Sarah pike 764467 crp 2 using his normal lfts and normal full blood count normal d dimer and raised at naught 0.6 myocarditis september 2024 pe heterozygous factor 5 leiden deficiency hypertension asthma vitamin d deficiency osteoarthritis ibs gourd social history there's no mobilizers with walker or wheelchair recent presentation to surgical assessment unit admitted on eighteenth of the seventh 20 25 5 days of bilateral flank and lower abdominal pains with fever bloods were reassuring ct scan ruled out surgical course for symptoms but discharged analgesia but no antibiotics given as white cells and crp normal ct urinary tracts july 2025 bimatolate lexis unremarkable pleural spaces normal appearances of the intra abdominal organs moderate hip joint osteoarthritis and degenerative changes in the partially imaged thoracic spine no cause for presentation identified hi yeah hi doctor christian at medical registrar it's nice to meet you hi how are you not doing too great actually I'm sorry to hear that why is that don't really catch pain you know you still got the pain at the moment yeah yeah I'm sorry can you describe the pain to me no I know I think really annoying pain I can't remember sometimes it's quite a fast but I have have been getting a really bad like sharp pain when did you first notice that that was last night when I was like dangling in you so you first noticed the chest pain when you were in early or just before you went trainee possibly it was when I was there I started getting it really bad in the right right side mhmm and so where did you go to a and e in the first place because of chest pain okay and I was still getting the abdominal pain from when I come in on thursday and friday mhmm I saw that when you came to the surgical unit yeah and you had a scan which didn't show anything worrying obviously good but you're still getting the tummy pain yeah okay so talk to me about the chest pain can you describe the pain to me it's like like a set of sharp pain but sometimes it's like a aching mhmm like up here mhmm but on the right side it was really really sharp mhmm and like really bad mhmm so like an aching pain does the pain change when you do anything no no and then an element of sharp pain on the right yeah yeah and then you said you're struggling to get some breath is that right in what way like like my my breathing is just like my my chest feels tight but I I did have a clot in my left lung in 20 twenties I read about that yeah and you've got factor 5 life alterations yeah I'm gonna put you at risk of these things do you take blood thinners yeah what do you take rivaroxaban have you been taking it yeah because I've got it in my first pack great good so you've been taking it all the time no I've not missed a dose no okay that makes that less likely then which is good but always a possibility that you've developed a clot on the lungs yeah obviously okay and then that's the chest pain and then tummy pain tell me about that like I've been getting really bad pains down here and or across the middle mhmm I know what I knew they did think it was kidney stones because on the wednesday my doctors said they was burning my urine k and I had a fever at home mhmm because I had the fever on wednesday and thursday okay so yeah and and you had a fever that you measured at a temperature or you felt feverish or they actually took my temperature temperature and said you had a fever at the gp okay alright and any pain passing water or anything like that no to the toilet more frequently than usual you're going to the toilet more frequently yeah but apparently it was my wee was fine mhmm but I did mention because I've got the coil mhmm and back in 02/2013 I had a procedure like type of sterilization called essure but because I've got 1 tube because I had an exotic pregnancy in 02/2008 I had a little coil in the tube in your fallopian tube yeah and I was wondering if it was any fits of any of them maybe maybe causing the pain all the down here have you had any bleeding or fluttering or I'm at a. For 4 years mhmm okay so you had no changes to bleeding or spotting or anything like that okay cramping type lower tummy pain or yeah yeah yeah okay alright I can ask the gullet that you've got in since you could be causing things with the coil there but it didn't show any complication related to the coil that burst or anything nasty going on yeah but obviously you haven't got to the bottom of your pain no how are your bowels doing sometimes I do struggle with the toilet mhmm but other times I'll go like 4 5 times a day mhmm and how often will that change within a week every no every couple of of weeks a couple of weeks yeah but you're constipated then have you used that come along with the tummy pain is that similar to the tummy pain you have at the moment no no the bowels change but there's no usually never usually any tummy pain yeah okay but like like I I'm like out of breath struggling to breathe yeah alright and have you have you got a cough as well I've just coughed because I'm I just heard you it went down the wrong way okay fine so you haven't had a cough before oh I have done in the past where I have it ongoing for like 11 12 weeks right okay but not this time good alright are your legs any swelling or tenderness in your legs not that I know of but you've been immobile recently for whatever reason I've I had a knee replacement last year last year yeah and I struggle a lot I've got osteoarthritis in this knee okay so so looking at the path they're about the same size aren't they no not really I do struggle a hell of a lot mhmm mhmm and I've got a lot of lower back pain have you yeah okay can I have a look at your look so your your scan showed you had arthritis in your lower back and in the middle of your back in your spine boy yeah then you can open that signs associated with arthritis yeah uterine and unpressing which is good I'll quickly listen to your back while you're suffering so most vital tell me this big breath whenever you're ready that sounds perfectly clear can you sit back up and listen to your front for some reason let's move your heart sounds listen to your tummy bowel sounds as well can I have a at your tummy can have a tummy tuck no what's that I'm feeling like I'm broke it really yeah are you are you what what are your bowels doing at the moment are you struggling to go or are you going a lot like I said sometimes I struggle sometimes and how about at the moment I have struggled sitting up in the knee okay okay that's was tender tender was it yeah alright and so what you said you've been struggling to go eat breakfast you don't care yeah yeah alright but I've not been eating properly mhmm mhmm and I haven't been drinking a lot either just because you've been feeling so wrong with this chest pain and tell me about your life more generally who lives at home with you no one's just me well any pets or anything like that no do you walk with this walker yeah but I struggle quite a bit mhmm in what way do you struggle because of your arthritis yeah sorry living nothing what's the last thing you did years ago it was car work okay just can't do it no neither of those drink when I feel like it but that's very rare okay what's the regular stuff I can't have codeine because I got a allergy no okay so I guess it's your what have you heard about your tests that you had anything like that tells the doctor just said that it was a bit yeah the marker of a clot somewhere in the body is slightly high it's the which raises the possibility of a clot in the lungs of course and what's reassuring is that your tracing of the heart is normal sinus rhythm with a not fast heart rate which is good so that goes again but it probably needs investigating a scan of your chest make sure that you haven't got it would it be anywhere else in my body so we've had a scan of your tummy very recently and it doesn't show anything what as about well as the legs your or anything so what is it a clot in your legs for my knees or a scan would be just of your chest to look for a clot on your chest as a cause for your chest pain just to put you into hospital sometimes people get clots in their legs but it certainly doesn't look like you've got clots in your legs from looking at it don't find anything on your chest I mean we can talk about whether we should obviously you've got 2 legs and with both of them looking the same very unlikely to have a clot I've been finding that already to around and I have been feeling a bit confused as well lately over the last few days yeah okay ask them to dip your urine ask them to give us a urine sample and dip it and see whether you might have a urine infection if you're going more frequently frequently and you've got tummy pain that might certainly yeah they've explain done that as well did that at the gp yeah it'd be good to repeat it because I don't have any of those results yeah so we'll dip in urine if you've got a urine infection on that we'll give you some antibiotics to treat treat urine infections cause your tummy pain we'll do a scan of your chest ctpa to look for a clot in the lungs we'll take it from there with the results I'll come back and talk to you and work out what you do I do feel like oh not a lot always good to drink isn't it especially when it's hot because it's muddy I'm not kind of paraffin that was in the first week mhmm I wouldn't drink the water well we can eat some tea if you like you can't touch the tea if like thing is then I'll end up going toilet along okay yeah it's nice to meet you too I do the thing is that ralph has sat so long let's just go for a good thing I mean you get a wash fine we I don't know if we have a shower here we just need to get you out of here don't we and you can be back here to empty alright got any other clothes or are you going home with this hospital garment no I've got some leggings and a t shirt great I'll get some things sorted okay thank you xiaflex