So next patient is kevin ridge foxtrot 323321 investigations crp 7 potassium 3.3 magnesium naught 0.68 alt 76 bilirubin 23 inr 1.2 white cells 5.9 with neutrals 3.7 crp 7 venous blood gas mild alkalosis only has undergone intravenous magnesium replacement with antibiotics to treat a lower respiratory tract infection chest x-ray demonstrating hazy bilateral pacification treatment so far includes 7.5 mg of bisoprolol iv magnesium 2 g 30 mg of prednisolone and salbutamol medical history implementation of dual chain pacemaker 2024 prostate cancer 2024 gleason 7 open brackets 4 + 3 grade group 3 atrial fibrillation ckd 2 2021 hypertension 2016 erectile dysfunction 2012 diverticulosis 02/2006 medications list pregabalin 50 mg 3 times a day tadalafil as required 10 mg bisoprolol 1.25 mg once a day the ical d 3 1000 / 880 once per day bisimepril 5 mg at night torcet 20 mg at night apixaban 5 mg twice a day and dapamide 1.5 mg modified release in the morning beclomethacin 50 microgram per dose nasal spray 1 or 2 to be used in each nostril twice a day regularly busoprolol 2.5 mg once a day for total dose of 3.25 mg of busoprolol no known drug allergies sleep in the past medical history is sleep apnea yeah at least just before the in the past medical history as well group based streptococcus sepsis requiring itu admission in huddersfield multi organ failure requiring intubation ventilation right empyema aki requiring hemofiltration pea arrest permanent pacemaker insertion persistent complex right pleural effusion we have a meeting at 10am severe sleep disordered breathing july 2024 nice prostate adenocarcinoma sabre radiotherapy to prostate and seminal vesicles 2024 bicalutamide during radiotherapy and decapeptyl started 14 days after bicolutamide continuing treatment radical hello stuff but I'd love to hear about how you're feeling and your symptoms you've worked out how to get you feeling better okay tell me the story it started off I had sepsis in 2016 then 2016 yeah and around here no no I've been traveling a lot for my mom's funeral yeah taken into addisonville groin and firmer yes and you had a bad time in there you had some respiratory failure went to itu your heart stopped briefly you had to have a pacemaker put in and you have a complex emphysema and infection around the lung following that I don't know about all of that thank you that's okay because a lot of a lot of times you can go for a appointment and the doctors don't really know that's the beauty of that that's why you have to start from of course and I think that's when I first started getting af mhmm but I didn't know at the time what af was mhmm in the years following that I started to get a horrible feeling of breathlessness and not being able to breathe and kind of racing heart so you have palpitations yes and you feel that you can't breathe can't get your breath that's it chest pain along with it not a pain as such but a tightness tightness around the chest as if somebody is tightening something and I was getting the I got prescribed medicines for this bisoprolol yeah and then it started getting kind of worse and they picked it up in cardiology because they got a pacemaker and they wrote to the gp a couple of times to say the patient potentially hates their so mental I saw a nurse specialist at my gp and he put me on an additional dose of bisoprol so I'm on 2.5 and 1.25 at night 3.75 in total yeah yeah and that kind of seemed to have settled it yeah okay but then it started january yeah after finished the cancer prostate cancer yeah yeah read about that as well after I finished that I started getting this feeling of breathlessness again and I got a cpap machine and that started off great but then the first mask it was so claustrophobic and pressing it on your sinus traps it was making my eyes swell up in the morning so they changed it for a different where the hose goes in at the top silicone tubing coming down and the mask goes under the nose a lot better so much better to breathe and do you still use that regularly have been in the night gasping for breath again I know I can breathe subconsciously I know and I'm telling myself I'm not dying I'm choking but it's the feeling you get because you have to sit up in bed to make yourself breathe I go bolt up right and does that make you feel better if you go bolt upright no not really and I take the mask off take the mask off fine and I try to go back to sleep and every time I 'm sleeping I can't wake up again of course go back to having your obstructive sleep apnea which the mask was treating so I'm sat bolt upright must be tough to eat that's yeah yeah it really is tough when he was in for a suit and his blood pressure was stiff and I had to do I think about 2 or 3 last yeah that's with the first mask I see because it was forcing the air into your stomach stomach but the second mask it vents so it comes down into the nose but 3 weeks ago I started getting this feeling I couldn't walk up the stairs 3 weeks ago yeah mhmm couldn't walk up the 1 night or 2 no of no it's it's about that because it took me a day and then running around on the floor like a child don't know finally it was june you know how to get where you are see I started getting this feeling where I couldn't go upstairs I couldn't breathe on my knees and I'm gasping up on my hands and knees so I onto the bed and I'm just lying there trying to breathe so I tried to make an appointment with my gp and they wanted to ask how the new mask was getting on and I said the mask is for breathing and they said that could be they said check your nostrils and well I can't breathe through really but this 1 mhmm perfect so they said you've probably got a deviated septum right for 1 and they said the other matter could be asthma and they said you suffer hay fever I said yeah and it'd be that you can get asthma later in life etcetera so they said contact your gp ask for a spirometric test okay so I've done that gp has come back said they've referred me okay checked with derriford and derriford said it's up to a 17 week wait I've contacted benadryl yeah and they've they've said they'll do it mhmm but they're not field but nuffield don't do it so I've come back to them and I'm hoping they're going to change it to express diagnostics thought the business part is very good but with this I cannot breathe properly and progressively get worse it is ruining my life I cannot go out cannot walk even out of the car do you think that the af is driving the inability to breathe you're getting the same symptoms that chest tightness palpitations along with the not being able to breathe for the last 3 weeks it's been going on all for the last 3 weeks well started in june and it's beginning progressively worse so even more than 2 weeks the last 3 weeks well for quite a long. Then it did everything and and a lot of stuff around the house it comes and goes but it's been particularly bad the last 3 weeks it's bad for a. In june as well yeah which led to you coming into hospital you saw thoracics uh-huh or you spoke to the thoracics on the phone yeah and they as I read that letter they say they write as you say that they want to do spirometry and they also want to look at the possibility whether this collection in your chest is causing things to be worse the second issue I'm having is my stomach is just massively bloated and for the past I'm pressing and okay the pain under the ribs here and pain down here as well and tell me about your bowel sorry saturday I was okay sunday oh yeah sorry sunday I had to clear myself back for the that's not the top end or at the bottom end bottom end bottom end middle end yeah yeah so I I went okay monday night and then tuesday morning mhmm and I had a so you feel banged up I feel as if I could go a bit later but I had a sigmoidoscopy a colonoscopy colonoscopy I had a colonoscopy when was that I didn't see that an itch of that is that a different is that a different hospital yes private hospital finance the gp referred me I see fine and when was that june they're resuming yeah when we were to work yeah that's alright yeah yeah fine it's the june time yeah yeah you went to have a colonoscopy and what did it show yeah because I don't have the result oh that's fine you had diverticulosis that outpouching of the bowel yeah things like that but nothing else worrying that's reassuring isn't it yeah did you die at all for the diverticulosis no no fine did they give you any advice about that no it's just something on the bottom of the printer refer to gp for a plan yeah but reading about it it says that can give you bad stomach it certainly can little outpouchings of the bowel wear and tear changes that are probably coming for all of us and who gets trapped in the pockets like this mhmm and then the pockets can become infected and get diverticulitis but it doesn't sound like that was on your colonoscopy because usually people would have very bad tummy pain fevers and past blood it doesn't sound like that to you not sure if it could be that or it could have been an episode of diverticulitis the best thing to do is to try to decrease the fibre in your diet because it's the fibrous things that stick in these pockets brown bread things like that all the nice tasty things vegetables with seeds seeds all those things pack in the diverticulae and they can increase the risk of symptoms coming back so people have good benefit from decreasing the fibre intake of their diet there's lots of good information online about it if you Google diverticulosis diet tell me lots so that's that it sounds like you're constipated at the moment doesn't it you feel bunged up you've got tummy pain your tummy's distended I can hear it's full of gas when I tap on it so there's probably lots of poo and air in there that needs to come out get you some laxatives to jump down the top end as well and we can try another nmo a bit later possibly improve your breathing and make you feel better so that's that then in terms of the fast heart rate have you been feeling okay in yourself the last 3 weeks are having any fevers or feeling generally unwell fever just feeling been bang on yes yeah but just feeling like you're just not right can't do anything mm-mm but have you had a cough or a cold cough cough yeah bring anything up sorry I'm I'm answering all the questions it's a team effort isn't when I when I do it it comes up like a a yellow green mhmm but has that changed yeah at the moment for the last couple of days oh yeah I've been coughing and I was retching on tuesday mhmm and it was just like a thick milky mhmm alright so you don't normally bring up sputum and then over the last sort of 3 months I do you do normally bring up sputum milky stuff no the every morning I have yellowy brown y I see when I wake wash brush my teeth I have to clean my throat I see bring that stuff up and then over the last 3 weeks it's become a bit more greeny yellowy so and gone on too it's white and now more white any rashes on your legs at all no like I'll a look at your hands it's okay good and you guys live together yeah anyone else at home no anyone ill at home you you can see me no no good that's fine take me home that's fine you're taking your blood thinner all the time I haven't taken it this year off today because it's been any me was told was not to mhmm and so if they'll take your meds fine you can have your blood thinner I would take it okay or whatever and they don't know what's going on but there's no you don't need to not have that thank you your pulse is going quite fast isn't it so thank you got that wheezing there did you ever heard that I'm sounding a bit wheezy I doubt you have a snare I think that the wheezing is from fluid building up on your lungs which can happen when the heart's not moving so much we don't know what the x-ray was it was the x-ray yeah I've seen the x-ray you okay do you have tissue on the last week then yeah are you sure yeah okay the x-ray shows the collection in your chest that we knew about after being in intensive care it's still there it looks about similar to the previous massively bigger and causing things but on the other side of your lungs there's some patchy hazy stuff that looks like fluid to me like there's fluid filled combined with difficulty walking upstairs and shortness of breath and the heart beats in very fast when the heart beats so fast doesn't move well and it's not able to move blood out of the lungs very quickly and blood backs up into the lungs fluid builds up in the lungs and that's certainly I think caused the change in what you're bringing in if the heart's not working very well at the moment you may have an underlying infection your blood tests don't quite unwell I think giving the antibiotics is quite a reasonable thing to do just in case the other thing that might be contributing to the link together probably okay I think the goal is to try and get the heart moving in various ways the heart directly with some medicines through the tummy with some laxatives have there any questions for you or anything like that no if you've got explained everything absolutely alright fantastic allergic to anything no fine work housework sorry housework in half of because of the dust the dust okay good do you drink or smoke no no neither of the 2 have you ever smoked before never in my life no fine what do you do for a living no I'm mentally retired mhmm I'm a pensioner now yeah fine and what did you do before the last ride to the raf okay fine driving lots driving before you that's fine any exposure to asbestos undergrowing fuel tanks in various locations in the air feel like a gray powdery substance and I don't know I don't know why that was it's always good to check and suppose you just hate farm animals of course yeah yeah but you know not working with it I'll go and get all those things sorted for you thanks 1 question will you be staying in so we'll put you on a cardiac monitor the nurse will come by I don't know if I'm gonna win today to I be honest with would like to see the rest of the blood test there's much else to fix if there are other things to fix then we might win but I think it's worth bargaining on staying here for the night that's okay yeah that okay that's much I think that's probably what's gonna happen but we'll try and manage each other as best we can right and we'll request a bed for you early if 's going that way thank you brian great so much appreciated it's a pleasure nice to meet ben thank you see you later bye