Man I'm having so many people come back investigations crp 29 ggt 40 eosin is normal lft is normal full blood count awaited ultrasound abdomen on fasted scan however appearance is suggestive of adenomyomatosis of the gallbladder chest x-ray from the july 20 hazy right lower zone opacification I'll see you at the morning yeah cheers mate right in here alright that's great it didn't you let's have a seat I'll send the light button alright I've got some money in the meter so you can get your left right really yeah I think so yeah yeah you're right I think we've run out of money yeah that's what it is darling sunset you know sunset it is how are you I'm fine good fine in fact how are you feeling tell me about your symptoms no I'm alright now but you feel well I saw you came in recently you're having some tummy pain yeah and and last pain's 2 saturday I've never experienced pain in all my life really a tummy pain yeah it was there once here oh and they fainted and I will never that's you I think it's not me I feel old to answer it and talk to everyone right lee yeah not at the moment you know I'm just hoping for an ultrasound right then I've got a phone for a taxi later on to go home yeah yeah well well we're not in the room darling I will give you a ring sweetheart alright alright love you sweetheart bye bye the ring I'm away checking up on you that night yeah lovely well she's school good to me oh good right and so you have you had some you had wheeze and you're short of breath and you got treated for a chest infection exacerbation of your copd and from that perspective how are you feeling yeah you feeling better oh god yeah good I am feeling much better have you finished the course of steroids and antibiotics no I've got I've got 6 steroids this morning yeah right mhmm and I've gotta take my antibiotic at 12:00 yeah and which antibiotic are you on 1 which 1 doxycycline no no epo effolin or effolin or something erythromycin strange 1 so I don't know because normally the doctor would have penicillin not penicillin because I'm allergic penicillin antibiotics are normally aldoxylate doxycycline yeah but I said well my doctor if I could have antibiotics because we doxylate she said oh haven't got that we've got you bevofloxacin yeah ebilin something like that yeah have a look and see if there's anything on here that shows what you had maybe there'll be a I'll record you oh yeah that would be great thank you they might be on there mightn't they they might be hopefully that'd be cool you'll ask me things from the hospital oh that's really helpful yeah yeah this is this very thing they are because prednisolone levofloxacin fine for 7 days when I collected that prednisolone 30 for 4 days okay yeah because when I collected that on monday they took me down from the ward 20 to 2 well I never had that till 5 and 20 to 5 and she said don't take no antibiotics no june or steroids because you had them in the ward this morning alright I said I haven't had any I haven't had any this morning she said you should have had your steroids this morning right this was monday morning she said you should have had your steroids she said 12:00 your antibiotic I said the last time I had a steroid and antibiotics mhmm was half past 11 quarter to 12 on a sunday when I was admitted how strange I said but I am on see it's prescribed tablets at all I can see it was prescribed which was prescribed but it's strange that you didn't have it then you didn't have it to me I'm sorry to hear that are you on some now I know exactly what medication I I gotta take right now when my car you know the little capsules open my airways mhmm I used to take 2 mornings and 2 evenings right mhmm but I was missing out the dinner 1 so I should have took 6 a day instead of 4 a day but now I take 6 a day mhmm okay alright so I'm alright on that good fine so I'm stuck with what I'm doing with my medication you've got it sorted I've got it sorted oh yeah you know but like I said I've pain in my our records say that you have it as a tablet on on the twentieth it looks like the nurse said that they gave it to you and it looks like the nurse said they gave you the steroids as well who knows the green box means that they think you had when was that monday morning on the twentieth was the twentieth monday yeah it was sunday morning and monday sunday sunday morning and then monday no steroids monday you didn't have them it's true no the only steroid and antibiotics was sunday not given who knows why well yes they warned me I mean I'll cut my steroids now but I never got enough so mhmm because I was in the hospital and I got released I was on the g time they should have given me the antibiotics and steroids in there but they didn't fine so you missed the day 1 day I messed mhmm but I'm not worried about 1 day yeah no me neither yeah I I started it all yesterday morning and I started again this morning so great I'm alright on that and looking at your blood tests we can see the markers of infection coming down really nicely I'll show you them I think this is what it was I I knew very well I had a chest infection right because I was coughing constantly and I was spitting this mucus out which was thick green mucus now I know I have a thick green mucus I know I've had a chest infection or viral infection yeah of course I know it was like how's your mucus changed now has it gone back to white no it was just a little bit nothing like it was it's coming down in volume it's coming down compared to what it was not a thing and we can see your blood tests have got better your crp the marker of infection was a 119 and now it's down to 29 yeah so it'll be completely normal in a couple of seconds coming down down I'm stuck in a week right mhmm and I thought if I still got this chest infection in this fall monday I'll call the doctor off yeah fine and and they normally say I'll walk you within an hour or 2 so you're not a taxi off and pull it off of course it didn't that way because I was admitted up past 6 sunday morning yeah of course because it was so bad that pain mhmm and I've never known my I've never ever known my life not even when I was pregnant with all 2 kids the pains in my stomach sickness nothing yeah but that I cannot handle yeah and your blood test when you were feeling sick showed slightly higher levels of jaundice in the blood but then that's now got better good and your ultrasound scan doesn't show anything worrying in the gallbladder there's a tiny area of thickening in the gallbladder wall they didn't get the most fantastic view of it because usually we ask people to starve themselves for a few hours at the scan so the gallbladder is nice and distended in your case you'd had some tea no 1 told you probably so the gallbladder was a bit more stuck together but from their perspective they didn't see anything worrying on the scan and there's no cause for your symptoms on the scan it may be that the bile didn't flow very well because of that tiny lump inside of the gallbladder but it's nothing sinister or worrying about so I haven't got a gallbladder in nothing am I you have got a gallbladder but you've not got a gallstone does that make sense so what's that well what's the difference between a gallstone well everyone's got a gallbladder and you have a gallbladder just under your liver which stores bile and you need bile to digest fat so your gallbladder looks like it's entirely fine with no stones in it but there's a tiny area of thickening in the wall of the gallbladder where the muscle grows into the wall of the gallbladder it looks it's entirely benign there's nothing to worry about oh that's but sometimes it can block the flow of bile slightly and cause the tummy discomfort and the high level of jaundice that's now got better oh because it all didn't come away so I must have a certain amount in my stomach that I chopped off so much as I could but it was still that little bit there on the gallbladder exactly yeah exactly so you're you should have another scan in a few months time right just to have a look at that area and make sure it's still the same yeah and that's and in that scan they'll ask you to starve for a few hours before the scan I don't mind not because I lose weight you don't need to lose any weight you're doing fine I do no you definitely don't you're but then we'll see the gallbladder in a bit more detail and we'll be able to make 100% sure that this is just a yeah growth of the muscle into the wall of the gallbladder oh that's alright does that make sense yeah other thing not got gallstones no not got gallstones gallstones never she got gallstones kidneys you know and her kidneys go still she'd been in agonies since january are very painful aren't they yeah they put a stent in mhmm like mhmm in 4 weeks she had lived for 16 weeks oh no she had a protection oh really or she and then it was there mhmm so I've done operation they took her back put another stent into her she's gotta go in there on the 20 eighth of well monday mhmm and all of sudden she'd been in agony agony apparently since january and and they turned on to start and they said look this should have been 8 weeks I'm not supposed to yeah fine I said don't tell me if I got gold I'll do my head in yeah but you don't have a gallstone thank god in your gallbladder you may have passed a tiny stone but we didn't see it it may be but we'd usually expect to see some gallstones it's not in me exactly yeah it it's in we usually see some other stones if that was the case you don't look like you're gonna make stones in your gallbladder and it probably is a combination of the antibiotics you had yeah which can slow the level of bile down mhmm and that thickening in your blood so there's nothing worrying or sinister so there's nothing to worry about then nothing to worry about well don't worry anyway like I say you know but I don't like the acoustic pain anywhere in my body anywhere but when it comes to abdominal pain finishes me my body goes all in like turmoil but I've had broken I've got a every rib of my body broke oh my god why well my son gave me a bear hug right no and he broke my 2 2 ribs right I got my ribs and now I put that common little organs right I'm sorry I could put up with that I have 4 I got a 4 on the bus and I brought my ribs mhmm right and I brought my little finger down so he's bent oh I see and then I had another 4 in my trap ben he was a living he's back and I brought me a me then right I brought before then brought all my reps at my in another hole then I brought my hip mhmm on the left outside brought my hip cool thing and then do you have to have a hip replacement yeah I could probably have and then I went up here for a thing next to her or whatever or something mhmm then they found a dirty bone going this big bone right wouldn't he been attached to the whole thing oh right yeah so I had to go in for another operation I see and now the bone removed okay that's why I've got 2 big scars on my left it doesn't look like dentin now because the scars is about that big wow I thought I was all coming but the tummy pain is even worse yeah I'm sorry sorry isn't it I had a fall on my deck in and I brought my humerus bony up mhmm you know that's why I can't hardly lift them mhmm but so far I can handle that but abdominal pain yeah of course horrible I'll finish you've got type 2 diabetes as well and cataracts in the past yeah had 2 cataract operations and osteoporosis are you on anything for your osteoporosis do you take something to strengthen your bones doesn't look like you do because I had a mini stroke and everything you know but I'm I'm alright with the medication I'm on I'm doing fine but I think I said to my doctor bones a bit stronger would be nice wouldn't it you're 81 now aren't you how much do you think you weigh well when I was a smoker mhmm right I weighed 8 still mhmm I popped out smoking 9 months ago oh good for you did you wrap this up yeah was out there mate was a bit wickedly out of nowhere brought it up man I don't believe that yeah it's really because I was ready for breathing problems you know that's that's what the when I was in the hospital not whenever I asked if I was a smoker I knew that they never nobody told me to pack it up nobody that was me far enough anyway I packed it up myself and health has gone right down right down like a waves on the ocean I ate some quick cups of tea sat in my little stool I'll be fine my coffee freaking hour off place the carpet relieved all my mucus off my chest yeah fuck then I put in the shower up over the street by 10 over 10 mhmm fine never smoked in the street mhmm whenever I know right and that's just a blood I felt before I went to bed nothing okay right so anyway with that I had trouble breathing problems mhmm the 20 sixth because it was my grandson's seventeenth birthday oh okay 20 sixth of that's when I was admitted and how much do you think you weigh 8 stone then 8 stone that the doctors weighed it yeah I was 9 stone oh you're 9 stone now 9 stone now I'm only then I was 8 stone 9 stone 8 no I'm only 9 stone 3 9 stone 5 pound in about 4 weeks so now I'm only 9 stone 5 and how tall are you what how tall are you well I was five' 2 now but I think I'm five' I shrunk hundred and 52 centimetres what you do when you get older you do shrink have your parents broken their hips as far as you know no good can you help us do you so your 10 year risk of fracture is 39% your 10 year risk of hip fracture is 20% you've already broken your hip once you need some treatment to improve your bone density we know you've got osteoporosis but you should really be on something another tablet which helps drive calcium into your bones as well as some calcium I'm on a calcium tablet are you you're on an adcab yeah I'm on a calcium tablet oh the calcium tablet's great I'm on that 1 but it doesn't look like you're on any alendronic acid have you ever tried alendronic acid or anything like that you were on it hell is that back in 2022 because well now this cyst in my throat yeah I know I had a thing in my throat because I could only swallow it once mhmm and I went to I said I've got a lump in my throat well you know I've got overactive thyroid gland anyway mhmm so every 6 months I've got for a blood test but top to where it's at it's on its own so I'm not worried about that subclinical hypothyroidism something to do with the plan so he said right I'm sending you anything so I went in that a and e yeah they put a camera up my nose which was alright I didn't mind that at all I said before you tell me look on that screen please tell me I said don't fire me up a little rubbish I I wanna said know so what happened to the alendronate why did it so I said why did the alendronate acid stop because they have reflexes when I come out from the house you have reflux reflux fine so they put me on these things or something to take yeah I'll never tuck on oh fine the omeprazole yeah I've never tuck on fine because like I said to the doctor I am not and and my doctors and the nurses everybody knows I'm not I will not fill my stomach with a load of tablets or nothing like that like keeps to what I've basically gotta take yeah and I'm fine but I will not take perfect a load of tablets because the minute they're in and if I have a reaction I've got to go for that pill or whatever reaction until it's out of my system and I will not do that fair enough I think the reason I suggest some tablets for your bones is because you're at very high risk of having a broken bone the next 10 years yeah said if I fall I will break a bone when you could die if you broke your hip could die from that you know yeah you want to do that at this age a broken hip would have a 50% mortality rate yeah my ex touchwood you're fine if you fell again and broke your other hip for example you'd have a fiftyfifty chance of dying in the 30 days after that oh think that's why I'm worried about it that's why I think getting your bones strong will be helpful I'm fairly I might be a little bit dodgy sometimes on my leg mhmm that's what I can't do without myself yeah and the claire the respiratory nurse you know from operating whatever mhmm they offer me with a walker walker so I've got my walker on and I said what I need to triple over that freaking thing of course and to go in the shop I'm trying to hold the door absolutely and pull the walker yeah I can't do it mhmm because it takes my breathing I I cannot do it fair enough so I I've only used it about twice since I've had it mhmm but I've gotta rely on my stick okay fine you know and if I feel a little bit budgey or something I'll sit down somewhere if I'm out I'll sit down somewhere mhmm and then I'll get me strengthening my legs and carry on able to cut down and see mister on my legs to strengthen my legs I do do that when you're on my bed my physio exercise get my legs and I pull some up and I do this and I touch word you're okay good it's walking a lot yeah but apart from that I'll ask your gp to add it to your prescriptions going forward and I'd suggest taking it to try and strengthen your bones like I say you've got high risk of your if I don't know if it's gonna be any if it interfere with the medication I'm on I know what you mean I've I've looked and at your medication that would it would be fine for you to have that along with these medicines that I've looked at there wouldn't be anything that would would interact certainly so and and how many times a day is that 1 it's once a week only 1 a week 1 a week oh aren't you bad I thought it was okay well I take it no no no on a monday or a saturday or whenever you want in the morning you have first thing in the morning have have the tablet and then stay upright for 30 minutes after having it and it'll strengthen your bones so you put that on my prescription I'll ask your gp to put it on put it back on because it was on before put it back on yeah is that alright yeah I think that's that'll be good I think I've got halendronic acid it's called think I've got them on the call they describe know they're may well be in my throat they may be out of date now because they stopped in 2024 that was a year ago but if they're in date then just start taking them and then next time you refill your prescriptions it should be on there okay okay great I can find bones out once a week your lungs are okay we know what the plan is for the tummy you have another scan in a few months' time to make sure it's not changed and then other than that we're happy but apart from now I'm fairly healthy really apart from that you're my age you're doing great yeah I'm doing alright for my age really you're really I'm doing much wrong with my health you know apart from my copd and things like that that'll get better now you stop smoking you get less exacerbations yeah like I say I was an eighth of 10 bloody clothes now on the twelfth of 40 and I don't make it 1 little bet adenomatosis a gb he's on your said I believe I used to skinny I said I don't bloody think so you know rescan please to assess gb poly great I'll book this for you routinely you'll get a letter through the post think my chest infection is clearing up with my antibiotics and really oh good it sounds like it it's not so bad I don't cough much so mucus off now as what I did they're all brilliant which is a good thing so I've requested the ultrasound for you to get a letter about it but we're all happy we're able to see you again I can write you a letter which you can pick up at the desk if you want but I'll also send it to your gp so you have it great and then you don't want anything I'll send it and I'll come I'll come off for another scan will you you'll get the letter the letter will go to your gp and then they'll know what the plan is I'll ask them to add the alendronate back to your exactly they'll do it okay no problem thank you ever so much rob it's really nice to meet you I have a lovely cup of tea and then you can eat oh good oh I was like I feel 3 bananas are coming you know that's good I'll tell you bob I'll tell you because I'll put chicken poppers on the top that's true I've got a lot of chicken pox mhmm and it's the first time I come to my rules 8 in 1 minute right mhmm my normal 6 in the morning gonna be a heart patient alright fine lovely to meet you no don't get out you go this way alright and that's back for a big time which way do I go left or right I would go right and you'll be able to get out that way to the main entrance I can so go right and then follow it through thank you rob you have a nice day thank thank you great question is resolving infective exacerbation of copd number 2 jaundice secondary to drug induced liver injury secondary to levofloxacin now resolved number 3 abdominal pain of uncertain cause may be related to exacerbation of copd, may be exas may be related to drug induced liver injury or may be due to bile stasis secondary to gallbladder adenomyomatosis plan number 1 ultrasound abdomen routinely to as to clarify gallbladder adenomyomatosis open brackets requested close brackets number 2 discharge from stic today number 3 complete course of antibiotics and steroids for exacerbation of copd number 4 gp to add alendronate back to repeat prescriptions as multiple risk factors for osteoporosis, multiple fractures and glucocorticoid use currently full stop