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Hello? Hi. Um should we start? Yeah okay. Hello how um. Good morning sir how can I help you this morning? Hello how are you? Oh hey um I've just had some diarrhea for the last three days um and it's been affecting me I need to stay close to the toilet. And um yeah it's been affecting my day-to-day activities. Sorry to hear that. Um and and when you say diarrhea what'd you mean by

diarrhea? Do you mean you're going to the toilet more often? Or are your stools more loose? Yeah so it's like loose and watery stool going to the toilet quite often uh and like some pain in my like lower stomach? Okay. And how many times a day are you going let's say in the last couple of days? Um probably like six or seven times a day? Yeah. Six seven times a day. And you mention it's mainly watery. Have you noticed any other things like blood in your stools? No no blood yeah just watery and loose stool. Okay.

three days or have you been at home? Uh yeah I've been going to work. Yeah. That must be difficult for you then. Yeah it's been quite difficult. okay. fine. And you said you mentioned you live with your wife and two children is that right? Yes yeah. Right alright. Um just a couple of other question we need to ask sir. Um do you smoke at all? Uh no I don't smoke. And do you drink much in the way of alcohol? Uh no I I don't drink alcohol no. Okay. Yeah. so um er normally at this stage I like to um examine you if that's okay but um

Yeah. but but having listened to your story sir I think uh um just to recap for the last three days you've been having loose stool diarrhea a bit of tummy pain uh mainly on the left-hand side um and vomiting and fever and you're quite weak and lethargic um you mentioned you had this Chinese takeaway as little as three days ago and I wondered whether that might be the cause of your problems. Okay. Um it seems like you may have something uh called gastroenteritis which essentially just a tummy bug or infection of your uh of your tummy. Yeah.

Uh mainly caused by viruses but there can be a possibility of bacteria uh causing its symptoms. Um. Yeah. At this stage uh what what we'd recommend is just what we say conservative management. So um I don't think you need anything like antibiotics. It's really just um making sure you're well hydrated so drinking fluids. Um there are things like Dioralyte you can get from the pharmacy which uh it's um it helps helps replenish

your minerals and vitamins. Okay. Um and if you are having vomiting diarrhea I would say recommend that in the first you know first couple of days. Yep. If you are feeling feverish and weak eh taking some paracetamol Yep. uh two tablets up to four times a day for the first few days can also help. I will certainly advise you to take some time off work actually I know you're quite keen to work but I would say the next two two to three days as the infection clears from your system to take some time off and rest. Um I'll admit if your

symptoms haven't got better you know in in three to four days I'd like to come and see you again. Okay sure. Because if it is ongoing then we have to wonder whether something else caused your symptoms. Yep. Uh and we may need to do further tests like um taking a sample of your stool so we can test that. Um etcetera etcetera. Yep sure yep. How's that sound? That sounds great yeah. Yeah. Do you have any questions for me? Um no no further questions no. Okay and is uh is the treatment plan clear? Uh

yes yeah that's that's very clear. Thank you. Great. Well I wish you all the best. Okay thank you. Bye. Thank you. Bye bye.

And you mentioned you've had some pain in your tummy as well. Whereabouts is the pain exactly? Yep. So in my lower abdomen so uh like um...yeah just to one side. One side. And what side is that? Uh on the left side. Left side. Okay and can you describe the pain to me? Yeah it feels um like a cramp like a muscular cramp and um yeah i feel a bit uh weak and shaky. Okay. And is the pain is that is it there all the time or does it

come and go? Uh it comes and goes. Come and go. Does the pain move anywhere else for example towards your back? Uh...no just mainly my stomach. Okay fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having uh have you been feeling feverish for example? Yeah. Um yeah it doesn't feel like -- yeah it just makes me feel weak. I haven't had a fever um at the moment but I did notice um a temperature when the symptoms started so um yeah around about three or

four days ago. You measure your temperature then? Yeah I uh I didn't measure my temperature no but I felt um just a bit hot. And y'know. Okay. Okay. Any other symptoms like sweating or um night sweats? No? And uh any vomiting at all? Yeah so um I vomited at the start of the symptoms but now um I've stopped vomiting. You stopped vomiting okay. And was your vomit I know it's not a nice thing to talk about but was it just normal food colour? Yeah.

And there was no blood in your vomit is that right? Yeah yeah just normal vomit yeah. No no blood no. Yeah. No okay. Um and um any any other symptoms at all? So you mentioned tummy pain you mentioned diarrhea you mentioned your vomiting uh anything else that comes to mind? Yep. Um I had a loss of appetite um so I haven't been eating as much but I've been able to hold down fluids. Okay. Okay so you're drinking fluids. Um what kind of foods have you managed to eat if anything? Um just soups

and uh yeah light foods. Like smoothies and yeah liquid foods mainly. Okay. Fine. Um and sir these started three days ago the symptoms. Are you aware of any triggers which may have caused the symptoms uh to kick on. So for example think like takeaway foods or eating out or being around other people with similar symptoms. Yeah so I had takeaway about four days ago um uh but other than that I've yeah been

uh eating normally. Okay. Nothing unusual here. Do you remember where you ate? Um yeah I ate at a Chinese restaurant with friends. Yeah. Okay. Anyone else unwell with similar symptoms? Um so no one else in the family so a wife and two kids and one um child was vomiting but they haven't got diarrhea. There's no one with the same symptoms. Okay okay. Fine. Um alright. And uh in terms of your your

overall health are you normally fit and well? Or uh Um yeah I mean other than um athsma um I use an inhaler everything uh else is fine. Okay. And is your asthma well-controlled? Uh yeah that's fine. I just yeah use an inhaler and uh that's under control. Fine. And you don't have any other tummy problem bowel problems I should be aware of? No. No okay. Um and apart from the inhalers do you take any other medications? Uh no no

other medications. Okay fine. And in terms of just your day to day life you said it's been affecting your life. Yeah. um in what way has it been affecting your life? Uh so I need to stay close to the toilet 'cause I go quite frequently during the these past three days. Um yeah other than that it's uh yeah the main concern. Okay. Yeah. And have you are you currently working at the moment? Uh yes yeah. I I work er. Um I'm an accountant. Would would work. Okay. Have you been going into work the last

Hello? Hello. Can you hear me well? Uh uh yes. I think. It's a bit better. It's a bit it's a bit it's not very clear. But let's continue anyway. OK. Uh OK. Let's start again. So how can I help you sir? Yes. So it's been a few days now. I have like a sore and a red skin. It's kind of it's really itchy and it's like super annoying. So I'd like to find something quick to solve it. No no problem. I'm happy to help. Um

whereabouts in your skin is it affected? Uh mostly like my chest my my hands my arms. Like like really it's it's super annoying. Like it's itching a lot like all the time. And I can't even sleep at night. I really need something quickly to to solve it. Because even at work I I can when I'm in a meeting and I have to like uh think about my work I can't focus I can't actually focus on my work. It's really annoying because I can't actually think about uh what I have to say. I'm always like uh disturbed by

it's you've got some dry skin and some uh cracked skin as well. Uh and has been very itchy. And so would your um Uh your your background of eczema. Um Sorry to say there's a couple of questions I wanted to ask you which I completely forgot my apologies. Um apart from the eczema do you have any other medical problems I should be aware of? Uh no. I just had asthma in the past. But not anymore. OK. Not anymore OK. And do you take any regular medications at the moment? Uh

Uh no. No OK. Do you have any allergies to anything? I like some sorry? Yeah? sorry I said do you have any allergies to anything? Hello? Hello? Yes. can you hear me? That's alright I think it . Uh do you have any allergies at all? Ohh allergies. Uh no. No OK. Um and tell me about your um uh your

situation at home. Who do you live with? Uh so I live with a few flatmates. I'm a so you know I'm thirty one. Uh I yeah I'm I have a full time job. And so I'm living with a few people to save money. OK. And what do you do for work? Uh I work uh at a pharmaceutical company. So it's been a it's been a few years now. Uh it's uh it's kind of interesting. We're working I'm a like a kind of project manager. Uh

I mean do you want to to know more about it? OK. Uh no no no that's that's absolutely fine. Um just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all? No. No. And do you drink much in the way of alcohol? Uh you know once in a while I can I like hanging out with people once in a while. So yeah I'd say a few a few beers per week. Something like this. Nothing nothing crazy. I used to drink a lot more when I was younger. But it's been it's been a while. OK. OK.

OK I've got to say at this stage I've got to say this sound quality is not uh great. But I will continue because we've come this far. Um So um based on everything you mentioned sir I do wonder whether this is a flare-up of your eczema. Um The reason being that you said it was quite itchy. Um it's mainly affecting your chest and your back. Um and uh having looked at your skin uh the the the rash does appear quite familiar. Um you mentioned using steroid creams yes

terday. Um from the pharmacy. I wonder whether giving you a stronger prescription of a of a steroid may be beneficial. OK. Uh which I'm happy to prescribe to you today. OK. As well as I'm going to give you something some emollients which helps to moisturize the skin. OK. Um which use in the bath and shower. And it's definitely worth um using that for the first seven to ten days. OK. Uh before we make the decision on whether it's working or not. Um it's also worth um using

antihistamines which you can sometimes buy over counter. Things like Loratadine or Piriton which can help the itchiness of your skin. OK. And uh um it's also worth keeping a diary of any triggers which are affecting your symptoms anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms then we need to have a discussion about an eczema CU. OK. Yes I have tried antihistamines uh lately but it didn't really help.

Ohh could you say that again sorry? I have tried uh antihistamines but uh but it didn't really help. OK. OK. So it's something for you to think about. you can get different types of antihistamines. I can give you something a little bit stronger today as well. OK. Um something like Fexofenadine which I can give to you today. It's definitely worth trying and it's not going to do you any harm. Um but I think using the steroids and the emollients um on a regular basis Uh over the next week to ten days should hopefully control your symptoms.

But do come back and see me next week if things don't get better. That sounds good. OK? Um do you have any questions for me? Uh no that's it. Thank you very much. Bye. Thank you as well. Bye. OK. Well I wish you all the best. Thank you. Have a good day.

this disease. No no OK. I'm certain this is obviously affecting you. And uh we'll try our very best to get get this sorted out for you. Um have you had anything like this before in the past? Um so yes. Uh earlier I was like prescribed for my eczema. OK. And they gave me like some cream and something to uh when I like shower when I was in the shower had to put something. OK. But um Did it help? Um I

mean at that time yes. That's those symptoms like these symptoms appear like when the symptoms appeared again I tried those and it didn't work. I've tried a few things. Like I bought a a steroid cream at the pharmacy last night. But it apparently didn't help because it's still itching a lot today. OK. Uh yeah. OK. Do you remember the name of the cream you bought? A steroid cream. OK steroid OK. um would you say these symptoms are very similar to your eczema symptoms or different? Um

Um it's much more like itchy. And my eczema was more like only in the arm. But now it's also on the chest. And in the on the on the hands as well. OK. Like pretty yeah when like I like for instance hiking during the weekend. And I am I can't really do it anymore because it's like very like I wanted to do that last weekend. It was super painful and I I have to take like showers every day to be able to kind of ease this itching part

which is very very annoying. No. Well OK. That's so you mentioned the itchiness. Um you also mentioned it's been quite sore. Um have you have you noticed any uh bleeding or discharge from your skins? No. Um so my skin is a bit cracked in some parts like kind of cracked if you see what I mean. OK. But uh yeah. You've not haven't uh seen any other uh pus or blood coming out of your skin. No. No. And you mentioned it all started three days ago.

four days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example have you changed your uh shower gel any clothing? Have you been around anyone else? No I It's actually like it's really annoying because I'm thinking about maybe I should change something. Because I I haven't and I don't understand I cannot um afraid of asking people around me because it's cannot you know um I don't feel really

comfortable asking about these questions. It's kind of intimate that. So I need your help now. Mm. No no OK. That's OK. Um Fine so just to resummarize. For the last four days you've had very itchy skin very sore skin all over your body mainly your chest. And did you also mention your arms and legs as well? Uh no. Just the chest hands and like like inside the elbows. Yeah. OK. anything on your face at all? In my what? On your face?

On my face? No. No OK. And apart from this any other symptoms have you noticed? For example have you noticed any temperature or fevers? No. just very itchy. Itchy. Nothing else. OK. So your your bowels are working OK? Your chest is OK? No cough no breathing difficulties? No. You're passing urine OK. I I think so. OK alright. Um It's always good to know.

So I mean do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? Um so I had eczema before. So maybe it's disease but it seems like more uh like uh my eczema was only on the arms. So I'm I'm not sure. I I really have no idea. OK. That's OK. So um normally at this stage I like to examine you. Um To see the rash itself to see exactly what type of rash it is. But from what you've told me you mentioned

Hello? Hello. Hello there. It's uh Doctor here. How can I help you this afternoon? Ohh I just got a terrible headache since mid-day. Um on the left side. It's just making me feel so ill. I just feel like I need to vomit. I'm sorry to hear that. Um can you tell me a bit more about the headache? Well you know I noticed some zig-zag lines in my vision a few minutes before the headache started. Mm-hmm. My vision blurred. Um

you know it just I yeah. Pain's just horrible. Just making me feel so unwell. Um Mm OK. And just want you to do something. Well let's try our best. Let's try and get you let's try and get you well soon. Um you mentioned it's on your left hand side. Is that right? And it started at mid-day a few hours ago. Yeah. OK. Um did the pain come on quite suddenly? Or was it more of a gradual build up? Don't know really. It just happened.

Go on. I've not been diagnosed. Right my next question was that of family history. Is there anything in the family? So apart from migraines is there anything else? Is there anything related to brain for example? as well. What was that sorry? My mom has an underactive thyroid as well. underactive thyroid as well. OK. Um OK any other problems with for example the brain or? Um you mentioned brain cancer. Any other family history of ? No. No OK. Um in terms of medications do you take anything on a regular basis? Um I take

the pill Microgynon. OK. And how long have you been on that for? three months. Three months OK. And is that mainly for contraception or is that for something else? it's for contraception. OK alright. That's something you meant to have a little discussion about today as well. Um Uh well my next question was about um your social your situation at home. You mentioned you work in the fashion industry. And your work is your job quite stressful at the moment? Yeah it's really stressful

actually. Have you been having problems at like work you know managers like putting a lot of pressure on me to deliver and uh yeah it's not a good time. Is it getting you down? I don't feel down just a little bit stressed. OK alright. And what kind of things do you do to alleviate your stress normally? Nothing really. OK. Do you do much in the way of exercise? No. No OK. Um who's at home with you?

Um I live on my own. OK. Um are you coping OK at the moment? Fine. Yeah? OK. Um do you smoke at all? No. and do you drink much in the way of alcohol? No. OK alright. Um so normally at this I'd like to kind of proceed to examination. Um That's um based on your story um I wonder whether you may uh may have a migraine uh

migraine type headache. Uh it sounds Um very classical of that of that nature the the the headache on one side throbbing nature the nausea vomiting um sensitivity to bright lights. Uh I'm reassured that you don't have anything more serious such as meningitis or indeed Brain cancer I know that was a big worry of yours initially. Um thank you uh thanks so much. I was so worried that

I had cancer. And ohh now you say migraine. Yeah I guess my mum has similar symptoms to me and yeah it does make sense. yeah. Yeah. Well I hope that puts your you know mind at ease. Um certainly this is the second migraine you've had in the space of a month. Um So I think moving forwards there's a couple of options. I think keeping a headache diary would be quite important uh to see exactly what's triggering these headaches. And in terms of trying to treat your headaches today some strong painkillers would be advisable.

So think about Paracetamol or even Co-codamol. Um and some anti-inflammatories such as Ibuprofen and Naproxen. How's that sound to you? OK that sounds good. Um and uh you know if your headaches were to become more persistent then we could maybe think about giving you some medications that will stop your headaches from happening in the first place something prophylactic medicines. OK. then we could have a discussion next time I see you next week perhaps. OK. OK.

a couple of things I want you to think about is you know if your symptoms aren't getting better next two three days or indeed they're getting worse. I'd like you to come back and see me um straight away if possible. So if your headache's getting worse not responding to medications Or your um neck pain is getting worse or you develop any weakness in your arms and legs or your vision then I want you to come back and see me straight away. OK? OK. Does that sound all OK? Doctor that's great. Great. Any questions for me? No. Thank you. OK. Have a good

day! OK thanks. Bye! Right.

OK. And are you able to describe what kind of headache it was? For example was it throbbing or was it more of a sharp pain? Yeah I guess it's yeah I guess it's throbbing um on that left side. And is it moving anywhere else at all? No but it's worse when I move. Uh OK. Is that when you move your neck? Well like if I lean forward or like move my head or neck yeah headache gets worse. OK. Um

I'm just really worried. Like I've just been googling and like I've read you know if your headache gets worse if you move it could be a sign of brain cancer. OK. Is that all you're worried about? Is that is that all your main worries today? Ohh yeah yeah and I'd like you know My my friend's mum she she recently died of a brain tumor. So it's really concerning me actually. Oh dear I'm sorry to hear that. I can I can understand

why it's affecting you. Um But why don't we why don't we take a good history first and let me examine you. And then we can have a little chat afterwards and see what's going on here. Um so you mentioned a few things. You mentioned a headache. You also mentioned some zigzag lines uh before the headaches came on. And your vision has been blurry as well. Is that right? Is that is that on both eyes or just in left left eye? Yeah. Eh feels like it some days. Both eyes OK. Have you any difficulty with seeing bright lights at all? Yeah well I'm wearing sunglasses

right now. It's just you know the light's really hurting my eyes. Ohh I see OK. Um and you mentioned that you felt quite nauseous. Have you vomited at all? Yeah. I vomited twice. Twice OK. Um earlier today OK. Um any temperatures or fevers? Um no I don't feel feverish. OK. Um any other funny skin rashes that you may have noticed? No I haven't noticed anything like that.

OK. Um fine. Um and do you normally get headaches? Um I'm not really prone to them no. No but I did I did have a similar headache a few weeks ago. OK. And what happened then? Just similar. How long did it last for? Couple of days. Did you do anything that made it better? Um yeah I had to take painkillers and had to go go to bed and rest and

Yeah. couple days off work and I work in the fashion industry. And you know they're wondering what's going on like I have to take sick days. Yeah. Yeah. I need to get back to work today. But you know what if it is a brain tumour? What's gonna happen with my future and my career? Yeah. Yeah. You know really about this. never had headaches like this before. Like why should I get them now? Yeah sure. I mean I can see your concern obviously is a lot there's a lot of worry there. Um but you know let let let as I said let's take it step

by step um to see exactly what the cause of these headaches are first. Um I'm just going to ask you some um very uh yes no questions if that's OK ma'am. Um Um have you noticed any problems with your speech at all any difficulties with your words? No. Any problems with your arms and legs? For example numbness or weakness? No. Any difficulty with balance your balance or coordination? No. OK. And have you had any injuries to your head? Have you had a fall recently or been knocked on the head? No. OK

alright. Um and and you're feeling otherwise OK. So for example your um Uh your your breathing's OK? You're not feeling breathless or No OK. Um do you have any other medical history I should be aware of? No nothing. No. So for example have you had has anyone told you you've had migraines in the past? No. No OK. Do you No. My mum my mum has has migraines. But I've

Alex. Ohh. Hello? Hi can you hear me? Yeah. OK great. Um how can I help you this morning sir? Alright so I've been feeling I've been feeling kind of uh under the weather for the past four days. Um it started with the um uh sore throat and runny nose and It's sort of um it's sort of going into a cough now. Um the sore throat

is kind of going away but um I'm starting to cough. Mm-hmm. OK. Sorry to hear that. And uh kind of uh bad and tired. Mm. OK. I'm sorry to hear that. Seems like there's a lot going on there. Um so let's start with your your sore throat first. Um tell me a bit more about that if you can. Um so I I you know I think I it all started with uh this colleague of mine she just kept sneezing

then they will come and go. OK. And with those headaches have you had any problems with your with your eyesight your vision? Um no. Uh any difficulty with seeing bright lights? No I don't think so. No OK. Um and just moving down now in terms of any any feeling nausea or any vomiting? No none of that. OK. Tell me about your bowels. Are your bowels working OK? Uh yeah yeah. Think so.

You're passing urine OK? Yeah yeah. How's your appetite sir? Yeah I've been I've been drinking a lot more than the usual. But uh so other than that OK. Um and you're eating and drinking uh you're eating OK otherwise. Um maybe a bit less than uh than what I I would usually have. OK. Um have you noticed any any funny rashes at all on your skin? Um no no.

And any general muscle pain or aches joint pain? Yeah yeah. Yeah that's that sort of started in the past couple days. Yeah OK. Alright um and uh just having a look at the rest of your history are you otherwise fit and well? Or do you have any other medical problems I should be aware of? Um so otherwise that uh I'm I'm fine. There's um there isn't anything that I'm taking or I'm being treated for. OK. Um

So you are otherwise fit and well. Uh any any allergies at all to any medications I should be aware of? Um no No OK. Um Any family history at all? So anything relevant in the family that I should be aware of? Anything like diabetes high blood pressure? Um yeah my grandma has diabetes. Um Your brother? you said grandma sorry my apologies. Grandma OK. Uh do you know what type

of diabetes it is? Is it type one? I think I think it's type two. OK. Um anything else which you think is significant? Yeah I I think um one of my uh great grandads had an eczema. Excellent OK. OK. Um just moving on to what we say social history just to get to know you a bit more as a person. Tell me who do you live with at home? Ohh um I live alone. OK. And you said you're working

at the moment? Yeah yeah. What do you do for work? I'm an I'm an accountant. OK and how's your work going at the moment? Uh over the last has it has it been affecting your work? Um a little bit. I've been a bit slower. And you know it's uh it's it's a bit of a stressful period just around the um end of the year. Mm OK. Is that stress is that affecting your um your mood at all any in any way? Um no

I think I think it's it's the you know it's the good kind of stress. OK. It's um it's good work. Well if there's anything you want to talk to me about you can always come see me about your mood um stress anxiety. happy to help. I don't know. I I like my job. It's just you know it's a bit more work than usual. OK. OK. And just very briefly just in terms of smoking uh do you smoke at all? Um yeah occasionally you know cigars and things on company parties. OK so not not regular. Um and what about

alcohol? Um occasionally yeah I would have some. I'm I'm not a very big drinker. Again socially with work. Yeah. Um OK. Um so um sir just having listened to your story um uh really just to summarize you know since the last four days you've been feeling generally quite unwell sore throat runny nose bit of a dry cough bit of muscle pain weakness. Um had initial fever but now settled. Um I don't

think there's a lot to worry about. I think you probably have you know a bit of a viral what we say viral illness maybe a viral upper respiratory tract infection or maybe early signs of a flu. Um these normally last about seven to ten days and just gets better really um over time. But things you can do to really help yourself um is get plenty of rest. I'd probably advise you taking a day or two off work if you can. Um Making yourself pushing fluids and make yourself well-hydrated. Continue with the regular

Paracetamol Ibuprofen. Um and and you should see how things go really. Um if next week you're still not better I'd like you to come back and see me. Um is that clear? Does that does that make does that make Yeah yeah that's that's it makes sense. Uh I think I'll take a couple days off yeah yeah and see how it goes. and things to look out for if you're really not getting better if you if you have a high fever or your breathing is becoming a bit more labored or chest pain I'd like you to come back and see me

next to me all the time. I think her kids are catching something from the uh from their kindergarten or something. And uh you know the it it started as normal sore throat and uh was quite painful for a couple days but then it was past. OK. OK. And did you have any uh difficulty or pain on swallowing? Um yeah. Yeah it was uh it was quite painful to swallow. OK. for one or two days.

much sooner give me a call. Um and we can help you out. OK? Yeah. Yeah yeah I understand. Uh I'll uh I'll take care. Great. Have a great day. Good luck with your work. Thank you. Bye bye. Bye bye. Thank you. Thank you. You too. Bye bye.

You did you manage to have a look at the back of your throat in the mirror? Um no not really. No. OK you didn't you didn't notice any abnormals white spots redness at the back of your throat? Um No. Um I I didn't think about uh looking. that's OK. That's OK. And you mentioned a runny nose. Um again what kind of discharge is coming out? Is it clear or is it a bit more coloured? Yeah yeah it's uh it's

clearing up. Sort of um sort of getting my nose stuffed all the time. It's very hard to uh to get it free. OK. You feel quite congested do you? Yeah quite congested. OK alright. Um you also mentioned a cough as well. Can you tell me a bit more about that? Um yeah that started recently like just uh um maybe yesterday. And um it's uh it's dry for now it's it's not very painful but it's sort of there

all the time. OK. And is it worse any particular time of the day? Sorry? Is it is it worse any particular time of the day? For example in the evenings night time mornings? Um or is it throughout the day? No it's it's um it's sort of it's sort of constant. Um I forgot to mention that um I'm also having uh night sweats. OK. Night sweats OK. That's that's very odd actually.

makes me a bit tired mm um makes my uneasy. I can imagine yes. Uh and this has again been going on for last uh three four days has it? Yeah yes. OK. Um right OK. Have you noticed any fevers or temperatures at all? Um I I had some some fever in the beginning but it's now sort of uh going down. I I've been taking some Paracetamol and Ibuprofen Okay for that

and uh they they help. That's very sensible. Um very good. Um in terms of your chest otherwise have you any difficulty breathing or any pain in your chest? Um so no pain in chest but uh I noticed that I um um so I feel a bit winded on exertion. So if I I I haven't been going going to the gym thus uh because of that. When you say winded do you feel uh do you

feel more short of breath would you say on exertion? Yeah OK. Um and and that's mainly on exercise. But when you're resting there's no problem. Yeah yeah. When when when I'm resting it's OK. So I've been actually going to work um sort of managing. OK fine. Just a couple other questions sir if you don't mind. Any pain in in your ears at all? Um no. No you don't feel blocked or any discharge coming out of your ears?

No I don't think so. OK fine. Um what I'm gonna do I'm just gonna run through a few uh yes no questions if you if you don't mind just a review of your systems. Any any headaches at all? Um yeah yeah. That that's still that's still there. Whereabouts are the head headaches? Um just sort of general. Uh and uh they're not they're not always there but you know every now

Hello? Hi Hi doc. Good morning Tim. Um how can I help you this morning? Um so I'm Having some some pain uh in my tummy like the lower part of my tummy. Okay. Um and I've just been feeling quite hot and sweaty. Right I'm sorry to hear that. When when did your symptoms all start? About two days

days ago. OK. And whereabouts in your tummy is the pain exactly? Uh like below my belly button it's like quite sore when I press on it. OK. Did the pain come on quite suddenly or was it more gradual? it's just it hasn't been it's more gradual and it's just it is getting a bit worse now. OK OK. And can you describe the pain to me? Uh it's kind of

covered everything that's really bothering me. Yeah OK. Um tell me tell me a bit more about your um medical history otherwise. Are you normally fit and well? Yeah well I haven't had any surgical I don't have any surgical history. I don't have any previous I haven't had any operations before or and I'm not on any other medication I just have the Implanon. OK. Um have you had anything like this before in the past? Any similar symptoms? I've never I've never had

had these symptoms before. No OK. Um Fine. Um any other family history I should be aware of? Anything relevant family uh related to bowels maybe related to history? No not that not that I'm aware of no. OK. Alright. Um and socially just tell me a bit more about your home situation. Who's at home with you? Uh I live in a share house and with two other two other room-mates.

OK. Um and uh are you currently working? Yeah I currently I am currently working. What do you do for work? I am an accountant. OK. Um Great ok Do you smoke at all Kim? No. No. And do you drink much in the way of alcohol? Uh socially I drink but uh I don't think more more than normal. No

OK. OK. Um just before I go to the examination I just want to go through just some few screening questions if that's OK yes or no. All right Uh we've we've covered the majority of them already. Uh but I just want to make sure I'm not missing anything else. Um how's your how's your chest? How's your breathing? Um any I don't feel short of breath uh or I'm not having any problems or I don't have a cough or anything that's worrying me. OK. Any uh funny heartbeats or rhythms palpitations?

Not that no. OK. Any headaches? Any problems with your vision? No. No OK. Alright. Um Fine OK. Um So really just uh moving on um And so based based on your story really uh uh Kim it's it's it's difficult. it's it's um you know you've got some tummy pain. You don't exactly know what's causing it. It could be a few different things that could be causing your pain.

Could just be a you know could just be a urine infection for example. Could just be something related to your gut. Um could just be something related to your you know a pregnancy-related cause. Um and so it's probably worth doing some tests initially. to try and rule out um what's going on here. Um which I can organize for you today. OK. Um and basically those tests we we'll have a better idea in terms of how we should proceed. But certainly it if

been going on for the last couple of days um Uh you know it's probably maybe worth empirically treating you for a maybe urine infection. And so it's an Yeah I can we do that instead of me going for tests and then seeing how that goes? Yeah absolutely. So um I think it's certainly worth you know covering you with some antibiotics today. Uh but i still want you to bear in mind you know have a pregnancy test done to make sure we're not missing anything else here.

And um and I want you to kind of really come back and see me in a few days time if your symptoms are not getting any better or indeed if they're getting worse. So things to look out for would be you know worsening tummy pain um if you're feeling really hot or sweaty your temperature's not coming down um vomiting et cetera. Does that make sense? Yeah I think I'm happy with that plan. OK. Um you can try just regular painkillers uh Paracetamol would be advisable. Um

make sure you drink plenty of fluids. You can try some cranberry juice as well which uh can sometimes help with your urine symptoms. Um take the antibiotics uh and give me a call you know if you are worried about anything else. Uh sure. That sounds great. Thank you very much. Um should I just collect the script at my pharmacy? Yeah i'll I send it straight to your pharmacy start the antibiotics today something called Trimethoprim. Um you can take two tablets uh one tablet twice a day for three days. OK that sounds

Uh let's see how you get on. OK. Thank you very much. Great. All the best! Bye. Bye bye.

like a a I guess a burning pain. Uh and it's just right there in that spot like uh that's mostly where I'm feeling it. It hasn't spread anywhere else. Just in just below your belly button you uh mentioned. Yeah. OK. Um and is the pain constant or does it come and go? It's pretty constant it's like getting worse. Um it's not like I I can still move and walk around. Uh I mean I'm still kind of functioning it's just uh

I'm aware of it time. Mm-hmm. OK. Um and with the pain have you noticed any other symptoms at all? So for example let's let's focus first on your bowels. Are your bowels working OK? Yeah I had a bit of constipation but that's better now. That was like since last week. OK. So you've got no other symptoms like diarrhea or loose stools? No I'm I'm my bowel movements are normal now. OK. And what about your waterworks? Are you passing urine OK? Yeah I'm fine that's fine that's. I did notice that I

was a little the urine was a little pink in colour. But I haven't like it hasn't really been burning specifically or hurting when I pee and uh. And I did notice I was going to the I was peeing more regularly but I have been drinking lots of fluids. So I wasn't sure um I wasn't sure um like you know if that was related to the pain. And when you mentioned pink urine do you was there any blood at all in your urine? Or was it difficult to say? I can't say I mean

maybe. OK alright. But otherwise it doesn't hurt uh or or or sting when you pass urine? And I haven't noticed that it really burns or anything like that. Um just that I'm peeing more than more regularly. OK. Um OK. And um moving on to other symptoms have you noticed any vomiting or feeling nauseous at all? Just a little nauseous um but no vomiting. No vomiting. Any temperatures or fevers?

I haven't really I felt a bit hot and sweaty but I haven't really measured it so I can't really say. OK fine. Um uh uh and Kim have to ask um uh all all all female patients. This this question is about your cycle if you don't mind me asking. Um are you currently um are you currently sexually active? Uh yeah I've I have had the same partner I am we were last sexually active about four days ago. Um my last STD screen was normal which

was about six months ago. OK. So you've had no other partner since then. No other partner since then. OK. Um uh and do you use any contraception at all? Uh I'm on the Implanon. I had the Implanon inserted about a year ago. Implanon OK fine. Um are you still having periods? Yes. When was your last period? Uh my last period was about three weeks ago. I mean two weeks ago. Two weeks ago OK.

So is there any chance you could be pregnant? I know you've got an implanon in there but is there any chance you could potentially be pregnant? It's something for us to think about potentially Well we don't use any other barrier method so we just use the I just have the Implanon and the same partner. Um. Theoretically if the Implanon hasn't been working then I could be pregnant but I don't suspect. Yeah OK. Well it's something for us to think about. Um uh maybe worth taking a pregnancy test later on just to confirm that. Um OK. And and so just to summarize so far if you don't mind it's really for the last

couple of days it's tummy pain that's really affected you mainly lower down towards your belly button. It's quite burning you said. It's getting worse. Um you noticed some pink urine. Um but no burning or stinging pain when you pass urine. Your bowels are working OK. You've felt a little bit nauseous um and feeling hot and sweaty. Have I got that all right? Yeah that sounds very accurate. Is there anything else perhaps that you feel like you should share with me at this stage anything that might be important? I don't think so I think I've you we've

Hello? Hello there. Uh hello. Can you hear me OK? Yes I can hear you. OK great. Are you the doctor? I am yes. Nice to see you here Oscar. Um how can I help you this afternoon? Um I'm contacting you because I've been quite short of breath lately. OK. Do you want to tell me a bit more about it? When did it all start?

Uh well it seems to have been slowly getting worse over the last couple of weeks. Um now it's become quite troublesome in the last few days. Uh I kind of normally I can walk to the shops without a problem but now I'm having to sort of sit down and catch my breath. And I'm really starting to get a bit breathless just about the house. And uh it's got me kind of worried don't really know what's going on. Is there anything you're particularly worried about?

which dose you're taking? I can't remember I'm sorry doctor. That's OK. I have to check. No problems. Um Any other medications? Uh yeah. I take Aspirin. OK. And uh Bisoprolol. The Metoprolol was it or? Uh Bisoprolol. Sorry the connection's not very good. OK. Thank you yeah. Um. And uh Simvastatin.

Simvastatin OK. Alright. Any allergies at all? Any medications? Uh no no allergies. OK. And is there anything in the family that's uh that that's uh that's important for me to know? Any family history of medical problems heart problems lung problems? Uh my my father died of a uh of a heart attack. I'm sorry to hear that. And um how old was your father when he passed away? Uh he was um early

early sixties. Early sixties OK. Alright. Anything else I should be aware of? Um my mother had osteoporosis. OK. Is your mother still with us? Uh yeah she's still living. OK alright. Um and socially sir just tell me a bit more about your situation at home. Who lives at home with you? Uh I live on my own. Well I got two cats. You've got two cats. OK great. Do they have name?