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00:08Good morning, Sadri.
00:10Is there anything to see then on the skin?
00:12Can we have a look?
00:13Yes.
00:14Oh, wow.
00:15OK.
00:18I had a pizza and my stomach was just on fire.
00:21It was really painful.
00:22When I go to the toilet, it's just more like...
00:24A bit looser.
00:25Yeah, yeah.
00:26Fair enough.
00:28And do you remember all of this?
00:30No, I don't remember a thing until I woke up from the surgery at St Mary.
00:40Honestly, I'm knocking on now, but I would quite like to go on a bit longer.
00:45But I'm actually really bored with having to survive like this.
00:53The problem is with blood pressure is sometimes it causes symptoms, but sometimes it doesn't.
00:58The heart's having to pump at a slightly higher pressure to get the blood out.
01:02You think of a car, it's almost like putting your foot on the accelerator.
01:04We're revving up that engine and it's never having a chance to recover.
01:07But.
01:21Morning!
01:21Morning!
01:40Yeah, but that was because of me, because I was finishing up something.
01:43Benjamin?
01:47Nice, though. Come on through. You're in the hot seat.
01:52Now, my name is Anna McHugh. I'm one of the doctors. It's nice to meet you both.
01:57Nice to meet you.
01:58So, Benjamin, what's been going on?
02:01Just coming to the end of school, I started feeling throat pains.
02:05OK.
02:06Recently, I've been playing a lot of rugby, football, and after school, singing, and I think it's just taking its
02:12toll.
02:13OK, so you're feeling a bit worn out.
02:15Yeah.
02:16And any shiver, shakes or fevers or anything like that?
02:18Last night, I didn't get much sleep because I was just feeling hot.
02:24But then the second I go out of the blanket, I'm shivering.
02:28You're not quite yourself.
02:29Yeah, not at all.
02:31Tell about your head and your knee. You missed that bit.
02:34And last Saturday, when I was playing a rugby match, I hit my head.
02:40OK.
02:41It was a mild one, but then the big one was on my knee.
02:44OK.
02:45And I'm not sure, but I might be worried that it might be internal bleeding because there's no bruise or
02:50anything.
02:50OK, in the knee?
02:51Yeah.
02:52Well, we'll definitely examine that.
02:53Not knee. Well, like, just below the knee.
02:55OK, OK, I'll definitely have a look and make sure that there's nothing worrying, like internal bleeding going on.
03:01Has this been kind of up and down?
03:03Yeah.
03:04I think about 10 days ago, he wasn't feeling well at all.
03:08And so I had to go pick him up from school.
03:10Yeah.
03:10And then this week again, he started, but he came back complaining that, oh, mama, I had a knock on
03:15my head.
03:16I'm feeling a bit, but I'm trying to say, did you hit your head?
03:20Can we?
03:20No, no, no, I'm fine, mama.
03:21This is what happens in rugby.
03:23It's not my favourite sport.
03:24Is it OK if we examine you?
03:26I might just get you up here.
03:30If you don't mind just facing out to me, yeah.
03:33And if you just open your mouth so I can have a quick look in, because the main thing was
03:37the sore throat today, wasn't it?
03:38And you have to say, oh, OK, so I can't see any massive swelling of the tonsils, which is good.
03:47I can't feel any lumps or bumps there.
03:51And you just take nice deep breaths in and out of your mouth.
03:59OK, so that's good.
04:00The chest sounds clear and the heart's good.
04:02I need to have a look at that knee that's sore.
04:08You have a good going bruise here.
04:11Yeah.
04:11Yeah, so I don't think there's internal bleeding.
04:15But you definitely got a good knock there.
04:18It's nice and swollen and there's a big bruise.
04:21So that should just take some time.
04:23So just simple painkillers for that.
04:26OK, and now I know you've got a head knock as well.
04:28So I want to just do a few extra tests, OK?
04:30OK.
04:31So arms up like a chicken.
04:33Nice and strong.
04:34Don't let me push down.
04:35Push down against me.
04:37Arms up like a boxer.
04:38Push me away.
04:40Pull me in towards you.
04:42Push me away.
04:43And can you follow my finger with your eyes?
04:47Any pain or double vision there?
04:49All of that's really reassuring.
04:51So do you want to pop your hat and your jumper and shoes back on?
04:55So, I mean, I think that it's more than likely that this is a viral illness.
04:59There's nothing worrying from the head injury perspective.
05:02And that's just a good going bruise.
05:06So I think, you know, you had a proper knock
05:09and that should improve in the next kind of one to two weeks.
05:13Yeah.
05:14And you have another rugby match on Saturday?
05:16Yeah.
05:16Will I be able to play?
05:18Don't be throwing yourself into too many tackles.
05:21OK.
05:21OK?
05:22And if it gets worse, you know where we are.
05:23Yeah.
05:24OK?
05:25All right.
05:25Thank you very much.
05:26No worries at all.
05:27It was nice to meet you.
05:28Bye.
05:34It's not that bad.
05:42Philip, please.
05:43Oh, yeah.
05:43All right.
05:44How are you?
05:45I'm not too bad.
05:46Good.
05:46Come through.
05:48Come through.
05:49Take a seat.
05:50I've been worried about what you're going to tell me.
05:52Nothing serious at all.
05:53I've got some, in a way, kind of good news.
05:56Oh, what?
05:57I've won some money.
05:59I wish.
06:00That would have been nice.
06:01You had some blood tests with us.
06:02Yeah.
06:02Most of them are absolutely fine,
06:04but one of your vitamins is a bit on the low side.
06:06Your vitamin B12 level.
06:08B12?
06:09Yeah.
06:09Have you been feeling quite tired recently?
06:11Oh, I'm tired all the time.
06:12Unbelievable.
06:13And how's the drinking going?
06:15How's the alcohol going?
06:16Well, I'm keeping it.
06:17Reducing?
06:18Yeah.
06:18Lovely.
06:19In a typical day, how much are you having, roughly?
06:21I try to stick to one pint.
06:23Yeah.
06:23Maybe half.
06:24I treat myself to another half.
06:26On the weekends, I meet some different people.
06:29And then sometimes, I have a Sambuca.
06:32Do you sip it or shot it?
06:34No, I sip it.
06:35Sensible.
06:36Very.
06:36And I love Sambuca, so I'm very aware not to touch it.
06:43Yeah.
06:43I won the bottle of Sambuca in a poker match.
06:46Oh, did you?
06:47Over a year ago.
06:48Yeah.
06:49And I've still got it.
06:50Yeah.
06:50I could easily sit there and drink it.
06:53Please don't.
06:54Well, no.
06:55The only reason I ask about alcohol is because we know
06:57if we drink a lot of alcohol,
06:59it can reduce the amount of B12 that's being absorbed in the body.
07:03If your B12 is very low, you can sometimes become anemic with it.
07:07You're not, which is good.
07:09In order for us to replace it, unfortunately, it is an injection,
07:12but we can get it sorted pretty quickly for you.
07:15Can't I take some pills from...?
07:17It's a bit too low to take pills.
07:20Because it's so low, we need to really give you a big booster dose
07:23to bring those levels up quickly.
07:25Because if we don't treat it, it can, in the long term,
07:29cause problems with the nerve endings, the brain, the spinal cord,
07:33that kind of stuff.
07:34So it's not the best news, but in a way it's good that we know about it
07:37because we can easily fix it.
07:39Because it's an injection, I have to give you the prescription.
07:42If you can collect it from the pharmacy
07:44and then I'll book you in with the nurse,
07:46over a two-week period, you need to have six injections.
07:50Sounds a lot, but that's just the loading dose.
07:53OK.
07:53All right.
07:54All right.
07:54Thanks a lot.
07:54My pleasure.
07:55I'll come out with you and get the girls to book you in for the B12.
07:58All right.
07:59All right.
08:06Kate.
08:10Come on in, take a seat.
08:11Yeah.
08:13No.
08:13This way?
08:14Yes.
08:14So tell me, Kate, what's been going on?
08:17So I injured my knee.
08:19I thought it was my knee, I don't know, close to two weeks ago.
08:22OK.
08:23I didn't do anything in particular, I was just out on a bit of a run,
08:25but essentially the pain is, like, shifting and it feels different.
08:28It's a bit more easy to manage in the mornings and then by the end of the day,
08:32I can't really, like, weight bear on my leg and, like, the throbbing pain is quite intense.
08:36Mm-hmm.
08:36So it starts in the, like, sort of mid of my calf and it can go up to, like, the
08:40lower third of my thigh.
08:42OK.
08:42If I stand it, then I feel like I can't fully weight bear without it causing, sort of, pain.
08:47But again, it's nothing sharp or intense, it's more of a, like, a throbbing pain.
08:51OK.
08:52Because my dad has quite a history of DVTs.
08:54So he's had both legs, lower, upper, and then he's also had a pulmonary embolism as well.
09:01Wow.
09:01OK.
09:14What would be causing the higher blood pressure?
09:16It can be family history.
09:19Mm-hmm.
09:20Tell me about your family history or your history.
09:22Have you ever had cancer?
09:24No.
09:24Is there skin cancer in the family?
09:25Anything like that?
09:26Is there any family history of bowel problems?
09:28No, no.
09:29I have had a problem with my blood pressure.
09:31Have you?
09:32Quite a while, yeah.
09:33Well, we have an history of it in the family.
09:35History of that in the family.
09:36Yeah, fair enough.
09:37And what about in your family?
09:38Does anything run in your family?
09:39They will die by 40s.
09:41Oh, no.
09:41It's all, it's all, yeah.
09:42What's where you'll die from then?
09:43Different things.
09:45Oh, gosh.
09:46My entire family has, like, a history of slipped discs.
09:49I have a history of strange stuff happening.
09:53Probably genetic, to be honest.
09:55Yeah, we're all covered in marks.
09:58Yeah.
10:01It's just because my dad has quite a history of DVTs.
10:04Wow, okay, so he has a significant clotting history.
10:07Yeah, exactly.
10:08In terms of, I suppose, risk factors for clots yourself, have you been on any very long-haul
10:13flights?
10:14No.
10:15Have you noticed any veins in your legs are more swollen?
10:17No.
10:18And has it been getting progressively worse or staying the same?
10:21I feel like the pain actually has been getting worse, particularly on Tuesday was a really
10:27bad day for it.
10:28And all I was doing was sitting in the office and it was just, like, constantly throbbing.
10:31You said there's no swelling in the calf, but the whole, like, the top of the leg hasn't
10:34been swollen or anything?
10:35No.
10:36I mean, there was, it was slight swelling difference between my two legs when I wore a pair of boots.
10:41I noticed, but very minimal.
10:42Okay.
10:43I might just bring you up here to examine you.
10:45Would you mind bringing the trouser legs up?
10:48Can you manage?
10:49Yeah, that's absolutely fine.
10:50So just looking at the legs, it doesn't look swollen or red or, you know, that kind of
10:56tense appearance that you get with a DVT.
11:00It's painful to the touch, for sure.
11:03More on the, feels more here when it's painful to the touch.
11:05Yeah.
11:08So I'm just going to measure them and then I might actually just ask you to lie down so
11:12I can fully examine them.
11:13Yeah, of course.
11:13If you're knees, okay?
11:15It's nice for everything.
11:17I know.
11:2342.
11:23So they're the exact same size, which is really reassuring, okay?
11:28So if you lie back for me.
11:30Good.
11:32So I'm going to move this and you tell me if there's pain.
11:36No.
11:36That way.
11:37No.
11:38That way.
11:38Okay.
11:39And then relax down.
11:40Bend your knee up.
11:43And I'm going to move it the whole way.
11:45Is that painful?
11:46Not, no.
11:47Just in the calf, really.
11:49Okay.
11:49Let me take the weight.
11:52Any pain there?
11:54No.
11:54Okay.
11:55And if you stand up for me.
11:57Yep.
11:58I just want to look at the back of the calf itself.
12:01It's a good choice of pants.
12:02Yeah, I try to be specific with the choice.
12:05Yeah, yeah.
12:05See, the calf is definitely more painful when I'm standing.
12:09Yeah.
12:11Okay.
12:12Take a seat.
12:17So a lot of the examination and the story actually is reassuring.
12:22Obviously, the main thing, the worry about your family history, problems and things like that.
12:27Yeah.
12:27So it's really important to come in.
12:29Sometimes you can get something called a Baker Cyst, which is a bit of a cyst in the back
12:33of part of the knee.
12:35So I would suggest just using anti-inflammatories and paracetamol.
12:40And what I'll do is I'll organise a routine ultrasound as well, just to see if we can get
12:45an understanding of what's going on.
12:47So just because it's really reassuring today, if it changes.
12:50I see a change, yeah, of course.
12:51But otherwise, I think it's pretty reassuring.
12:53That sounds great.
12:54Any questions?
12:55No.
12:56That was it.
12:56Sounds good.
12:56Yeah.
12:57Okay.
12:57A bit of peace of mind.
12:59Mind yourself.
13:00Bye.
13:00Bye.
13:01Bye.
13:04Bye.
13:10Kathleen?
13:12Yeah.
13:12Hi there.
13:14Hi.
13:14How are you?
13:15I'm good, thank you.
13:16How are you?
13:17Oh, I might be playing centre forward for Chelsea, that's for sure, this week.
13:21Won't be headbutting no more.
13:22I've got the medical student in with me.
13:24Yes, that's fine.
13:25Yes, that's fine.
13:26Yes.
13:26Perfect.
13:26Come and take a seat.
13:27Right.
13:28So what's happened?
13:30I had two bleeds on the brain.
13:33I tripped over my dog and I went down and smacked my head.
13:37Oh, wow.
13:38And all that day I was starting getting confused.
13:41I lost 40 years of memory.
13:44Oh, my gosh.
13:44My daughter, who's 50, half told her, I said, you shouldn't be here.
13:48You should be at home doing your homework.
13:50You've got your exams coming up.
13:52And do you remember all of this?
13:54No, I don't remember a thing until I woke up from the surgery at St. Mary's.
13:59Wow.
14:00Apparently that was the blood pushing against my brain and it was pushing on the memory part.
14:04Yeah.
14:05And that's why I lost so much memory.
14:07Just to go over, when did you say the operation was?
14:10Tuesday.
14:11When they took the drains out there and there, as you can see, that's when they put the stitches in
14:17and I worked it out to have them taken out today.
14:21Okay, brilliant.
14:22Have you ever had stitches taken out before?
14:24Yes.
14:26I've got scars all over my body from my childhood.
14:29Okay, fine.
14:30Brilliant.
14:31So what I'll ask you to do is pop yourself on the bed if that's okay.
14:35Yep.
14:36I can't wait to wash my hair.
14:38I bet.
14:41Do you know what you do?
14:42The brain is such a complex organ, your brain.
14:46You know, and different parts of your brain affect different parts of your body, like memory,
14:52speech, movement.
14:54And then pop yourself back there.
14:55Yes.
14:56Is that comfortable?
14:57Yes, I am absolutely fine.
14:59I've been wearing hats, so I have.
15:01Well, I was going to say that you look very good.
15:04Thank you very much.
15:04In your hat that you're wearing.
15:05Very chic.
15:06Every time I put it on, I feel like, what was that, Frank Spencer?
15:10Oh, no.
15:14And how was your dog?
15:15Is your dog okay?
15:16Yeah, I didn't see him behind.
15:17I don't know which one it was, but I've just gone back.
15:21But as I've sat, I've whipped my head back.
15:23Oh, my gosh.
15:25I was still confused the other day when I saw the doctor, but it really is improving.
15:31I've got a lovely family around me and my neighbours have been absolutely superb.
15:37Oh, that's so good.
15:38Yeah.
15:39They're coming in, doing the washing and...
15:41I think make the most of it.
15:43Your hair might get a little bit quarter-nish.
15:45No, don't worry.
15:46I've got hair is there.
15:48It doesn't matter.
15:50They're coming out nicely, which is great.
15:55And my friend owns the shop just around the corner, the hairdressers.
15:59I've got to go in there next week and they're going to try and do something with it.
16:03Oh, nice.
16:04Yeah, put some hair extension in the market.
16:06Oh, lovely.
16:07Yeah.
16:07And my son works in India.
16:10What does he do?
16:11His wife works for the British government.
16:13Okay.
16:14He loves India.
16:15He's just fallen in love with it.
16:19Okay, I'm just on to your drain one now.
16:22I might actually have to have you sitting up for this one.
16:25Yes.
16:25Do you want me to...
16:26Or just...
16:27Just there.
16:28I can just sit here like this.
16:30Is that okay for you?
16:31Yep.
16:33Okay.
16:33I think it just is that one at the back because I can see all the drawings.
16:38Mm.
16:39They were marvellous.
16:40I'll tell you what, people don't realise how blessed they are to have a National Health Service.
16:44Absolutely.
16:45There's a little scab at the top there.
16:47But I don't think that's a stitch.
16:48I think that's just a...
16:49Yeah.
16:51A little bit of a wound.
16:54Yeah.
16:55War wound.
16:57Mm.
16:58I don't feel any of that.
17:00You must be just marvellous.
17:01Oh, good.
17:01Good.
17:02I'm pleased.
17:04That was fantastic.
17:06So, it's looking really good.
17:08I would keep it dry for at least another 24 hours.
17:12Yes.
17:12Just because when you're taking out the stitches, you kind of disrupt everything a little bit.
17:15If you want to wash your hair after that...
17:18I'll do it tomorrow.
17:19Yeah.
17:19But I would recommend not rubbing vigorously on that side.
17:22No.
17:22Look out for any signs of infection.
17:24But as far as I can see, it looks really good.
17:26Oh, that's fantastic.
17:27Yeah, it looks really good.
17:27You're doing really well.
17:28I'm so impressed.
17:29Thank you so very much.
17:31Okay, God bless.
17:32Bye.
17:33Bye.
17:38How's your weekend?
17:39Uh, the whole house is unwell.
17:42And I'm the only one who is well.
17:44Oh, God, you're so going to get ill and take the week off or something.
17:46No, no, no, no.
17:48I only take time off work.
17:50Right now, I've ended up in hospital.
17:52You ended up in hospital?
17:54We had our Christmas party on the Friday.
17:56On the Monday, I woke up and I was like, I feel dead.
18:00Mum was like, there's no staff.
18:01You have to come to work.
18:03You know, it doesn't help when your mum's the manager.
18:05It got to a point where I was vomiting up.
18:07Oh, my God.
18:08And then I ended up in A&E because I had a clot in my lungs.
18:11Well, that's fun.
18:14Morning surgery.
18:20Noah.
18:23Morning.
18:24Hi, you all right?
18:24I come through.
18:25I'm George, one of the doctors.
18:26Nice to meet you.
18:27Nice to meet you.
18:27Take a seat.
18:28How are you?
18:29Yeah, I'm good.
18:30Lovely.
18:31How can I help today?
18:32I was on a flight home yesterday from Vietnam.
18:34I felt a lump on the side of my neck, which I usually have.
18:37Fair enough.
18:38First time you noticed it?
18:39Yeah.
18:39Yeah, fine.
18:40Is it painful?
18:40Kind of, like, uncomfortable to touch.
18:42I won't say it's, like, overly painful.
18:44And is it feeling?
18:45It's got slightly smaller since I've had it, but I might be making it up.
18:48Any recent illnesses, viral infections, been run down or anything like that?
18:51I've been in Vietnam for three weeks.
18:52Yeah.
18:53I've been generally just underslept and probably had some sort of slight parasite or something for a while.
18:59Do you think?
19:00Yeah, okay, fair enough.
19:01No, I've been fine.
19:02Fine, okay, good.
19:02Night sweats, where you have to change the sheets because they're drenched in sweat.
19:06Good.
19:06And any weight loss without trying recently?
19:09A bit, but I've obviously just not been eating as much.
19:11Fine, so no unintentional weight loss or anything like that.
19:13Good.
19:14Do you smoke at all?
19:15I have been for the trip, but not usually.
19:17Fine.
19:17And alcohol, typical week, do you drink much?
19:19For the past few weeks, quite a bit, yeah.
19:20Yeah.
19:20How long were you away for?
19:21Three weeks.
19:22Okay, nice.
19:23Did you have a good time?
19:23Yeah, that's great.
19:24Yeah, would you recommend it?
19:25Yeah, lovely, guys.
19:26Definitely, yeah.
19:26The only other thing, I've had two rabies post-exposure procedure shots recently.
19:31I need another one tomorrow, actually.
19:32I don't know if that would be linked at all.
19:33Could be, absolutely.
19:34It's the only other thing I can think of.
19:35Fine, let's check a few things then, if that's okay.
19:37Nothing serious.
19:37It all sounds very reassuring, which is great.
19:40First of all, can I pop this on your finger?
19:42Yeah, that just checks your heart rate and oxygen levels.
19:45Lovely.
19:45Would it be okay to have a feel of your neck?
19:47Good.
19:47I'm going to stand behind you to do that, just because that's the best way to do it.
19:50Heart rate's a little bit elevated.
19:51Your oxygen levels are normal, 100%, so that's good.
19:54But your heart rate's settling nicely.
19:56Do you mind if I feel your pulse manually?
19:58Is that all right, just on this side?
19:59What did you do there?
20:00Oh, I shattered my wrist a couple of months ago.
20:02Oh, God.
20:02That's our surgery.
20:04Pulse is nice and regular.
20:05That's good.
20:07Lovely.
20:07Right, I'm going to stand behind you.
20:08If you sit up straight for me, that's great.
20:11You...
20:11Yeah, great.
20:11So I'm going to start right at the centre there.
20:15Good, so no submental or submandibular nodes.
20:19No pre- or post-auricular.
20:21Posterior cervical chain's okay.
20:24Is that it there?
20:25It's slightly further back, I think.
20:28Yeah, around that area.
20:30Yeah, just there, right?
20:31I think so.
20:33Yeah.
20:34So it feels soft, it's fluctuant, it's moving, so that's all very reassuring.
20:38Do you mind if I just have a little feel of your tummy on the couch?
20:41Yeah, that's fine.
20:42If you just lie down for me on your back, that would be great.
20:45A little bit.
20:46You can keep everything on, you're absolutely fine.
20:49If you pop your head flat for me, that relaxes your tummy muscles.
20:52Great.
20:52And I'm just going to check under the arms, is that okay?
20:55I'm going to draw on that just to make sure.
20:58Good.
21:01Perfect.
21:01No rashes on the skin that you've noticed?
21:03Er, no.
21:04Okay, absolutely fine.
21:05Lovely.
21:05All done.
21:06Good.
21:07So I don't think it's anything to worry about at all.
21:08It feels just like a normal lymph node.
21:10So it could be up for all manner of reasons.
21:13The rabies vaccination could have done it.
21:15Feeling a bit run down when you were away could have done it.
21:17The good news is it feels very healthy and normal.
21:19Extremely temperature.
21:20Okay.
21:21Lovely.
21:22Temperature's 36.
21:23That's absolutely fine.
21:23So I would just keep an eye on it.
21:25If it's getting bigger, painful, changing in its consistency,
21:28so becoming really firm, really hard, craggy, that kind of stuff, let us know.
21:32If it persists beyond about four to six weeks, so that sort of ballpark figure,
21:36again, let us know because we can then scan it for you with an ultrasound probe.
21:39It's only a day or so, a couple of days.
21:41Nothing's right about it at all.
21:42I think it's absolutely fine.
21:44All right.
21:44Any questions?
21:46No.
21:47Good.
21:48Yeah, I saw a check because I've had them here before,
21:49but I've never, didn't even know you could have lymph nodes.
21:51You can, you've got them all over, all over the body.
21:53All the bits that I examined, you can get lymph nodes there, loads of them,
21:56and you've got loads in the neck as well.
21:58All right.
21:58Very, very common.
21:59Brilliant.
22:00All right.
22:00See how you go.
22:01Thank you very much.
22:02Pleasure.
22:02Take care.
22:02Cheers.
22:03Bye-bye.
22:10Jane.
22:11Yes, hello.
22:12Thank you so much.
22:13I think we haven't met Dr. Preswick, is it?
22:16Yes.
22:17Yeah, nice to meet you.
22:18And you.
22:19So, Sam just did an ECG for you, is that right?
22:22She did, yes.
22:22She just waved it under my nose and it looks okay.
22:25Because it's, yes.
22:26I tell you what isn't okay.
22:27I've got this terrible swelling in my feet and my legs.
22:33Right.
22:34Are terrible.
22:35How long has this been bothering you for, Jane?
22:38Oh, well, for some time now.
22:39Right.
22:40And do you feel like it's getting worse or just staying the same?
22:43Um, when it's not getting better, it's definitely having an effect on my walking.
22:50Sure, because they're heavy.
22:52Oh, because they're heavy.
22:53Painful as well?
22:54Yes, they are a bit, actually.
22:56They're fairly irritable and I scratch them like hell.
22:59Yeah, okay.
23:00We've got symmetrical, which is reassuring, and feeling down the back.
23:04Yes.
23:04You know, feeling the deep veins, also reassuring.
23:06The redness, um, shows there's some kind of chronic venous insufficiency,
23:12so the veins which carry the blood back up to the heart.
23:15And the circulation are probably struggling.
23:18And, um...
23:19I am too.
23:20So a combination of the fluid and the stretching,
23:22but also the venous insufficiency, um, can make the skin irritable.
23:27And, of course, what I don't want you to do is itch it and itch it and itch it
23:29and get an ulcer that then becomes a pain to treat.
23:31Well, of course, I've been doing everything you're saying that I shouldn't be doing.
23:35I honestly think I've got something else wrong with me.
23:38Well, I've certainly got Alzheimer's, that's for sure.
23:41Well, sort of the start of it.
23:43But I really do feel shabby.
23:46And I always think, well, what a good word that is.
23:49It's very descriptive.
23:50Yeah.
23:51And the fact is that I just don't feel very well.
23:55MUSIC
24:07Where do we begin?
24:08How are you feeling?
24:10Pretty awful.
24:12I just... I've not been feeling well.
24:15How are you?
24:16Pretty grim at the moment.
24:17Are you, sweetheart?
24:18The last ten days I've just been feeling pence.
24:21Oh, no. Sorry to hear that.
24:23Just really light head.
24:24I feel like I am going to collapse.
24:26Even now I feel, you know, a bit funny.
24:31It really knocked the wind out of my sails.
24:34I'm just not feeling well, I'll be honest.
24:36I just don't feel well at all.
24:39There's another term which some people don't like.
24:42What is Alzheimer's?
24:43No, frailty.
24:44What frailty refers to is essentially when multiple systems of the body are...
24:51Giving up.
24:52Generally slowing down, it can mean that it's harder for you to bounce back from illness.
24:58Very well described.
25:00And patients who have it usually say that kind of who they are and how they feel don't quite line
25:06up.
25:06So I think the way you've articulated that is feeling shabby.
25:10I mean, obviously I'm knocking on now, but I would quite like to go on a bit longer.
25:16But I live in a little house.
25:18I have a bit of help.
25:20Is it getting dressed, washing, cooking, housework?
25:23Don't ask me about cooking.
25:25I don't cook a lot.
25:27And I have an awful lot of takeaways.
25:30Well, I'm surrounded by them.
25:33But I'm actually really bored with having to survive like this.
25:38I want to focus now on the legs because I think there may be something that we need to do
25:43about that.
25:45I'm thinking about your heart, basically, because sometimes pooling of fluid down in the legs means that it's not being
25:52pumped vigorously enough by the heart.
25:55And it could be the valves as well.
25:56So let me just come and do your blood pressure, have a listen to your chest, and I think we
26:01may have to get you in for a blood test as well.
26:03OK.
26:03That's OK.
26:08Now, how can we help today?
26:11On Saturday, yeah, Saturday, today is what, Tuesday?
26:13Yeah.
26:13I started getting very red here and very, very hot.
26:17OK.
26:18Even sleeping on this side, you know, it's quite painful, yeah.
26:22OK.
26:22So the skin became quite red, did it?
26:24Yes.
26:25And if I touch, you know, it's like it's bruised inside.
26:28OK.
26:28You know, that feeling of all the way here.
26:31Let's have a look at it.
26:32Let's see what's going on.
26:33It just sounds a bit of an odd one, doesn't it?
26:34Yeah, it does.
26:35Is there anything to see, then, on the skin?
26:37Can we have a look?
26:39Yes.
26:39Oh, wow.
26:40OK.
26:41I'm just going to come around the other side.
26:43Mm-hmm.
26:43OK, so, in fact, so it starts basically at the midline
26:48and it comes round as a stretch, doesn't it?
26:50And here, it's like my husband said it was, like, bruised.
26:52It is.
26:53And there's a little bit of the skin is broken just at the top here.
26:56And was it like a little blister, like a little fluid?
26:59Yeah, and I, yeah.
27:00And you popped it.
27:00And I took the crust.
27:00That's OK, that's OK, that's OK.
27:02But my husband said, yeah, maybe you touched on it.
27:04It's the infection, it's gone.
27:05I said, no.
27:06Actually, I think...
27:07It's really hot and painful.
27:08Can I feel it just gently?
27:09Yes, yes, please.
27:10Is it like a burning pain?
27:11Yes, yes.
27:12So if I touch it here, it's quite warm, isn't it, and not here.
27:15And what's happening with your belly button?
27:18It looks sore.
27:20I know, it was, again...
27:21What happened to it?
27:23I'm very anxious, I'm very depressed.
27:26OK, OK.
27:27And sometimes I'm...
27:28You scratch it?
27:29Yes, so much.
27:29It's a human nature thing.
27:31I know we all do it and I know we all know we shouldn't, but...
27:33And I think, did I make... I know.
27:34So this is different to this?
27:35Yes, OK.
27:36Yes, because, I mean, that hasn't got anything...
27:38I can give you some cream for that.
27:40Please.
27:40Let's try and get that to go away.
27:42When you're in your bikini, you don't want to be showing people that, do we?
27:44So let me just grab a swab.
27:46No.
27:46Let's swab that and get that better.
27:47Thank you, Doctor.
27:48I think the other one, to be honest, I think this is shingles.
27:52Oh.
27:52That's what it is.
27:52It's nothing to panic about.
27:54I'm just going to very gently take a swab of the bit that's open here and just inside...
27:58Because it started on Saturday.
28:00Yeah.
28:00Let me help you up.
28:01As if it was painful during the evening.
28:03Yeah.
28:04Even here when I'm moving...
28:05It comes right round.
28:05I mean, it's a really good stretch of shingles you've got going there.
28:08Yay!
28:09That's OK, because we can get rid of it.
28:11Even putting my clothes on top is painful.
28:14I know.
28:15And that's the worst thing about shingles.
28:17But...
28:17You can get rid of it.
28:18That's good.
28:20So what I'm suggesting is I arrange for a blood test for you, which is a marker for the effectiveness
28:28of the heart pump.
28:29If we get an abnormal reading, then we would send you...
28:31Carry my numbers up.
28:33No, it's actually something that if we identify, we can do something about it.
28:37You've had some bloods recently, so I think it's...
28:41I feel safe starting a medication for you now, which will help you get rid of some of
28:44that fluid, a diuretic medication.
28:47Right.
28:48It'll make you pee a bit more, but some of that fluid will hopefully go away.
28:53I'll tell you one thing that has suddenly occurred, if I want to spend a penny, I have
28:58to go quickly.
29:00So continence issues is another one of these problems that we commonly see in frailty.
29:06Not in older people, it's not necessary, it's not an inevitable part of ageing, but it
29:09can be a part of frailty, along with reduced mobility, falls, memory problems, mood.
29:15Such a good doctor.
29:20So we've identified something now that we need to look into.
29:23You know my father lived to 100.
29:25There you go, you've got 14 years.
29:27My mother, she dropped off her perch at 86.
29:32Anyway, I could go on.
29:34People say Jane, she never stops talking.
29:35Well, that's why we'll have a follow-up, Jane.
29:37Yes, all right then.
29:38Thank you very much.
29:39Please don't ever hesitate to get in touch with us.
29:41No, well, I mean, I have been, but I don't want to become an absolute bore.
29:45Oh, look at me.
29:46Most people we don't see for decades, but there's always a stage in life where you might have
29:50to speak to your GP every now and again.
29:52Thanks very much.
29:52Aren't you tall?
29:55Good to see you.
29:56Thank you so much.
29:57Goodbye.
30:02Because what shingles is, is that in the past you must have had chicken pox.
30:06We get rid of the chicken pox, which is all over, but it sits in our spinal cord in the
30:10middle.
30:10And then for some reason, and sometimes it's when we're run down, sometimes it's for no
30:14reason, it decides to travel along the nerve and it causes a red burning irritation with
30:22some little blisters sometimes, which is what you had there.
30:25But the reason we treat it is we want the virus to go down very quickly because otherwise
30:31it causes damage to the nerve.
30:32And sometimes people get better from the shingles rash, but the nerves stay damaged.
30:36And it's called post-hepatic neuralgia.
30:39I mean, I had it once on my shoulder and it was horrible.
30:41I felt like I'd been hit by a bus.
30:42I was exhausted.
30:44And it's because your body's fighting getting you better.
30:46So let me, I'll send a swab off about the belly button and I'll give you some cream
30:50and you just put it on a small amount, two or three times a day.
30:53And I'm sending the prescription, that's to the Fontaine pharmacy.
30:57Fontaine pharmacy.
30:57So you can pick it up straight away and it will say, take one tablet, five times a day
31:02for the whole week.
31:03Then hopefully this nerve pain will go away and we can forget all about it.
31:05Yeah, I hope so.
31:06Wow.
31:06And this is five times?
31:08Five days.
31:09Seven days.
31:10Oh, seven days.
31:10It comes in a pack of 35.
31:11You just keep going till they're all done.
31:13Keep going till they're all done.
31:14Wow.
31:14I know it's an awful lot of medicine, but it's the long-term prevention.
31:18Thank you so much, Dr. Pierce, and have a great day.
31:20All the best.
31:21Bye-bye.
31:21Bye-bye.
31:21Bye-bye.
31:26You're just laughing at me smelling the milk, aren't you?
31:29Oh, my God, no.
31:30I smelt it and look.
31:32No, no, no, no, no.
31:33It's like gloopy.
31:34No.
31:35It is.
31:36It's solid.
31:36No, see, this is why you need to smell it.
31:38I did smell it and it smelled fine.
31:40It's disgusting.
31:41This place gives me the ick.
31:44Oh, my God, it's like solid.
31:46Did you put it back in there?
31:47No, I'm going to put it back in.
31:49I literally thought you put it back in there.
31:52Now you don't judge me for smelling the milk.
31:53No, I never judge you.
31:56You never judge me.
31:57It's just a thing I do.
31:59It's like...
32:05Nice to see you, please.
32:06Hello.
32:07Hi there.
32:08Coming through.
32:09Take a seat.
32:10I'm George, one of the doctors.
32:11Good to see you.
32:11Hello, nice to meet you.
32:12Hi, good to see you.
32:13How are you?
32:14How can I help today?
32:16I want to check if I have a gluten allergy.
32:19OK, tell me a bit more about this.
32:21During my GCSEs, I've noticed that whenever I had something like either gluten or lactose,
32:25my stomach would have really hurt afterwards and I would bloat a lot.
32:29I had a pizza and my stomach was just on fire.
32:32It was really painful.
32:33So I went and bought those boot kits, like, you know, just a swab test,
32:37trying to see maybe it was about lactose, just in case.
32:40And I came back and I was highly intolerant to gluten.
32:43On the scale, she was at the top.
32:45So I took a screenshot.
32:48So, yeah, you're right.
32:48I mean, for the gluten, you're off the chart.
32:50So my brother got diagnosed with celiac disease three years ago.
32:55And everybody got tested, my family, including me, and they said, I'm fine.
33:00With celiac disease, it's an autoimmune problem.
33:03So basically the body, whenever it is in contact with gluten, it attacks the small intestine.
33:08So often you get really bad abdominal pain, diarrhoea, that kind of stuff.
33:12We have tested you for that because I've seen the test here
33:14and it has come back negative.
33:15That was in February 2024.
33:17We can, of course, repeat that.
33:18That's not a problem at all.
33:19You could have something that is a sensitivity to gluten,
33:22but not so much an autoimmune destruction or problem there.
33:26So the gluten intolerance and sensitivity, is there a test for that?
33:29Unfortunately not.
33:30It's just a case of checking for celiac disease.
33:32And once we rule that out, then we say it's probable that you've got more of an intolerance
33:36or a sensitivity to gluten rather than...
33:39Okay.
33:39How do you feel about having another blood test?
33:41I'm okay with you doing it.
33:42She's not like, she's not me.
33:44He knows me.
33:47That's why I ask.
33:48But yeah, not a problem at all.
33:49In order to get a reliable celiac screen,
33:52ideally you have to have been eating gluten for a good few weeks beforehand
33:55just so that we don't get a false negative.
33:57So if you've completely cut it out and we do the test, you might not show up.
34:00A cut out, I mean, like, I might have, like...
34:02Yeah, so you've not been too strict with it, but you've sort of reduced.
34:05Fine, that should be fine.
34:07Should be fine.
34:07I'll just print this out for you.
34:08But she doesn't have any sort of bleeding or any vomiting.
34:11It's just a pain.
34:13It's just pain.
34:14And then when I go to the toilet, it's just more like...
34:16A bit looser.
34:17Yeah, fair enough.
34:18So see how you go with that.
34:19Perfect.
34:20Give it a few days.
34:21But yeah.
34:21Is that all right?
34:22Perfect.
34:22Perfect.
34:23Thank you so much.
34:23You're very welcome.
34:24All the best.
34:24Take care.
34:25Have a nice evening.
34:25You too.
34:26Have a nice evening.
34:27Bye-bye.
34:37Anika.
34:39Hello.
34:40Hiya.
34:40Hiya.
34:41Dr Pearson.
34:42It's funny how...
34:43I mean, it's not funny, but it's amazing how just a bad start to the day
34:46and a stressing in traffic and it just sends the whole day into kaput,
34:50doesn't it?
34:51It does.
34:51It's just stressful.
34:52But today, you look better.
34:54Yeah.
34:55I am feeling...
34:56Are you feeling a bit better?
34:58Should we check the dreaded blood pressure?
35:00Yes.
35:01I'm going to be honest.
35:02Yeah.
35:02The tablet that you gave me made me feel absolutely sick.
35:06Oh, no.
35:07Oh, I'm sorry.
35:08I've continued the Apple tablets, but I just...
35:11Not the new one.
35:12Yeah, because it just made me feel sick.
35:14Okay.
35:14No, that's miserable.
35:15And then I felt very pleasy.
35:16Okay, sorry.
35:17No, right.
35:17Well, then we'll avoid that.
35:18What we'll do is let's check this now.
35:22And we're going to relax.
35:24Rest your arm down.
35:25Okay.
35:26Let's not talk while we do it a couple of times.
35:27Just sit back.
35:28Think of a nice summer holiday somewhere.
35:31Wow.
35:31It's a bit relaxing.
35:44So we're getting 148 or 101.
35:47148 is a bit above what we want, but that 101 is annoyingly high above what we want.
35:51It could be, I don't know, my mum's being a bit of a handful at the moment.
35:56I am getting overly stressed.
35:59Everything's on me all the time.
36:01And I think that...
36:02I totally hear that.
36:04I think the problem is with blood pressure is sometimes it causes symptoms, but sometimes
36:08it doesn't.
36:09But this just tells me that the heart's having to pump at a slightly higher pressure to get
36:13the blood out, but then it's never relaxing.
36:15So if you think of a car, it's almost like putting your foot on the accelerator.
36:19We're revving up that engine, and it's never having a chance to recover.
36:22And the problem is, is that then the heart will get tired before it needs to.
36:26And you're young.
36:27You're 46.
36:28I know.
36:29I was on social media yesterday, and this young girl was talking about that, like her mum never
36:35rested.
36:36And it was too late when she realised that mum needs to rest.
36:47I genuinely thought your life was going to be busy and stressful this week, but then
36:51that's all going to calm down.
36:52But the reality is, it's always stressful.
36:55And I think when you've got three children and you're a single mum, there's a lot of you
36:58living in that house.
36:59There's a lot of pressure on you, a lot of stress.
37:01There's work.
37:01So if the result of it is it's contributing towards the blood pressure, then we still have
37:06to deal with it.
37:07And I think we still have to try and get it down.
37:09And I'm sorry that that other tablet didn't work, but I think we've just got to try another
37:13one.
37:13We've got to, because you're on the 20 of lazinopril already.
37:17You're on 10 of amlodipine.
37:18I can't go up with those because they're at their max.
37:21Yeah, I just think, like I said, the stress just hasn't come down, you know.
37:26Mum won't accept that she's getting older.
37:28Okay.
37:29But, you know, I'm young, but you're getting older because you don't know how to do a lot
37:33of stuff.
37:33And I'm the one who gets all of that pressure, yeah.
37:37It's a lot of, just a lot of pressure.
37:39I think the most important thing is we look after your health.
37:42And I hear that we're waiting for support from the MINT team and everyone else to try
37:46and get his help.
37:47Yeah.
37:47It's just a waiting game.
37:48It's just a waiting game, but you're on it, and so I will keep checking.
37:51I think it's being realistic that it's not going to solve everything suddenly, but I
37:55think it'll help you understand that all the trauma you've been through, all the challenges
37:58that you've had in your life, they'll impact anybody, however strong you are, but how can
38:04you help deal with those things and move forward?
38:06Yeah.
38:06I think we have to treat your physical health as well in the meantime while we make sure
38:10that you're okay.
38:11It is taking a toll on my body, the mental, the physicals.
38:15Let's try another tablet.
38:17Yeah.
38:17Let me just check what you've had in the past so I make sure we don't just give you
38:19ones that you've had before.
38:21So we did try a diuretic back in August.
38:23It was called bendrofluorazide.
38:26Why don't we add that one in every day?
38:29Yeah.
38:30And why don't we do this for one month and then we meet up again?
38:33Okay.
38:34All right, well, let's book up for four weeks' time.
38:35I'll speak to Millie and she'll book it up on the thing and we'll get sorted out.
38:38Okay.
38:39All right, and I'll send the prescription straight to you.
38:40Okay, thank you.
38:40All right, well done.
38:42Well done, sweetheart.
38:42Let's do...
38:49Um...
38:49Sorry to hear about your back.
38:51Listen, I'm going thick.
38:52I've got an extremely bad back.
38:55Basically, I've got like a static nerve thing going on.
38:58Oh, okay.
38:59It's dropping nuts.
39:00Whereabouts is the pain?
39:01Lower back?
39:01Lower left.
39:02Lower there.
39:03Standing up, looking down like that will give me a back ache.
39:07Watching the dishes can be a bit of a...
39:09That's not a reason to get out of the dishes.
39:12Would it be okay to examine your back?
39:14Yeah, yeah.
39:14Is that all right?
39:16So there's no spinal tenderness.
39:18That's really good.
39:19Okay.
39:20It's a bit sore.
39:20Tender.
39:21So you've got a very exaggerated curvature of the spine.
39:24We know about that, don't we?
39:25Oh, yeah.
39:25About.
39:26Yeah.
39:27Oh, bless it.
39:27And if you bend forward as far as you can, stop when it's painful.
39:31Oh, that's about it, mate.
39:32That's about it.
39:32Oh, gosh, that's not very good.
39:33Put your arm behind your back as if you're doing a brass strap like this.
39:36Yes, but it's really painful.
39:37Very tender.
39:37That's right.
39:38And then if you bend back, it's not as bad.
39:42It's fine.
39:43And then straighten up when you're ready.
39:44Brilliant.
39:45Yep, and then the other side.
39:47Quite reduced range of motion in all planes, really, isn't it?
39:50A few gentle exercises will help strengthen the muscles around the area
39:54and take a bit of the pressure off the joints.
39:56Would that be okay?
39:57Yeah, yeah.
39:58All right.
40:00Hiya.
40:01How's my fellow back sufferer?
40:04All right.
40:04How are you?
40:06You're walking well.
40:08A bit better, yes.
40:10John came in for a wound review because he recently had a lumbar decompression.
40:15He had part of a bone removed.
40:19I've had multiple back surgeries, so I get, John, I get back pain.
40:26You have a lay down on your side.
40:28I will, I will.
40:29Get comfy.
40:32Is this sore or have you been okay with the actual wound?
40:37The nurse down at Parsons Green?
40:40She had seen the photograph that you'd taken.
40:43Yeah.
40:44She says it looks better.
40:46Excellent.
40:46That's what we want.
40:47You can now judge what you think.
40:49It does look like that gape is closing up now, which is much better.
40:57Good.
40:59No, it does look like it's healing.
41:01It's just really scabby.
41:02But it's not like you can pick your own back, which is a good thing.
41:07It is a good thing.
41:09Does it feel better now the stitches are out?
41:12Yes.
41:13I would say so, yes.
41:16The wound bed is healthy, but you are getting granulation underneath there, so it is healing.
41:25Explain that.
41:26What is granulation?
41:27It's healthy tissue.
41:29Okay.
41:30Healthy tissue underneath, so it's good.
41:32It's a good sign.
41:33Okay.
41:34Are you pottering around at home?
41:37There are two things I can do pain-free.
41:40Yeah.
41:41And that is cycle.
41:42Oh, you're very brave.
41:44And swim.
41:46But you can't get in the pool until this.
41:48You told me, yeah, which is a great disappointment.
41:51I know, I'm really sorry, but if you get in the pool and that's even a little bit open,
41:57the chances are of infection, we can't be having that.
42:02Does that feel okay?
42:04Feels fine, thank you.
42:05You're welcome.
42:08Can I sit up?
42:10Yeah, of course you can.
42:11Yeah.
42:11You are remarkable.
42:14It's done.
42:15So I need to book you an appointment with me again.
42:19Yep.
42:20Could you come in Friday?
42:22Yes.
42:2310 to 12, is that okay?
42:24I don't think it would be long.
42:26Okay.
42:28Done, sir.
42:29Good.
42:30You've been very kind.
42:31Thank you very much.
42:32You're very welcome.
42:33I told you, you're my twin.
42:36Yes, I am.
42:37I am your absolute twin.
42:39You are.
42:40But there's not that many L4s and L5s knocking around, are there?
42:44And Virgos.
42:45Yes, and Virgos.
42:47You've got your glasses, you've got your phone.
42:49I have, thank you kindly.
42:50You've got everything.
42:51All good to go.
42:52Okay.
42:52See you Friday.
42:53Slow and steady, John.
42:54Okay, thanks very much indeed.
42:56Bye.
42:57Anything else I can help with today?
42:58No, that's it.
42:59All right, all the best.
43:00Get well soon.
43:01Thank you, Doctor.
43:01Take care, pleasure.
43:02All the best.
43:03Thanks, bye-bye.
43:04Thank you so much.
43:05Pleasure.
43:06We'll be finishing soon.
43:07Hope you have a nice weekend.
43:09Thanks, you too.
43:10Bye.
43:10Bye.
43:12That's what we like.
43:13Well done.
43:14All right, well, listen, take care.
43:15Look after yourself.
43:16Enjoy.
43:16All right, take care.
43:17Bye-bye.
43:18Bye.
43:28Bye.
43:28Bye.
43:29Bye.
43:30Bye.
43:30Bye.
43:31Bye.
43:33Bye.
44:10I think walking is safer for now.
44:13But it's just so useful to control the sugar.
44:16Some type 1 diabetes.
44:18Let me know what happened.
44:19Oh, gosh, so you can't even really get it at all.
44:22I only smoke five a day.
44:24How long have you smoked four, Doris?
44:25Down from three to five.
44:26I think I've done well.
44:28Well done.
44:28Considering I started at 18.
44:30I think it happened when I saw the dog.
44:33Sometimes I didn't feel good.
44:34And then I stopped from three to five times.
44:36Bye.
44:36Bye.
44:36Bye.
44:42Bye.
44:44Bye.
44:47Bye.
44:53Bye.