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00:11Morning surgery. I'm told that cobwebs are the best thing. That's not advice that I'm familiar
00:18with. That is my modern tablet for all day. You must feel like you're rattling sometimes. It's a lot
00:25of work. This foot is normal. Yes. This foot looks like a Cornish pasty. I got out of bed and
00:36all of a sudden, you know, this part of the blood, my nightdress was full of blood. It's good, John.
00:47It's really good.
00:56I got out of bed.
00:57I got out of bed.
01:12I got out of bed.
01:24Morning.
01:25Vernon. Yep. Hello. Morning.
01:28We're in here today. It's a bit warm, but not too bad. Have a seat.
01:33Should I sit here?
01:33No, you get this seat. I need to play on the computer sometimes.
01:36Sorry. Sorry. Sorry.
01:37No, no, no.
01:37Don't be silly. What's happened?
01:39no I've got a lot of complaint oh dear um I had some pain okay I don't know if
01:47it's liver or whatever but it was around here it was very hard okay and then it
01:53moved to here oh so how long has all this been happening for them for weeks
01:59months months okay I think over half a year but my stomach hmm I had some funny
02:09as I got up in the morning straight away I got a toilet and that was not normal so
02:15that was going to the toilet to open your bowels yes a bit funny I mean I
02:19didn't mind it but it wasn't usual no so there's a change for you I'll just show
02:25you something doctor yeah that is my mount a tablet for all day so you all this in
02:33the morning yeah is the supplements okay take myself so you've got these ones
02:37that we give you these in the evening yeah and you know why you're taking all
02:41these tablets Vernon well I know some of them when when I had the heart attack on
02:46and that stroke and thing I know some of them is in that area yeah blimey so the
02:51problem is that each one of these tablets is there for a reason and it does seem
02:56like a lot you must feel like you're rattling sometimes it's a lot yeah let's
02:59think about it it's 14 15 tablets and you're gonna live to 100 with all of these
03:04because we're gonna keep going so you're gonna keep going with them and I think I
03:09I am slightly worried about the pain can I just have a feel of your tummy is that's
03:12all right come and pop up on here let me just um if you just that's why I want to
03:16come and see
03:16it up because I've been seeing you when I had my heart attack it was you I know
03:20like that when I had my stroke it was you come to my thing can I just have a
03:23feel of your tummy okay any pain in your tummy now no and if I just press at the
03:29back any pain in the pain was up here now so it's much higher right there the
03:33pain was stay sitting I'm gonna have a listen to your heart for a minute
03:39strong as a horse oh not as a human no as a whole but that's all your tablets
03:46that you're taking keeping your heart good so that's good I'm assuming that I
03:49am a little bit more worried about your bowels and things a slight change in
03:52bowel habit needs to be checked okay so what I will do sweetheart is that do you
03:57think you can drop in a stool sample for me a poo and if this is negative then I'm
04:02happy with that then we'll move on and work out what else we need to do okay and
04:05let me just get you a pot there's one in here okay so this is how we do it it's
04:10called a fit test this is how we do it yeah there's a song I know there's a song
04:17you've got a lovely voice this is the test we do it's very easy to do the
04:21instructions tell you what to do and then drop it back around here so I won't
04:24seal it but I'll give you all of this all right go and have your breakfast
04:27yes I feel good that I came down good okay all right you're gonna have your
04:31breakfast and you take care all the best bye bye bye bye bye bye have a nice day
04:38time
04:43Cosimo Cosimo okay so take a seat my name is Anna McHugh I'm one of the doctors it's nice to
04:53meet
04:53you you too thanks for seeing us no worries so what's been going on do you want to show
04:58her so he basically has got it's he's got infected thing but it was massive yesterday and I I got
05:04it out
05:05can you see but it's refill it's really painful for him when did this cup all
05:09start when did I ask the day morning I was so quite quick so you've been 21 yeah he
05:16woke up with it didn't you and did you bang your finger off anything but don't know
05:20okay what did you do oh you just woke up with this okay you weren't digging in the
05:27ground or anything like that or biting your nails or anything no and have you ever
05:33had it has he ever had anything like this no well we have a little look so I just didn't
05:40want to
05:40leave it and it to get worse yeah so it looks like what's called a paronychia it's quite sore
05:45is it I'm sorry so there's definitely a collection of puss there yeah looks like it's infected we'll try
05:53four times a day an antibiotic cream okay and if you've noticed that it's not improving let's say
05:59in 48 hours then we can yeah we can give you an oral antibiotic yeah okay okay oh would you
06:07have you stick it yes I think we do have one I have some options for you what do you
06:13say
06:15um what's your favorite animal the lion yeah perfect so you see what it says
06:22awesome nice well done thank you so much what do you say what do you say say thank you thank
06:31you
06:39uh jack please jack
06:45and here hello how you doing um lovely to meet you I've been um reading all about you and I
06:51had a
06:51chat with dr pearson as well you poor thing that sounds like it's been a well window a few weeks
06:55for
06:55me how are you getting on actually better than I thought I would okay I think kind of after going
07:01through brain surgery I thought I thought I would need a bit more time to feel back to normal but
07:06actually what are the initial symptoms that you had that sort of prompted this whole I honestly I'd
07:11never had any symptoms prior to the seizure that actually had um that put me in hospital so just a
07:15one-off seizure went into hospital did a scan they found a benign brain tumor thankfully thankfully
07:21yeah goodness and then you're in surgery straight away yeah cut it all out brilliant so Jack is a
07:27young lad who presented initially to the um hospital services having had a seizure on uh investigation it
07:34was found that he had um meningioma which is a type of brain cancer so he was rushed into um
07:39emergency
07:40surgery and it was removed thankfully it was a benign tumor fine okay and how's the recovery been you say
07:46I mean I've I've had my at my sleepless nights for sure go you poor thing you've been through the
07:51mill haven't you what are we doing today how can we help so I've been feeling like uh some chest
07:57pain
07:57whilst lying down um and initially I thought it might be muscular you know I just felt muscular but
08:05it's only on the right side there are many complications after such major surgery one thing
08:11that we do worry about a lot is a something called a pulmonary embolism which is a blood clot that
08:15affects the blood vessels around the lungs and that can often present with sharp shooting chest pain
08:20and it's been now three or four nights where I've you know it's been quite painful and I've kind of
08:27had
08:27strain breathing difficulty breathing
08:52is it that loud I don't know if you do it on purpose I'm not doing it on put I
08:56swear to god I saw your typing
08:57Look, even on my phone, yeah, like, I'm like this as well, like, it's just the nails.
09:02Don't be a hater, be a lover, yeah?
09:04I'm always a lover, baby.
09:06That's how I like it.
09:14Jennifer.
09:16Come on through.
09:18Tell me, and what's been going on for you?
09:22We'll have a little look at this foot.
09:23Oh, yes.
09:25Right.
09:25There you go.
09:26So, excuse the toenails.
09:28You can pop the foot down and we'll get the story first.
09:30Okay, so I've been, I've just been on a fitness week.
09:33Okay.
09:33So before that, my navicular bone was really hurting.
09:38Are you medical?
09:39Navicular bone is very...
09:40No, I'm horsey.
09:41Oh, you're horsey.
09:42Okay.
09:42Sorry.
09:44When I was on my fitness week, this toe hurt like mad when I was pressing it down.
09:50And since then, the side of this, the bone up the side here has been really hurting.
09:56Yep.
09:57And obviously you can see that it's hugely swollen.
09:59Quite swollen, yeah.
10:00Can I ask, did you have any trauma to it?
10:02Did you fall or go over on it or anything like that?
10:05A five-bar gait.
10:06Okay.
10:07And I know it's really hot at the moment, so I know people's feet are likely to swell.
10:11Yes.
10:11But this foot is normal.
10:13Yes.
10:13This foot looks like a Cornish pasty.
10:15But we definitely have an injury on that foot.
10:18Okay, well, we'll examine you here.
10:20I'm just going to move the foot, okay?
10:22It hurts on top of the toes.
10:24Top of the toes.
10:26Keep your leg where it is.
10:27Just move the ankle bone like this.
10:28Like that?
10:28Yeah, exactly.
10:29It hurts on the outside.
10:30Okay.
10:31And move your toes up and push down as if you're pressing on a pedal.
10:34Fantastic.
10:35Is that painful?
10:35Nope.
10:36Okay.
10:36So it's more than likely that you've done some musculoskeletal damage, so kind of a ligament
10:41or something like that.
10:42Great.
10:43So what I think we should do is the usual.
10:46Yeah, rest, ice, elevate and compress.
10:49Okay.
10:50Then I'll give you anti-inflammatories for a week, and I'll give you a tummy tablet alongside
10:55that.
10:56That's kind.
10:56Yes.
10:57I think that once we get this injury rehabbed, I think physio is also a good idea.
11:02We need to definitely give this some time to heal, and hopefully we'll be on to a winner.
11:08That would be really good.
11:09That's really kind.
11:10Lovely to meet you.
11:10Lovely to meet you.
11:11Where are you from in Ireland?
11:12Cork.
11:13Oh, are you?
11:14Yeah.
11:14Oh, yeah.
11:14My husband got divorced in Cork.
11:16Oh, God.
11:17Great place.
11:17Everyone has a story from Cork, I think.
11:19They do.
11:20Thank you very much.
11:21Take care.
11:28Can't listen to your breathing, is that okay?
11:31Great.
11:32Can you take a few deep breaths in and out for me?
11:35Lovely.
11:36Take a very deep breath in and then force out as quick, as hard as you can.
11:41Oh, it's not bad.
11:45Okay.
11:47Okay.
11:48And then you breathe deeply in and out through your mouth.
11:54Nice deep breaths for me.
11:56Lovely.
12:04Yeah, that sounds pretty good.
12:05That sounds pretty good, which is good news.
12:11Any shortness of breath when you're up and about?
12:13No.
12:13Sort of walking around and stuff?
12:14No.
12:15No.
12:15Good.
12:15Any wheezing sounds coming from the chest that you've noticed?
12:18Not, well, I mean, force wheezing, yeah, but like trying to loosen the chest up.
12:25And have you managed to bring anything up?
12:27No.
12:27It's been really dry, right?
12:29And you mentioned it's only been sort of three or four nights maybe?
12:31Yeah, so it's Saturday afternoon up and feeling us.
12:34Yeah, we did like a big day out, which he hasn't done a lot of exercise in a while.
12:39Yeah, of course.
12:40So when he came home, that's when it started to hurt.
12:43Are you able to lie on the couch?
12:46Yeah, sure.
12:46Is that okay?
12:48Grand, clear, lovely, really, really good.
12:50And it's all on this side?
12:51Yeah, all on that right side, yeah.
12:53When I can pinpoint the pain when it's really bad, it's kind of in behind here.
12:57Right, back there.
12:58Yeah, kind of there.
12:59Yeah.
12:59Yeah, fine.
13:00Can I get you to take a deep breath in and out for me?
13:05Good, really good.
13:06Are you able to sit up for me?
13:14Brilliant, that's really good.
13:15Thank you so much.
13:16So there's good air entry throughout, normal sounds, so no crackles, no wheeze.
13:20The thing that I was thinking of as well is could there be a bit of crepita, so air in
13:23the wrong bit?
13:24Right.
13:24I'm not feeling that or sort of getting a sense of that.
13:27So I'm really reassured it's nothing serious.
13:29It most likely is muscular.
13:30Now what you could do is use a bit of ibuprofen gel, a topical therapy, just to rub into that
13:36area.
13:36When the air turn and stuff.
13:37Exactly, Voltrol, whichever one.
13:38If there's any other symptoms, so the shortness of breath is getting worse on exertion or when you're upright and
13:44stuff, then come and let us know.
13:46If the chest pain is happening, not just on lying down and not in certain positions, again, it's something to
13:51let us know about.
13:52Do you have time now for a quick blood test?
13:55Yeah, sure.
13:55Yeah.
13:56Sharp scratch, three, two, one.
14:03There we go.
14:04So these results should be back by tomorrow, actually.
14:06And then our policy is that if they're really abnormal, we'll contact you.
14:10Yeah.
14:11If you don't hear from us, you can assume they're fine, but of course you're welcome to call for the
14:14results.
14:14All right.
14:15Perfect.
14:15Thank you very much.
14:16Great.
14:16My pleasure.
14:16You're very welcome.
14:17Amazing.
14:17All right.
14:18Thank you so much.
14:18Nice to meet you.
14:19Thank you very much.
14:28All right, Shane, come on to you, sweetheart.
14:33Hello.
14:34Come on in.
14:35Come and have a seat.
14:36How are you doing?
14:37No, 50-50.
14:39You poor thing.
14:39So tell me what's happened.
14:42I think since we started this journey, I have lost, I was at my biggest 24 stone.
14:46I'm now 13 and a half stone.
14:48Wow.
14:48I mean, you do look fantastic, sweetheart.
14:49You look really good.
14:50And obviously I can tell you're really pleased with yourself.
14:52I don't know.
14:53It's just, I got discharged.
14:55I was doing really well.
14:56I feel like my ADHD at the time, because of the severity of it, it was masking quite a lot
15:01of my borderline and how much I was actually really struggling with that.
15:04Okay.
15:05Yeah.
15:05So I thought I was doing all right.
15:07Things weren't terrible at the time.
15:08They weren't great, but I thought I could deal with everything that was on my plate.
15:11I thought I'd process stuff I clearly hadn't processed.
15:14And then I got to stop the aeropripozole, but I was only ever on five.
15:18So I've known Shane since she was a child, and she's been struggling with her weight and her mental health
15:22for most of her life.
15:24And we've been trying to help support her through both of these challenging journeys.
15:27She's managed to drop her weight and her BMI considerably, and it will hopefully help with some of her musculoskeletal
15:33problems.
15:34Her mental health has often been a challenge, and that often comes in combination with being overweight.
15:39And she's currently under the crisis team who are there to help us when things are really very difficult.
15:44So are you on anything then at the moment, nothing at all?
15:46And do you think you can manage without anything?
15:51If the support is there...
15:53Yeah.
15:53Yeah.
15:54But what support do you think would help?
15:57I don't... I have no neighbour... I have no one to speak to.
16:00And friends and stuff from Fulham, are they able to come...
16:02I don't have many friends.
16:04And it's difficult, isn't it?
16:05Yeah, and it's hard to let people in, and...
16:07My mental health is always just everything...
16:10I don't know, something about...
16:11I don't know.
16:12If I'm happy, I'm manic.
16:14I'm not just having a good day or anything.
16:16There's something wrong with me.
16:17If I'm sad, I'm depressed.
16:18There's always something wrong with me.
16:19I always am mentally ill to a lot of the extended friendship group, and it feels like no one ever
16:25trusts me.
16:26And what I'm saying, they don't check in on me.
16:29They've never...
16:30The ignorance around mental health, that we people are frightened of it, they don't know how to do it,
16:34so they often don't pick up the phone because they're not quite sure what to ask and what to say
16:37and things,
16:37so it's not so much that they don't like, necessarily, as a person, they just don't know how to approach
16:41it.
16:42I can understand I'm not the easiest.
16:44And the fact you're engaging with the crisis team now is great,
16:46and I think if they do want you to start on medicine, obviously we'll help support that.
16:49You know what it's like for me.
16:50I've been in and out of hospital, being stabbed and poked and scammed since the age of 11,
16:56and it doesn't look like it's going to stop.
16:58ADHD, higher-a-team have been amazing.
17:00So far, so good.
17:02So I don't think we've got a shared care.
17:04No, not problem.
17:04I'm still dose-dose-deciding.
17:06So, of course, as you know, we're happy to support that.
17:08So once you're stable, we'll take over that, and I think we'll try and just keep things moving.
17:13The only other question I had was, I have a plastic surgery appointment on the 10th of July at Chelsea
17:17and West.
17:17You have it?
17:18What are we asking them for?
17:19Tummy tuck, arms, boobs.
17:21Okay.
17:21Because if you've lost all that weight and you've got all this excess skin, it is horrible.
17:24Yeah.
17:24They will want to know that your weight has been stable for at least two years.
17:27It's been coming down.
17:28Because they'll be nervous to operate if your weight is fluctuating.
17:31The problem is when you have a weight of that weight, it will have impacts on your body.
17:35You did the right thing.
17:36You've dealt with that.
17:37But now we've got all the other bits and pieces that we'll try and deal with.
17:39All right.
17:40Well done, sweetheart.
17:40Well, good luck with things.
17:41You take care.
17:42Thank you so much.
17:43Bye-bye.
17:52Martin.
17:53Yes.
17:56Hi, Doctor.
17:57Hi there.
17:57Hi there.
17:59Come on in.
18:04All right.
18:04How are you, Doctor?
18:05Hi.
18:05I'm Doctor Prestwich.
18:06Nice to meet you.
18:07How are you doing?
18:08I've got this backache.
18:10I don't know what you can do about that.
18:11Backache?
18:11Well, I've got this curvature of the spine.
18:14Yes.
18:14How long have you had this abnormal curvature of your spine?
18:18Well, it's gradually got worse over a number of years, really.
18:22Right.
18:23I suppose for a couple of years or so.
18:25Okay.
18:25So it's not something that you had all throughout your life.
18:28No.
18:29No.
18:29No.
18:29I think, yeah.
18:30Okay.
18:31And any idea what's led to that?
18:33I took a lot in the post office and I think they've always carried things on one side.
18:39I don't know really.
18:40Okay.
18:40I mean, I can only assume that that has something to do with it, really.
18:45It's all right when I'm sitting down a line there.
18:47Right.
18:47But when I'm walking, I find it's getting worse, really.
18:52And where is the pain?
18:54I mean, the bones are sticking out a bit there, really.
18:57So it's down in the lower back area.
19:00Yes.
19:01Have you ever seen a bone specialist about this?
19:03No, I haven't, no.
19:04I did have an x-ray a year or two ago.
19:08It's okay if I examine your back.
19:10Could you come and stand behind here for me, please?
19:19And are you standing as straight as you can right now?
19:22Um, almost, yeah.
19:24This is where it's hurting you the most?
19:26Yes, yeah.
19:27I mean, it's sort of painful.
19:28I lean against anything.
19:31Just trying to feel where your hips are as well.
19:33Yeah.
19:34Okay.
19:36And this is getting worse than when Dr. McNabb was last saw it?
19:40Yes.
19:41Okay.
19:45So July last year, we did an x-ray.
19:49I'm inclined to repeat x-rays, okay, if it's getting worse,
19:56and I'm referring you not to physiotherapy, to an orthopedic specialist.
20:01Yeah, yeah.
20:01I thought I was wondering.
20:03It is a significant deformity, isn't it?
20:06Yeah, yeah.
20:07And it's really impacting you day to day as well,
20:12limiting your functioning, causing you pain.
20:14That being said, Martin, I'll refer you to them.
20:17I don't know what the treatment options are.
20:21So I don't know what your expectation should be in regards to what they can do.
20:25Well, yes, just because they know what the options are, really.
20:30Do you live on your own, Martin?
20:31No, it's with me, my brother.
20:33Your brother.
20:34Your brother.
20:34Okay.
20:35Is he in good health?
20:36Yes, yes.
20:37Yeah?
20:37Okay.
20:38But he is 80.
20:40Okay, so he's a bit older than you.
20:41Yeah.
20:42And so you're living in a house together, but you have no one else coming in with help at all?
20:48No, no.
20:49Okay.
20:49And do you feel like there's anything you do need extra help with at the moment?
20:53Um, not particularly.
20:55Okay.
20:56That's good.
20:57Yeah, so what I'm going to do now is I'm going to request x-rays of the thoracic and lumbar
21:02spine.
21:02Right.
21:03And then once we've got those back, I'm going to put them in a referral, send them to the
21:05orthopedic team.
21:07Okay.
21:07Okay, I think that the most pressing thing is, you know, getting that x-ray done.
21:11Yes, yeah, yeah.
21:12Great.
21:12Okay.
21:15Do the hand.
21:17There it is.
21:18Yeah.
21:19Okay.
21:20I like that.
21:21Okay, thank you, doctor.
21:22Nice to meet you.
21:22Thanks.
21:28Gemma.
21:29Hi, y'all.
21:31I want one of these scams.
21:33Oh, they're so good.
21:36Come on in, have a seat.
21:37I'm Dr. Dad, Jim, we've met before.
21:41Coming on nearly four years ago, I ended up having a big accident in my home which caused
21:46my jaw to be crushed.
21:48It was left inoperable because of the nerve that's in the way.
21:52But the last couple of weeks, I've had changes.
21:54Like, I've got constant tingling sensation.
21:56Like, I'm getting headaches.
21:58So, all around the back of my ear, like, under my eye and around the back of my neck.
22:03But now, even when I'm talking to you, it's like, the tingling sensation is just constantly
22:08in the side of my face.
22:10Okay.
22:10And I've noticed, like, even in the way that I chew my food and the way that I'm talking,
22:13I'm very conscious and aware that there's a change.
22:17Yeah.
22:17Like, I can...
22:17Have you ever had the tingling before?
22:19Is that completely new?
22:20I've had tingling before, but not all the time.
22:23Okay.
22:24But you would say you've had this tingling?
22:26Yeah.
22:26So, it's been aggravated before, but it's not been long-lasting.
22:30Yeah.
22:30Okay.
22:31And what did the surgeon say when they kind of last saw you?
22:34So, they said that they had to leave it.
22:37And left inoperable because the nerve said it caused me to be paralyzed if they touched it.
22:56Right.
22:56Right.
22:57So.
22:57Oh, yes.
22:58I met...
22:59When was this?
22:59I met him on...
23:00Saturday.
23:01Saturday.
23:01See, you know better than me.
23:02Yes.
23:03So, he came around 7.30.
23:06So, he came...
23:06All right.
23:07A bit later.
23:08A bit later.
23:10So, we drove.
23:10It was a nice drive.
23:11He actually even had his hand on my leg like this while he was driving.
23:14I'm like, oh, I feel like a princess.
23:16Okay.
23:17He bought all the food.
23:18So, and then we're talking, talking.
23:21And then, obviously, he started kissing me.
23:23All right.
23:23And then, obviously, I'm eating as well.
23:28One minute, one minute.
23:30You're kissing him while you've got chicken in your mouth.
23:33I was hungry.
23:36Okay.
23:37Diet, you man.
23:38Hello, surgery.
23:43When they'd done the 3D x-ray, it was described as my jaw was crushed.
23:47Ever tried any painkillers for the nerve pain?
23:49I have tried, but nothing is helping at the moment.
23:53And what have you tried?
23:54I've tried naproxen.
23:55I've tried cocodomols.
23:57I've tried normal paracetamol.
23:59I've tried hot and cold compressions on it.
24:02And nothing seems to be making a difference.
24:04Okay.
24:05Let's have a little look in the mouth.
24:07When was the last time you saw a dentist?
24:10About a year ago.
24:11Okay.
24:12But they even struggled because I can't open my mouth as wide as what I used to either.
24:16And any pain kind of internally at the moment?
24:19Or is it just this tingling?
24:20Not internally, no.
24:21It's just a constant.
24:23And it's more of an ache, like a fuzzy ache, like something's constantly on the nerve.
24:28That's what it feels like now.
24:30And if you were to kind of get the exact path where it goes in your cheek, where would you
24:33say it is?
24:34So it's all here.
24:35Yeah.
24:36It goes around the back here.
24:37Around the back.
24:38Around, like, to the back of my neck there.
24:39And sometimes I get the thingy under the eye.
24:42You know, it feels like it's twitching.
24:45But let me have a quick look in your mouth first.
24:48So I'm just going to feel around the teeth.
24:49Any pain there?
24:51Uh-huh.
24:52And on the upper?
24:53Uh-uh.
24:53No?
24:54There?
24:55Yeah.
24:56Where does that pain?
24:57Right into the cheek?
24:58Yeah.
24:58Okay.
25:00Okay, and this side's okay?
25:01Mm-hmm.
25:02When I press there, is that the same pain?
25:04Yeah.
25:13I'm just going to fill up your neck.
25:15Any pain up in here?
25:17Mm-mm.
25:19Any pain when I press along there?
25:22Yeah, it's...
25:23It just feels like I said more than eight.
25:27Okay, and you just smile.
25:28Show me your teeth.
25:30Good.
25:30Puff your cheeks out.
25:32That's okay.
25:34Yeah, and just open your jaw.
25:36Good.
25:37Okay.
25:38So I think it could be the nerve pain.
25:41It could all be from the injury in the past.
25:44But I think you're quite tender over your teeth.
25:48So in those kind of molars.
25:50So I think probably the first thing to do would be to go and see a dentist.
25:53And just check it's not a dental problem.
25:56Okay.
25:56If we then link it back to the injury before,
25:59and we think it's, you know, nerve pain.
26:01So you have a nerve that kind of goes like this.
26:04So if we think it is a nerve kind of shooting through,
26:07then we can give nerve painkillers rather than your simple paracetamol,
26:11ipofen, those kind of things.
26:12So that definitely would be an option that we could consider.
26:14But I think at the moment, with it being new,
26:16and with you being really, really tender when I, you know,
26:18press over the teeth,
26:19I think you need to see a dentist initially.
26:22So I would try and get even an emergency appointment
26:25and try and get in there.
26:25And at least then they can be like whether there's any infection.
26:28And then once you've seen a dentist,
26:29obviously if they can't refer you
26:31or they want you to see us about the pain
26:33or, you know, we need to get in touch with all surgeons again,
26:35we can definitely do that.
26:36Is that all right?
26:37That's fine.
26:37All right.
26:38Thank you so much.
26:39Not at all.
27:03Oh, it's like lava out there today as well, isn't it?
27:06I sweat a lot.
27:07It just runs down my face.
27:09Are you not hot in that?
27:11Yeah, I don't wear T-shirts.
27:13I don't care about my fat arms.
27:14It's too hot.
27:17It's hot.
27:19You know when it was hitting like 38, 40,
27:21I was sat there with a jumper on.
27:24Were you?
27:27Is it really hot outside now?
27:29It is.
27:31Enjoy the sunshine.
27:32Thank you very much.
27:37It's hot out there today.
27:39I ain't been out for over a week
27:41because I've had this bug.
27:42Really?
27:43Yeah.
27:43You did call the other day
27:44and said I'm really unwell.
27:45I took everything.
27:46I've been very unwell.
27:48It's getting on me wick now.
27:50Do you need me?
27:51Come through.
27:52Lovely to see you.
27:53Yeah, I'm not well.
27:54Looking very summery.
27:55You're not well.
27:56I'm sorry to hear that.
27:56I don't know how much it's a bug up.
27:59Take a seat.
28:00Make yourself comfortable.
28:03Lovely to see you.
28:04So tell me what's been going on.
28:05How can I help?
28:05I got up on Monday morning.
28:07I'm still a bit dizzy
28:08because I've been getting dizzy,
28:09especially when I lost my brother and sister
28:11in the same week.
28:13Got out of bed
28:13and all of a sudden
28:15I felt something come down
28:17and my nose poured with blood.
28:19My nightdress was full of blood.
28:20And then I sat down for a little while
28:22and I started getting the shakes
28:25and then I started burning up
28:27and all my throat
28:28and everything.
28:29I'm not well.
28:30Any other symptoms?
28:31Any difficulty swallowing,
28:32food not going down,
28:33getting stuck?
28:34To tell you the truth,
28:35this week,
28:35because I do Jenny Pick,
28:37this week all I've had is toast.
28:39Yeah, so a lot of...
28:40And cold water.
28:41Lots of appetite.
28:41And hot lemon.
28:43Yeah, good.
28:43And honey.
28:44Good.
28:44I just want to get better
28:46so I can get out and about.
28:47But just from a safety point of view,
28:49I just need to know,
28:50have you been struggling with swallowing?
28:52Is food still going down?
28:54Is it getting stuck?
28:54Is it coming back?
28:55No, no.
28:56But you can still swallow?
28:57Yeah.
28:57You can still swallow?
28:58Brilliant.
28:59And any drooling,
29:00any excessive saliva production
29:01and drooling not able
29:02to swallow your own saliva?
29:04No, I spit that out on you both.
29:06That's absolutely fine.
29:07Any rashes on your skin?
29:08No.
29:09Good.
29:09Any headaches?
29:10Yeah, I've had headaches.
29:12Yeah.
29:12All on top.
29:14Yeah, and what do they feel like?
29:15How do you have to describe them?
29:16Well, on Sunday,
29:17I was washing up
29:18and all of a sudden
29:19I had this pain here.
29:20Okay.
29:21And I had to stop.
29:22And did you have any visual changes
29:23associated with that?
29:25Yeah, I get goody.
29:26No, sorry, visual changes
29:27where you can't see it.
29:28Yeah, I've just had the cataract done.
29:29No, sorry.
29:30Yeah, sometimes.
29:31With that headache that you had
29:32on that one side,
29:33when that headache happened,
29:35was there any change in your vision?
29:36Any blurred vision?
29:37Loss of vision?
29:38Zigzag lines?
29:39No, just like dizzy.
29:40You know, like you're going like that.
29:42Yeah, okay.
29:43So dizziness.
29:44Drinking water,
29:44keeping hydrated.
29:45Yeah, I've got to get some today.
29:46That's fine.
29:47And are you passing urine okay?
29:49I've got an infection,
29:50I think, again.
29:52Well, but...
29:52Because you know when I go away,
29:54it sort of burns worse
29:55and it comes up.
29:56Does it?
29:57And it sort of comes up
29:58and I've got red in the face.
30:00What comes up, sorry?
30:00But I do suffer with, like...
30:02You get flushes?
30:03Yeah, flushes, yeah.
30:04Like a hot flush
30:05when you're urinating?
30:06Yeah.
30:06Okay, and how long's that been going on for?
30:08Well, up and down, up and down.
30:10Because you know I've been in hospital
30:11and I've had the prolapse.
30:12Yes, I know, I know.
30:14Yeah, yeah, okay.
30:15I'm just trying to ascertain acutely
30:18in the last week or so
30:19what the main issues are.
30:21Today, my job is to make sure...
30:22Get rid of this.
30:23Absolutely.
30:24Patients often come to see the doctor
30:27with a vast array of different symptoms.
30:30It's really important at the onset
30:32to try and establish
30:34exactly why the patient is there to see you.
30:37We don't want to risk missing something serious.
30:40It's perfectly fine to have a list
30:42but maybe tell your doctor
30:44what the list is
30:45before the consultation starts
30:47or at the start of the consultation
30:48so that we can prioritise
30:50and work through the main issues.
30:52Are you able to open your mouth
30:53really wide for me?
30:54Stick your tongue out and say,
30:55ah, lovely.
30:55Ah.
30:56Yeah, say ah again.
30:57Ah.
30:58Lovely.
30:58So yeah, I think you've got a little stone
31:00in that tonsil on the right-hand side.
31:02Yeah, I can get that there.
31:03A tonsil of stone.
31:04So they can happen, you know,
31:05very commonly.
31:06It's just a build-up of sort of calcium
31:07and things like that.
31:08It will go, absolutely.
31:09But we can help with the discomfort
31:11and the symptoms of it for you.
31:12Not a problem at all.
31:13Yeah, because you know it annoys me.
31:15That's why I'm...
31:16Of course, yeah.
31:16So what's caused that?
31:17The infection?
31:18It could be a bit of an infection,
31:20most likely viral,
31:21and then sometimes you can get
31:22a sort of a stone forming as well.
31:24What are you going to give me?
31:25So I'm going to use a bit of Dithlam spray,
31:26which will help numb the back of the throat.
31:28It'll be really, really good for that.
31:29And then the stone will just work its way out.
31:31If you eat sort of more citrusy fruits
31:33and things like that,
31:34it will encourage it to work its way out.
31:36It might be a bit painful.
31:37I do eat strawberries, grapes.
31:39Yeah, that's fine.
31:39Brilliant, absolutely fine.
31:40Yeah, really, really good.
31:42And then in terms of sort of bereavement support,
31:44there's an amazing organisation called CRUZ.
31:46I know, that's it.
31:46Do you remember I told you about it last time?
31:48Yeah, have you contacted them?
31:50No, I don't have the internet on.
31:52Well, that's fine.
31:53I'll give you their phone number.
31:54You don't need the internet.
31:55You can just call them.
31:57She had a big funeral.
31:58Yeah.
31:59I miss her.
32:00Of course you do.
32:01Of course you do.
32:01It's, you know,
32:02when these things happen so suddenly,
32:04it's really difficult.
32:05At least if it's...
32:06Because they used to phone me every day.
32:07Oh, I'm so sorry, Jacqueline.
32:09I'm really sorry.
32:10Give that number a call.
32:11They're fantastic.
32:12Only when you're ready, though.
32:13You know, it's a process.
32:13Yeah, I will.
32:14And remember, you will get through this.
32:15It's just a matter of time.
32:16It will get, you know,
32:18you'll learn how to deal with it
32:19in slightly different ways.
32:20I've left all my sisters now.
32:21Oh, I'm sorry to hear that.
32:22You know, we're always here.
32:23If you need anything,
32:24do let us know.
32:25Yeah.
32:25Good.
32:25Thank you, Jacqueline.
32:26Brilliant.
32:26All the best.
32:26Take care.
32:27Look after yourself, all right?
32:28Thank you very much.
32:29Pleasure.
32:29You're very welcome.
32:42John?
32:43There's the time.
32:44I'm watching.
32:44How are you?
32:45Bring that with you.
32:46Bring that with you.
32:46Come on.
32:48How are we?
32:49Oh, more...
32:50Hopefully I'm improving.
32:52You feel better?
32:55No, much the same.
32:56Getting pain.
32:58Where?
32:58In your foot?
32:59From down there, yeah.
33:00Right.
33:00But anyway,
33:01you're going to tell me
33:01that it's improving.
33:02That is wonderful.
33:03I don't know, yeah?
33:04It might be falling off.
33:05I hope not.
33:06How are you feeling?
33:08Are you feeling better in yourself?
33:10Can't say I am, no.
33:11I'm still failing big time
33:14and trying to get my life organised.
33:19Now, what does that look like?
33:23Looks like pretty awful, isn't it?
33:25No, that's just the cover.
33:28Well, it is getting smaller, isn't it?
33:29Yeah.
33:30Or is it?
33:30Oh, wait a minute.
33:31Of course it is.
33:33Well, that's looking more than pink to me.
33:34That's looking a bit raw.
33:36It's not raw.
33:37This is healthy.
33:38Okay.
33:39I promise you,
33:42this is moose skin.
33:44It is called epiphyls
33:47and epiphyls is
33:48the final stage of healing.
33:51So this is really, really good.
33:54No, but we said
33:55a minimum of six weeks, didn't I?
33:57Well, we know now
33:58that we're in about the eighth week now.
34:00Yeah, so not too bad.
34:02But I bungled the beginning of it.
34:03Could you pull it on here for me?
34:05Yeah.
34:07That's it.
34:10It's good, John.
34:12It's really good.
34:14I mean, look at that.
34:16Can you see that?
34:18Yeah, yeah, yeah.
34:19And look at this.
34:20It's still white there,
34:21but it's receding.
34:23This is impressive.
34:24So another six weeks.
34:26Now you've got new skin coming through.
34:30I would say in,
34:31probably by next Friday,
34:33we'll have a nice pink covering over that.
34:35I think we're getting there.
34:36I really, really do.
34:38Considering what it was
34:39when you first come in.
34:40Oh, yeah, yeah, yeah.
34:41The bit that's white now,
34:42is that dead skin or is...
34:44It's just dried skin.
34:46So that will regenerate.
34:49Like sunburn,
34:50when you burn yourself,
34:51and then after a while,
34:53the skin peels,
34:54and then you get the new layers
34:55of skin coming through.
34:57If it starts coming away,
34:59we put amide pore plaster over the top.
35:01One of the ones you gave me?
35:02Yes.
35:03No, it's still putting
35:04the night stalks on with the...
35:06But make sure they're loose,
35:07remember, not tight.
35:09And I want you to offload that ankle
35:11as much as possible.
35:14OK.
35:15OK?
35:17We are getting there, sir.
35:19Good.
35:20Take care, John.
35:21Yeah.
35:30Catherine?
35:31The doctor's ready for you.
35:32Room four.
35:32Yeah.
35:35Hi.
35:36Hi.
35:37How are things?
35:38Fine, actually, yeah.
35:39They're all good.
35:39Yeah, they're all good.
35:40And how are you?
35:41What's happening?
35:41I'm so...
35:42I've developed this thing on my head.
35:44Don't know what it is.
35:45It just came out of the blue.
35:47Wow.
35:47It was very obvious
35:49yesterday and today, obviously,
35:50and the day before I could see
35:51something coming up.
35:52Don't know what it is.
35:53I don't know if I've got any other
35:54kind of marks on my body.
35:56I haven't noticed any,
35:57but I'm a little bit brown,
35:59so it might be a little more difficult.
36:01You're at home,
36:02when you woke up,
36:03it was like this.
36:04Yes, I've been traveling for work,
36:06but I just noticed it.
36:10And no way you could have
36:11banged it or anything
36:13without noticing.
36:15No.
36:16Well, it's a bruise.
36:19And as with bruising,
36:20it's to do with clotting,
36:22which is to do with red,
36:24white cells, platelets, liver,
36:27all those sorts of things.
36:27I know I have had problems in the past
36:29with blood clotting.
36:32I know that was picked up in pregnancy
36:34and I had hemorrhaging,
36:37kind of severe hemorrhaging
36:39for my,
36:40but for bursts.
36:42Yeah.
36:43There was some underlying thing,
36:45but I don't think it was ever
36:45followed up on.
36:47Okay.
36:47Some people can get
36:48spontaneous bruising
36:49for no reason.
36:50However, we need to rule out more.
36:52Yeah.
36:53Pathological causes,
36:54so to speak.
37:12Do you feel well?
37:16Fatigued a lot,
37:17I would say,
37:18generally.
37:19So virally in any way?
37:21No, not really.
37:22No sore throats,
37:23nothing like that?
37:24No, no.
37:24No, no, no, no, no.
37:26Yeah, apart from the sort of
37:27general low-level fatigue,
37:31I just did an MRI
37:32because I've got pancreatic cysts
37:35which are being monitored.
37:37Yeah.
37:37And that was when?
37:39I saw,
37:40I had the scan done
37:41two weeks ago.
37:42Two weeks ago.
37:43One always gets worried
37:44about bruising,
37:45spontaneous bruising.
37:46We investigate
37:48for every possible cause.
37:50It can be due to
37:50a more worrying
37:51pathological cause
37:52such as leukaemia.
37:54Or it can just be
37:56a symptom
37:56that can run in the family
37:58or there can be
37:58no cause found.
38:00Pancreatic cysts
38:01are very close
38:02to the liver
38:03and the liver
38:04is where
38:05clotting is processed.
38:06so we need to do
38:08a blood profile
38:09to rule out
38:10any more sinister
38:12pathological causes.
38:16I can feel a little
38:17gland there.
38:18I don't know
38:19if that's painful at all.
38:20Is it like a bruise
38:21tender?
38:22Is it?
38:22Yeah, I can feel it.
38:23You can feel it.
38:24As though there is
38:25something.
38:26So you can't really
38:28feel a bump
38:28but you can feel it
38:29more tender
38:30than the rest of it.
38:30And it's the only place
38:32there's no others.
38:33Yeah, I haven't
38:33noticed anything else
38:34and I've seen these
38:34things but they're
38:35not that I'm aware
38:37of anyway.
38:39So I think you do
38:40need to go for
38:41some blood tests.
38:42I think the sooner
38:43you go the better.
38:45And if you go today
38:46I'll have the results
38:47tomorrow basically.
38:48So we'll look out
38:49for them but do call
38:50anyway.
38:51Brilliant, thank you.
38:52And we'll just
38:53have a look at those.
38:54Thanks a lot.
38:55Nice to see you anyway.
38:56Yeah, take care.
38:56Bye.
39:05So tell me
39:06what's been going on
39:07for you.
39:08So I've noticed
39:08some basically
39:10some red patches
39:11around my skin.
39:12Okay.
39:12It's a little bump
39:13but it itches.
39:15That eats a lot.
39:16Bums a lot.
39:17And it's really itchy
39:18and uncomfortable.
39:20Some on my torso,
39:21some on my arms,
39:22some on my legs.
39:23It itches mildly,
39:25not so horribly.
39:27So they're slightly
39:28raised and a bit
39:29scaly, aren't they?
39:30Yeah.
39:31So it's on the skin
39:32and the hair,
39:33here,
39:35in the back.
39:36And on my scalp
39:37as well.
39:38Okay, so pretty
39:38diffuse.
39:39Oh, it's annoying.
39:45Jennifer?
39:46Oh, yes.
39:50As my records
39:51probably show,
39:52I had a new hip
39:53about eight or nine
39:54weeks ago.
39:55Looks to be working well.
39:56It's working well.
39:57You pleased with it?
39:58Yes, very.
40:00All I came in for really
40:03was a prescription
40:04for this ointment.
40:05Okay.
40:06Which you said
40:07I hadn't had since 1960
40:10or something.
40:11Somebody did.
40:12I couldn't believe it
40:13because it was first
40:15given to me
40:16for something on my leg
40:17which was pretty well
40:18healed.
40:19But that's cured it.
40:21Hmm.
40:22So this is
40:23fucidic acid cream.
40:25What do you
40:25understand about
40:27this cream
40:27in terms of
40:28what it does?
40:29It seems to help.
40:31Yeah.
40:31This isn't a balm
40:32for all conditions
40:33really.
40:34It's actually quite
40:34specifically just a cream
40:35for like mild
40:38bits of infection.
40:40So yeah,
40:41looking at your skin
40:42can I have a look
40:43at that bit there?
40:45Yeah, so you've had
40:46a surgery there
40:46haven't you?
40:47You've got some scarring
40:49and there's some scale
40:50and thickening there.
40:51Does that get a bit itchy?
40:52It gets itchy.
40:53Yeah.
40:54It gets a bit sore
40:55from time to time.
40:57So it looks like
40:58you've got a few
40:59kind of sun related
41:01and maybe age related
41:04bits on the arm
41:05on the face.
41:06Yes, exactly.
41:07And down here
41:08you know
41:09on the ankle as well.
41:11This isn't the cream
41:12that I would normally
41:12give for those.
41:14Oh really?
41:14For dry skin
41:15I would be using
41:16something else
41:17a dry itchy skin.
41:18I would just be using
41:19you know
41:20an emollient
41:21moisturising cream.
41:23Yeah.
41:23I don't think you need
41:24something that's got
41:24antibacterial properties
41:25in it.
41:26No.
41:26If you ever did get
41:28something that looked
41:28like a skin infection
41:31an early skin infection.
41:32What can I do about this?
41:33Because this does
41:33worry me.
41:35There's some letters
41:36here from dermatology.
41:37I can quickly
41:37just have a look.
41:39Yeah, some
41:40actinic keratosis
41:42on your nose
41:43behind the shoulder
41:44the right side
41:45of your forehead.
41:45That's the other thing.
41:46Yeah.
41:47But I put it down
41:48to that cream
41:49having made it better.
41:51But you say it didn't
41:52so you know.
41:55So these skin changes
41:56are not cancer
41:58but some of them
42:00can progress
42:00to squamous cell carcinoma
42:03which is a slowly
42:05locally spreading
42:06skin cancer
42:07which can cause
42:10nasty skin breakdown
42:11it can go into
42:12surrounding tissues
42:13and cause bleeding
42:14and things like that.
42:15But there's no
42:16sort of cream
42:17I can put on
42:18to ease it
42:19because I really felt
42:20that that made it better.
42:22So I suspect
42:22that all it's doing
42:23is just softening
42:24this a little bit
42:24for you
42:25so I can give you
42:26something that will
42:26do that for sure.
42:28I'm told that cobwebs
42:30are the best thing.
42:32That's not advice
42:33that I'm familiar with.
42:34OK.
42:36I must have
42:36put cobwebs on burns
42:38and things.
42:39OK.
42:40Yes my knowledge
42:42isn't very up to date.
42:43I think it's only
42:44if you've got
42:45very thick ones.
42:46You're going to give me
42:47a prescription
42:48or can I buy it
42:49over the counter?
42:50No a prescription
42:50for you.
42:51Right.
42:51Absolutely.
42:52OK.
42:53We'll sort you out.
42:55Right.
42:55Thank you very much.
42:57All right.
42:58Thank you so much.
42:58Not at all.
42:59Have a great afternoon.
43:03Just let us know
43:03how you're doing.
43:04All right.
43:05Take care.
43:05Bye bye.
43:06Bye.
43:08OK.
43:08Thanks a lot.
43:09OK.
43:09Good to see you.
43:10And you too.
43:11Thank you so much.
43:12Pleasure.
43:12You're very welcome.
43:13Take care.
43:13All the best.
43:14Bye now.
43:14Bye bye.
43:22See you later.
43:24Bye bye.
43:28Bye bye.
43:29Bye bye.
43:31Bye bye.
43:44Bye bye.
43:48Bye bye.
44:21I'm scared to go on my bed.
44:24As I said, enough is enough.
44:26It's having a big impact on your quality of life.
44:28Last week, this was red raw.
44:31All of a sudden, I just woke up to three paramedics.
44:34So you've had a seizure.
44:36You are worried, okay.
44:37Could it be some sort of throat cancer or whatever?
45:08I'm scared to go on my bed.
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