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00:09Morning surgery my BMI is 42 and I'm at high risk even nine months pregnant I wasn't this heavy
00:17there's a smell to this there is yeah and it's got a green tinge to it
00:24I just put your eyelid down so I can see the redness there
00:32I walk down the stairs with my hand on the handrail and my other hand on the banister and I
00:40go down
00:41step by step really carefully because I'm in pain I think sometimes I might die and I've got to get
00:51out I've got to see people I feel closed in so closed in
01:08good morning
01:34Daniel let's go let's go let's go now come and have a seat how are you yeah good thank you
01:39yeah come and have a seat over here now tell me what's brought you in to see us today okay
01:44so I
01:45got this tattoo done a couple of days ago okay and it's just a bit bit red bit inflamed it's
01:50not the
01:50worst but it was angry it was like painful it was hot as well okay okay I'd sort of best
01:57get checked
01:57good idea really good idea so you had it done two days ago and it's getting more red and you're
02:03obviously a bit of a pro at having tattoos aren't you covered in them exactly so I've noticed this
02:08was not quite right right so this isn't healing the same as the other ones do and and the pain
02:12level
02:13it did wake me up last night okay this never happened before what about in yourself any
02:17temperatures fevers yeah a bit of a little bit of a temperature but nothing to be too concerned
02:21okay but I have been taking hyperproof and trying to get the inflammation down good well done okay I mean
02:27we always worry a little bit but looking at it I mean you're quite right here it looks lovely doesn't
02:31they so it's very sort of white and normal around it and here it's quite red and angry isn't it
02:35because what worries me a little bit is if we put your other hand next to it although there's the
02:39redness there actually you can see there's some redness here okay here and it wasn't like that
02:43yesterday so it was very like defined yeah and actually if I feel it so that's quite pale and that's
02:49quite warm so you can feel it's quite hot isn't it yeah so it's hot it's red and possibly a
02:54little
02:54bit swollen now we do expect it when we tattoo the body yeah okay a bit of trauma a bit
02:58of trauma to the
02:59body where did you have it done just to check uh here in London perfect it was a good legit
03:04yeah
03:05yeah I think it's probably just because the area it wasn't a holiday no no no no okay so that's
03:12good
03:12news that's good the fact that the redness is more than it was yesterday tells us that instead of going
03:17in the right direction of getting less it's actually going in the opposite direction of getting a bit
03:21worse we're all covered in bacteria and things on our skin and when we chew a tiny little needle of
03:25putting the ink in there's a small chance there always is even in really good reputable places
03:29yeah that we push a tiny bit of bacteria in and we get an infection yeah so let's zap it
03:34sweetheart
03:34okay it's flue gloxylin this is the best antibiotic for skin bugs okay the problem is you get rid of
03:40it very quickly so you have to take it four times a day oh so it's a little bit like
03:43a bit of an
03:44annoying just because your body you pee out the antibiotic and you want to keep the antibiotic in
03:47the blood so it's killing off the bug to get you better okay how many days a week that's fine
03:51it's fine it's got to be dead it's my fault getting the tattoos but what is important is if you
03:56have
03:56something like this if it gets red and sore and angry you need to come see it yeah so i
03:59went to
04:00the pharmacist and she was like to be honest i think you should just go so you went to the
04:03pharmacy first good on you we like that and actually they will stop a lot of people i need to
04:06come in
04:07yeah but they're quite right she was like you just go in yeah thank you so much good luck with
04:10it
04:11just keep it clean okay you don't need to do anything else special to it and it will heal up
04:14okay amazing thank you for that thank you so much all the best nice to see you don't you bye
04:17bye
04:21come and take a seat oh look at you you're so big yeah so big
04:27and how's everything going yeah good yeah okay did you have a nice birthday for him we did we did
04:33a
04:33little uh party at my grandma's house just in the garden bit suspicious about the cake yeah
04:39do you know what i don't think i've been to one one-year-old's birthday party and they haven't
04:43cried yeah yeah oh bless him um and how's everything going sort of like moving around
04:50is he pulling himself up yes he is yeah i feel like he's days away from walking oh wow a
04:56very
04:56speedy crawler now yes yes you are and are you breastfeeding uh just stopped two weeks ago fine
05:03and how are you feeling from that yeah fine yeah yeah breasts okay yeah do you have his red book
05:08i do
05:09a chance do you want me to grab it um it's just yeah so um i'll go through the ones
05:13that we're doing
05:14today so one year vaccinations it's four injections um two in each leg if he does get a temperature
05:22please do give him cowpole okay but this shouldn't last longer than 24 hours and then the last one is
05:28the mmr the measles mumps and rubella the mmr might cause a temperature a rash or sore throat a bit
05:35swollen
05:35it shouldn't last longer than a day or two um however please do come and see us if you um
05:41are worried
05:42about anything how does that sound yes that's good yeah very curious don't know it's taking all the
05:50tissue absolutely fine and are you going back to work or have you gone back to work yeah going back
05:56on the 16th who's going to be looking after him i'm just gonna watch him a bit while i'm first
06:02back
06:02and then perfect yeah i'll get now three okay so i'll just ask you to pop him one of his
06:08turn him
06:08around just a little bit so his legs are going down this way and then if you just cuddle him
06:12give him a big hug and hug his arms and then i'll do one leg when i say we'll turn
06:18him around do your
06:18leg and then cuddles afterwards but if you want to stop at any point just let me know
06:21here all right all right all right all right all right i'm sorry i'm sorry i'm sorry
07:02Oh my sweet, I'm sorry, great boy, there you go, you want this?
07:10Oh, it's a lot, some real tears here, oh sweet, all finished, I promise, well done, I'm sorry, perfect, thank
07:26you, bye, bye, hello baby, I'll be a really good mom,
07:39yeah, I think you would be, do you think you'd be a strict mom, I'll be a chill mom, I
07:44wouldn't be strict, oh god, brother, is there something you've got to say, I'll be the godmother, I'll watch my
07:50kids, absolutely not, yes, we'll be fine, what about you, you think you'll be strict, yeah, probably, really, I wouldn't
07:57be that strict, like, if you want to have fun, go have fun, have fun in a good way, I'll
08:00support you, absolutely not, you're like that crazy auntie, I'm not going my kids with you,
08:04honestly, what a crazy auntie, we'll all have fun together
08:13Michael
08:16How are you doing?
08:17I'm doing good, I'm loving the look, nice to see you
08:19I'm loving the look
08:20Yeah
08:21How are you doing?
08:22Not too bad, you know, not too bad at all
08:25Yeah, in a while
08:26It's been a little while, but
08:28Ticking along?
08:29Ticking along, pretty good
08:30Yeah
08:31However, I developed this lump on my throat about a week and a half ago
08:37Right
08:37It was probably about the size of a 50 pence piece
08:41There by my, by my, Adam's apple
08:44Yeah
08:44It's actually gone down quite a bit
08:48Before that, nothing
08:49Before that, nothing
08:50I've never had any problem with my throat
08:53And that just suddenly developed overnight, literally
08:56And you're not more croaky than normal
08:59I know you've got croaky boys anyway
09:00Um, not really
09:02It doesn't hurt when I swallow or anything like that
09:06But it's only when I go to touch it that it's a bit sensitive
09:09Okay, yeah
09:11And you feel it where?
09:13Right here
09:14Yeah, yeah
09:15Right above your Adam's apple
09:17Yeah
09:18Right above your Adam's apple, actually
09:19But it's, it's, it's like
09:20It's a bit of two little lumps
09:22One, two, three
09:23Yeah
09:24Three
09:25One
09:25Two
09:26And then this slightly bigger one here
09:28Yeah
09:29And you feel absolutely fine
09:30Fine
09:31Yeah
09:31I'm just going to feel your neck
09:32Sure
09:32I don't know if it's a thyroid plane up or not
09:38Yep
09:39Okay
09:40So no particular
09:42No tenderness around it either
09:44No
09:45Nothing
09:46Can I just get you to lie down?
09:48Sure
09:48Just have a
09:49Relax
09:49So that, all your muscles are nice and relaxed
09:55Yep
10:00And tender, yeah?
10:01Painful?
10:03Not so much now
10:04Yeah
10:04Came to being
10:06Yeah
10:06So I thought, like you, it would be more like thyroid
10:11But this is too much in the skin
10:13I can just wiggle it about
10:14I can get behind it
10:16But you can understand what you're saying
10:17Yeah, yeah, totally
10:39My cysts from hair that's grown inwards instead of outwards
10:44They're very much in the skin
10:46There's probably an infection there
10:47I'm going to treat it with some antibiotics
10:49And I'm hoping that it will have dissipated in about two weeks
10:54Right
10:54If it's not, or if it's getting worse, come back quicker
10:57But I'll put you down for a review in two weeks
11:00But it's not deep enough to be your thyroid
11:02So I'm reassured by that
11:04But it's good for you to be aware of things too
11:07Interestingly, they feel as though they've been there a little while
11:09I know you've only felt them for a week and a half
11:10But you think
11:12Literally a week and a half
11:14Yeah
11:14Probably just popped up
11:17And it kind of seemed to have got slightly bigger
11:20But it's remarkably, in the last two days, it's gone down
11:24Going down
11:25And I think what would help it go down quicker
11:28Along with what I'm going to give you
11:29Would be a warm flannel
11:32Just resting it there
11:33Heating it up
11:34And, you know, maybe some gentle massage
11:37Will just disperse those cysts
11:39Right
11:39While treating you with antibiotics
11:41Okay
11:41I think just gently, not squeezing it or anything like that
11:47And then I'm hoping that it will have shrunk and reduced considerably
11:52By the time I see you next time
11:54If it isn't, then you'll consider other things like scans and stuff like that
11:59Brilliant
12:00Great
12:00Nice to see you
12:01Nice to see you as well
12:03Thank you very much
12:04Yeah, no worries
12:05I'll see you in a couple of weeks
12:06Oh, right
12:06Okay, take care
12:07Bye-bye now
12:13This is Kelly
12:14Hello, good morning
12:18How are you today?
12:20Yeah, I'm okay, not bad
12:21My name is Nilou
12:23I'm the dietitian
12:24And you are referred to me regarding weight management
12:27Yes
12:28How have you been recently?
12:29Any recent changes in your diet?
12:32In your lifestyle?
12:32It just seems to be a long, long road
12:35It's not like I was always like a bigger woman
12:39And I've struggled with my weight
12:40I never struggled with my weight
12:42When I was young, I used to always be active
12:44After I had my son, I bounced back
12:46And I don't know whether it was after I lost my mum
12:4910 years ago
12:51I went on antidepressants
12:52One of the side effects was rapid increased appetite
12:56Okay
12:56My BMI is 42 and I'm at high risk
12:59Even nine months pregnant
13:00I wasn't this heavy
13:01Okay
13:02So, like, I was like, right, enough's enough
13:04So when I was working at school last year
13:06I started doing intermittent fasting
13:08Okay
13:08The weight was dropping
13:10I dropped half a stone in a week
13:12Are you still doing intermittent fasting?
13:14No, because I'm now off on the summer holidays from school
13:17Okay
13:18So the routine's changed
13:19I just feel stuck, like, with just getting moving
13:22What I need to do is, like, increase my sort of knowledge of things that I, you know, I like
13:27I think it's, as well, the cooking
13:30Like, for example, because when I was at work, they used to provide a meal
13:34If they provided a meal with salmon, I'd eat it
13:36Yeah
13:36So I think it's just the, it's learning to, to, to, to, to have a love for cooking
13:43Because, you know, we are what we eat
13:44So we will start the calorie counting for one week to four weeks
13:49It's up to you
13:50If you could do it for four weeks, better
13:52If not, only one week would be fine
13:54Which one would be better for you?
13:56Application, or simply, like, food diary for a few days
14:00I mean, what, you mean, I use apps?
14:03Yeah, which one is that?
14:04It's my fitness pal
14:05Most people don't have that on
14:05Oh, yeah, yeah, yeah, I used that before
14:07Uh-huh
14:08Try to learn from it, okay
14:10Not just putting numbers there
14:12You put five casheonads
14:14You will see it's, like, 120 kilocalories
14:17For the first week, just don't make any changes in your diet
14:21I just want you to have a report of your current diet
14:25Then, after one week, you can set a goal with the application
14:29You can say, I want to lose two, three kilos per month
14:33And it gives you a total calorie
14:36Is it called MyFitness?
14:37MyFitness, but I'll send you everything as a message
14:40And we also have this model, which is very easy
14:44A quarter of your plate, this is really important
14:47From carbohydrates
14:50Preferably complex brown carbohydrates
14:52If you do bread, brown bread
14:54What about just cutting out the bread?
14:56If you usually do brown carbohydrates
14:58They are high in fibre
15:00Oh, okay
15:01So you need to compensate your fibre intake
15:03Portion size is the key
15:05And half of your plate from vegetables
15:09And controlling your oil intake
15:12One tablespoon of any oil
15:14Even, like, the best olive oil
15:16Has 120 kilocalories
15:18You won't be able to control your life
15:21Your diet all the time
15:23You're not a robot, okay?
15:25So if you found those goals difficult
15:28If you needed something like a tailored diet plan
15:31Then we can work on that together
15:34It's the, yeah, it's the calorie stuff
15:35It's just being consistent with that
15:37And getting
15:38But I just felt I just needed
15:40Do you know, like, a little bit of help to
15:41Yeah
15:41So, perfect
15:43Let's see how it goes
15:44But it's so bad
15:45I'm sitting there thinking about diet coke
15:46I know, it's the blood sugar levels
15:48Don't worry about the diet coke for now
15:50You won't be able to change everything
15:52Only one go, okay?
15:54So let's see how it goes
15:55Take care
15:56Thank you
15:56Bye-bye
16:05Fabia, please
16:06Hi there
16:07Hi
16:08Come through
16:09I'm George, one of the doctors
16:10Nice to meet you
16:11Hi, George
16:11Take your seats
16:12How are you?
16:13I'm actually okay right now
16:14Good
16:14It's a silly question I know
16:16When you come to the doctor
16:17How can I help today?
16:19I've been having some strange symptoms recently
16:21That I'd like some follow-up on
16:22Yeah, of course
16:24I don't know what you can see
16:26I saw your patches consultation
16:27Yeah, so it says something about regurgitation
16:29So I'm guessing is that sort of upper GI regurgitation?
16:32Yeah, well, it started
16:33It started maybe a few weeks ago
16:35Like I've been burping quite a lot more than normally
16:38The first few times it was just liquor that I was bringing up
16:41But yesterday I brought bile up
16:42And my throat was feeling a bit, you know, sore
16:46And how long has that been going on for you?
16:48So the burping's been going on for like a couple of months
16:51But the like bringing stuff up past two weeks
16:54Any sort of acidic taste in the back of the throat?
16:56Yesterday there was
16:57But before then, no
16:58And any abdominal pain sort of quite high up
17:00That often radiates up into the chest?
17:02Not high, no
17:03I wouldn't say I have much pain
17:05Yeah, good
17:05Any heartburn, reflux?
17:07No, not really
17:08Good
17:09And you mentioned a change in bowel habits
17:11Yes
17:12So I haven't been going to the toilet as often as normal
17:16And when I do it, I have a constipation or diarrhoea
17:19So it can alternate between the two
17:21Yeah
17:21Fair enough
17:22And any blood mixed in with the straw?
17:23No, no blood
17:23And how long have you noticed that change for?
17:26Has it coincided with the sort of regurgitation?
17:27That has been happening for the past couple of months I would say
17:30Yeah
17:31And appetite, is that okay for you?
17:33Yeah
17:33Yeah, you don't get full very quickly after eating?
17:35No, I've always had really good appetite
17:36Good, perfect, that's good
17:37And any bloating, abdominal bloating?
17:39Yeah, I would say I've had some bloating
17:41I'm not sure if it just coincides with when my periods do or something
17:44Yeah, which brings me really neatly on to the next sort of questions really
17:47Any change to periods?
17:49Are they regular?
17:51They're, well, I'm two days late now
17:53But I think that's quite normal for me, yeah
17:54Perfect, really good
17:55What I'd like to do if it's okay is have a little feel of your tummy today
17:58And then maybe we can think about some investigations that might be useful
18:00Just to rule some things out
18:03And are you in any pain or discomfort at the moment?
18:05No
18:06Lovely
18:06So yeah, sometimes it could be because the stomach's producing a bit too much acid
18:10And it can be causing these types of symptoms
18:11Often you do feel it, but sometimes you don't
18:14We call it sort of a silent reflux
18:15And it presents in these other sort of more vague ways really
18:18So if I press there, is that okay for you?
18:20It's a bit uncomfortable
18:20A bit tender, yeah
18:23Okay, that's fine
18:24It's lovely and soft
18:25So that's a really good sign
18:26There's no abnormal masses or anything untoward like that
18:31Lovely
18:31Absolutely fine
18:32Thank you so much
18:32All really good
18:33So I think, yeah, what we should do is
18:36To investigate the change in bowel habit
18:38There are a couple of poo tests we should do
18:40Just to make sure we're not missing anything
18:42We should also check for a bacterial infection in the stomach
18:46Called helicobacter pylori
18:47And so sometimes that can cause these sort of upper GI type of symptoms
18:50So we can easily screen for that
18:52If you've got it, we can easily eradicate it
18:54We just give you some antibiotics
18:55And that sorts it out for you
18:57As well as that, we should maybe think about doing some bloods
18:59Just to make sure kidneys are okay, liver's okay
19:02No sign of anemia, thyroid, diabetes
19:04The whole lot really
19:05Just to make sure
19:06And then we take it from there
19:07Does that sound okay?
19:09The general principles are sort of avoid the triggers
19:11So we know the big triggers are caffeinated drinks, fizzy drinks, citrus fruits, chocolate, ultra-processed food, pastries and things
19:20like that
19:21Tomatoes, stuff like that
19:22So yeah, all the good stuff unfortunately
19:24You can still have that
19:25But just in moderation really
19:27To help mitigate the symptoms really
19:30And then there's a sample box outside
19:32So you can just drop it in there whenever you're ready
19:34And we'll take it from there
19:36Okay, thank you
19:37Have a good day
19:37You too, bye now
19:43You just text people on messages
19:45And WhatsApp
19:46As a no socials
19:48I don't like texting people on messages
19:50It feels too serious
19:52No
19:52Then WhatsApp feels like I'm like a middle-aged woman
19:54Me and mum message you're on WhatsApp
19:57Yeah, my mum's a middle-aged woman
19:59So that checks
20:00And she's made me into a middle-aged woman now
20:10Afternoon surgery
20:13Oh, God
20:14Shall we come on through?
20:15Let me give you a
20:16How are you?
20:17Hello
20:17How are you?
20:18You all right?
20:19You're not coming in?
20:21No
20:21No
20:21He's going to have a quiet afternoon
20:23He's going to have a doze
20:25Now, you've been avoiding me
20:26I've been in hospital
20:28I know you have
20:29Sweetheart, you poor thing
20:29Has it been awful?
20:30It has been dreadful
20:32Oh no
20:32Because you were in for a while, weren't you?
20:35Ten weeks
20:35Ten weeks
20:36Yes
20:37Oh, goodness me
20:37I had two days
20:39To put that on
20:40Just to make sure
20:40And two nights out
20:42Oh, no
20:43And then you had to go straight back in again
20:45Yeah, straight back in
20:46I had a urine infection
20:48Well, they wrote and said you had sepsis
20:50That was when I went in
20:53I had sepsis
20:54Oh
20:54And it took them a while
20:56To figure out why I had sepsis
20:59That I had an infected stone in my gallbladder
21:02I have several stones in my gallbladder
21:07And I have to have an operation
21:10To remove them
21:11But I've written a list of things I've got to talk to you about
21:15Go, tell me
21:16What can we do today then?
21:18First of all, I need a referral to a physio about my mobility
21:24Yeah, so tell me
21:26Yeah, so tell me, because you've had falls and everything, haven't you?
21:30Oh my goodness, let's have a look
21:32When did you do that one?
21:34A couple of days ago
21:35It's got my nose too, that's why I've got my glasses on my nose
21:39So it banged across there and across there
21:41And across there, yeah
21:42So where are you falling?
21:44Just in the home?
21:45Yeah
21:46Dripping over my slipper
21:47You know, my foot
21:48But is that because with the MS you can't sort of feel
21:51And you don't know where the feet are going
21:53Yes, and I can't look down
21:55Because if I look down, I lose my balance and I fall forward
21:59So I've got one of those walking frames
22:02Okay, so you use the wheelchair for outside
22:04And the frame
22:06For inside
22:07I've got one on the floor that I sleep on
22:10And then I walk down the stairs
22:13Okay
22:14With my hand on the handrail
22:16And my other hand on the banister
22:18Okay
22:19And I go down step by step
22:22Really carefully
22:23Really carefully because I'm in pain
22:25Do you feel, I worry about you coming down the stairs a little bit
22:29No, no, the council said they'll put a stair lift in for me
22:33Brilliant
22:33Have the council given you any sort of time frame for this thing?
22:36Do you think maybe we could chase them up?
22:37Do you want me to give them a bit of a sort of boot
22:39In the right direction
22:40And sort of ask if we can do it
22:41I'd love it if you could
22:42Yes
22:42That would be amazing
22:44Nicolette suffers from multiple sclerosis MS
22:47And has done for many years
22:49And sadly it is progressing now
22:51I've looked after her for 20 years
22:52I remember she used to walk in to see me
22:54And then we started using a frame
22:56And now she's in a wheelchair
22:57But again, she's taken these steps
23:00Although they're disappointing and hard for her
23:01She's amazing how she's managed to rally through
23:04And with the help of her partner and her family
23:06But often us as the GPs get very involved
23:08In any sort of social support
23:10Or anything else that we need to do
23:11Allowing her to live her life
23:13To its maximum potential at the moment
23:15Despite the disabilities that the MS has thrown in
23:17I have had very low mood
23:20Do you think that was due to being in hospital?
23:23Or do you think it's just
23:24Yes, it was being in Rome on my own
23:27Completely on my own
23:28Gosh
23:29There was no pictures on the walls
23:32No TV
23:33I just had plain walls to look at
23:35Or a window that I could look out of
23:39And I could see the tree
23:42In the distance
23:44And see the wind blowing the leaves on the trees
23:47And I used to watch the sunrise
23:50And the sunset
24:08Are they itchy?
24:10A little bit
24:13They are really long
24:14They're kind of scary
24:15They do look a bit scary, I know
24:18And is it not just like
24:20When you open your eyes
24:21This is just black
24:23Like this
24:24Yeah, it is
24:25Yeah
24:25Really?
24:26But is there like a black line
24:27At the top of your vision?
24:28A little bit, yeah
24:29But I can see though
24:31My vision
24:31Still clear
24:33God, they're massive
24:34Yeah, like spider legs, aren't they?
24:39Hi
24:44They were really worried about you
24:46You were poorly, weren't you?
24:47I was really ill
24:48I didn't realise just how ill I was actually
24:51I was talking about people that weren't there
24:55I was also having
24:58My nights were filled with dreams about my son
25:03Okay
25:03Who died
25:04Yeah
25:04That was on my mind constantly
25:07And what I did wrong and where I went wrong
25:10If you're starting to get muddled
25:11Which you may not realise
25:12Because we often don't if we're getting confused
25:14But the people who know you really well
25:16And start thinking
25:16Mum, you're talking rubbish
25:18Yeah
25:19You know, if you start having funny, vivid dreams
25:20Something
25:21Come to us sooner
25:22You've lost a lot of weight
25:24Because you've been gone for such a long time
25:25Hiding in the hospital
25:26I know
25:27I know
25:27And I've missed you
25:28And I've missed, you know
25:30Well, we can book again
25:31And book our routines back again
25:33And things to do it
25:34Yes
25:34I'll get these bits and pieces sorted out today
25:37Thank you
25:38I've changed your prescription
25:39As per what the hospital sent us
25:40A list of what you were on
25:42Do you need more of them today
25:43Or have you got enough of everything at the moment?
25:45I think I've got enough at the moment
25:47Just for the next month
25:48And let's go and make an appointment
25:49For a few weeks at the desk
25:50So at least then we can
25:51Thank you
25:52That's it
25:53I'm going to
25:53I think I've done everything
25:56And I'll do Tav's prescription
25:57Oh, lovely
25:58Thank you very much
26:05So Michael
26:06Straight on the bed
26:07Is that all right?
26:07On the bed
26:07Oh, yeah, sure
26:08It was okay on Monday, wasn't it?
26:11Yeah, it was okay
26:11You tolerated it okay?
26:13And this time I took some painkillers ahead of time
26:15Well done
26:15If this has not improved within four weeks
26:19Yeah
26:19You have to be referred to tissue viability
26:22If there's no improvement after four weeks, okay?
26:25Tissue viability
26:26Yeah
26:26You know you said
26:27That they think the ulcer has come from
26:30Because you're veiny
26:31Yeah, because they did the ultrasound
26:34I've been having a look
26:35Okay
26:35Sickle cell
26:37Is well known
26:39To cause ulcers
26:40Yes
26:41So sorry
26:42It's okay
26:46Are you on antibiotics for this?
26:48No, no, I'm not
26:48You're not
26:49In the first week
26:51They gave me amoxicillin
26:53See, amoxicillin
26:54So now I'm not
26:55The first line
26:56It's not what we would give you
26:57Okay
26:57For wounds
26:58We would give you flu clocks
26:59I'll get one of the doctors
27:01To send one across for you
27:03Yeah
27:04It has improved, no?
27:06Am I wrong in thinking that?
27:08I'm just going to swab it
27:09Sorry, Michael
27:10That's okay
27:11I actually don't feel that
27:13That's because you're high on painkillers
27:15Probably
27:18Yeah, I think you definitely need flu clocksacillin
27:20Because there's a smell to this
27:23There is, yeah
27:23Yeah
27:24And it's got a green tinge to it
27:27And green is pseudomonas
27:30It's that thick bit
27:32In the middle
27:35It's so hard to moisturise as well
27:39Yeah
27:39Because everything you put on your leg
27:41The plasters won't stick to after
27:44So
27:44You okay?
27:45You need help with that
27:46No, no, it's okay
27:47I think I got it
27:48This one is
27:49That one is opening
27:50It's longer so it's a bit tight
27:53So when I'm out
27:54If I'm moving
27:55Yeah
27:55It's good
27:56Yeah, but because you've got an ulcer
27:58At the ankle area
27:59You've got to be more prone to swelling
28:01Yeah
28:02So if you cut your foot at all
28:05Straight to the doctors
28:06And say
28:07I've had an ulcer
28:09Oh, okay
28:09Yeah, because now you've had one ulcer
28:12You can have another
28:13You can get more, unfortunately
28:14So all done
28:16Well done
28:16Thank you
28:17Okay
28:17All good, yeah
28:18Yeah
28:19Thank you very much
28:20I'll leave you to it
28:21Let us send this off and see
28:23But it does take about six weeks
28:24Okay
28:25For the results, okay
28:26Don't forget to book my appointment
28:29Get out
28:30I'll phone up to book
28:31Yeah, thank you
28:32You see why he joined me
28:35Yeah, it's because it's me
28:36Yeah
28:37Take care
28:38Thank you
28:42We're going to end up breaking that chair
28:44And then we're not going to know how to fix it
28:45I'm trying to push it up
28:48Oh my god, it's not going up
28:49Do you know how to push this chair going up?
28:52Do the thing
28:54You have those magic hands
28:55I don't know how
28:58Go on, my babes
28:59Thank you, my babes
29:01Oh
29:01I'm sorry
29:02I feel like I'm going to fall
29:03Oh
29:04How do I send it back forward?
29:06It's the other
29:06Oh
29:08You touched it
29:09And now we're broken
29:09I didn't
29:10She held it at first
29:11You're blue
29:13Hiya, I've got an appointment
29:18Come and have a seat
29:19Nice to see you
29:20So I'm Dr Pearson
29:21Nice to meet you
29:22Now, how are you?
29:23I'm good
29:24Good, good
29:25In the last month
29:27I've noticed that my balance is a little bit off
29:29Okay
29:29And I was just up
29:31Visiting my mum up in Newcastle
29:33I was talking to them about it
29:35And they said it could be an inner ear thing
29:38Yeah
29:38Yeah
29:39So tell me what happens when you feel your balance is off
29:41I just feel a little bit wobbly when I stand up
29:45Okay
29:46Yeah
29:46So as soon as you get up
29:48Yeah
29:48Do you feel you're falling to one side?
29:51Yeah, a little bit
29:52Okay
29:53Falling to the right, I think
29:55Okay, tipping over to the right a bit
29:57Yeah
29:57And have you ever passed out or collapsed or fainted or anything like that?
30:01No
30:01No
30:01Does it ever happen when you're at rest or just lying in bed or sitting down?
30:05It's only when you stand up and things, is it?
30:07Yeah, or walking
30:08Or walking
30:09Yeah
30:09Okay
30:09Do you get any visual problems or headaches or anything?
30:13I'm visually impaired but other than that, no
30:15So tell me about your eyesight, what's happened to your eyes?
30:18So I, it started, I was born blind and then they figured that out when I was 10 days old
30:24Oh gosh
30:25Um, I was rushed into surgery at 10 days old and I regained sight in my left eye
30:31Wow
30:31But I haven't noticed this balance thing recently
30:34Before?
30:35Okay
30:35And it was glaucoma, was it?
30:37Yeah, it was
30:37Yeah
30:38Okay, so that's rubbish, isn't it, to have that when you're done
30:41A little bit, yeah
30:42So you've been able to sort of school and go through things you can see after?
30:45I live independently
30:46Brilliant
30:47Have a job, you know, yeah
30:49Just a couple more questions with it
30:51Yeah
30:51Have you noticed any change in your vision though?
30:53No
30:54Above what normal is for you?
30:55Like, you don't think it's anything to do with your eyes at all?
30:58No, and that's always my go-to, is my, if my vision changes, immediately go to the ophthalmologist
31:05But no, there's been no change
31:06And there's no way you're pregnant when you're pregnant?
31:08No, no, definitely not
31:09Definitely not, okay, alright, I'll let you get away
31:11Any young woman who's dizzy and feels a bit funny?
31:13Oh, I know
31:14It's been several months
31:16Oh, alright, so we'll put that one aside
31:18Yeah
31:18And you recently had some blood tests
31:20I have, yeah
31:21Your blood count is lovely and normal, your liver's lovely, your thyroid, your vitamin D, your diabetes test is clear
31:27as a whistle
31:27The only one was your kidneys were a little bit dehydrated on that day
31:31Okay
31:31So we just wanted to repeat it
31:33Can I do things like check your blood pressure while you're here?
31:35Yeah, of course you can
31:36Alright, let me just grab my machine, so this just goes on your arm
31:41Okay, and this will just take a minute
31:44I've had blood pressure taken so many times in the hospital
31:48Oh, I'm sure you have, you're a pro at it all now
31:50Yeah, 26 surgeries on my eyes
31:5326?
31:54I know, it's crazy
31:55More planned and things
31:57Well, presumably in my life, but I mean, things are stable right now, so
32:03One, two, five, seventy-five
32:04So that's good news
32:06Have you had any cough or cold recently or picked up a virus on the tube?
32:11No, no ear pain?
32:13No
32:14Can I have a look in both of them?
32:15Of course you can
32:15So just me prodding them a little bit
32:17Let's just have a look
32:19Do you ever get itchy ears?
32:22Sometimes
32:22Do you ever sort of put your finger in your ear and want to scratch them and itch them a
32:25little bit?
32:25Because the ear canal looks quite sort of red and a bit angry
32:29I mean, do you wear AirPods or anything like that?
32:31Yeah, it's just sometimes that can inflame
32:34But that's not really the inner ear, which is what affects balance
32:38And that's a little bit the same that side, actually
32:40But the eardrum looks lovely
32:41There's not lots of fluid in it
32:43There's not lots of wax
32:45It looks good
32:45I mean, that's sort of incidental
32:47More sort of outer ear
32:48Do you do swimming?
32:49No, I don't
32:50One thing I can do to get help with the ears a little bit
32:52Is that there's a very good spray that we can use to try and clear the ears
32:55Okay
32:55To stop sort of any irritation and itch
32:57And it'll get rid of the redness for you
32:58But I still think we need to find out what's causing this
33:01Yeah, the weird balance thing
33:03Can I just have a listen to your heart?
33:06Of course you can
33:07Because you don't need to move or anything
33:08I'm just going to put this on your chest
33:09I'm just going to put it in
33:10Just listen to your heart for a second
33:14Sorry, that's my phone, not my heart
33:16No, that's alright
33:21Strong, normal, going lovely and steady and things
33:23Balance is controlled in our inner ear, inside
33:25Which is strange
33:26Which is strange, isn't it?
33:27But sometimes when we have some sort of ear symptoms
33:29It can change the blood flow a bit to our ears
33:32And make us feel a bit odd
33:33So I think it'll be interesting to see if the spray makes any difference
33:36So you can have it in your bag
33:37And just take it as and when if you do need it
33:40Still doesn't answer what it is
33:41So we still need to come back to investigating it
33:43I just want to do an ECG as well
33:45A reading of the heart
33:46Now I'm sure you've probably had lots of them
33:47If you had loads of anaesthetics and things of you
33:50Your bloods are good
33:50But we'll double check those anyway again
33:52And then we'll sit down and go through it all
33:54And see how we're getting on
33:55Thank you so much for your help
33:56Not at all, so we'll see you on Thursday
33:58Sounds good
33:58And you're going to the chemist to pick up everything
34:00Yes
34:00Alright
34:00Thank you
34:01Okay, nice to meet you, Margaret
34:02You take care, look after yourself
34:04All the best, bye-bye
34:05Bye
34:13No, I'm not
34:14I think you're looking really well
34:15I'm happy to see you
34:16Likewise, come through, it's been a while
34:19Lots of stories to tell you
34:21Good, good
34:21Take a seat, make yourself comfortable
34:26Right, okay
34:28I'm suffering complete panic attacks
34:30When I'm in my flat
34:33It can come on just like that
34:35I have to get up and go out the house
34:36Is there a tablet that can help me
34:38Just calm down when it comes on me
34:41Where I don't have to feel that way
34:42What sensations do you notice when it happened?
34:46A lot of fear
34:47I've got fear
34:48I think sometimes I might die
34:51And I've got to get out
34:52I've got to see people
34:53I feel closed in
34:55So closed in
34:56Yeah
34:56And that's happening quite a lot lately
35:00And it's frightening me
35:23Is there a tablet you can help me
35:25I mean there is
35:26But they're highly, highly addictive
35:27That's the problem
35:28What is it?
35:29Diazepam
35:30If you had very physical symptoms of anxiety
35:32Where you were having palpitations
35:33If you're sort of very sweaty
35:35A bit tremulous with it
35:37Then there's a beta blocker we can use
35:38Very safely
35:39Oh yeah somebody said you could give me a beta block
35:42Yeah propranolol we can try that
35:43But it doesn't sound like that's the symptoms you're experiencing
35:46Because I get in a really bad state
35:47Even at half two in the morning
35:49I come out of the house
35:51Because I'm panicking
35:52At two in the morning?
35:53I do honestly
35:54I wouldn't do that
35:54Because I know I have to come out
35:56How's the smoking going as well by the way?
35:59Oh yeah I'm still off the cigarettes
36:00Well done
36:01That's incredible
36:02That's really good
36:03Yeah but there is another problem
36:05There is another problem
36:06Go on
36:07When you stop smoking you eat more
36:09You eat more exactly
36:10Yep
36:10This is what I wanted to ask you today
36:13I would like you to give me that Majora injection
36:16The difficulty is on the NHS at the moment
36:19They say we can only use it if the following criteria are met
36:22Your BMI is over 40
36:24And we can calculate that today
36:25And you've got four different medical problems
36:28So the arthritis and the hip pain absolutely counts as one without a doubt
36:32But then they've got to be things like diabetes
36:35High blood pressure
36:36High cholesterol
36:37All of those other bits
36:38Well I must have all that
36:39Look at the size of me
36:41I mean your diabetes marker is nice and low
36:43Your cholesterol is high
36:44So I'll give you that
36:44There's two
36:45Can we check your weight today?
36:47Yeah
36:47Yeah let's give it a go
36:49You know since I stopped smoking I put on more weight
36:52Well of course you will
36:52Absolutely
36:53And the weight loss will help
36:54Definitely take the pressure off
36:55Wait on
36:56Sorry
36:57No it's alright
36:58Don't worry
36:58Can you manage?
37:01Lovely
37:01Good
37:02Are you okay?
37:03Nice and steady
37:04I need to let go
37:05Because it's going to affect that
37:06Just for a second
37:07So 86
37:08Fine
37:09Don't tell me what it is
37:11Okay fine
37:11Don't tell me what it is
37:12There you are
37:13Lovely
37:13Right let's check
37:15I mean your BMI is 35
37:17I don't know what it should be
37:19It should be less than 25
37:21Oh
37:22Yeah
37:22It's a bit high
37:23I was thinking maybe if you gave me that for a little while
37:26While I had the operation
37:28Yeah
37:29And then I wouldn't have to stay on it
37:32You know what I think we can make a case for it
37:34I think it will really benefit you
37:35I really do
37:36And I'm sort of not saying that lightly
37:38Thank you
37:38But guidelines are there for a reason
37:39They're just a guide
37:40They're not sort of set in stone
37:42We are seeing more and more people come to the surgery
37:45Asking for Manjaro prescriptions
37:47We are quite limited however
37:48With who we can and can't initiate it for
37:51Alice is waiting to have a hip operation
37:54I felt that by giving her Manjaro
37:55It would help to optimise her for surgery
37:58So it's a short term measure for her
37:59Really just to help bring that weight down
38:01Nice and quickly
38:01To make it a little bit safer for her
38:03To go under general anaesthetic
38:04How do you feel about giving yourself an injection
38:07I'm not worried about any of that
38:08Okay great
38:09I just want to have this operation done quickly
38:13I'm willing to do anything to get out of pain
38:16Yeah it's not nice to be in pain
38:18And maybe when I've had all the pains gone
38:21I might have a holiday
38:22You should definitely treat yourself
38:24After 18 years
38:25Absolutely you deserve it
38:27So yeah see how you get
38:28Okay thank you very much
38:29My pleasure you're very welcome
38:30You are lovely
38:31Thank you very much
38:33Bye
38:33See you later
38:40I play hockey
38:41Do you enjoy it?
38:42Yeah I love it
38:43I couldn't live without it
38:44Recently I've just been playing a lot of rugby football
38:47I think it's just taking its toll
38:49So you're feeling a bit more nice
38:50I played tennis a while ago
38:53And I just kept playing too much
38:54So it hurt then
38:56When I was playing a rugby match
38:57I hit my head
38:58Okay
38:59It was a mild one
39:00But then the big one was on my knee
39:01I was worried that it might be internal bleeding
39:04Because there's no bruise or anything
39:05I get an occasional sort of quite bad twinge
39:08But it does affect the only couple of sports that I do
39:11Which are archery and pistol shooting
39:14I took a hard hit a couple weeks ago
39:16Straight through the shoulder
39:17They actually thought I got knocked out
39:19Because I was down for a little bit
39:20So were you going in for the tackle?
39:23Or were they tackling you?
39:23You got taken out
39:24You got taken out
39:25And then I played Aussie Rules over here
39:27I just noticed it was quite sore
39:29Because Aussie Rules is quite physical
39:31You obviously enjoy that
39:32You want to get back to it
39:33Yeah
39:33So that's fair enough
39:38Sully
39:38Oh yeah
39:39Hello
39:39Hi let me call you back
39:40But I'm about to go into a GP appointment
39:42That's fine
39:42That's it
39:43No no I'll call you back in two minutes
39:48Hello
39:50Hi sir come and have a seat
39:51Come and take a seat
39:52I'm Dr Pearson we've met before haven't we
39:54Yeah definitely
39:54Now how are you
39:55Nice to see you again
39:56You're looking well
39:56It's been a few years
39:57It has been
39:58It has been
39:58How are things
39:59It's been alright
39:59Yeah yeah
40:00I just graduated from uni this year
40:01Oh congratulations
40:01What did you get
40:02What did you do
40:03So I get my results at the end of the month
40:05And I did criminology and criminal justice
40:07Criminology
40:07Oh my lord
40:08What are you going to do with that then
40:09So there's a variety of things I can do
40:11Lawyer
40:11Forensic science
40:12Police
40:13Police
40:13Yeah definitely
40:14Oh it opens lots of doors doesn't it
40:16Well congratulations
40:17That's brilliant
40:17I remember you when you were little
40:18So I think you graduated from uni
40:20I feel very old
40:21So tell me what's brought you in today
40:23So I had a jiu-jitsu incident a couple weeks back
40:26With my eye
40:27So there was like a clash of heads as we were sparring
40:30Oh dear
40:31And then I have a bit of eye trauma
40:34Redness
40:34Redness
40:35Yeah
40:35There's been like no pain or anything
40:37But I just wanted to get it
40:38Get it checked
40:38No absolutely
40:39So tell me
40:40So it was a couple of weeks ago
40:41A couple of weeks ago
40:41And what exactly happened
40:42So when we were sparring
40:44Our heads accidentally clashed
40:46And then
40:47It was initially around here
40:49But then
40:50It wasn't until I got home
40:51That I noticed the redness of the eye
40:54And did you have any sort of
40:55Loss of consciousness
40:56Did it knock you out
40:57Or anything like that
40:58No I was fine
40:59Did you vomit or pass out
41:00Anything at the time
41:01Good
41:02Good
41:02Okay
41:03Let's just have a look at your eye
41:04Just to give my dad peace of mind
41:06Is he a worrier?
41:08He's the one who sent you here
41:09Yeah
41:09I went to Parsons Green Clinic
41:12And he was saying
41:13Oh they're not like the doctors
41:14They're nurses
41:15But I was like
41:16They're more than uniquely qualified
41:17To go
41:18It's tricky isn't it
41:19Because I think the old fashioned thing
41:20Is that you see the doctor
41:21But actually
41:22There are lots of really qualified people
41:24Like the chemists
41:25The pharmacists
41:25Are amazing at dealing with things
41:27At Parsons Green
41:27We have paramedics
41:28And people often
41:29Who are seeing patients
41:29And what they are particularly good at
41:31As well
41:31And you can tell that
41:32Is that
41:33If they think
41:34They're not sure about it
41:35They have a very left
41:37Threshold
41:37For phoning us up
41:38And going
41:38Can you see them
41:39I think you did the right thing
41:40You did the right thing
41:41You can tell dad
41:42That I'm very happy
41:43Do you know what
41:43I'd be happy to
41:44Call them right on
41:45They are really good
41:46I just want to have a look
41:47At your eye
41:47So if you say straight ahead
41:49I'm just going to shine it
41:50In your good eye first
41:52Okay
41:53And if I
41:53Can I just put your eyelid down
41:55So I can see the redness there
41:57And if you look over
41:58Towards the wall
41:58Sort of that way
41:59That's it
42:00And you can move your eye
42:01Around okay
42:02And if you stare at my finger
42:04Okay
42:05And just follow it
42:06With your eyes
42:08Do you ever see double
42:09Or is that okay
42:10No it's okay
42:10So the pupils
42:12Which is the black bit
42:13In the eye
42:13That opens and closes
42:14Is doing exactly
42:15What it should be doing
42:16The back of the eye
42:17Looks lovely in here
42:18But it doesn't look
42:19I can't see any bleeds
42:20Or anything horrible
42:21To be honest
42:21If there was
42:22Your vision would be affected
42:24You'd have lots of floaters
42:25And funny things
42:26And you wouldn't be
42:26We all get the odd floater
42:27But you'd have big splodges
42:28In your vision
42:29Things like that
42:30So I think the eyeball
42:31Is okay
42:32The problem is
42:33The tiny little blood vessels
42:34On the surface
42:35It just takes a bit of a knock
42:36And they bleed
42:37It's a burst blood vessel
42:38I think
42:38She said it was
42:39A subcontravital hemorrhage
42:40That's it
42:41Hemorrhage
42:41So it sounds like
42:42A drastic
42:44Subcontravital hemorrhage
42:45It's just a bad blood vessel
42:46It's a tiny little
42:47Bad blood vessel
42:47And it shouldn't affect
42:49Your vision
42:50So the key is
42:50If your vision
42:51Starts getting affected
42:52If you start getting headaches
42:54If you start vomiting
42:55If something strange happens
42:56You come and see me
42:57Straight away
42:58Okay
42:58Well done
42:59And good luck
42:59With your results
43:00Yeah
43:00Thank you so much
43:01All right
43:01But you take care
43:01And just let me know
43:03If anything changes
43:03All right
43:04Take care
43:05Bye bye
43:05Not at all
43:06Nice to see you
43:07You too
43:07All right
43:08We'll take care
43:09All the very best
43:09Take care
43:10Bye
43:12Well thank you Emily
43:13Well done Doris
43:15Nice to see you next Thursday
43:16Yes
43:17You take care
43:18All right my love
43:19Thank you
43:20Lovely to see you
44:05You take care
44:20Last night, I probably got up 20 times.
44:23I feel like I'm not going to breathe no more.
44:25Scary, isn't it?
44:26You know that you had a toe taken off?
44:28Yeah.
44:28That was because the blood supply to the toe wasn't great.
44:32Because my toe was black.
44:33I just black out.
44:35And when you wake up?
44:36I just lie there and I think what in God's end am I doing?
44:39I'm down here.
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