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00:08Warning surgery.
00:11When I had my blackout faceplant, I just go boom.
00:17I've had 38 surgeries in 25 years.
00:23I haven't had my period in 7 months.
00:25Okay, that's a whole other story.
00:30How much higher is it?
00:31Your blood pressure at the moment was 172 over 111.
00:36Jesus.
00:37Exactly.
00:40Do you mind if I draw on your face?
00:42No, I don't.
00:52I'm not liking the look of this. I'm a little bit worried.
00:55Good morning.
01:11Good morning.
01:31Stephen.
01:32Doctor.
01:33Hello.
01:37Can I have a seat?
01:40My arthritis at the moment, Doctor, has gone on another scale.
01:47Really, yes.
01:48Yeah.
01:49I've got arthritis in my right knee.
01:51Yeah.
01:51I've got arthritis in my left knee.
01:52So I'm struggling walking both of my wrists.
01:56I'm having this mental health issue again because of the way I'm feeling.
02:02I want to be active, but I can't be.
02:04Because something's hurting?
02:05Yeah.
02:06The bottom of my feet are hurting.
02:08Can I have a look at your feet, please?
02:10Is that all right if you just pop your shoes off?
02:11Yeah.
02:18Can you feel that touch?
02:19Yeah.
02:20Yeah.
02:22Ticklish.
02:23Yeah.
02:24Is there any tenderness around pressing?
02:26There.
02:26Yeah.
02:26So here?
02:27There.
02:28So a lot of pain around this area can be caused by a condition called plantar fasciitis,
02:32which is inflammation of the soft tissue on the bottom of the foot.
02:36That may be what's giving you this grief, actually.
02:39Yeah.
02:39So what do you take to manage the arthritis?
02:42Nothing.
02:43Right.
02:44I've never been prescribed anything for my arthritis.
02:46Can I ask you about alcohol?
02:48No, I don't drink.
02:49Fifteen months now.
02:51Well done.
02:51Okay.
02:51Since I've quit drinking, I have put on a little bit of weight, you see, because I'm
02:57no longer going for the drink.
03:00I'm going for something else, maybe a snack or something.
03:03Yeah.
03:04And what kind of snacks?
03:05Sweet.
03:05Sweet.
03:06So a lot of these kind of ultra-processed snacks do actually trigger inflammation in the body.
03:12And then, like I said, other things like, you don't smoke, do you?
03:16A few.
03:16Okay.
03:17Not many.
03:18Even smoking as well has an inflammatory effect on the body and cutting that down,
03:22stopping, could help as well.
03:25There is the option of going for a topical treatment, so a cream that you put on.
03:29You ever use Volterol gel?
03:30No, no, no.
03:31So it's anti-inflammatory medication, so really good at reducing inflammation in joints,
03:36improving pain, and you just put it on the area.
03:39And just let me know how you get on with it, okay?
03:42I'm going to send something to you now.
03:43There's good evidence that physical activity is beneficial for people with joint problems,
03:48whether it's arthritis or something else.
03:50So, yeah, if we can get your pain well managed, I would like you to be being active,
03:56because the long-term benefits are a net positive for you, okay?
04:02And do you know what it's really good for, especially? Mental health.
04:05Yeah, yeah, yeah.
04:06But I do think that whilst it might be hard now, putting that effort in now may pay dividends in
04:15the future,
04:16and it would become easier.
04:17Even whilst you're talking to me and explaining this to me, it's kind of like making me feel better.
04:24You know?
04:24You've had a little nudge.
04:25That's what you need, doctor, sometimes, you know?
04:28You know, you get stuck in the spot, like, you know, and you don't want to move from it, like,
04:31you know?
04:32Yeah.
04:33Okay.
04:33Can we circle back in a couple of weeks and just let me know if anything has changed, hopefully for
04:39the better?
04:39We are only giving you a cream for this pain, and I want to know that it is actually helping.
04:44So, two weeks' time, then. Can we agree on 10.45?
04:48Fantastic.
04:49That'll be on the 14th, Tuesday.
04:50Fantastic. 10.45.
04:51You'll get a text message.
04:53Okay, then.
04:54Well done, doctor.
04:55Thanks.
05:02Josie?
05:02Oh, yes.
05:03That's me.
05:04Hi there.
05:05Come on through.
05:06Nice.
05:07So, take a seat.
05:07Oh, thank you.
05:09You came with a bundle of letters?
05:11Yes.
05:12Some of them are NHS.
05:13Some of them are from DC.
05:15Okay.
05:16What's brought you in here today?
05:17I just moved, so I need a new GP, and I have Crohn's disease, so I need someone to help
05:24take care of that.
05:24Absolutely.
05:26We're happy to do that.
05:27Crohn's disease is a chronic disease, and it essentially is caused when anywhere from the digestive tract from the mouth
05:36to the anus becomes inflamed.
05:39So, essentially, that manifests with tummy pain and diarrhoea, sometimes blood in the diarrhoea.
05:46How old are you?
05:4717.
05:48How was it diagnosed?
05:49I was complaining of a stomachache for about three months, and then I lost the ability to digest food and
05:54end up in the hospital for ten days.
05:56Okay.
05:56Okay, so that must have been quite scary.
05:58I was very out of it during the entire period.
06:00Fair enough.
06:01So, since you were 17, so you're 23 now.
06:05Yes.
06:05Have you had many flares of your Crohn's disease?
06:08It's been pretty decently managed.
06:10I basically just take care of it, not to anger it.
06:14And are there specific things that you've noticed that are triggers for it?
06:18Whole nuts, seeds, and raw greens.
06:21How is your tummy?
06:22Do you have any pain in the tummy?
06:24At the moment, I'm pretty decently managed.
06:26I'm in the middle-ish of my cycle.
06:28Okay.
06:29So, I'm due for an infusion in about four weeks.
06:32So, you're on infliximab infusions?
06:33Yes.
06:34And do you have that infusion sorted?
06:37I think so.
06:37Okay.
06:38Well, that's good.
06:38Yes.
06:39Okay.
06:39And any other issues?
06:41Any rashes or...?
06:43I haven't had my period in seven months.
06:44Okay.
06:46That's a whole nother story.
06:47Yes.
06:47I know that's a whole nother story.
06:49Okay.
06:50So...
06:50And I am not sexually active.
06:52Okay.
06:55And...
06:56No.
06:57No.
06:58And have they been regular up until that point?
07:00Absolutely not.
07:01Not regular.
07:02Well, they were regular, then I got Crohn's disease, and then they became chaos.
07:05Okay.
07:05So, this isn't unusual for you?
07:07Yes, but seven months.
07:09Seven months is a long time.
07:10Missing like a cycle or two isn't unusual, but...
07:14Over kind of that six-month period, we tend to look into it a little bit more.
07:17Yeah.
07:18So, if you're happy for me to organize a blood test looking at hormonal levels, and we can do an
07:23ultrasound scan.
07:24If we're still in a position where in, you know, coming up on a year, you haven't seen any periods,
07:31then definitely we'll be sending you through to the gynecologist.
07:33Yeah.
07:34Don't get me wrong.
07:34I'm pretty delighted about it for just the not wrecking underwear reasons, but it's also kind of concerning.
07:40Yes, you should be having a period, you know, at least every three months.
07:45Obviously, when you have a significant illness, it definitely impacts our hormonal balance and things like that.
07:50But, you know, you are kind of six years into this, and it's worth looking into.
07:54Yeah.
07:54So, if you drop these to reception, book in a blood test.
07:59Okay.
07:59I'll make a referral for an ultrasound scan of your pelvis to see if there's anything going on in the
08:04ovaries or within the womb itself.
08:07You should be hearing from the gastroenterology.
08:09Great.
08:09And if I'm pregnant, I get to start a new religion.
08:13Well, just let us know if that's the case as well.
08:15Yes, if that's the case, we have bigger problems.
08:17Yeah.
08:17Okay, Juicy.
08:18It was nice to meet you.
08:19Nice to meet you too.
08:20Bye.
08:21Hello.
08:22Bye now.
08:33Let's fill this up somewhere.
08:35Do you have water?
08:37Do you want me to get, I can get you some.
08:38Is that okay?
08:39Yeah.
08:49Thank you so much.
08:50There you go.
08:51Sorry, I dropped the link.
08:52It's okay.
08:54I'm Dr. Dungeon.
08:55Nice to meet you.
08:56Nice to meet you.
08:56So, what can we do for you?
08:57I need to get another search and repeat prescription.
09:02Okay.
09:02I went travelling to Asia and Australia in January 20, 24.
09:08Yeah.
09:08So, basically, just before I went, my GP, this was in Devon, where I used to live,
09:13um, prescribed me six months.
09:16Yeah.
09:17Of a hundred milligrams.
09:18Okay.
09:18So, it would last me.
09:19Yeah.
09:20I see.
09:20So, you've just been on 50, though.
09:22So, how are you feeling on the 50?
09:23Yeah, fine.
09:24I had, like, maybe four or five days where I just, like, didn't take it because I, like,
09:31didn't have it.
09:31It was weird.
09:34Okay.
09:34So, you sort of noticed.
09:36Yeah.
09:36Yeah.
09:36My head was, like, doing that, like, tingly thing.
09:39And I felt really dizzy.
09:40And I was, like, profusely sweating.
09:42And I was, like...
10:02For the first, like, two days, I was, like, oh, like, whatever.
10:05Maybe I'll just, like, see if myself off.
10:08Yeah.
10:08Because I'm very aware that it probably needs to happen at some point.
10:11We do know you shouldn't stop it suddenly.
10:14Okay.
10:14So, some of that might have been that you kind of just stopped abruptly rather than the
10:18fact that you wouldn't be able to manage without it.
10:21There's also no need to come off it.
10:22Yeah.
10:22So, if you feel good on it, there's no rush.
10:24Yeah.
10:25Like, honestly, when I'm...
10:27Don't know why I'm going to cry.
10:28I feel so much better.
10:29Good.
10:30You're sorry.
10:30I don't mean to be upset in here.
10:31I literally just cried at everything.
10:34But you say on it your mood feels good.
10:37Yeah.
10:37I'm a very emotional person and I still feel, like, everything like that.
10:43But it's not, like, a constant overwhelming.
10:47It just completely eliminates that.
10:48And I feel the things that I feel a normal amount of anxiety as opposed to, like, a complete
10:56consumption of life, which is horrible and I don't want that.
11:00So, was it more of anxiety you went on it?
11:01Yeah.
11:02Yeah.
11:02Yeah, I, like, went through, like, a two-year bout of, I want to say, like, anxiety-based
11:08depression.
11:08Yeah.
11:09Obviously, some people go on medication and then really want to come off it.
11:11And some people actually think, well, actually, I feel great on it.
11:14I'd rather stay on it.
11:15I would.
11:16I would rather stay on it.
11:16And that's fine.
11:17And it may be that at some point you feel actually you'd like to try without it.
11:22And we can support you through that as well.
11:23But don't do what you did last time and just suddenly stop it.
11:26Because that is when you can get kind of withdrawal side effects and things.
11:29Yeah.
11:29Did you have talking therapy and things in the past?
11:31Oh, I've literally tried everything.
11:33I mean, we can always increase the dose and the medication.
11:35Yeah.
11:36Talking therapies will always be there.
11:38Yeah.
11:38But I suppose it's, it's what you feel would be helpful for you.
11:41I don't, I don't really want to increase because I don't want to become, I know obviously
11:45right now I'm not addicted to them, but I'm reliant on them.
11:49It would be nice to, like, see an exit.
11:52Okay.
11:53But I think I'll just be on them for a little time.
11:56You mean about, you mean see an exit as in coming off them?
11:58Yeah.
11:58Yeah.
11:58There is no need to come off them.
12:00I wouldn't put that kind of pressure on you.
12:02Yeah.
12:02You know, if you end up on them for years and years, that's okay.
12:05They're not addictive in that sense.
12:07Mm-mm.
12:07What talking therapies do you, do you guys have?
12:10So back on track and they would assess you and then they can kind of decide whether it's
12:14counselling, CBT.
12:16Mm-mm.
12:16So you can do that at any point.
12:18But if anything gets worse in the mood or you feel actually you're struggling a bit more,
12:23especially going into winter having been in-
12:24Yeah.
12:25Have you been in Australia?
12:26Yeah.
12:26Yeah.
12:26So, yeah, so.
12:28It must have changed.
12:29Slight change with the weather.
12:32So.
12:32But, you know, some people and some people do find that really hard.
12:35You know, British winters are something, a quiet taste.
12:39So miserable.
12:40So, yeah, so if you find that that's sort of triggering things, having spent a couple
12:44of years in Australia and lovely sunshine.
12:46Yeah.
12:46Then we'd rather you came in sooner.
12:48Okay.
12:48And we're here to help.
12:49Cool.
12:50Perfect.
12:50All right.
12:51Nice to see you.
12:53Thank you so much.
12:54Have a good afternoon.
12:55Bye.
13:01David.
13:05Yeah.
13:05How are you?
13:06I'm good, yeah.
13:08I can't see you yet until I get apart.
13:11We're going to go this way.
13:11Is that all right?
13:12A yard in front.
13:14Yep.
13:15Come have a seat here.
13:16I'm actually nervous.
13:18Why are you nervous?
13:19Well, because I got a phone call this morning saying I was going to be having a small operation.
13:25Ooh.
13:26That's not true, is it?
13:27I think I was just going to have a look at your, what was...
13:29Oh, I know you're going to look at that, but you're not going to operate today, are you?
13:32I'm not going to operate today, no.
13:33No.
13:34Or tomorrow, or next year.
13:35Because the thing is, there's no pain at all.
13:38Right.
13:39Does it ever not go back in?
13:42No, it doesn't go back in.
13:44Well, have a look.
13:45Yeah.
13:45Do you want me to take my shoes off?
13:46No.
13:47No.
13:47We can leave them on.
13:51No, I'm not overweight.
13:53Yeah.
13:53And I'm not ready for a nursing.
13:56Yep.
13:57Perfect.
13:58Yes.
13:59Can you relax back?
14:01This is what you're worried about, this bit.
14:03Yep.
14:05It's not painful, no?
14:06No.
14:06No, no, no.
14:07So this is your bottom of your sternum, there, and your ribs all go into it, yeah?
14:14Which, the joint which connects to the bottom of the breast bone.
14:19Right.
14:19And that's why it's swollen up a wee bit to heal as it gets better.
14:22Yeah.
14:23I'm going to help you to get up slowly if you can.
14:25I just want to see your muscles as you get up.
14:27Yeah.
14:28So they don't protrude or anything there.
14:30No, you see.
14:31And there's no pain at all.
14:32Yeah.
14:33You all right getting the off door into four?
14:34Oh yes, I'm sure I'll be fine.
14:37I thought it was going to be a hernia, but it isn't.
14:39Well, that's what I thought it was.
14:40Yeah.
14:41You probably damaged it somehow.
14:43Yes.
14:43With one of your falls.
14:44Yeah.
14:47I don't think you need to do anything about this, so no operations today.
14:51No.
14:52And hopefully...
14:53But hopefully it will get better.
14:54Yeah, I think it will just calm down.
14:56Yes.
14:56As long as it's not causing you any pain.
14:58No, I think if I was...
14:59No breathing problems, nothing, you see.
15:01Nothing like that, no.
15:03Well, you're very...
15:03I couldn't have a better doctor, because I feel as if I'm being spoiled.
15:09Well...
15:09And I appreciate it.
15:10Sure you deserve it.
15:11Yeah, yeah, I'm glad.
15:12Don't leave.
15:13I'm not, don't worry.
15:14Not that I know of, anyway.
15:15Don't leave till I've gone to the other planet.
15:18I wouldn't wish to be with anybody else.
15:20Yes.
15:20Aw.
15:21Can you manage?
15:23All right, David.
15:23Lovely to see you.
15:24You take care.
15:25It's very appreciated.
15:26All the best.
15:27Thanks a lot.
15:28Take care.
15:29Bye.
15:32Caitlin.
15:33Hello.
15:34Yes.
15:35Nice to see you.
15:36How are you?
15:37I'm good.
15:37You're looking good.
15:38Thank you very much.
15:39Well, so are you.
15:40Come and have a seat.
15:41So what are we up to today?
15:42I'm 42.
15:43Yep.
15:44I'm starting to feel perimenopausal symptoms.
15:46Yeah, yeah, yeah.
15:46Okay.
15:46So tell me, what sort of things are you getting?
15:48Mainly I'd say brain fog and memory lapses.
15:51Yeah.
15:52Extreme fatigue.
15:53Okay.
15:54You know, one day I'll be okay and the next day it'll just hit me at six o'clock in
15:57the
15:57afternoon and I'm like, I have to go take a nap.
15:59Yeah.
16:00And that's really unlike you, is it, to be a sort of...
16:03And you're 42 now.
16:04Yes.
16:04So it is completely normal.
16:06So perimenopause, we often say we get symptoms up to 10 years before the menopause happens.
16:11Right.
16:11Which we sort of say is around 50, but it could be 45 to sort of 55 almost.
16:14So it's very normal to feel them now.
16:16And all those symptoms you were describing, brain fog and that sort of tiredness, can absolutely
16:21Sometimes I think my brain just doesn't work.
16:22Yeah.
16:23It's very strange.
16:24But then other times I'm quite on it.
16:25You're on it.
16:26And so I don't, yes.
16:27It's still working and...
16:28Yes.
16:29Yeah.
16:29Okay.
16:30And is that going okay?
16:30Or are you finding it's interfering with work or anything like that?
16:33It's interfering with work.
16:34Yeah.
16:34I'm kind of in between things, but still doing some consulting.
16:37And so sometimes I feel like it interferes and I just sit there going, oh my God, I know
16:40the answer to this.
16:42And it's not coming.
16:42I just had this conversation with this person and it's just not coming.
16:45And that's really frustrating, isn't it?
16:46Yes.
16:47What about your sort of mood in yourself?
16:49Are you feeling okay in yourself?
16:50Some people find they feel a bit down, a bit frustrated.
16:53Do you ever find that?
16:54I mean, I do feel I guess sometimes more frustrated with how my body feels and how my brain feels
17:02and then get a bit down.
17:04Okay.
17:04I mean, I wouldn't go as far as to call it anything quite like depression.
17:07No.
17:08But it's effective.
17:09Okay.
17:09And some days are better and I feel like perkier and happier and I don't want to, you know,
17:13smash the wall or strangle my husband.
17:15Yeah.
17:15Yeah.
17:16But there are times.
17:17But there are other times where I'm like, oh.
17:19So I suppose the question is, is that, is this perimenopause, which it does fit lots
17:24of the criteria.
17:25Yes.
17:25There is also things like thyroid problems that can sort of happen at this age as well.
17:29I've read about that.
17:30And these are things that creep in.
17:31Sometimes we're a bit anemic or the blood's a bit abnormal and that can cause some symptoms.
17:34So I'm quite a fan of having a screen just to make sure that we're not missing something
17:41else.
17:41Okay.
17:42Because your symptoms totally fit in with that.
17:44It could also be something else.
17:45But it would be silly to go down one route and actually your thyroid's become underactive
17:48and actually we could have replaced that very easily and you'd have felt a lot better
17:51and we don't want to give you HRT and it doesn't make any difference because we're
17:54treating the wrong thing.
17:55How do you feel about HRT?
17:56If it's necessary and it will help improve my symptoms, I'm all for it.
18:00Well then why don't we do the test and test it for everything and then have a look and
18:04then we can make a plan going forward.
18:06Okay.
18:06Is that okay?
18:07That would be great.
18:09We'll see you for that blood test and then we'll catch on.
18:11Thank you so much.
18:11Okay.
18:11Nice to see you.
18:12Take care.
18:12Bye bye.
18:17It looks really sore.
18:19It looks really tender.
18:21Yeah, so we've got a good amount of swelling at the back of the ankle there and redness
18:25and there's heat.
18:26I've got like a swollen eyelid.
18:28You can see the swelling there, it's a bit red and inflamed.
18:30Straight away we can see that foot's a bit bigger than that foot isn't it?
18:33A bit more swollen.
18:35Yeah, you can see exactly where it is.
18:37What I can see on the outside is a sort of dome shaped lump.
18:41Lift your eyelid up and try and look in, I can see the same thing there so it's like
18:44a decent size.
18:46This hurts up here, this hurts obviously.
18:48I mean I said to the guys at work, you know, I could look like the elephant man but
18:51as long as it didn't hurt, I wouldn't mind.
18:55Mr. Volpe?
19:01Hello Doctor.
19:02First time I see you.
19:04Have a seat.
19:04I know I've spoken to you on the phone lots.
19:07Anyway Doctor.
19:08Yeah, today.
19:09This worries me.
19:11Okay.
19:12What is it?
19:12I thought it was a hole coming off, you know.
19:15How long has it been like that?
19:17About seven or eight days ago.
19:18Before.
19:18Okay.
19:19And before that, no swelling, nothing?
19:21No.
19:22I felt this.
19:23So I say it's a pimple, so you know, you get them everywhere in the neck.
19:28Yeah.
19:28Then it gradually getting bigger and bigger.
19:30I squeezed again, my pink blood, you know.
19:34Now all this is all red.
19:38Any pain here?
19:39Not there.
19:40The only pain I get here, where you see on the ear.
19:45Yeah.
19:45Yeah.
19:47And here, you feel swollen.
19:49Look, a lot swollen.
19:50My concern is that it's quite red and swollen now, isn't it?
19:54Red, yeah.
19:55That is what I found you today.
19:57You see on TV this insect.
19:59I say, could it be one of that here?
20:01I think it possibly might have started out as a bite.
20:04I'm just concerned the infections coming onto your face.
20:07Yeah, up to the eye.
20:08You see the heat, you feel it.
20:10And it's weather giving you all antibiotics is going to be enough.
20:14You do feel a bit in the head, you know.
20:17You feel a bit, you know, like you're too much.
20:19Yeah.
20:20You hear too much, you know.
20:21What I'm going to do is I'm just going to call the ambulatory unit.
20:25Do you want to just have a seat on the chair outside for a minute?
20:27Yes.
20:28And I'll call them.
20:29All right, and I'll call you back in in one second.
20:31Okay, sir.
20:36My name's Dr. Dutch and I'm a local GP.
20:38I just wanted to call you about a 78-year-old gentleman.
20:41So he had a possible insect bite, I think it was around Friday.
20:46And then Saturday it started sort of pussing.
20:47And since yesterday he's had sort of spreading cellulitis.
20:51But it's almost up to his eye and there's a bit of redness below his eye.
20:55And it's really hot and warm to touch and significantly swollen on the left above his ear.
21:00Okay, so it would be A and E.
21:02Yeah.
21:03Okay.
21:20Did you just open wide for me?
21:22Say ah.
21:23Ah.
21:24Ah.
21:25Ah.
21:26Ah.
21:27Wow.
21:27That is spectacular.
21:29Let's take it out.
21:30Or even better.
21:31Ah.
21:32Ah.
21:34Ah.
21:34Ah.
21:34You see, that's quite red but then you've been coughing quite a lot haven't you?
21:37Oops, sorry.
21:38You all right?
21:38I'm just going to press the tongue down.
21:40Yeah, that will...
21:41Ah, sorry.
21:42No, don't worry.
21:43I don't like it either.
21:44Ahem, ahem, ahem, ahem, ahem.
21:47Oscar?
21:48Yes.
21:52Good morning.
21:53How are you?
21:54How are we doing?
21:55No, my name's Anna McHugh.
21:57It's nice to meet you.
21:57Nice to meet you, Doctor.
21:58So, Oscar, what's been going on?
22:01I've got a quite a sore throat.
22:03I've been getting some headaches on this area of my head.
22:06So, how long has that been going on for you?
22:08It started a year yesterday.
22:10Okay.
22:11And have you ever had anything like this before?
22:12Uh, yeah, I had something with my throat around it.
22:17A strep?
22:18Yeah.
22:18Yeah, streptococcus.
22:19Okay.
22:20Um, so, it's kind of been in the last 24 hours that you're feeling like you have a sore throat
22:24and a headache, is that right?
22:26Is it okay if I examine you?
22:27Yeah.
22:28Now, if you open your mouth as wide as you can and say, ah, and say, ah.
22:33Well done.
22:34So, there are a small amount of, uh, white dots there that you can see.
22:39You can relax.
22:39I'm just feeling for any lymph nodes.
22:41Is it painful when I'm pressing there?
22:43No.
22:44I'm going to take your temperature as well, okay?
22:47Yes.
22:49Did you check his temperature yesterday?
22:51I checked it yesterday.
22:52I haven't checked it today.
22:53It didn't feel hot this morning.
22:55It was more the white dots that were concerning, but we did some kind of saltwater gargling.
22:59Yeah, that's a good idea.
23:00Absolutely.
23:00Last night.
23:02Was it worse?
23:03A little bit worse yesterday?
23:05It was a bit worse yesterday.
23:07Okay.
23:08Okay.
23:08So, no temperature.
23:09So, the main thing really that we're looking at is tonsillitis.
23:14More often than not, these are viral.
23:17So, he is meeting the criteria to give him an antibiotic.
23:20I think we should do that for five days.
23:22Obviously, if he's getting worse or not improving, please come back and see us.
23:26But I would imagine that this will improve for him.
23:29The other thing just to mention is if he's having tonsillitis frequently,
23:34so, you know, seven episodes needing antibiotics in a year,
23:38it would be kind of a point to maybe have a think about whether, you know,
23:42we need to talk to the specialists.
23:46Absolutely not at this point in time.
23:48We're not there yet.
23:49But just so you have it in the back of your mind.
23:51Sure.
23:52Okay.
23:52Do you have any questions for me?
23:54Yeah.
23:55Okay.
23:55All right.
23:56So, we'll go for that.
23:57Okay.
23:58Great.
23:58All right.
23:58Nice to meet you, Oscar.
23:59And we can pick those up now, can we?
24:00Yes.
24:01Okay.
24:01Amazing.
24:02Thank you very much.
24:03Thank you so much, Doctor.
24:05Thank you so much.
24:06Bye.
24:15Come back through.
24:16Okay.
24:23Have a seat.
24:25So, I had a quick chat with the medical team at the hospital,
24:28and they're happy that we start you on oral antibiotics initially.
24:32Mm-hmm.
24:32What they want us to do is review you in 24 hours.
24:35Okay?
24:36And if it's getting any worse, then we need to refer you up to the hospital.
24:40Do you mind if I draw on your face?
24:42Not at all.
24:43Just a little bit.
24:44Just a little bit.
24:45So, I'm just going to mark the area a little bit.
24:48So, where I've marked is the kind of deep red bit.
24:51So, if over the next 24 hours you see it's spreading a lot, or getting worse, go straight
24:56to A&E.
24:57But I'm going to give you an appointment for tomorrow afternoon anyway.
25:00I want you to come to it, so we can review how you're doing.
25:04Yeah, yeah.
25:04Your temperature's fine at the moment, but if tonight you get a high fever and feel
25:07very unwell, please go to A&E.
25:09I will now.
25:09Okay?
25:10And then we'll see you tomorrow to see how it's doing.
25:11Yeah.
25:12Okay, don't.
25:12Three o'clock.
25:13Three o'clock, yeah.
25:15Not at all.
25:15Nice to see you.
25:16You've done a lot for me.
25:18All right.
25:18Bye, Mr. Volpe.
25:19Bye.
25:20Bye.
25:28We're in here today.
25:29Come and have a seat.
25:30How are you?
25:31Yeah, good.
25:31Good, thank you.
25:32Good to see you.
25:33Now, what are we up to today?
25:35I actually made notes.
25:36Okay, good.
25:37The pains that I'm experiencing, they're now on the shin, both legs.
25:43They're so uncomfortable that they do keep me awake at night and they do wake me up.
25:48So both thighs, the sensation would be a sudden cramp and trapped nerve all in one.
25:54So if I'm walking, it halts me.
25:57I have to stop and I can't move.
26:00And what halts you, the pain?
26:02The pain.
26:03In both legs?
26:04In both legs.
26:05Okay.
26:05Before it was on the right, if you remember, that's what I was reporting.
26:08Now it's happening on both.
26:10Okay.
26:10It's painful enough that it brings tears to my eyes.
26:13So really bad.
26:14You know, the level.
26:14Yeah.
26:15Yeah.
26:15And stopping it.
26:16Yeah.
26:16And do you just wait a few minutes and then set off again?
26:18I'll tell you what I do, doctor.
26:20I jog or I just kick just so I can keep moving because I've got a train to catch.
26:27Oh, I see.
26:28So you've just got to keep moving so you can't just stand still.
26:30Yeah, yeah.
26:30I can't.
26:31Sometimes, obviously, I would stand still or I find that if I just sit down and rest up,
26:41then I'm fine.
26:42So it's almost like waiting.
26:44It sounds like it's escalating a bit more.
26:46Do you know what?
26:47It's escalated in the sense it's now affected my left side.
26:49I wanted to discuss also with you about the blood test results because I did receive a
26:53notification.
26:54The rheumatoid factor on the blood test has come back.
26:58She said it's not rheumatoid.
27:00What the rheumatologists have said, however, is they've said physiotherapy is what we need
27:05to do and chronic pain team if the pain continues.
27:09I haven't heard from them.
27:11So I can chase all that up.
27:15She's put in the note that they talked about cocodomol.
27:19I don't want to rely on the medicated room.
27:22I know.
27:22I need to find out what other options do I have.
27:27Okay, which is good.
27:28And I think you're quite right.
27:29Because they did all the scans.
27:32They looked at the MRI of your lumbar spine.
27:34They've done all of this to check that there wasn't any sort of critical sort of nerve compression
27:38or anything we need to worry about.
27:40There isn't.
27:40But it's not completely normal.
27:42Although it's not life threatening.
27:44It's nothing awful that we need to jump up and down about.
27:46It is pressing on nerves.
27:48So the rheumatologist feels this isn't an active rheumatoid arthritis picture.
27:52But you clearly have disc problems and onset of musculoskeletal problems that we need to learn to manage better.
28:00And we need to help you with that.
28:02Can we try and get the pain clinic to try and have a look at this?
28:07They've not.
28:07They've not.
28:08I'll chase them.
28:09We'll try and get them involved.
28:10Because I think your regimen that you're doing with the painkillers is brilliant.
28:14Yeah.
28:15But I think the fact that it's stopping you walking.
28:17It's stopping you doing things.
28:18We've still got a long way to go haven't we?
28:19So we're not there yet.
28:21There.
28:21Yeah.
28:22I understand.
28:23I've got a list of medicine that I need.
28:26Okay.
28:26Codidromal.
28:27Codidromal.
28:28Is it the patches?
28:29You know the HRT?
28:32The HRT one.
28:33I mean one option with the patches actually.
28:36You're only on 50.
28:36You're on a reasonably low dose.
28:38We could go up to the 75 just this month.
28:41Then we can meet up again in a month's time or so and see if it's made any difference.
28:44So I'll send those through to Boots.
28:46I'll do a pain clinic referral.
28:48And then you and I catch up again in a month and see how you're doing.
28:51Okay.
28:51All right.
28:52Thank you very much.
28:53Good luck with things.
28:54Nice to see you.
28:54And why don't we book?
28:55If we speak to the girls at the front desk if you could book it again for say four weeks
28:58time.
28:58Something like that.
28:59Four weeks time.
28:59I'll do that now.
29:00You take care.
29:01Nice to see you.
29:01All the best.
29:02Bye bye.
29:07Mr. Wisseidling?
29:08Yes.
29:11Come on in.
29:11Have a seat.
29:12I'm Dr. Dudgeon.
29:13We've met before.
29:14A while ago.
29:16Here.
29:16Oh a urine.
29:17Perfect.
29:18I've just been three months in Denmark.
29:19Oh amazing.
29:20I saw a doctor friend of mine and I had some tests taken.
29:24Okay.
29:24Of course I have a kidney patient.
29:26Yeah.
29:26He looked at my figures and he said you should just check for urine infection.
29:32Okay.
29:32Have you got any symptoms of a urine infection?
29:34Yes.
29:35I go to the toilet a lot.
29:36Mm-hmm.
29:36I think it's a little painful.
29:39Okay.
29:39Yeah.
29:39And is that a new symptom?
29:41Yeah.
29:42I would say.
29:42Yeah.
29:43I've had it a couple of weeks.
29:46Does it burn or sting?
29:48Yeah.
29:49A little bit of burn.
29:50And you saw the kidney team this week.
29:53Is that right?
29:53That's correct.
29:54Yeah.
29:54Did you let them know about the symptoms?
29:56I didn't.
29:56So they feel your kidneys are sort of stable?
29:59Yeah.
30:00Okay.
30:00How long time do you think they'll remain stable?
30:03Yeah.
30:04The function of the kidneys, they call it EGFR, so your estimated filtration rate.
30:08Yeah.
30:08So yours is 14 at the moment.
30:10Yeah.
30:1120, 24, you were about 16.
30:13I think it's very slowly getting a bit worse.
30:18Have you got pain in the tummy at all?
30:20No.
30:20No.
30:20No fevers?
30:21No.
30:21Okay.
30:22But you wouldn't say you're always needing to go or it always burns?
30:26No.
30:27No, just sometimes.
30:28Okay.
30:29Let me dip it and we'll send it to the lab as well.
30:32Yeah.
30:32Okay.
30:34Do you notice the symptoms are worse if you don't drink much or?
30:38No.
30:39I mean, I start the day by drinking a big glass of water.
30:43Good.
30:44There's a tiny trace of blood and a tiny trace of white cells.
30:49The urine.
30:50We're definitely going to send it to the lab and that will tell us whether or not there's
30:53an infection or not.
30:54Yeah.
30:55If the symptoms are very mild and they've been there a few weeks.
30:57Okay.
30:58Especially with the kidney symptoms, let's wait the results and then decide whether or
31:03not to treat you once we know whether or not there is an infection.
31:06Sounds good.
31:06If over the next couple of days the symptoms get worse, call us and we can always give some
31:11antibiotics.
31:12Okay.
31:13Very good.
31:13Thank you very much.
31:14Not at all.
31:14Tell me, is Dr Pearson still here?
31:16Dr Pearson still here?
31:18Yep, she is.
31:19Yep.
31:19Because she looked after me for the last 25 years.
31:21Aww.
31:22I'll send her your love.
31:24All right, have a good afternoon.
31:25Bye.
31:26Bye.
31:28Would you rather only buy all your underwear secondhand or all your toothbrushes you have
31:35to buy secondhand?
31:36Underwear, because you could wash them.
31:38No.
31:38So someone else's bits have been in your underwear secondhand.
31:41Yeah, but you wash them, you can bleach them.
31:43You would say underwear.
31:44Mags, what did you choose out of the underwear or the toothpaste?
31:47I said I just got Phil Commander.
31:50Maggie does that anyway, isn't it?
31:51Yeah.
31:56Yeah.
31:56Pamela.
31:57Yes.
31:58How are you?
31:58My ankles are swollen, my legs are swollen, I can hardly walk and I feel sick.
32:04Let's hopefully sort you out.
32:06Yes, please.
32:08You know, I've never had swollen feet before.
32:11Take a seat, make yourself comfortable.
32:13So leg swelling, both sides, three days, one leg is worse than the other.
32:18Yeah, the right leg is terrible.
32:20Shall we have a look at your legs?
32:22You can have a look at this one in particular.
32:24Are they worse at night and better in the morning?
32:27No.
32:27Can I just press on your leg?
32:29Yeah, that's a bit sore.
32:31It's not pitting, so that's good.
32:32It doesn't look like there's any fluid there, so that's really good.
32:34Really?
32:35Yeah.
32:35This one isn't quite as bad.
32:39Sorry, is this painful?
32:40No, but you can feel that it's swollen.
32:42Yeah.
32:43Right, let's measure them.
32:45Ten centimetres down and measure.
32:47And no periods of lying in bed for days on end recently.
32:51I'm sleeping a lot during the day.
32:53If I sit down to watch television, the news or anything, I go to sleep.
32:56That's not me.
32:57It's not usually you.
32:59Good.
32:59They're exactly the same, 35 on both sides.
33:01Really?
33:02Really, really good, yeah.
33:02I agree with you.
33:04At the sort of bottom, near the ankle, this does look more swollen than this one.
33:07Yeah.
33:08I think I've got arthritis in there, actually.
33:10Yeah, I would agree.
33:11Look at that fat.
33:12Yeah, it is arthritis.
33:13So what I think is going on is what we call venous insufficiency, which basically means
33:18the blood vessels in the legs are just not quite working as well as we'd like them
33:22to.
33:22And so blood is getting down to the legs, but it's not going back up towards the heart
33:27as efficiently as it once did.
33:30And that's really just age-related changes and various other bits like that.
33:34Can I have a little listen to your heart?
33:35Yes, you can.
33:36I feel there's so much going wrong with me.
33:39I've never had this before, this feeling, even when I came out of hospital with a stroke.
33:52Pamela, I can hear a bit of a murmur in your heart, so I wonder if there might be either
33:57a bit of a narrowing of one of the valves or if one of them is a little bit leaky.
34:01So I think we should do some more tests for you.
34:05I'll see if the girls can do an ECG now for you to save you having to come back.
34:09Please don't panic, but I think there's a few things we should do just to make sure.
34:13Is that all right?
34:14Any questions?
34:15That's a lot of information.
34:17Well, my worry is my heart.
34:20I mean, it's always been fine.
34:23Let's hope it stays fine.
34:24You know?
34:25Yeah.
34:26Oh, God.
34:27We'll sort you out.
34:27Don't worry.
34:28We'll get it sorted.
34:47If I could ask you to just pop both your feet flat on there.
34:51I should know the rules by now.
34:59Why do you get scared?
35:01Do I?
35:02No, I'm not scared.
35:02Well, did you just zone out for a second?
35:03I just zone out, yeah.
35:06Perfect blood pressure.
35:09129 over 76.
35:11Gorgeous.
35:12That's really good.
35:15Andrew?
35:16Yep.
35:17Hiya.
35:18Hiya.
35:22How are you?
35:23I'm fine.
35:24I'm fine.
35:24Pop your bag on the chair.
35:26So, we're going to do your blood pressure.
35:29I've not seen you for a while, so that's a good thing.
35:31It's a year.
35:32Is it a year?
35:33So, it's going to be every year.
35:35Yeah.
35:36When you're on medication, we do like to keep an eye on you.
35:39Right.
35:40You look fit.
35:41Well, yeah, because I sort of cycle every day.
35:43Yeah.
35:44I sort of do about 150 miles a week.
35:46That's amazing.
35:47Relax.
35:47I walk everywhere, and I eat healthily, but I do smoke.
35:52Okay.
35:53Yeah.
35:53Little skinny ones.
35:54Well, when you want to give up, come and see us.
35:57I don't want to give up.
35:58Fair enough.
35:59I'm 76 years old.
36:01You're amazing.
36:01And I can run a little bit.
36:03I remember your mum, so.
36:04Right.
36:05You are.
36:06You're amazing.
36:07Okay.
36:08Relax.
36:09And no talking from now.
36:17It's high.
36:18I remember we had this before, didn't we?
36:21Is it that much higher?
36:22It is high.
36:23But don't stress about it, because it'll make it go up even.
36:27Right.
36:27Okay.
36:28Great.
36:30Happy place.
36:31Happy place.
36:32Hmm.
36:34Happy place.
36:36Sounds like a rusty old moped, doesn't it?
36:41It is too high.
36:44Too high?
36:45Yes.
36:46Right.
36:47Ideally, we would want another 24 hour off of you.
36:51You know, the 24 hour monitor that you had before.
36:54How much higher is it?
36:56We would ideally want you to be under 140 and under 85.
37:02Right.
37:02Your blood pressure at the moment is, the lowest one was 172 over 111.
37:09Jesus.
37:10Exactly.
37:11And he's not helping.
37:14Not today anyway.
37:16You can see a doctor at four o'clock today.
37:22Okay.
37:23So let's tackle you today.
37:25Is that okay?
37:26What would be causing the higher blood pressure?
37:28It can be family history.
37:30But it's not running in the family.
37:32If I had an answer for it.
37:34Yeah.
37:34You wouldn't be sitting here.
37:35You'd be sitting in Monte Carlo.
37:36I know.
37:37Exactly that.
37:37Yeah, quite.
37:39All right.
37:40Thank you very much.
37:41Bye.
37:48So we're doing your ECG.
37:50Yeah.
37:50I'm such short-legged.
37:52Okay.
37:53Luckily, this is one of those beds that moves up and down for you.
37:57Do we need to move them a bit more over?
37:59I'm going to have to put two on your legs.
38:01Is that okay?
38:02I'm just going to pop it on top.
38:05Two go on your wrists.
38:07Okay.
38:11I'm just going to pop it between your legs and then I'm going to run the ECG.
38:15Let's have a look.
38:24Okay.
38:24Okay.
38:25So I'm going to pass the ECG back over to Dr. George, who will have a look at it.
38:33Okay.
38:33That's all done for you.
38:35Do you need help?
38:36I have to put my hand, yes.
38:36There we go.
38:39Okay.
38:39Okay.
38:39So that's...
38:40That's okay.
38:41Lovely.
38:42All done.
38:44That's okay.
38:46We'll wait in the waiting room and I'll speak to Dr. George.
38:49Lovely.
38:50You're welcome.
38:52Is that real?
38:54No, it's not.
38:55No.
38:55It looks real, doesn't it?
38:57I know.
39:01Let's have a look at this.
39:03So, baseline's a bit messy, but that's okay.
39:07No ST elevation.
39:10Progressive lengthening.
39:12I'm not liking the look of this.
39:15I'm a little bit worried.
39:16She can go home.
39:17I don't think we're doing anything acute.
39:18There's nothing to suggest that.
39:21I'll go and tell her.
39:27That's absolutely fine.
39:28You can go home, not a problem at all.
39:30Just to let you know, the ECG is okay.
39:32I'm going to run it by a cardiologist though, just for reassurance.
39:35Any problems at all, just give us a call.
39:37Okay.
39:37All right?
39:38My pleasure.
39:38You're very welcome.
39:39All right.
39:40Take care.
39:46I think I'm going through here.
39:49Is that a tricky?
39:50I had a bad one.
39:51I feel like I'm cutting a fever, you know?
39:55People have made me sick.
40:01David.
40:02Hello.
40:02Morning.
40:03How are you?
40:04I'm good.
40:04How are you?
40:05I'm okay.
40:07Come on in.
40:10How are you doing?
40:11Okay.
40:12When I had my last blackout faceplant,
40:16my family is now saying I should get my hearing checked.
40:19Okay.
40:19Maybe the best thing to do is see if I got wax first and then see if...
40:25And then go and do something.
40:25Yeah, yeah, yeah.
40:26So very sensible.
40:27So when you collapsed last time sort of thing and you faceplanted,
40:30do they know why you're having those collapses?
40:32Well, I've been poked and prodded considerably.
40:35I know.
40:36So two neurologists and a neurosurgeon later.
40:39And the cardiologist.
40:39Yeah, yeah.
40:40I've added that in the mix as well.
40:42I know you've seen so many different consultants.
40:44It's a combination of, you know, AFib.
40:46So your pulse suddenly speeds right up, does it?
40:48Well, I just go boom.
40:50After 38 surgeries in 25 years, I should write a book.
40:57So poor David has skin and joint problems and has had multiple knee replacements,
41:02knee operation, shoulder operations, etc.
41:05He's enjoyed some quite extreme sports and he's very active.
41:08And as a result with his skiing and things, he's often had other accidents as well
41:11that have then resulted in him having 35 surgeries in total.
41:14Can I feel your pulse now?
41:15Let's see.
41:16Are you in fibrillation at the moment?
41:17Can you feel?
41:18Right now I feel fine.
41:19Okay.
41:19It's just odd.
41:22It's the last month, I mean, that it's so high and so low.
41:25So it's going sort of fairly steadily at the moment.
41:27And just remind me, your medication, you're on blood thinners.
41:30Yes.
41:31And I have a bicep roll.
41:33So they're all helping your heart.
41:34But of course the blood thinners, if you're crashing and falling and breaking things,
41:36we don't want you on blood thinners, but you have to be on the blood thinners for the heart.
41:39So your ears, we're worried that they're going to continue to give it.
41:42You know, let's tell me that they just got wax in them and then...
41:46That would be the easiest of the problems to solve, wouldn't it?
41:48All our balance is actually controlled inside our inner ear.
41:51So in David's case, it's probably quite complex that it might be a combination of potentially a heart rhythm problem,
41:57as well as the balance problems with his ear that are causing him to collapse,
42:00which in itself is also very dangerous.
42:03So we'll have a look this side.
42:04It tickles a bit, I'm afraid.
42:05Yeah.
42:05Is there any pain in your ears?
42:07No.
42:08Well, there's no wax in that at all.
42:10David, in the eardrum looks absolutely perfect.
42:11So that ear looks perfect.
42:12So we've got a one to compare it to, which is good, right?
42:14Let's just have a look this side.
42:17There's absolutely no wax at all.
42:18Not a drop.
42:19David's clear as a whistle.
42:21And the eardrum looks healthy.
42:23Good.
42:24Which...
42:24And so obviously the ear wax is the...
42:26Well, I mean, that would be...
42:28If it had been ear wax, that would have been a simple fix, wouldn't it?
42:30But it's never quite that simple.
42:31Yeah.
42:32It means it's not the outer ear.
42:33The middle ear is sort of represented a bit by the drum, which looks healthy on both sides.
42:38Mm.
42:38Which means it might be that the transmission of sound through is the problem.
42:43The little bones will have to sort of oscillate next to each other.
42:45But nothing in the middle of you.
42:47Nothing, yeah.
42:47Nothing in the middle between there and there.
42:49I think it's worth doing a hearing test.
42:51Yeah.
42:51There's certainly not a reason not to.
42:53Because if you're not hearing right, it's not going to be helping with the balance issues
42:57and everything else that we've got.
42:58I'll refer you for the hearing test.
42:59Let's get that done.
43:00We can see if we can help with that side of it.
43:02Right.
43:03Good luck, David.
43:03Let's get the hearing sorted out.
43:05Thanks.
43:06You take care.
43:06You take care.
43:07Look after yourself.
43:08Bye-bye, David.
43:10Take care.
43:11All right.
43:12And enjoy your 20 more holidays.
43:14See you later.
43:14Bye.
43:15Good to see you again.
43:16Yeah, good to see you too.
43:18Thank you, Doctor.
43:19That's all.
43:19You take care and we'll give you a phone call.
43:21No problem.
43:23Bye.
43:24Perfect.
43:25It was so good to meet you.
43:26Bye-night.
43:47Bye-bye.
43:49Bye-bye.
44:19Bye-bye.
44:20Bye-bye.
44:21So I've been suffering from very severe pain, like a sharp knife.
44:26First thing, I'm coughing a lot.
44:27Second thing, I have blood when I cough and doesn't want to stop.
44:31Well, I have to confess, I actually sterilized a needle.
44:34Oh dear God.
44:35And then the postage are coming out.
44:37It's odd.
44:38I've not seen that before, if I'm honest with you.
44:39I've not seen somebody who's on four high-dose blood pressure tablets still have a blood pressure
44:44as high as yours.
44:47Mambo
44:48Life
44:48Life
44:48all
45:08Life
45:12both
45:13vaccines
45:13You
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