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00:08Morning surgery you should have nice pointy bits at the bottom of your lungs and they're
00:12not they're full of fluid so what's going on I think in your case it might pop I'm
00:18quite helpful at making that happen please don't force it I'm so wobbly I find it difficult to
00:26make it to the bus sounds a bit scary as well I'm very scared actually yes
00:33I'm just wondering what the results were on the third poo I did
00:43you still have a drink occasionally yeah every day steroids and alcohol and blood thinners
00:50it's a potentially dangerous mix
01:05it's morning
01:06it's morning
01:29it's morning
01:30day me hi hi have a seat well I was in Spain
01:36about a week ago a little dot appeared underneath there I think still there
01:41about a week ago yeah and then this thing in the in the corner here is a two
01:46or three days old okay I'm waking up with gooey eye you know really gooey after
01:51any kind of medication I dropped so I did a week ago and we did and my
01:56girlfriend got some eye drops yesterday and was cleaning it up and when did you
02:00notice that it started kind of swelling the swelling's only in the last 24 hours
02:04okay so that's new and and the redness of the eye that was there that's been
02:08getting worse the last couple of days okay and how is the pain I'm beginning to
02:13feel a bit of a little bit something behind the eye as such something okay and
02:19your vision is that's a good point that's okay okay let's just have a look so if
02:27you just look up for me so what you've got which you've already seen is quite a
02:33nasty calasian so like a little cyst just shut your eye for me any pain when I
02:39press here no no but what I noticed was the one in the corner and then there's if
02:44you undo the center of that there's a white dot there which is what the
02:48original problem was okay so I'm wondering if that was caused by that other so I
02:52think what it is is is a calasian so they're also called my boemian cysts and and
02:57you've basically got a cyst which is kind of under the the eyelid and it's got some
03:02pus in it and then the rest of the eyes would become kind of inflamed with it so
03:07yours it is quite big ophthalmology if you were to see them sometimes drain them but
03:11obviously we can't do that here so what we can do is give you some antibiotic
03:18ointment and drops the other thing I want you to do is some hot compresses
03:22so you can either buy like special eye masks and or just like a flannel in hot
03:29water so not that's going to burn you the idea of the heat is it draws the blood to
03:32the area and and then we're trying to soften the stuff in the cyst and ideally
03:37the cyst at some point will just dissipate well either dissipates or I think in your
03:41case it might pop and I'm quite helpful at making that happen yes you don't so
03:46please don't force it after about five minutes of kind of the heat then just try
03:50and massage it so you're just gently rubbing along okay so not squeezing it I don't want
03:55you to get your eyelid and press it together because the problem with that is then the
03:58infection can spread I have done that before with what you said yeah so what I'll do is
04:01I'll um I'll give you the antibiotic drops I'm going to give you some oil
04:03antibiotics just because it is quite a big cyst and then see how things go the next 24
04:0748 hours if it's getting worse so you notice that swelling we definitely need to see
04:11or if it's you know really severe it would be eye casualty which would be up
04:15oh we don't want to go there I really don't think that's going to happen
04:17hopefully it'll burst and just resolve thank you all right have a great afternoon cheerio bye
04:28okay Emma hi let's go hello Emma how are you say hi come on in
04:38you want to draw yeah you do that mommy's going to tell me what's going on okay okay
04:42she's breathing really bad how do you call it it's like in spain we call it we call apnea
04:48apnea yeah so pauses and breathing yeah okay hold it I don't think it's normal because you really
04:55have for her sometimes I have to do like this to check if she's breathing or not okay how long
05:01do you
05:01think she pauses for I don't know for how long yeah for seconds enough to worry yes
05:07yeah yeah okay and how often is that happening oh no mate it's a it's a more science is baby
05:13but
05:13like uh last year it is even worse so ever since she's been a baby she's had these yeah yeah
05:19is there
05:21a family history of any respiratory problems so asthma yeah I have asthma yeah okay so let me come and
05:29have a listen to her now okay yeah then we'll have it we'll have a think okay now don't be
05:34trouble
05:34Emma Emma been a key and that he's gonna take your breathing okay tell me when you're ready you're
05:41ready okay she doesn't cough at night no I know what I'd like to do next is have a lick
05:50inside your
05:50mouth if that's okay oh you want the pencil okay but you need to open now your mouth can you
05:55open your
05:56mouth your mouth your mouth your teeth your teeth do you want me do you want me to show you
06:08what it
06:09looks like no yeah oh yeah see me up Emma Emma Emma so her chest sounds clear yeah I cannot
06:20hear any
06:21wheeze today what I think you should do Lorena is try and get video of yeah okay yeah and in
06:29kids
06:29their breathing patterns do vary so some pauses and breathing we don't worry about okay okay so be good
06:36to have that video and then yeah we see what you see yeah and we can tell you if there's
06:42something to
06:42worry about okay it would be nice to see the back of her throat just to make sure she doesn't
06:45have these
06:46giant tonsils that are making her snore that are gonna be obstructing her airway while she sleeps
06:50yeah we'd love to see you face to face again and then we'll try and lick in her throat again
06:53yeah open your mouth and he's gonna check your belly okay so we'll have to go say bye thank you
07:25I've been lucky enough to work at the fuller medical center now for almost 22 years you'd be
07:30registered here as long as I've been here to be honest 1990 something and I absolutely love working
07:37there and I love the team I work with do you like seeing me yeah thanks to bring my nan
07:42in to see
07:43the doctors in the doctor surgery as long as you don't get fed up with me oh how can I
07:48be fed up with
07:49you a big reason why I chose to become a GP was really because of the continuity of care getting
07:55to
07:55know patients especially having been here six years now you get to know the families you watch the
07:59children grow up well it's nice to see your family all well kids growing up beautiful stuff they always
08:03are one minute you could be seeing a gynecological problem the next a child that's why I like seeing
08:09you because you know me how long but it's also great working in a bigger team every day is different
08:18that's what makes it fun so we work with a lot more allied health professionals now I think we're so
08:24lucky to have this paramedics and dietitians pharmacists no I mean it I'm not just trying
08:31to say the right thing the people are likely they're absolutely incredible we work really well as a
08:35team I mean I've been here since I was born she's a long time you do get the sense that
08:40you're doing
08:40something for other people and so it's rewarding in that sense all right give me this if I can make
08:46them smile when they're going through maybe the most vulnerable time of their life then it's worth
08:51it there goes your lung I don't think I've got nothing wrong with me lung despite all the challenges
08:59it really is the best job in the world and I honestly couldn't see myself doing anything else
09:03so you like it here do you I do yeah let's see if I can stay here as long as
09:07you not 78 years
09:08it's a bit excessive but it's nice to meet you thank you hello hi hi my name's Dr Pearson I'm
09:17the
09:17GP's come have a seat how are you I'm all right I've got a bit of a sore back yeah
09:23slash chest so
09:25what's happened um so two maybe more than that 200 years ago I had a skiing accident and went into
09:31hospital got had a knee surgery then came out and got really bad pneumonia I didn't know about
09:39the pneumonia until it was really really bad and then I was admitted to hospital for like five days
09:43I think it was and it was all full of and it was infection wasn't it and of course and
09:47pyema they
09:48caused it took me ages to get better and it took like almost until recently where I feel like I've
09:54got
09:54my normal energy levels okay and so when the pain started again that's when I decided actually I
09:59probably should do something about it yeah more quickly so I went to A&E where they did it some
10:05blood tests and an x-ray okay in the x-ray they couldn't see anything okay but I was still
10:11I'm still
10:11in pain and I don't want to take codeine anymore no if I can avoid it yeah yeah so tell
10:16me about the
10:16pain and when it started and what it is this um so it started maybe Tuesday last week so almost
10:21a week
10:22okay um it felt exactly the same where I thought it was musculoskeletal okay so I left it for a
10:27while
10:28yeah and then the pain was getting worse and so and I had to take more painkillers and can't sleep
10:34because I can't really lie down all the way on my bed how's your breathing fine and was your breathing
10:39fine before as well so all well apart from this pain which feels very similar to before when you had
10:44the impairment so you quite rightly went to A&E they sort of said the x-ray was fine and
10:48we've had a look at it
10:49and it shows chest x-ray there was blunting of the angle suggested that you have got a slight pleural
10:55effusion you do have fluid in your lung yeah
11:15I mean I just feel my lungs are really not operated to full capacity can I listen to your own
11:19lungs
11:20yeah yeah bugs love hot wet places and the lungs are great I'll have a listen in just to make
11:25sure
11:25the lungs are okay have you been to the lung function test yes that's the one are you coughing
11:31at all not because I've got like a tickle in my lungs we need to get you some new lungs
11:35and a new
11:36heart so the reason I'm listening there is just to make sure there's no fluid build up around the
11:40lungs and there isn't so the lungs sound crystal clear you do have fluid in your lung yeah you should
11:50have nice pointy bits at the bottom of your lungs and they're not they're full of fluid okay so what's
11:55going on yeah why is it there can I have a listen to your lungs because I think we need
11:59to find out
11:59why are you getting this and where are you getting the pain like brow strep area on my right on
12:06this
12:06right hand side yeah I can just hear there's slightly reduced air entry on that right side
12:14the oxygen's 97 98 so that's good the question is that that x-ray does show come have a seat
12:19a bit of
12:19fluid in your lung so your lungs yeah your lungs themselves can't feel the pain sort of the pleura
12:25it was called the plastic bags they sit in that's what gets sort of inflamed or if there's fluid there
12:30it's pressing on it and it's it's an uncomfortable feeling and it's horrible and as you said before we
12:34left it and it built up and up and up so I'm worried yeah I don't want it to get
12:39to that level again
12:39so an empyema is when pus basically infection cells build up between the lungs and the wall
12:46of your chest so it's not actually in the lungs it's trapped there between them it's not a common
12:50condition but it can happen as a result of a pneumonia a really nasty chest infection
12:54they've left untreated empyema can be really serious the collection of pus can build up and
12:58that can squash your lungs and make you very short of breath and also potentially the infection can
13:03spread in other parts of your body and potentially to sepsis if nothing is done about it and I do
13:08worry
13:08that if we don't do anything then you're going to end up feeling poorly or having a temperature in
13:12five days in hospital again which we don't want to do they do have at the hospital what we call
13:17it
13:17the AEC which is an acute assessment unit before you've been there before they are so good they
13:22are so basically they're a sort of consultant-led urgent thing where we can't wait weeks yeah what
13:27we don't want to do is it to build up so we need to stop it and then we need
13:31to ask the question
13:31why if anything has it come back and how can we prevent it coming back again do you mind having
13:36a
13:36seat in the waiting room just for a few minutes and I'll try and get hold of them on the
13:39phone
13:39and sometimes it takes a bit of phoning around all right um have a seat I'll call you back in
13:43two
13:43minutes okay thank you hello hi my name is dr pearson I've got a 37 year old lady she's had
13:53a
13:53history of an empyema and I've had a look at the x-ray and it does show there is some
13:57blunting of
13:58acostrophrenic angles and I'm worried that it might have escalated over the last 24 48 hours
14:03okay I'll get her to come straight away thank you so much bye bye
14:10Elena yeah go straight up okay you take a good luck today Elena all the best
14:18yeah will I bring my coffee you can of course yeah go for it why not can you take it
14:23of course I can
14:23in case I spill it yeah I've been well looked after this morning I went on a starvation from
14:29lunchtime yesterday oh no you didn't need to do that oh it's farting from midnight oh bless you
14:36so I was gasping for coffee oh I can imagine I'll leave this here for a second how have you
14:43been
14:43though are you well I'm up and down a bit yeah a bit a little bit more up than down
14:49well that's good
14:50but it's you know I'm not hundred percent I get really cross with myself actually well remember to
14:55be kind to yourself because you know I think we're all our own worst critics aren't we yeah
15:01there you are thank you yes I've had so many pains and and things that I thought well I better
15:08have as
15:08pure as I can blood test sorry enough yeah the thing is I'm just wondering what um what the results
15:15were on the third poo I did yes which you know these pains are crucifying me when I get them
15:25unannounced unexpectedly I haven't had one for a month but it could come tomorrow anytime yeah fair
15:33enough the last poo that came in that one I had more in the bottle than I had in the
15:39last two bottles
15:40fine because I was getting more experienced yeah so you're a pro now exactly so that since then I've
15:48had no pain but when it happens I have to lie flat on my tummy yeah take a penadol yeah
15:54and take the
15:55bucket with me into bed because I heave a lot bless you and nothing comes up and an hour later
16:02I can get
16:03out of bed stand up as though nothing had happened where about in your tummy is it painful down here
16:10somewhere yeah fair enough and there's no pattern to the pain starting it just happens spontaneously I
16:15know when it's gonna happen now do you it's usually when I've done a wee and then suddenly I know
16:19that
16:20something happening down there I can hardly walk the pain is so severe doubled over with it so the the
16:26first poo sample the one that looks for microscopic evidence of blood that we don't see with the naked eye
16:31right the good news is that's come back completely normal right which means the chances of your
16:36symptoms being due to bowel cancer is less than one percent which is a really really good it's a
16:41nice rule out so we can safely say that the other two fecal calprotectin test it's called it came back
16:47elevated on one occasion and then we repeated it but we haven't given it long enough we only repeated
16:51it a couple of weeks later and it was still a bit high so the reason we do that one
16:56is to screen for
16:56something else like an inflammatory condition of the bowel something like colitis Crohn's disease
17:02that kind of stuff and so that has come back elevated we should refer you to the gastroenterology
17:07doctors and I think if you're having the abdominal pain with it then absolutely we should be sort of
17:13you know investigating that further I'll refer you to the gastroenterologists see what they say
17:19oh that's it that's it then okay done done done done are you okay getting home did you order the
17:26transport I've got dalek hair good okay I'll bring this out for you and you can finish it in the
17:31waiting room not a problem at all I read my book yeah exactly you've come prepared yeah okay it's not
17:36your first rodeo you're right Millie hey oh gosh it is a full bit sweaty I honestly thought I was
17:50going to be late really yeah because a train station there near my area was closed I had to go
17:56all the
17:57way to another one I'll take a bus so annoying morning surgery how are you uh well uh totally
18:07different in a good way yeah yeah in a good way but I would like to discuss uh those okay
18:14I had
18:15perimenobus symptom and especially this is mental brain fog yeah yeah memory relapses so many of them
18:23difficult to concentrate uh so well I started this one yes and that one yeah and I put only one
18:34those
18:34one pump yeah and when I tried to I started feeling a little bit nausea okay is it fine and
18:43I stopped
18:44the second okay so you went back to one yes okay so yes so this is the estrogen and estrogen
18:50I suppose
18:51sometimes can give some side effects so yes some people might feel a bit nauseous when they increase
18:56the dose some people get things like breast tenderness in most cases you get used to the dose and those
19:01symptoms go away okay how do you feel on one pump uh fine like I'm still like myself good uh
19:11maybe my
19:12libido not the hundred percent as it was I wonder is it for the whole my life it will be
19:18lower libido
19:19for the libido okay have you noticed any change in the libido with estrogen it improved okay but like
19:26not the hundred percent if we take the libido out of it yeah how much better do you feel on
19:33one pump
19:33after two weeks I noticed the difference in my body and mental especially uh I got a new job I
19:40passed
19:41interview so well done yeah it was a uh how intensive period but thanks to these things good I'm glad
19:48it's a miracle yeah I mean I definitely noticed a difference in your positivity today really nice to
19:53see because I know you were a bit nervous about going on it weren't you yeah so I read a
19:59lot I
20:00spoke with many people about connection with breast cancer and so on I was worried about this a lot
20:08um I think some of the data with breast cancer is not you know they're still studying it because
20:12it's quite new and we know until you're 50 you're at kind of population risk of breast cancer
20:18so it doesn't matter not until you're 50. So we know that for women between age 50 and 59
20:24if we put a thousand women on HRT there would be four additional cases of breast cancer
20:29and however there's lots of other factors that increase breast cancer so smoking alcohol being
20:34overweight lack of exercise so when looking at risks um of HRT with a woman we need to look at
20:41their family history and we also need to look at those lifestyle factors for the libido we know that
20:46the estrogen can help but I think last time you asked about testosterone as well yeah yeah so we can
20:53give testosterone okay it's more how you you feel we want to do the best for your symptoms
20:58I would like to try testosterone what we'll do is why don't you try two pumps and see if it
21:04makes you
21:04feel any better uh-huh if after a couple weeks you think or even a week if you think two
21:09pumps is not
21:09for me stay at one pump and then come in and have your bloods checked and we'll do your testosterone
21:14level and everything okay yeah and then I'll see you and we can talk about adding in the testosterone if
21:20the bloods are fine all right yeah perfect all right so any worries in the meantime come in okay
21:27okay I'm so glad that you're feeling much better yeah me too thank you not at all have a great
21:32afternoon yeah you too bye
21:42my voice sound okay it sounds you've got the sexy telephone voice not really I think I do at night
21:48oh toss I've been told my voice is very soothing oh yeah I think it is right oh it is
21:55I've got a
21:56soothing voice you too as well and me I've got a sexy telephone voice yeah you do you sound so
22:01pot
22:01hello hello I'm calling for fuller medical center it depends who I'm calling I do put on a little
22:10sexy voice and there's someone's sound really nice in the phone right oh that's okay no worries yeah
22:20come and have a seat tell me what are we up to today right I don't know about my x
22:26-ray tools okay we
22:28can have a look at that but tell me what sort of symptoms you've still got pain and things the
22:32pain
22:32is just getting bad and it's also around the lower back for some reason well it's both my left and
22:41my
22:41right okay but the right is so bad I can't sleep properly I can't sleep I mean the x-ray
22:48was done
22:48in April and they're saying that actually the bones look quite strong but there is a bit of narrowing
22:54they're wondering if the tendons and sort of things that hold our bones in place whether they've
22:58been damaged a bit did you fall over or last year mm-hmm I moved elderly gentleman I had to
23:07pull him
23:08from his kitchen to the front room which I and then so my back you hurt your back look and
23:14I think then
23:14that did you what you requested some prednisolone some steroid tablets so I was put on that for a few
23:20months but it helped the soldiers it did help me in my knees and all that you're absolutely right
23:26steroids can really help inflamed joints so there's no doubt there the problem is it's not generally
23:31steroids that we take by mouth we normally try and do a cortisone a steroid injection into inflamed
23:36tendons ligaments things like that to reduce it so we target it to where the problem is rather than
23:42getting into the whole body the reason being is because steroids have a lot of side effects a couple of
23:47the side effects that are very relevant here where we have to be careful one is it can actually thin
23:50bones and do damage to bone so we don't want to make that worse second of all I'm always more
23:56worrying is sometimes they thin the lining of the stomach do you still have a drink occasionally yeah
24:02every day and how much do you drink every day oh it's gone up to about two four cans a
24:10day and the
24:11whiskey again and this is why I worry and I know I've found like a broken record saying this to
24:17you
24:17again but I worry Peter that that that amount of alcohol is it's it's not great for your stomach
24:22lining and when you're on a blood thinner which you have to be because you've had these blooming blood
24:26clots yeah so the mixture of steroids and alcohol and blood thinners it's a potentially dangerous mix
24:33that could then make you bleed and get really poorly and you've already had how many blood clots
24:39and it's not like the blood clots are just in your legs they're in your lungs they're in the
24:42dangerous place and if we don't treat them and they fly off they go up to the brain if we
24:46have a
24:46blood clot in the brain that's a stroke we don't want that so we've got to do everything we can
24:50to
24:51avoid causing harm and problems and alcohol I mean do you do you want any help with that at all
24:57for you I've done that what five times seven months gone to the places seven months that's a long
25:04time to have given up for you I know so what's made you go back to the drink I just
25:10want it
25:11you like it I just want it yeah I started at the age of nine you start drinking at nine
25:17yeah
25:39have you been to turning point is that who you've been to before no so there are current provider of
25:46alcohol services they are really really really good I'm going to send you how to contact turning
25:51point if you choose to do it I genuinely think it is never ever too late nobody will be cross
25:55that
25:55you've done it before and relapse that's the nature of alcohol sometimes so as far as the shoulder
26:00can I get you a steroid injection into it can I get the the get the steroid in but do
26:06it locally
26:07rather than into the whole system hmm run this point around the back it's getting and getting
26:14bad and the thing is I'll tell you the truth I will get a load of painkillers put in a
26:20bottle
26:21of fruit juice hmm when I feel I can't do no more I'll just drink that take the lot yeah
26:27have you bought
26:28all the tablets to do that or anything like that not yet not yet do you feel you're getting towards
26:33that point yeah yeah yeah and what is it that stops you from doing it now um because I can
26:45move about I
26:46still can move and I still can look after people okay and I've got me two cats I love the
26:52cats that's
26:53good but you're saying when the pain gets such all that you can't move and you can't do things
26:57for yourself you don't want to be I don't want to be where it's gonna be bad if the pain's
27:04gonna be
27:05bad I hear you and I I'm not gonna be burdened to nobody okay so why don't we try and
27:12help you with
27:13this pain try and work out what's causing the pain give me a chance to go through and see what
27:17you've had done I'll just get a referral sorted out for the next people for the steroid and things
27:21that but I'll then try and find out exactly for the back and everything where we're at what we're
27:25doing we'll move on and we'll make some progress and let's keep in touch a bit more Peter and if
27:29ever things get so overwhelming that you feel that maybe the tablets and the bottle and things at
27:34time come and see me okay all right all right so you tell well listen lovely to see you today
27:40come
27:40on let's get you sorted out and you know where we are if you need us all right I'm gonna
27:45get it
27:46sorted all right thank you all right you take care so you look after yourself all right bye bye
27:51Peter bye-bye tell me what's been going on okay I have a lump almost seems to be getting bigger
28:06I've
28:06noticed a lump here on the neck and I wanted to check it I've got a lump on my armpit
28:11it's getting bigger
28:12many many years ago I did get a lump on the side here and tell me a bit about it
28:17when you noticed
28:17it I just noticed it today this morning okay mirror it's underneath it's tender isn't it it's just
28:26sitting there isn't it yes and it moves around a little bit which is a good sign it was 40
28:3250 years
28:32going but actually it's gone down that so what can I do for you well we met before yeah my
28:43breasts
28:43I'm going to the breast like they I was supposed to have gone yesterday wouldn't they have to change
28:47it since then I thought it was first it was a bite and I had look and there's nothing there
28:52just
28:53there's some lumps okay and it's quite swollen and hurt and I just thought I should come and see you
28:58and see if anything going on did you say you have an appointment the best clinic tomorrow no I had
29:01one
29:01yesterday which they had to change I think now it's about two weeks time well have you been seen
29:05since I referred you no no because that was back in May wasn't it yeah Marla was referred to the
29:10breast clinic for breast pain so she'd actually been having breast pain for around five months
29:15she is on HRT which definitely could be a cause of her breast pain but the guidelines suggest that
29:20breast pain over three months we should refer to the breast clinic for assessment are you all right
29:24if we have a little look yeah that'd be okay that's fine you can lift the top up or just
29:30lift it off if
29:30that's easier I'm just gonna grab some gloves okay let's have a look at these lumps so just relax your
29:39arm down here yeah yeah mm-hmm yeah so there is still a bit of a lump there do you
29:46shave the area when you know I
29:48don't I don't so I thought it might be an ingrat I sort of I thought I said it was
29:51a bite because it
29:52was felt small and sort of itchy pain and then it didn't go so that moves the hair but that's
29:57yeah
29:57that's not the most fun that's a bit sore yeah I'm just gonna check the other side if that's all
30:04right
30:06I can't feel anything that's I don't know we checked the breast last time I'm just going really
30:10quickly for neck if that's okay not notice any lumps or swellings there stiffness recently
30:15so especially sort of down here and no lumps or bumps in the morning you've noticed no that's fine
30:23you can say you come and have a seat the lumps it could be a couple things one is it
30:29could be some
30:29lymph nodes the other option is it is a sort of was an infected cyst and you and now it's
30:34getting
30:35better was it ever red and hot or just quite tender no not red I think because there's lumps there
30:41and
30:41they've been there three weeks and we're not 100% sure what they are well I'll request an ultrasound
30:46off them you're obviously going to be seen in the breast clinic in a couple of weeks anyway
30:49and so they'll be checking the breast but let's put an ultrasound request through and we'll just
30:54get that done so that we know exactly what they are and does that sound all right all right not
30:59at
30:59all and then we'll see you probably in three or four weeks to follow up everything but any concerns
31:04or if anything gets worse in the meantime so three to four weeks yeah great okay all right
31:07thank you not at all bye bye
31:16it's going to say I can have a silly question of post-surgels after this one yes that post-natal
31:22depression is after after having a baby post-traumatic was it PTSD post-traumatic PTSD post-traumatic
31:38stress disorder so it means after you go through traumatic experience huh you're not even listening
31:45so I asked you one question you want to give me 10 examples of where there's post in it
31:48the post goes in the little box
31:54come in please nice to meet you please have a seat my name is Nilu I'm the dietitian and you
32:02are referred to me regarding weight management that's right yeah you have tried to work on
32:07your diet yeah what changes have you made in your diet I normally eat healthy but with South Asians we
32:17are dependent on a rice-based okay and it's almost every day that I eat rice all my adult life
32:26I've been
32:27overweight but in the last few years I have gained say about 20 kilos okay what do you usually have
32:34for lunch so again rice okay with with lamb or chicken curry is that a curry yeah okay yeah how
32:44much
32:44rice would that be half a plate quarter of the plates maybe one plate one plate and what about your
32:50dinner similar to my lunch what would be the biggest problem in your diet if you wanted to
32:56portion size portion size so this is a picture like with half of the plate rice so this plate has
33:04a 1200
33:06kilocalories as a man it's usually between 1800 to 2000 kilocalories per day so imagine one plate will
33:15definitely be one thousand five six hundred then if you repeat that for dinner that would be three
33:23thousand then for the breakfast snacks another one thousand you get something between four to five
33:31thousand kilo calories per day that's why you're not able to shift the weight how flexible are you like
33:38in changing your diet whenever you're having one tablespoon of rice just imagine you're having half a
33:45teaspoon of sugar in your experience would you advise going for something like a monjaro privately so
33:53a monjaro I recommend to the patients who have tried everything and no good results because you're not
34:01going to be able to be on monjaro for the rest of your life if you don't improve your diet
34:06then once you
34:08start taking monjaro you will put the weight back on and this will actually damage your metabolism system
34:15yo-yo dieting losing weight putting on weight but work on your diet for one month or two
34:21you have a good weekend take care bye bye
34:33come and have a seat hello I haven't seen you for about 20 years you haven't changed I could never
34:39get an appointment with you oh I know well it's always difficult to get appointments isn't it I'm
34:44sorry I know it's busy how are you doing today right okay about 12 years ago a virus attacked my
34:51middle ear in a rear in a rear and my head balance problems but the balance problems have sort of
34:57come back yeah so it's got quite bad you know the 414 we've only got one bus yeah sometimes you've
35:05got
35:05to wait like 20 minutes half an hour for the four there's no seats and there's no seats when the
35:10bus
35:10comes I'm so wobbly I find it difficult to make it to the bus that sounds a bit scary as
35:17well I'm very
35:17scared actually yes yeah and have you had any falls at all yeah but I tripped over two weeks ago
35:24I was
35:24on the way to physio oh dear yes I saw well but you have bashed it yeah good job you
35:30didn't break
35:31anything or harm yourself yeah well I have done in the past do you ever get any palpitations or any
35:36funny heart I do you know it does a little bit yes okay tell me a little bit about the
35:41heart when
35:42you're getting the palpitations um you know I can just be sitting somewhere and suddenly oh you feel
35:48a bit odd it's a funny feeling well I started it now a bit is it yeah but just just
35:55have a listen let's
35:56just have a tiny bit okay that's okay and we'll just see if we can pick anything up tell you
36:07what
36:07I'll do it sounds good you've got a strong heart which is good it's just going slightly irregularly
36:14it's not going totally do you ever feel that that your heart is beating a bit and finally you just
36:19have
36:19a feel of your pulse again for a minute and then what we'll do is I can let me just
36:26see what Sam's
36:26up to you don't have any heart problems or anything I've never had in the past no I'm 73 now
36:34okay
36:35you're still young still got another 30 years to go my friend we need to get you an ECG is
36:46what we
36:46need to do to get to to have that reading of the heart just to make sure if the part
36:50is beating
36:51irregularly what happens is that it does a few in a row then it pauses just for a few seconds
36:55and
36:55then it does a few more and it pauses and it's during the little pauses is that sometimes the
37:01blood might sit like it does if you cut your skin the blood comes out and then it clots and
37:06then if
37:06it forms a little clot in your heart and then it starts beating again it might send that clot up
37:10somewhere and that causes sometimes things like strokes which we want to avoid so we need to get
37:15the ECG just to confirm is that all right yeah come on through to Sam and then I'll have you
37:20back
37:20again with the ECG in a few minutes thank you if you have a seat but don't run away once
37:24you've done
37:25this don't run away because then I'll see you again in a minute I will see you in a few
37:31minutes but
37:32have a seat in waiting room again and then I'll see you do not run away no all right okay
37:35thank you
38:02I've got a yeast infection yeah really
38:06common unfortunately with all that but at this moment in time there's nothing I'm worried about
38:10good is if it being anything more sinister I literally threw up like yeah yeah I vomited
38:16reassuring thing is it's really common to feel a bit short of breath with it so that I wouldn't worry
38:21too much what do you think about stress can stress bring out skin conditions sometimes you can get
38:25stressed very very common very very common our skin is absolutely representing often what's going on
38:30inside how are you with having your blood taken all right unlike my husband I'll stand on the side
38:35of needles it's very common in men yeah come on back in right we found what's going on thank you
38:45all right no because it's been terrible so what it showed is what we suspected so it's this funny
38:52condition so your heart look at this it's going really lovely that's great but it does have this
38:57atrial fibrillation so it's sort of you see it's going and then it's a slightly smaller gap here
39:02and then there's a longer gap here and a smaller gap here so it's never going to stop this isn't
39:06life-threatening in that I'm worried about your heart it's just what happens it's really common
39:11because your heart rate was going quite fast and things I think that's why you're feeling probably
39:15tired of dizzy and a bit odd and we can slow it down that's easy it is with a tablet
39:20but I honestly
39:21think the tablet will make you feel a bit better it's a very low amount of it called a beta
39:26blocker
39:27it just calms things down a little bit but we do have to take a blood thinner as well just
39:32because
39:32of these little pauses here we don't want a blood clot okay so actually if you take this so from
39:38today
39:38we can go to the chemist and get hold of it today you're going to be absolutely fine it's it's
39:43keeping
39:43your heart and your brain and stopping it reduces the chance of stroke which is what we want
39:48you're far too busy to have a stroke and be ill let me send it through to boots here so
39:52you can
39:52just nip next door to boots and then we'll catch up on friday and see how you're feeling okay well
39:57look you you are you're going to be all right to get to boots and get oh absolutely I feel
40:01so much
40:02better already thank you so much all right not at all I'll see you on friday and if there's any
40:06comments before you just give me a shout all right good oh I'm not going on the day again
40:14from yesterday yeah that always happens to me I become so dramatic after getting an injection
40:20I remember at my old school I got one and they had to put a thing down on the floor
40:24because I fainted
40:32how are you guys good oh how are you gorgeous boy how's everything been going we've had a few
40:41weeks of it it must be sad do you remember last time I came in I said he had a
40:46heart like he had
40:46a hernia yeah we went for the surgery on that a couple of weeks ago and was obviously meant to
40:53be
40:53like the most routine procedure and the surgery went well but he had a really quite a nasty turn
40:59afterwards and ended up needing two blood transfusions oh gosh so that was just obviously
41:04like the last thing we needed absolutely we'll aim to do all of the 12-week vaccinations yes so that
41:12will be the six in one yeah um so that will cover him for diphtheria tetanus whooping cough polio
41:17haemophilius influenza b and hepatitis b yeah and then the second one is the pneumococcal um vaccination
41:23okay um what does that protect against um so pneumonia come on then hello bubba oh my boy
41:31so we'll do the rotarix vaccine that goes in his mouth first
41:39we should be used to this you take lots of oral medication at home
41:44good boy good job bud okay so we'll do one leg turn him around do the other leg and then
41:53cuddles
41:53afterwards okay mommy doesn't like this you don't know what's coming do you are you gonna be a brave boy
42:01i'm sorry oh sweet boy it's okay i know it's horrible come on darling i'm so sorry oh it's okay
42:26mummy's here
42:37okay mommy's got you you might find that his legs are a little bit red a little bit raised there
42:45might
42:45even be a little bit of a bruise that's all completely normal i will see you in four weeks
42:50next time yeah perfect and that will be the last one for a while thank you well done thank you
42:57so
42:57much take care bye bye don't worry don't worry thank you so much all right nice to see mr take
43:03care bye
43:03bye great thanks kate i just thought i better just come in and have it checked definitely okay
43:09thanks so much thank you thank you bye bye thank you very much dr george yeah take care all the
43:15best to you too bye now
43:24bye bye
43:25bye
43:26bye
43:26bye
43:27bye
43:27bye
43:27bye
43:28bye
43:29bye
43:34bye
43:36bye
43:42bye
43:43bye
43:53bye
43:54bye
44:15I was up a ladder, I was fitting a window and the expanding foam tin exploded in my face.
44:22There's all these bloody hallucinations around me. There's one that's always sitting in my place.
44:26I want to change my life. I want to stop the drugs and everything.
44:52I want to change my life.
44:54I want to change my life.
44:57I want to change my life.
44:59I want to change my life.
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