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00:09Morning surgery first thing I'm coughing a lot second thing I have blood when I cough and doesn't
00:16want to stop I'm gonna die soon well I have to confess I actually sterilized a needle oh dear
00:24God and then pasta actually coming out so I've been suffering from very severe pain from this
00:33side like a sharp knife it's odd I've not seen that before if I'm honest with you I've not seen
00:41somebody who's on four high dose blood pressure tablets still have a blood pressure as high as
01:00yours
01:02morning
01:22Joyce. Hello. Hello, my darling. How are you? I'm very well. How are you? I'm sort of half all right.
01:29Half blind, half deaf and got one big. Well, it could be worse, couldn't it? It could be worse.
01:36Come on in. Let's have a shower. People are a lot worse off. We're just in this one here.
01:40I'll go first, if you like. I have to jump out your way. You're going to take me out with
01:44that.
01:46Do you want me to... Yeah, so if you park up there, that's brilliant.
01:51That's okay. Right, so it's nice to see you. You've been through the wars, haven't you?
01:56Yeah, well, you were with your broken foot. Well, that was a while ago. You beat me by
02:01having a leg taken off. Oh yeah, that one taken off. I'm just hoping that one's not following suit.
02:08So this is your false leg that you've got on? Yeah, I've got my false leg on. That's all right.
02:13It's no problem. So what are we up to today? What have you come in for today? This foot,
02:18I've been going to the chiropodist, but they make me an appointment in three months.
02:24And after three months is up, my toenails are so thick and so long, they make holes in my socks.
02:31Oh no. And now they've damaged my toenails.
02:35Oh, help a bit. Right, I'll pull it gently from the top there.
02:38Okay, so here we've got the nails. So they've cut the nail quite short here, haven't they?
02:45Yeah. The nail looks quite good, but which... It grows so long and...
02:49Is it painful or causing you pain? So it's painful sometimes.
02:53Yeah. I take the dressing off.
02:55And actually your foot's quite warm. I was worried it was going to be quite cold.
02:59So you've got a reasonably good blood flow coming back into your foot. It goes pink.
03:03Is it okay? Yeah, because look, if I press it at the end, it goes white and then it pinks
03:08up quite nicely.
03:09See, they said I had... That's a good thing.
03:11It might be the blood flow that gave me that cholesterol.
03:15I think the problem was, Joyce, is that what they call the arteries,
03:19the ones that take the blood to the foot in this leg, they just became so narrow that they blocked
03:25off
03:25and they had to take the leg off. Oh, right.
03:27So we're a bit nervous about this leg, but this is why it's so, so, so important.
03:31We look after your feet, your toes and everything, because we don't want infection
03:35or ulcers or anything happening in the foot. We've got to look after this leg,
03:39because we've only got one left. The toes are right, but...
03:41My daughter said I'm certainly going to take that toe off.
03:45I don't think they're going to take your toe off. Put your foot back in your shoe, can we?
03:49But your feet are brilliant. I'm really happy with them. They look great.
03:52Oh, that's good. Thank you very much.
03:54You have such a positive attitude, which helps you heal.
03:57You've got a lovely family, which is so supportive, haven't you?
03:59So I think you're doing all the right things. I think you're going to be fine.
04:02And I think you've got through this slight trauma with the other leg,
04:04but let's keep this one good. All right.
04:07Right. Let's go. Let me get... How are you going to get out?
04:09Are we going to reverse? How are we going to do it?
04:11Yeah, I'll reverse.
04:13All right. I'm going to open the door. Let me stand back.
04:16Yep.
04:16Or you can do a u-ey or whatever, if you'd rather.
04:18Don't stand beside me, because I don't want to run over your feet.
04:21I'll jump out the way. That's it.
04:25Oh, it goes quite fast, doesn't it?
04:27Yeah.
04:27Right. Now, you're going to hit the wall there a little bit there.
04:29Oh, it's so good to see you.
04:31I'm really pleased.
04:31Well, you're looking great. I'm really pleased for you.
04:33Well done.
04:34So are you.
04:35Bye, Dr Pearson. Lovely.
04:39Oh, she is lovely. So are you.
04:51Maya, please. Yes. Hello. You've been very patient. I'm so sorry for the wait.
04:55It's okay. It's okay. Hello. How are you?
04:58I don't know if you've seen Maya before, but not.
05:01I think I might have done. Yeah. Yes. Hello. What are you eating? Are they nice?
05:05Some vegetable sticks. Lovely. Take a seat, make yourself comfortable.
05:08How can I help today?
05:10Yeah, so she's had a few...
05:13Maya, now.
05:13What, you want to sit on that chair?
05:15She's had a few episodes of very extreme constipation.
05:19All right.
05:20When she is in the process of trying to do it, it's so, so difficult,
05:24and it's built up so much, it's actually just hard for her to pass,
05:27and it ends up passing blood as well, because it's extremely painful.
05:31How long has it been going on for?
05:32Maybe over the last sort of three or four months.
05:34And how's her appetite? I mean, she's happily eating there.
05:37Does she eat well?
05:38Yeah.
05:38Good.
05:38Generally, yes.
05:39Brilliant. And does she eat most things? Do you eat your vegetables?
05:43We try, don't we, Maya? We try. We like our fruit.
05:46We like our fruit more than we like our vegetables.
05:47That's okay. That's fine.
05:48Definitely.
05:49If you like broccoli, little mini trees.
05:51They're so good, aren't they?
05:53And she's generally well in herself, otherwise everything's okay.
05:56Yeah.
05:56Good stuff.
05:57No more. You finished them all.
05:59We did, Maya. You finished them all, yeah.
06:00Well, guess what I've got for you. I've got some stickers. Would you like a sticker?
06:03Which one would you like?
06:04Yeah.
06:05Yeah.
06:05You want the zebra?
06:07Good choice.
06:08Would it be okay if I had a little feel of your tummy on the couch, just to make sure
06:12it's okay?
06:13Yeah.
06:14Yeah?
06:14Let's see if we can find those crisps you just had, those vegetable things.
06:18Oh, we jump up here.
06:20Brilliant.
06:21If you lie down for me.
06:23Okay.
06:23Right, let's have a little look.
06:25So that looks absolutely fine.
06:27Does that tickle?
06:28Not too bad, is it?
06:34Perfect.
06:34Good girl.
06:35Let me just quickly have a little listen to your bowels, and then we're done.
06:39Well done.
06:44Yeah, nice and active.
06:45Absolutely fine.
06:46Lovely.
06:46Really good.
06:46You're finished.
06:47You're done.
06:48Well done.
06:49Yay.
06:49The first thing to say is this is really, really common, really nothing to worry about at all.
06:53Completely harmless.
06:54I'm going to give her some Movicol sachets.
06:56I would just start off with maybe even half a sachet a day.
06:59You just dissolve it in a bit of water, or in milk, or in juice, whatever, it doesn't matter.
07:02Okay.
07:03And she just drinks it.
07:04Every day?
07:04I would, for now, yeah, absolutely.
07:06Just for, you know, a few weeks.
07:08Maybe even up to a month.
07:09Okay.
07:10Just so that we're getting nice, regular bowel motions, nice and soft.
07:13All right.
07:13Thanks very much.
07:14Any questions?
07:15Any other questions?
07:15Any side effects from it or anything like that?
07:17Just diarrhoea, if it goes the other way.
07:18If it goes the other way.
07:19Yeah, absolutely.
07:20I love your top.
07:21It's really cool.
07:22It's sparkly.
07:23Can I get a high five?
07:25Yes, Maya.
07:28Yes.
07:28Well done.
07:29Good girl.
07:30Lovely.
07:30Really good seeing you.
07:31Thanks very much.
07:31Any problems, yeah, as I say, just come back.
07:33Okay, great.
07:34Okay, Maya.
07:35That's us.
07:36We're done.
07:37Yeah.
07:38Okay, Maya.
07:38Let's go.
07:39Keep going, keep going, keep going.
07:57I'm in?
07:58I'm in, yeah.
07:59Me?
07:59Yeah, hi, I'm in.
08:02Hi, I'm in.
08:03Take a seat.
08:04Not too bad.
08:05How are you?
08:06I'm very sexy.
08:07Oh, no.
08:08So, tell me what's been going on for you.
08:11First thing, I'm coughing a lot.
08:12Second thing, I have blood when I cough.
08:16Okay.
08:16So, when did the cough start?
08:18A long time.
08:19And it doesn't want to stop.
08:20Like, it's making me, like, upset.
08:22I don't know why.
08:23Yeah, I'm sorry that it's upsetting you.
08:25And are you feeling breathless?
08:27Yes, yes.
08:28When I was smoking.
08:30But now I stopped smoking, but still carry on.
08:32I don't know.
08:32When did you stop smoking?
08:33Like, before two months.
08:35Brilliant.
08:36Well done.
08:36Yeah.
08:37Okay.
08:37And you said that you're bringing up phlegm.
08:40Blood.
08:40Yes.
08:41Yes, you know, sometimes when I cough, cough, cough, cough, like very hard, I see blood.
08:46I vomit blood.
08:47Okay.
08:47And do you have pain in your chest?
08:49I get pain a lot.
08:50That's why I came.
08:51I got a pain a lot.
08:52I can't sleep at night.
08:53And have you had fevers or chills?
08:55Yes, that's every day.
08:57Every day.
08:57Yeah.
08:57Okay.
08:58And you said you were a smoker.
09:00How many years did you smoke for?
09:02Right, when I was young.
09:04So you're 20 now, so you're still young.
09:06Yeah, I'm still young.
09:07But when did you start smoking?
09:10From 14 to 20, I smoked.
09:1314 to 20, okay.
09:14But now I stopped.
09:16Well done.
09:16Can I examine you?
09:17I'll do your blood correction.
09:18And I have, look, here.
09:21When I have depression.
09:24Yeah, is that from Selfarm?
09:26Is it Selfarm?
09:27Yeah, yeah.
09:28Oh, I'm sorry.
09:29How are you doing from your mood perspective?
09:30And this one, like, every time in the night, when I see it, I cry, cry, cry.
09:35Ah, that's really tough.
09:36Like I said, this is not my life.
09:38Yeah, yeah.
09:40Look, I think that, you know, there are a lot of things going on for you.
09:43And I think, you know, knowing that we're here to support you is really important.
09:47But we need to look into trying to help you with the coughing, because it sounds like it's contributing to
09:52your mood as well, okay?
10:15I think that talking therapy, you know, might be really helpful for you to talk through
10:23some of the things that have gone on for you and your mood, okay?
10:31Can I pop this on your finger?
10:4099 and 80, so good oxygen levels, which is reassuring.
10:46So normal temperature.
10:51So your blood pressure is good, isn't it?
10:55Can I go up underneath your jumper?
10:57Yeah.
10:59So nice deep breaths.
11:07Okay.
11:09So with this, you need to take a deep breath in and as fast as you can, blow out.
11:19That's not great.
11:21Do you think you'd be able to do one more time?
11:23So all the way out, deep breath in as much as you can and quick.
11:27You know when I do, yeah.
11:29Yeah, okay.
11:30Well, if it's hurting you, then we can leave this for now.
11:34With the blood and the phlegm, we definitely want to look into that further.
11:39So I'm going to arrange a chest x-ray for you.
11:41I'm going to give you an antibiotic and I'm going to give you five days of steroids, okay?
11:46Just for the, the chest is quite tight and there's a bit of a wheeze.
11:49Oh my God, I'm going to die soon.
11:52No, look, I appreciate it's been going on for a long time and it's stressful for you.
11:56But we need to do that chest x-ray.
11:58I need to treat you for the infection.
12:00And I think because this has been going on for such a long time, a blood test is also a
12:04good idea.
12:06Does that sound okay?
12:10I'm scared like they say something.
12:12I think you have an infection.
12:14So that's what the steroids and the antibiotics are for and the new inhaler.
12:19Okay.
12:20Okay.
12:21And if there's anything on the chest x or the blood test, we'll call you.
12:24Okay.
12:24Doctor, thank you very much.
12:26Yeah, mind yourself.
12:27Nice to meet you.
12:28And with regards to the mood, okay, once this is all sorted, I think we, you know,
12:33talking therapies and things like that would be a good idea.
12:36Oh, doctor, you can't like understand me.
12:38Now, like, I don't have anyone here.
12:41That's the problem.
12:42Yeah.
12:43I'm going to send you a link for counselling, okay?
12:46And try to help me.
12:48I appreciate that.
12:49Okay.
12:49No problem.
12:50Next, I'll bring you chocolate, yeah?
12:51Oh, don't be silly.
12:53Okay, mind yourself.
12:54Bye now.
12:54All right, thanks.
13:00I'm just much more aware of my tongue.
13:02I felt a sort of weird taste in my mouth.
13:04My tongue sort of coated a bit.
13:06How is it?
13:07Any white coating?
13:09Yeah, yeah.
13:10And it's on this side, you say?
13:13My mouth is so dry.
13:15I'm drinking an awful lot of water.
13:17My lips as well.
13:18They've been really, really dry.
13:21And if you stick your tongue out and move it side to side?
13:25Do you have any issues inside the mouth, like sore tongue?
13:28And is it inside the cheek?
13:30Cheek's fine.
13:31Say, oh, please.
13:32Mm-hmm.
13:33I'm going to push your tongue down.
13:35Can you open your mouth for me?
13:36Really, why don't you stick the tongue out?
13:37And say, ah.
13:39Good.
13:40OK, thank you.
13:43Come and have a seat.
13:44Now, what are we up to today?
13:46I just wanted to ask a few questions.
13:48I'm probably overreacting.
13:49It's all right.
13:50But I'm getting the thing on my tongue a lot.
13:53Like, it is geographers' tongue, but it's just because it's happening so often.
13:58So geographic tongue is a benign condition that's nothing to be worried about,
14:01but it's where the tiny little papilla, little hairs almost, that grow on the surface of our tongue,
14:06they are disappeared in certain areas, and it causes it to be very flat and red in areas.
14:10So it looks a bit like, call it geographic tongue, because it looks like a map.
14:13It's painful.
14:14Does it hurt if you're drinking or eating?
14:16I mean, yeah, just any sort of pressure on it is quite sore.
14:19And what have we done about it in the past?
14:21Have we managed to get it to go away or anything?
14:23It goes away by itself.
14:24OK.
14:25But just this last couple of months, I don't know if it's, like, work's been quite intense.
14:29Like, yeah, I've been doing, like, a lot more hours than normal, so I don't know if that's, yeah.
14:34And are you enjoying work? Is work going OK?
14:37Yeah, it's OK. I think it's, it's not what I want to do forever.
14:40I, um, hopefully next September I'll be starting to study to become a paramedic, so that'd be cool, yeah.
14:46You always wanted to be a chef, though, but you're sort of, you're moving away from that now, right?
14:50Yes. I'd rather do something that was, like, helpful, not just, yeah.
14:54Well, you should come and talk to our lovely paramedic.
14:56I mean, I think you'd be a fantastic paramedic, but Megan, who works here sometimes,
14:58she is unbelievably brilliant, and they're part of our community team now, very much so,
15:03they're not what they used to be, and, you know, you'd be a fantastic paramedic.
15:07Can I have a look at your tongue now, and then will you stick your tongue out for me?
15:10So it actually doesn't look too bad at the moment, it's a slightly different colour on the end,
15:14but I have seen it where it's completely patchy, isn't it?
15:17Yeah, sometimes it's more, sometimes it's less, it's just, yeah.
15:21One thing we can do as well, Evie, is just take a swab of the tongue,
15:23just to check that there's nothing else that's on there that could be contributing.
15:26I just need to rub this on the tongue, so if you just open wide, it feels a bit weird,
15:30I'm afraid, but sometimes we can have oral thrush and things like that.
15:33Now, your tongue's a little bit white, but it's not too bad.
15:36Let's send that to the lab and see what that shows, but I'll check the bloods,
15:41we'll send the swab, but I think, you know, eating sensibly, drinking lots,
15:46rinsing your mouth out after you eat can sometimes help a bit with this, especially if it's sore.
15:50A geographic tongue is a temporary condition. We don't really know why it happens,
15:53and we don't really know what causes it, but it's just occasionally worth checking
15:56for underlying vitamin or mineral deficiencies that can sometimes be contributing to it.
16:01Thank you so much.
16:02All right, but let's keep in touch and we can see what's going.
16:04Thank you. Do you want me to book in?
16:05Yeah, if you book in with the girls, they're much better than me,
16:07and they'll know you've got your rota, and then let me or someone,
16:09they can book it in for you. Thank you so much.
16:11Not at all. Nice to see you. Bye-bye, stop. Bye-bye.
16:20What are you eating?
16:22Porridge.
16:22That's quite nice.
16:24Much healthier than a crunchy.
16:26I'm sorry, do you remember the many times you've eaten a whole pot of ice cream for lunch?
16:31Yeah, but the way your mum's feeding you?
16:34I mean, making eat all this healthy food.
16:37Green salads and hummus and bread steaks.
16:42Hummus and bread steaks is quite nice.
16:43Yeah, but you're still a teenager.
16:54Come in, come in, have a seat.
16:56Oh, lovely.
16:57So, how are you?
16:59So much to say because lately I haven't been welled.
17:03Tell me what's been going on.
17:05I've been suffering from very severe pain from this side, really bad, like a sharp knife.
17:13You know, when you sit and have coffee and then you want to say goodbye or whatever,
17:17it feels like...
17:18Open your bowels.
17:19...kills me, you know, really bad.
17:21Even when I'm walking to the clinic today, you know,
17:24you feel like you're walking with the pain, which is, I never had that before.
17:28When you pass urine, is that more painful?
17:30Or when you open your bowels, is it more painful?
17:33Yeah, it's more painful because you have to put pressure and it hurts.
17:37Any blood or mucus in the stools?
17:39No, thank God.
17:40So, what I'll do first, if you pop your nail, have a little listen and feel of your stomach.
17:44I apologise in advance if my stethoscope is cold.
17:47OK.
17:47Are you Irish?
17:48No, I'm Essex.
17:50I've got a cold at the moment, so that's why my accent's a bit all over the place.
17:53Shall I lie down for you?
17:54Yes, if that's OK.
17:55Sorry if my hands are cold.
17:56No, that's fine.
17:57Don't worry, darling.
17:58So, you're saying that the pain's more here, just above your bladder?
18:01Yeah.
18:02Have you opened your bowels today?
18:03No.
18:03No.
18:06It's gurgling away nicely.
18:08Raise this leg for me against my hand.
18:10So, bring this leg up.
18:11Any pain in your stomach doing that?
18:13Yeah, yeah.
18:14Yeah, OK.
18:15Pop down.
18:15That's fine.
18:17There's nothing I think you need to go to hospital to get scanned today.
18:21So, what is it exactly here?
18:23So, most people who get pain here sometimes can be linked to things like diverticulitis,
18:29OK?
18:29Especially if it's to do with your bowels and emptying your bowels,
18:32it could be that there's some diverticula there that's causing irritation.
18:37Diverticulitis is a flare-up of little sacs that can sit in the wall of the colon.
18:43These can become inflamed and infected.
18:46Symptoms tend to be abdominal pain, sometimes you can have looser stools,
18:50in severe cases you would have a fever, feel very run down.
18:55Pain relief-wise, what have you been using?
18:57To try and help.
18:58Erm, I took two yesterday, paracetamol.
19:01Mm-hm.
19:02So, if you could grade your pain, zero being no pain,
19:05ten, worst pain you could think of, what is it right now?
19:07Your stomach.
19:08Stomach.
19:09And what is it after taking paracetamol?
19:11At the moment, you can say seven to eight,
19:14but when I take the paracetamol, it goes down to like four or five, which is good.
19:19Okay, that's good.
19:20Is it Dr Pearson you normally see?
19:22Yeah.
19:23So, I'm going to have a chat with her after I've seen you.
19:25I don't think we need to do anything in regards to scanning today,
19:29but I think we should probably refer you on to Gastro.
19:31Yeah.
19:31Get them to probably do a camera to have a look what's going on,
19:34because six months of that sort of pain is not normal.
19:37No, and now I'm talking to you, believe me, it kills me.
19:40Leave it with me.
19:41That's great.
19:42Okay.
19:42And the paracetamol is going to the chemist, yeah?
19:44I was a chemist.
19:45Okay.
19:45Thank you so much.
19:46Lovely meeting you.
19:47Lovely meeting you too.
19:48Take care, okay?
19:49You are the best.
19:50Bye-bye.
19:51Bye.
19:57Take a seat.
19:58How can I help?
20:00I'm thinking about doing a physical wellbeing course,
20:04but it involves swimming.
20:06Yeah.
20:06So, they needed me to get the all clear from.
20:09Yeah.
20:10Good.
20:11Because of my breathing difficulty.
20:14Of course.
20:14What we should do today, if it's okay with you,
20:16is check your blood pressure, have a listen to your heart and lungs,
20:18check your oxygen levels and heart rate,
20:20and then we can do a quick sort of ECG,
20:23which is like a tracing of the heart that tells us about the electrical activity of the heart.
20:27Is that all right?
20:28Yeah.
20:29Let's check a few bits.
20:30Any concerns?
20:31Any worries about it?
20:32Are you sort of excited, looking forward to it?
20:35Well, I was already at police, so I did life saving.
20:40Amazing.
20:41All right, let's check this.
20:42I won't talk to you because I don't want to push it up.
20:48Your blood pressure's quite high there.
20:50Are you taking all your meds okay?
20:52Yeah?
20:53160-odd over 100.
20:55It's still really high, despite all of the medications for your blood pressure,
20:58and you're on quite a few of those.
20:59So that's four medications for blood pressure,
21:02and you're taking them every single day.
21:04Yeah.
21:04It's odd.
21:05I've not seen that before, if I'm honest with you.
21:07I've not seen somebody who's on four high-dose blood pressure tablets
21:11still have a blood pressure as high as yours.
21:14Just on that.
21:14At least it's not in the 200-plus bracket, which I've had before.
21:20Well, yeah, but I mean, it's still dangerously high,
21:23and we don't want you to have another stroke.
21:24We don't want you to have a hemorrhagic stroke where you have a bleed on the brain
21:27because the blood pressure's too high.
21:39Right.
21:40Well, I have a blood pressure problem.
21:42Mmm.
21:43I think Sam booked you in today because your blood pressure was a bit on the high side.
21:47Is that right?
21:47More than a bit high.
21:48Yeah.
21:49You need to be relaxed for this.
21:51There we go.
21:51Okay.
21:52Here we go.
21:53Okay, relax.
21:55And no talking from now.
21:58Take some nice deep breaths in through your nose.
22:00Think of somewhere really nice.
22:03I've got a holiday in two weeks.
22:04Think of that now.
22:06Happy place.
22:07Happy place.
22:08Mmm.
22:10It's on the high side.
22:12156 over 83.
22:14That is a bit high today.
22:15Okay.
22:17So we're getting 148 or 101, so that 101 is annoyingly high above what we want.
22:23Is it that much higher?
22:24It is high.
22:25But don't stress about it because it'll make it go up.
22:28Right.
22:29Okay.
22:30Great.
22:31Yeah, we want it to be a bit lower than that.
22:33Yeah.
22:34So it might just be, you know, you're here.
22:36I've stressed you out.
22:37See how high you put my blood pressure up?
22:42I can't in good conscience recommend any form of activity just yet until we really control it
22:48because it's very, very high.
22:52How do you feel about that?
22:54Okay.
22:56Whatever.
22:57Well, I mean, it does worry me a bit because I don't want you walking around with a blood
23:01pressure of 160 over 100.
23:03When Emily, our nurse, checked it just a month ago, it was actually much better than that.
23:08So I wonder if it's just when you're in front of a doctor it's high,
23:11but when you're with the nurse it's okay.
23:12So why don't we get it checked with the nurse again and see what that shows.
23:17And then we'll do this just now just to make sure that's all okay.
23:21So with this, if you put two fingers on there and then if you just hold it with both hands,
23:26that's it.
23:29Good. That looks normal. Thank you. All done. Brilliant.
23:36That looks really good. So that's fine. Let's have a little listen.
23:40Nice deep breaths if you can.
23:46It's very reduced air entry globally.
23:50I did have a bit of pneumonia. They said my lungs were scarred.
23:58Yes. I think that in combination with the COPD makes it a bit tricky and causes a lot of shortness
24:05of breath. Good.
24:07Do you know the name of this program, this sort of exercise thing? Do you know what it's called?
24:13No. Maybe let's do a bit of research about it first. There are certain things you can do,
24:18but I don't want you to overdo it and cause more harm than, you know.
24:22I have an hemorrhagic stroke.
24:26Yeah, exactly. We don't want that. We absolutely don't want that.
24:29So my priority is to get that blood pressure well controlled for you.
24:32You know, make sure you're taking them every single day, your blood pressure tablets.
24:35Is that all right?
24:37I'm taking all my medication.
24:39Yes, exactly, exactly. Definitely take all your medications.
24:43And then we'll keep an eye on things. All right. Any questions?
24:46Yeah. All right. Brilliant. Thank you. Lovely seeing you. Take care.
24:51Thank you. My pleasure. You're very welcome.
25:02Peter. Yeah. Hi there. Hello.
25:06Pop it on the bed if you want to. That's great. It's really just, it's my finger. A couple of
25:11splinters.
25:12Have a seat. Thank you. That's so kind. Thank you. It's lovely to see you.
25:14I'm going to pop this down. Good. Okay. And then what were you doing?
25:19Well, I was, it was, it was a painting, which I, which I had and I went to pick it
25:23up and I got a couple of splinters in there.
25:25When did you do this? Oh, it was about 10 days ago.
25:27It might be a bit cemented in there. It went, it went sort of septic. I thought, and I, ah.
25:33Is it sore? Yeah, it's a bit sore. Oh. Yeah. You've done a job here. I've, I've, I've.
25:40You have really done a job on that. Yeah, I know, I know.
25:43Is that tender? It's a little bit tender, but I mean, I've, I've been squeezing it myself.
25:48Never now and then. Okay. I can see it. Don't worry. Yeah.
25:51I'm squeezing it now myself. Stop squeezing. All right. Okay. Stop. All right.
25:56Do you think you've got the splinter out? I think there must've been another one in there,
26:00but anyway, I've been squeezing it every day. When you get pus, it's infected. Yeah. Okay.
26:06So I think we're going to start you off on antibiotics. Can I see your other finger compared to this
26:11one?
26:11See, it's quite there. See, it's quite large. Yeah, it's big. It's, you know, it's gone, it's gone big.
26:16It's definitely big. Okay. I'm going to give it a bit of a push. Yeah, do, do, do.
26:22So have you been squeezing this every day? Yeah. And does stuff always come out of it?
26:25Well, it's, it's gone down. It was, it was quite large and it's gone, ow.
26:29Sorry. So down there is tender? Yeah, down there is tender, yeah. Okay.
26:33But I play hockey, so I want to get this just fixed before playing.
26:38In a team? Yes, yes, yes. Yes, it's good for the...
26:41Do you enjoy it? I love it. Once a week?
26:43Yeah. I couldn't live without it. Sorry, sorry, sorry.
26:49I want to see the opening. Yeah, well... That's what I'm looking for.
26:53Well, I have to confess, I actually sterilised a needle. Oh, dear God.
26:58And then, then the pus started coming out.
27:00So you lanced it with a needle. I lanced it, I lanced it.
27:03How big was the needle? It was tiny.
27:05We're going to put some honey on it, cover it up. Okay.
27:08This is medicated manuka honey. Oh, okay. All right.
27:11I'm just going to literally... Oh, look at that.
27:12..dob. You have a blob on there.
27:14Blob this. Mm-hm. That's great.
27:17We need the honey to go to work. Yeah.
27:20Medicated manuka honey, we use it to treat wounds.
27:24They used to use it in the Victorian times because it's brilliant for everything.
27:28It can take all the yucky stuff out without being very invasive,
27:32and it does make you heal quicker.
27:35Now, we twist it, twist it. Oh, brilliant.
27:40And then push it down. Oh, that's clever.
27:43Well, you can get out of the washing up now, can't you?
27:45Oh, no. I'm sorry.
27:46I'm also going to speak to a doctor
27:48and get some antibiotics sent to my health pharmacy.
27:51Oh, smashing, yes, okay.
27:52On Thursday, hopefully, it won't be so tender.
27:54It won't be so tender. But usually, when you've got that opening
27:57and you push and push and push... Yes.
27:59..it would work its way out. I love the human body.
28:02I know, the human body is... Don't like mine anymore.
28:06..but it's always aching.
28:07Well, I look in the mirror and I say,
28:09hell, kid, with you, it's the real thing.
28:10Heart 21, yeah.
28:13All done, sir.
28:14OK, darling, good. Thank you very much indeed.
28:16Take care. Thanks a lot. OK.
28:18Bye. Very good. Bye-bye.
28:23Maggie?
28:24Mags?
28:25I'm in the middle of patches here.
28:27Leave the patches. I've got something really important to ask you.
28:31Oh, God.
28:33Happy anniversary!
28:37Look, Mags, 25 years...
28:40..to rain, snow, epidemics.
28:42Oh, God, we've been clear. Oh, yay!
28:44Here's to another 25 years.
28:46You have to have the first piece.
28:49There, Mags.
28:51Oh, God.
29:04John, please.
29:05Yes. Hello.
29:06Hello to you.
29:07How are you?
29:08Medium rare.
29:09Good to see you.
29:10How are you recovering from the back operation?
29:13Jury's out.
29:14OK, fair enough.
29:15Any movement, sadly, is rather sore.
29:18Lovely to you. I'm George, one of the doctors.
29:19We've spoken on the phone before, so how can I help today?
29:22Well, to wind the story back, I came to see Dr T.
29:25I had this penile thrush, for want of a better word.
29:29He gave me some cream to try.
29:31Did that for two weeks.
29:33No good.
29:34Came back, gave me something stronger, which will also be noted there.
29:38Yep.
29:38And the two weeks finished about the day of my operation.
29:42The indications were still there, namely sort of redness
29:46with two sort of concentric rings around the shaft of the whatever, blah, blah, blah.
29:50Then I went in for the operation.
29:52When I came out in the morning, or came to in the morning, I should say,
29:57my testicles, particularly the left, had swollen significantly.
30:01And the sac, what is the right, scrotum.
30:04Scrotum.
30:05Was pretty red.
30:07Okay.
30:08Now the condition has sort of transmogrified into sort of a redness and a crusting,
30:15and even a bit of bleeding, which clearly is not what the doctor ordered.
30:19Would it be okay to have a look?
30:21Sure, no, I wouldn't you do.
30:22What I'll do is, I'll get you behind the curtain.
30:23Okay.
30:24I'll close the curtain.
30:25Right, I'll take these.
30:26You can just sort of pull them down ever since I need.
30:28Well, I deliberately wore these to make life a bit easier.
30:31Yeah, fair enough.
30:32There we go.
30:33Are you ready?
30:34Yeah.
30:34Great, I'll come through.
30:36Brilliant.
30:36I've brought a swab with me just in case we need to swab anything,
30:39but we might not need to.
30:40Are you comfortable like that?
30:41Oh, wow, gosh, yeah, it's really crusted over.
30:43Now that, of course, wasn't like that while I was in the hospital.
30:49Yeah.
30:50That's developed over the ensuing days.
30:52Yeah.
30:53Because the skin is really inflamed and there's a lot of crust on it,
30:58I'm going to give you some antibiotics to take orally,
31:01which I think will really settle it down.
31:03And then I'm going to give you a cream to put on it as well
31:05that'll just help soften the skin as well.
31:07So you're sure?
31:08Comfortable with that?
31:09Fairly confident, yeah, absolutely.
31:11Sorry that you are.
31:12That's OK, hang on.
31:13Let's get this bit further up with the...
31:16That's it.
31:17There we are.
31:18And this one.
31:20Gotcha.
31:20Great.
31:21All right.
31:22Is that OK?
31:23Yep.
31:23Do you want me to help you around?
31:25Yep.
31:25You can manage?
31:25That's fine.
31:26Are you Dr George?
31:27Yes.
31:28George is your first name?
31:28Well, George is my first name.
31:29It's Dr Horsch, but people get a bit confused when I say Horsch,
31:33and they're like, oh, how do I say it?
31:34So I just go by Dr George.
31:35It's not Houchy or Houchy or Houch.
31:38Unusual.
31:39Yes, Lebanese, that's it.
31:41Oh, Lebanese.
31:42Yeah.
31:42Ah, lovely place.
31:44Oh, thank you.
31:45Have you been there?
31:46Not for a long time.
31:47Not for a while, at some point in a time.
31:48Part of my work patch.
31:51Oh, really?
31:52Oh, nice.
31:53What did you do?
31:54Re-insurance.
31:55Oh, wow.
31:55OK, nice.
31:56Because you've got a penicillin allergy,
31:58I'm not going to give you filthoxicillin, which we would normally use.
32:01We'll try instead some doxycycline.
32:05The cause of this is what again?
32:07I think it's a bacterial infection.
32:09Lots of bugs live on our skin quite happily anyway.
32:11Yeah.
32:11If there's like a little nick or there's a little abrasion,
32:14the infection can sort of just get under the surface of the skin,
32:17the bacteria can get under the surface of the skin and cause an infection.
32:21The presentation sort of post the following day was entirely different almost.
32:27It hung like a horse with it, it was just very red, no crustacean,
32:32that it just looked like a shire horse.
32:36I suspect what's causing it is a bacteria called Staphylococcus aureus.
32:40When Staphylococcus causes this type of infection,
32:42it's really common after the initial stages to get lots of crusting on the surface of the skin,
32:47and that's exactly what it looks like, so that's why I'm thinking that.
32:50Right, OK.
32:51That's it, all done.
32:52Thank you very much for your time.
32:54My pleasure, you're very welcome.
32:55Any final questions or concerns or anything?
32:56No, I don't think so, thank you.
32:58If I do, I'll come back to you.
32:59Yes, please do, absolutely.
33:01Any problems, let us know.
33:03Jolly good.
33:03Thank you very much.
33:04Take care, look after yourself.
33:05All right then.
33:06You're very kind, thank you.
33:06My pleasure.
33:07Nice to meet you.
33:08Yes, likewise, all the best.
33:16John.
33:17Hi.
33:17Good afternoon.
33:18Good afternoon.
33:20Hello, Dr Prestwich.
33:21Hi, and I'm here.
33:22Just so please, thank you.
33:27Pleasure.
33:28And the reason I've come to see you is because earlier in the year I was diagnosed with emphysema.
33:34Right.
33:34And in my sleep, I've been waking up with not being able to breathe, or throughout the day,
33:40like, if I catch my breath, I can't breathe and I cough and I feel like I'm going to...
33:45Right.
33:46Yeah, we don't usually say emphysema much these days, we tend to say COPD.
33:50Yeah, I was telling you this thing before I had COPD, but then they said no.
33:55And they said we've done the x-ray and then they came back and said it was emphysema.
33:59Do you know what might have caused it?
34:01Smoking.
34:01Smoking?
34:02Yeah.
34:02Yeah, have you packed it in now?
34:04No, that's another thing we need to ask you for.
34:06Okay, yeah, we can have a think about that.
34:08But yeah, I want to explore these new symptoms that you've been having.
34:12Yeah.
34:12So what happens in the day?
34:14In the daytime, I could be sitting there and I just begin to cough, but then something catches and I
34:19can't breathe at all. I'm just stuck and I can't breathe. I'm coughing. And twice it's happened in
34:25the night when I've been asleep. It frightens me then. And I can't seem to stop or control the
34:30coughing and it's like here.
34:43Okay, so tell me, what sort of things are you getting?
34:45Mainly I'd say brain fog and memory lapses.
34:48You were going to come in for a memory test.
34:51Yeah? Do you remember?
34:53You remember it?
34:55I think I'm losing my memory. I don't know.
34:57I've got some memory problems. Oh, yes.
34:59The memory's not great.
35:01The memory situation is getting really bad.
35:05Yeah, I lost my memory.
35:06I lost 40 years of memory.
35:09And do you remember all of this?
35:11No, I don't remember a thing.
35:13Sometimes I think my brain just doesn't work.
35:15We can always do a memory test, all right?
35:18If you're ever concerned.
35:19Yeah.
35:20They're going to have a look at it again in two weeks' time.
35:22Two weeks' time.
35:24Now, I remember that one.
35:28I've got your back.
35:29It's very nice.
35:30I'm licking that.
35:33Okay.
35:35So, we're going to do a mocker test, a memory test.
35:38And we've done one before.
35:40So, we'll see how we compare today, yeah?
35:43Quite that doom, actually.
35:45Do you?
35:45I'm so pleased with myself when I get the thing right.
35:48It keeps the mind active, doesn't it?
35:50So, the first bit, one goes to A.
35:54Where will two go to?
35:56If one goes to A, two must go to B.
35:59So, draw the line.
36:00Okay.
36:01And then carry on.
36:03That's A.
36:04A goes to two, that's after one.
36:06Two goes to B, that's after A.
36:09So, I'm looking for C, which is here.
36:12Remember, one is A, two is B, now where?
36:17Three C, isn't it?
36:18Three out of two.
36:19Yeah, that's the pattern.
36:21B, C, down here.
36:23Yeah.
36:24Okay, carry on.
36:26Four for that one.
36:29Lisa came in for MOCA, which stands for Montreal Cognitive Assessment,
36:34and it's a tool we use to screen someone's memory.
36:37Lisa had an adjustment in her medication, so we wanted to see if there was an improvement
36:42or an impairment of her memory.
36:46Now, I'm going to give you five words, and I want you to try and remember those five words.
36:51Yeah.
36:52Yeah.
36:52The words are face.
36:54Face, yeah.
36:55Okay.
36:55Velvet.
36:57Uh-huh, velvet.
36:58Church.
36:59Church.
37:00Daisy.
37:01Daisy.
37:02And red.
37:03Red.
37:04The colour.
37:04Okay.
37:06Okay, what's 100 take away seven?
37:09Seven from ten is three, but it's not ten.
37:13Nine.
37:13No, it isn't, it's, it must be three.
37:17Three somethings or others.
37:18A hundred take away seven.
37:21Yeah.
37:21So what's, what's the?
37:23The answer.
37:24Yes.
37:24Three, isn't it?
37:26No.
37:27A hundred take away seven.
37:28The answer is 93.
37:30It's okay, let's see if you get this one then, okay?
37:33Yeah, I can't do these.
37:34What's 86 take away seven?
37:37Okay, so it goes on to 80, which goes down to 79.
37:41Brilliant.
37:42What's 79 take away seven?
37:4572.
37:46And last one, 72 take away seven.
37:49It's a five off of 70, which is 65.
37:52Yes.
37:53Yeah.
37:54It's okay.
37:56What's the similarity between a watch and a ruler?
37:59What do they both do?
38:01They both measure.
38:03That's it.
38:03Measure.
38:05Measure.
38:05That's what I was looking for.
38:07This wasn't.
38:08Okay, can you remember those five words I asked you to remember earlier?
38:12Probably not, no.
38:13Any of them?
38:15Let's see, there was, there was red, wasn't there?
38:17Yes.
38:18There was, there was an F as well in it, wasn't there?
38:21So it was like fancy or something.
38:23I'll put it there.
38:24Er, frank.
38:26It's okay.
38:27Don't worry.
38:27Don't, if you guess it, you're going to pull the others out of context.
38:31Can you remember any of the others?
38:34Well, I can't remember specifics.
38:36If you've lost it, you've lost it.
38:38It's fine.
38:38I think I've lost it.
38:39Okay.
38:41So you get this kind of coughing bouts and you're struggling to get air in.
38:46Is that quite frightening?
38:47Yeah, of a nice it is.
38:48In the daytime, I can sort of control because I grab onto the chair or make me raise the
38:52kitchen for a drink.
38:53I just want to be really clear, like, does it feel like you can't get air in or you're
38:58coughing so much that you feel like...
39:00I can't get air in.
39:01You can't get air in, right.
39:03When I was first diagnosed, I was given a blue inhaler, which doesn't seem to do anything.
39:08Patients with emphysema or COPD essentially find it hard to breathe because of air getting
39:13traps inside the lungs and the airways being narrowed, and that can be really quite uncomfortable
39:17and distressing.
39:18The damage to the airways is, in most cases, due to cigarette smoke.
39:22It is a chronic disease.
39:23It tends to be progressive, especially if the patient hasn't stopped smoking.
39:28First of all, and I do think it's probably one of the most important things that we can do,
39:33can we get you off smoking?
39:35Yes, that's most important because I was an alcoholic, I am an alcoholic, and I've stopped
39:41just three years drinking.
39:43Well done.
39:43And it was just the smoking part of it that I thought I needed to tackle next, but because I've
39:48got
39:48stones in my pancreas at the moment, and my doctor said to me, you know, if you drink again,
39:55you're going to end up in intensive care.
39:57Yeah.
39:57And I just thought, I can't have somebody else fighting for my life, I need to fight for my own
40:01life.
40:02Good.
40:02And I just stopped drinking.
40:04Obviously, giving up alcohol is very hard.
40:06What do you find helped you with that?
40:09Cups of tea.
40:10OK, so replacing it with something else.
40:12Yeah, yeah.
40:13I think what you need is nicotine, so we have to think about how we give it to you, OK?
40:17There are patches, there's gum, yeah?
40:20For no teeth.
40:21Not a great idea.
40:22And there's also a spray, which I think is really good.
40:25That sounds interesting, actually.
40:27That helps to break the cycle.
40:29Yeah, yeah.
40:30And do you have that blue inhaler here with you?
40:32No.
40:33Because I really wanted to see you using it to make sure that you're doing the technique right.
40:37Because if you're saying it's not working for you, it might be that you're not quite using it properly.
40:41Using it the wrong way, yeah, because I wasn't giving you any instructions on it.
40:45I'm hoping that stopping smoking alone will mean that next time we speak, you'll be feeling so much better.
40:50I hope so.
40:51If you're still getting these problems with your chest, you know, then I think we'll have to bring you in
40:55and check your inhaler technique.
40:57Yeah.
40:57Obviously, if you get any severe symptoms in the middle of the night, you know, you're really fighting for air
41:02and it's not getting better.
41:03I do want you to call 999.
41:05Yeah. Well, thank you very much.
41:06Nice to meet you.
41:10Enjoy your day.
41:11Cheers.
41:11Thank you very much.
41:12Bye.
41:18I'm not having you stressing out.
41:20Yeah.
41:21Give me that pen back.
41:24Do you know what?
41:26You've done better.
41:28That's my fault.
41:28You scored.
41:29Last time it was 14 out of 30.
41:31You've scored 20 out of 30 today.
41:34Much better.
41:35So that's brilliant.
41:36So it just goes to show, I thought it looked better.
41:39Yeah, you said that.
41:40There has been some improvements with the change in medications since May.
41:45There's been a few changes.
41:47The proof's in the pudding, isn't it?
41:48So you are.
41:49You're doing better.
41:49Can I take a copy of that because it's okay.
41:52I can definitely copy the mocker for you, if that's okay.
41:56Are you going to practice before the next one?
41:57No.
41:58Get it out.
41:58No cheating.
41:59Because it hasn't changed.
42:00She's got to walk around saying Frank, Fred.
42:02Frank, Fred, Paul.
42:03But it's a good way.
42:04If you go through the alphabet.
42:06Yeah, yeah, it works.
42:07I do that when I'm doing silly chores at home.
42:10Yeah, yeah.
42:10Because my family have got a history of dementia.
42:14But it was much better at least this time.
42:15Yeah.
42:16So that's positive.
42:17Yay.
42:17Glad you came in.
42:18Got to celebrate that by getting something.
42:21A cake, I'm sure.
42:22I'm sure it'll be the cake.
42:23If you make a cake, we want some.
42:24Oh, yeah.
42:25All done, my love.
42:26All right, good.
42:27All right.
42:27Okay.
42:28I'm really happy.
42:29Well done.
42:29Me too, me too.
42:31Take your nice bag before I nick it.
42:34Oh, yeah.
42:34It's good for all sorts of things, this bag.
42:36It is.
42:37Are you okay?
42:38Yeah, I think so.
42:39Turn around.
42:39It's just a little turn, isn't it?
42:41Take care, okay?
42:42All right, thanks so much.
42:43Bye.
42:44See you.
42:44Lovely seeing you again.
42:45Take care.
42:46All the best.
42:46You too.
42:47Bye.
42:47Bye-bye.
42:49Okay, fine.
42:50Thanks very much.
42:51All right.
42:51Bye-bye.
42:52Take care.
42:53Look after yourself.
42:54Any problems, just let us know.
42:55Appreciate it.
42:55Okay?
42:56Thanks.
42:57Well, nice to see you.
42:58When you take care and look after yourself
43:00in the meantime.
43:01Bye-bye.
43:01Bye-bye.
43:08Bye-bye.
43:31Bye-bye.
43:32Bye-bye.
43:41Bye-bye.
43:44Bye-bye.
43:46Bye-bye.
43:47Bye-bye.
43:49Bye-bye.
43:51Bye-bye.
43:52Bye-bye.
43:53Bye-bye.
43:53Bye-bye.
43:55Bye-bye.
43:56Bye-bye.
43:57Bye-bye.
43:58Bye-bye.
43:59Bye-bye.
44:00Bye-bye.
44:00Bye-bye.
44:00Bye-bye.
44:27Transcription by CastingWords
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