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00:11Hello, Sudri.
00:14Oh, wait, this is freaking me out.
00:16Yeah. Pulse is really low.
00:21Well, I'm a bit of a guinea pig at the moment.
00:24They're testing me out with chemo tablets, and that's daily.
00:29I have a lot of ulcers, and my mum counted 13 by now.
00:3313 ulcers!
00:37I do apologize. I know this is quite sick.
00:44Oh, God, I could cry again now.
00:45Oh, bless you. What you went through is absolutely horrific.
00:48Yeah.
00:48I just can't believe I can live again now.
01:24Paul, come on through.
01:25Thank you. Hi, Christine.
01:26Hi.
01:27We're in this room today.
01:29Right, you're all right. There we go, Christine.
01:31If you sit there, I'll get the door.
01:33Now, how have you been?
01:35Up and down with a few little bits and pieces, knees, hips.
01:38Yeah.
01:39How's everything else going?
01:41I'm just going to get you to have a look inside my ears.
01:44Okay.
01:45Because I've had my ears, my left ear's been, where I've been, feel as if it's, I can't hear
01:51out of it properly.
01:52Okay, okay.
01:52So, I'm not screaming. I put eye drops in instead of ear drops.
01:56What, into his ear?
01:57Yeah.
01:58We've got eye drops instead of...
01:59But see, I didn't have my glasses.
02:02Well, we must make sure we put them in your eye and not your ear.
02:04I mean, joking aside...
02:05It was just a pure accident.
02:07I didn't have my glasses and I see E and I see drops.
02:11So, you shoved them in his ear, but they were meant for his eye.
02:13Whoopsie.
02:14Right, so it's this one that's dodgy.
02:15Right, I'm going to...
02:16Should I come round, Paul?
02:17That might be easier.
02:18Yeah, it's absolutely blocked with wax, Paul.
02:21So, it's not...
02:21It doesn't look red, angry or infected.
02:23It's just totally blocked all the way round.
02:25Can't see anything.
02:25So, it's what we call impacted.
02:26So, there's a big blob of wax.
02:27We need to clear that out.
02:29Right.
02:29Okay.
02:30So, but we need it soft.
02:31Can I just check the other one?
02:32Yeah, of course.
02:33Because if we need to put drops in, we might need to do both.
02:36No.
02:37Clear as a whistle, this one.
02:37Not a drop.
02:39It's funny, isn't it, how the body does that?
02:41We need some drops to soften it, because the problem with earwax is it will build up and
02:45it's just A, blocking the sound getting in, and B, it starts causing pressure on the
02:49ear canal a bit and starts causing a bit of pain or a bit of discomfort.
02:52All right.
02:53Do you have any ear drops or anything?
02:54No, it was eye.
02:55Any eye drops?
02:56Right, don't put those in.
02:57But I can give you something to help you with that, because it's got a little dropper attached
03:00to it.
03:00But yeah, not in the eye.
03:03You can put it in up to twice a day, but most people, especially at night time, put
03:07it in minimum ten days before you even stop it.
03:11And then you can always knit back and we can have another look and just check it's gone.
03:14All right, okay.
03:17Right, got there in the end, all right?
03:20Okay, take care.
03:21All the best, Paul.
03:21Bye-bye.
03:22Bye-bye.
03:22Bye-bye.
03:53Come through.
03:53Lovely to see you.
03:54On the stickers as well.
03:55Would you like a sticker?
03:56I love stickers.
03:57Let's take a seat.
03:58Let's see how we can help.
03:59Lovely to meet you all.
04:00Lovely to meet you.
04:01Lovely.
04:01How can I help today?
04:03So, I have observed.
04:06It's got really, really big tonsils.
04:08And I don't think it's from tonsillitis or anything, because I only really see them when
04:13he's laughing or I'm hanging upside down or something.
04:15Yeah, apparently.
04:16But I've noticed it on and off for quite a long time.
04:20But the first time I saw it, I assumed it was just an inflammation or cough.
04:23Yeah, yeah, yeah.
04:23Still seems to have them.
04:24It doesn't affect his mood or energy or anything.
04:27But he snores ridiculously.
04:29I mean, in children, tonsils can be quite large.
04:31And then as we get older, they do get smaller and smaller.
04:33Oh, OK.
04:34So, they're, you know, a really important part of the immune system.
04:37And, yeah, those and the adenoids as well, which we can't see with the naked eye, sort
04:41of, they can sometimes be quite enlarged.
04:44And sometimes if they are touching, it can look really quite scary.
04:46And if the uvula is sort of inflamed a little bangly bit, if it's inflamed and touching it,
04:50you can think, well, gosh, what's going on here?
04:52Sure, sure.
04:52I think, yeah, let's check a few things.
04:54Right, let's do the fun bit.
04:55Sorry.
04:56Can you open your mouth really wide for me, do you think?
04:58Ah, he said, ah, honey.
04:59I'm just going to shine a torch here.
05:00Can you say, ah, Henry, please, ah, ah, yes.
05:04Yeah, they are big, aren't they?
05:05Jeez, yeah.
05:06Good job, Henry.
05:06You did see them.
05:07No, they're really large.
05:07They are big.
05:08Yeah, yeah, yeah.
05:09No, you're not.
05:09You're absolutely right.
05:11They're decent.
05:12Yeah, he's got good going tonsils, absolutely.
05:14So, what's that mean?
05:16I think it's just normal for him.
05:18Oh, OK.
05:19Yeah, nothing to be worried about at all.
05:20But please do keep an eye on things.
05:22If he thinks things are getting worse, if his breathing is labored, if he's sort of, if it's
05:26starting to interrupt his sleep, then obviously let us know.
05:29Can I get a high five?
05:30It was amazing.
05:31You did such a good job.
05:33Well done.
05:33So, thank you, Dr. George.
05:35I love it.
05:35Yeah, stand on tiptoe so you're a bit taller.
05:38It is a spider.
05:38That's what I do as well.
05:40Don't tell anyone.
05:41Let's go.
05:42Let's go.
05:43All right, silly.
05:44Bye-bye.
05:45Say bye-bye, Henry.
05:46Bye-bye.
05:47Bye-bye, Henry.
05:48See you.
05:48Bye-bye.
05:55Let's go look at this.
05:56Like, you know.
06:01Natalie.
06:02Hi, good morning.
06:06Good morning, Doc.
06:11Hi, come on in.
06:12I'm Dr Prestowicz.
06:14How can I help?
06:15Of recent, I've been having this, like, sharp, I had some chest pains, and it happened, it
06:21was happening last night, and I was having palpitations with it, and I was worried, like,
06:27is there something wrong with my heart?
06:29Is there something not okay with my heart?
06:31And I sometimes feel, like, a stabbing, like, pain just below my abdomen area, like a stabbing
06:39pain.
06:41And sometimes across my chest, I feel the same pain.
06:44So I was like, I'm a little bit worried about it, because I don't know why it's happening.
06:49Have you been having these pains for a long time?
06:51Three, four months or so.
06:52And how often are you getting these pains?
06:54Like, kind of daily.
06:58It comes and goes.
06:59Are there any other symptoms with the pain?
07:01Sometimes I sweat.
07:03I don't...
07:03Yeah, and I breathe a little bit.
07:05Your shortness, slight shortness of breath.
07:07Any family history of heart disease?
07:10My mum passed away in 2016.
07:14She had, like...
07:14She died of, like, a heart attack, I'm guessing.
07:17Something along with it.
07:18It had something to do with her heart.
07:19Her heart wasn't very good.
07:20How old was she when...
07:2153.
07:42Hi, good morning.
07:43Sorry for the wait.
07:44I do apologise.
07:59I am overslept my alarm for the first time.
08:02I can't remember.
08:03Oh, no.
08:04And I miss my reform of Pilates class.
08:05Oh, no.
08:06Which I'm very sad about.
08:08Oh, no.
08:17Doris?
08:18Ready.
08:23Sorry about the wait, Doris.
08:25That's all right, darling.
08:25It's my time.
08:26I've got nothing.
08:28How are you today?
08:30I feel right.
08:31My back is better.
08:32Oh, no.
08:33Oh, God.
08:34Take it slow.
08:34It is like...
08:35Stop telling me at the moment.
08:36I bet it is.
08:38Tomorrow, isn't it?
08:39Right.
08:39Come on through.
08:42Do you know what?
08:42As we've got your eye drops out, I'm going to sit on the bed and I'll do your eye drop
08:46straight away.
08:47Right.
08:50Oh.
08:51This one first?
08:53Yeah.
08:56Well done.
08:57Blink, blink, blink, blink, blink.
08:58I feel all right?
08:59Yeah.
08:59See the other one.
09:01Sorry.
09:02That's it.
09:02Blink, blink, blink, blink, blink.
09:04Sorry.
09:05Oh, God.
09:07Feel better?
09:09They do feel better.
09:11Yeah.
09:11I'll go like them done.
09:12Yeah, definitely.
09:13Doris is amazing.
09:14She is 94 years old.
09:16She comes to see us twice a week, but we generally see her once a day because she'll pop in
09:20and
09:20just have a chat.
09:22You'll find the tissue in there because they're a bit big.
09:25Oh.
09:26I've got to get some of them.
09:29What do you call them?
09:30What you put in shoes?
09:31Oh, inner soles.
09:32Yeah.
09:33Yeah.
09:34This looks new.
09:36Is it?
09:39Oh.
09:40I look at my body and think, now, how did I do that?
09:44I know.
09:45Do you know what, though?
09:46It's easily done.
09:48Doris' leg wounds started off from just a knock, but because of her age and bad circulation,
09:55unfortunately, these wounds can turn into ulcers.
09:58So it's really important that patients like these come to see us on a regular basis so
10:03we can dress the wounds, check the signs of infection, and just keep them clean and getting
10:08better as quick as possible.
10:10How have you been, Doris?
10:12Oh, I've been okay.
10:14Yeah?
10:14I've been okay.
10:15Just this pain in my back.
10:17Last night, it drove me mad.
10:19When I'm walking, I don't get no pain.
10:24When I'm walking.
10:26I try to walk to Sainsbury's every day.
10:29That's very good.
10:30That gives me a little bit of exercise.
10:32Yeah, absolutely.
10:33Otherwise, I'd be housebound.
10:36I don't want that.
10:38I think you're doing amazingly, Doris.
10:43It's looking good, Doris.
10:44I can say, do you think it's looking good?
10:47It is.
10:49We're not putting any of the gel on this big one.
10:55We're just going to put two dressings on.
10:58So hopefully, it won't be as oozy.
11:02Lovely.
11:03Yeah?
11:03Let's get your shoes in.
11:05You want to see me when I'm getting better, don't I?
11:07Oh, I think you are doing amazingly, Doris.
11:12That's it.
11:13That's it.
11:14Okay.
11:14I won't be going out today now.
11:17I've had me walk.
11:19All right, my lovies.
11:20Perfect.
11:21Well, it's lovely to see you, as always.
11:23Yeah.
11:23All done.
11:24All done.
11:25Well done, Doris.
11:26Okay, my lovies.
11:27See you next week.
11:29Yeah.
11:29Bye.
11:30Bye.
11:32Bye, ladies.
11:33Bye, Doris.
11:34Bye.
11:38What I'd like to do now is examine you.
11:42I was nervous if I needed to see, like, a heart doctor.
11:45I sometimes kind of overthink things.
11:47I don't know if I have to see a heart doctor and a cardiologist or something like that.
11:50Well, especially if your mum has had serious heart problems.
11:54Yeah, she did.
11:55At a young age.
11:56So what I would like to do, do your blood pressure or listen to your chest.
12:00And then we'll think about the rest of the plan once all that's been done.
12:03Yeah.
12:11Not bad.
12:12Bottom number's a little bit high.
12:13Mm.
12:21Great.
12:22In terms of the chest pain and, you know, is it related to the heart as well, it's not
12:26the classical picture of, you know, angina where it's a very intense kind of heavy pressure
12:32on the chest with kind of profuse sweating, breathlessness?
12:36Yeah, that's the textbook kind of syndrome.
12:41Is it possible to have cardiac chest pain that doesn't look like that?
12:45Yes, of course.
12:45And we have to be wary of it, particularly of a family history.
12:49Although I'd still say that the probability of this being heart-related is on the lower
12:54side, okay?
12:55But, yeah, we should still probably consider referring you to a chest pain clinic, especially
13:01with a family history, okay?
13:02Yeah, yeah, yeah.
13:02And that's, yeah, if you do get severe central chest pain, like sweating, breathlessness,
13:08feeling like you can't, you know, lightheaded.
13:11So let's get you booked in for that ECG, okay?
13:12Cheers, Doc.
13:13I could even do it this week.
13:15That'd be great, actually.
13:16Yeah?
13:17So four o'clock on Friday?
13:19Yeah, yeah, yeah.
13:20Cheers, Doc.
13:21Thank you very much, yeah?
13:23Have a nice day.
13:24Have a nice day.
13:32Hi, Dean.
13:36Hey, look, you're as lovely as ever.
13:39Oh, thank you.
13:40How are you?
13:40I'm fine.
13:41How are you?
13:42Effie.
13:42Good day is a bird.
13:44Yeah.
13:44I've got an appointment.
13:45Hello.
13:46Hello.
13:46How are you?
13:48Effie.
13:48Your appointment is with me.
13:49Great.
13:50Now.
13:51Oh, thank you.
13:52Lovely to see you.
13:53It's been a while.
13:57Hello.
13:57Hi.
13:58Right.
13:59Come on through.
14:00Hello, Teddy.
14:00Come and have a seat.
14:01You get the special seat today.
14:02Let's get a chair up for Mum.
14:04Right.
14:05Hello, my friend.
14:06So, what's brought you in to see us today?
14:09Well, I have a lot of ulcers, and my mum counted 13 by now.
14:1313 ulcers.
14:14Horrible.
14:15And how long have they been there for?
14:16It started on her like three or two days ago.
14:18Okay.
14:19Okay.
14:20She only has one ulcer, and I have a lot.
14:22Okay.
14:23Well, you're a family of ulcers.
14:24This is not great, is it?
14:25He's suffered quite a lot.
14:27When he gets the flare-up, they are spread everywhere.
14:30He's got them down the back of his throat.
14:31Oh, dear.
14:32But why are you getting them, I suppose, that's the question, isn't it?
14:34Well, I mean, it's a bit of a family history.
14:37Okay.
14:37My sister suffered with them when she was younger.
14:40Okay.
14:40Like, horrifically.
14:42He's exactly the same.
14:43He'll have a few good weeks, and then he'll have a flare-up where he wakes up swollen from it.
14:49And do you think his diet's quite good, sort of, relatively?
14:52Or have we got a bit of a sweet tooth?
14:54I wouldn't say it's bad, no.
14:56And what about things like brushing your teeth and things like that?
14:58How good are you at that?
15:00Well, I'm not that good, but I can sometimes handle it.
15:04Okay.
15:04And how many times a day do you brush your teeth?
15:06Twice.
15:07Good boy.
15:08I mean, there are various reasons, and sometimes it's because people are never brushing their teeth,
15:12sometimes it's because the food they're eating is all wrong, but it doesn't sound like that's the case here.
15:16Do you ever get tummy pain?
15:17Does it ever hurt when you eat?
15:18Well, I don't get it usually, but when my tummy just randomly acts up sometimes, that's hurt.
15:26You do say your tummy hurts quite a lot.
15:28And when you say it acts up, what does it feel like?
15:30Sometimes it just feels like a needle.
15:33Okay, so sharp pain.
15:34Yeah.
15:35And whereabouts, if you were to point, where do you feel the sharp pain?
15:38Well, like around this area.
15:39Okay.
15:40Can I just have a feel of your tummy and then we can have a look in your mouth?
15:42Is that okay?
15:44You get to lie on my bed.
15:45Look at this.
15:45I've got the world's biggest toilet roll.
15:46Look.
15:47See, it's actually attached.
15:48Come on, look at that.
15:49Do I just sit on that?
15:50Yeah.
15:51So then you just sit on here like you're sunbathing on a lounger.
15:53Yep.
15:54Right.
15:55Can I have a look in your mouth, sweetheart?
15:56So where are the bad ones at the moment?
15:59Well, most of them are just white under my tongue.
16:01Okay.
16:02Yeah, the lip, too.
16:04They are huge, sweetheart.
16:05Pull your lip down a little bit.
16:06They're big hands, yeah.
16:07Can I just touch it gently?
16:09And if you close your mouth, look at those.
16:10Look at those.
16:11That's it.
16:12And just let me pull the lip down and open it a little bit.
16:15Look at the size of those.
16:17Sweetheart, you poor thing.
16:18And open wide.
16:20Let's have a look.
16:21And lift your tongue up.
16:22Good boy.
16:23Good boy.
16:23So there are some there and there.
16:25He has a lot, doesn't he?
16:27Yeah.
16:28Poor chap.
16:29Right, can I feel your tummy?
16:30You know when you get that sharp pain sometimes?
16:32Where do you feel it a little bit if you're lying here?
16:34Right in the middle.
16:35Right in the middle here.
16:36Okay.
16:37And does that hurt at all?
16:38Yeah.
16:40A bit uncomfortable.
16:41We all have acid in our stomach.
16:43And sometimes that can come up and it can cause discomfort.
16:45And sometimes that can come into the mouth and trigger ulcers and things.
16:48Come and have a seat for me.
16:49Come and sit back down, sweetheart.
16:50You all right?
16:50Well done.
16:51So I just wonder whether we try something to help a little bit.
16:57So for the ulcers, what do you use for those at the moment?
17:00So we've tried all the gels, Bungela and Bissol.
17:03Yeah.
17:04I would say it's like the slightest bit of relief and then it's still really pain.
17:08I just wonder whether we look into whether we could try something, whether it's to do
17:13with anything to do with digestion and acid a little bit.
17:17And there's one of the first things I'd like to do is test, weird, this is weird, it's going
17:21to sound weird, but is do a poo test.
17:24Because sometimes people have a bug in their stomach that can cause excess acid and other
17:27problems that can then cause dental problems and other things.
17:30So why don't we do the test first?
17:32Because if that's positive, that's easy to treat and that may solve a lot of the problems.
17:35Here we go.
17:36There you go.
17:36So you can take that to any chemist.
17:37There we go.
17:38And drop in the poo and then we'll have a chat and we'll work out a plan.
17:41All right?
17:43Don't forget your school bag, is that?
17:45The poo thing is still weird.
17:47You still think it's weird?
17:47I agree it's still a bit weird.
17:49I agree it's still a bit weird.
17:50We haven't completely come to the answers yet, but we're going to work on it, all right?
17:54Okay.
17:54All right.
17:54Well, thank you for coming.
17:55All the best, guys.
17:56Bye-bye.
17:57Bye-bye.
17:58Bye-bye.
18:02Hello, surgery.
18:04And that's, see, is it, sorry, did you say it's your teeth?
18:08You'll have to go to a dentist.
18:12Oh, man called the wrong surgery.
18:16He thought he was a dentist.
18:21Shall we go through?
18:23How are you?
18:24You're looking well.
18:26It's got people's feet turning.
18:27You're looking very trim.
18:30Take a seat.
18:30Lovely to see you.
18:31How can I help today?
18:33I keep feeling dizzy.
18:35Oh, no.
18:36I keep feeling dizzy and really nonplussed.
18:40Yeah.
18:40How long has it been going on for, do you think?
18:42It's been going on for pretty much most of this week, but it's just got really bad today.
18:47Okay.
18:48And is it a rotational dizziness, as if the room is spinning, or just more unsteady on your feet?
18:53A bit of both.
18:54And I kind of feel, I'm not shaking, but I kind of feel shaky inside, if that makes sense.
18:59Yeah, absolutely.
19:00Any associated chest pain with it at all?
19:03No, it's just this real yucky feeling.
19:06Yeah, absolutely.
19:07And any pain in your ears, or hearing loss, or ringing in the ears?
19:11No.
19:11Good.
19:12No hearing loss, or something like that.
19:14Perfect.
19:15Any shortness of breath with it, or palpitations?
19:17Oh, like, whereas I'm here now, it is like shortness of breath.
19:22You feel a bit short of breath.
19:23Yeah.
19:24Wait, this is freaking me out.
19:26Yeah.
19:26Let's check a few things for you.
19:28Can I feel your pulse manually?
19:30Is that okay?
19:30Because I feel really yuck right now.
19:33Yeah.
19:34I can feel my heart thumping in my chest right now.
19:38Yeah, your heart rate's a bit irregular.
19:42Your pulse is a bit on the low side, in the high 50s.
19:46The oxygen levels are normal.
19:48Pulse is really low, though.
19:50Bear with me.
19:50I'll be two seconds.
19:56Sorry.
19:57I need someone to do an urgent ECG for me.
19:59Do an urgent ECG for a wheelchair.
20:02He's just quite unwell.
20:03He's got an irregular pulse.
20:04I'm just worried about AF.
20:05So you're going to be out?
20:06Oh, she's going home.
20:29I'm not feeling the way I'd like to feel like.
20:31I'm slightly dizzy.
20:33Right.
20:35Sometimes I feel like I'm going to pass out.
20:37Okay.
20:37Just fall over.
20:39What did you feel?
20:40Just like everything was coming around.
20:44I keep feeling like my heart's really racing.
20:47I just feel a little bit wobbly when I extend out.
20:51Okay.
20:51Yeah.
20:52Do you feel you're falling to one side?
20:54Yeah.
20:54Wobbly a bit.
20:55I go completely what I'd call woozy.
20:58Yeah.
20:58I just feel really unwell.
21:01Horace, can you pop in this room for me and I'll do the ECG myself?
21:04Is that okay?
21:06Just come through.
21:09Yeah.
21:10If you just lie there for me,
21:12you're able to take your T-shirt off for me.
21:15Oh, he's lying down again.
21:17He's just, everything's just spinning.
21:19Yeah.
21:20Sometimes if you're unwell,
21:21the heart can go in a funny rhythm,
21:22but then it goes back to normal.
21:24So I'm sure it's nothing,
21:25but it's better to be safe than sorry, I think.
21:31Hi.
21:32My name is Tracy.
21:33I'm a pharmacist here.
21:34Okay.
21:35Yeah.
21:35You're coming for an asthma review today.
21:37That's right.
21:37That's correct.
21:38Yeah.
21:38Okay.
21:39Okay.
21:39How are you feeling about your asthma?
21:41It's been very bad lately.
21:43Very bad.
21:44Very bad.
21:44I've been using my inhaler most days.
21:47I do the steroid ones most morning.
21:50Yeah.
21:51With the hot weather,
21:52it was absolutely terrible.
21:54I've been wheezing.
21:56It's just like you're swimming against the tide all the time.
21:59But sometimes you just need a little bit of help.
22:02Pharmacists are moving more towards,
22:03like a clinical role to help patients in GP and in the community.
22:08We've done our four-year degree.
22:11I mean,
22:11we're fully trained in terms of the with medication
22:13and how to manage non-term medication.
22:16So obviously that's safe of GP's time.
22:19Patients can have easier access to pharmacists.
22:22So it's benefit for both the NHS and also the patient.
22:27Right.
22:27Okay.
22:29Ah, the old peak flow test.
22:31Yeah.
22:31Do you know what's your normal reading?
22:33No, I really don't.
22:34Let's have a look.
22:35I can just remember my name these days.
22:38Right.
22:39The highest one was 500.
22:42That's good.
22:43That was in 2018.
22:45Yes.
22:46Do that.
22:46Let's try that.
22:48Okay.
22:51Oh, that's not bad.
22:53Is it?
22:55That's 270.
22:57So hopefully you can get at least up to 350,
23:01which was the reading in 2023.
23:14I see on here that we suggest to use four-step as a preventer
23:19and also a reliever to you before.
23:22The difference between four-step and the ventillin
23:24is the ventillin opens up your airway
23:27for maybe roughly about two hours or so.
23:31Four-step is like a longer acting one,
23:33so it will open up your airway for a bit longer of times.
23:36It's a steroid-based, isn't it?
23:38It is a steroid-based.
23:40I wonder if I'd grown a beard.
23:42No, I'm sorry.
23:45So, um...
23:46I do apologise.
23:47I know this is quite serious.
23:48It's all right.
23:49My apologies there, Tracy.
23:50That's all right.
23:51There are sort of two ways to manage asthma.
23:55Traditionally, there is a preventer inhaler
23:57which contains steroids
23:58and also a subutimal inhaler,
24:01commonly known as ventillin.
24:03However, asthma management sort of move towards
24:06a combination inhaler
24:08which you can use as a preventer and reliever,
24:10which is easier for patients to use
24:13because they only have one inhaler
24:15and that is their only inhaler.
24:17So, I think we previously suggest
24:19just to try the force of one puff morning,
24:22one puff at night.
24:23Whenever you feel breathless,
24:25you can top up with an extra puff.
24:27What I'm going to do is
24:28I'm going to give you a call in three weeks' time.
24:31Okay.
24:31And then you can let me know
24:33how you're getting on with it.
24:35So, what if I give you a call
24:37maybe on the 21st?
24:40No, my son's getting married on the 23rd.
24:42Good.
24:43I have the phone ringing up
24:44in the middle of the church.
24:46Yeah, exactly.
24:47Oh, hello.
24:49Especially with my ringtone,
24:50it's the Muppet Show.
24:54So, that would go down well with a vicar.
24:58So, I'll make sure I'm not calling you
25:00on the 23rd then, yeah.
25:02Okay.
25:03Yeah, thank you.
25:04That is absolutely fantastic.
25:06You take care now.
25:07You take care.
25:07I'll see you in three weeks.
25:09Bye-bye.
25:13Thank you, ladies.
25:14I lived and fought another day.
25:17I know.
25:23Come through.
25:24Take a seat.
25:27Lovely.
25:28Thanks for that.
25:28Sorry about that.
25:29Good.
25:29So, your ECG is completely normal.
25:31There's nothing going on with the heart.
25:32Everything's looking good.
25:34Your pulse is just a bit on the slow side,
25:36but actually, it seems to be normalizing,
25:38which is great.
25:39I think it's this condition called BPPV,
25:41whereby the crystals in the ear
25:42are just a little bit dislodged,
25:44and that's what's causing that dizziness,
25:46that vertigo, that spinning sensation.
25:48So, there's a really common condition called BPPV.
25:51It's benign, paroxysmal, positional vertigo.
25:53So, in your inner ear,
25:55there are semi-circular canals,
25:56which help us to maintain balance
25:58and to sort of know where we are in space.
26:00And suspended in that fluid are little crystals.
26:03In this condition, BPPV,
26:04those crystals can become dislodged,
26:06and that can be really uncomfortable.
26:08I'm going to give you some exercise.
26:09It's like a maneuver that you can do at home,
26:11and that will help relocate them.
26:13For the nausea and the sort of feeling really rotten with it,
26:16I'll give you a little bit of cyclizine
26:17just to help with that.
26:18You can take that three times a day if needed,
26:20and that should hopefully improve things for you.
26:23If it doesn't, or the symptoms are getting worse,
26:25or changing in any way,
26:26obviously just come back and let us know.
26:28Is that all right?
26:28Okay.
26:29Great.
26:30Take care.
26:30Cheers.
26:31Keep us posted.
26:33All right.
26:35Yeah, so you get nice and stow.
26:36That's it.
26:38And keep while hydrated as well.
26:40All right.
26:40Cheers.
26:41Take care.
26:54I'm sweating.
26:55You too.
26:56Yeah.
27:00Amelia?
27:01Yeah?
27:02Bye.
27:04Hi.
27:05Come on in.
27:05Have a seat.
27:08I'm Dr. Dutch, and nice to meet you.
27:10Nice to meet you too.
27:10What can I do for you today?
27:12So I've been in before for suspected endometriosis.
27:16I think they found on the ultrasound.
27:18Yeah.
27:18Let me have a look.
27:19I've been kind of getting pain before and after bowel movements,
27:25not during, pain during and after urination.
27:30And then also my hips and my legs have been getting quite sore.
27:34Okay.
27:34To the point where it's actually starting to impact my mobility.
27:37Okay.
27:37And when you get the pain, what does it feel like?
27:40Kind of like tearing around here.
27:43Yeah.
27:44And then also kind of sharp pains at the back as well and around the hips.
27:48Okay.
27:50So you had the scan back in February.
27:52So this ultrasound that you showed showed adenomyosis.
27:56So it was when the womb lining kind of grows into the muscle of the womb.
27:59But we can't really diagnose endometriosis by an ultrasound.
28:03It just doesn't tend to pick it up.
28:05Let me have a really quick feel of your tummy just with those new pains.
28:09Endometriosis is a condition which is estimated to affect around 10 to 15% of women of childbearing age.
28:16It's where cells similar to those that line the womb, so your uterus, grow outside the uterus.
28:21So they might grow around the ovaries, the fallopian tubes or around other pelvic organs.
28:27Just give it a quick feel.
28:29Where do you feel the pain's worse?
28:31Usually about down here.
28:34And no burning or stinging when you pass urine?
28:36No.
28:37Nothing like that?
28:42And no new partners or risk of sexually transmitted infections?
28:46No.
28:46No.
28:46Okay.
28:47Because I know you've had lots of, you've had all those kind of tests in the past.
28:50Yeah.
28:52What I'll do is I'll, I think you've had, I mean you've had all the gynae tests.
28:55It does sound, your history sounds quite classic of endometriosis, but quite severe endometriosis.
28:59So I think we need to get that sorted for you.
29:01But I really think seeing gynecology is the right next step.
29:05Yeah.
29:05So they would talk about other treatment options, kind of surgical options, and kind of go all through that with
29:10you.
29:10The main treatment is hormonal treatment.
29:12So in the case of Amelia, she had a Moina coil in situ, which is a hormonal coil.
29:17But things like the combined or contraceptive pill can also be used.
29:22For patients with more severe symptoms, treatment often can be surgical.
29:25And this involves removing the endometrial tissue to improve patient symptoms.
29:30So we should probably just try and make sure you've got enough pain relief and things for the next month
29:35or two.
29:35And if anything gets worse, if the gynae symptoms, you get anything new or something you think actually this seems
29:40really different, then come in.
29:42It's okay.
29:42Yeah.
29:42Thank you so much.
29:44All right.
29:44Have a good day.
29:45Thanks.
29:45You too.
29:53Where did you get that time thingy?
29:56It's brilliant.
29:57It is.
29:59I have to say though, it does remind me of The Wizard of Oz, which is one of my favourite
30:04films ever.
30:05Yeah, it's two hours, ten minutes long.
30:08Is it?
30:08Yeah.
30:09Wow.
30:09I timed it on my first day.
30:12So we are having a look at your toes today.
30:17Mm-hmm.
30:19So they were dressed...
30:22Last week.
30:24Last week.
30:25And what was it from?
30:28I'm having chemo at the mast.
30:30Yeah.
30:33And the side effects as such include issues with both toenails and fingernails.
30:40Fine.
30:40Okay.
30:41I see.
30:41I see.
30:42Okay.
30:42Okay.
30:43What I'm going to ask you to do...
30:44Yeah.
30:45...is sit on the bed, if it's okay.
30:48And if it's easier, taking off your shoes first, whatever it is.
30:52Okay.
30:55So how often are you having your chemotherapy?
30:59Well, I'm a bit of a guinea pig at the moment.
31:01They're testing me out with chemo tablets.
31:04Okay.
31:04And that's daily.
31:06Okay.
31:06And how are you finding the side effects other than the nails?
31:10Well, I've been on some form of chemo or radiation now for the best part of two years.
31:16So side effects are such as you lose your taste buds.
31:20Mm-hmm.
31:21Shortage of breath.
31:22I don't know whether that's it.
31:24Sometimes that can affect me.
31:26I've had some issues with nosebleeds, that kind of thing.
31:29Okay.
31:31Toenails, fingernails, definitely.
31:34Okay.
31:34By and large, I've got away quite lightly, I think.
31:37Yeah.
31:39Okay.
31:40Right.
31:41If this is uncomfortable or painful at any point, just let me know.
31:46I do have sensitive feet, I'm sorry.
31:49I was going to say, you can't have tickly feet doing this.
31:56That one looks great.
32:00No signs of infection.
32:02Looks very dry.
32:04Okay.
32:05Looks good.
32:06Are you doing anything nice for the rest of your day?
32:09I've been ordered to go and get some shopping by her ladyship, so...
32:12Yeah.
32:13Got to get one of my granddaughter's birthday cards.
32:15How old is she turning?
32:17She'll be 11 going on 18.
32:19Oh.
32:20Already got the present through her mother.
32:24Briefed me on what she wanted.
32:25What has she requested?
32:26Something in fashion at the moment, a white fox t-shirt, whatever.
32:31Oh.
32:32My children are a bit younger, so we're still at the Peppa Pig stage, which I'm fine with.
32:39Yeah, absolutely.
32:40Okay, you're all done.
32:42Great.
32:46Okay, so, can we bring you back in on Monday, and then we'll see you Mondays and Thursdays?
32:53Okay.
32:54Lovely.
32:56Thank you very much.
32:57Lovely to meet you.
32:57You too.
32:58Any problems, let us know.
33:00Bye.
33:01Bye-bye.
33:16Juliette, hello.
33:18Can you manage?
33:19Do you want a hand?
33:19Yep.
33:20Yep, no, I'm fine.
33:21You sure?
33:21Is that yours as well?
33:22It is.
33:23Let me take that one for you.
33:24It's a cart horse in a pretty good front.
33:25What is in that?
33:26That is hefty.
33:29I'll take you in.
33:29We're in this room today.
33:30Right, I'll tell you what.
33:31Let me put it there so we don't fall over it.
33:33There we go.
33:34You have a sit down.
33:35All right.
33:38What are we up to today, Dia?
33:40How are you?
33:41Well, I've got loads of questions for you.
33:43Okay.
33:44Fire away.
33:45My UTI.
33:47Yep.
33:49I'm 99.9% certain it's still there.
33:53Oh, no.
33:53Okay.
33:55Oh, dear.
33:56Because, I mean, that doesn't look too bad, but this morning it was dark red.
34:00Was it?
34:02I mean, when do you last think you were free of symptoms from your bladder?
34:05About a year ago.
34:06Okay.
34:07I was throwing up yesterday.
34:09Oh, no.
34:10But not today.
34:11But today you've been a bit better, not vomiting.
34:14Yeah.
34:15Not vomiting.
34:16You've eaten something.
34:17Still feeling.
34:18Are you?
34:19I think that's the problem, isn't it, Dia?
34:21I think that you've got all these constant symptoms.
34:23And because, A, having a catheter in is horrible, having enormous kidney stones, which we're waiting
34:27to get sorted out, and the kidney problem, you've got all of these reasons why you have
34:32the symptoms.
34:33And we wrote to the urology people and said, look, we're just getting all these infections
34:36and these symptoms, and the kidneys don't not...
34:39Exactly.
34:39I just need a date, you know, because at the moment I'm in limbo.
34:47And it is intolerable, isn't it?
34:48And it's killing me.
34:49Yeah.
34:50It's absolutely killing me.
35:08You're getting really fed up with it all.
35:10Absolutely.
35:12So your latest urine test that we got back on the 8th a few days ago.
35:17Yeah.
35:17I mean, that was all, that had some white cells in it, but no growth, no bacteria grew.
35:23Yeah.
35:23Do you think we can send off another catheter sample and see what it shows?
35:27I think so.
35:28It's just horrible for you, so it's hard to know when it's infection and when it's not.
35:31Exactly.
35:32Next thing.
35:34Mm-hmm.
35:35Ankle.
35:36Yes.
35:37So the last time we were talking about how the brace was sort of rubbing on the ankle a bit.
35:43And it had caused a problem with the skin.
35:45Yes, it's healed.
35:47OK.
35:48But I went up to A&E.
35:51OK.
35:52Oh, dear.
35:53Last week, because I was in so much pain.
35:55Oh, no.
35:56Would it be easier to come and lie on the bed, do you think, Julia?
35:58OK.
35:59Do you want me to help you across?
36:00Let me put some paper down.
36:02Let me help you, because I think it might be easier to see it for you as well.
36:05Can you manage?
36:06Blimey.
36:07I've got it.
36:08Let me help your boot off.
36:15So, it's here on the sides.
36:17Yeah.
36:17I can see it is quite sore here.
36:20But it's because it's rubbing right across the knob of the bone, isn't it?
36:23Exactly.
36:24Exactly.
36:24And we talked last time about getting in touch with the appliances people.
36:30Yeah.
36:30Anything?
36:31Nothing.
36:32OK.
36:33So, I'm going to try as well, then.
36:34Would it help if we put a patch of sort of material, like, you know, like gauze and sort
36:40of taped it on?
36:41OK.
36:41I mean, why don't we at least try that for now?
36:43I mean, my ankle, ever since I damaged it 12 years ago, it's always been really painful
36:50because I've got nerve damage.
36:52OK.
36:53But this is beyond.
36:56Yeah.
36:58Never mind.
36:59I'm still alive.
37:00I'm going to get your stick as well because I think you're better with that.
37:02Oh, yes.
37:03I need that.
37:04So, let's get that.
37:05Brilliant.
37:07Right on the edge.
37:08Feet are down.
37:09Yeah, we're up.
37:09Yeah, I'm fine.
37:10OK.
37:12Fabulous.
37:12You're in sample.
37:13The girls have got a pot and a form ready for you.
37:15Don't go without sending that.
37:16I think that's really important.
37:18Sorry.
37:18All right.
37:19Well, I hope that helps your ankle a little bit.
37:21I'll chase up appliances.
37:22Brilliant.
37:23All right.
37:24Just take care, sweetheart.
37:25You all right?
37:25Yeah, yeah, yeah.
37:26Look after yourself.
37:27Well done.
37:27Wrong direction.
37:28Bye-bye, sweetheart.
37:29Bye-bye.
37:33I keep getting, like, loads of just random spots on my arm.
37:36So, you are very frackly, though, aren't you?
37:39Yeah, yeah.
37:39You've got the sort of type one skin, haven't you?
37:41And then you've got some bits...
37:43Two ginger grannies on both sides.
37:45OK.
37:46OK.
37:47We've got those jeans sort of thing.
37:50I think it's only rough because I've been scratching it so much.
37:54That's not worrying at all.
37:56Oh, thank God.
38:00Declan.
38:05I've got a mole on my back.
38:06It's been there for a while.
38:07Yeah.
38:08We've kind of tracked it for a while.
38:09Yeah.
38:09Taken a few pictures of it.
38:10But at the moment, it's, like, a little bit itchy.
38:13Right.
38:13And a little bit, like, sometimes painful.
38:16Yeah.
38:16And then it's also kind of changed shape.
38:19OK.
38:20And, like, it's raised as well.
38:22Yeah.
38:22OK.
38:22Yeah.
38:23You've got some pictures?
38:23Yeah.
38:24Yeah.
38:24Yeah.
38:24This was it, like, probably last year.
38:27Yeah.
38:27This is, like...
38:29Yeah.
38:30It's only small.
38:31And then this was it sort of, like, today-ish.
38:33Yeah.
38:33It's very similar.
38:34OK.
38:35But it's just, it's more of, like, the itchy and the pain.
38:38That's...
38:38That was it today, did you say?
38:39That's today, yeah.
38:40Yeah.
38:40But, yeah, let's have a look.
38:45See what you mean?
38:46That it is different from the others.
38:48But it's strange how it's changed as well.
38:51I see, you know, what the concern is.
38:54Because the others look completely flat.
38:57Normal, yeah.
38:59With that information, I would say we would normally send the pictures to the dermatology
39:04department, and they would decide what to do, whether you need a biopsy or not.
39:08So, we'll get you assessed anyway.
39:11I'm only slightly concerned.
39:13You're incredibly young to get anything like that.
39:16Yeah, I just want to get it.
39:16So, it's incredibly unlikely that it's going to be anything nasty.
39:19But we'll get it assessed anyway.
39:20OK, thank you.
39:21Thank you so much.
39:21Yeah, no worries.
39:22Take care.
39:33How are you?
39:34Good to see you.
39:34It's been a while.
39:36You're looking very well.
39:37Oh, thank you.
39:38Come through.
39:38Take a seat.
39:39Lovely to see you.
39:40Lovely to see you, too.
39:41How can I help today?
39:45So, I'm here for something else today.
39:49I don't want to get emotional.
39:50But I've made the decision now, Dr. George, to relocate.
39:53Oh, OK.
39:54Yeah.
39:54Oh, where are you going?
39:55Back home to my family.
39:56Amazing.
39:57To my home country.
39:57Oh, good for you.
39:59And obviously, I didn't want to leave.
40:01I've got to cry again now.
40:02Oh, bless you.
40:03Well, there's some tissues there, so help yourself.
40:04But, oh, you've been through so much, honestly.
40:06Like, you've been an absolute trooper throughout.
40:09You've always kept a very positive attitude.
40:11You know, what you went through is absolutely horrific.
40:13The car, the accident and stuff on the bike and the surgeries that you had.
40:17And, I mean, you've made an incredible recovery.
40:19She was out for a run one day and, unfortunately, was run over.
40:23She was a victim of a road traffic collision and sustained many, many injuries.
40:26And was in hospital for a very long time.
40:29To complicate matters, this all happened during COVID.
40:32And her family live in Sweden.
40:35So, we're unable to come and be with her and support her through arguably the most difficult time in her
40:40life.
40:40Obviously, when I got my diagnosis of PTSD and we had to wait for the referral and you told me
40:45that you can come and see me here every Friday.
40:49Oh, bless you.
40:51It really made a difference for me.
40:53Yeah, I mean, you know, what you went through is absolutely horrific.
40:55You just sort of, you've never hoped anything like that happened to anyone.
40:58I just can't believe I can live again now.
41:00Like, you know, I sacrificed all this year just to recover physically, emotionally and mentally.
41:06And the therapist you sent me to was life-changing.
41:09Amazing, good.
41:10Of course, I have symptoms still, but I now have the tools on how to, you know, how to get
41:17back, which I've learned.
41:19I've got something for you.
41:21Oh, you shouldn't have, honestly.
41:22Oh, that's so sweet.
41:23So, it's only just a book and some Swedish chocolate and a card for you.
41:26Oh, thank you.
41:26That's so kind.
41:27Oh, thank you so much.
41:28Honestly, that's so kind of you.
41:30You deserve it.
41:30I really appreciate that.
41:32Oh, I love it.
41:32You have a big impact on me.
41:33I've heard of this book, actually.
41:34I've been meaning to read it for a long time.
41:36So, yeah, that's amazing.
41:37Thank you so much.
41:38That's really kind.
41:39Honestly, you've been an absolute pleasure to work with because no matter how difficult it's been,
41:44you've always sort of, you know, pushed through and persevered, makes it so much easier.
41:49And I haven't done anything.
41:50You've done it all yourself.
41:52I've just been there to sort of listen and guide you and do a few referrals.
41:56And that's pretty much it.
41:57But that changed my life.
41:59It changed my life.
42:00It's the least I can do.
42:01I think, well done.
42:02Honestly, you've been incredible.
42:03Yeah, I just feel so much gratitude, you know, for just being able to breathe again.
42:09It was very sweet.
42:10Often patients just, you know, go and we don't see them again.
42:14And, you know, you wonder how they're getting on.
42:16But it was nice to have a bit of closure and sort of see her come full circle from when
42:23I first met her to now.
42:25It's been an absolute pleasure.
42:26Thank you, Dr. George.
42:27Just to sort of see you on this part.
42:28It has meant a lot to me and I didn't want to live without.
42:30Oh, that's very kind.
42:31Letting you know that you have had a very big impact to me.
42:34You and my surgeons in Sacmaris have, I don't know, I will never forget you guys.
42:38Oh, bless you.
42:39Well, I'll never forget you.
42:40You're, you know, one in a million type of patients.
42:42So, I'm really pleased you're doing so well.
42:43So, well done.
42:44Brilliant.
42:44Take care.
42:45All the best.
42:45Look after yourself.
42:46Bye.
42:46Bye-bye.
43:05Thanks so much.
43:13We'll speak before the weekend.
43:15You take care.
43:16All the best.
43:17Bye-bye.
43:22Bye.
43:22Bye.
43:23Bye.
43:42Bye.
44:18Would you just feel a palpitation?
44:20Hmm.
44:22What do you think they're going to tell me tomorrow?
44:24They're going to cull it off.
44:26I think then it might be a good idea to take him up to the hospital.
44:31Bye.
44:32Bye.
44:36Bye.
44:39Bye.
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