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00:06My mum smoked, my dad smoked, my brother smoked.
00:09We actually followed on the family and I've done it for when I was 18.
00:18Oh gosh, so you can't even really stick.
00:23This is a very specifically difficult situation.
00:32I do tend to do everything like this.
00:36I drop something off the shelf and say I'm bruising, smashed it and all hummus went everywhere.
00:40I've put a whole cup of tea over my bed.
00:46You have significant swelling, you have bruising.
00:49I am worried about a break in the stress.
00:52Really? Yeah.
01:09Okay.
01:27Good morning.
01:28It's OK.
01:34Matthew, please.
01:35Hello. Good to see you. How are you?
01:38I'm very well. How are you?
01:38I have some students with me. Do you mind if they sit in?
01:40Is that all right?
01:41Lovely. Come through and take a seat.
01:42Hello, students. How are you doing?
01:45These are my third years.
01:47Third years.
01:47Make yourself comfortable.
01:49So they're far enough into it that they can't kick them out, basically.
01:53Right.
01:55What are we doing today?
01:55I had some bloods done recently and subsequently you said,
02:00do a urine sample and you'd look for proteins in my urine
02:04and whether I need to be careful of my kidneys or liver.
02:08That's right.
02:09Yeah, very good.
02:10So, yeah, what we've seen is the rate at which your kidneys are filtering
02:13is a little bit reduced, but when we see that,
02:15we like to make sure that the kidneys aren't leaking out any protein.
02:18That's why we do the urine sample.
02:19Yeah.
02:19Now, your kidneys, unfortunately, are leaking a very, very small amount of protein.
02:22You've got this condition called chronic kidney disease, CKD.
02:25Yes.
02:26And we don't want it to progress.
02:27And I'd much rather know about it now...
02:29Yes.
02:30...than for it to develop and for us not to detect it.
02:32You might ask, well, what's caused it?
02:34Most of the time, unfortunately, we never figure out what's caused it
02:37and it's just something that happens as we get older.
02:39Sometimes if someone's got really bad diabetes, that can set it off.
02:43If they've got really uncontrolled high blood pressure, that can set it off.
02:47If they've got other sort of problems with the kidneys, the structure of the kidneys,
02:50lots of cysts on them, et cetera, that can cause it as well.
02:53Right.
02:53There's nothing to suggest that with you.
02:54Right.
02:55So, unfortunately, with the best one in the world, I couldn't tell you exactly why this has happened.
02:59What I'd like to do today is check your blood pressure because one of the medications that I would recommend
03:04technically is a blood pressure tablet.
03:06Yes.
03:06But my main concern is I don't want it to be too low now.
03:09If it's too low, then I wouldn't really be able to start this tablet because it will drop it much
03:13lower.
03:14Shall we check your blood pressure?
03:21There we go.
03:22Lovely.
03:31One, three, nine, eighty-six.
03:32Good.
03:33So, there's absolutely scope to give you a very low dose of this tablet and it really will make such
03:38a difference.
03:39It's called Lisinopril.
03:41Okay.
03:41And what it will do is it will help protect the kidneys and also protects the heart.
03:45It's a really good medication to use.
03:47Now, one of the side effects, it can just drop your blood pressure a bit too much.
03:49If you feel a bit lightheaded or dizzy or whatever, stop it and tell us.
03:53We don't just start you and say, look, off you go, see you later.
03:55We'll bring you back in two weeks time to have your blood pressure checked and also another blood test to
04:00make sure the kidneys are doing well.
04:02And then we do another urine sample for you to make sure that protein in the urine has gone away
04:07and that you're no longer leaking any protein out.
04:09Okay.
04:09And then we know it's working.
04:11And if that's the case and you're happy and everything's looking good, then that's it.
04:14We'll just continue.
04:15That's great.
04:15Thanks for your help.
04:16My pleasure.
04:16You're very welcome.
04:17Take care.
04:18Look after yourself.
04:18Okay.
04:19Bye.
04:19Nice to see you fellas.
04:21Bye.
04:27Oscar?
04:27No.
04:28Oh, yeah.
04:29How are you?
04:31How are you doing?
04:33I'm okay.
04:34Thank you so much.
04:34You're welcome.
04:36So, what am I doing?
04:37Oh, yeah.
04:38Well, I believe you need to take the sample.
04:41Okay.
04:42Of...
04:43I have a fungus in my back.
04:45So, I'm taking a swab of mine?
04:46Swab.
04:47Shall I take my jacket off?
04:48Yes, please.
04:49How's the restaurant?
04:51Doing away?
04:51Oh, the restaurant is going well.
04:52I mean, not well, as you know.
04:55Nowadays, it's not really as good as it used to be.
04:59But was summer good for you?
05:01Summer was okay.
05:03Let's have a look at your bag.
05:05So, do you mean up here?
05:07Yeah, it is up here.
05:08And...
05:09Like here, here.
05:11Yeah, yeah.
05:11I have been using the Dacro or...
05:14Bactical.
05:14Bactical, yes.
05:15It has had no, what you call it, effect at all.
05:19Yeah, if we take a swab, it might tell us exactly what it is and how we can treat it.
05:25Right, right.
05:26Okay, so I'm just going to go for the biggest one.
05:30So, you're just going to feel me twiddling.
05:34Twiddling, twiddling.
05:35Don't even think that's a word, but never mind.
05:38And because it's quite superficial, it won't hurt, so that's good.
05:42No pain, no pain.
05:44No pain, no gain.
05:45Yeah, exactly.
05:47Okay, that's enough.
05:48That's it?
05:49Yeah?
05:50It's as simple as that.
05:51I was expecting some screaming and everything.
05:53Well, I could cut it off with a scalpel.
05:57I can make you scream if you want.
05:59That's the opposite of our job.
06:02Have you got anything planned for the weekend?
06:04Anything nice?
06:06No, tomorrow is football, so it's going to be crazy.
06:10But Sunday, hopefully, we have a little bit of relaxation.
06:13So, that's good that you've still got the football match here.
06:16Yes.
06:16Because that brings the trade in.
06:17I mean, I have been here...
06:18You've had, like, Maradona, haven't you?
06:20I had Maradona there.
06:22I had Zola, Vialli.
06:25Oh, Zola's my fave.
06:26I love Zola.
06:29Zola was just absolutely class at football.
06:31Yeah, they were all...
06:32And Vialli.
06:34But we had a good time with all of them.
06:37The day of the football is booked two, three weeks in advance.
06:40So, you're not going to retire any time soon, are you?
06:42I am already retired 15 years ago.
06:44But you're still in there.
06:45But I'm still there.
06:46I like to work.
06:47And I think getting retired and sitting home and waiting for death, no.
06:51People, they come and we know them and they know us
06:53and we love everybody and everybody loves us
06:55and they're happy every after.
06:56I hope it lasts a bit longer.
06:58That's like him.
06:59We're happy every after.
07:00Anyway, thank you so much.
07:02You're very welcome.
07:06You're very kind.
07:08You're very welcome.
07:09Have a lovely day to you and enjoy your day.
07:11Thank you so much.
07:12Take care.
07:12Lovely.
07:13Bye.
07:13Bye.
07:16Ow.
07:19Do you think of a skirt?
07:21It's nice.
07:22That's a good one.
07:24You need options, don't you?
07:25You've got lots of options now.
07:27Do you look nice, you do?
07:28Hi, guys.
07:29Come on through.
07:30Hello, hiya.
07:31Hiya.
07:32Bit colder this morning.
07:33Cheers.
07:36We're in this one again today.
07:38There we go.
07:39Come and have a seat.
07:40Hello, Sophie.
07:40How are you doing?
07:41Now, how are you?
07:42I'm okay, but I'm not okay at the same time.
07:45Okay.
07:46Because we are having a lot of very bad wells.
07:48Okay.
07:49It's very stressful.
07:50It's hard because you're sleep deprived,
07:52so you can't regulate your emotions.
07:54I know, yeah.
07:55And then it's really frustrating.
07:57We'll have arguments about the silliest of things.
07:59Yeah.
08:00Like, she'll tell me there's a fish in the water bottle,
08:03and I'll be like, but there isn't,
08:06and I don't know how many times I can say it.
08:07And then the carers say it as well, and it's like...
08:10So Sophie had this drink and she wanted you to drink it,
08:12but you could see fish in it, so you didn't want to drink it.
08:15Yeah.
08:16And then it causes a bit of an argument.
08:17Causes a big argument.
08:18And Lisa, do you think those fish were really in it,
08:21or do you think it was a hallucination?
08:23I know that hallucinations seem to be distant.
08:25It's gone out there and so on and there.
08:27They're very real, aren't they, the hallucinations?
08:29I've had all of that, yeah.
08:30I've also had occasions where I go, damn well, it's not true.
08:34So Lisa experiences lots of hallucinations,
08:36which can be quite common in Parkinson's,
08:37especially in quite severe Parkinson's,
08:39and she's experienced in horrible things,
08:42from snakes being in her flat, to dogs eating her,
08:45to multiple people being in her chair, in her bed,
08:47and they are very real to her.
08:49Even though she knows they're not real, they are seen.
08:52She can see them and she talks to them sometimes,
08:54and that's really distressing for all around her as well.
08:57And me and the carers all say to her,
08:59Yeah.
08:59We know it feels real for you, but we're being honest with you,
09:03there's nothing in there, why would we put it in there?
09:06And it's a transparent water bottle.
09:09Yeah, yeah.
09:09So maybe do you think maybe getting non-transparent water bottle?
09:12I mean, the reason we got clear ones is so we can see how much she's...
09:15She's drunk.
09:16In the past, somebody told me once that they took a photograph of something,
09:20and then showed the person the photograph,
09:22and sometimes the hallucination doesn't always appear on the photograph.
09:25That's right.
09:26Has that worked at all?
09:27Yeah, yeah.
09:28And I'm sad that if it's causing problems,
09:30because, you know, we both acknowledge Sophie is amazing in what she does.
09:33Absolutely.
09:34There's no doubt about it.
09:35And I know...
09:37You've been such a pin in all of this.
09:39I feel like it when you are, like, sort of so frustrated and...
09:42And that's the thing.
09:42And when we get frustrated, we have to think,
09:44well, why?
09:45It's just sleep deprivation.
09:47It's so draining.
10:02Do you think the hallucinations are getting less, Lisa?
10:05Because we tried titrating up that quetiapine medicine
10:08to see if that helps reduce the hallucination.
10:10Yeah.
10:10Do you think it's worked?
10:11I was going to say, yes, I did,
10:13because I thought...
10:14I thought it was a couple of nights,
10:16I was thinking it was nice and quiet, you know.
10:17So, I'm pleased if some of the hallucinations have been less,
10:20but it sounds like we've still got quite a way to go
10:22to get them to damp right down, haven't we?
10:25We've got the quetiapine,
10:26and the plan is we're just going to see how much that works.
10:29And she's also on a wait list for talk therapy.
10:32But she also said that she thinks I need it as well
10:34because of what I've been going through.
10:36You know, it's tough, isn't it, guys?
10:38Yeah.
10:39But in a way, I suppose,
10:40maybe just someone else on your side, Sophie,
10:42helping you find some of this.
10:44Yeah, yeah, it's always...
10:44I get an impression it isn't...
10:45I feel like I need an advocate.
10:46I don't have time and energy to do these things.
10:50It's like trying to get the wheelchair.
10:52So, we got...
10:52This is actually a Neighbours that we've been using
10:55because the one that they sent had a...
10:57It didn't have the brakes here,
10:58which is very handy for me being six foot five.
11:00Yeah.
11:00They had them down on a wheel.
11:02The mum can't do it because of her hand.
11:04It's just kind of right.
11:05So, we asked and they said,
11:06Oh, well...
11:07I mean, there is this taller version one.
11:09Because you're so tall.
11:10I'm getting back pain.
11:10Yeah, you will, yeah.
11:11You know, but it's...
11:13But there's a lot of waiting then,
11:13with lots of different people you're waiting...
11:15It's been a year.
11:17You know, a year of having to bend and push and...
11:21It's not good.
11:23Our link worker people, have they helped at all?
11:25Well, maybe, yeah, give him my number.
11:27Yeah, can I do that?
11:28I think, let's...
11:29I think it's just a very specifically difficult situation.
11:33Yeah, no, it is.
11:34Well, let's catch up again in a few weeks and see, OK?
11:38Can you come and see me as well, OK?
11:42OK.
11:43OK.
11:44OK.
11:44Right, Lisa, I'm going to put this down and one foot up.
11:47There we go.
11:48So, make sure you're safe.
11:49Right, I'm going to let you do it,
11:50because you're infinitely better than me.
11:51Although, you were having to bend right over.
11:53It's ridiculous.
11:55I know, it is.
11:56It's really hard, isn't it?
11:57I mean, if they could come up with a thing that is taller.
12:01I know, I know.
12:02Well, that's because she's so beautifully tall.
12:05I'm difficultly tall.
12:06Yeah.
12:07It's difficult.
12:07My sister was six foot, like, six foot one,
12:10and she always struggled with it.
12:11And you're six foot five.
12:12It's interesting, because you always do, like, clothes
12:13and things like that.
12:14A six foot one, you can still find it.
12:16Yeah.
12:17Six foot five.
12:24The first thing is my eyes.
12:26I think I'm going blind.
12:29Scratch cards are not too bad.
12:31I love doing them.
12:32I wish somebody would give me about 50 of them.
12:35If I was born in 1930, what does that mean?
12:40I get confused with that.
12:41You used to be an accountant.
12:42You're good at that.
12:44I've got to have my morning.
12:45I forgot to tell the eating off.
12:47Been on all night.
12:49Oh, no.
12:50And, of course, my flat was like an oven.
12:52Yeah.
12:52Oh, I got you a present.
12:54Turkish 11th.
12:55Yeah.
12:56Oh, you're sweetie.
12:59Oh, love.
13:01Thank you, darling.
13:06Doris.
13:07Hello.
13:12Take me a few minutes.
13:18Right.
13:20I've got a horrible problem.
13:23I've got a lot of mucus.
13:27And when I go to bed, I'm all right.
13:29I go off to sleep or whatever.
13:31But I wake up in the night and I want to cough.
13:36But it's not a mucus cough.
13:38It's like a dry cough.
13:40But it doesn't do that during the day.
13:43Right.
13:43And it's making me a little bit breathless.
13:48I can't...
13:49I mean, I'm using a box of tissues a week with the mucus.
13:55And the mucus, any colour?
13:58I mean, white.
13:59It's only like a white mucus.
14:00OK.
14:02And how is the breathing, Doris?
14:05I've got very clever.
14:09Especially if I've had a little walk.
14:12And I, you know, get indoors and I have to sit down straight away.
14:16Do you think that this cough could be related to your COPD and your smoking?
14:24Well, I only smoke five a day.
14:26How long have you smoked for, Doris?
14:2820 to five.
14:29I think I've done well.
14:30Well done.
14:31Considering I started at 18.
14:33So you were smoking 20 a day?
14:35Yeah.
14:36For 76 years?
14:36Until I started having all this.
14:39And then I got down.
14:40I can't cut that five off.
14:42OK.
14:43I'm living on my own.
14:45I'm bored.
14:46I don't know what to do with myself.
14:47Yeah.
14:48And that's the first thing I go for is a cigarette.
14:51Yeah.
14:52So I know I'm not going to give those up.
14:53Is there anything else you could do if you were feeling bored that would take that boredom away?
14:59I read and I, what's the telly called?
15:05I do jigsaw puzzles sometimes.
15:08Thousand pieces?
15:10But I'm more interested in whether my chest is OK.
15:15Let me come and have a listen to your chest.
15:16You've got a big thick jumper on, Doris, so is it OK if I just lift it up for you?
15:22All right, are you OK there?
15:23Yeah.
15:24OK, good. Just breathe in and out through your mouth for me, please.
15:37It's like having a perpetual cold.
15:41There's no signs of any infection or fluid or wheeze or anything in your chest at all.
15:45OK?
15:45Good.
15:46Can I have a quick look up the nose?
15:49Yeah.
15:50OK, just look up for me.
15:52I'm going to come in here, OK?
15:56Well done.
15:57Good, yeah.
15:58See the other one.
16:01OK.
16:02So, a little bit inflamed up there.
16:05I think your cough, Doris, is probably multifactorial.
16:09So there may be a bit of mucus up here in the nose.
16:13Yeah, probably.
16:13I think that the smoking is probably irritating your lungs as well.
16:17Yeah.
16:18Yeah.
16:18Yeah, because you do have COPD.
16:21But it's so annoying when every five minutes you're taking a tissue.
16:27I'm just trying to find out which nasal spray you're using at the moment,
16:30because that's what I think will help you a lot with this.
16:34Benosol and the other.
16:36Beclametazone nasal spray.
16:37And we prescribed that a month ago.
16:40Let's give it a bit more time.
16:41I'll send another one to the pharmacy for you.
16:43OK.
16:44But also, you know, because of the lungs having been damaged by smoking for many years.
16:48But my mum smoked, my dad smoked, my brother smoked.
16:52So, of course, I gradually followed on the ferry.
16:56And I'd done it from when I was 18, so.
16:59But I think, really, I'm lucky that I got that far.
17:03Yeah.
17:05But, OK, Doctor, well, thank you.
17:08OK, Doctor, thank you very much, love.
17:10Bye.
17:14Bye.
17:15Bye, Doris.
17:17Bye, Doris.
17:18Have a nice weekend.
17:20Have a nice weekend.
17:20Oh, free Monday.
17:37Nicholas, please.
17:39Hi there.
17:40Oh, hello, how are you?
17:41Yeah, yeah, good, how are you doing?
17:42I have some students with me.
17:43Do you mind if they sit in?
17:44Is that all right?
17:45Yeah, I can.
17:46Whatever.
17:46Are you sure? I really don't mind.
17:47No worries.
17:48Take a seat.
17:48How have you been?
17:50Yeah, good.
17:50How can I help today?
17:54Yeah, basically, I've got, like, a sciatic nerve thing going on.
17:57Oh, OK.
17:57Like, it's been going on for months and months.
17:59Yeah.
17:59I've done the whole physio thing.
18:01I've done, like, dry needling and try massages and a lot of deep tissue massages.
18:05And I've tried, like, a spinal central where it's, like, trying to realign stuff and it's
18:10just, it's just not working.
18:12It's driving me nuts.
18:12The lady who went to see the spinal central petition, whatever, she said, just exercise
18:16normal, go running and get football.
18:17How could I possibly do that?
18:19It's hard, I know.
18:19That's clearly...
18:20Because she's saying it's just a nerve thing, so you'd be OK to do it, but I don't
18:23want to aggravate it even worse, because it got really piqued.
18:26I played football and it was like I was kicking a cannonball.
18:27It was really...
18:28Exactly.
18:29Normally we say if it's a muscular thing, then, yeah, absolutely keep exercising as
18:32as you can.
18:33Find a good routine that you're doing.
18:35But when you start getting nerve impingement and there's sort of ridiculous features, we call
18:38them ridiculous features, because the nerve root is being impinged, it sounds
18:42like to me from what you say, then I agree you have to exercise much more caution with
18:46that, because we don't want to make matters worse for you.
18:48Is it all just on the left side?
18:49Just left, yeah.
18:50Like the top of the glute.
18:52Yeah.
18:52All the way down to the...
18:53We're just constantly...
18:54Like here now, I feel like I'm stretching.
18:56I'm not stretching.
18:57Just from a safety point of view, any urinary or bowel symptoms, no incontinence,
19:02nothing like that.
19:02Good.
19:03And no numbness in between the legs?
19:04No.
19:04Good.
19:05Brilliant.
19:05Do you mind if I examine you?
19:06Is that OK?
19:07Yeah.
19:07I'm going to press down your spine and get you to do a few movements for me.
19:10Yeah.
19:11Shoulders are really well aligned.
19:12You've got really good normal curvatures of the spine, so that's brilliant.
19:15Yeah.
19:15And it's like right at the top.
19:16As I get lower down, on the left, do you sort of feel that?
19:20No, it's like in the top.
19:21More in the glute.
19:22Like it's good right in there.
19:23So good.
19:24There's no spinal or paraspinal muscle tendons.
19:26So that's brilliant.
19:26That's really reassuring.
19:27What do you do?
19:28To lie down.
19:31I'm going to lift this leg up.
19:32Yeah, sure.
19:33And let me know what happens.
19:34Oh, sorry, sorry.
19:35Oh, gosh, so you can't even really lift it very high at all.
19:37Sorry.
19:38Yeah, that's fine, that's fine, that's fine.
19:39It's just...
19:39Can I do this one?
19:40Yeah, yeah.
19:41Is that OK for you?
19:41Yeah.
19:42But I can still feel it over there.
19:43I can feel it there, yeah.
19:44Yeah, but...
19:46If you push me up with this leg.
19:48Yeah.
19:48Good, push me up with this one.
19:49Push me down.
19:51Good, push me down.
19:52Good.
19:53And then if you bend your knees for me, kick me out with this one.
19:56Pull me in towards you the other way.
19:59That's it, yeah.
20:00I'm just going to check your reflexes are OK.
20:01Yeah, I think we need to refer you.
20:03An MRI would be good.
20:04Now, the problem is I can't directly refer you for an MRI,
20:06because they don't let me as a doctor, as a GP.
20:08You have to go through the musculoskeletal route.
20:10But I'll...
20:10That's perfect, thank you so much.
20:11No worries.
20:12I'll refer you to them, and they usually offer you an appointment
20:15within two weeks.
20:17The initial consultation might be a telephone, so don't be put off by that,
20:21but definitely just tell them everything that's happening,
20:23and then they can hopefully get you...
20:24Yeah, that's fine.
20:24That would be good.
20:25Yeah, yeah.
20:26The nice thing about the MSK team is if there's a problem there,
20:28they can fix it as well.
20:29So if they need to put a joint injection in, or whatever it might be,
20:32they can discuss that with you.
20:34So that's absolutely fine to do.
20:35Fine, no worries.
20:36OK, good.
20:37Keep us posted.
20:38If you develop any numbness, tingling, weakness in the legs,
20:41they're not working properly, numbness in between the legs,
20:43just come straight back.
20:44No worries.
20:45Great, brilliant.
20:45Take care, all the best.
20:46See you later.
20:47Good to see you.
20:47Thanks.
20:48Pleasure.
20:49Bye-bye.
20:58You've got one eyebrow hair that's like...
21:00It just stays up.
21:02I'm not going to put it out.
21:03I just want to move it.
21:04Yeah, yeah.
21:05I need Sanford to do her, like, threading again.
21:07I need to get my eyebrows threading.
21:08Sanford is threading.
21:10It's because I don't use glue.
21:12Glue?
21:12Some people put glue in their eyebrows to keep it in place.
21:15It's just a long one.
21:16There you go.
21:16Yeah, I hid it.
21:17Yeah.
21:17To trim it.
21:18Not glue.
21:18It's like gel and you kind of put it in place.
21:21You're the wrong one.
21:23We'll use the gorilla glue.
21:26Oh, my God.
21:30Oh, my God.
21:35Julian?
21:36Hi.
21:37Hi.
21:37How are you?
21:41Take a seat.
21:42Hi.
21:43Hi.
21:43Hello.
21:43Hi.
21:46So tell me what's been going on.
21:49I had an epileptic fit.
21:50I came off my bike on Thursday last week.
21:54It was a smash on my knee, a smash on my shoulder.
21:58I had a swelling here really quite high.
22:01Immediately?
22:01Oh, yeah.
22:02But essentially, you know, I thought, nah, I can bear this.
22:06What's happened in the last 36 hours is much more pain.
22:11So the pain went down through about three days.
22:14It's just picked up again.
22:16And I've got a sort of noticeable bruising area.
22:18Yes.
22:18But I've got pain all over the arm.
22:20Yes.
22:21Yeah.
22:21And maybe even a slight click when I do a bend.
22:24Don't bend for a moment.
22:26I'm just going to see.
22:27It's a little bit swollen here.
22:30Well, yeah, I mean, it's calmed down the swelling, but the pain is high.
22:34Can I compare them?
22:34I mean, I got woken up this morning at 6.24 by the pain.
22:38Okay.
22:38And if you were to move the wrist back, how far can you go?
22:43Or don't...
22:43Well, I will, but...
22:44No, that's okay.
22:45Don't push your...
22:46That's uncomfortable by there.
22:48And certainly I can't take any weight on it.
22:50Okay.
22:50And you're not able.
22:51And that's uncomfortable by there.
22:53Okay.
22:53Squeeze my fingers.
22:55That's beautiful.
22:55Yeah, I suppose.
22:56Yeah, I can.
22:56Okay.
22:59I'm worried about a break in this wrist.
23:03Really?
23:03Yeah.
23:04You have significant swelling.
23:05You have bruising.
23:06And if you're not able to, you know, at this stage, you should be able to do more with it.
23:11So I'm definitely going to organise an x-ray.
23:13Okay.
23:14So you can go to Chelsea and Westminster to walk in.
23:16You just say your name.
23:17The opening hour is, I think, between 9 and 4.
23:19Mum tells me I've broken that twice and that once.
23:22I had no recall of breaking my right one.
23:24Really?
23:24Well, I'll say epilepsy for you.
23:26I suppose...
23:27I've had, yeah.
23:28I mean, my seizures have actually gone in the right direction.
23:31Because I logged them one, two or three.
23:33And obviously this is a three.
23:35Yeah.
23:35The ones are the ones where I actually remain conscious.
23:39Yeah.
23:40But I get no warning.
23:42It's come down from last year.
23:43Yeah.
23:43I had 112 last year.
23:45Yeah.
23:45Yeah.
23:45Because I've had only 67 this year.
23:4767.
24:03Uh, Thomas, please.
24:04Hello.
24:04Going through.
24:06I'm George, one of the doctors.
24:07Lovely to meet you.
24:08Nice to meet you.
24:08Um, are you quite new to our surgery?
24:10Uh, I've just, you know, I just...
24:12You just joined.
24:12I just, uh...
24:13Great.
24:14Take a seat.
24:15Make yourself happy.
24:15Uh, I'm feeling well.
24:17I still keep my diet because I cannot go actually higher than around 90, 95 kilograms because of the
24:26medicaments.
24:27And what medications are you taking?
24:28Uh, it's Atacrolimus and it's, uh, it's normally it's Mifenax.
24:32And how many of these do you take?
24:33Two twice a day?
24:34Yes, yes, exactly.
24:36And what are you taking these for?
24:37After heart transplant, six years ago.
24:40Heart transplant.
24:41Heart transplant.
24:41Sorry, yeah.
24:42Yeah, yeah, yeah.
24:43And so you're on these because of that, yeah.
24:45Yes, because of the heart.
24:46Oh, gosh, you poor thing.
24:47And this was all done in Poland?
24:49Yes, yes, exactly.
24:50It was six years ago.
24:51Yeah.
24:51Why did they do the heart transplant in the first thing?
24:53It was due to the flu.
24:54I got the...
24:55Oh, so a really bad case of flu, like myocarditis or something.
24:57Inflammation of the heart tissue.
24:59Yeah, some, some bacteria attacked my, my, my heart.
25:04Ah, okay.
25:04Yeah, yeah, yeah.
25:04The flu bacteria's infection.
25:07I, you know, the function of my heart was 17, uh,
25:10Percent.
25:11Percent.
25:11Oh, wow.
25:11If I wouldn't get this heart transplant,
25:14just, just a week, two weeks,
25:17and I, and I would die because of the, because of the infection
25:20and, and, and because of the antibiotics.
25:23It's really difficult to have a transplant of any sorts,
25:27especially a heart transplant.
25:28Uh, patients need to be on anti-rejection medication
25:30so that their body doesn't reject the, uh, organ in question.
25:34And that can require a lot of, um, blood tests
25:36and monitoring, uh, throughout their lives.
25:39Uh, patients with heart transplants will also need regular echocardiograms
25:42to make sure the heart is still functioning adequately.
25:44How would, would it be okay if I did a blood test today for you?
25:47Yes, yes, yes, that's fine.
25:48Just because we don't have anything on our system.
25:50Mm-hmm.
25:50You're new to our surgery, so it would be good.
25:52And then we can send everything off to our cardiology doctors.
25:55Exactly.
25:56Can I check your blood pressure?
25:57Yes, yes, of course.
25:57Thank you so much.
26:02Yeah, so it's a little bit elevated today, 151 over 88.
26:05Ah.
26:05This bottom number is good.
26:07Yes.
26:07This one is a little bit higher.
26:09Yeah, yeah, yeah.
26:09And, yeah.
26:10Because you've had the heart transplant,
26:12it's even more important to keep your blood pressure at a,
26:16at a normal level.
26:17So I think we need to find a new tablet for you
26:19and then we can keep your blood pressure within the normal limit.
26:22That would be really good.
26:23But let's check your kidneys, check your liver.
26:25So, can I do your bloods today?
26:26Is that okay?
26:27Thank you so much.
26:28Sharp scratch, 3, 2, 1.
26:31You've been through a lot, haven't you?
26:32You've been through a hell of a lot.
26:34Yeah.
26:35How are you coping?
26:36Are you managing okay?
26:37Do you feel like...
26:38Actually, from a half year, I'm taking as well some,
26:42you know, medicaments to keep my mental health good as well.
26:47I was 23 years old when I got sick on my heart and now I'm 42.
26:51And so, you know, I'm just, I'm just, I'm just really tired about...
26:55I can imagine.
26:56Of course you are.
26:57And that's only this.
26:58And, you know, sometimes I'm just got, you know, crazy.
27:01I'm just a very active person.
27:04Yeah.
27:05I do a lot of workouts.
27:06Even once I started in Ironman competition.
27:09Oh, wow, did you?
27:10Well done.
27:11Honestly, but...
27:12Incredible.
27:12Yes, but, you know, I had to swim in the sea,
27:16so when the waves come, I just, you know, gave up
27:20because it was too hard for me.
27:22You've been through so much in your life.
27:24It's, you know, a real inspiration to meet you.
27:27I think you've been through so much.
27:28So much has happened and you're still fighting.
27:30And, you know, this is a very complex history.
27:33There's a lot that's happened.
27:34Yes, yes.
27:34So, my priority for you now is let's make sure the heart is okay.
27:37And then we'll optimise all your medications.
27:40We'll sort out your mental health.
27:42But it's going to take a little bit of time.
27:43That sounds great. Thank you.
27:44Is that all right?
27:45Thank you very much.
27:46All the best. Take care.
27:52I think there are specific things, you know,
27:55that you need to be safe about when you're having...
27:57Yeah, I'm aware of that.
27:58...this number of epileptic seizures.
28:00Obviously, you'd say, well, don't ride a bike,
28:03but it's just so good for controlling my sugar levels.
28:05But I'm going to have to have an absolute new discipline
28:08of staying off my bike in the evenings
28:10because that's when the fits tend to happen.
28:12Yeah.
28:13And staying off my bike very carefully
28:16if I'm even likely to be in a cluster period
28:18because I have two cluster periods a month.
28:21I think walking is safer for now.
28:23Well, I'm going to have to go a bit old school,
28:25but it's just so useful to control the sugar.
28:27Yeah.
28:28Because I'm type 1 diabetic.
28:29I know that you've had quite a complex, you know,
28:32combination of diabetes and...
28:34...and seizures.
28:34Have you spoken with neurology?
28:36I know the last time we spoke I sent a letter through
28:38to see if we could get you seen sooner.
28:40I'm in direct touch with that whole group I'm building up
28:44which is giving me things to do, actually.
28:47The epilepsy community, in which I've got 89 people in London.
28:51That's really good.
28:52I've identified a lot of people in my age group
28:54particularly feel a bit cut off in life.
28:57They feel a bit lost.
28:57Yeah, having that support in the community is really important.
29:00So, you know, it's great that you have created that space.
29:04But from management of the seizures perspective,
29:08for your safety perspective,
29:09I'll send another letter through just to see if we can get neurology
29:12to see you again.
29:14Okay.
29:14And then the other thing is really and truly no ladders, no cycling.
29:20Well, I need to control the sugar.
29:23It's a balancing act, for sure.
29:25But from here, I think, you know, falling off your bike
29:29and if you're cycling on a road with traffic, like, it is worrying.
29:32So, from my perspective, I'm worried that there's a fracture there
29:36so we'll get the x-ray today.
29:37Mm-hmm.
29:37I'll send another letter through to neurology.
29:40Okay.
29:40Groovy.
29:41All right.
29:41Thank you very much.
29:42Yeah, no worries.
29:43That will keep Mumsy happy too.
29:44She was all worried that I was ignoring it.
29:46Yeah, I think that if you have a significant fall
29:49and it swells immediately, it's worth getting checked by a doctor.
29:52Okay.
29:52All right, Julian.
29:53It's good to see you.
29:54Hey.
29:57Thanks.
29:58I know.
30:04Do you like jumping?
30:07No, please, not my dress.
30:11Okay.
30:11Should we put it back?
30:13Tidy up.
30:17Kit.
30:18Kit.
30:24Come on.
30:25Out we go.
30:30You all right?
30:32That's okay.
30:33You okay?
30:34It's okay.
30:34It's okay.
30:35It's okay.
30:35It's okay.
30:35It's okay.
30:35It's okay.
30:36It's okay.
30:37It's okay.
30:37You have got belly now.
30:40Now you want to hang out with me.
30:44Wow, a fish.
30:46Yeah.
30:49Hiya.
30:50Hello.
30:50Nice to see you.
30:51A seat with the arms.
30:52That's the...
30:53Keep him tied in.
30:53Hello.
30:54Hiya.
30:54How are you?
30:54I'm Dr Pearson.
30:55Hello.
30:55Nice to meet you.
30:56You too.
30:57Now, so we think it might be this hand, foot and mouth.
30:59He's appearing on his hands.
31:01He's got a couple on his feet.
31:02He's got some on his back.
31:02It's all over his bottom.
31:05And, er...
31:05So, tell me, when did it start?
31:07What happened?
31:08After tea yesterday, around 5.30, I noticed two tiny little blisters here.
31:12And I thought, oh, there we go.
31:13And then when we went to bath time, he's got a bit on his back.
31:16Okay.
31:17And then I saw his bum and I looked closer at his nappy rash and I was like, hmm, that's
31:20got little blisters on.
31:21Yeah, little blisters on.
31:21And then he didn't go to sleep till one o'clock in the morning.
31:24Oh, cool.
31:24And from 5.30 till one, all this came up.
31:27Oh.
31:28So he had nothing.
31:29Look at it around his mouth.
31:29It looks so sore, doesn't it?
31:31And up his nose.
31:32And in his mouth, I think.
31:33And you should see his bottom.
31:34Do you mind if we ever look at his bottom?
31:36Let's put him on here.
31:38Look at your poor mouth and all up your nose.
31:41And it's all got a little bit infected.
31:42It's a little bit crusty.
31:43That was honey-coloured crusting.
31:45That wasn't even there last night.
31:47Oh, my lordy-dawdy.
31:48That has come up, like, really badly overnight.
31:50Goodness gracious me.
31:52Poor little chap.
31:53That must be so sore.
31:54Imagine if, as adults, we got this sort of thing.
31:56I mean, we'd be in a right state, wouldn't we?
31:58A friend of ours got it.
31:59He was taking codeine to try and sort of...
32:01Yeah, it's so red and angry and slightly infected.
32:04I think we need some antibiotics.
32:05And that's what sometimes happens.
32:06Because hand, foot and mouth, we don't treat.
32:07The problem with any of these viral things is sometimes,
32:10like chickenpox, we don't treat chickenpox,
32:11but sometimes they get infected.
32:13So poor Kit had horrible hand, foot and mouth disease.
32:16It's a condition which is caused by a virus,
32:18which is nothing to be overly concerned about.
32:20It's a common childhood illness.
32:21It doesn't normally make children terribly ill.
32:23It just goes away on its own.
32:25Unfortunately, sometimes, and in Kit's case,
32:27the spots, they can get infected.
32:29And unfortunately, you need antibiotics in this case.
32:31Let's give you some of the cream,
32:32that really good antibiotic cream.
32:33Yeah, and then what is that?
32:34You just put that on all the time, basically?
32:37Put it on every time you do a nappy change.
32:38Ethan, can we put a tiny bit of here?
32:40Absolutely.
32:40So the cream can go anywhere where it's reddening
32:43and sore and inflamed.
32:44So around the mouth, even if the spots look really sore,
32:46it won't make a huge difference if the skin isn't broken,
32:48but it is around the nappy sort of region a bit
32:50and around the mouth it is.
32:51Yeah, let's not lick all of that.
32:54That's been in my ear.
32:56Let's give you a sticker.
32:57Why don't we give you a sticker?
32:58Which sticker would you like?
33:00Which one?
33:00The bee, the ladybird, the caterpillar, the butterfly.
33:05Why don't we do that one?
33:06Oh, look, it's got its fingers in it.
33:07Look at that.
33:09Then you can play with that, my friend.
33:12Well done.
33:12There we go.
33:13Well done.
33:13I was brave for the nurse.
33:15Oh, for the doctor.
33:16Yeah, well, same thing, same thing.
33:18Right, so I'll send that through with the cream,
33:20which are the two prescription ones.
33:22OK, thank you very much.
33:23It is hard, but you know, you're doing a grand job.
33:26Oh, you know.
33:27And it's hard when you've got another one at home as well.
33:29All right?
33:30Fantastic, thank you.
33:30OK, right, let me let you out.
33:32All right, good luck.
33:33Get some sleep.
33:34We haven't slept for three years.
33:36I know, well, I know, I know.
33:37Good luck.
33:38Cheers, bye-bye.
33:39All right, come on, you.
33:40Oh, you want this?
33:42Elena?
33:46Hi, come on through.
33:48Hello.
33:48How are you?
33:49I'm fine.
33:50How are you?
33:50I'm fine.
33:50Good, thanks.
33:51Nice to see you.
33:53Well, the last Friday I was, it's like a NCHS seminar for breast cancer.
34:01OK.
34:01So they teach us how to check ourselves.
34:07Well, I've done it, and I think I can feel lump.
34:11They ask me about my family history, and my aunt, she had breast cancer.
34:18OK.
34:19And now I use combo hormonal therapy.
34:23Yeah.
34:24And I'm not 50 years old yet, but I don't know, is it normal or not?
34:29I feel a little, like, a little thick.
34:33Thickening bit.
34:34Yeah.
34:34So you've definitely done the right thing coming in.
34:37And what we'll do today is have a look.
34:39Do you think it's new, the thickening, or difficult to say?
34:44Honestly, maybe couple months, maybe half year.
34:48Yeah.
34:49But just like I, sometimes when I press more intense, I can feel it.
34:55So it's definitely something you feel different.
34:57Yes.
34:57Why don't we, are you okay if we have a look today?
35:00Yeah.
35:01Perfect.
35:02If you just pop off your top half, ideally.
35:09Can you just pop your arms up like that?
35:11OK.
35:11Just lie back.
35:13So normally we just start on the side where you don't feel a lump.
35:16And I'm just going to check that side for you.
35:22That all feels fine on that side.
35:24Mm-hmm.
35:24You can relax that side down.
35:25Just pop that arm up.
35:26So you feel it here?
35:28Well, near nipples, I think.
35:30Mm-hmm.
35:31But more inside.
35:34I just really press myself to find something.
35:37Yeah.
35:37I even feel it here.
35:39Yes.
35:40I'm sorry.
35:41Is it painful?
35:42A little bit.
35:42Mm-hmm.
35:43Like on nerves.
35:45Maybe it's normal.
35:46I don't know.
35:50Just there?
35:51Yeah.
36:08So what I can feel is like a tiny, tiny pea-like cyst, but it's quite mobile.
36:13I don't think it's worrying, but we do just want to, because you've noticed it, I think
36:18it's important we do get some imaging.
36:20It's X-ray?
36:22Depends.
36:22Probably a mammogram, which yes, is an X-ray, but sometimes they might also do an ultrasound.
36:27All right.
36:28I'll let you get dressed, then we can have a chat.
36:31They told it's very quick procedure.
36:35It's not painful.
36:36A mammogram can be a little bit uncomfortable, but yes, not overly painful.
36:44So what I'll do, I'll refer you to the breast clinic.
36:48Now, all breast clinic referrals do go under a query breast cancer referral route.
36:54Mm-hmm.
36:54But that's for any breast lump.
36:56Okay?
36:56So it's the only way we can get breast imaged.
36:59So I don't want you to panic that that means I think it's something really concerning.
37:03Mm-hmm.
37:03Does that sound all right?
37:04Yeah, of course.
37:05Because I had this doubt and I just, if after this imaging I can exclude...
37:11Exactly.
37:12Exactly.
37:13So what we're doing is we're just getting some imaging to make sure it's nothing to be concerned
37:16about.
37:17It doesn't feel, though, like a lump that feels something sinister or doesn't feel like breast
37:21cancer, but it's always best that we check.
37:24All right.
37:25Not at all.
37:25Have a great day.
37:27Yeah.
37:28And let us know if you don't here in the next two weeks.
37:30Thank you very much.
37:31That's all right.
37:31Bye.
37:32Bye.
37:32Nice to see you.
37:33You too.
37:41Tracy.
37:42Hello.
37:44Come on in.
37:47Hello.
37:47How are you?
37:48You're getting skinnier.
37:49Oh, no, I'm not.
37:50Well, except everyone's had a bug.
37:52Everyone hasn't been very well, really, in my house since last few weeks.
37:54Everyone in my building's been poorly.
37:55I know.
37:56I think it's the time of year, isn't it?
37:57Everyone catches things quite quickly.
37:59How's the cold weather?
38:00Does it affect things?
38:01Not really.
38:02Oh, tea.
38:03Lovely.
38:04Oh, you're so good at bringing tea.
38:05I get some new ones.
38:06That's a really nice one.
38:07Oh, it sounds good.
38:09They all smell lovely, don't they?
38:10Oh, thank you.
38:11You shouldn't bring tea every time.
38:12You're so good.
38:13We love it.
38:13I don't every time.
38:15Caffeine-free as well.
38:16Even better, so I don't have to have palpitations when I drink it.
38:19No, you don't.
38:19Tell me about this.
38:21Right.
38:23Not because I've been lightheaded, that isn't the reason I started using it, but I tripped
38:28last week getting off the bus.
38:30I dropped something off the shelf in Sainsbury's and smashed it and all hummus went everywhere
38:34in Sainsbury's the other day.
38:36I've put a whole cup of tea over my bed and soaked the duvet.
38:41That's a nightmare, isn't it?
38:42Then I caught my finger in the chute last night.
38:45Do you think we need to go back to the hand connects?
38:48If we have a look at it, so this one's already been fixed, doesn't it?
38:50I mean, they've all had...
38:51They're no joints.
38:52But we haven't seen the hand people for a long time, have you?
38:56If I get to the point that it's a bigger problem, then I will.
38:59And you know I will.
39:00I will.
39:01You know I will.
39:01I've known Tracy for many years now and looked after her, and she suffers from a horrible
39:05condition called psoriatic arthritis, where the bones of the hands literally fall into
39:11each other and they destroy, and the body's destroying the bones from within.
39:15So various surgeons and people have tried to help her by fixing the bones so they don't
39:19just destroy each other, but it's left her with very fixed deformities of the hands,
39:23which makes day-to-day living very difficult.
39:25I mean the surgery, you know, it's helped a bit, but I mean it's stopped them sort of
39:30telescoping into themselves, the joints, but it hasn't stopped them.
39:33The problem is, if you think all these have been done, they are new joints, but where
39:39are they?
39:40They're not there, are they?
39:41They've gone, well that's there, this one is non-existent, they're not the best.
39:47It's really hard isn't it?
39:48But I do like this, even if you can't grip it properly, even if it's something you can
39:50lean on, even if you use your forearms a bit as well sort of thing.
39:53I guess it makes me feel safer.
39:54And it is safer, I mean it's, and I know, you know, it's brilliant and you don't have
39:58to carry anything just as those extra legs to sort of support.
40:01It's just the fact that I can't grip it.
40:03Yeah.
40:04You know, I do tend to do everything like this.
40:07It's good.
40:07You know, everything is, you know.
40:09But how do you hold it then?
40:10I do that, I just do this.
40:12I can do it with them, I just do that.
40:14You can't get your hand round it?
40:15No.
40:16I was talking with my sister this morning, we were talking about getting an alarm.
40:19OK, the pendant alarm.
40:21Yeah.
40:21Because she was saying to me, the worst thing would be if I got a phone call and then I've
40:24got to drive there to London to get into your flat, find you dead on the floor, wouldn't
40:29it be more sensible to start?
40:31But I do think having a pendant alarm is sensible.
40:33I do think this is sensible.
40:35I know.
40:35Because the last thing we want is big falls and things like that.
40:38The thing is, you don't look like you've got any sort of disability but actually your
40:40joints are in a lot of pain, your feet are difficult, your hands are difficult, you
40:44know, all the joints and knee.
40:45I mean, I'll be honest, today everyone sort of got out of my way and I was like, oh actually,
40:49maybe I should get a bigger one.
40:50Let's do, what about your tablets?
40:51You're OK, let me do all of these tablets then for you today.
40:54Let's do these ones, we can get them one at a time.
40:57You're coping with the inhalers and things, they're working?
40:59Yeah, they're fine, they're fine.
41:01OK, let me send all this through, let's book up for four weeks' time.
41:06OK?
41:06OK.
41:07Well listen, good luck, you take care, all the best and thanks again for the tea, that's very
41:10kind.
41:10You're welcome.
41:11Take care, bye bye, nice to see you.
41:12Have a good day.
41:13You too, we'll get you sorted, don't worry.
41:16This is much more than a job for me, it really is a vocation.
41:19Alright, take care, look up to yourself.
41:21Thanks.
41:22I just feel so fortunate that I can get the opportunity to help people and yeah, it gives
41:29me a lot of purpose and adds a lot of meaning to my life.
41:33Thanks.
41:34Nice to see you.
41:35Nice to see you too.
41:36I've already got these relationships kind of forming with patients and it's always
41:39nice to see that they've come back to you.
41:42Thank you Doctor.
41:45You get to see people from cradle to the grave, as the cliche is.
41:49Don't leave.
41:50I'm not, don't worry.
41:50Don't leave till I've gone to the other planet.
41:53I wouldn't wish to be with anybody else.
41:56I think it's important in this day and age to know that you can see a doctor who has
42:02been with you since birth basically.
42:05I think it's really important.
42:07Alright David, lovely to see you.
42:08You take care.
42:09Nothing wrong with me.
42:10Your heart's okay.
42:11I don't know about your brain.
42:13I like seeing different people.
42:17I learn a lot from them.
42:19Things that I wouldn't learn, you know, in your day to day life.
42:21It's nice to see you.
42:23And I cry when they cry a lot of the time.
42:26Well that's very kind of you.
42:27Thank you for seeing me so quickly.
42:31Have a great afternoon.
42:32Yes.
42:32Thank you very much.
42:33Bye.
42:34So you'll have days where everything's going smoothly.
42:36And then you'll have days where you're running really late.
42:39There's lots of complicated patients.
42:41But I do feel like I've got a really good team supporting me.
42:43And I feel I can always go and ask for advice or help if I need it.
42:47Health promotion, health prevention is something that I'm really passionate about.
42:50Having those conversations that might, you know, even with one or two people,
42:55make a little bit of a change that can impact their life.
42:58That's what I love about being a GP.
43:01We are genuinely like a little family here.
43:04And that's not just us saying that because we're trying to get a pay rise or anything.
43:09But, yeah, genuinely, hand on my heart.
43:12I wouldn't change our team for the world.
43:15I really enjoy being a GP.
43:17And having been in the same practice for over 20 years,
43:19I've watched these patients go on a journey.
43:22And sometimes that's a journey of illness.
43:24Sometimes it's a journey of life.
43:25It is never, ever boring.
43:27And it is fun.
43:28And it is worthwhile.
43:29And you can learn an awful lot and be really inspired by lots of these patients.
43:31Sometimes that's counts as well.
43:50I don't know anything.
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