03Bye.
29:07Mr Wissidling?
29:08Yes.
29:11Come on in, have a seat.
29:12I'm Dr Dudgeon.
29:13We've met before.
29:14A while ago.
29:16Here.
29:16Oh, a urine.
29:17Perfect.
29:18I've just been three months in Denmark.
29:20Oh, amazing.
29:20I saw a doctor friend of mine and I had some tests taken.
29:24Okay.
29:24Because I have a kidney patient.
29:26Yeah.
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.
29:35I go to the toilet a lot.
29:36Mm-hmm.
29:37I think it's a little painful.
29:39Okay.
29:39And is that a new symptom?
29:41Yeah.
29:42I would say, yeah, I've had it a couple of weeks.
29:46Does it burn or sting?
29:48Yeah.
29:49A little bit of burn.
29:50And you saw the kidney team this week, is that right?
29:53Yes, that's correct.
29:54Yeah.
29:54Did you let them know about the symptoms?
29:56No, 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.
30:08Yeah.
30:09So yours is 14 at the moment.
30:10Yeah.
30:102024, 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?
30:20No.
30:20No.
30:20No fevers?
30:21No.
30:22No.
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.
30:32Okay.
30:34Do you notice the symptoms are worse if you don't drink much or?
30:38No.
30:38I 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.
30:50We're definitely going to send it to the lab and that will tell us whether or not there's
30:53an infection or not.
30:55Yeah.
30:55If the symptoms are very mild and they've been there a few weeks.
30:58Okay.
30:58Especially with the kidney symptoms, let's wait the results and then decide whether or
31:03not to treat you once we know whether or not there is an infection.
31:06Sounds good.
31:06If over the next couple of days the symptoms get worse, call us and we can always give
31:11some antibiotics.
31:12Okay.
31:13Very good.
31:13Thank you very much.
31:14Not at all.
31:15Tell me, is Dr. Pearson still here?
31:16Dr. Pearson still here?
31:18Yep.
31:18She is.
31:19Good.
31:19Because she looked after me for 25 years.
31:22I'll send her your love.
31:24All right.
31:24Have a good afternoon.
31:26Bye.
31:26Bye.
31:28Would you rather only buy all your underwear secondhand or all your toothbrushes you have
31:36to buy secondhand?
31:36Underwear?
31:37Because you could wash them.
31:38No.
31:39Someone else's bits have been in your underwear.
31:41But you wash them, you can bleach them.
31:43George said underwear.
31:44Mags, what did you choose out of the underwear or the toothpaste or the toothbrushes?
31:47I said I just got Phil Commander.
31:49Maggie does that anyways.
31:51Oh, yeah.
31:56Pamela.
31:57Yes.
31:58How are you?
31:59My 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.
32:08You know, I've never had swollen feet before.
32:11Take a seat, make yourself comfortable.
32:14So 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?
32:22You can have a look at this one in particular.
32:24Are they worse at night and better in the morning?
32:27No.
32:27Can I just press on your leg?
32:29Yeah, that's a bit sore.
32:30It's not pitting, so that's good.
32:32It doesn't look like there's any fluid there, so that's really good.
32:34Really?
32:35Yeah.
32:35This one isn't quite as bad.
32:39Sorry, is this painful?
32:40No, but you can feel that it's swollen.
32:43Yeah.
32:43Right, let's measure them.
32:45Ten centimetres down and measure.
32:47And no periods of lying in bed for days on end recently.
32:51I'm sleeping a lot during the day.
32:53If 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.
32:59Good.
32:59They're exactly the same.
33:0035 on both sides.
33:01Lovely.
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.
33:08I 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 the blood vessels in
33:19the 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
33:28as it once did.
33:29And that's really just age-related changes and various other bits like that.
33:34Can I have a little listen to your heart?
33:35Yes, you can.
33:37I feel there's so much going wrong with me.
33:39I'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.
33:55So I wonder if there might be either a bit of a narrowing of one of the valves or if
34:00one of them is a little bit leaky.
34:02So I think we should do some more tests for you.
34:05I'll see if the girls can do an ECG now for you to save you having to come back.
34:09Please don't panic, but I think there's a few things we should do just to make sure.
34:13Is that all right?
34:14Any questions?
34:15That's a lot of information.
34:17Well, my worry is my heart.
34:20I mean, it's always been fine.
34:23Let's hope it stays fine.
34:24You know?
34:25Yeah.
34:26Oh, God.
34:44If I could ask you to just pop both your feet flat on there.
34:48I should know the rules by now.
34:57Why do you look scared?
34:58Do I?
34:59No, I'm not scared.
34:59Did you just zone out for a second?
35:00I just zone out, yeah.
35:03Yeah.
35:03Perfect blood pressure.
35:06129 over 76.
35:08Gorgeous.
35:09That's really good.
35:12Andrew?
35:14Yep.
35:14Hiya.
35:19How are you?
35:20Oh, I'm fine.
35:21Pop your bag on the chair.
35:23So, we're going to do your blood pressure.
35:26I've not seen you for a while, so that's a good thing.
35:28It's a year.
35:29Is it a year?
35:30So, it's going to be every year.
35:32Yeah.
35:33When you're on medication, we do like to keep an eye on you.
35:36Right.
35:37You look fit.
35:38Well, yeah.
35:38I sort of cycle every day.
35:40Yeah.
35:41Sort of do about 150 miles a week.
35:43That's amazing.
35:44Relax.
35:44I walk everywhere.
35:46And I eat healthily.
35:47But I do smoke.
35:49Okay.
35:50Yeah.
35:51Little skinny ones.
35:52Well, when you want to give up, come and see us.
35:54I don't want to give up.
35:55Okay, fair enough.
35:56I'm 76 years old.
35:58You're amazing.
35:58And I can run a little bit.
36:00I remember your mum, so.
36:02Right.
36:02You are.
36:03You're amazing.
36:04Okay, relax.
36:06And no talking from now.
36:14It's high.
36:15I remember we had this before, didn't we?
36:18Is it that much higher?
36:19It is high.
36:20But don't stress about it, because it'll make it go up even.
36:24Right.
36:24Okay.
36:25Great.
36:27Happy place.
36:28Happy place.
36:29Hmm.
36:31Happy place.
36:33Sounds like a rusty old moped, doesn't it?
36:38It is too high.
36:41Too high?
36:42Yes.
36:43Right.
36:44Ideally, we would want another 24 hour for you.
36:48You know, the 24 hour monitor that you had before.
36:51How much higher is it?
36:53We would ideally want you to be under 140 and under 85.
36:59Right.
36:59Your blood pressure at the moment is, the lowest one was 172 over 111.
37:06Jesus.
37:07Exactly.
37:09And he's not helping.
37:11Not today anyway.
37:13You can see a doctor at four o'clock today.
37:19Okay.
37:20So let's tackle you today, is that okay?
37:23What would be causing the higher blood pressure?
37:25It can be family history.
37:27But it's not running in the family.
37:29If I had an answer for it.
37:31Yeah, you wouldn't be sitting here, you'd be sitting in Monte Carlo, I know.
37:34Exactly that.
37:34Yeah, quite.
37:36Alright, thank you very much.
37:38Bye.
37:40Okay.
37:45So we're doing your ECG.
37:47Yeah.
37:47I'm such short-legged.
37:49Okay.
37:50Luckily this is one of those beds that moves up and down for you.
37:54Do we need to move them a bit more over?
37:56I'm going to have to put two on your legs.
37:58Is that okay?
37:59I'm just going to pop it on top.
38:02Two go on your wrists.
38:04Okay.
38:08I'm just going to pop it between your legs and then I'm going to run the ECG.
38:12Let's have a look.
38:21Okay, so I'm going to pass the ECG back over to Dr. George, who will have a look at it.
38:30Okay, that's all done for you.
38:32Do you need help?
38:33Put your hand, yes.
38:34There we go.
38:36Oh, that's okay.
38:39Lovely, thank you.
38:40All done.
38:41That's okay.
38:43We'll wait in the waiting room and I'll speak to Dr. George.
38:46Yes, okay, lovely.
38:47You're welcome.
38:49Is that real?
38:51No, it's not.
38:52No.
38:52It looks real, doesn't it?
38:54I know.
38:58Let's have a look at this.
39:00So, baseline's a bit messy, but that's okay.
39:04No ST elevation, progressive lengthening.
39:10I'm not liking the look of this.
39:12I'm a little bit worried.
39:13She can go home.
39:14I don't think we're doing anything acute.
39:16There's nothing to suggest that.
39:18I'll go and tell her.
39:24That's absolutely fine.
39:25You can go home, not a problem at all.
39:27Just to let you know, the ECG is okay.
39:29I'm going to run it by a cardiologist though, just for reassurance.
39:32Any problems at all, just give us a call.
39:34All right?
39:35My pleasure.
39:36You're very welcome.
39:36All right.
39:37Take care.
39:43I think I'm going through it.
39:46Is that a tricky?
39:47I had that one.
39:48I feel like I'm cutting a fever, you know?
39:52People have made me sick.
39:58David.
39:59Hello.
39:59Morning.
40:00How are you?
40:01I'm good.
40:01How are you?
40:02I'm okay.
40:04Come on in.
40:07How are you doing?
40:08Okay.
40:09Um, when I had my last blackout faceplant, my family is now saying I should get my hearing
40:16checked.
40:16Okay.
40:17Maybe the best thing to do is see if I got wax first and then see if...
40:22And then go and do something.
40:22Yeah.
40:23So very sensible.
40:24So when you collapsed last time sort of thing and you faceplanted.
40:28Do they know why you're having those collapses?
40:30Well, I've been poked and prodded.
40:32I know.
40:32Considerably.
40:33So two neurologists and a neurosurgeon later.
40:35And the cardiologist.
40:37Yeah, yeah.
40:37We've added that in the mix as well.
40:39I know you've seen so many different consultants.
40:41It's a combination of, you know, AFib.
40:43So your pulse suddenly speeds right up?
40:45Well, I just go boom.
40:46Okay.
40:48After 38 surgeries in 25 years, I should write a book.
40:54So poor David has skin and joint problems and has had multiple knee replacements, knee
40:59operations, shoulder operations, etc.
41:02He's enjoyed some quite extreme sports and he's very active.
41:05And as a result with his skiing and things, he's often had other accidents as well that
41:08have then resulted in him having 35 surgeries in total.
41:11Can I feel your pulse now?
41:12Let's see.
41:13Are you in fibrillation at the moment?
41:14Can you feel...
41:16Okay.
41:16It just...
41:18It's just odd.
41:19It's the last month, I mean, that it's so high and so low.
41:22So it's going sort of fairly steadily at the moment.
41:24And just remind me, your medication, you're on blood thinners.
41:27Yes.
41:28Yeah, good.
41:28You have to be on them.
41:29Biciprol.
41:30So they're all helping your heart.
41:31But of course, the blood thinners, if you're crashing and falling and breaking things,
41:33we don't want you on blood thinners, but you have to be on the blood thinners for
41:36the heart.
41:36So your ears, we're worried that they...
41:38Yeah, so let's tell me that they just got wax in them and then...
41:43That would be the easiest of the problems to solve, wouldn't it?
41:45All our balance is actually controlled inside our inner ear.
41:48So in David's case, it's probably quite complex that it might be a combination of potentially
41:52a heart rhythm problem, as well as the balance problems with his ear that are causing him
41:57to collapse, which in itself is also very dangerous.
42:00So we'll have a look this side.
42:01It tickles a bit, I'm afraid.
42:02Yeah.
42:02Is there any pain in your ears?
42:04No.
42:05Well, there's no wax in that at all.
42:07David, and the eardrum looks absolutely perfect.
42:09So that ear looks perfect.
42:09So we've got one to compare it to, which is good.
42:11Right, let's just have a look this side.
42:14There's absolutely no wax at all.
42:16Not a drop.
42:16David's clear as a whistle.
42:18And the eardrum looks healthy.
42:20Good.
42:21And so obviously the ear wax is the, well, I mean that would be, if it had been earwax,
42:26that would have been a simple fix, wouldn't it?
42:27But it's never quite that simple.
42:29It means it's not the outer ear.
42:30The middle ear is sort of represented a bit by the drum, which looks healthy on both sides,
42:35which means it might be that the transmission of sound through is the problem.
42:40The little bones all have to sort of oscillate next to each other.
42:42Nothing in the middle.
42:44Yeah, nothing in the middle between there and there.
42:46I think it's worth doing a hearing test.
42:48There's certainly not a reason not to, because if you're not hearing right,
42:52it's not going to be helping with the balance issues and everything else that we've got.
42:55I'll refer you for the hearing test.
42:56Let's get that done.
42:57We can see if we can help with that side of it.
43:00Right, good luck, David.
43:00Oh, let's get the hearing sorted out.
43:03Thanks.
43:03You take care.
43:04You take care.
43:04Look after yourself.
43:05Bye-bye, David.
43:07Take care.
43:09And enjoy your 20 more holidays.
43:11See you later.
43:12Good to see you again.
43:13Yeah, good to see you soon.
43:15Thank you, doctor.
43:16So, you take care, and we'll give you a phone call.
43:18No, no problem.
43:20Bye.
43:21Perfect.
43:22It was so good to meet you.
43:23Bye, David.
43:25Bye, David.
43:25Bye.
43:26Bye.
43:27Bye.
43:27Bye.
43:28Bye.
43:28Bye.
43:28Bye.
43:29Bye.
43:29Bye.
43:33Bye.
43:43Bye.
43:46Bye.
44:12Bye.
44:17Bye.
44:18So, I've been suffering from very severe pain, like a sharp knife.
44:23First thing, I'm coughing a lot.
44:25Second thing, I have blood when I cough, and doesn't wanna stop.
44:28Well, I have to confess I actually sterilized a needle and then the past eyes are coming out. It's odd
44:34I've not seen that before if I'm honest with you
44:36I've not seen somebody who's on four high-dose blood pressure tablets still have a blood pressure as high as
44:42yours
45:10I've not seen somebody who's on four high-dose blood pressure
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