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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.
01:09Morning.
01:11Morning.
01:14Morning.
01:17Morning.
01:31Stephen.
01:32Doctor.
01:33Hello.
01:37Have a seat.
01:40My arthritis at the moment, doctor, has gone on another scale.
01:48Really, yes.
01:48Yeah.
01:49I've got arthritis in my right knee.
01:51Yeah.
01:51I'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.
02:21Okay.
02:23Ticklish.
02:23Yeah.
02:24Is there any tenderness where I'm 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.
02:36And that may be what's giving you this grief, actually.
02:39Yeah.
02:39So 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.
02:4915 months now.
02:51Well done.
02:51Okay.
02:51Since I've quit drinking, I have put on a little bit of weight, you see, because I'm no longer
02:58going for the drink.
03:00I'm going for something else, maybe a snack or something.
03:03I don't know.
03:04And what kind of snacks?
03:05Sweet.
03:06So a lot of these kind of ultra-processed snacks do actually trigger inflammation in the body.
03:12Mm-hmm.
03:13And then, like I said, other things like, you 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, 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.
03:43There'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,
03:56because the long-term benefits are a net positive for you.
04:01Okay?
04:01And 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 in
04:15the future,
04:16and 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.
04:24You've had a little nudge.
04:25That's what you need, doctor, sometimes, you know?
04:27So, you know, you get stuck in the spot, like, you know, and you don't want to move from it,
04:31like, you know?
04:32And, yeah.
04:33Okay.
04:34Can we circle back in a couple of weeks and just let me know if anything has changed, hopefully for
04:39the 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.
04:46Can we agree on 10.45?
04:48Yeah.
04:48Fantastic.
04:49That'll be on the 14th, Tuesday.
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.
05:13Some 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.
05:20And 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 diarrhea, sometimes blood in the diarrhea.
05:45How old were you when you were diagnosed?
05:47Seventeen.
05:48How was it diagnosed?
05:49I was complaining of a stomachache for about three months, and then I lost the ability to
05:54digest 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, have 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?
06:37I 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 other story.
06:47Yes, I know that's a whole other story.
06:49Okay, so...
06:50And I am not sexually active.
06:52Okay.
06:52That is always a discipline of a question.
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.
07:03Then I got Crohn's disease, and then they became chaos.
07:05Okay.
07:05So, this isn't unusual for you?
07:08Yes, 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.
07:17So, if you're happy for me to organize a blood test looking at hormonal levels,
07:22and we can do an ultrasound scan,
07:24if we're still in a position where, in, you know, coming up on a year,
07:29you haven't seen any periods,
07:31then definitely we'll be sending you through to the gynecologist.
07:33Yeah.
07:34Don't get me wrong.
07:34I'm pretty delighted about it for just the not-wrecking-underwear reasons,
07:39but it's also kind of concerning.
07:40Yes.
07:40You should be having a period, you know, at least every three months.
07:45Obviously, when you have a significant illness,
07:47it definitely impacts our hormonal balance and things like that,
07:50but, you know, you are kind of six years into this,
07:52and it's worth looking into.
07:54Yeah.
07:54So, 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
08:02to see if there's anything going 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.
08:15If 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...
08:37I can get you some.
08:38Is that okay?
08:39Yeah, yeah.
08:49Thank you so much.
08:51Sorry, I dropped the link.
08:52It's okay.
08:54I'm Dr. Dungeon.
08:55Nice to meet you.
08:56Nice to meet you.
08:57So, what can we do for you?
08:57I need to get another search and repeat description.
09:02I went travelling to Asia,
09:04and then Australia in January 20, 24.
09:08Yeah.
09:09So, basically, just before I went,
09:10my GP, this was in Devon,
09:12where I used to live,
09:14prescribed me six months of 100 milligrams,
09:18so it would last me.
09:20Yeah, I 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
09:28where I just, like, didn't take it
09:30because I, like, didn't have it.
09:31It was weird.
09:34Okay, so you sort of noticed.
09:36Yeah.
09:36Yeah.
09:36My head was, like, doing that, like,
09:38tingly thing,
09:39and I felt really dizzy,
09:40and I was, like, profusely sweating,
09:42and I was, like...
10:02For the first, like, two days,
10:04I was, like, oh, like, whatever.
10:05Maybe I'll just, like,
10:06see if I can actually just
10:07wean myself off
10:08because I'm very aware
10:10that it probably needs to happen
10:11at some point.
10:12We do know you shouldn't stop it suddenly.
10:14Okay.
10:14So, some of that might have been
10:15that you kind of just stopped abruptly
10:18rather than the fact that
10:19you wouldn't be able to manage without it.
10:21There's also no need to come off it.
10:22So, if you feel good on it,
10:24there's no rush.
10:24Yeah.
10:25Like, honestly, when I'm...
10:26I don't know why I'm going to cry.
10:28I feel so much better.
10:29Good.
10:30I don't mean to be upset in here.
10:32I literally just cried at everything.
10:34But you say on it,
10:36your mood feels good.
10:37Mm.
10:37Yeah?
10:38I'm a very emotional person
10:39and I still feel, like,
10:42everything like that,
10:43but it's not, like,
10:44a constant overwhelming.
10:47It just completely eliminates that
10:48and I feel the things that I feel
10:50a normal amount of anxiety
10:52as opposed to, like,
10:54a complete consumption of life,
10:57which is horrible
10:58and I don't want that.
11:00Was it more of anxiety
11:01you went on it originally?
11:02Yeah.
11:02Yeah.
11:02Yeah, I, like,
11:03went through, like,
11:04a 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
11:10and they really want to come off it
11:11and some people actually think,
11:13well, actually,
11:13I feel great on it.
11:14I'd rather stay on it.
11:15I would rather stay on it.
11:17And that's fine.
11:17And it may be that at some point
11:19you 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
11:24and just suddenly stop it
11:25because that is when you can get
11:27kind of withdrawal side effects and things.
11:29Did you have talking therapy
11:30and things in the past?
11:31Oh, I've literally tried everything.
11:34I've tried everything.
11:35Yeah.
11:36Talking therapies will always be there.
11:38Yeah.
11:38But I suppose it's what you feel
11:40would be helpful for you.
11:41I don't really want to increase
11:43because I don't want to become...
11:44I know, obviously, right now,
11:46I'm not addicted to them,
11:48but I'm reliant on them.
11:49It would be nice to, like,
11:51see an exit.
11:52Okay.
11:53But I think I'll just be on them.
11:55You mean about...
11:56You mean CNX isn't 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.
12:02You know, if you end up on them
12:03for years and years, that's okay.
12:05They're not addictive in that sense.
12:07What talking therapies do you guys have?
12:10So back on track
12:11and they would assess you
12:13and then they can kind of decide
12:14whether it's counselling, CBT.
12:16So you can do that at any point.
12:18Yeah.
12:18But if anything gets worse in the mood
12:20or you feel actually you're struggling a bit more,
12:23especially going into winter,
12:24having been in...
12:25Have you been in Australia?
12:26Yeah, so...
12:28A slight change for the weather.
12:32But, you know,
12:32some people and some people
12:33do find that really hard.
12:35You know, British winters are something,
12:39a quiet taste.
12:39So miserable.
12:40So, yeah, so if you find
12:41that that's sort of triggering things,
12:43having spent a couple of years in Australia
12:44and lovely sunshine,
12:46then 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.
12:52Thank you so much.
12:54Have a good afternoon.
12:55Bye.
13:05How are you?
13:06Good, yeah.
13:08I can't see you yet
13:09until I get above...
13:10We're going to go this way,
13:11is that right?
13:11A yard in front.
13:14Yeah.
13:15Come and have a seat here.
13:16I'm actually nervous.
13:18Why are you nervous?
13:19Well, because I got a phone call this morning
13:22saying I was going to be having a small operation.
13:26That's not true, is it?
13:27I 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,
13:31but you're not going to operate today, are you?
13:32I'm not going to operate today, no.
13:33No.
13:34Or tomorrow.
13:34Or next year.
13:36Because the thing is,
13:37there's no pain at all.
13:38Right.
13:39Does it ever not go back in?
13:42No, it doesn't go back in.
13:44Well, have a look.
13:45Yeah.
13:45Do you want me to take my shoes off?
13:46No, no.
13:47We can leave them on.
13:51No, I'm not overweight.
13:53Yeah.
13:53And I'm not ready for a nursing home.
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,
14:14the 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.
14:31And there's no pain at all.
14:32Yeah.
14:33You all right getting off, don't you?
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've probably damaged it somehow with one of your falls.
14:47I don't think you need to do anything about this,
14:50so 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.
15:18I wouldn't wish to be with anybody else.
15:20Oh.
15:21Can you manage?
15:23All right, David, lovely to see you.
15:24You take care.
15:25All that.
15:25I very appreciate it, Owen.
15:27All 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.
15:38Thank you very much.
15:39Well, so are you.
15:41Come on up to the seat.
15:41So what are we up to today?
15:42I'm 42.
15:43Yep.
15:44I'm starting to feel perimetopausal symptoms.
15:46Okay, so 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,
15:55and the next day it'll just hit me at 6 o'clock in the afternoon.
15:58And I'm like, oh, I have to go take a nap.
16:00And that's really unlike you, is it, to be a sort of...
16:02Yeah.
16:03And you're 42 now.
16:04Yes.
16:05So it is completely normal.
16:06So perimenopause, we often say we get symptoms up to 10 years
16:09before the menopause happens, which we sort of say is around 50,
16:13but 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 thing,
16:20tiredness, can absolutely...
16:21Sometimes I think my brain just doesn't work.
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...
16:27Because you're still working and...
16:28Yes.
16:29Yeah.
16:29Okay.
16:30And is that going okay?
16:30Or 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.
16:39And I just sit there going, oh my God, I know the answer to this.
16:42And it's not coming.
16:42I just had this conversation with this person.
16:44And it's just not coming.
16:45And that's really frustrating, isn't it?
16:46Yes.
16:46What 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
17:01and how my brain feels and then get a bit down.
17:04I mean, I wouldn't go as far as to call it anything quite like depression.
17:08But it is, right, and some days are better and I feel like perkier and happier
17:12and I don't want to, you know, smash the wall or strangle my husband, you know?
17:16But there were times?
17:17But there are other times where I'm like, oh.
17:19So I suppose the question is, is that, is this perimenopause?
17:22Which 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.
17:29And these are things that creep in.
17:31Sometimes we're a bit anemic or the blood's a bit abnormal
17:33and 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.
17:41Because 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.
18:12Take care.
18:12Bye-bye.
18:13Bye-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's 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.
18:43I can see the same thing there, so 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.
19:03Nice to see you.
19:04I know, I've spoken to you on the phone lots.
19:07Anyway, doctor.
19:08Yeah.
19:09This worries me.
19:11Okay.
19:12What is it?
19:13I thought it 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 primbersome, you know, you get them everywhere in the neck.
19:28Yeah.
19:28Then it gradually gets them big and big.
19:30I squeezed again, my pink blood, you know.
19:33Now all this is all red.
19:38Any pain here?
19:40Not there.
19:40The only pain I get here, where you see, on the ear, I hear.
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, and that is what I found you today.
19:57You see on TV, this insect, I say, 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.
20:09You 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, you 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 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, and then Saturday it started
20:47sort of pussing, and 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.
21:00Okay, so it would be A and E.
21:03Yeah, so what I can do is it's a bit of a badge.
21:21Did you just open wide for me?
21:22Say ah.
21:23Oh.
21:24Ah.
21:25Ah.
21:26Wow.
21:28That is spectacular.
21:29Stick your tongue out.
21:30Oh, even better.
21:31Ah.
21:33Ah.
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.
21:41Yeah, that'll...
21:42No, don't worry.
21:43I don't like it either.
21:44Ahem.
21:45Ahem.
21:45Ahem.
21:45Ahem.
21:47Oscar?
21:53Good morning.
21:53How are you?
21:54How are we doing?
21:55No, my name's Anna McHugh.
21:57Nice to meet you, Doctor.
21:58Oh, so, Oscar, what's been going on?
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?
22:12Uh, yeah, I had something with my throat around it.
22:17A strep?
22:18Yeah.
22:19Yeah, a 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, well done.
22:34So there are a small amount of white dots there that you can see.
22:39You can relax.
22:40I'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?
22:51Checked it yesterday.
22:53I 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.
23:00Last night.
23:02Was it worse, a 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, so 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
23:41think about whether, you know, we need to, yeah, talk to the specialists.
23:46Absolutely not at this point in time.
23:48We're not there yet, but 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.
24:02Thank 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, and they're happy that we start
24:29you on oral antibiotics initially.
24:32What they want us to do is review you in 24 hours, okay?
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.
24:45So 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
24:56to 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 how you're 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, please go to A&E.
25:09Okay, and then we'll see you tomorrow to see how it's doing.
25:11Okay, don't.
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.
25:32Good to see you.
25:33Now, what are we up to today?
25:35Well, I 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, the 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.
26:00And what halts you, the pain?
26:02The pain.
26:03In both legs?
26:04In both legs.
26:05Before it was on the right, if you remember, that's what I was reporting.
26:08Now 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.
26:15Yeah.
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.
26:20But I jog or I just kick just so I can keep moving because I've got a train to catch.
26:27Oh, so you've just got to keep moving so you can't just stand still.
26:30Yeah, yeah, I can't.
26:31Sometimes, obviously, I would stand still.
26:34Or I find that if I just sit down and 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 chase all that up.
27:15I've told, she's put in the note that they've talked about cocodomol.
27:20I 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.
27:35To check that there wasn't any sort of critical sort of nerve compression or anything we need to worry about.
27:40But 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.
27:52But 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?
28:07Yeah, they'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 I think the fact that it's stopping you walking, it's stopping you doing things, we've still got a long
28:18way to go, haven't we?
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, no worries.
28:26Codidramol.
28:27Codidramol.
28:28Is it the patches?
28:29You know, the HRT.
28:32The HRT one.
28:33I mean, one option with the patches, actually.
28:36You're only on 50.
28:36You're on a reasonably low dose.
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.
28:43So 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, it's a good luck with things.
28:54Nice to see you.
28:54And 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.
29:00You take care.
29:01Nice to see you.
29:01All the best.
29:02Bye-bye.
29:03Bye.
29:07Mr. Wissidley?
29:08Yes.
29:11Come on in.
29:11Have a seat.
29:12I'm Dr. Dudgeon.
29:13We've met before.
29:14A while ago.
29:16Yeah.
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.
29:24Of course, I have a kidney patient.
29:26Yeah.
29:27He looked at my figures and he said, you should just check for urine infection.
29:32Okay.
29:32Have you got any symptoms of a urine infection?
29:34Yes.
29:35I go to the toilet a lot.
29:36Mm-hmm.
29:36I think it's a little painful.
29:39Okay.
29:39Is that a new symptom?
29:41Yeah.
29:42I would say.
29:43Yeah, 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?
29:53That's correct.
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.
30:00How long time do you think they'll remain stable?
30:04The function of the kidneys, they call it EGFR, so your estimated filtration rate.
30:08So yours is 14 at the moment.
30:10Yeah.
30:1120, 24, 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 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, I 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 an infection
30:54or not.
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
31:02whether or not 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 some 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, yep.
31:18Yep, she is, of course.
31:19Yep.
31:19She looked after me for 25 years.
31:21Oh, I'll send her your love.
31:24All right, have a good afternoon.
31:26Bye.
31:28Would you rather only buy all your underwear secondhand or all your toothbrushes you have
31:36to buy secondhand?
31:36Underwear because you can wash them.
31:38No.
31:39So if someone else's bits have been in your underwear.
31:42Yeah, 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?
31:47I said I just got Phil Commander.
31:50Maggie does that anyways.
31:56Pamela.
31:57Yes.
31:58How are you?
31:59My ankles are swollen, my legs are swollen.
32:01I can hardly walk.
32:03Well, let's hope.
32:03And 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?
32:29No, that's a bit sore.
32:31It'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, like, 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.
33:01Really?
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.
33:08Yeah.
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
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
33:27as efficiently as it once did.
33:30And 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.
33:36I feel there's so much going wrong with me.
33:39I've never had this before, this feeling, even when I was coming out of hospital with
33:43a 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
34:00of 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?
34:15I know that'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.
34:56Why do you look scared?
34:58Do I?
34:59Or did you just zone out for a second?
35:01I just zoned out, yeah.
35:03Perfect blood pressure.
35:06129 over 76.
35:08It's gorgeous.
35:09That's really good.
35:12Andrew?
35:13Yep.
35:14Hiya.
35:19How are you?
35:20I'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?
35:30Yeah.
35:31So 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.
35:45I 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.
36:10Hmm.
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.
36:58Right.
36:59Your blood pressure at the moment is, the lowest one was 172 over 111.
37:06Jesus.
37:07Exactly.
37:08And he's not helping.
37:11Not today, anyway.
37:13You can see a doctor at 4 o'clock today.
37:19Okay.
37:20So let's tackle you today.
37:22Is 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.
37:32You'd be sitting in Monte Carlo.
37:33I know.
37:34Exactly that.
37:34Yeah, quite.
37:36All right.
37:37Thank you very much.
37:38Bye.
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.
38:10And then I'm going to run the ECG.
38:12Let's have a look.
38:21Okay.
38:22So I'm going to pass the ECG back over to Dr. George, who will have a look at it.
38:30Okay.
38:30That's all done for you.
38:32Do you need help?
38:33There we go.
38:37That's okay.
38:39Lovely.
38:40All done.
38:41That's okay.
38:43We'll wait in the waiting room and I'll speak to Dr. George.
38:46Lovely.
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.
39:02The baseline's a bit messy, but that's okay.
39:04No ST elevation.
39:07Progressive 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?
40:09Okay.
40:10When I had my last blackout faceplant, my family is now saying I should get my hearing checked.
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.
40:23Yeah, yeah, yeah.
40:23So very sensible.
40:24So when you collapsed last time sort of thing and you faceplanted, do they know why you're
40:29having those collapses?
40:30Well, I've been poked and prodded considerably.
40:33I know.
40:33So two neurologists and a neurosurgeon later.
40:36And the cardiologist.
40:37Yeah, yeah.
40:37We've added that in the mix as well.
40:39So I 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, does it?
40:45Well, I just go boom.
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, et cetera.
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 if you're in fibrillation at the moment.
41:14Can you feel?
41:15Right now I feel fine.
41:16Okay.
41:17It just, it'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, because you 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 won't contribute to you there.
41:39Okay.
41:39You know, let's, let's, 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.
41:49So 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 at 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.
42:11Let's just have a look at 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.
42:21Which, and so obviously the ear wax is the, well, I mean, that would be, if it had been
42:25ear waxed, that 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 will have to sort of oscillate next to each other.
42:42Nothing in the middle.
42:44Nothing, yeah, 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, it's not going
42:52to 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.
43:00Good luck, David.
43:00Oh, let's get the hearing sorted out.
43:02Thanks.
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.
43:12Bye.
43:12Good to see you again.
43:13Yeah, good to see you soon.
43:15Thank you, Doctor.
43:16So you take care.
43:17We'll give you a phone call.
43:18No problem.
43:20Bye.
43:21Perfect.
43:22It was lovely to meet you.
43:23Bye, natürlich.
44:17So I've been suffering from very severe pain like a sharp knife.
44:22First thing, I'm coughing a lot.
44:25Second thing, I have blood when I cough and doesn't want to stop.
44:28Well, I have to confess, I actually sterilized a needle.
44:31Oh, dear God.
44:32And then the pastas are coming out.
44:34It's odd.
44:35I'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.
45:10And then the pastas are coming out.
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