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00:09Morning surgery you told somebody that you're starting to struggle at home really I think
00:16people put things in my mouth at times do you feel okay in yourself I'm sweating like hell
00:26do you have any other medical conditions how long have you got you can't be ill you're too busy to
00:34be ill you've got your restaurant if I'm home you know I'm working more than what I'm doing at the
00:39restaurant too busy to be ill on Sunday all of a sudden I had this blackout faded it just happened
00:48just just just like good morning
01:23with you hello come on through it's nice to see you I've not seen you for a while
01:27no but I remember you now tell me how are you I've got doctoritis yeah absolute agony yesterday
01:35I mean it's been getting bad this knee here okay about a week and then last night I could hardly
01:42sleep I ring you and I mean it still hurts but it's I can walk we cured it on the
01:47telephone
01:49I'm so sorry because obviously something's going on causing all that pain so go twisting or you
01:55didn't slip or bang it or anything recently not that I can remember okay and the pain describe
02:00what you were feeling the other day yesterday and things why did it what did it feel well it's
02:04like a sort of two notes on the piano it was all steady for ache and occasionally um okay and
02:13did
02:13it stop you doing things like was it yeah I didn't go for my daily walk okay did you do
02:19anything
02:20yesterday to make it get better did you take any medicine or strap I took I had a couple of
02:24um
02:25cocodermol or something like that yep yep good do you mind if we have a look at your knee would
02:29that be all right now we can come and sit on here let me just have a look are you
02:33all right no I'm
02:34just gonna have a look at your good knee first of all if I press around any pain there at
02:38all
02:38nothing if we bend it and if I press it left has never given me trouble I'm pushing it nothing
02:45I'm just
02:46gonna pull it no problems okay so that knee looks pretty sturdy well it's never been wrong never been
02:52wrong right and I'm just gonna press around so tell me of any place I press there there so and
02:57is it on the inside sorry no no no this is where it's then you can guess yeah can't or
03:03gauge if we
03:04bend it up like the other one and if I press in again it's here is it that's there yes
03:08so it is
03:09down this side is where it's sore isn't it it's not grossly swollen which some people are no it's it's
03:14not quite right it's doctoritis I think there's might be something going on in your knee to be honest
03:19will you I think we need to look into it come and get yourself down let's put these here we
03:23go
03:23let me just you're right on there let me just wash I'm fine um the thing is with knees but
03:28it's
03:29they're pretty important come and have a seat I think looking at the knee there's a bit of swelling
03:35and it was tender and it's sore on that inside and what happens if we look at the knee joint
03:39what
03:39I'm worried about is that if there's a bit of rubbing so what happens is the little bits of bone
03:44sort
03:45of end up jarring a little bit when we bend it or when we move it sometimes it can just
03:49start rubbing
03:50a bit if that is the case why didn't it hurt straight away so you're quite right if we x
03:55-rayed
03:55you every day last week the bone hasn't changed suddenly but what's happened sometimes it can be
04:00the way we've sat or we've just moved or we've done the gardening or something's happened and then
04:05suddenly we get inflammation around it the bones are starting to get a bit worn away and then what's
04:10happened is it's all become inflamed and that's why it becomes very sore very quickly so the
04:14arthritis which I suspect this might be hasn't developed yesterday you know your bones are 76
04:20years old this hinge has been going for 76 years there we go so 77 years almost this hinge has
04:27been
04:27bending and if you think of a door and anywhere else it's not surprising it gets a bit of wear
04:30and
04:30tear yes I'm sure do you understand that the thing is is that they don't like us calling it wear
04:34and
04:35tear because wear and tear implies well don't wear it out then rest it but actually it won't get
04:39better if you rest it and it's really important you keep walking for all the other health benefits so
04:44what we ought to do is why don't we get an x-ray of your knee have a look at
04:47it that'd be great
04:48so I'll send the x-ray form which you can go down for any time and we'll ring you with
04:51the physio
04:52you're adorable thank you so much we'll get you sorted but keep on your feet you're not doing
04:55anything wrong you're doing it all right and I think it was quite right you came in today to get
04:59it checked you are kind well thank you very much indeed you take care nice goodbye all the best
05:02bye-bye strut bye-bye oops that way yeah that way yep different room
05:09uh lucas please oh hello hello how are you both fine thank you I've just been reading all about
05:17you I'm george one of the doctors lovely to meet you hi take so you make yourself comfortable how
05:20are you doing good oh bless you what happened you tell a story we were staying with some friends in
05:27the country and they were all playing football outside and the kids were having a glass of water
05:31someone kicked a football which hit the glass which went into his um yeah so it was it was pretty
05:39deep
05:40luckily it didn't go all the way through but he had to have stitches good and they've removed all the
05:46foreign body is nothing well they gave it a good clean but the reason I'm here is it's quite boring
05:50really uh they gave me antibiotics and um supposed to be 10 mil three times a day for five days
05:55but
05:56they only gave me 100 mil so we've now run out yeah absolutely fine but um as we're here I
06:01just
06:02wonder if you could have a look anyway and just and just see okay well let's check a few bits
06:06for
06:06you not a problem at all and then we can get that prescription uh done let's have a closer look
06:11is the pain okay is it sore or is it not too bad oh you're brave aren't you hard as
06:16nails i love it
06:16yeah it's good it's healing nicely i'm just gonna yeah i mean is it that sticking out a bit the
06:22stitches yeah that's fine i wasn't sure if i should try and snip the ends but i didn't really trust
06:27myself to to do it necessarily a great job the they're dissolvable ones aren't they they are yeah
06:32so they all dissolve really nicely and then whatever's left over you're right you can just
06:36snip but we can do that for you yeah lovely good can you open your mouth for me i'm just
06:40gonna lift
06:41this lip up a little bit just to check your gum is okay good i don't want to press too
06:45hard lovely
06:47absolutely fine are your teeth wobbly at all no no but he says it hurts but i don't know if
06:53that's
06:53just the gum being yeah a bit inflamed absolutely yeah exactly i'll just quickly check your temperature
06:59and then send this so well done you are brave goodness me that's uh on stitches not not fun
07:07yeah i think it was five or six or something in the end so temperature is normal as well brilliant
07:12lovely leave that with me get that sorted any problems just let us know okay perfect thank
07:16you very much take care pleasure you're very welcome all the best
07:31i've got so much anxiety about going away i always get like this before you should see me what i
07:36do
07:36is before i go away as i have a to-do list and like referrals needs to be done a
07:41certain way and
07:41like and then you have to print it off so i can check it when i come back you're gonna
07:44give me a list
07:45of stuff to you i know it's just one list that everyone works on oh i see yeah yeah so
07:51maybe you're
07:51a bit controlling thanks doris hello hello mate oh different room today
08:16right you're okay then oh so doris you're nice and early and we have a double appointment booked
08:23we have lots of time what have i not come in for oh you're not sure no okay no one
08:30told me nothing
08:30oh right okay um my understanding doris is that and that you told somebody that you're starting to
08:38struggle at home oh really i think people put things in my mouth at times i mean i i don't
08:47say
08:47i struggle um i get in and out of bed okay on me own i've got one of those little
08:56other things yeah
08:57the worst part for me is loneliness loneliness yeah because i'm on my own and now the two people
09:06that looked after me they've moved now over the other side so i've lost them yeah sometimes i wake up
09:15and think why must you there
09:34you've mentioned kind of feeling like what's the point going on i want to explore that a little bit
09:41more and i have some specific questions that i want to ask you um and i notice that you do
09:47take
09:47an antidepressant medication you take a very very low dose of sertraline um okay i also take tablet for
09:54a panic attack you do the questions i'm about to ask you doris are specifically designed to assess for
10:00any features of depression in in people who are older so over the past week do you feel that you
10:10are
10:10basically satisfied with your life yes good over the past week have you felt like your life is empty
10:18oh i suppose i'm bored really when you're on your own
10:25got no relatives no i've never even given it a thought actually no do you often get bored
10:35bored yeah bored no i don't think so i've got a habit now doing scratch cards so no i read
10:45i watch telly i've got scratch cards are you in good spirits most of the time oh yeah yeah i
10:52enjoy
10:53my own company at times good are you afraid that something bad is going to happen to you
11:02do you feel happy most of the time do you often feel helpless no do you feel that your situation
11:12doris is hopeless oh no good good and do you think that most people are better off than you
11:21well younger than me yeah i think probably there's people off that are worse off than me
11:29better off than me and i wouldn't like to answer that one okay that's fine it's actually quite nice
11:35to hear you some of those answers to that question um i think that one of the things that you
11:40said
11:40matters most to you and is your priority is is this loneliness so i think so really for now we
11:47won't
11:47do anything with regards to getting no if there's anything desperate i will what i do want to do
11:54if it's okay is ask our social prescribers to visit you so that they can give you some help with
12:00um
12:01this feeling of loneliness oh and i've got a plan in place for that we'll see how it works okay
12:06well
12:07thanks doris when talking to doris about what matters most to her having more care and more support
12:12wasn't high on her agenda would you do me a favor would you weigh me yeah you can get onto
12:19her scales
12:20she's still fiercely independent and even though some of our colleagues might have thought she would
12:24benefit from extra support she's perfectly entitled to say no thank you for that help right now and of
12:29course if anything changes we can revisit that 43 kilograms that says okay i'll convert it for you in
12:37a minute let me move that out of the way 43 kilograms i can't be much slower than that i
12:44don't
12:45think i eat a lot of chocolate so this is 43 kilograms it's just over six and a half stone
12:54six and a half i put on a bit then you are putting on a bit that's made my day
13:00do you eat meat and fish
13:02protein is important to keep your muscles strong which is in older age which is the best one you
13:07get that from you get that from most meat sources and from some vegetables as well yeah and things
13:12like cheese so i eat a lot of chocolate that's good for me isn't it you got to enjoy these
13:20things
13:20all right well thank you very much thank you doris
13:26i've had this really itchy skin thing basically and where does it affect your on the body i don't know
13:31if
13:31you can see but kind of small bumps under my skin last september i suddenly got the most awful eczema
13:38and itches from head to foot i keep getting like loads of just random spots on my arm what do
13:44i do
13:45about this and my hands were so so sore they felt as if i was holding thistles moisturize moisturize
13:51moisturize got this funny thing here what i do think that is something called an actinic keratosis okay english
14:01john yeah so they're going to run the show today if that's okay does that work for you i'm going
14:10to
14:10be here listening okay have a seat so hello there my name is shiromi i'm one of the medical students
14:18okay
14:19hello um so can you tell me about why you've come in today uh just a penal rash there's sort
14:26of a slight
14:27ring around the stalk of the penis is it itchy uh i'm conscious of it a feeling i wouldn't call
14:35it pain
14:35or i wouldn't call it an itch you're just aware that it's yes there okay um and have you been
14:41like
14:42seeing any discharge or anything like has it been like flaking nothing it's just red yes
14:50do you have any other medical conditions how long have you got i have the typical medication of
14:58someone of my age for cholesterol yeah and blood pressure blood pressure and that's for high blood
15:04pressure right it is it's okay and if it's okay to ask um have you been having any like sexual
15:11activity
15:12recently no no okay yeah okay so i think that's it for me how did she do terrific
15:22so what are you going to do doctor um so i think we're gonna do a swab just to see
15:28if there is
15:30any infection i guess or to see um like what the causative agent i guess is there you go i
15:36think
15:37sorry we'll be good yeah
15:43uh kuleen please hello
15:49i come through take seats i'm george one of the doctors nice to you how are you i'm fine thank
15:54you
15:54yourself lovely yeah good thanks how can i help today um i have a condition called hs yep but i've
16:00got a lump under my arm and it doesn't look it's not the same characteristic so i just want to
16:04make
16:05sure hs or hydradenitis suppurativa is a chronic skin condition it's characterized by the formation of
16:11skin tracts or sinuses that form from the surface of the skin and they migrate in they can often get
16:16infected and be very difficult to live with very painful very itchy very uncomfortable and when did you
16:22first notice it monday and then it's just getting bigger yeah yeah is it painful yes it is anything
16:28coming out of it any discharge no it's quite soft though in certain areas yeah fair enough and do you
16:33feel okay in yourself any fever nausea or vomiting i'm sweating that hell are you yeah yeah do you think
16:37it might be related or hard to tell it's hard to tell it's so fun any infective symptoms at the
16:42moment
16:42so like coughs colds runny nose and you know that chest infection nothing like that at all and
16:47nothing in the run-up to this so last week or anything and whereabouts is it under the armpit yeah
16:50fine
16:51would it be okay to have a load yeah all right look this
17:01oh wow yeah it's big oh bless you
17:07sorry
17:12yeah it's got a punctum i think it's a cyst okay so it's the hs it might be the hs
17:17but it could be
17:17you know a different sort of cyst altogether so yeah it could be it might may not be related to
17:22the hydradenitis it's tricky it doesn't sort of look actively infected but i do wonder if we should
17:28just in case give you some antibiotics that's bad again i know i'm so sorry well we don't have to
17:34we
17:34could adopt a wait and see approach and say look give it a couple of days and if in in
17:38the next 48 hours
17:39or 24 hours it's regressing getting smaller getting less and less painful fine you don't need anything if
17:44however in that time frame it's getting bigger redder angrier more painful then unfortunately
17:50we probably should you know try of course for antibiotics especially with your diabetes as
17:54well we need to be very very careful um before you go just to make sure that there's no sign
17:58of
17:58infection in the body can i just check your heart rate and oxygen levels is that okay and then your
18:02temperature as well
18:07oxygen levels are perfect 96 so that's really good just check your temperature there ignore the beeping
18:13it does that lovely temperature 36.2 heart rate is less than 100 so absolutely fine it's really good
18:19brilliant see how you go any problems just come back all right okay thank you my pleasure you're very
18:24welcome take care you see this ring around yeah and you see the redness and inflamed yeah it's not
18:40normal to have that but i can definitely see it's marked inflammation and does that irritate you
18:48well i'm conscious of it as i said i can feel it but it's not pain and it's not
18:53an itch i don't have to scratch it yeah that sort of thing there you go good luck
19:00yep yeah just keep going i'll do the other bit as well good yeah it looks quite sore doesn't it
19:09hmm there we go perfect well done yep all done yes all right i would say we're going to send
19:19that
19:19away okay um but i'm going to give you some treatment anyway what treatment would you suggest
19:29um alcantarine or the oral flu flu flu flu or that was it perfect um
19:39so yes you mentioned an oral tablet treat you from the inside one-off tablet and the cream yeah
19:48two-pronged attack what is that likely to be so it is a this yes yeah yeah i mean it
19:54looks like a
19:55thrush basically inflammation no funny smells or anything you know any other discharges or anything
20:01like that no excellent so that takes a few days to get the result but i'm sure okay it'll be
20:08you know i'm sure it'll just come back showing a yeasty infection looking at him what do you
20:15what are you thinking what's he dressed as tennis player maybe so i mean sports uh you know all goes
20:24with thrush basically loves hot sweaty environments oh right yeah so when you do i should lead a more
20:31sedate life is that what you're proposing not at all so you're going to get one capsule and some cream
20:38okay you're going to use the cream smearing it around yeah end and um should settle down for a
20:46while but because you enjoy the sport and stuff that can just occur again always worth having
20:53the sugar test which we do anyway what's the correlation everything a penis and the sugar
20:58reading so a high sugar in your urine which you might do if one had diabetes yeah allows yeast to
21:05grow all right it feeds the yeast so if you like something today yeah for you tim thank you all
21:14right
21:14and thank you for talking to them it really helps thank you thank you thank you thank you
21:20tim thank you no problem take care bye
21:25the men are really bad at generally coming to the gp but john was very staunch and very game on
21:33for
21:33showing the students which was great because they're one of the biggest trainers of
21:38doctors in in london and i think they did really really well how did that go that was good yeah
21:47yeah
21:47he was comfortable yeah talking to you you're asking all the right questions yeah i thought you were
21:54brave doing the sexual history well done um yeah and your examination and um taking this one all good
22:13so we're here today because because of my medication i know you know what i'm going to say
22:17it's good to see you're looking well i'm i'm absolutely fine actually you know that yeah yeah
22:22but you were fine when you had a bit of a twinge in your chest exactly but when we got
22:26you up to
22:26the hospital and you weren't actually they said they said oh you have uh uh you know had a heart
22:31attack so exactly and that's the thing so you had a heart attack which which just meant that there was
22:35a blockage there again and you've had obviously how long ago was the previous heart attack 17 isn't it
22:4016 okay so 16 17 and then it was this march time sort of thing when we got you to
22:46go back
22:46up again and it was such a smile symptom wasn't it it was a bit of a warning so i
22:50think i suppose two
22:52things one is that's a big learning point that if you get any funny twinges or difficult or funny
22:57just go and get it checked because if they do an ecg in that blood test and it's not your
23:01heart they'll
23:01kick you out straight away exactly but if it is your heart you're in the right place but what i'm
23:06what
23:06i'm worried about with your medicine and i know i've heard on the grapevine that you're not taking all the
23:12medicine at the hospital no no the medicine which they have given because they you know i wasn't
23:17feeling right with them these tablets actually they're not making me feel better they're making me
23:35feeling
23:36never take pills i know if you can avoid them they're best avoided but sometimes they are needed
23:42lordy dordy look at all these i know it's the side effects from it or what of course there are
23:48loads
23:48of side effects geez oh yeah absolutely aspirin yes folic acid yes stomach on yes statin yes thank
23:55god for that i've spoken to a few people and when they tell me how many you know medications are
24:02on
24:02i went what yeah i mean you're doing really well i couldn't believe it you know
24:09problem is i think that we suddenly threw loads of new tablets on you you fell ill we've stopped
24:14them all and gone back to what we were on before but what worries me a little bit is that
24:18you when
24:19you have the first heart attack the blood vessel was blocked and they put a stent in yeah and when
24:24you have the second one when they've gone back it's dilated there's a bit of what they call a sort
24:28of
24:28aneurysm there's a dilation around it and the problem is blood sits and clots in those dilated bits
24:34right so they're worried that just one blood thinner isn't quite enough okay then they look at and
24:41think well hang on the cholesterol was part of the problem in the first place it blocked things
24:46and that your cholesterol was still a bit raised despite being on the maximum dose of statin so
24:53that's why they added in the other one as well okay now i was thinking one option is what about
24:58if we
24:59look at all the new tablets prioritize which are important and try one at a time that's good and then
25:04if you feel unwell we know that that's the only change that's been done so that is the tablet that
25:09doesn't suit you that's fine and i know i can't bear patience on lots and lots of tablets but every
25:15single one of those is individually doing a really important job and you're young you're fit you're
25:21healthy you've got your wife you've got your family you've got your grandchildren living with you you
25:25are you can't be in you're too busy to be here yes i am too too busy to be i'm
25:30telling you if i'm home
25:31you know i'm working more than what i'm doing at the restaurant because five of them are on me all
25:36i know so i think what we need to do is think it's not ideal being on all these tablets
25:41but i
25:42genuinely think that if we want to keep you from not having strokes not ending up in hospital or sick
25:49or not being able to do things or ultimately the worst thing of dying then actually we need to look
25:55and try and get you on these tablets to try and really improve the the outlook going forward we will
26:01try you know maybe whatever whatever it is there you know i'll try one more thing i want you to
26:06know
26:07if did you get the result from the cardiogram it was good it's pretty good all your your heart muscle
26:13is pretty good yeah they're all fine we've got a good heart but we need to keep it that way
26:18because
26:19reality if you stopped all of it and didn't exercise and ate what you wanted blah blah pretty much
26:25you will have more heart attacks things so we we don't want that to happen so they want you to
26:29stop
26:29the aspirin now and just continue this other blood thinner river oxabam with the clopidogrel okay
26:34why don't we just do that one change today and then if you feel awful you let us know let
26:40me know
26:40let me go we can then we'll stop it yeah okay that one and we'll see if there's an alternative
26:45or a
26:46sister one or something that doesn't make you feel ill and then we'll look at the other ones one of
26:50the
26:50next one we'll review it we'll see and then we'll move on to the next one okay and we'll get
26:54you to 100
26:56that's the plan that's all all we stay together oh exactly no chance of getting away from me and
27:03i'll keep nagging you um and any problems if you find you haven't got the tablet same or you're not
27:06sure or someone's throwing them out or something just do you know no no we will have them i'm sure
27:11i'm sure i'm sure perfect save you thank you so much all right no worries thank you yes we will
27:15all
27:15thank you thank you bye bye bye oh what happened to not drinking red bull huh i know i shouldn't
27:26i'm
27:27actually quite concerned for you stop drinking it yeah okay i i i promise thank you let's cut it down
27:32to one a week of course all right mom this is my last one i promise on everything i love
27:42so tell me what's brought you in i'm having serious problems with my ears okay originally i
27:48thought it's tinnitus my mother gets tinnitus i don't think it is um i've been using a tinnitus
27:54relief spray nothing is helping they suddenly just get blocked and sore and i then can't hear properly
28:03out of this ear specifically okay and then i get a headache okay and i don't know what to do
28:07okay so how long has this been going on for for you for six weeks yeah so you mentioned tinnitus
28:14are
28:14you having ringing in the ear i mean everything sounds really hollow and slightly just like you're
28:20underwater kind of ish yeah yeah okay and any vert vertigo symptoms so feeling of the world spinning
28:26around you occasionally yes occasionally okay okay when i stand up okay and how long do those episodes
28:32last for uh i stand up i sway and then i'm fine okay so short any sore throat or cough
28:40uh i've had
28:41a bit of a sore throat this week but and what about a stuffy nose a little bit but a
28:47little bit okay
28:48okay will we have a look please okay so i'm gonna look in the normal ear or the less severe
28:56ear first
28:56if that's okay with you no that's fine that is perfectly normal and very clean thank you
29:04i do try to keep them clean good that looks fine as well actually there's no redness it doesn't look
29:12inflamed or it doesn't look like it's bulging so this doesn't look like there's an infection there
29:16okay um can i have a look in your throat so just open your mouth and say ah
29:23yep okay that's fine so no swelling of the tonsils i'm gonna feel your um lymph nodes in the neck
29:32okay all righty so what i think is going on is actually you to do with your eustachian tube so
29:37i
29:37think that may be blocked and causing you the popping and the fullness feeling and the discomfort
29:43so i think if i give you a nasal spray which sounds probably odd but fine yes it's worth trying
29:51i
29:51think that actually will really improve things for you i will also give you a spray for your ear and
29:57just to make sure if there's any inflammation in that ear that's causing the discomfort that that's
30:02also covered perfect thank you so much i really appreciate it right now thank you so so much
30:20uh leslie please hi come through
30:28take a seat how can i help today are we here to take the stitch out yeah yeah did you
30:33put the cream
30:34on yes i did amazing good would you like to lie down is that a bit easier for you leslie
30:39was
30:39unfortunately uh intubated and ventilated in itu following a very lengthy operation of lung cancer
30:45and they needed to do a tracheostomy um to help support her breathing tracheostomy is a surgical
30:51procedure whereby an incision is made in the neck to gain direct access to the windpipe or the trachea
30:57lovely so i'm just going to bring that down oh yeah brilliant we get a much better look on it
31:04is that
31:05painful i just hate the thought anybody touch yeah i know it really just that's just a bit of cool
31:16salty water which will just clean the area to make sure i don't introduce any bugs
31:21nice got much planned for today
31:25you know i know what you can't wait now
31:34sorry doing really well
31:38there we go done well done you did really well excellent brilliant let's just make sure that's
31:46okay yep lovely i was just removing the sutures from the site they had not dissolved and um yeah
31:55we needed to just get them out uh otherwise they were an infection risk thanks very much my pleasure
32:00you're very welcome anything else i can help with today do you need anything else from us or medications
32:04or anything no how uh how's your breathing at the moment all good i've just finished antibiotics yeah
32:12i had my chest right on this moment oh did you let's have a little listen for you not a
32:16problem
32:16at all i've got another spare set antibiotics if i need them sure yeah good good to keep them on
32:22standby if your sputum's changing color you're feeling more short of breath particularly wheezy
32:27yeah obviously let us know and you can start them at that point let's just check a few things pop
32:35that on your finger thank you
32:41do you mind if i just slide this under like this thank you
32:49good
32:57perfect really good
33:02lovely chest is nice and clear heart rate is normal oxygen levels are normal so that's really
33:06good so i don't think you need any more antibiotics for now which is great you know i've got to
33:10see
33:10how you go yeah absolutely i'll send the um for you all right take care any problems just let us
33:17know thank you very much you're very welcome thank you for taking that my pleasure you're very welcome
33:24all right bye now bye
33:43all right
33:46edward all right come on through
33:52hi come on in have a seat all right
33:56how are you well um not bad at the moment but on sunday all of a sudden i had this
34:04blackout of
34:05faint i fainted just without even any i didn't have any anything it just happened just just just like
34:12that okay and did you fall i was falling but just happened that i was that the rail yeah where
34:18you can
34:18support yourself it was just close and i just grabbed it okay did you think you lost consciousness
34:24or you felt like you were about to about to about two yes and i stayed there yeah for 10
34:30minutes i
34:31think okay then it subsided okay and what did you feel just like everything was
34:39yeah so you felt really lightheaded what about um any pain in the chest i could feel the chest
34:45tightness and and so then you went to a and e yesterday yes what did they do there and then
34:51they
34:51they gave me this medication um but for dizziness okay did they do any blood tests they didn't like
34:58take the blood they didn't take the blood okay and did they do an ecg did they stick stickers on
35:02your
35:02no chest they didn't they didn't do that okay they told me that my pressure was too high and then
35:09they told that they invited me to talk to your gippy okay and right now you feel fine i still
35:15feel a
35:15little bit okay um let's check your blood pressure today okay
35:23yeah just pop it up so just relax from just a deep breath in and out for me okay
35:30to deep in and deep out just really try and slow your breathing down for me
35:39that's good just stand up for me
35:48that's fine you can have a seat
35:51so your blood pressure i mean it's a little bit lower standing but it's it's not really low
35:57okay so i just want you to look straight at me
36:05okay and i want you to follow with your eyes
36:13good eyes really tight perfect show me your teeth
36:17like that can you stick your tongue out wiggle it from side to side
36:23yeah perfect and puff your cheeks out so just like this
36:28that's fine i'm just going to touch your face you can relax it does it feel the same on both
36:31sides
36:33yeah okay okay i'm going to have a quick listen to your heart okay
36:49have you ever been told you've got a murmur of the heart what's that
37:13a murmur is when we listen to your heart and we hear a sound so normally we wanted to go
37:18da da da da da da when we hear your heart beating so in your case today what i hear
37:23is like a whoosh da
37:24whoosh da but it's it's quite loud so sometimes it can mean there's an issue with the valve
37:29um some people will always have had murmurs and sometimes it can be new okay what we need is we
37:37need
37:37to get some blood tests done we need to get an ecg done okay um and we need to sort
37:44out this new murmur
37:45and whether that's relevant to the dizziness that you're having okay okay because obviously if it's
37:51linked to the heart we might need to to get you seen by cardiology i'll give you a blood form
37:58okay
37:59and i'll call the cardiologist okay just in case they want to see you okay then yes yeah yeah sure
38:08can it develop into something else i think my concern is that you saw cardiology not that long ago and
38:14had
38:14lots and lots of investigations and there's no mention of a murmur so what i want to do is just
38:20make sure that it's nothing that to do with the heart okay does that make sense yeah let me give
38:26you
38:26a letter and then you can take it to chelsea a and e
38:31sometimes when you're stressed yeah it can be one of the reason why i went you're going through some
38:37uh because i've been going through a lot of uh uh war worries and of course worrying about my work
38:46okay created such a terrible anxiety i couldn't i couldn't sleep do you still feel you're dealing
38:54with a lot of this yeah i'm so sorry i mean you're right stress can cause lots of symptoms okay
39:01um i think
39:03today we need to make sure it's not related to your your heart but i think once once you've been
39:09seen by a and e and we know it's nothing to worry about then why don't you come back and
39:12and we can
39:13talk about all the anxiety and the stress and things so if you take this to to a and e
39:18so that's just me
39:18asking that they urgently assess you with the ecg and view of the history all right okay thank you
39:24that's all right oh thank you all right i'll have a look later once you've been up at the
39:31paperwork okay then all right nice to see you nice to see you bye now how are you what's happened
39:45oh dear
39:46i can't sleep because i can't lie down i get earache if i lay down last night i probably got
39:52up 20 times
39:54oh no so have a good sleep that's actually one of the most important thing for our health
40:01it's supposed to help stop the nerve firing a bit at night it makes you quite sleepy
40:06you know maybe taking it at night might be a good idea yeah i could do the sleep yeah exactly
40:12i'm tired
40:15tell me what's been happening well
40:19i'm feeling very tired yeah and sleeping is a problem okay basically i don't have a problem
40:28falling asleep yeah it's just within seconds yeah yeah but i wake up between two and three
40:35and then i can't get back to sleep again yeah yeah okay which is irritating yeah this all started
40:42really once i started taking beta blockers is that could that be something beta blockers can definitely
40:49cause fatigue medication is very much related to i'll check your blood pressure now anyway but
40:54how long do you feel is it's been going on for at least uh nine months anything else changed you're
41:02not
41:02stressed particularly not more stressed and of course between two and three i have to go to the loo yeah
41:08that's sort of you know yeah standard once once once you get you don't go more than three times at
41:16night to pee no no generally without no i've been drinking a lot it's fine waking up early that um
41:22you know it can be a sign of other things like stress like anxiety but do you exercise all the
41:27time
41:27i cycle yeah i play tennis yeah so with all that exercise sounds like you do need some sleep
41:38full blood count normal good red and white cells liver function tests great
41:48cholesterol fabulous at 4.8 well done um i don't know how you feel about it if we gave you
41:54sort of
41:56maybe five sleeping tablets to try and get you out of that couch 22 because is this it's a routine
42:05that's right yeah see if it's you know got you through and stop that cycle happening obviously don't
42:12take it on consecutive nights because then you know you'll be get addicted you get addicted
42:20and you worry about not having it yes yeah what i'd like you to do is take it um sporadically
42:29meaning
42:30not every tuesday don't make it regular yeah okay if that's not helping you know there are therapists
42:39out there and we can refer you just like talking therapy and cognitive behavioral therapy which we can
42:45refer you to where they're teaching you coping techniques for waking up early yeah perfect okay
42:51lovely all right i'll send you an appointment okay all right nice to see you take care have a good
42:56day
42:57okay take care thank you
43:02thank you very much
43:09all right okay not at all nice to see you all right take care all the best bye-bye
43:14take care hopefully see you again bye take care bye-bye
43:17have a good afternoon bye-bye
43:22yeah
43:22yeah yeah yep don't do without that all right nice to see you take care thank you bye
43:26Bye.
44:06Bye.
44:26Bye.
44:32Bye.
44:32Everybody tells me it's not cancer, it's not cancer.
44:35One, six, three, four, five, six, seven, eight, nine, ten.
44:36Coming out.
44:37It all healed really nicely.
44:39Famous last words.
44:41Can't lose my foot.
44:42I mean I'm getting older now.
44:43I feel like I'm finished.
44:44I'm knackered.
44:44Old? Yeah?
44:45You're only 67.
44:46Seven.
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