Lisa gerald alpha236230 33 year old lady presenting complaint medical history adhd learning disabilities laparoscopic salpingectomy 2022 with domestic violence asthma allergies rigvedilian next plan on mirena current medications symbicort 200 x 6 turbuhaler 2 inhalations twice per day mirtazapine 15 once at night phenergan 25 mg at night for sleep espergulahex dexerol d 3 1 to be taken per day anus suppositories as required equasym aquasym xl 2 10 mg tablets once per day ptsd chronic widespread pain fnd background investigations chest x-ray clear lung fields full blood count white cells in neutrophils normal ecg sinus rhythm rate 81 no signs of ischemia or pulmonary embolism hi I'm rob oliver hi rob gastro intrinsic doctors 1 of the medical needs how are you tell me yeah okay hi I'm rob 1 of the doctors nice to meet you nice to meet I'm not pain in here now and your back I was starting to sweat again really been shivering shaky and feeling hot and cold yeah I've been like that for a few days for a few days I even had to have a shower because I was too hot really this morning oh wow okay been really hot for a few days you've been feeling cold or just hot I had cold sugars but I also it's more of the hot I had a temperature of 39.9 mhmm why day I'm sorry if I'm dizzy fever fine and when was that literally last night last night and then it was 37.4 I was doctors I actually my doctor told me I was fired up me and my son almost died oh god of pneumonia from got it but I remember all night having coughing fits and struggling to breathe yeah yeah sore throat I brought up blood oh gee for a few days yeah okay when you cough were you coughing anything else up other than blood it was like not a lot it was just a bit of brain mhmm gunk so sorry should we just yeah good idea good idea what's the other part brown from the nipple wasn't a lot it was normally blood it wasn't bright red it was bright red blood bright red blood okay right and then that bit of brown stuff in it okay and this has all been happening over the last few days yeah 3 days or so yeah I'd show a bit normally I'm up at past 5 in the morning I've got adhd mhmm so normally I'm up yeah I'm fine but the last few days actually dragged my eyes at the bed really because my language is what I have it's okay yeah it's alright I've not been wanting to start already any trouble with your waterworks or anything like that alright you've got asthma yeah and you're feeling more wheezing yeah you have a lot more I've been taking my puffs a lot more have you how many how many times a day have you taken it over really as needed a month so you're normally meant to take like 2 puffs twice a day yeah 8 times a day 8 times a day yeah and I've took over that because I couldn't control my breath puffs 4 times a day is that right or do you take 4 puffs I take 4 puffs twice a day 4 puffs twice a day but I am starting to sweat again let's feel feel me I'm starting to sweat again yeah yeah oh you are hot you're hot or 3 nights ago I thought that I had an sti not true but no signs and stna nothing like that no okay so it's all yeah I didn't I just ran it in my throat so it's it literally come from my throat chest throat okay and then change your bowels at all I've ibs okay that's good but is it worse than normal or no I can't really go fine you're perfect yeah I've got a really bad pain in my head at the moment your mother but I suffer with migraines do you or yeah then usually I have a functional seizure really when you have when you're ill yeah then you get get them to take your temperature give give him some paracetamol to work right my music's running don't worry it's okay gonna have a quick look at you do you mind no that's absolutely fine interest is that okay I'll leave it there yeah let's start okay I'm just getting up there together at home yeah got 2 other kids oh sorry yeah this 1 teach a training day today oh I see so they weren't happy that she on a friday that's cheeky isn't it yeah but they wouldn't happy that she's off yeah fine your other kids yeah yeah very jealous like that listen to your heart first okay get really sore when you take a big breath yeah in your back in your lower back yeah yeah let's take big deep breaths for her eve that's fine okay okay she's just got to she's not got any investigation crp less than 1 fbc normal d dimer negative lft is normal neutrogen is normal urine dip yeah negative apart from trace of blood your blood tests have come back and they're absolutely pristine your markers of infection are undetectably low your white cells are normal it's all very strange yeah you're in dips normal so it's certainly if you had a nasty chest infection I'd expect your arcuate infection to be high yeah but I haven't got to the bottom of it and without making a diagnosis I'm gonna feel very confident in anything to be honest with you I think more tests is the solution more tests okay to look into why you've got this pain I think an ultrasound of your tummy would be helpful to see if there's anything there causing discomfort or pain but certainly none of your blood tests are worrying me and it doesn't look like you've got a pneumonia I've had a really careful look at your it may be that you've got a viral infection particularly a viral upper respiratory tract infection but the swab hasn't come back yet it'll probably come back tomorrow or the next day so I'll keep an eye out for that and let you know what the outcome is on the phone I can give you a call we've got your number I guess which is ending in 649 6649 yeah yeah brilliant so I can give you a call with that so what because you're saying that the pain I don't know causing the back of my tummy yeah the like the back the back yeah exactly so sometimes these pains in the tummy can radiate around to the back yeah I haven't had any pain here it's just here in the bottom mhmm can I look at your back can't really see it I know sometimes you might have rash of shingles or anything like that nothing and this is where it's sore oh yeah yeah it's very tender yeah it's tender yeah yeah and how about your back and your and down your spine is that sore yeah I've got a lump in my spine and I have had to wait for an mri that's never to work okay to see what that lump is I've 1 for my head I've head ct that is working really feel it but I've got 1 there and it's where yeah it's literally it comes up like a hard 1 very tender isn't it yeah yeah tender all the way up and down yeah and how's that that's been there for ages that is getting worse alright I know you've touched that I'm getting pain under here oh really yeah yeah do you have you see is it it's pain you've had for a long time is it back pain no this is kind of got tender and swollen feel bad since you touch my spine feel that side but up here is where it hurts the nose there okay and it kinda sticks out more here it sticks out more than that side that is very painful warning yeah it's strange don't it's strange certainly of your blood tests are really worrying yeah in terms of having a nasty infection or anything like that but I don't haven't come up to with what's causing your symptoms either yeah I don't think so I know there's a time pressure with things I don't know if it's easy to call you yeah so what I I want to give you some follow-up but I understand you've got you need to but she starts to school next week mhmm and if we can try and get an appointment for them that time in the next 3 weeks because they they just finished school 3 weeks time for 6 weeks holiday okay so then I can get my dad if we do it next week get my dad to pick them up yeah fine and I don't need to pick them up and I can have as much time as I need brilliant fine and I might just end up with 3 kids and me in the end great I'll put you in ultrasound over time I'll add some further blood tests on but you don't need to wait for them to come back and if they're abnormal I can give you a call yeah or if you're a viral screen if you get a call with that result yeah so my my spine's been held up badly lee mhmm and I have been waiting for a c mri and I never got it for a door and who who my doctor booked that because there was a lump there there was a lump there and it didn't hurt me but now my spine's really painful mhmm okay fine alright so I can I'll have a look at that I'll speak to paul write a letter to gp about it and make sure they're equipped for you and see what they put is that okay yeah I feel like I haven't really answered any questions for you because I haven't come with the diagnosis no it's honestly it's fine like I said I reckon the swab at all yeah I've been on this I think you're probably right yeah yeah I reckon swab at all but my spine has been which way would I go this way to go out just waiting your day you know that oh yeah yeah I've got a quick tour is that okay yeah please do alright you haven't got a cannula in or anything you've had that taken out no I've I did have a cannula taken great alright thank you bye so plan outpatient ultrasound of the abdomen routinely add on lipase ast ggt discussed with gp regarding mri spine on examination of back profoundly tender throughout the spine and in the lower chest / upper abdomen however no organomegaly identified no focal spines tenderness tenderness to touch throughout the back and spine