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[doctor] judy gomez , mrn 869723 . date of birth , 5 , 7 , 1961 . she's in office today for ongoing management of psoriatic arthritis . hello , judy , how are you doing today ?
[patient] i'm doing good , thank you . how are you ?
[doctor] i'm great , thanks . so how have you been since the last time ? i know the last time we were talking about decreasing your prednisone dose , correct ?
[patient] yes . i'm just on one now and that seems to be enough .
[doctor] aw , that's great to hear .
[patient] yeah , there were a couple days there i took an extra one , just because there was a little extra pain in my feet . and i do have a desk job , so when i have a day off where i'm moving around a lot they do tend to hurt a bit more .
[doctor] okay . how many times did you do that ?
[patient] um , it was n't often , maybe once a week .
[doctor] okay . so it sounds like we're still on track for discontinuing the prednisone . we'll do that today and you can let me know how it goes on your next visit . and how about the methotrexate , do you think that helped with your joint pain ?
[patient] yeah , definitely . because i went to get my covid shots , um , but from the letter i got about it , it said that it could interfere with the vaccine , you know , reduce the efficacy . so i did n't take it on the week that i got the first shot .
[doctor] okay . and what happened ?
[patient] i felt absolutely horrible until i took it again a week later .
[doctor] i'm sorry to hear that . and- and what did you do about the second dose ?
[patient] well , i called into the hotline because i was in so much pain with the first one . and they said , " no , just go ahead and take it , " so i did .
[doctor] okay . that's good then . we do have to keep an eye out on it since it's a high-risk medication . do you have an appointment to get your blood drawn for the next time ?
[patient] no , they did n't give me one .
[doctor] okay . so we can do that for you too . uhm , so what questions do you have for me , judy ?
[patient] well , i just wanted to know why i was getting all these bruises here , so like when i bump myself . i do n't know where they're coming from .
[doctor] okay . that's probably from the prednisone , it can increase bruising .
[patient] okay . i did n't know that . um , i do n't even feel it when it happens , they just show up .
[doctor] yeah . unfortunately that can happen , but we're working on discontinuing that so let's see if the bruises do go away .
[patient] okay . that sounds good , thanks .
[doctor] okay , judy , please , um , sit up here and i'll take a look . shoes and socks off please .
[patient] all right .
[doctor] all right . let me see here . okay . so where is it hurting ? in your joints right here ?
[patient] yeah , a little . also in my feet joints as well .
[doctor] okay . and how about when you bend the knee like this ?
[patient] well , it hurt before we increased the methotrexate , but it's doing pretty good now .
[doctor] okay , good . can you flex your toes please ? good range of motion . also ridges in nails , that's from the psoriasis .
[patient] yeah . they've been like that for a long time now .
[doctor] okay . all right , uhm , ms gomez , it looks like we're moving along with your treatment nicely . we'll stop your prednisone and continue with the methotrexate . make sure to stop by the front desk and make an appointment for the blood work , and i'll see you in three months .
[patient] all right . it sounds good . thank you so much , it was great to see you .
[doctor] it was great seeing you too . thank you .
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Hello. Can you hear me OK?
Ohh yes, I can. Can you hear me?
Yeah, good, good. So, my name is Joe. I'm a doctor, um, here at Babylon. Can I just confirm your name, please?
Uh, my name's Vincent.
And, your date of birth?
Uh.
Uh, ninth of May, two thousand and sixteen.
OK, great.
And are you in a, uh, a safe place, ohh sorry, a safe and , confidential place to talk and just, happy to go ahead with the consultation?
Yeah. Yeah, I am.
Yes, yes I am.
Great. So, how can I help?
Yeah, so, have a . I've been having a cough and a sore throat, for about a week, and, it's been causing me problems. I've had to stay away from work, for about three or four of those days, because of how bad is.
OK, I'm sorry to hear that. So, you've had a cough, and a sore throat, for about a week?
And what came, what, what came first?
Yes.
Uh, the, sore throat came first, and then, after a day or two, the cough.
OK, OK. And, uh, are you coughing up anything?
No, it's very dry.
OK, So I'm, I'm just gonna ask a few questions about the, uh, your current symptoms. And a little bit about your background.
Um, and, something else about what we can do, a little bit later on in the consultation, to help you. So, before we go on. anything you're particularly concerned about? Um, or have any ideas, what might be going on? You said that you had a cold.
OK.
, well.
I mean, you , you know how, we all are. Once this happens, you Google it and, there seems to be, all kinds of bad things it could be. It could be, could be a cold or, flu obviously, but it could also be tuberculosis. It could be, cancer always comes up so.
It'll be good if, none of those.
Great, so, so yeah. I can provide a bit of reassurance, um, and uh, we can talk about those a little bit, as well. And was there anything you were particularly expecting, or hoping to get out of this consultation? Um.
OK.
Uh. Uh, well, uh yeah, so reassurance. So like, hopefully some sense that it's not anything too serious. But also, is there anything you can prescribe me to make it better? Or any advice?
Or maybe even a sick note. So that, if I need to stay away from work for a bit longer, I can get one.
Sure, sure, OK. All right, so, we'll talk a little bit about the symptoms, and I'm sure we can , get a, um, those things, uh, and some reassurance, um, about your concerns.
OK.
So, um, you mentioned that you started with sore throat about a week ago, developed into bit of a dry cough. Um, , I'll just ask a few questions around those. So, um, do you have any shortness of breath?
No.
Yes, yes, I've been having shortness of, . Yeah, I've been having shortness of breath, yeah.
You are short of breath. And, uh, do you have any wheeze? Or chest pain?
Uh, yeah, a bit of both .
You're, you're feeling a bit wheezy, with some chest pain as well.
Yes.
OK. And, how, ah, when did you start to develop the shortness of breath?
. So, so the sore throat, so today's Friday, sore throat was about, last week, Friday or Thursday.
Cough was Saturday or Sunday. So the, so the, shortness of breath was I think, shortly after the cough. So maybe a day or two later. So, three, four days ago.
Three or four days ago, you started develop . And is the cough worse at night-time?
No, no, it's the same throughout the whole day.
Same throughout the day. Um, and, uh, when you say you're short of breath.
Just need to try and get an idea about how short of breath you are. So, are you able to, so , um, so, uh, like walk up a flight of stairs, for example? Um, or, or, are you short of breath at rest?
Ohh yeah, it's, it's like, so when I'm doing walking. Um, and I do exercises now and then. So it, it hasn't been .
Superbad like, hasn't stopped me from doing any of those things, but it's been pretty unusual, and a little bit worrying.
And you're a bit concerned about that, OK.
So, I just need to ask a few, uh, things about your background as well. So, um, do you have any other medical conditions, or medical history?
No, just, no, no , past medical history, no.
No . No history of asthma?
No.
Um, and any, uh, uh, history of, uh, clots on your legs, or your lungs?
So these . Uh, no one in your family's had those? Clots on the legs, or the lungs?
Well, my mother had lung cancer.
Your mother had lung cancer. Do you smoke?
No.
You ever smoked? Or been exposed to asbestos? That you know of?
Don't know with asbestos. Ever smoked, . I mean, once or twice in Amsterdam, if that counts, but, not really.
OK. Um, and, uh, this, so just going back to the, your symptoms of shortness of breath, with the cough. It's a dry cough, no, you're not coughing up any flem?
Um, do, do you have, uh, and you don't, you say you don't have any chest pain, as such?
Um. Uh, are you taking any medications, currently, at the moment?
Uh. No, no.
OK. Are you allergic to any medications?
Not to any medication, but I'm allergic to peanuts.
Peanuts. OK. Um, and, uh.
You mentioned that your mother had, uh, lung cancer. Um, any other, family history of any significant illnesses, uh, run, running in your family?
No, no, that's the only one. Just lung cancer, from my mother.
Just lung cancer. OK.
And you say you have a cold. So, do you have , sinus congestion? Or, um.
No, it seems to be , entirely with just my throat. So like, my nose is like, .
So, , just your, just your throat. And, any recent travel? Or have you always lived in the UK?
Uh, no, so I, I, I haven't always lived in the UK. Like, so I was born in the US, and moved over.
Well, it was twelve years ago, but, in terms of recent travel. Just to Europe, nowhere too exotic.
OK, so no, so no recent travel, no significant recent travel any, anywhere. Um, OK.
And, are you coughing up anything other than, . Um, uh, so you, you're not coughing up blood, or anything like that? No, no.
Um, good. And, uh, are you feeling feverish, hot, cold, sweaty?
Yeah, so, a little bit feverish, uh, um, at first. So the first three or so days of this, but then it, the fever's gone away.
OK. And in general, do you . Sorry? Yeah.
Yeah, I was just gonna say, also had a bit of a headache. But like, headaches that come and go rather, but like, right now it's fine.
Uh.
OK. And in general, would you say you're feeling, you're, you're beginning to, to feel better? Worse? Or, or sort of, um, staying the same?
, so it's like, it's up and down. So, so let's see, so I, , it started last week, and I stayed home from work two days this week.
I think it was maybe, Tuesday and then Thursday. So like, I felt better and then worse again, and then better and then worse again. So it's been, yeah, a kind of constant, but constant and being, variable, if that makes .
OK.
And I just , need to ask any, other sort of risk factors. Um.
That you may have. So, , um, no sort of significant weight loss? Um, or unexplained weight loss? Any ?
So no weight loss, but I have been, have been losing my appetite recently. And I mean, I usually eat a lot so, and I, and I enjoy eating as well, but like, so that's been a bit concerning.
You've been losing your appetite recently?
Yes.
And you're a little bit concerned about that? But you haven't, you haven't lost any weight, that you think of?
Yes.
No. Not that .
And any, um, sort of rashes or anything? Or, uh, , and you.
No. Not .
Not that, not that you can think of. OK.
Um. So, I would ask to examine you now, but um, I, I don't know if I could sort of look inside your throat, at least. To see if there's a, probably, there's.
Ohh, we can try .
Ohh no, well, no, it's OK, I , might think about doing a. Have you got any lumps or bumps around your neck? That you can feel?
Uh.
No.
No that you, no, OK.
Um. And, so finally, you, you were talking about, uh, . I mean, it sounds to me that, um, you've been a little bit up and down. Sore throat. Developed a dry cough.
Um, you are slightly short of breath, but not too overly concerningly short of breath. What I would say, we're just coming to the end of consultation now, . If you feel significantly worse .
Mm-hmm.
Um. Uh, if you get more short of breath, or sudden change in your breathlessness. Um, or breathlessness that you are concerned about. Then I would advise you to see, no , go and see a GP. Um, and actually see somebody physically.
Um, uh, but I think, for now I can sort of, uh, try and reassure you that, um, if this clears up, as I expect it would. So, I expect this to sort of be getting better in the next, four or five days. Um, if it's not, please get in touch with a medical professional again.
Um, and, uh, I would expect it to, and so therefore, I wouldn't be concerned about tuberculosis
Um, your concerns about lung cancer, are. And, was that the other thing you're concerned about?
Ohh yeah, yeah. Yeah.
Yeah. So, so, um, again, if you're not getting better, please see somebody again.
Um, I've just got four seconds now. So, nice talking to you. And, have we gotta? We gotta, tidy up, yeah. OK, so, uh.
All right.
Uh, and I'll provide you with a sick note, just to give you a few more days off work.
Um, and paracetemol. Lots of fluids. Um, and, uh, rest up. And, as I say, if you're not feeling better, please get in touch. OK?
Have a good day.
. Thank you.
Bye.
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Hi.
Hello. Hi, I'm Doctor Jacob and welcome to Babylon. Hello. Hi. So, um, just before we start, is it all right if you could confirm your name for me please? And your date of birth?
Sure, my name is Mary Smith.
My date of birth is August sixteen, nineteen seventy six.
And your email address for me, please.
My email address is Mary dot Smith at gmail dot com.
That's correct. And just to confirm, that you're in a secure location, and we can have a confidential conversation.
Absolutely.
Right. So you've mentioned that you have some pain in your jaw. Is that correct?
Um, well.
I think that's just, like, the first thing that I typed, but, uh, uh, it wasn't really what I, you know, I just typed it and then I clicked submit, so, that was uh, um.
I mean it's part of the problem but I would say that, more of a problem for me, is that I can't quite move my left arm. I mean, I can move it but it's it's numb, and then I also feel some, like tingling in my fingertips.
OK, so numbness in the left arm, yeah? How long has it been going on for?
Yes, yes.
So, I've started taking this boxing class. I've been taking this boxing class for a few weeks, and I feel like maybe, um
Mm hmm.
It's probably been, I'd say, for at least two weeks, and it's kind of gotten worse. Like,in the beginning, I just kind of felt a little bit of a tingling.
Mm-hmm.
and then it's gotten, it's gotten worse since then. Then the numbing kind of started I can feel it both in my, uh, um, you know a little bit in my elbow, and then in my arm, as well as in my hand
Mm-hmm.
And now because it hasn't gotten better, I tried to get a massage, it's not better. Or, you know, try to take warm baths. It's not better, so I figured I'd call you and, and just figure out what's going on.
Right. So, have you mentioned that message and a warm bath, any medications that you've taken so far?
Uh, well it's.
You know it's, it's numb and I, I kind of looked at stuff online, um, but you know I, I do take Ibuprofen because my muscles were sore, a little bit, and I've been taking this boxing class.
Uh huh.
So, you know, I kind of hurt like my knuckles on my right hand. So that's been a little bit painful, so I've just kind of taken ibuprofen for that.
OK.
But, like I said, I mean, I tried massage, I tried some hot baths, and that didn't help with this numbness thing.
Mmm.
Sure.
I'm just kind of getting a little worried.
Of course. So you just mentioned that your pain is from elbow downwards, is that, you know, the tingling, numbness elbow . Not from your shoulder?
And, um, well it's kind of funny, you know sometimes I will feel it in my shoulder. Like if I try to, if I try to like you know move like in boxing and stuff, I will even like, uh, um, maybe feel a little bit of, a little bit of pain.
Uh, but I would say, if i'm just like resting if I'm sitting like, right now, I can feel like it's numb, and I, I actually feel, tingling right now, not in all of my fingers, just in some.
Yeah. So, which fingers do you feel numb?
OK, so it's my second, third, and fourth finger.
Uh huh. Second, third and fourth finger. And is it your palm side or, you know, the back of your hand side which is numb, or both?
No. It's, it's the, it's this side. So, the front side.
It's the front side. OK, right. And have you been dropping things at all? Like, you know, when you try to hold onto things, like a glass or something, have dropping it?
Yes.
So not so much with the glass, but I will say, um, well I play a little bit of a piano and so I just noticed it's been kind of harder to get the notes.
Mm-hmm.
I can, I can grasp, I can grasp a a glass but because I use my right hand most of the time, you know, I'm not left handed so, it's kind of hard for me to.
So So you would say this in mind weakness, mind. So just to get my facts right. So you would say it's definitely weakness rather than because of the pain, you can't hold it. That's two different things. So you know sometimes you can't hold it because it's hurting you .
Yes.
Yeah.
No, no, it's not hurting, it's not hurting, it's, like, numb, I can't feel it, right? Well, yeah.
OK. Fine. So, you're definitely having some sort some form of weakness, OK. Edward, any neck pain at all?
Yes, absolutely.
No, not, no, nothing .
neck pain and all? OK, right, OK. So, just a bit more of a background because I don't have much information on the system. Um, do you have any past, uh, medical history that you'd like to share?
Mm hmm.
Well, I guess because of this. You know, I'm not sure if it's boxing. I also had a really bad cold, like a month ago.
Mm-hmm.
I mean, I was out, you know, drinking with, uh, friends, um, one of our co-workers just had his three year anniversary and
We kinda went crazy and we were like out partying until, you know, late hours, and I just got uncharacteristically drunk for me. And then after that, I was sick for probably good like two weeks. I was at home. I think I must have had some kind of like a flu or something.
what
Mm-hmm.
So it's that. And then, I'd say another weird thing that happened to me a few weeks ago, is like, I all of a sudden just couldn't see from the, uh, from my left eye. Like, I, I lost some, like a little bit of a field of vision
Uh, and, but that, that just lasted not very long. I mean, that just lasted maybe for, I don't know, twenty, twenty minutes?
OK.
Uh, and I kind of thought, I don't know maybe it was the the cold you know and the virus and all that so
Mm-hmm.
I, I guess that's what I can, you know, that's the last thing I can remember, but in general, I'm, I'm pretty healthy. You know, I work out, uh, , and I, I don't really have any medical problems.
Yeah.
Do you have any headaches at all, from the, in the recent past?
Um, sometimes I get headaches but I think they're just tired headaches. You know sometimes I'll get kind of
Tired but I think that's probably because I work too much. Or, you know because like I'll go for a workout and then I'll really just exhaust myself and then I just kind of feel this fatigue.
Uh, or sometimes like this morning for example, I just felt really, fatigued and I couldn't even get myself to the gym. But, you know, since I have this numbness it's kind of like, hard to workout right?
Hmm.
Do you wear glasses at all, glasses, contact lenses?
No.
No, so no glasses . And, you've not experienced anything like a seizure or a fit, anything like that?
What's a seizure?
Like when you you lose consciousness and you start shaking.
Ohh, no, no, no, no, nothing like that, mmm mmm.
OK, no fits, yeah, OK. And your weakness is only in your left arm. Legs are walking and all this, normal, yeah?
Right, exactly.
Yeah, yeah, yeah, walking is normal, yeah.
You mentioned for a while you couldn't see, you know, the outside peripheral vision from your left eye. How long did that episode last for?
You know I think it was only maybe like twenty minutes or so. It's almost like it happened and I thought ohh my God. It's probably I'm still like sick from this, you know virus thing, cold, and so I just kind of slacked it off. And then when I, uh, um, when I woke up it was gone.
Sure, OK. Um, OK. So is there any regular medications that you're using?
Not really. I just take ibuprofen every once in a while, I take vitamin D. Um, I take some I, I like my my GP really wants me to take iron supplements, but you know, they're just like huge pills so I, I, most of the time I just forget.
OK.
But, vitamin D I take. And then, sometimes I take Melatonin to help me sleep.
OK
Alright.
And any family history you'd like to share? Any significant family history?
I know that my dad has I don't know if it it's hypo, I think it's hypothyroidism.
Yeah.
Um, and then my, like, he's got he's got some autoimmune stuff going on, like that much I know.
Mm-hmm.
And then, my mom, my mom, she's actually not in a great shape. She's got diabetes type two.
She's got hypertension, um, she's got, gosh, what is it, ohh, yeah, she's got high cholesterol, um, and I think that's it for her. Yeah.
Yeah, right. Any neurological conditions in the family?
Uh.
there are related conditions. No, OK, that's fine.
OK, so, right. So after, you know, speaking and examining, you know, yourself, I think it's quite important that we do investigate it a bit further. I'm just wondering whether there's something a bit more than just the boxing here.
OK, few things that's, made me think other than, just like a boxing injury, is for instance, um, you know, when you said you can't, your vision went, your peripheral vision was not there for about twenty. So, and that with the weakness of the arms, make me think, is there something else going on rather than just an injury?
OK.
What do you think may be going on?
sometimes you know you do get things like MS, multiple sclerosis. So people with multiple sclerosis can have, um, visual problems, like what you've experienced and sometimes you know the odd numbness tingling sensations going on. OK?
Ohh!
Ohh my God! Will I be in a wheelchair?
We, if we capture it a bit early there are treatments for it. OK? I'm not, obviously I'm not suggesting that you do have it, but it is quite important to find out that, whether you have it or not that's the most serious kind of thing that needs to be, uh, dealt with here.
Yeah. So, what we can do is I'm going to do an urgent, very urgent neurology referral. Yeah? What they, what that might entail is the brain scan and things like that. Hello?
K, OK.
OK
I see. Yeah yeah yeah! Yeah, I'm here, I'm here.
I know this might sound a bit of a shock to you, um, but I'm, I think it is more important that we investigate this a bit more seriously.
Yeah.
Alright. Yeah, that makes sense.
OK. Any questions at all?
Well, what's, OK, so you're gonna do the referral, um, should I be taking any drugs or, um
No, that's something we can't do. The treatment for it is actually some steroids and things like that, uh, when you have an acute you know, acute reaction or things like that. But, saying that, first we need to firm diagnosis.
Yeah. While you're waiting for this to be done, if there's any weakness, uh, you know, if the weakness progresses to your legs, or there's any kind of headaches, vomiting, fits, and your visual symptoms are getting worse and not getting better, then that would be an A and E.
Mm hmm, yes, OK.
OK, got it.
Alright.
Sounds good! OK, thank you, doctor.
Yeah. I'm I'm sorry. I, I do appreciate you are a bit worried, but, you know, it's good that we know that you've come and spoken to us today, and hopefully we'll get things sorted and the ball rolling. OK?
Thank you, doctor. Appreciate your time.
That's OK. You take care.
Thank you.
Bye bye!
Good bye now, bye.
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[doctor] okay well hi joe i understand you've hurt your knee how how are you doing
[patient] i'm doing okay this feels you know definitely feels like it's swollen and kinda hurts me a little bit
[doctor] so what did you do what happened
[patient] i was i was skiing with some with some friends and i was going down it was snowing pretty hard and i could n't really see as as the two paths kind of come came together and i the front end of the skis i kind of dug into the snow and i ended up basically doing a cart wheel but kinda like stopped halfway through and could feel a pop in my my right knee and then you know just pain right after that came about through the knee so
[doctor] yeah that sounds painful and so when did this occur
[patient] it it occurred over the weekend on saturday
[doctor] and have you been able to to walk at all at all or no
[patient] a a little bit but it's definitely swollen and it's definitely painful
[doctor] okay so what all have you been doing for the pain
[patient] just like taking some you know advil and then just icing you know icing on and off you know a little heat here and there just you know trying to comfort but that's about it
[doctor] have you ever had any type of injury to your knee before and it is this the left or right knee
[patient] it's the right knee no it's the first time i've had any knee injuries
[doctor] okay alright let's see take anything for it okay well let's see let's just do a quick physical exam here so so your now your vitals those look alright your no fever you're at ninety seven . nine your heart rate is sixty four sounds healthy respirations are sixteen blood pressure is one ten over seventy four your o2 sat looks good at you know ninety eight percent so look real healthy there and so i'm just gon na do a quick physical exam so i do appreciate some edema and some ecchymosis around surrounding your knee your right you said right knee right
[patient] yeah
[doctor] okay positive pain to palpation and let's bring your leg out are you having pain when with flexion or extension
[patient] a little bit no not not crazy real pain but there is definitely some pain there
[doctor] okay pain with flexion and extension and how about the range of motion having full range of motion here
[patient] yeah pretty much i can get the full range just feels a little tight and will hurt
[doctor] okay alright and for diagnostics so your x-ray so there's no fracture appreciated no bony abnormalities so that looks alright so let me tell you a little bit about my impression and plan with this so you have a knee contusion so for treatment we'll we need to rest that apply ice you know two three times a day for twenty minutes at a time take some nsaids or you know nonsteroidal anti- inflamma medication such as ibuprofen every six to eight hours as needed so i just wan na really get some rest with that if that does n't improve then we can go ahead and maybe come back in and we might do some physical therapy as well i do n't know i'm not sure i like this one all that well any do you have any questions on that
[patient] no sounds very good
[doctor] okay let's venture a little bit more because i need five minutes so where so where were you skiing at
[patient] so i was actually up we actually took a trip up up north and i was in the i'm in mount saint helen and washington so i was just walking in myself going out and stuff but yeah it was it was a good trip but cut a little short because of that yeah it was fun though i like going i like going to skiing so hopefully i can do some more
[doctor] well washington sounds nice i have n't been there but it sounds like it's pretty nice area to be in and they have a lot of maple syrup there do n't they produce a lot of maple syrup
[patient] they do they do have a lot of maple syrup and it's it's it's interesting that the the winter actually is n't their busiest time for vacation or vacations or it's more into your spring into your fall with hikers and all the outdoor activities there's actually a very impulsive torist during the summertime which i never knew but one of the locals have told me that they do actually better business during the summer so the hikers kayakers and the maple syrup in the fall and everything so
[doctor] that sounds good now i also meant to ask you so when you did this cartwheel through the air did you have any other injuries to any other parts of your body anything else that you're having any issues with
[patient] my shoulder feels a little bruised
[doctor] okay
[patient] little bit but that's about it yeah just because i kinda landed on that lead shoulder when i fell
[doctor] okay let's take a quick look yeah i do appreciate a little bit of bruising here are you having any problem raising it up or or with movement with your range of motion
[patient] once i raise it up though it's a it is a little little tender i can feel it being tender when i raise it up
[doctor] okay we'll just go ahead and get an x-ray of that right shoulder too just to be sure if you because who knows maybe you might have done something with that as well so we'll go ahead and have my nurse take you to do that and then we'll talk again alright
[patient] sounds great
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[doctor] hi , ms. thompson . i'm dr. moore . how are you ?
[patient] hi , dr. moore .
[doctor] hi .
[patient] i'm doing okay except for my knee .
[doctor] all right , hey , dragon , ms. thompson is a 43 year old female here for right knee pain . so tell me what happened with your knee ?
[patient] well , i was , um , trying to change a light bulb , and i was up on a ladder and i kinda had a little bit of a stumble and kinda twisted my knee as i was trying to catch my fall .
[doctor] okay . and did you injure yourself any place else ?
[patient] no , no . it just seems to be the knee .
[doctor] all right . and when did this happen ?
[patient] it was yesterday .
[doctor] all right . and , uh , where does it hurt mostly ?
[patient] it hurts like in , in , in the inside of my knee .
[doctor] okay .
[patient] right here .
[doctor] all right . and anything make it better or worse ?
[patient] i have been putting ice on it , uh , and i've been taking ibuprofen , but it does n't seem to help much .
[doctor] okay . so it sounds like you fell a couple days ago , and you've hurt something inside of your right knee .
[patient] mm-hmm .
[doctor] and you've been taking a little bit of ice , uh , putting some ice on it , and has n't really helped and some ibuprofen . is that right ?
[patient] that's right . yeah .
[doctor] okay , let's review your past history for a second . it looks like , uh , do you have any other past medical history ?
[patient] uh , afib .
[doctor] okay , and are you taking any medications for that ?
[patient] yeah , i am . um , begins with a d.
[doctor] uh , digoxin ?
[patient] that's it . yeah , that's it .
[doctor] okay , all right . how about any surgeries in the past ?
[patient] i have had a nose job .
[doctor] all right . um , let's do your exam , okay ? so is it tender ... where is it mostly tender right now ?
[patient] right on the inside of my knee . right here .
[doctor] all right , so if i bend your knee forward , does that seem to hurt ?
[patient] yes , that hurts .
[doctor] all right , how about if i twist it a little bit that way .
[patient] that hurts a lot .
[doctor] okay , okay . and how about down here ? do you feel me touch you down here ?
[patient] yes .
[doctor] all right . any other pain down here in your calves ?
[patient] no .
[doctor] no , okay . so on exam you do have some tenderness over the medial portion of your knee over the medial meniscus area . uh , there is no , uh , there is a little bit of tenderness when i flex your , uh , when i , uh , uh , do some valgus stressing on your , on your leg . um , you have normal sensation . so let's take a look at your x-rays .
[patient] okay .
[doctor] okay . hey dragon , show me the x-rays . so looking at the x-ray , um , of your left knee , uh , it appears to be there's no fractures there right now . i do n't see any , uh , there's a little bit of , uh , fluid , uh , but there is no , uh , there's no , um , fracture or there's no dislocation . everything else seems to be lined up properly , okay ?
[patient] okay .
[doctor] so in summary after my exam , uh , looking at your knee , uh , on the x-ray and your exam , you have some tenderness over the medial meniscus , so i think you have probably an acute medial meniscus sprain right now or strain . uh , at this point , my recommendation would be to put you in a knee brace , uh , and we'll go ahead and have you use some crutches temporarily for the next couple days . we'll have you come back in about a week and see how you're doing , and if it's not better , we'll get an mri at that time .
[patient] okay .
[doctor] i'm going to recommend we give you some motrin , 800 milligrams . uh , you can take it about every six hours , uh , with food . uh , and we'll give you about a two week supply .
[patient] okay .
[doctor] okay . uh , do you have any questions ?
[patient] no , i think i'm good .
[doctor] all right . hey , dragon , order the medications and procedures discussed , and finalize the report . okay , come with me and we'll get you checked out .
|
Hi there. Good morning.
Hello, good morning.
Um, I'm Doctor Deen Mirza from GP at Hand. Nice to see you.
Nice to see you.
OK. Before we start your appointment, could you please tell me your first name and your date of birth.
Yes. Uh, my name is John Smith. And I was born on the fifth of April, uh, nineteen seventy three.
OK, that's great. Thank you for that. Um, are you in a private place where you're OK to speak freely?
Yes. .
OK, OK, great. OK, so um, tell me a bit about what's been happening? You said you mentioned in the notes that you've got a problem with your elbow.
Yeah. Um, I just noticed this like about a week ago, or something? Um, have like a weird swelling on, on, on my elbow. I noticed that when I was in the shower. Uh,
It's not painful at all, or like, I I feel fine. But it's just, just a bit, a bit weird, to see that.
Um, it's, it's slightly warm. Um, and I, I, cannot feel like this, little bit fluid in inside, or, uh, um?
Sure.
Sure, sure. , and .
So, I, I like to know what's going on with .
, and so, did you say it was the left elbow or the right elbow?
Um, it's the, the left elbow.
Left elbow, OK. , and have you banged that elbow? Do you have any kind of injury?
No, not really. Um, not that I know of. I haven't noticed anything. I can actually like move it normally. Um, it's just, I , I can just see that. It feels a bit strange, a bit
Sure, OK. , and um, , in terms of your job, do you do anything physical?
Not really. No, I just, you know sit at a desk. Um, yeah.
Right. OK. , and um, has this happened before?
No, no I haven't noticed that before. Um, I don't have any like history of, of seeing this. I don't remember .
Sure, OK. Uh, and can I um, can I just double-check? Has anyone in your family, got any, kind of rheumatology, diseases, like rheumatoid arthritis, or lupus or anything like that?
Um, no, well I, I do, well I think, I think I have something like uh, osteoarthritis. Um,
Uh, uh, it sometimes kind of hurts, uh, my joints. But uh, in my family, I'm not sure.
OK.
. No.
Sure. , so you know you said you think you've got , uh, osteoarthritis. Has anyone ever told you that? Have you ever seen a doctor who's confirmed that, and told you you've got osteoarthritis?
Um, yes. Yes, a few years ago.
OK. , was that a GP or a specialist or, was it, a physiotherapist?
a a GP. Um, yeah.
GP, OK, all right. Um, look can I just, uh, sorry can I just double-check how old you are please?
I'm uh, fifty three.
Fifty three, OK. Fantastic. All right. Um, and, do you have any other illnesses at all?
Um,
Well not, not really, no. Um, I'm, I'm allergic to, to peanuts. Um, but that's, that's pretty much all I uh, have to say about my medical history, yeah.
Right, OK. .
OK. Uh, are you, are, are you allergic to any medication?
Uh, no. Not that I know of.
No.
Sure. , and um, do you um, are you on any medication on a regular basis?
Uh, no.
No, OK. And are you normally fit and well? Mobile and active?
yeah. I do, I do, I do some sports. I run regularly, like two, three times a week. Um, yeah, no, I'm, think I'm healthy.
OK, good, good, glad to hear. Well done that's , it's good that you're doing that on a regular basis. OK. Um, and um, uh, can I, is it possible for me to have a look at your elbow, now?
Uh, yeah, sure.
OK, good, bear with me one second.
Right, OK. And if you can just raise your elbow up a little bit like that, a bit higher, so I can just see the underside. OK, fantastic, all right.
And then, just, bring it round to this side, , I can see other side. OK, fantastic. All right. And if you can just touch the tip of your elbow with your fingers.
There's, , is it, is it hot, compared to the surrounding skin, the adjacent skin?
Yeah.
It's a bit warm, yes.
It's a bit warmer. OK. Um, and um, is it very tender when you're pressing on that nerve? Is it, if you, if you give it a press, does it hurt you at all?
On the, on the tip of the elbow, it's, it's OK, just like, next to it like where the, the swelling is, it's a bit, yeah it feels weird.
OK. All right. Um, well, um, I noticed the skin was a bit dry, , on the tip of the elbow. Do you, do you have dry skin anywhere else on the body?
Uh, no not really. I have skin really dry now.
, do you , do you suffer from eczema at all?
No.
No. Alright.
OK. So um, what I think we should do, with regards to your elbow problem
OK. Is um, I think, it would be worthwhile. , this seems like uh, what we call the Bursitis. OK. So, that's an inflammation of one of the fluid sacs around the joint.
Um, what I think we should do is, I think you should be on some anti-inflammatory medication, in the, in the first instance.
OK.
And, as well as that, what I would like to do, is to get some blood tests done, to check for other types of uh, causes of joint swelling. K?
Alright.
So, um, what we're going to do is, we're going to arrange some, um, blood test forms to be sent out to your house. And, there'll be instructions within that pack, about where to go to get those blood tests done.
And, that will involve you, um, having some tests done to check for inflammatory markers, infection, rheumatological antibodies.
So we'll do a full screen, and also check for things like Gout as well, OK. Um.
OK.
The time frame for that, will be um, the results will come back to us after about five or six days. Um.
K . O
From now, but it may take time for the form to come out to you. And if you get the form get the blood tests done straight away, by the time that we're expecting result back, you know one or two days after that, we're looking maybe six days.
And, what I would suggest, is, we can arrange a follow-up appointment for you, in one of our clinics, where we can have a look at your joint, feel it, we can review the blood test.
OK.
Uh, we can um, get a gauge as to, uh, what's going on. Now in terms of your joint right now,
It doesn't look like, to me that's something called, excuse me, septic arthritis. So, we're worried sometimes that someone might have an acutely infected joint.
Mm-hmm.
Um, and uh, your, your joint doesn't look like that.
Yeah.
However, if your, the elbow was to become very red, very painful, uh, and the redness was to spread or become uh, you know more intense. Then you need to get on the phone or get, have a video appointment , with one of us as soon as possible.
OK.
'Cause that would be an emergency. That would require more immediate assessment, more immediate treatment. OK?
do you, do you think it's something dangerous? Like something, like could I die from that, or is it, is it
No. I, I don't think this is anything dangerous. don't need to worry. OK? What I'm doing, is I'm just outlining the worst case scenario if things were to, to develop. K? So, , this, this is not the case right now. Right now, it looks quite straightforward.
OK.
Yeah, OK, I see.
It's nothing , sinister or life-threatening. Um, what I'm doing is I'm just saying, in case things worsen, these are the things that we'd be looking out for, and this is what we have to do. But you don't have that now, thankfully, and I don't think you're going to have it.
OK.
But I'm just saying, the what if scenario. Is that OK?
Yeah that, that sounds good. Thank you.
All right. Did you have any questions that you wanted to ask me?
Um, well just yeah I just wanted to know about this. Um, yeah it feels a bit better now . Uh, but yeah, no that's it. Thank you.
OK, all right. Um.
OK. So, I, I would take Ibuprofen regularly, OK. You can get that , over the counter. Um, that's four hundred milligrams, two times a day. And you should take, take that after food, not on an empty stomach. If you get any heartburn, stop taking it. OK.
OK.
Sure. thanks. Bye.
All right. So, what I wanna do is, I'll get the forms sent out to you.
And, um, we are going to arrange a, a follow-up appointment.
Maybe within a um, actually you know, the follow-up appointment doesn't have to be face-to-face, if it's more convenient for you do, to do it over the phone, we can do that over the phone, uh, over video. We can do that as well, that's, that's your call. But you contact us, , after you've had the blood test done, and we can review things then, OK.
OK.
OK, yeah that sounds good. I, I'll do that. And if I see that it's getting worse, I'll probably ask for a physical appointment.
Sure, sure that's a good idea. All right then, OK. Um, take care then. So , look just leave that with me, I'll sort all those bits and pieces out, and then we'll get them sent out to you, and then we'll, we'll um, review you after the tests, things goes well, OK.
Thank you. Alright. Sounds
All right then. Take care then, all the best. Bye bye.
Bye.
|
Hi.
Hey.
Hi. Can you hear me?
Yeah. I can hear you.
Good. Um, my name is Doctor Gohil. I'm one of the physicians that works here at Babylon.
OK.
May I confirm your name and date of birth, please?
Uh, uh, my name is Sarah Smith. And, my date of birth is the twentieth of April nineteen eighty.
Great.
Nineteen eighty three. And, are you in a space that's private and quiet, and you can talk?
Yeah.
Yeah.
Good. So, it says, erm, I've got a note to say, it says you're feeling short of breath. Is that correct?
Yeah, yeah.
OK. Are you able to tell me a little bit more about that?
Yeah. I was watching TV and, um, just like over the last hour, I've started to feel, like, a bit short of breath.
That is, while you're sitting watching TV?
Yeah.
OK. And, have you noticed anything like this before?
Um, no.
OK. And, apart from the shortness of breath, have you noticed anything else?
Um, so, I , I started with a cough yesterday.
OK.
Um.
Yeah. I, I don't know if it's, um, relevant, but I had a C-section a few weeks ago.
OK. And, how long ago was that? Just a few weeks?
Yeah, four weeks.
OK. And, are you with baby at the moment?
Yes, I am.
And, how is baby doing?
Yeah. .
OK. Any coughs or colds with, uh, them?
No, no. He's fine.
OK. So, you've noticed shortness of breath for just an hour, while sitting and watching TV?
Yep.
Mm-hmm.
And, you had your C-section a couple of weeks ago?
Yeah.
And, yesterday you noticed a cough?
Yeah.
So, talk to me about the cough. Have you bought anything up?
Uh, no, I haven't, no.
And, when was the last time you were ill with the flu, or symptoms like this?
Um, you know, I get coughs and colds quite a lot, but probably.
Good few months ago.
OK. And, this shortness of breath you're having, is it getting worse?
Um.
No. I mean, I don't know. I feel like I'm getting really stressed out because, like, my heart, it's really going.
OK. So, you're feeling your heart more than normal?
Yeah.
And, the shortness of breath, does it cause any pain in your chest?
Um, no.
How about when you take a very deep breath in?
Um, I mean, yeah. My chest feels sore, but so does my C-section scar. You know, it's, it's all tender.
OK.
And, since your C-section, did you have to take any medications?
Um, no. Just some painkillers.
All right. And, can you remember what the name of those were?
Uh, they gave me some, uh, Codeine.
And, have you had to use that regularly?
Uh, yeah. I, I've been taking that fairly, fairly regularly. But, probably haven't taken it for a week.
OK. And, apart from the C-section and the shortness of breath, have you got any other medical problems I should know about?
Yeah.
Um, no.
And, you were .
tell you, I'm allergic to Ibuprofen, though.
OK.
And, what happens when you take Ibuprofen?
Um.
I don't know. Sorry.
So, I need you to do something for me. Have you measured the rate of your heart before?
Uh, yes.
Have you measured it recently, either with an iWatch or something similar?
No, I haven't, no.
OK. We might need to do that over the phone. So, are you able to put your right hand on your left wrist, just underneath your thumb? And, see if you can feel your heartbeat.
Yep.
Yep.
So, uh, what I need you to do is, when I count to three, count down from three, just count the number of beats you've noticed. And, I'll tell you when to stop. Is that OK?
Mm-hmm.
Yep.
So, we'll start in three, two, one. Go.
Great. That should be enough. How many did you count?
Uh, I counted thirty.
Good.
So, your heart is running slightly fast at the moment, which is probably because of the shortness of breath and some of the pain that you're under.
Mm-hmm.
OK.
Given that you've had a C-section, and you're short of breath, which has come on quite recently and quite quickly
It might be worth you going into the hospital to get checked out the bit further.
OK.
So, there's two ways of us doing this. The first is, I can call an ambulance. Or, you can take yourself to the hospital with baby.
Mm-hmm.
Which one would you prefer?
Uh, it feels a bit dramatic to call an ambulance. Um, I, I will, I will go. I will, I will take myself.
Sure. And, what I would suggest is, go fairly quickly and take some bits for baby at the same time.
OK.
And, if you're taking any medications like Codeine, don't, don't take them for the time being.
Mm-hmm, OK.
Is anyone else with you at home?
Uh, no. My partner's at work.
OK.
So, I think that's the best thing to do, for the time being.
Mm-hmm.
So, what I'm worried about at the moment is, given that you've had a C-section
Some people can suffer with clots. And, those can either be found in the legs or your chest, so in your lungs.
Yeah.
It's quite a common thing to happen. And, it's not something to worry about. But, needs to be checked out in the hospital first.
OK.
And, if it, if that does become the case, they can give you something to reduce the clot.
All right, OK. That makes sense.
Fairly quick process.
OK. Yeah. I mean, my mum's had, uh, clots in her legs before. So, I guess, you know.
Yeah, that makes sense. I know, I know what they are.
Good. Are you, uh, are you particularly worried about anything, or do you want to ask me anything, before we go?
No, no. I'm fine. I'll, uh, I'll just take myself to the hospital.
Great. Thank you so much.
All right. Thank you. Bye.
|
Hello.
Hello, hi, I'm Doctor Jacob and welcome to Babylon. Hello.
Nice to meet you.
Nice to meet you too. So just before we start, is it all right if you could confirm your name for me please?
Michael John .
And your date of birth?
Oh nine two nine eighty-three.
OK, and your address for me please.
Two three one, Leonard, London street uh, sorry, London.
OK and that's correct, and just to confirm that you're in a secure location and we can have a confidential conversation.
Yes.
OK, uh, you've mentioned on our notes that you're suffering from bad diarrhea. I'm sorry to hear about it. So if you tell me a bit more about it, please.
Uh, it's been happening for about, three days now? Um, yeah it, started off uh, was, I don't know it's just something that I thought would go away pretty quickly.
OK.
I've had that from time to time after eating certain types of food or going on certain travels, but, uh nothing funky in my diet and no travels recently, um and it just kinda kept up. I'm a bit confused as to what to do .
Mmm.
Mm-hmm.
So you haven't had anything from outside? Nothing dodgy anything ? No.
No, no no no, just a little bit, yeah I I don't know I mean it's pretty standard diarrhoea, where it's was like a little bit of abdominal pain. I threw up once, that was a little worrying, uh.
Mm-hmm.
Repeat that please, that wasn't clear. What did you say?
I threw up once, yeah.
After that we'd said something.
Uh, nothing else was worrisome.
OK, right, and with the diarrhea, how many times a day are you going to the toilet?
Uh, four to five.
Four to five times, yeah. And is there any? And it's like water? Is it like water or is it just loose?
Uh, what do you mean?
Are you going like water? Or is it just, you know bit, bit of solid stools, bit loose kind of thing?
It probably depends on the time of day to be honest, .
Sure OK. Bit of both and is there any blood or mucus?
No blood. What do you mean mucus?
It's like the snotty stuff.
In the stool?
Yeah, it looks like snot .
No.
No, so no mucus, OK. Any fever at all?
Uh, maybe a little bit, but.
Mm-hmm.
It hasn't been, that in particular hasn't been too worrying.
Are you still able to eat, and drink?
Uh, a little bit of.
Appetite loss I guess worse than normal, but also not something I've, like I, if that was alone I wouldn't have, reached out.
OK.
Sure. So but you're you're still able to drink quite a bit yeah? You're drinking plenty.
Yeah yeah yeah.
OK. Excellent.
Mostly it's been dry and red.
OK, and, um, what have you take, have you taken anything so far for the diarrhea?
Nothing yet.
Nothing yet, OK. Anything for the abdominal pain?
Uh, nothing yet.
OK. Right, and any unfortunately we don't have any of your past medical history, is there anything you'd like to say?
Uh, I.
Probably I I had asthma.
Mm-hmm.
Um or, or I don't know I guess I still have it.
OK and uh, are you, any, uh, anything else other than asthma?
Uh, my dad had hypertension.
OK.
Has hypertension. Had hypertension. Yeah he died of bowel cancer ten years ago.
Yeah .
Ohh dear, OK. Bowel cancer. Ten years ago. And how old was he when he died?
Uh, sixty-two.
K, and um, you mentioned you had asthma, are you using any inhalers at all?
Yes.
Which ones?
Lexapro.
Sorry?
Lexapro.
Laxepro.
Yes.
OK, not heard of it may. Is it like Salbutamol? Is it like a blue colour?
Yellow.
Yellow, OK. I'll have to check that one, not sure. Laxepro.
OK. Um, that's fine. Any other medication that you're using?
Over the counter, anything at all?
OK. Right. Any allergies?
No.
Nothing, yeah, nothing.
No allergies at all, righty . Fine so, obviously, you know you just have diarrhea it's about four to five times a day. Um, you're still drinking plenty and you look like you're not dehydrated which is a good sign, OK? Um, when we start worrying about diarrhea is if you're going more than eight times a day.
That means probably you are, you know, whatever you're eating is going straight through, OK? You still need to drink plenty of water because you're losing a lot of fluids.
Mmm.
OK, when you go to the toilet. Um, things that one would advise is a soft diet. So avoid dairy, fish, meat, eggs, while you're having the diarrhea. Go, sorry?
Soft .
What is a soft diet? What does that ? Like, outside of, not those things, what do you mean by soft?
OK, so that will be like crackers, toast, jam, those kind of things that's easily digested. Like what we are good give babies yeah. When they start eating you give, simple food for babies. You don't give eggs or meat the first time they start feeding. So that's the kind of soft diet we're talking about, yeah? Once you are able to, you know keep most of it in, you can start off with some just boiled vegetables and mash.
Once you're OK with that for about forty-eight hours then you can start having meat. So just don't have meat once you feel like you're slightly better, because you might go back to square one again, all right?
What do you mean OK with that diet, like once?
Forty-eight hours you're not having any diarrhea, you're fine then you can go and start having meat, egg, fish and all. So that .
OK, if if the diarrhoea is getting better but isn't getting, or do you want it to go away completely at that point, or if it's like trending upwards?
No, no, no preferably just don't because, what why do we say this? It's because it takes much more time for meat to get digested. So because your gut flora, you know, the, the, the bacteria in your gut is not you know as it should be, it takes a bit more effort for one to digest these food.
While it doesn't take that much of an effort to, you know digest mash and vegetables. Does that make sense?
Yes.
Yeah? So, um, at the same time you could have some, although you can't milk is not a good idea, yoghurts are a good idea because they are probiotics, it help to build up the normal, um gut, gut bacteria back.
OK.
OK.
So those kinda, now, things to look out for, if your diarrhoea doesn't go away in a week's time, or if you're passing blood, we need a stool sample, because that means you you may have , um, some particular bugs that might need treatment with antibiotics.
OK.
OK. If you're again, as I've mentioned previously if you're going about six to eight times a day, that means there's a high chance that, uh, you are, having dehydration and you might need to go into hospital at that point in time. If that happens you get in touch with us again, all right?
OK.
Any questions? You look a bit confused.
No, that's it.
Yeah? OK and also you could get something called Dioralyte over the counter. So, it helps to uh, replenish your, the salts that you've been, that's lost through going to the toilet.
OK.
OK? If you're a bit confused you know you can actually, uh, all this is all recorded in your app. So you can go back. I'll put that all in detail so if, you know I know sometimes it's a bit difficult to process everything, you can go back and read, read the notes.
Perfect, that's great.
Is that OK?
All right then, you take care.
Bye.
Bye now, bye bye.
|
Hi.
Hi, hello. I'm Doctor Jacob and welcome to Babylon. Hello. Hi. So just before we start, is it alright if you could confirm your name for me please?
Hi there.
get to my name
. And your date of birth?
Fourteenth November nineteen ninety six.
And your address for me please?
And twenty eight Great Road SW nineteen one EZ.
That's correct. And just to confirm that you're in a secure location, and we can have a confidential conversation.
Thank you.
OK. So you've mentioned in in our notes that you've got some tightness. If you'd like to tell me a bit more about it please.
Yeah about two to three days ago, I was running with a friend. And usually I can talk to her whilst I run, but I found myself actually short of breath. I'm not really sure of that when I'm walking. Um, but definitely um, if I'm walking briskly now. Um, and I've used my blue inhaler but to no avail. It hasn't really helped me.
. OK.
Um, ohh yeah, so I'm having, I'm just wheezing a bit, and coughing and just generally a bit short of breath
Wheezing and coughing, OK. And you've mentioned you're using the blue inhaler. So, how often are you using the blue inhaler?
Um, I think I'm just using that as and when I have symptoms.
Yeah. So, um, at the moment you are having shortness of breath. So, are you using it every day at the moment?
Um, yeah, and morning or evening to kinda prevent it as well.
OK, and um what, which colour? What's the name of your preventor?
Um, it's blue. Um, I think, in totality, I'm Salbutamol, Flanel Bactroban and Hydrocortisone that I'm taking as well.
Yeah.
OK. So could you repeat that?
Er, Cetraben and Hydrocortisone.
And hydrocortisone. So you'd have eczema also, yeah?
What's that, sorry?
You do have a history of eczema, ?
Em, my brother is asthmatic and my sister has eczema. Em, and I've got a few issues, um, that I think could be eczema as well.
OK, right. So coming back to your, um, you know your shortness of breath. You've mentioned you're wheezy, and you're coughing. Are you bringing up any phlegm at all?
Um, no I don't, um, I'm not covering up much .
OK, no sputum, OK.
Right . And um, how are you using your, um, your ? So are you using it every day?
Um, I think I'm using that every day and the Salbutamol just like as and when
So, how are you using the ? Is it twice a day?
Um, yes
twice
OK. And have you ever been admitted in hospital because your was so bad?
Um, no, I haven't.
OK.
Righty-ho. When was the last time you had an asthma attack?
Um, about three to four years ago.
Three to four years ago. And what, what did the GP do at that time?
Um, just, um, encourage me to carry on using my inhalers as a preventative.
OK. So you didn't have any oral steroids or antibiotics?
Not that I can remember.
OK. Um, OK. Right, have you ever had oral steroids in the past?
Um, no.
When was the last time you had an asthma review with our nurse?
Uh, about two years ago.
OK. Two years ago.
OK. But, your asthma was pretty under control till, till now, isn't it?
Uh, yes, just in the last two to three days .
Yes. So do you do a peak flow meter at home? Peak flow reading? Where you blow into, you know
Do you do that? No?
Um, just every now and then. I haven't done overlap since I've has symptoms.
OK. So, what was what's your peak flow reading when you're good?
Like normally peak flow reading.
Um
Um, I think
OK. Let's see it's about, um, three eighty, yeah? Yeah? three . OK.
Yeah.
Right. So that's your normal, yeah? Righty-ho, OK. So what we need
Mm-hmm.
OK. Do you have any allergies at all?
Erm, I have a fever.
Sorry, could you repeat that please?
Sorry, I have hay fever.
OK. Now any allergies to medication?
Ohh no
OK. So you're not allergic to anything? OK.
So no allergies. OK, excellent. Righty-ho.
So what we need to do that obviously we you haven't had an asthma check for sometime and it looks like you can be having a small, small exacerbation.
So what, I would like you to be seen by one of our GP's in the next few days.
Mm-hmm.
In the interim, what I'd like you to do is you can use your blue inhaler as and when.
OK. You can use it maximum about every two to four, four hours, but if you're using it that often that means pretty much that, you know, your asthma is really bad. You can use it, but that's not ideal.
Mm-hmm.
But uh, the brown your Clenil. The brown inhaler.
Yeah.
You can up the dose. If you're using just three puffs twice a day, you can increase it to four puffs twice a day.
Yeah. And while, this is to do while you're waiting to see us.
Mm-hmm.
Now, I've mentioned, you know, you're doing you know, increase the, uh, Clenil to four puffs twice a day and you're using the asthma, you know, the blue inhalers every two to four hours.
OK.
And your breathing is getting really worse, then you would need to take yourself to A and E. You shouldn't wait for our appointment.
OK. So, when you'd opt to sneeze you, what we're going to do is we're gonna examine your chest, yeah.
Yeah.
Make you do the peak flow reading. So depending on what we find, you might need some antibiotics and some steroids.
Yeah.
But anyway, while you're at home, we're going to by increasing your Clenil, we are increasing your steroid intake anyway.
OK.
So, yeah. So, any questions you wanted to ask me?
No, that's thanks.
Yeah. So, book an call support, book an appointment to see and I will recommend that meet her face to face.
In the interim, increase your brown inhaler to four puffs twice a day, and your salbutamol inhalers up to every two hourly. But, if you breathing's getting worse and you've not seen us, do take your puffs to A and E.
All right?
Great, OK. Thank you so much for your time. Thank you.
You're welcome. You take care then, bye, bye now, bye. Bye.
|
[doctor] next patient is randy gutierrez . date of birth , 8/10/2020 . please use review of symptoms . all text to write . physical exam , auto text uri .
[doctor] hello , how are you doing today ?
[patient_guest] we're okay , thank you .
[doctor] that's good to hear . so , how many days has randy been feeling sick ?
[patient_guest] well , i would say it started around supper time last night .
[doctor] last night , okay , and what's been going on ?
[patient_guest] well , he started to get a runny nose .
[doctor] okay , and is he stuffy too ?
[patient_guest] yeah . yeah .
[doctor] okay , and have you noticed , is his mucous clear right now ?
[patient_guest] it is , it is right now , yes .
[doctor] okay . and , does he also have a cough ?
[patient_guest] yes , but it's not barky .
[doctor] and does he act like he has a sore throat or is he pulling on his ears ?
[patient_guest] well , i know he's been pulling on his ears , yeah .
[doctor] okay .
[patient_guest] you know , he also , he's also been going crazy rubbing at his nose too .
[doctor] okay . and , any fever you've noticed ?
[patient_guest] i checked his rectal temperature and it was 100.3 .
[doctor] okay . so , a little bit of a low-grade fever there , definitely . and , how was his appetite ? did he eat last night ?
[patient_guest] yes , he did . yeah .
[doctor] and how about this morning ? did he eat his breakfast ?
[patient_guest] uh , this morning he ate about seven ounces from the bottle .
[doctor] okay .
[patient_guest] and then he got another bottle , and he barely ate that . um , i offered him cereal and he would n't eat that either .
[doctor] okay .
[patient_guest] so , he varies i guess .
[doctor] how is his energy ? does he seem like he wants to take more naps , or does he have pretty good energy ?
[patient_guest] mmm , it seems like he's irritable .
[doctor] irritable because he is n't feeling good ?
[patient_guest] yeah . he is energetic , but it seems like he ca n't go to sleep , like , he's fighting it really hard .
[doctor] okay , and just for the chart , is there anyone , anybody else exposed to him who has been sick ?
[patient_guest] yes , his older sister's been sick .
[doctor] thank you .
[patient_guest] we also had a play date with my nephew , who i learned later had a sinus infection .
[doctor] and what medication have you tried for him ? anything at all ?
[patient_guest] um , i've been doing the saline mist in his nose .
[doctor] good , good . that's a good choice .
[patient_guest] i did give him tylenol really early this morning because he was warm when i took the sleeper off of him , and we had the ac on in the house , but his whole body was sweating .
[doctor] i see . and , any other medications ?
[patient_guest] we did put some baby vick's on his feet last night to try and help him breathe . and , i also used the humidifier .
[doctor] okay . that's good .
[patient_guest] okay . okay .
[doctor] so , there was another thing i wanted to bring up since we're here . it appears that his cradle cap has gotten a little worse . what are you using on it ?
[patient_guest] i've been using the cradle cap brush , and then i use regular aveno shampoo .
[doctor] is it a dandruff shampoo ?
[patient_guest] no , i do n't think so .
[doctor] okay , thank you . well , let's complete his exam and then we'll talk about the next steps .
[patient_guest] okay , sounds good .
[doctor] can you take a big breath randy .
[patient_guest] where's mama ?
[doctor] do n't forget to breathe little one . okay . let's try the front too .
[patient_guest] yeah , it's okay buddy .
[doctor] excellent . he's doing excellent . next let's- let's check out those ears .
[patient_guest] okay .
[doctor] let's try to make sure you do n't tip all the way over .
[patient_guest] dino , you're doing so good .
[doctor] all right . ears look okay . we're going to slide you forward so you do n't bump your head when i lay you down .
[patient_guest] hey , you're- hey you're okay . you're okay .
[doctor] okay , you can go ahead and sit him back up if you like .
[patient_guest] all right . thank you .
[doctor] all right . so , he's just kind of getting started with this , and i think we're seeing something viral right now . often sinus infections will start out as a virus and then will become bacterial infections if left alone and does n't go away . but , i do n't think he needs any antibiotics , at least not at this point in time . um , keep up with the fluids , rest , and i would watch him very carefully for a barking cough . if he does get a barky cough , then that tends to be a little bit more significant and a little more severe . so , if he develops a barky cough , i want you to give him a half a teaspoon of his sister's medicine .
[doctor] you know , i'm almost tempted to give you some of the medicine because they're probably sharing the same virus .
[patient_guest] okay .
[doctor] actually , i will . i'll go ahead and just give you some as well .
[patient_guest] okay . okay .
[doctor] but , if he does n't become barky , you do n't have to use it . it only works for the barky cough .
[patient_guest] mm-hmm , got it .
[doctor] okay . we'll do the same thing with him , as long as nothing gets worse , and we'll see him back in one week . so , it wo n't get rid of a regular cough . he can use zarbee's , but use the dose for kids under a year of age . so , if you wan na get some of that , you can definitely try that for him , it can help out a little bit with the regular cough .
[patient_guest] i do have a question . do you or do you not give honey to babies ?
[doctor] yes , that's a great question . you do n't give honey to kids under a year , instead , you can give them agave , which is a different type of nectar . um , now you can give honey to his older sister , that is okay , but for him , it would not be very good because his stomach acid's not good enough to break down the botulism spores . so , it'd cause him harm . um , you should look at the package of say , honey nut cheerios . it says right on there to not give it to a baby .
[patient_guest] okay .
[doctor] now , whether that would really hurt a baby , i am unsure , but it has real honey in it . so , no honey for him , but agave is definitely fine .
[patient_guest] okay . so , zarbee's for the stuffy nose .
[doctor] yes , zarbee's .
[patient_guest] and then you said , uh , which medicine to give him just in case ?
[doctor] i'm gon na give him the same medicine as his sister , and just hang onto it , um , just to watch and see . if this was a monday and we had a whole week to watch , i would say to just call us if things got worse , um , but since , um , if it's gon na be the weekend , and things might worsen tonight or tomorrow night , i'd rather you have just what you need on hand .
[patient_guest] okay .
[doctor] right , does that make sense ?
[patient_guest] yeah , yeah . that makes sense .
[doctor] okay , great . and that way you do n't have to share , um , with his sister .
[patient_guest] right , okay .
[doctor] and since he's about half her size , we'll do half the dose , which is a half a teaspoon .
[patient_guest] okay . will this information all be in the papers ?
[doctor] yes . and so , if he ends up starting the medicine , just give him a half a teaspoon for five days .
[patient_guest] okay .
[doctor] yeah , that's the only thing it wo n't say is , " as needed , " or anything like that .
[patient_guest] mm-hmm , understood , thank you .
[doctor] you're welcome .
[patient_guest] and the cradle cap ?
[doctor] what i would do is use something like either head & shoulder's , or selsun blue , or nizoral ad . now , do n't get the extra strength stuff , just use the regular strength . um , cradle cap , it's just basically a fancy way of saying dandruff . so , those shampoos will help get rid of it . it's not an immediate thing 'cause they , um , they are all dead scales , and you still have to brush them off . so , continue to use the soft brush and some baby oil , or something that will help get the scales out , and those shampoos will actually help to prevent it as well . use it two times per week , not every day , but maybe twice a week .
[doctor] so , two days between shampooing , use what you normally use any other time . and then , often , within six weeks or so , you'll notice that the-the cradle cap is just , um , not coming back anymore . but , he has to be careful because it's not ph balanced for eyes . so , just make sure when you're rinsing his hair you avoid his eyes .
[patient_guest] okay . okay .
[doctor] all right . and , if it keeps getting worse , definitely let us know .
[patient_guest] okay . sounds good .
[doctor] good . and , since they do n't have covid-19 , you can go right ahead and check out .
[patient_guest] okay . and both appointments in the week ?
[doctor] correct . we'll see you all then . bye randy , feel better .
[patient_guest] all right , great . thank you so much .
[doctor] you are welcome , and have a good rest of your day .
|
Good morning. I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address please?
Hi. My name is Susan. Um, thirty, Redbridge Street, SW two two HZ.
Hello.
And your date of birth?
forty, oh two, nineteen seventy four.
OK. Are you in a private place so you can have a consultation today?
Yes I am.
OK. What can I do for you?
It hurts when I pee.
OK, and how long has that been going on for?
It stays now.
Pardon?
Uh, six days.
Six days, OK. And just tell me a bit more about that. How did it start?
Um, I've got this thing when I pee, and it hurts when I go to the loo, and I've got this very unpleasant smell that comes out.
OK. And, have you had any other symptoms along with that? Have you had any abdominal pain, or back, lower back pain at all?
I've got, pain in my tummy.
Uh, whereabouts?
In my lower tummy.
OK. Is it one-sided, or in the middle?
In the middle.
And how bad would you say that is on a scale of one to ten? With ten being the worst pain.
Seven.
Seven.
And is it, constant, or does it come and go?
Comes and goes.
OK. And have you actually been able to pass water OK?
Yes, but I've had spotted, uh, blood in my urine. Spots.
OK. And is that just over the last, six days?
Yes.
Right. And have you been able to eat and drink OK?
Yes.
Um, and, have you had a temperature? Do you feel like you've been feverish, or had a temperature with this?
No, not at all.
Um, and any, did you , you said you didn't have any lower back pain?
No, I've got.
Um, and no loin pain as well.
OK. And, have you had these symptoms before?
No.
Never.
No.
And was there anything you were doing recently, which you think may have contributed to it? Have you , have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse or anything?
No.
No, OK. And, any, any other symptoms, any vaginal discharge or, anything like that?
No, just the blood spot, in my.
No. Do you have regular periods?
Yes I do.
OK.
Um, and , in the past, have you had any medical problems at all?
No medical, no.
Have you had any problems with your kidneys, or any urine infections?
I had IBS before.
OK.
And how's that been recently? Any change in your bowel habit? Any blood when you pass stool?
Yeah, I've had spotting in my urine.
In your, OK. Um, any change in your bowel habit? Any weight loss or anything?
No.
No.
Any other medical problems, or surgery in the past?
No.
Do you take regular medications?
I've had Mebeverine, Mebeverine. I've had Mebeverine.
Pardon? No birth .
Do you take that regularly?
Yes.
OK. And it, do you take it three times a day?
Yes I do.
Two hundred milligrams?
Yes.
Any allergies?
Any allergies?
Clindamycin.
You're allergic to Clindamycin, OK.
And anyone in your family had any medical problems?
No.
That's fine. And whereabouts, do you live? Do you live with friends, family?
I live with friends.
OK. And where do you work? What's your job?
I'm a support worker.
OK. Do you drink alcohol at all?
Occasionally.
So how much in a average week?
One glass of wine a week.
OK. And do you smoke?
No.
OK. Um, it sounds very much like you, might have an infection in your urine. Did you say, you haven't felt feverish?
No fever at all.
Have you got a thermometer at home?
No.
OK. It would be helpful if you could get a thermometer from the pharmacy and, do check your temperature, just to make sure that it isn't, going up and down.
OK.
Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.
OK.
Um, how do you feel about that? Are you happy to take a course of antibiotics?
Yes I would be.
It would just be for three days.
OK.
Um.
, get my prescription.
Yes, so I can send a prescription through to your requested pharmacy for that. If you take them, as soon as you can, get them, pick them up as soon as you can, and start taking them.
The other thing which is important to do is to drink, lots of water. So, two and a half to three litres a day.
Um, you can get some cranberry juice and take, drink that as well, that sometimes helps. And also some, sachets um, which you can get from the chemist, some sachets which just help change the acidity of your urine. So I, I can put the details of that on your notes.
Yeah.
OK then.
Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine. Then it's very important that we speak to you again.
OK.
Um, the other thing is that if it becomes a, common, thing or a recurrent problem. Then we need to talk to you again about it.
So, do I have to call after I finish my course of antibiotics.
No, not if you're better. If you're, if you feel like your symptoms get worse at any point, or they're not resolving with the treatment. Or you keep getting a similar, um, you keep getting a similar, problem, reccurently. Then it's important for us to talk, talk to you in more detail about that.
OK.
Yeah.
OK then.
Um, have you got any other questions?
Uh, no. Uh, where will be the pharmacy I'll be picking up, my medication from?
Um, so have you already requested a pharmacy through Babylon?
Yes I did.
Can I just check that with you?
Knightsbridge, Practice.
OK, that's fine. So the antibiotics, that I'm gonna prescribe, um, will go through to that, pharmacy.
How soon?
And then , you'll be able to pick them up from there.
How soon is that gonna be, at the practice? In five minutes?
Um, I would give it longer than that. Give it a, an hour or so.
All right then. Thank you, I'll pick that at lunchtime.
OK. All right then. Take care. Bye.
Thank you.
. Bye.
Sorry, I .
|
[doctor] hi , cheryl . how are you ?
[patient] i'm doing well . how are you ?
[doctor] i'm doing well . so i know the nurse told you a little bit about dax . i'd like to tell dax about you .
[patient] okay .
[doctor] cheryl is a 34-year-old female with a past medical history significant for hypertension , who presents today with back pain . cheryl , what happened to your back ?
[patient] so i've been walking a lot lately . i've been walking to ... 30 minutes to an hour or so a day . and all of a sudden , um , when i was walking , my , um , back just kind of seized up on me . and i do n't really know what it was . maybe i was going a little bit faster . but it just all kind of clenched .
[doctor] okay . so you felt like , maybe like a spasm or something like that ?
[patient] yeah .
[doctor] okay . and how many days ago was that ?
[patient] that was about six days ago now .
[doctor] okay . and what have you taken for the pain ?
[patient] i've been taking ibuprofen . um , and then i've been putting some heat on it . but it's still pretty stiff .
[doctor] okay . all right . um , and did you have any trauma before that happened ? were you doing anything strenuous like crossfit or lifting boxes or anything like that before you went for , for the walk ?
[patient] i have been lifting more , um , probably around three times a week . so i do n't know if it was because i was doing deadlifts that day and then walked .
[doctor] okay .
[patient] um , maybe i was using my back more than my legs .
[doctor] okay . all right . and was it any particular area in your back ? was it the lower back ?
[patient] yeah , it was .
[doctor] okay . on one side versus the other ?
[patient] um , kind of both equally .
[doctor] okay . all right . and any numbing or tingling in your legs or your feet ?
[patient] no , i have n't felt anything like that .
[doctor] okay . any weakness in your lower extremities ?
[patient] no .
[doctor] okay . all right .
and then in terms of your blood pressure , how are you doing ?
[patient] so i got that cuff that you suggested the ... our ... the last visit , and i've been doing readings at home . and that's been looking great , too . i've been watching my diet . again , my boyfriend's been great and dieting with me so i do n't have to do it alone . and everything's been good .
[doctor] okay . excellent . and you're taking the lisinopril ?
[patient] yes .
[doctor] okay . wonderful . okay . so i know you did a review of systems sheet with the nurse , and i know you endorse , you know , this back pain . um , do you have any other symptoms ? fever , chills , congestion , cough , chest pain , shortness of breath ?
[patient] i have a little bit of nasal congestion , but that's just from my seasonal allergies .
[doctor] okay . all right . well , let's go ahead . i want to do a quick physical exam on you .
[patient] okay .
[doctor] okay ? hey , dragon , show me the vital signs . so good- you know , here in the office , your vital signs look great . your blood pressure's really well controlled , which is good . so that's a good job . so i'm going to take a listen to your heart and lungs . i'm going to examine your back , and i'm going to let you know what i find . okay ?
[patient] okay .
[doctor] okay . all right . so on physical examination , you know , everything looks good . you know , on your heart exam , i do hear that slight two out of six systolic ejection murmur , but you've had that before . that seems stable to me . on your back exam , you do have some pain to palpation on the right lateral aspect of your lumbar spine , and you do have pain with flexion and extension as well , and you have a negative straight leg raise . so what does that mean ? so we're going to go over that . okay ? let's ... let me look at some of your results , though , first . okay ?
[patient] okay .
[doctor] we did an x-ray before you saw me , so let's look at that . hey , dragon , show me the back x-ray . so looking here at this x-ray of the lumbar spine , everything looks good . there's good boney alignment . there's no obvious fracture , you know , which is not surprising based on your history . okay ?
[patient] hmm .
[doctor] hey , dragon , show me the labs . and your labs that we did before you came in all look great . there's no elevated white blood cell count . there's no signs of infection . again , those are all really good . okay ? so let me go over with you about my assessment and my plan for you . so for your first problem , this back pain , i think you have a lumbar strain , and , you know , that might've happened , you know , lifting something or exercising . and so what i want to do is prescribe meloxicam , 15 milligrams once a day . uh , i want you ... you can ice the area , and you can also apply heat sometimes as well . um , you know , i'm going to refer you to physical therapy just to do some strengthening exercises of your back , um , because i do want you to continue to be able to work out and exercise . okay ?
[patient] okay .
[doctor] and for your last problem , your high blood pressure , again , everything looks great here . um , you know , i think you're doing a really good job with that as well . i want you to continue on the lisinopril , 10 milligrams a day . and then , uh , let me know if you notice any increases in your blood pressure readings . okay ?
[patient] okay .
[doctor] do you need a refill of the lisinopril ?
[patient] yes , i do , actually .
[doctor] okay . hey , dragon ? order lisinopril 10 milligrams po daily . okay . uh , so the nurse will be in soon , and she'll get you checked out . okay ?
[patient] okay .
[doctor] all right . hey , dragon ? finalize the note .
|
Hello.
Hi there.
Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?
, yeah. Uh, my name's .
Makes sense. Yeah.
So, . Sorry, your name is?
Name was Brian.
Brian. Hi Brian. Nice to
Hi.
Um, uh, and your date of birth.
Yeah, my date of birth is the eighth of August, nineteen eighty two.
Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?
Yeah. No, no one else can hear me.
Great. And you're happy to continue with the consultation.
Yes.
Marvelous. OK. So, um, how can i help today?
Yeah, um. So basically it's, just been happening over the last few weeks or so.
But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.
Often.
Yeah just like, doing most things that I would normally find, easy , is become quite difficult.
OK. So, things have become quite difficult for you.
Yeah.
Is there anything else?
Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.
OK. I'm sorry to hear that.
Um, so you had difficulty waking up. No energy, not eating.
And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?
Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.
Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.
When did you start your new job? Two months ago, did you say?
Yeah.
OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?
More like, , two months, I would say, yeah.
OK.
Alright. So, um,
Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?
Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.
, eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.
Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?
Whatever, that'd be really useful.
OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.
And then we can go on to sort of what can be done from there. Is that alright?
OK.
OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?
Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.
, difficulty sleeping as well.
Yeah.
Um, and have you, and, how, how has your mood been over this period?
Have you been feeling your usual self?
Um.
Distracted, , I'd say. Uh, I, I kind of, um.
Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.
Um, not unhappy or, happy, but just uh, quite, just , not focused.
OK. So difficulty focusing, quite distracted.
And, would you say you've been in good spirits? Or is your mood low?
Um.
Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.
Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.
Right.
K. And uh, so lower mood, decreased sex drive recently as well.
And, just on that note, just a few questions around that.
Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,
Do you tend to, to have morning erections like you, is that something that you've noticed, ?
Yeah.
Um, I haven't noticed anything like that, specifically, no.
So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.
Yes.
I have not noticed those recently.
OK. So, and that's been a change, has it?
Um.
Important one I don't think, um, yeah. Not, I don't think it's important to change, no.
Sorry?
Uh, so you, you, you, you don't think there's been a change there. You
No, there hasn't been a change there.
Ohh OK, sorry. Right, so
OK. So, um,
Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.
Yeah.
Yeah.
Um, and in what way has your sex drive been lower? are you in a relationship at the moment?
Yeah, I, I'm married, um, have been for, many years.
Mm-hmm.
And, uh, yeah just, um. Over the last few months, just uh, been disinterested.
Disinterested.
OK.
OK. Sorry, you froze there for a moment.
Um, . So less interested as well, OK.
Yeah.
And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?
Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?
Um, so, in the past, um, I have a, a history of, hypothyroidism, um.
Hypo?
Hypothyroidism.
Hyperthyroid.
Yeah.
K, so that's high thyroid, just to sort of confirm that.
Um.
Sorry, can you say that again please?
hyper, as in high, hyperthyroid.
Hypo.
Hypo, OK. Hypothyroid. Thank you.
Thank you. Um.
Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.
OK.
Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.
OK.
OK. And um,
Uh, do you take any medications?
I had a, a, drug history of Thyroxine.
Mm-hmm.
So, maybe, yes.
Do you, do you continue to take Thyrocsin now?
Yes.
You do. You're, so you're taking Thyrocsin at the moment?
Um.
Yes.
Cool. And any drug allergies? Are you allergic to any medications?
No, I have no uh, medication allergies, no.
No.
No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?
No.
No depression or anything like that running in your family, or uh,
Uh, nothing, nothing, that sort.
OK. And your mother is, is well? Any brothers or sisters?
Yeah she's fine, um, and no, I'm an only child. Um.
Um,
OK.
So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?
No
No, no, nothing like that.
. OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?
No.
No.
No, not , not really, no.
and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?
Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.
So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.
OK. So you, you've become more short of breath over the last few months.
Yeah.
Um, and you've had a
OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?
Mmm.
Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?
Um, no, nothing specific, no.
So, um,
We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,
I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.
So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.
Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.
, yes.
That makes sense, yeah.
Is that alright?
Yeah, that's very useful, thank you, um.
OK.
Yeah, it feels, better to have some kind of plan, uh.
Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.
Uh, but we've at least started the ball rolling with um, some further investigations and tests.
I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.
Mm-hmm, yes.
And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?
Thank you very much, for taking the time. Thank you.
OK. Thank you. Thanks.
|
Hi there. Good morning.
Hello.
Um, I'm Doctor Deen Mirza from GP at Hand. Nice to see you.
Lovely to meet you.
OK. So, before we start your appointment. Can I please confirm your full name and date of birth?
Uh my name is, Tracy Chapman, and, um, my date of birth is.
God . , I'm forty five.
Just tell me how old you are.
, OK. Uh, and could you just confirm the first line of your address, and your postcode?
Uh, fifteen Babylon Street. Um, W six five .
That's great, OK, thank you. Um, are you in a private place where you're OK to speak at the moment?
Yes.
OK, fantastic. All right, so tell me what's been going on. You said you're, a bit short of breath. Is that right?
Yeah, yeah, feeling very sort of breathless recently.
Um, like, I don't know, whenever I like breathe deeply, I, it sort of catches in, in the, right-hand side of my back.
Right, OK, OK. And how long has this been going on for now?
Just, just today really.
Right, OK. Any other symptoms at the same time, uh, that you've had this pain?
Um, well I've had a , I've got a bit of slight fever, um, and, and, uh, well like, I coughed up a bit of blood on, on two occasions.
Right, OK.
what that means.
OK, all right. , well it might, it might all be connected then. Um, and um, yesterday, before this, all of this, were you completely fine?
Um, yeah, yeah, kind of, I , I, I can sort of feel my heart beating, but , other than that, no, sort of fine.
OK. So you can feel your heart kind of, um, beating a little bit, bit faster, do you think than normal? Is that?
, I don't know I can just sort of feel it, more , you know. Um, but I've, I've also, I've been feeling a bit, like a bit tired at work.
OK. Sure.
Haven't really been, like exercising has been a bit difficult, because I've been feeling tired.
Um, and, , yeah performing, , performing daily activities has, has been a bit harder than usual.
. OK, all right. , and um, how long has that been for? The tiredness and, you know, , not wanting to exercise and.
Um, , only after, only for a couple of weeks or so.
Couple of weeks, OK. And then, and the last day or so that's when you get the cough and the pain in the side? And you've cough blood, OK, all right. Um, you said you felt a bit warm. , have you measured your temperature at all?
Yep.
Um, with the back of my, my hand, yes.
just with that, OK, fair enough, all right. Um, OK. And now, can I just ask? Um, do you smoke at all?
Uh, no.
OK. What do you work as?
Um, I work in an office, just a, desk job.
OK, all right. And, um, do you live alone?
Uh, yes.
Yeah. In a flat or a house?
Flat.
OK. Do you have any pets?
Cat.
A cat, OK. Um, uh, uh, are you on, any medication at all? Regular medication?
Uh, yeah, um, , Methotrexate, Methotrexate, that's.
Methotrexate. OK. , what are you on that for?
Um, I've, I've got SLE.
SLE, OK. Do you have any other , diagnoses? Any other illnesses at all?
No.
Right, OK. Um, and do you have any allergies to any medication?
No.
Any other allergies at all?
No.
OK. So, um, you're on, you're taking Methotrexate at the moment. When was the last time you had Methotrexate?
Uh, this morning.
Ohh, you had it this morning. OK, ohh right, all right.
OK. Um , um, couple of things I'd like to do in order to try and um, get an idea of how, unwell you are.
OK. Um, the first thing I'd like to do, is to try and measure your pulse.
So, what, the way we're gonna do this, is that, if you're, if I can get you to try and locate the pulse in your wrist.
. Not everyone can do this, so don't worry if you can't.
But if you, if you can tell me whether you can feel the regular pulse. It's just under the thumb. If you put two fingers up and down like that, you might be able to feel the pulse.
I've got it.
You got it, OK. Are you sure?
Yep.
All right. So what I'm going to do, is I'm going to tell you when to start counting, and when to stop counting OK. So I'll just get my stopwatch up.
OK. So if you can, um, you've still got the pulse?
Yep.
OK. So if you can start counting, now please.
One, two, three.
Five, six, , eight, , ten, .
If you can stop now, . That, I think that was about eleven or twelve. Um, so that would make your heart rate about, sixty six to seventy four, that's, that's OK, good.
Fantastic. And the next thing I'd like you to try and do, OK. Um, it depends on the lighting, so it may not be possible.
But the next thing I'd like you to try and do is just, to get you to squeeze the tip of your finger.
And then let me see how quickly the redness come back. OK, so if you can see what I'm doing now. My finger's come, right behind the screen, I'm squeezing it, OK. , just watch me first, it's all right, just watch me first. Yeah, I'm, I'm squeezing it.
And then you can see, that, it goes, pale and then it goes back to the normal red colour, OK.
So if I can get you just to put your finger up to the, your camera. And then with the other hand, just try and squeeze it, and see.
You look like you've got very good circulation.
OK, perfect, that's great. Thank you so much.
The last thing I'd like to do, is I'd like , to , try and have a look down your throat.
OK. Are, are you doing this consultation via, um, a phone or a , laptop?
Phone.
A phone?
rested it on my laptop, so I think we're good to go.
, sorry, say that again.
Got it rested the laptop but I can.
OK, , OK. So if you, if you, um, position your device up above your head, put your head back, mouth open wide, and let me see if I can have a . That's, fantastic. And say ah.
Ah.
Perfect. Thank you for that. Excellent.
Lovely.
OK. Last thing, is if I can get you to feel inside your neck. Just on the sides here, OK, um, by your Adam's apple. Tell me whether you can feel any enlarged glands or not.
No, they feel pretty normal to me.
. OK.
I think.
All right. Um.
Now, um, uh, . Sorry, I've forgotten your name.
Um, Doris.
Doris, OK Doris. Um, so, so Doris, um, what, what I think we need to do, is um. This sounds like you might have a chest infection.
OK. If you're coughing up blood, and you're feeling your heart racing. Um.
Uh, I think, you need to be examined today, someone needs to listen to your chest.
And, um, maybe check your blood pressure as well, check that, you're stable. I have to say examining you now, from what limited, examination I could do online.
You're, everything does seem to be OK, in terms of, you, you don't seem acutely unstable.
However, if you've got, this kind of pain, um, when taking a deep breath in and you're coughing up blood. We do, do, we do need to assess you to figure out whether you have a Pneumonia or chest infection.
And um, that would involve someone listening to your chest with a stethoscope, and you may need um, an antibiotic. Uh, there's one thing I need to ask you. Have you been, on any long-haul flight recently?
No, no.
No, OK. Have you ever had any clots in your legs, or clots in your lung? Blood clots?
Not that I know of, no.
No, OK. Anyone in the family have that?
No.
No, OK. All right. Um, what I think we'll do is um, we'll arrange for you to get reviewed in a clinic today.
OK. Um, I would like someone to listen to your chest, and check your blood pressure.
And to, to recheck your pulse as well. Just make sure, and check your temperature, make sure all those parameters are OK.
You may well need an antibiotic, OK. Um, do you have any allergies to any antibiotics?
No.
No, OK. Um, I, I'm not, I'm gonna, not, I'm not going to prescribe anything for you now, because I think you need to have that, basic assessment first.
Um, before we proceed to the next step. But the, that's what I would predict the next step might be. Um, I'm going to leave the number in the notes for this appointment, for you to ring our support team.
And then, they will, book you in for a face-to-face appointment with one of our GPs today.
And then, they'll do that assessment, and then we'll take it from there, OK.
OK.
But we don't think I'm dying of lung cancer.
Um, uh, given the, the way in which you uh, have presented now. Just one day, with a fever and, this slight pain, , concurrent with the, the blood in the, the, the flem.
That's not usually how lung cancer is presented. It's more insidious, over a longer period of time, with other symptoms.
Um, however, we might need to get some investigations to exclude that. It depends on the examination finding, when we see you.
OK.
All right. , are you worried about lung cancer?
Well you know, you start coughing up blood and you think you're, gonna, die of lung cancer, so.
. Sure, of course yeah. So, just remind me how old you are again. I'm sorry.
Forty five.
Forty five, OK. It's something we do need to be cognisant of, OK. Um, and, we may end up having to do a follow-up chest X-ray, if things don't settle down. But at the moment, it, it seems more like a chest infection, rather than a lung cancer.
That's good to know.
Yeah, that, that is good to know, yeah, so that's, 'cause that's easier to treat. But we still need to make sure that things are OK because, chest infections can become nasty as well.
It can lead to infection inside the body, , we want to avoid that as well. So, let's get you checked out today, and hopefully we can put your mind to rest, and get you on the right course of treatment.
Yep.
Perfect. Thank you very much.
All right, you're welcome. All right, take care then. All the best.
Bye.
|
[doctor] alright you can go ahead
[patient] hey alan i good to see you today so i looked here my appointment notes and i see that you're coming in you had some shoulder pain left shoulder pain for the last three weeks so
[doctor] how you doing is it is it gotten any better
[patient] yeah yeah i've been having a lot of pain of my shoulder for the last three weeks now and it's not getting better okay do you remember what you were doing when the pain first started
[doctor] so i i was thinking that i i ca n't recall like falling on it injuring it getting hit
[patient] hmmm
[doctor] i have been doing a lot of work in my basement and i even i put in a new ceiling so i do n't know if it's from all that activity doing that but otherwise that's that's all i can think of
[patient] okay so do you remember hitting it or anything like that
[doctor] no nothing at all
[patient] okay alright did you fall do you remember doing that
[doctor] no
[patient] okay hmmm so like a little mystery so have you had pain in that shoulder before
[doctor] i mean i'm very active so i can get pains in my shoulders but it's nothing that sometime some tylenol can help
[patient] okay and are you able to move the arm or is it kinda just stuck
[doctor] i'm having a lot of pain like i can move it but you know when i try to reach for something lifting anything and even like i do n't even try to put my hands over my head because it causes so much pain
[patient] alright so does that pain radiate anywhere or like where would you say it is in your shoulder
[doctor] it actually it stays pretty much just right at the shoulder it does n't go down anywhere
[patient] okay and the pain is it is it all the time or does it come and go
[doctor] it's pretty much all the time anytime i put any pressure on it like when i'm trying to sleep it hurts even more so it's been affecting my sleep as well
[patient] okay so i know you mentioned tylenol so this time i have n't taken anything for it
[doctor] yeah i i do the tylenol which usually works for me and it does take the edge off but i still have pain okay did you try icing it at all
[patient] i iced it initially but i have n't iced it at all recently
[doctor] alright
[patient] and so with your shoulder have you experienced any numbness in your arm or in your fingers
[doctor] no numbness or tingling
[patient] okay good so i'm gon na go ahead and do a quick physical exam and take a look at your your shoulder so i reviewed your your vitals everything looks good with that so touch here in your shoulder so your left shoulder exam you have limited active and passive range of motion so pressure here so that there is tenderness of the greater
[doctor] okay
[patient] tuberosity of the humerus let's see there is no tenderness at the sternoclavicular or acro
[doctor] yeah
[patient] acromioclavicular joints
[doctor] yeah yeah
[patient] and looks like you have good hand grip let me see so on the neurovascular exam of your left arm your capillary refill is less than three seconds and your sensation is is intact to light touch
[doctor] yes thank you yep
[patient] so you did get a we get we had to get a x-ray of your shoulder before you came in and so it's normal so that's really good so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you you do have that left shoulder pain so your symptoms are
[doctor] most likely due to a rotator cuff tendinopathy so this means that you injured tendon you have injured tendons and muscles that make up your shoulder and make up your shoulder muscles so what i'm gon na do is i'm gon na order an mri of your left shoulder
[patient] and so we're gon na begin with that just to make sure nothing else is going on have you done physical therapy before
[doctor] i have n't
[patient] okay so what i'm gon na do i'm going to refer you to physical therapy for approximately six to eight weeks and so they can help you strengthen those muscles around your shoulder and that should definitely help with the pain during that time you can also continue to take tylenol i do n't think i need to prescribe anything else for the pain you said as it's working pretty good for you so if your symptoms do n't improve we can consider a steroid injection of your shoulder which should provide some relief but i think right now we can just go with the the pt and hopefully that works to alleviate your injury so do you have any questions about the plan
[doctor] so like i said i'm really active do you think that this pain will ever go away
[patient] yeah so many patients are very successful with rehab and so we'll start with that and see how you do most most of the time once we build up those muscles around that shoulder you know things things the pain alleviates itself and and and you will be good to go back to working on your basement and running and jogging and lifting weights all all the active things people do these days
[doctor] okay alright thank you
[patient] bye
[doctor] okay bye
|
[doctor] hi , andrew , how are you ?
[patient] hi . good to see you .
[doctor] it's good to see you as well . so i know that the nurse told you about dax . i'd like to tell dax a little bit about you .
[patient] sure .
[doctor] okay ? so , andrew is a 62-year-old male with a past medical history significant for a kidney transplant , hypothyroidism , and arthritis , who presents today with complaints of joint pain . andrew , what's going on with your joint ? what happened ?
[patient] uh , so , over the the weekend , we've been moving boxes up and down our basements stairs , and by the end of the day my knees were just killing me .
[doctor] okay . is , is one knee worse than the other ?
[patient] equally painful .
[doctor] okay .
[patient] both of them .
[doctor] and did you , did you injure one of them ?
[patient] um , uh , i've had some knee problems in the past but i think it was just the repetition and the weight of the boxes .
[doctor] okay . all right . and , and what have you taken for the pain ?
[patient] a little tylenol . i iced them for a bit . nothing really seemed to help , though .
[doctor] okay . all right . um , and does it prevent you from doing , like , your activities of daily living , like walking and exercising and things like that ?
[patient] uh , saturday night it actually kept me up for a bit . they were pretty sore .
[doctor] mm-hmm . okay . and any other symptoms like fever or chills ?
[patient] no .
[doctor] joint pain ... i mean , like muscle aches ?
[patient] no .
[doctor] nausea , vomiting , diarrhea ?
[patient] no .
[doctor] anything like that ?
[patient] no .
[doctor] okay . all right . now , i know that you've had the kidney transplant a few years ago for some polycystic kidneys .
[patient] mm-hmm .
[doctor] um , how are you doing with that ? i know that you told dr. gutierrez-
[patient] mm .
[doctor] . a couple of weeks ago .
[patient] yes .
[doctor] everything's okay ?
[patient] so far , so good .
[doctor] all right . and you're taking your immunosuppressive medications ?
[patient] yes , i am .
[doctor] okay . all right . um , and did they have anything to say ? i have n't gotten any reports from them , so ...
[patient] no , n- nothing out of the ordinary , from what they reported .
[doctor] okay . all right . um , and in terms of your hyperthyroidism , how are you doing with the synthroid ? are you doing okay ?
[patient] uh , yes , i am .
[doctor] you're taking it regularly ?
[patient] on the clock , yes .
[doctor] yes . okay . and any fatigue ? weight gain ? anything like that that you've noticed ?
[patient] no , nothing out of the ordinary .
[doctor] okay . and just in general , you know , i know that we've kind of battled with your arthritis .
[patient] mm-hmm .
[doctor] you know , it's hard because you ca n't take certain medications 'cause of your kidney transplant .
[patient] sure .
[doctor] so other than your knees , any other joint pain or anything like that ?
[patient] every once in a while , my elbow , but nothing , nothing out of the ordinary .
[doctor] okay . all right . now i know the nurse did a review of systems sheet when you checked in . any other symptoms i might have missed ?
[patient] no .
[doctor] no headaches ?
[patient] no headaches .
[doctor] anything like that w- ... okay . all right . well , i wan na go ahead and do a quick physical exam , all right ? hey , dragon , show me the vital signs . so here in the office , your vital signs look good . you do n't have a fever , which is good .
[patient] mm-hmm .
[doctor] your heart rate and your , uh , blood pressure look fine . i'm just gon na check some things out , and i'll let you know what i find , okay ?
[patient] perfect .
[doctor] all right . does that hurt ?
[patient] a little bit . that's tender .
[doctor] okay , so on physical examination , on your heart exam , i do appreciate a little two out of six systolic ejection murmur-
[patient] mm-hmm .
[doctor] . which we've heard in the past . okay , so that seems stable . on your knee exam , there is some edema and some erythema of your right knee , but your left knee looks fine , okay ? um , you do have some pain to palpation of the right knee and some decreased range of motion , um , on exam , okay ? so what does that mean ? so we'll go ahead and we'll see if we can take a look at some of these things . i know that they did an x-ray before you came in , okay ?
[patient] mm-hmm .
[doctor] so let's take a look at that .
[patient] sure .
[doctor] hey , dragon , show me the right knee x-ray . so here's the r- here's your right knee x-ray . this basically shows that there's good bony alignment . there's no acute fracture , which is not surprising , based on the history .
[patient] mm-hmm .
[doctor] okay ? hey , dragon , show me the labs . and here , looking at your lab results , you know , your white blood cell count is not elevated , which is good . you know , we get concerned about that in somebody who's immunocompromised .
[patient] mm-hmm .
[doctor] and it looks like your kidney function is also very good . so i'm , i'm very happy about that .
[patient] yeah .
[doctor] okay ? so i just wan na go over a little bit about my assessment and my plan for you .
[patient] mm-hmm .
[doctor] so for your knee pain , i think that this is an acute exacerbation of your arthritis , okay ? so i wan na go ahead and if ... and prescribe some ultram 50 milligrams every six hours as needed .
[patient] okay .
[doctor] okay ? i also wan na go ahead and just order an autoimmune panel , okay ? hey , dragon , order an autoimmune panel . and you know , i , i want , i want you to just take it easy for right now , and if your symptoms continue , we'll talk about further imaging and possibly referral to physical therapy , okay ?
[patient] you got it .
[doctor] for your second problem , your hypothyroidism , i wan na go ahead and continue you on this ... on the synthroid , and i wan na go ahead and order some thyroid labs , okay ?
[patient] sure .
[doctor] hey , dragon , order a thyroid panel . and then for your last problem , the arthritis , you know , we just kinda talked about that . you know , it's gon na be a struggle for you because again , you ca n't take some of those anti-inflammatory medications because of your kidney transplant , so ...
[patient] mm-hmm .
[doctor] you know , let's see how we do over the next couple weeks , and again , we'll refer you to physical therapy if we need to , okay ?
[patient] you got it .
[doctor] you have any questions ?
[patient] not at this point .
[doctor] okay . hey , dragon , finalize the note .
|
Ohh, hello.
Hello. I'm Doctor Geraghty. Ohh, sorry. . Can I take your, full name, date of birth, and, your home address please?
Uh, yeah it's uh, . Um, and, five, um, Kings Place.
And are you in a, uh, and your date of birth?
Uh, it's the twentieth, of the fourth, nineteen ninety.
OK. And are you in a private place you can have a confidential consultation today?
Yes, I am.
What can I do for you today?
Um, I've got a really bad headache, had it for about a day now.
OK, and can you just tell me about, how it started? What were you doing when it came on?
Um, yeah, just ever since yesterday morning, since I woke up really. Um, just yeah, kind of throbbing headache, haven't really wanted to leave the house much since then.
OK, and whereabouts in your head is the pain?
Uh, mainly on the left side.
OK. What does it feel like?
Um, it just, kind of feels like it's throbbing, it's quite intense, sort of comes and goes. Um, yeah, quite sensitive to light, um, but yeah, quite painful.
K and . When, when you say it comes and goes, does it completely go away?
Uh, just kind of fades, so it's still there a little bit but, it kind of gets more or less, severe.
OK. And any, any other symptoms that you've had, any problems with your eyes, or your eyesight?
Uh, no, not at all.
Any abnormal smells or tastes?
No.
Any, any nausea, vomiting?
Uh, no, no, been feeling fine actually.
And have you been eating and drinking OK?
Yeah, yeah, .
OK. And, normally, do you get any headaches?
Uh, no not really, it's not something I've, ever had before.
OK. And, has it occurred at a particular term in your menstrual cycle?
Um, no, not particularly, and my period was about a week ago.
Right, OK. And how we're you the before it came on? Have you had any other symptoms, like feeling feverish, , runny nose, sore ears?
No, not really any sort of, cold symptoms, I seemed OK the day before.
OK. And, at the moment, how are you feeling?
Um, it's still pretty bad. Um, yeah, still the kind of throbbing, yeah.
Have you had any changes in your skin?
No, skin feeling fine.
Have you checked your temperature at all? Have you got a thermometer at home?
Um, I haven't. Um, I don't feel like I'm feverish, but I haven't checked.
And any problems with weakness, tingling, numbness in your arms or legs?
No, not at all.
And what have you been doing since it came on? Have you been able to go to work, or have you been at home?
Um, taken some painkillers, mainly been at home. Um, yeah just kind of, kind of seems to be worse, when I'm in a light room or like sunlight. So I've kind of just been staying in as much as possible.
OK. Does it get worse with any position that you're on? Is it worse when you lie flat, or when you bend forward?
Um, no, think I've generally been lying down, seems to be better that way.
Any problems if you cough or sneeze?
Uh, no, but I haven't really got a cough or anything.
OK. And can you just tell me a bit about, your medical history in the past? Have you had any significant medical problems? Any hospital admissions, operations, something like that?
Uh, no, not recently, nothing.
Do you take any medication?
Uh, no, just contraception.
And which contraception do you take?
Uh, Microgynon, pill.
When did you start that one?
Uh, about six years ago.
Do you get any side effects from it?
Um, not really, um, no, not too much.
OK. And, anyone in your family had any medical problems?
Uh, my mum had, uh, high blood pressure, and she's got a history of migraines. Um, but it's not really affected me before.
OK.
And have you had your blood pressure checked recently?
Uh, I haven't actually, no.
Have you had it checked, when you've had the , repeat prescription done?
Yeah, yeah, so uh, probably about six months ago.
Do you know if there's been any problems with it?
Um, it's always been fine I think.
OK. Um, and whereabouts, whereabouts do you live at the moment? You've given me your, address. Do, who do you live with at home?
Uh, just with housemates, um, just friends.
OK. And do you drink much alcohol day-to-day?
Um, I'd say a normal amount, um, probably, you know, a few drinks at the weekend.
OK. And do you smoke?
No.
Do you take any other drugs of any sort?
No.
Um. So, , what, what tablets did you say you've been taking already? Yeah.
Sorry?
What tablets have you been taking already, for it?
Uh, just Paracetamol. Um, I'm allergic to Aspirin, so I haven't been taking that.
What happens when you get a, when you take Aspirin?
Um, I just feel really sick.
OK. And have you ever, taken any, non-steroidal anti-inflammatories, like Ibuprofen, Naproxen, anything like that?
Um, I have in the past, I haven't been taking it, last few days.
OK. Um, so, this headache is new to you, and you've, you've not had regular headaches before?
Yeah.
What I would, suggest is, taking, uh, um, some anti-inflammatories, along with the Paracetamol.
OK.
Um, as a. Uh, you said you're eating OK?
Yeah, yeah, fine.
I mean it, from the sounds of it, it does, sound quite like a migraine, but obviously if you had no history of that, in the past.
Um, and is anything changed recently, or any, anything you've done recently might've, triggered it?
Uh, not that I can think of, um, may have been a bit stressed out at work, that kind of thing, but .
Yeah. Um, well that would be the first thing to do, is to take some anti-inflammatories along with the Paracetamol. Make sure you're really well hydrated.
Um, and, see how that goes, and if it, if it isn't settling, or it's getting worse, or you get any other change in your headache. Um, or you're unwell with it, with a high temperature, then we would certainly need to speak to you.
Straight away about that. The other thing is if you, if you're getting persistent, um, headaches, or headaches associated with your menstrual cycle, or certain things seem to trigger these headaches.
Then, it, it would be worth, having a further discussion about it, to see whether we can, work out if we can help the, that longer-term.
OK, brilliant, thank you.
Um, I would, try and arrange to get your blood pressure checked, if you haven't had it checked for a while.
Uh, and, thing to do is to have a thermometer at home, so you can make sure that your temperature's OK.
OK, sure.
Yep.
If you have a raised temperature or, your headache's just getting worse, or you develop any rashes or anything like that. Then we'd need to speak to you straight away.
Yep, OK, that's brilliant. OK, so I'll take some Ibuprofen and I'll um, hopefully, be a bit better in a day or two then, so yeah.
OK, so, have you got any other questions?
Uh, no, that was it today.
OK. OK then, we'll, we'll, we'll, um, speak to you again.
OK, brilliant. Thanks so much.
, very much. Bye.
Bye.
|
Hi there. I'm Doctor Smith from Babylon.
Hi.
Hi there. Can you just confirm your name, date of birth, and the first line of your address, first of all please?
Yeah. Uh, my name is Valerie Cole. My date of birth is the nineteenth of September, nineteen ninety three.
My name's .
My address is, uh, sixty four, Cliveden Place, in, South Wimbledon.
OK. Are you in a private place where you can have a confidential consultation today?
Yes I am, yeah.
What can I do for you?
Um, I've been feeling really anxious over the past few months. Um, I just get really nervous every morning about leaving the house, and it's started to really worry me, and just add up, and build up on that anxiety. And I just didn't know, who to talk to or, so I wanted to check with my GP.
OK. Do you mind just telling me a bit more about, when it started? Do you think there's something which changed in your life at that time?
Um, I guess so, I think um, I would say maybe about two months or so, I've been feeling like this, and that probably coincides with, me starting a new job, um.
Which I , I would say it's quite , I mean every job is stressful, and when you first start, but it's been really stressful I think over the past two months, definitely.
What's your job?
Um, so I work for a, a, a fashion retailer, in um, the head office team, and it's just a brand new sector. I've never worked in retail before, my boss is not very nice to me and I don't.
But I also think that, it's just been, I just really dread, going there. I just hate, speaking to her, I hate like seeing everyone and, really worried about whether I'm doing well or not.
And it's really impacting on like, on the rest of my life, like my sleep and stuff like that.
OK. So, um, just day-to-day, tell me, from the start of your day, how it affects you. You said that you, you dread going to work.
How, how does it affect you, in terms of like your sleep at night, and things like that?
Right.
Yeah, this is really so, I, I, I've, as I say like, I don't want to go to work in the morning, so I just find no way of, I can't get out of bed.
But it's also because, when I leave I just, when I've left work, I just feel so stressed and so worried about everything I've done, I can't get to sleep for hours and hours and hours. So I.
OK. So what time, what time do you go to bed at night-time?
About ten, eleven, probably.
And what time do you get to sleep?
Not for ages, I'm, I'm lying awake all night
OK. And, when you eventually get to sleep, do you wake up with your alarm in the morning, or does something else wake you up, before then?
Mmm.
So I find my, my heart kind of racing, and then I'm just like panicking that I'm gonna be late, and that that's gonna make work even more stressful. So I do have an alarm, but I find myself waking up before that, 'cause I'm just my heart is racing. And actually the other day, I was just like, I was lying in bed and I really thought my heart was racing so much, I thought I was gonna have a heart attack in the morning.
OK. And, so how many hours sleep do you think you get a night?
, I just, I can't even tell because I feel like I'm, even when I'm in sleep it's such a shallow sleep, but maybe, three, four hours, I'm getting now.
OK. And, what about your eating patterns, any change in how you're eating, or whether you, your appetite's changed?
Probably, not, significant changes maybe. No I wouldn't say that, I wouldn't say that I'm eating like, much differently. Ohh that, I probably have more chocolate than normal, just because I feel, so down.
OK. You're eating regularly otherwise?
Yeah, .
OK. And, you told me about the palpitations, just tell me a bit more about that.
Yeah, So um, it's, it's usually kind of like, when I realise in the morning that, either um, I feel like I'm gonna be late, because I've like overslept 'cause I'm so tired.
Um, or I wake up in a panic thinking I am gonna be late so, it's just kind of like, just a constant like, rapid heart beating. It's just really, really stressful. I don't know if it's, stress or if, , or I did think it was like, a heart problem really actually.
Does it feel like a regular fast beat, or an irregular, beat?
Irregular, I think.
And how long do you think it lasts for when you get it?
Ohh it can be anything, I think couple of minutes, or the other day I was actually just, sort of lying there for like, holding my hand on my chest for like ten minutes.
OK. Is that something that you've had before this, or is that a new thing?
Yeah, but I would say this is only in the past. Sort of like, couple of months as I say that I've been, experiencing this.
OK. Any chest pain with that?
No, um, well yeah it's painful to , when the heart, when my heart is beating fast but, but, yeah.
OK.
And, in the daytime, how, how, you said you, you're not getting much sleep so, how's your energy level in the daytime?
It's just, really, really low, I mean I, I'm finding now that I'm just, I find no enjoyment at all.
It's kind of day-to-day, and anything that I'm doing. It's not just my job it's, you know when I leave I'm just so tired that, anything that, previously was, really fun is just not, it's not enjoyable. And I'm like, yeah, on edge the whole time.
OK. So what do you do in the evenings?
Well right now I'm, I'm working so late, and everything is really, really stressful. So I don't really get much time to myself but, when I do wanna go out, or, you know, see friends or just relax. It, it seems quite difficult to do that.
OK, and , are you avoiding contact with friends, or do you still see them?
I avoid them insomuch that I, feel like I'm.
Yeah, so I mean sometimes it just, I know that I'm not gonna have fun, because I don't want to, go out and, do things that I would normally have done.
OK. What about, hobbies, or exercise, or anything else outside work? Do you do anything else outside work?
Yeah, as I say like everything that I had previously been doing has been, just difficult to continue with like, I did used to like to like go running, and.
And to play tennis and stuff, but now it's just not, I'm just not enjoying it, I'm not, I'm not like, I'm not going out to do that quite so much.
And have you, has it ever got so bad that you've actually had to miss work?
No, 'cause I think that would just add to the tension, but I do like pretty much every morning I think, ohh I should call in sick or like, just not go.
OK.
And, what's the worst that it's got? Have you ever, been, um, so overwhelmed that you couldn't, get in to the office, you couldn't, go into a situation?
Have you ever had a panic attack?
, um.
No I wouldn't say so, I think, I've always managed to make it to work.
But I, I wonder if it's building up. So this is why I wanted to call, I'm just worried it's building up to that, and I don't know what to do 'cause I have, feel it, felt it, get worse and worse over the past couple of months.
OK. And apart from work, are there any other situations which evoke quite extreme anxiety, like being, in public places, social situations, public transport, anything like that?
Yeah I mean, I find public transport really stressful anyway, especially being on the tube it's, 'cause it's quite, getting warmer so it's just really airless.
Um, but I think the majority of it, 'cause my life is just so focused around work right now, the majority of it is focused around work as well.
OK. Before this did you have any similar times in your life when you felt like this?
Not really I, I'm, no, I would say. I mean everybody always has a bit of tension, a bit of anxiety but, I've never felt, anything this bad before.
OK. And what about your mood day-to-day? I mean, I can see that you're quite distressed by like that. Do you ever get really down about this?
Yeah.
Um, I mean, yeah, yeah, 'cause I do, yeah. I'm pretty much, down like, I don't enjoy, being and not just my day at all 'cause.
I'm just so worried about everything, um, and I find that even when I'm not, like even at the weekends and stuff it's just the, kind of like constant, feeling of just being a bit, down, a bit unhappy.
When do you think you last felt yourself?
Um.
I don't know, that's a good question, I can't really, I can't really put a on that at all.
. And has your mood ever been so low that you've felt like you just couldn't carry on with your job, or with your life, or with your normal, uh, things as they we're going on?
I wouldn't, no I wouldn't say that I've had, I haven't had any suicidal thoughts or any, thoughts that have been that extreme like, I haven't.
You know I have, I have a good support system, like I do have good family and stuff. So I, I have, I don't have, uh worries about, actually wanting to, um, not go on. It's just that, I don't wanna go on like this.
Yeah. OK. And where do you, who do you live with at home?
Sorry?
Who do you live with at home?
Yeah, I live with my parents, just my parents.
Um, and, how much alcohol do you have in an average week do you think?
Um, ooh I don't know, probably quite a lot on the Friday or Saturday, just because, that, that's kind of normal, um.
Uh, maybe I, maybe I do have like a bit during the week. Like, my parents obviously are retired, so they just drink whenever they want, so, whenever they're having a glass of wine, they'll offer it to me and it's like. I guess I don't really keep track of it that much.
OK. So, how much would you, would you guess?
Probably like, probably quite a lot on a Friday or Saturday, because it's usually going out, so maybe like.
I probably go over my limit just on those days, anyway, and then like, maybe a glass of wine during the week .
OK. Do you smoke or take any other drugs, or anything?
Um, I try not to smoke, but I do, occasionally, but I don't take drugs.
OK. And have you done , anything yourself to help? Have you , have you talked to anyone, talked to any counsellors? Done any, online, looked online at all? Any ways to ?
I, well I talk to my mum, because she also suffers from, well she's , suffered from like depression in the past. I didn't think that it was, that I was suffering from, actual depression because it just seems to be, manifesting as, as total , as just stress the whole time.
OK.
But um, I did talk to my mum about it but I haven't sought any, she recommended that I come to the GP, um, but I haven't sought any other.
OK.
And would you be happy to, have, some one-to-one therapy?
Yeah I think, yeah I think so. I've never done that before, but yeah.
OK. I mean what we would suggest in the first instance is to, to. So you can self-refer via the NHS, for what we call like, talking therapy which is a type of inter-behavioural, where they can really look at your situation. How you're reacting to, the, , why, what's provoking anxiety, and what you can do, to try and overcome that.
OK.
Yeah.
Um, so I can send you the link for that.
Um, in the meantimes it can be a bit of a wait. There are some online resources that are really helpful. Um, can put the details, on there and you can, get on with them straight away and try and work through them as well.
Uh-huh.
Um, and if you're feeling like it's not helping at all, or your anxiety is getting worse, to the point where you can't cope with work, or you can't, just do your normal things day-to-day. Then, it's important for us to, for you to give us a call, back and just discuss that, further.
OK. .
I mean some people, with anxiety they, do need to take medication to control that but that's, not something that we'd suggest in the first instance.
OK.
And I'll put some more information on your notes about, helping with your, sleep patterns and things like that.
That's great, I look forward to reading it.
Um, in terms of palpitations, it is most likely to be a, , associated with anxiety, but it's probably worth having couple of basic blood tests just to make sure that, there's not something triggering that off. And then arranging a GP follow-up a week after you've had the tests, so we can just go through the results with you.
OK, OK. Yeah, .
So if you call the support line you can arrange the, to have the blood test done.
OK, I'll call them up.
OK?
Thank you so much.
All right. Take care.
Have a good day. Bye.
Sorry. .
|
Hi there, good morning. Or good afternoon, sorry. Hi.
Hello there. Uh, good afternoon. This is Jack.
Good afternoon.
Hi. This, this is Doctor Deen Mirza from GP at Hand.
I do.
All right. So before we start your appointment, could I please confirm your full name and date of birth?
Yes, uh, my name is Jack Armani.
That's great, thank you.
And my date of birth is
twelve August nineteen fifty eight.
That's great, thank you for that. Um, are you in a private place where you're OK to speak at the moment?
Yes, I am.
OK. So, how can I help you today?
I am. So, I woke up, um, this morning, and, um.
Hello?
Yeah I'm still here, you'll tell . Yeah.
Uh so I'm a bit worried 'cause I woke up this morning, about an hour ago, and I couldn't move my left arm any more.
OK. Uh, and how's your arm right now?
Um.
Well like, I feel no pain but just, uh, can't move it.
That you still can't move. And, and what time did you wake up? You said it was an hour, you're sure about that?
Yes.
OK, um.
Now, can I just double check? Has this ever happened before?
No. No, uh, it's really the first time.
OK. And, did you sleep, anything, in an awkward position, or in a different bed, or anything like that last night?
Uh no, uhf, everything as usual.
OK. Um, and um, is there any discoloration in your hand?
Um, no.
K, um, does your hand feel cold?
Mmm, no, really the, mmm, the arm feels fine, apart from me not being able to move it.
OK. And it's to your on your left side. Have you had any symptoms in your left leg at all?
No, but um, I feel a bit of tingling on the left side of my face.
Right, OK. Um, and how long has that tingling been there for?
Uh, since I woke up. Um, since I started to feel the , since, since the the arm really it stopped moving, so an hour ago.
OK, um.
Now, um, I can't see you. It's, it's telephone appointment. Have you noticed any kind of, um, asymmetry in your face, or did your face expression look different on one side compared to the other, or anything different at all?
Um.
Mmm, no, not really, it's just.
Uh, having like a bit of issues like, uh, I was trying to drink earlier and I'd be bold a bit and and the tingling on, on the left side.
OK. So, um, you have some difficulties swallowing, is that right?
Um, yeah.
OK. Any problems with your speech? Is your, is your, is your speech different to how it, um, sounds normally?
Um, yeah it feels a, a bit harder . It's more complicated maybr, maybe um, be more slow. I need to think more about it.
OK. Is there anyone at home with you?
Uh, no.
OK.
Is this something I should be worried about?
Um, well, um, I'm I'm concerned that some of the symptoms you've got may be, um, symptoms of a stroke.
Hmm, wow.
OK? So, um, that's something that can be dealt with, but it needs to be dealt with as an emergency in a hospital.
Would, should I call , would you be able to call the ambulance for me?
Yeah I'm, I'm happy to do that. Um, what we need to do is to make sure that they've got access to you when you come. So, um, maybe you could, uh, leave the front door, um, unlocked, sit in the hallway. But I'm gonna arrange one of my colleagues next to me to, um, call an ambulance to your home address now.
OK.
OK. OK. Thank you.
So that's being done right now, as we speak. Uh, while we're waiting for that, I'm just gonna ask you a few more questions. Is that OK?
Sure.
OK. Do you have any other illnesses at all?
Um.
I have, uh, type two diabetes and, uh, high blood pressure.
OK. And, um, are you on any medication for that?
Um, I'm taking Metformin losartan and Amlodipine.
OK. Do you have any, um, uh, allergies to any medication?
Um, only penicillin, I believe.
OK.
Um, are there any illnesses in your family at all?
Uh, my dad has got, um, heart disease.
But, uh, but don't, I don't know more detail.
OK, anyone else?
Not really.
And um, are you normally living alone?
Uh, yes.
K. Do you smoke at all?
Uh, I used to.
OK. How much alcohol do you drink?
Uh, I will have a few drinks over the weekend. Um, maybe a, a couple more during the week.
So, what, what drinks are we talking about?
Uh, uh, beers, uh, like pints.
OK.
OK.
All right, um.
How are you feeling now? Have you got the symptoms right now still, that, um
Yes, yes. The the arm still can't move and I think the speech is getting a bit harder.
OK, all right. So, the ambulance is on it's way, all right? Um, and what they're going to do is, they'll probably take you down to, um, the local hospital, A and E. And then, they'll they will ring through for the, um, the stroke doctor to assess you, to see whether they can give you any kind of, um
Treatment for that OK? So no worry. They're they're on their way, um, and what I'm gonna do is, I'm gonna stay on the line until they reach there. Just to make sure that you're OK.
OK.
OK. Is there anything I should be doing now?
Um, not at the moment, no, not at the moment, Just, uh, make sure the the front door's open. Sit in the hallway, by the front door so that they've got access if needs be, if for any reason you can't open the front door. OK, um.
OK.
All right, then so I'll be staying on the line and we'll and we'll wait until the ambulance comes.
OK, I'm gonna go to the door.
OK then, all right. Thank you.
Thank you.
K, bye bye.
|
Hi.
Hi there. It's Doctor Smith from Babylon.
Hi Doctor Smith. Hi, can you confirm your name, date of birth, and your home address please?
Hi Doctor Smith.
Yes. My name is Mary Jo. Date of birth is January first, nineteen eighty.
And my address is uh, sixty Sloane Avenue, London.
OK, I, are you in a private place where you can have a consultation today?
Absolutely.
What can I do for you?
So, a couple of things. I, I, think I may have, overdone my workouts, and now my knees are hurting, and they're clicking a lot, and it's starting to worry me.
Um, I can't run very far, um, any more without just feeling, pain in my knees.
And then, sometimes I also get this weird tingling in my toes. Um.
So yeah, that's, that's it. I'm just concerned and I figured you know I'd call and, see if you can, help me figure out what's going on.
OK, that's fine. So when do you think it started?
So probably, it's been about two weeks.
OK. Um, and, any joint problems before that?
You know not, not really. I mean I play a lot of sports. Um, and I had a , like I play some ice hockey, and I had this injury a few months ago.
You know I just like, fell on the ice and, and, you know had a, huge bruise but, I think that's about it.
OK, So, um, at the moment, just tell me about the exercise that you're doing, normally.
So I'm training, well, I'm currently training for a marathon, um, that's gonna happen in, June. And so, I'm trying to run like.
I mean right now, I'm actually not even doing such long runs, maybe like seven or eight miles. And so, I started about uh, maybe a month ago.
Uh, I've done like, you know, four or five miles, and I've just done like a couple of seven, mile runs.
And then uh, uh, and then you know I go to the gym like few times a week and, kinda do my, usual routine.
Um, but, yeah, I think the only thing that's really different has, have been, the runs, the longer runs.
And, have you had, any times when the knee feels like it's giving way underneath you?
Um, well, I, what do you mean by that? I'm not sure what, what that means.
So, it means if you're, if you're there and uh, you just feel it sort of jolt, like give way, feel unstable underneath you.
Not, not bad, I mean it just kinda starts hurting, you know. Um.
And does it hurt, uh, how far into the run does it generally hurt?
You know I would say probably starts off like after, uh, maybe, twenty minutes or so. Which is, probably I don't know like somewhere around mile, three maybe, two and a half or three miles.
OK. Ooh you're fast. Um.
switching my kilometres and miles, I'm not sure, all right.
Um. And, um, do you have to stop running, or can you run through the pain?
Yeah, that is a good question. So, um, you know the last few times, the last time I actually stopped, I mean I ran a little bit longer, but then I stopped, because it was um, I, I feel like it's getting worse.
OK.
Um, and, when I start doing my abs, that's, you know when I do my abs. It's kind of requiring me to move my you know, um, to kind of go from the flex position on my knees, and straighten my legs, then I feel all this clicking.
OK.
And, I think that's also freaked me out, and uh, I just figured you know, something's wrong here.
Right. And, you said before, it's both knees.
So it's more, um, it's actually my right knee that hurts.
And, any problems with your left one?
No.
OK, and, can you just describe in the knee, or show me whereabouts the pain, is happening mainly?
So, ah, you know I, I feel it, it's kind of weird, I feel it in the middle, but I almost feel like maybe it kind of uh, um, moves to the right, to the right of my knee a little bit.
OK. Have you noticed any tenderness when you press over any areas in the knee?
So, yes, well it's, I have, probably some fluid. I googled it, and you know it says that sometimes fluid accumulates uh, I.
OK. , does it look swollen to you?
Sorry?
Does the knee look swollen?
Um, well it did, like, the first time I ran, it was a little bit swollen, but then I just put some like ice on it, and it went away.
Um, but, right now, right now it's not swollen, and right now it doesn't hurt, you know.
Um, but, it just kind of comes on when uh, um, or you know right now when I flex and extend my leg, it, there's no clicking but, I'll notice it in the gym and then, you know, when I run it'll start hurting.
OK, and, if you're sitting, still for a while, do you have any problems when you stand up, any locking up of the knee?
No.
Can't straighten it. Any problems going up and down stairs?
No.
Any problems just walking normally?
No, none, I don't.
And intervals of range of movement. Are you able to fully straighten the leg?
Yes.
And what about fully flex it?
Yes.
OK. Are you taking any medication for the knee?
Well, um, since you're asking. Um, yes I , I take Ibuprofen, um, and I'll just kinda, use it sometime like uh, um, like sometimes I have some joint issues, but you know, that kind of, is not very frequent. So I'll take Ibuprofen for that.
But you know it's nothing like major maybe, like, four hundred milligrams max, something like that.
I also sometimes will um, you know, smoke a joint.
Um, and, yeah, other than that, that's it.
OK, and any other joint problems, that you're getting? Any back pains? Small swelling of your, hands, feet, elbows, wrists? Any pain?
No.
Uh, well I have sometimes, you know how sometimes like if you stand for a long time, your feet will kinda, or your legs will swell up. Like I noticed it because of my socks, I'll just kind of, notice this indentation.
OK.
And then, another weird thing. I've felt this just once, but there was this tingling in my toes, like uh, um, after the run.
There was tingling in my toes like on my, you know my right toes, um, so.
On your right side.
Yes.
Any change in colour, or temperature of your lower legs?
No.
Any swelling which stays if you push in, and then you release it, that it stays there?
Well I don't know if I really try that, but I, I will tell you that, what I noticed is like if I, you know when my socks come off, I kind of notice that indentation a little bit, I mean it's not like major, right but, I. Uh, I mean do you mean I just need to like press and see what happens, if it like kind of stays or, .
Yeah, any, or any pain in the back of the calf or anything like that?
No, no, nothing like that, no.
Um, and, with your foot, has that gone back to normal now? Do you feel any altered senstation, tingling numbness, anything like that?
No it was just, it was that time, uh, but it was just really weird, because it kind of went on for a while.
OK.And any pain in the joints of your foot or , on the underside in the arch? Any problems walking round on hard floors?
No.
No.
OK, have you had, any other medical problems before?
Uh, well, I had uh.
You know what just, kind of your garden variety stuff, right, colds and, uh. I mean I, I do have, I'm far-sighted, and so I had uh, I had Lasik surgery.
And then, once I had this really bad UTI, they thought it was kidney stones, and so they had me actually in ER.
And if my GP didn't call them, tell them, that you know, they don't need to give me Morphine.
Um, that was kind of an awful experience but, uh, other than that, you know, I'm, I'm, I'm pretty good.
OK, and, do you take any other medications, apart from the ones you told me about?
Well, I'll take uh, I take vitamin D.
Uh, I take melatonin. Sometimes, you know, just for cramps, I'll take, like, uh, um, ibuprofen, or actually , uh, I'll take, what am I taking? Aleve. Whatever Aleve is.
Think that's maybe um, Acetaminophen, or, I can't remember what class of drugs.
You know occasionally, if I'm really having hard times, like I'll, I'll sleeping, I'll take Xanax.
Um, but, I prefer Melatonin, it's just sometimes Melatonin doesn't work.
OK. And, any problems with your stomach, or asthma, indigestion, acid reflux?
No, no, no problems.
. And, what I would suggest is, definitely carrying on with the ice therapy that you've been using. So, as much as you can, 'cause that really does make a difference to injuries.
Brings the healing blood into the area, and it gives it the best chance of, getting better. So, as much as you can, use the ice.
Mm-hmm.
Um, obviously you're trying to stick to a marathon programme, but.
Um, I would, try and ease up on the running, if you can. And if it, if it's painful enough that you're, having to stop running, then it's not a good idea, to do that.
Um. It's fine to take the Ibuprofen. Um, I can prescribe you a slightly stronger, anti-inflammatory that you can take regularly instead of the Ibuprofen, but not with the Ibuprofen.
Hmm.
But make sure that with food. Ultimately we probably need to, examine the knee.
I see.
Um, so, the best thing I would, suggest, getting a appointment with the physiotherapist first, who can do like a long, assessment, and examination of the knee.
And then we can make an assessment as to whether we need to do any, um, imagery to , have a look inside the knee, and see if there's any problem with the, cartilage.
OK.
Well, you know I read, I read some stuff online that, that maybe like my ligaments there's, I think it's like ACL or, or something like that right, and so if that. I mean I'm kind of like freaked out that that may break.
So do you think it's that, or?
Um, it's, it's not really possible to, diagnose that over the , over the video. So we definitely would need to, see you. And, the, a physio is the best point of call, because they'll probably be the most likely initial treatment.
Right.
But certainly if the appointment time's too long to wait, then we can see, we can see you in our clinic as well.
OK.
OK.
Can you, so are you going to send referral for that?
Yep, we can, we can do a referral before that. If in the meantime you develop like persistant swelling, heat, redness, um, of the knee, or high temperature, feel unwell, or it completely locks up and you can't bend and stretch it.
OK. Great.
Then, you'd need to see a doctor urgently, so call us back in that, case. .
Mm-hmm.
That sounds good. Thank you yeah. , sure I mean, give me the, stronger medicine, I'll give that a try.
OK. I'll send it through to your pharmacy for you. OK? Thank you, bye.
OK. Sweet. Thanks so much. OK. Bye, bye.
|
There's no . , hello?
. Hi there.
Hello there. Um, thanks for, thanks for, being here. Um, before I go any further, can I uh, confirm your name and your age please?
Yes, it's um Adriana Katherine . And I'm twenty six year old.
OK, Adriana, and how can I help you this afternoon?
Well, I have this like really crazy headache that's been going on for a few days. And it really annoys me.
Ohh dear, OK. , when, when did it exactly start, this headache?
Eh, around three days ago, maybe.
Three days ago, OK. And whereabout in your head, is this pain?
Um, it's basically like, it kind of feels all over my head, but like mainly, um, around my right eye. Um
, OK. Um, and is the, headache there all the time, or does it come and go?
Um it's, it kind of comes and goes. Um but, I mean it is there all the time, but like sometimes it's stronger.
OK, so it comes and, fine, OK. And if I was to ask you on a scale of one to ten, um, ten being the worst type of pain you ever had. How would you rate this headache?
Ohh it's probably a eight.
Eight. And if I was to ask you describe the headache to me, um, in terms of the nature of the pain. Is it sharp? Is it dull? Is it crampy? Is it throbbing?
Um, it's kind of, it's dull but sometimes it gets a bit sharper. So basically it like, it developed gradually, I guess. It's like the first day it just started when I was at work.
Mm-hmm.
And by the end of the day it was like pretty, pretty, like it was a lot, basically. And then I was thinking OK, maybe I'll just go to sleep. And when I woke up the next morning like, it was even, even worse basically. So
Mm-hmm.
So, you think the headache is getting worse over the last three days?
Yeah.
OK. Have you tried anything which has made the headache better?
Um so I tried uh Ibuprofen. Um so I took, like a few. Um for the last two days, basically.
Did that help?
But it doesn't really help, no. In in the past it did help me, which is why I decided to try it. But
OK, all right. And except for the headaches, any other symptoms at all?
Um
So, example any, problems your eyesight or your vision?
Not really, but just when it started, I I got this like weird shooting lights. And like now like light is quite annoying, my eyes.
So when you say annoying, does it hurt to look, uh, look at bright lights?
Yeah, yeah. It hurts. So
, OK. And um, have you had any loss of vision or blurry vision?
Not loss of vision, I wouldn't say. It's just like some lights from, shooting lights .
Mmm, , OK. Any nausea or any vomiting?
Um, well I'm like basically, I I'm sick with the headache. But I, no vomiting.
When you say sick, you mean you feel sick? OK. Yeah, no vomiting, OK. Any neck pain or neck stiffness?
Yeah.
No.
OK. And any difficulty with speaking or, um, speech?
No.
Any difficulty , with weakness in your arms and legs?
No, it's hard to focus though. So, I I had to take a couple of days off work, actually.
Ohh really? OK. OK, yeah probably, well I'll, I'll ask you a bit more about your work later on. Um, any recent head injuries at all?
Uh, no.
OK. And have you had anything like this before in the past?
Yeah I mean, headaches, you mean.
Or, uh, or similar, similar to, similar to this kind of headache, ?
Yeah. I mean I had. But, usually after I I take uh Ibuprofen it kind of goes away. So, but this time it's just not. .
not, OK. All right. Um, any temperatures, or fevers?
No.
Any rashes at all, on your skin?
Mm, no not that I've noticed.
OK. And just moving forwards. Are you otherwise fit and well, Adriana?
Am I what, sorry?
You fit and well? , do you have any other medical history?
Yeah, I think so. It's just the headache.
Any history of migraines at all?
Not myself, I've never had a migraine. But my sister and my mom have them quite frequently.
OK. Um, fine. I'll ask you a bit more about that in just a second. Before I go any further, can I ask, do you take any regular medication?
Uh, no no.
Are you on the pill?
OK. Do you have any allergies to any medications?
Mm not that I know of.
OK. So you mentioned your mother and sister both have migraines.
Yeah.
Are they, is that normally well-controlled or are they um, having difficulty, controlling their symptoms?
Um so my sister's, like better. Like it's kind of, it's very rare. But my mom's is like quite bad, um usually when there's like a season changing and stuff like that. It's, yeah.
Mm-hmm, OK.
Takes her out for a few days, basically.
Ohh right, OK, fine. Um, socially, tell me a bit more about your life, outside of, um, outside of, work. So , who lives at home with you?
Uh I live with housemates. So, three of them. So we're four .
OK. Excellent. And are you working at the moment? You mentioned this , impacting on your work.
Yeah so I work, well I work in IT. So I work with computers a lot. So it kind of is difficult to focus. Um I had to like reduce the uh, brightness of my screen.
Mmm. OK. Do you wear glasses?
Yes, I do.
Have you had any, uh, have you had any recent eye check, done? Eye test?
No, uh I've been wearing them since I was five , five year old. So, it's quite a long time.
OK, all right. Something for you to bear in mind if you feel that you are, your eyes are straining. Um I would always recommend having a repeat eye test done. Um, have you been feeling more stressed or anxious at work recently?
Well, it's been a bit stressful, kicking off a new project. But um, yeah nothing out of the ordinary, really.
OK, all right. Great. Um, regarding smoking or alcohol. Do you drink or smoke at all?
I socially smoke. And I drink only socially.
But only socially?
OK.
Right. Now um, Adriana, do you have any ideas as to what could be causing your symptoms? Have you, have you read anything online, or spoken to people?
Um
Not really. Um at first I thought it's stress, or maybe I didn't drink enough water. Because sometimes when I don't drink enough water, I I like get headaches. Um
Mm-hmm.
But, I don't think that's it. And I'm like worried, it's, I don't want it to be a migraine. Because I know what it's like, from my mom and my sister.
Mmm.
And it's really annoying. So I I really don't want to have that. And I know it's genetic. So I've researched that. Um but I don't know if that is the case. So, yeah.
OK. Is it anything in particular you were hoping I could do for you today?
Yeah maybe just kinda, if you have any recommendations of that I can take something stronger. Because apparently, Ibuprofen doesn't help me. Uh
OK.
Usually it gets resolved if I have headache in like, after like one or two days. But currently it, it didn't help me.
How many tablets did you take of Ibuprofen?
Uh, three a day.
Three a day, OK. All right. Um, so uh, Adriana, so um, really what I think is going on here. I , uh, unfortunately I do think this could be, a headache very similar to a migraine.
Um, the reason I say that is because the history is very suggestive of it, given your mum and your sister also migraines. I think it's something for us to think about.
Um, now I'm not saying it's gonna, keep happening, but, it may just be a one-off. But it's certainly worth treating it today stronger analgesia or painkillers.
Um, now moving forward, we have some options which we can discuss. Uh, you tried the Ibuprofen. Now, my only worry is, I'm not sure whether you're taking, the correct dose. You can take up to two tablets, three times a day.
Ohh right.
So, so , there's definitely room for, improvement there. Or, I can prescribe you something stronger, like Naproxen, which is another anti-inflammatory, which can be helpful.
Mm-hmm.
Um, we can also add in other, painkillers like, Paracetamol, or Codeine. Which might be helpful as well.
Mm, yeah. I think is what my mom takes for when she has um, um migraines.
OK. And I think it's , certainly worth looking into that, so I can give you a , prescription for that today. Um, with regards to um, the next few days. It may be worth keeping a headache diary so we can try and work out what's, you know, if there's any triggers which could be causing your headaches to become worse.
Mm-hmm.
And, and, you know I'd like you to come back and see me, in about uh, a week's time, week to two weeks' time.
If you are having , more frequent episodes of these type of headaches. We can think about giving you medications as, prophylactic. Which basically means, medications to stop you from having these headaches on a regular basis. But we can have that discussion next time.
Mm, OK.
OK. In the meantime if your headaches aren't getting any better, or they're getting worse. Um, you know, I want you to give me a call, or come back and see me sooner. OK?
OK. Yeah.
So, if you're having any problems with your vision, or weakness in your arms and legs, or you're just not feeling very well. Just give me a call, and come back and see me.
OK.
All right?
Great.
Great. Well, have a good day.
Thank you. You too. Bye!
Bye.
|
Hi there, I'm Doctor Smith from Babylon.
Hi. Can you just confirm your name, date of birth and your address, please?
Yes. Italy.
And,
I see, sounds a bit . Um.
Are you in a private place so you can have a consultation today?
Sorry?
Are you in a private place so you can have a consultation today?
Uh, yes.
What can I do for you?
So, I have had a pain in my lower tummy the last two days. I feel kind of hot and sweaty.
OK. And any pain like this in the past?
Uh, not yet, no.
OK, can you just describe to me whereabouts it is?
Um, so, I don't, what, sorry?
Can you describe to me whereabouts the pain is? Is it, is it.
So it's my lower tummy.
Yeah. Is it in the middle or to one side?
Uh, not, um, with a needle.
In the middle, OK. And any other symptoms along that, with that? Have you had any nausea or any vomiting?
Uh, no. I'm just a bit nausea but no vomiting.
OK. Any change in your bowel habit recently, or any diarrhoea? Constipation?
Uh, I had been constipated in, like, in the last, um, last week, but now it's fine. And, yeah, like
to the toilet?
Sorry?
When did you last go to the toilet?
Uh, like two hours ago.
And was it normal?
Yeah.
Any blood in the stool?
Um, so there was some, like, slight, uh, blood in the urine, but, like, it was a little bit pink but.
OK. And has this ever happened in the past before?
Um, no.
Right. Any pain when you pass water?
Uh, no, that's fine.
Are you having to go more often than normal?
Uh, yeah, a little bit, but I wasn't drinking a lot in these days.
Are you more thirsty than normal?
Uh, yeah.
And you said you felt hot and cold. Have you measured your temperature?
Uh, yes, I measured it but it's fine, like, around thirty seven.
What was it? Thirty seven. Have you measured it at any other time when it's been raised?
Yeah.
Sorry?
Have you measured it at any other time when it's been raised?
Um, no, no, I just measured, like, one hour ago.
OK, that's fine. And, are you getting any pain higher up in your stomach? Any acid coming up into your throat or anything like that?
No, no, but like just a bit of nausea but not vomiting.
OK. And any other discharge below?
Uh, no.
OK. Um, and have you been abroad recently?
Um, no, no.
No. And no similar problems to this before?
No.
Have you had any other medical problems in the past?
Um, no, no, nothing sore. I mean, depends what, like, normal stuff like cold, flu.
OK, nothing significant. Any allergies to medications?
Uh, yes, amoxycillin.
OK. Do you take any regular medications?
Uh, no.
Any over the counter medications?
No. I have had the just, the, uh, internal uh, contraceptive implant, but like, for one year, now, no more.
OK. Um, and do you have regular periods?
Uh, yeah.
Any bleeding in between periods or after intercourse?
Um, no, no, no.
OK.
Just like
Right. Um, and you haven't felt shivery or sweaty? You said you had felt a bit sweaty.
Yeah. , yeah.
OK. And any, any back pain or strong smell to the urine?
Uh, no back pain. No, I typically don't suffer from back pain, so, no.
Right, OK. Anyone in your family had any medical problems before?
Uh, so, actually my mom had the breast cancer. Uh, but, again, not so important. I mean, just, like, the beginning it was , uh, cured in time.
OK.
OK. And who do you live with at home?
Um, sorry?
Who do you live with at home?
Uh, with my parents.
And, do you smoke or drink alcohol regularly?
Uh, yes.
How much in a normal week?
Uh, so, I don't smoke. I drink, I .
Four times per week.
And how much?
Uh, yeah, a beer like, per time, let's say. .
What per time?
Uh, let's say a beer.
OK.
Four times a week on average, yeah.
Right, OK. Um, so, it, it may be possible that you might be having an infection in the urine.
Uh-huh.
If you feel like you're, you're going, you're having a little bit of difficulty when you're passing urine.
Yeah.
Um, it might be worth taking a three day course of antibiotics.
To clear that. Um, but, if the pain is getting worse, or you have a high temperature or back pain or develop any new symptoms, we feel like it's not getting better, then, um, we should speak to you again, because we might need to see you face-to-face for an examination.
Uh-huh.
Uh-huh, OK.
Um, have you allocated a pharmacy with Babylon?
Uh, yes.
OK. So, are you happy to take a course of antibiotics, if I send it through to the pharmacy?
Uh, yeah, that's fine. If it helps, yeah. OK.
OK, so I can do that for you. Start taking them as soon as you get them, it's just twice a day for three days. Um, if your pain's getting worse,
OK.
um, or you've got new symptoms, just contact us straightaway, or if you're getting a recurrence of the same problem again.
Uh-huh, OK. Sure. OK.
OK? Alright then, have you got any other questions?
Uh, no, that's fine. Yeah. Thank you. Thank you. Bye.
OK, thanks a lot. Bye.
|
[doctor] good alright hello hannah how are you today
[patient] i'm doing well
[doctor] you're doing well
[patient] i did have this this hacking cough for about three days now
[doctor] okay tell me more about that cough
[patient] it started three days ago i was around my sister and she has been sick with the same kind of symptoms and so this cough has just started off with like a gradual cough and now i've just been coughing up some green phlegm here
[doctor] okay okay so you you started having some mucus with it
[patient] yes
[doctor] okay and how about any other symptoms with your cough
[patient] i'm having a little bit of a sore throat here and then a little bit of a some nasal congestion as well
[doctor] okay okay and how about any fevers
[patient] i have n't had a fever yet
[doctor] no fever okay and then any shortness of breath
[patient] no shortness of breath
[doctor] no shortness of breath okay and what have you been doing for your cough
[patient] i've just been kinda drinking lots of water taking some cough medication over the counter and it seems like it's not really working
[doctor] it's not helping okay and tell me do you have any history of any seasonal allergies
[patient] right around spring time i get a little bit of sneezing and the runny runny nose
[doctor] okay okay and then any how about any body aches for you
[patient] no body aches
[doctor] nausea or vomiting
[patient] no
[doctor] okay alright so we will definitely examine you and talk more about that and as far as your diabetes how has everything been going with that checking your sugars how has that been going
[patient] i've been pretty good at checking my blood sugars they've been running around one twenty range
[doctor] okay okay and i know the metformin is a we started you on a lower dose it's the five hundred milligrams it's a new medication for you you've been tolerating it okay
[patient] yes i have n't had any problems
[doctor] okay good any diarrhea sometimes patients will say that
[patient] no diarrhea
[doctor] no diarrhea okay and then how about as far as your blood pressure
[patient] blood pressure has been a little bit high i've noticed
[doctor] okay
[patient] kind of one forties the top number
[doctor] okay
[patient] and the lower numbers seems like it's been okay around seventies
[doctor] seventy okay so a bit high and the hydrochlorothiazide have you been able to take that everyday
[patient] yes i've been taking it everyday
[doctor] okay and how about your diet how's been thing as far as salty foods
[patient] i've been trying to stay away from the salty foods but sugar intake i'm having a little bit of trouble with that
[doctor] okay okay but it seems like you've been making good progress and that could be difficult sometimes and you mentioned being around i think you said your sister a few days ago or a family member
[patient] yeah she was just kinda sick with similar symptoms and i noticed i started to developed a little bit of a cough right after
[doctor] after that okay and how is your family doing how is everyone doing other than that other than being sick for your sister how is everyone going
[patient] everyone's doing great
[doctor] okay
[patient] working busy with life yeah
[doctor] okay and for you too were you on vacation last week and a lot of people had vacation last week
[patient] yes i was on vacation last week actually
[doctor] okay hopefully you were n't sick for too much of it
[patient] no i was feeling okay
[doctor] okay okay
[patient] got back and started feeling poorly
[doctor] sorry about that alright so what i'm gon na do now is i'm gon na go ahead and start your physical exam i looking at your vitals vitals look overall pretty good i do see your blood pressure is elevated at here it's one forty four over seventy two otherwise everything else looks good so let's check you out so first starting i'm just gon na check start with your sinuses and when i press here do you have any pain any tenderness when i do that
[patient] no
[doctor] no okay so no frontal sinus tenderness how about when i press on the on your cheeks here
[patient] maybe a little bit just a little bit
[doctor] on both sides
[patient] yes
[doctor] okay so bilateral maxillary sinus tenderness alright and i'm just gon na take a look at in your mouth if you can open up okay so i do see some do have some erythema of the pharynx and the tonsils are symmetrical i do n't appreciate any exudates now i'm just checking your neck and i do appreciate some anterior cervical adenopathy alright and i'm just gon na take a listen to you alright so listening to your heart so you have a nice regular rate and rhythm and you do still have that two out of six systolic ejection murmur at the left base now i'm taking listen to your lungs and on your lungs exam okay your lungs are nice and clear i do n't appreciate any wheezes rales or rhonchi alright and just looking at your lower extremities i do n't appreciate any edema there so let's talk about my assessment and plan so for your first problem of the cough so looking at your cough it does seem like you have a upper respiratory infection and so basically that's a virus most likely it's a virus that's causing your symptoms especially being around someone else who has similar symptoms and seems like most likely they spread it to you so i want you to continue with doing a lot of the time is just letting the virus run it's course and taking things just to help with your symptoms so drinking lots of fluids that's gon na help you trying i know you've been doing a cough medicine you can even try another one you have to be careful with the blood pressure and diabetes so you can try like a coricidin hbp can help with the cough and lots of rest okay lots of rest now we are in a current pandemic and so something i can check for you if you're okay with that is checking for covid if that's okay with you
[patient] yes i'm okay with that
[doctor] okay so we will check you for that today and see how you're doing with that and then we will give you those results okay any questions about that
[patient] no questions
[doctor] no okay so for problem number two the type two diabetes so we'll continue you on your metformin five hundred milligrams daily or twice a day you had blood work at your last visit so you'll be due at your next visit for your hemoglobin a1c and that's the check the sugars on your red blood cells so we do that about every three months so at your next visit we'll check that for you and then we will go from there but it seems like you're doing well with that now as far as problem number three your high blood pressure so your blood pressure is elevated here and it sounds like it's been you know creeping up just a little bit at home as well you're on a very tiny dose of the hydrochlorothiazide so what i would like to do is increase it to twenty five milligrams once a day again i would recommend that you take it in the morning just because you may have noticed it can make you urinate quite a bit and then i would love for you to just continue checking as you have been a few times a week just checking your blood pressure at different times of the day so we can continue to see how you do with that okay
[patient] okay alright that sounds
[doctor] alright any questions for me
[patient] no questions
[doctor] okay
[patient] thank you
[doctor] thank you alright so at this point now i'm just gon na press the
[doctor] i'm gon na
|
[doctor] julie cruz is a 17 -year-old non- binary immensipated minor with no significant past medical history presents for evaluation of newly diagnosed hypercholesterolemia patient is here at the clinic hi julie how're you doing
[patient] i'm okay
[doctor] so i now i know you're worried about you know what's been happening with your with your you know with your blood cholesterol so can you tell me a little bit more about what's going on
[patient] yeah i mean i'm worried about this finding i went for my annual checkup and they checked my cholesterol one of those finger prick tests and it came back elevated and they told me i should come and see you
[doctor] okay alright well i think it's a good thing that you know we're aware of this elevated cholesterol at a young age and that we can do something about it so lem me ask you julie a couple of questions here okay so what kind of activities do you like to do
[patient] well i really like to go outside i ride my bicycle a lot
[doctor] okay
[patient] which is it's a lot of fun i ride the trails
[doctor] that's fun very nice so you stay pretty active it sounds like
[patient] well i keep pretty active during the week yeah
[doctor] okay very good good for you now tell me what what kind of foods do you like to eat
[patient] well i mean i really like chocolate chip cookies
[doctor] yeah
[patient] i mean i i try to cook pretty much everything is fresh but i i really do like like cookies and i i mean but even after that i mean i i try to eat pretty clean diet most days
[doctor] yeah
[patient] that's why i was really surprised my cholesterol was high
[doctor] yeah okay well we will we will try to look check and see what's going on there okay so so what kind of so have you you've done any fun activities that now that you know it's getting warm out
[patient] yeah i went for a bike ride over the weekend and some friends have morning we we went for a bike ride and then we had a pick
[doctor] that's fun
[patient] it was pretty nice it was a little chilly but it's nice now that it's springtime
[doctor] yeah but yeah that sounds like fun
[patient] it was fun
[doctor] techniques are fun so tell me do you do you have any history at all of you know hypercholesterol serol anemia on the like at a early age any other you know family members that that you remember that may have that problem
[patient] well i do n't really think so i do n't really talk to my parents too much
[doctor] i know
[patient] but i i have a pretty good relationship with my grandparents
[doctor] okay
[patient] you know and i remember talking to my grandmother and my grandfather both and they do n't they said that when they were young they did n't have anything like that so i had mine checked last year and the doctor said it was a little borderline
[doctor] okay
[patient] but it was n't anything to be worried about that time it kinda just blew it off just told me to watch what i was eating and now they say it's really hot and i do n't understand what's going on
[doctor] okay alright okay we'll we'll we'll we'll take a look at that okay now tell me have you had any issues you know with growing growing up bones are feeling okay you feel like you're growing okay
[patient] i i guess so i mean when i met with my doctor i they talked about making health goals and making sure that that i i feel okay and i i decided about two years ago that i i do n't feel much like a girl i it's it's more of just kind of a nongender and that's how i've been living
[doctor] yeah
[patient] and but i mean i thought i was healthy
[doctor] yeah okay well you know we can get you there too you know we can work on that so we we'll take we'll talk more about some tips to help achieve those goals okay
[patient] okay
[doctor] okay and tell me does anyone at home smoke
[patient] well when i used to live with my parents they did but i live on my own now
[doctor] right
[patient] nobody smokes my apartment
[doctor] okay you know if your friends come over if they smoke too or what okay
[patient] nope
[doctor] okay
[patient] no nobody that i spend time with smoke
[doctor] okay now tell me is there any history at all of like maybe heart disease or sudden death you know like early early in those your family's years
[patient] well come to think of it i did have my my grandparents told me that that i had a cousin that died and and he was only like forty four or forty five
[doctor] okay
[patient] they they think that he had a heart attack
[doctor] okay well i'm sorry to hear that okay so that's that's helpful information though okay let's go ahead and do physical exam on you there julie i'm gon na go ahead and take a look at your vital signs looks like your blood pressure looks good so that's good now on your heart exam i do n't appreciate any murmur rubs or gallops on your lung exam your lungs are clear on your eye exam i do n't appreciate any zenthomas and also on your neck exam here there is no thyroid megaly so now on your abdominal exam i do n't appreciate any hepatomegaly or splenomegaly why can i see these today so i reviewed the results of your cholesterol level and it was elevated at two ten so that's high so let me go ahead and tell you about my plan so for your problem of elevated cholesterol what we wan na do is you know the american academy of pediatrics actually recommends that all children be screened screened once you know they become between ages and nine and eleven and then again between ages seventeen and twenty so that's why you were screened okay so we do we yeah so we do this because studies have shown a link between high cholesterol and premature heart attacks so i wan na go ahead and order a full cholesterol panel there could be other reasons that could be causing the the high cholesterol but i'll go ahead also and check some glucose a complete metabolic panel some thyroid studies and liver panels and i wan na perform a genetic testing to see if this problem is familial or this is a secondary cause so we are also gon na go ahead i wan na follow up in a follow-up with a well balanced diet so including a variety of foods that are lower in saturated fat and sugars so i want you to follow that and i want you to meet a nutritionist and so who can give you information about what kind of foods to eat okay
[patient] okay
[doctor] alright now i do want you to continue to be active and exercise so that's great especially that you know your bike riding so you keep that up that's a great thing and you're doing well with that so keep that up for you okay and then i wan na follow up with another cholesterol level in three to six months after you've met with the nutritionist and then and they've you know instituted those dietary changes
[patient] okay it sounds good
[doctor] okay good well take care julie i'll talk to you soon
[patient] alright thanks document
[doctor] thank you bye
|
Ah.
Hello.
Hello.
Hi, uh, my name is Doctor Kumar. I'm one of the GPs here. Can I just get you to confirm your name and date of birth for me, please?
Uh, yeah, I'm Maria.
Yeah.
Date of birth?
Sorry?
And your date of birth?
Um, twenty second uh, of March, of um, ninety.
Again, how can I help today?
Um, so, I'm having like a really, really strong headache. I don't know what is happening. I'm, quite concerned.
So, it started in the morning. Um, I feel like um, uh, dizzy. Uh, my vision is a little bit blurred. Um, like, it's, it's really painful, and I'm getting really concerned. Especially because I'm having like these, uh, changes in the vision.
OK. So, it started this morning, was it a sudden onset headache, did it come on suddenly?
Yeah, yeah, yeah.
OK. And did it come on really bad or did it start off, uh, like a slight headache and build up to a, a severe headache?
Uh, it came like, kind of suddenly.
And if , if ten is the worst pain you've ever felt in your life, how bad would you say the pain was between one and ten?
Well, I had the kidney stone, so let's say that that's ten. Um, I have now, , maybe five, well, six, six probably.
It's not ten. Great!
But, it's more about me being really concerned, because this is very weird.
OK. No, that's fine. Have you ever had a headache before?
Sorry?
Have you ever had a headache like this in the past?
Um, well not, really.
OK. So, it's a first .
Like this, I, yeah, like this, no, definitely. It's something new.
OK. OK. If you had to say where uh, uh, across the head, uh, the headache is, is it across the front, around the back?
It's in uh, one side, uh, the left side, only.
And tell me what visual problems are you getting?
My vision is quite blurred. Um, it, it's, it's really weird, like some zigzag lines.
OK.
Kind of. I don't know how to describe it properly.
OK. And, um, have you tried any painkillers for this already?
Yeah, I tried Paracetemol, but uh, didn't work. To be honest, I feel exactly the same.
OK. Um, OK. Um, what time did you take the paracetamol? How long ago was it you'd taken it?
Uh, well, uh, the headache started like four year, four hours ago. So, I would say like, maybe three hours ago, because I couldn't stand it.
OK. Um, and your visual problem is still ongoing now?
Yeah, yeah, yeah. I feel a little bit, a little bit better. , I cannot stand screens.
Um, but, yeah, definitely. And, when I move, like the thing is that if I, if I leave bed, I start to feel like, even worse if I move.
So, I just want to have my hay, my head like really, uh, not moving.
OK. OK, Um, so, what about, , have you felt sort of nauseous or like you want to vomit?
Ohh yeah. Ohh, I forgot to mention, definitely, I vomit twice.
Actually, as soon as the, the headache started, I also vomited. So, initially, I thought it was something that I ate, but then the headache started to be really bad, and I still feel nausea.
Still feel.
To be honest, I'm about to vomit, very soon, I think.
All right. OK. You've mentioned, in the past, you've had kidney stones, any other medical problems?
Sorry?
Uh, you've mentioned that in the past, you've had kidney stones. Have you had any other medical problems in the past?
Yes.
Uh, so, uh, uh, not actually. Uh, my mother has migraines. I'm not sure if that's relevant?
And uh, also, I have hypothyroidism in the family.
So, it might be. I don't know, uh, I've, I don't know.
, what else do you have in the family?
I think we are losing connection. Sorry, I, I think we lost connection.
Ohh, can you still hear me? Ohh, it's gone. You can hear me. Um, you said, you mentioned your mother has migraines. What else do you have in the family?
Yeah. Yeah, yeah.
Hypothyroidism.
Hyperthyroid
. She also has Hypothyroidism.
OK. Bye. OK. Um, and no other relevant family history?
Uh, no, not that I'm aware.
And do you take any regular medications?
Uh, no.
Are you allergic to any medications?
Not that I'm aware, uh.
Yeah, not that I'm aware.
OK. Is there any chance you could be pregnant?
Uh, I really doubt it.
Fine. And so, you're not allergic to any medications. Fine from.
And what, what were you thinking might be going on? I know you seemed quite worried about it. Was there anything in particular you were worried about?
Well, I'm a little bit hypochondriac. So, I feel that this can be some kind of brain tumour, tumour or something? Because, I'm like this is, , really, the pain is so horrible that, or maybe a stroke. I don't know, it's, it's just like you know, you hear so many stories.
That, you definitely start wonder, if i should go to A and E urgently, because , I might really have something serious.
OK. OK, fine. Um, now just, uh, another, uh, question, have you noticed any weakness in your arms or legs, anything like that?
No, no , no, no.
Uh, and when you're walking, you're able to walk fine in a straight line or is your, your uh walk, are you walking a bit funny?
Uh, not really.
OK.
It's really about the head. That's why I find it very weird.
OK. So, just, just to clarify what, what you said . This morning, uh, you woke up and then later on in the, in the morning, about four hours ago, you've developed a headache?
Um, on the left side of the head?
Yep.
Yeah.
Left side of the head, is it behind the eye?
Exactly.
Sorry?
Is it behind the eye? Is that where the pain is?
Uh, no, no it's, ugh, I don't know how to describe it. But it's, just like, , kind of.
Um, you've .
OK. That's fine. You've noticed that your vision is blurry, there's funny lines, you feel a bit nauseous, you vomited twice.
Um, and, uh, you feeling dizzy as well, but your, you've got no neurological symptoms. You're walking fine.
Yes.
Um, and, and you've taken paracetamol and it hasn't helped. Is that all? OK.
No.
So, it sounds like what you're suffering from is what's known as a migraine. Is that something you've heard of before?
Yeah.
Uh. Uh, no, it's the first time.
OK.
But, to be honest, I'm very familiar with the disease, because my mother has it, so.
Uh, well, but I never had it, and I thought that the onset of migraine will be, you know, in much, uh, early ages. So, that's why I'm not sure, if migraine makes sense. .
OK. So, um, usually with, with migraines they can present at different times in people's lives, so, sometimes they can present as a child, sometimes they can present when they're older.
Um, and sometimes they can present, you know, even postmenopausally.
So, there's different, there's different ways you can get migraines. Uh, and the reason why this sounds like migraines is because it's on one side of the head.
typical of a migraine, you've got blurry vision, again which is very typical, with the nausea and vomiting, that's also typical of a migraine.
Mm-hmm.
Now, um, uh, obviously, if the headache is really severe, and I'll suggest some medications you can try, if that doesn't work, we would want to see you, um, as soon as possible, to do like a full neurological exam as well.
to make sure that, you know, there's, you know, when we do a more specific examination that, um, everything all seems fine.
Ohh, that's great.
Um, I I would recommend in the time between now and when we can see you, uh, if you take some medications, maybe something like ibuprofen?
Yeah.
OK. So, and, uh, you're, you're saying that if this is a migraine, and if I try that medication. This should go away, kind of, today?
So, yes, a migraine, yeah, no, you know, even sooner than that, we can look at maybe half an hour to forty minutes, depending on what your response to it is, for some people,
Uh, whatever medications they take the migraine doesn't improve, um, and they can last from anywhere from four hours to seventy two hours, migraines can last. Um, but .
Ugh. OK. That doesn't sound good.
No. So, what, there's lots of medication treatments so, there's, it can be ibuprofen with an anti-sickness, um, so and , which you can get from the pharmacy.
Um, and you also to drink, uh, sugary and carbonated drinks, something like Coke.
OK.
For the three of them is, uh, is a good sort of cocktail to start them, then we can go up the treatment ladder, you can get specific migraine relief medication.
And that should be something to try between now and when we see you to do the, um, to do the assessment.
OK.
OK. Sounds.
assessment to where we can see you today at some point.
OK.
And, but however, if you do take these medications and, you know, by the time your appointment time comes in and you feel much better in yourself, you can cancel it, um, you can give us a call and cancel it.
OK, sounds good, yeah. Sounds, sounds a good plan.
OK.
Uh, any, any questions for me?
Uh, no, thank you very much. You were very helpful.
All right. OK. Um, any, any further problems between now and your appointment, please do let us know.
OK, yeah. Thank you very much.
OK. Bye.
Should I disconnect?
|
Hello. Good afternoon.
Hiya.
Hi there. This is Doctor , from GP at Hand.
Hi there. My name's Atan.
Hi Anthony. So, could I have your um, before we start, could I have your full name and date of birth? If that's possible?
Sure. So, it's Ayrton Warren. Um, and my date of birth, is the sixteenth of May, nineteen, eighty two.
That's , thank you for that. Are you in a private place where you're OK to speak?
I am, yes.
OK, great. So how can I help you today?
Um, so I kind of woke up this morning, um, and I've just got this, really horrible pain on the left side of my head. Um, a real kind of headachy feeling.
Sure, OK. And, um, uh, , did the, did the pain wake you up?
Yeah, it woke me up, um, quite early this morning.
What, what time did it wake you up?
Um, probably around, five thirty ish.
And, what time do you normally get up?
Um, I normally get up at about, seven o'clock.
Is the headache still present now?
Yes, it is.
OK. Have you had this kind of pain before?
Um, I mean uh, I've, had a bit of a history with headaches, but nothing as severe as this before.
So they were less severe. Were they similar in nature in terms of being one-sided and the type of pain?
Um, not so much on the one side, it tends to be, a bit of a cluster at the front of my head in a way. Um, but this time it's just kind of more prominent on the left side which, I've never really had it, normally they kind of spread across the front of my head.
OK, all right. And, um, can I just double-check, do you have any neck stiffness at all?
Uh, no.
OK. And do you have any fever?
No.
All right. Um, how are you with bright lights at the moment? Do you feel sensitive to bright lights or can you, can you tolerate them all right, OK?
Um, it, I'm a little bit sensitive it just, it kind of, makes my eyes a little bit sore, but nothing that I can't really handle.
OK. And, can I just double-check, um, are you feeling nauseous at all?
Um, not really, like . When I first got up this morning, my head felt a bit dizzy, but that's kind of subsided now, and I, seems to, be fine.
OK. Um, and um, can I just double-check, does anyone in your family have any migraines or anything like that? They've been diagnosed with migraines?
Uh, no. They haven't.
OK. Um, and um, are you under any particular stress at the moment?
Um, work's kind of, um, a bit stressful at the moment. I've got a lot going on.
Um, yeah, I just seem to have like, a lot of, kind of, a backlog of work that I need to go through at the moment. So, I've kind of, been, doing a lot of late nights as well.
Right, OK. Um, and, um, how long has that been the case for?
Uh, for probably about a couple of months now.
, how would you say your mood is?
Um, I'm not, like moody, I'm not angry or, um, like I get a bit frustrated during the day. Um, but , it kind of, um, ebbs and flows every now and then, but, yeah.
OK. Do you have, have you ever been diagnosed with anxiety, or depression or stress in the past?
Um, I've had, um, so I had, like anxiety for about, two years now, and I've been on, uh, Sertraline for, a while.
OK. Are you taking Sertraline at the moment?
Yes.
OK. Um, and how do you feel in terms of , anxiety at the moment? Do you feel anxious at the moment?
, no, not necessarily at work, sometimes I do feel a bit anxious. Um, but I, I kind of just, uh, the panic of not being able to get my work done on time.
Um, but other than that, I, I don't, feel, um, massively anxious.
OK, all right. Um, now, sorry to ask this, just need to ask this for , anyone suffering from anxiety. Do you have any , have you had any thoughts about harming yourself or hurting yourself?
No.
Good, I'm glad to hear that. Um, now, with regards to this headache. Is it worse when you lie down, or um, is, is, is it better when you lie down?
Um, when I lay down, like, uh, it kind of feels a little bit sore at first, um and it takes me a while to get comfortable. Um, so yeah, at the beginning it does, but then again that's just kind of, um, soothes a little bit.
OK.
Um, so, would you say ultimately, it's better when you lie down? Or have you not ?
Uh, yeah, I would say so.
OK. Um, and um, in terms of um, this, headache since this morning, have you taken anything for it yet?
Um, I've taken some Paracetamol.
Has that helped?
Um, not really, no.
OK. Taking anything else at all?
No that's it, just Paracetamol.
OK. Um, do you have any other illnesses at all?
Uh, none.
Have you ever been diagnosed with high blood pressure?
No.
Have you ever had your blood pressure checked?
No.
OK. Um, and are there any illnesses in your family?
Um, no, there's nothing. My parents, uh, my mum's had a history of anxiety as well but, no kind of like physical illnesses or anything like that.
OK, all right. And um, are you on any medication?
Um, no, other, other than Sertraline and having taken, um, Paracetamol this morning, uh, nothing else.
Do you have any allergies to any medication?
Not that I'm aware of, no.
All right. And, are you living by yourself at the moment, or living with someone else?
Um, I live with my partner.
OK. Are you a smoker?
No.
OK. And, uh, do you have any pets at home?
Uh, I have a cat.
OK. And, can I just double-check, how much exercise would you do normally a week?
Um, so normally I, try to go running at least three times a week.
OK.
And what's your diet like?
Um, it's OK, um, it's nothing, it's nothing um, really healthy, um, but it's fine.
OK.
I wouldn't say unhealthy.
All right. Um, now um, in terms of this headache, uh, obviously I haven't been able to examine you, or see you directly.
But, um, it sounds like it might be one of two things. It could be an element of what we call tension headache.
Sure.
OK. That's one possibility. Um, and what makes that, more likely is the fact that, you've been under some pressure, and you have a history of anxiety in the past, OK. Um.
OK.
The other possibility is, um, migraine as well.
OK. Um, and, the fact, what makes that more likely is the fact that it's on one side, and that you've got some sensitivity to light.
OK.
OK, So, what, what I think we can do, is um, I think we can give you some, um, generic, pain relief.
OK.
That would be the appropriate first step, for, migraine type headaches. OK. So I'll tell you what it is in a second.
OK.
And the other thing that I was gonna suggest is, we maybe look, explore things to try and decrease the stress from work.
So, um, the medication-wise, the things that we'd start off first line, if someone had migraine was to, would be to start Ibuprofen.
OK.
And um, uh, that, the doses of Ibuprofen can be a bit, more than the normal doses Ibuprofen so that's one thing we can start. You can keep on taking Paracetamol as well if you like, but the, the Ibuprofen's um, actually more effective , for migraine.
OK.
And, um, yeah, so the, the guidelines have changed, recently we used, we, before that we used to give Paracetamol as first line but now it's, um, Ibuprofen or Aspirin.
Ohh right, O.
That's, thing. Um, the other thing I'd like you to do, is maybe consider taking some time off work. OK, because if the headache is due to stress from work.
OK.
OK.
Um, maybe having a week off if you self-certify, that might help with things. And I'd also like you to explore, counselling options as well so there's, a counselling service in your area, that I can give you the link for, for you to self-refer.
I'd like you to, , OK I'd like you to try that. Um, what, we're gonna do is, we'll have a follow-up in a week's time.
Yeah, that'd be.
As well as those two things, other things I'd like you to do, is to try and ensure that you're having a minimum of seven, eight hours sleep at night, every night. And you're drinking a minimum of, um, one point five to two litres uh, of water or fluids a day, and that's not including coffee or tea.
OK.
OK.
All right, because sometimes dehydration and you know uh, fatigue can be causes of headaches as well. Um.
Ohh OK, I didn't realise that.
Yeah, so it, that, that, that is um, you know, we need to rule those things out. Um, let's, let's try that.
OK. Um, and let's have a follow-up appointment, if we're finding that things are not getting better, we might need to arrange some blood tests or um, look at uh, other possibilities, but, we'll try that in the first instance.
Um, if anything changes in the meantime, or you get worried or things get worse. Feel free, have a lower threshold for ringing us back and we can book you an appointment, and we can reassess the situation.
OK. Yeah, the, that, that sounds brilliant. Thank you so much for your help.
OK, no problem. So there'll be a summary of all of this in the notes. Um, and I'll also leave a link, to some of the danger signs of symptoms of headaches, in the notes. If you can read through that in your own time, that will just help you to have a bit more, control over what's going on and understanding of what, what, what kind of things, should trigger you contacting another doctor.
OK. That's perfect. Thank you so much for your help.
No problem, OK. So we'll, we'll touch base in a week's time, with me or, myself or one of the other doctors, and we , we'll take it from there, OK.
OK. Thank you. Yeah, I'll book an appointment, in, um, yeah, in that time.
Brilliant, OK then, all right. Take care then, all the best.
Bye.
Thank you, and you.
Bye bye.
Bye.
|
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