Leslie harvey +1 49273 82 year old lady made a big puddle of blood what it's it's called an edema it's flooded edema deep bleeds over the lower leg so it's all greased over here god I can't believe it you know that's so cool it's just a yeah hello hi hi I'm rob I'm 1 of medical nurse stretch hello there nice nice meet you I'm vicky nice to meet you hi rob how are you nice to meet you nice to meet you how are you not too great sorry to hear that I hear lots of leaking from the legs oh and then I read that your gp was running back and breathing this morning well she was it was a bit a quick touch list back list which I get with the the the opv no I don't think so okay good I'm glad but the legs are the number 1 problem the feet are streaming I'm sorry and I don't want to be and when did it all start when did it all start the legs well the day I came home from hospital that was the november 21 november 21 I went to hip mhmm and this just happened off the hip hip wasn't it it was a hip hip complete hip operation mhmm which had given me hell for about 2 years mhmm and I was delighted to go in and delighted to feel I woke up there was no pain at all how lovely oh it was wonderful but that night I had easily gotcha mhmm by by the epidiolex my kidneys are bad mhmm think hospital can do that oh well yeah this 1 was what I was trying to get out of it at work time I couldn't understand where it was mhmm so when you came out of hospital that was about 3 days later yeah mhmm I had the the operation friday yeah sunday I gave home mhmm and then I started I had to go to the toilet during the night mhmm and and I noticed that the bleeding bottles and water and blood and that was started pretty soon after yeah did but that was on the leg that you had the hip which is your fibrous that was only on the leg with the hip what seems to have happened in the intervening. The other leg has got swollen too much look at the you're they dressed you're on no we've taken the bandages off bed as they were sitting laying too much very wet very swollen they've calmed down a bit actually but I guess that's all fluid that's come out of them we know that on the right leg an actual wound yeah there is a hip operation and they've from the hip operation they've actually admitted because we've been taking it further because we weren't particularly happy because I was very very frightened last year of course yeah and they were warned about that and we spoke to the theater a team theater happened yeah yeah something to do with the what the gp was concerned about that maybe there's some circulatory or heart issues or something else well my theory I didn't go any theory tell us yeah I can get these I reckon because my torn exit of exercise mhmm to get myself back to recovery this swelling is now that's very sore I know you did that swelling is due to water there's a lot of water in there isn't it it's all flowing like a puddle isn't it yeah and then you've got very thin skin that can just break through very easily that's where the pain is coming from as well and the fluid can come from lots of places it can come from the kidneys it can come from the heart it can come from the liver it's worth investigating all of those potentials well the doctor wants you to do just keep the following your leg yes it's from the outside you don't give her a real cold hand it's a clean look give her you were your son did you manage it or no I did no I gave it to you did you give it to the nurse at any. Or does it sit it's still in here ah that's good it's for yesterday I don't know why you just carry around the box I'll be carrying carry it carry it around stop yeah lovely thank you very much yeah hello good to have fun yes well certainly not a lot of fluid on the left hand side okay and it's on both sides and it actually goes up a fairway doesn't it up to your hips I think that would be absolutely that that would be obviously the hip and tell me about you and your life more generally how much do you move around what do you do the day oh quite a lot once I've moved it's been 2 years since I've moved around a lot mhmm but doesn't matter I've got 1 very very happy mhmm good I love my home and house proud mhmm and I work hard yeah fine but not ugly okay and what stops you lately the legs yeah I know that this is where it ooze out mhmm as soon as I try to exercise of course yeah and that's not nice yeah it's been a tricky thing isn't it because obviously she came about so keep moving keep doing your exercise for your hip and the hip the irony is the hip is just free so it's really loud yeah but of course she's not really been able to do any these exercises or take advantage of the new hip because of all this mhmm I'm so disappointed yeah sorry that's right and it's a vicious cycle because the fluid builds up mhmm and the less you move your legs the more the fluid builds up I know so just I know as you know right you need those really muscle pumps to move the fluid up to your heart in order to mobilize it do you raise your legs up when you're sat there oh 0 yes okay oh yes well you do as far as you can not necessarily above a heart particularly but you sit with your legs up you're sufficient because of a lot more proof or whatever yes as long as it's off the ground mhmm that's probably good other than being on the ground so yeah because that hurts when I suicide as soon as I put them to the ground mhmm the blood flow makes makes them painful yeah walking do they get painful when you walk I can't walk a lot mhmm because a I didn't I wasn't fitted out with the dirt crutches mhmm I'm really afraid to help mhmm I do know that I have a lot of goodness they're very keen for me do you mind you were we were and then we are we were talking a little bit about what kind of things you do at home yes you're very house proud you do all of the things yourself at home who does the shopping well just recently we used to do my family my husband and I did mhmm but it was in the last few years I mean I was found mhmm more or less since the hips and the legs and since the legs no problem hips were agony mhmm and I had to walk with a friend all the time and then laterally in a wheelchair I'm sorry to get so so now the children some them have we help out with meals but dad does dad is our registered carer mhmm but you know he was 90 in february and unfortunately he's at the minute he I mean he'd be here now would be insistent on being here but he's been sitting with a sort of flu virus thing so he's not we've just sent about his paper so so so somehow I really don't do it so yeah and yes so we've we've kind of making it easy coping with that but yeah I gotta put a lady in to help me with the there's a couple there I've been done of course she don't need to be okay know why but she does wash and toilets and mazes okay and she gets on well as we like her k wednesdays I go to the lady and shower me because I used to have a bath but my husband decided he'd like a shower oh first but that's not been possible with sore legs and so I feel doing it and a sore hip so I've been feel hard done left done yeah yeah mhmm of course do feel that I have lost unnecessary time which I'm not sure I've got a lot of left mhmm pretty much more than that was but thank you you know mhmm fine I'm I'm resentful a little bit and that's silly but that's understandable it's 3 nearly 3 years of my life mhmm I've got a lovely granddaughter who wants to get married in may and I wanna be there yeah sweet and the right place to get sorted out I know the gp at mom's chest is there's gonna be fluid on the lungs she said it sounded it sounded clear by investigation okay let me find out you mind if I examine you quickly is that alright no no no can I look at your legs good can I have a look at your hands is that alright yeah thank you fitting your heart since you've been here the results are better alright you yep fine your kidney function's good your liver function's good your markers of infection and inflammation are slightly raised but nothing crazy which probably goes on with some chronic inflammation because of that wound on your leg probably I don't know why toasted wound I was yeah I woke up and looked down and I thought what you know my because I was sweating a year mhmm and not all day that's yeah yeah there were 3 tiddy glasses mhmm on these huge scars oh sorry yeah and there was bleeding have you used steroids in the past do you put for polymyalgic steroids for your chest for my chest yeah because I've had a terrible panic attack mhmm in the week and I thought it was gonna end up being here unfortunately I didn't I did go to town a little bit with my inhalers I thought well I gotta get through this somehow mhmm my husband wasn't well I couldn't leave him of course so and and then then I put on what they call the rescue pack yeah is steroids steroids and syntax yeah I've coped with that a lot you you use use that that and how many times every year would you use that yeah oh I'm just a month on it no I hardly use it at all oh good okay in fact I only just remembered it I no I was reminded able to sit forward and I'll work on a listen to your back thank you do you still smoke yes how are you so would you do then mhmm big breath's gonna be ready and that was for me me very good and that works there'll be 1 more did your asthma smoke no he stopped smoking daddy was in the baby mhmm and other 1 was cheap and he didn't like it but I try to just go in to the moment sorry what if I touch your tummy is that the case yeah that's very swollen always really I do get constipated when's the last time you went for a poop or a poop mhmm about a week ago I suppose is that normal for you yes oh yeah not in abnormal it's everything yeah we've had a bloated tummies that's investigated various kinds of it can't put it wrong is alright I think tummies do a lot to do with drugs quite a lot mhmm and beacons and things doesn't help tell you does it no oh yeah good and not being active doesn't help it's that's okay doing my housework and gardening you're still slim thank you fat is it no no so where'd it go it's just the low oxygen levels we should investigate we should have a chest x-ray to look at that that's a reasonable thing to do just as your gp says sounds entirely clear so I don't think that you've got a chest infection or anything there but it's worth investigating that k to see what's probably that you run a chronically low oxygen level because of the smoking probably and given that they haven't put you on oxygen here makes me think it might have got a little bit better since you were with your gp in terms of investigating for the cause of the swelling in the legs an echinacea scan of the heart is a good first step to look for problems with the heart that's the most likely thing to be causing the fluid in the leg if that's the case then we've got lots of medicines we can use to try and get some fluid off and I'll start 1 of those medicines straight away if that's alright to try and get some of the fluid off the leg a dip of your urine just to make sure the kidneys are fine is also a sensible thing to do to try and help the kidneys just to see whether the kidneys are producing too much protein and if they are we can try and help the kidneys with some different meds me on they put me on high end tablets just before yeah so you were up in a yeah and also blood thinners around the time of the operation because you're immobile after well I did stop them for a little while before the op because I thought we want to put we just wanted things in blood stone mhmm but I wanted it too mhmm but I don't know what I did right might or wrong because I was getting different tails mhmm I got of course and in terms of this wound on your leg obviously the vascular supply to that area may be compromised so we should look at the vascular supply to that area with a doppler scan of the arteries in your leg we have done that that fine I'll have a look at those results then not today not this time no no this time I all the just all the information fine okay done before they were concerned about it healing exactly etcetera and the fact that it hasn't healed for such a long time makes me you need blood to heal and you also need all of the white blood cells in your body to be working well and smoking we know means that you don't heal very well unfortunately the ongoing smoking and nicotine it's not even smoking it's just the nicotine so even nicotine replacement things stop you healing unfortunately and so that's the potential for that I suggest that it's probably slightly infected so having a short course of antibiotics to cover for an infection in that area with a swab taken to work out what the cause is is probably sensible because if it's less inflamed your body will have a bit less to deal with then the question is about your legs what we do with them if we can get some water off the legs with some tablets that'd be great if we can't then my colleagues in tissue viability some of our nursing specialists might be able to help with some pressure dressings and things like that to try to dry things they hurt they do hurt they hurt yeah they're not nice especially with sore legs anyway yeah yeah they they dogs felt raw in their head you've been given some fluid retent fluid retention tablets think it was a lot precise yeah I I answered the list on your list yeah so I think she's you came I came off a little bit because it worked well said you really weren't giving me a good 10 days to work and I wasn't getting that and they were working mhmm so you gave them 10 days to work they didn't do anything no okay but I won't go back again you know did you be better so a lot when you were on the tablets all through the nights no they are not I don't they shouldn't be doing it through the day you've got a lot of fluid on there like look can you see look at your legs no I don't you don't want to on your it looks like you've got a calf muscle but it's actually just a bag of fluid and that's a fair amount of fluid to mobilize and wee out what it's gonna take time do it's I feel like this isn't do that would work yeah you'd get another infected wound unfortunately I know it's frustrating I'm sorry I don't have a magic book to wait to fix it I wish I did and I would I think it's gonna be it's taking time to for them to get back this and it's gonna take time to get them better I know get to the weak course of it and be yeah feeling that so but really you know say for example you have a jelly scan and it shows that your heart's not fantastic because of you know being how old you are and smoking for a while can can affect affect the the heart heart mhmm what's gonna be the treatment for that water tablets really so I stick to them so it's not I think it's a good place to start oh yeah I think so the oxygen again not a theory my youngest daughter kate is very fond of bright red bear wash isn't she well when yes when they tried to take your oxygen she put a finger and had red nail rash I know and it was particularly low and it was especially for christmas and this is when the doctor goes oh dear you know this I'd sedicate take it off take it off and see what happens and it went up yeah no it definitely doesn't work with copd it can go up and down anyway can't it yeah definitely so you know you do need a theory done to this day yeah so if I have trouble any with the rest of my shift I'm mucking up come back to me do a bit of a what happens nowadays well yeah no well I all of these things we can do with you in hospital or with you out of hospital is what I was gonna say I don't know I we'd be you're here in hospital you've waited a long time we'll be more than happy to take you to 1 of our wards and do the staff as an inpatient but at the same time I can arrange you all of these tests now as an outpatient and you can try and go home and I really don't mind which you want to do now you probably will get the test quicker as an inpatient but you'll be sleeping in our hospital bed in a crowded ward full of people with flu but you know that's fine if if you know I'm not I'm not trying to downsell the hospital experience it might not be full of people with flu and it might not be both noisy and loud and it but you know it's it can be as I'm sure you know I'll always go and nod yes you were probably 1 of the noisy ones though that's it well you're drinking badly I'm just thinking of the other patients yeah she had to say anything yeah oh my god here they are again the 1 thing I would caveat that is if your oxygen levels are really low you do need to be by the fact they haven't taken you on any oxygen I don't think you if they are no I'd have to ask my clinic my nurse and can I do anything at this at home because I do love my own health yeah I think I can arrange you all of those tests as an outpatient and and so I think the only the only difficulty with that mom is is good about is getting because dad isn't up to I don't know he will be for a week or so up to driving you in me and my sister have find you know what I'm saying though sweetheart I've got theory my long corridor from my toilet to my bedroom is a pain in the ass because I've moved you yeah I think with everything my dad comes along the scopes along with it I'll go up and get rid of that but I find it very good exercise although I'm holding on to my frame mhmm I'm moving my legs yes ma'am I'm just at the outpatient yeah it's basically a hacky scene for lots several different oh that's that's I'm trying to get you in here because obviously me and sister are both working very challenging it's is it a bit of a challenge so on 1 hand being in the hospital I do understand on how you you do it I mean I guess there would be would that literally be sort of half a dozen appointments potentially or gently scan of your heart a chest x-ray we do today mhmm gently scan of your leg to look at the vessels in your leg mhmm that's 2 appointments isn't it yeah and then I guess it depends what they find you never know you know their tests do stand to spawn off the tests but I would think 2 appointments is what we'd bargain for mhmm to give us a bit more information but I do think the outcome is very likely to be which is a reasonable prescription that's why couldn't do that so the chest x-ray can be done while she's here yeah of course it's just around the corner okay that's that was yep that I'm fairly confident about that and it just wasn't so clear yeah just before my operation yeah I had a complete scan well that's good and they find nothing wrong until then I know yeah I know I understand that I'm so old he was going to lose ills cancer which is what I was frightened of bone cancer I haven't got which I was frightened of yeah okay so we just need to do the assessment do I don't mind I'll arrange all the tests for you you'll put in all the requests for the kid yeah and then we can make a plan we can come out and see the consultant in morning because it's not half the consultant's only in clinic for the hour or so medications list for this lady respimat 2.5 micrograms per dose solution 2 puffs once a day ferrous sulfate 200 mg tablets once a capitugol 75 mg once a day monopost 50 microgram per mil eye drops 1 drop to be used at night in both eyes duorasp spiramax 3 20 microgram by 9 microgram dose dry powder inhaler 1 puff twice a day spiriva respimat it's duplicate theical d 3 take 1 daily bisacodyl 5 mg 1 to be 2 to be taken at bedtime if necessary acetylcysteine 600 mg tablets 1 to be taken per day ventolin inhaler lansoprazole 30 mg once each morning chlordiazepoxide 5 mg capsules 1 per day levothyroxine sodium 100 microgram tablets 1 to be taken each morning past medical history peripheral arterial disease june 2025 hip osteoarthritis august 2024 prediabetes capd 2017 still smoking breast cancer 2005 grade 3 ductal cancer left breast er negative hypothyroidism julian nelson 1983 investigations creatinine 34 sodium a 131 lfts normal amylase normal crp 10 urea normal ast normal full blood count white blood cells 11.2 neutrophils 9.4 platelets 671 with hemoglobin a 124 so impression multifactorial bilateral edema with chronic inflammatory state secondary to non healing ulcer peripheral arterial disease likely underlying cardiac failure or possible cor pulmonale and immobility all contributing next issue is constipation next issue is no sats with gp but now normal for further investigation plan number 1 echocardiogram number 2 increase furosemide or retrial of furosemide I should say number next oral flucoxicillin to treat infected leg ulcer number next ultrasound doppler of the bilateral legs to assess vascular supply number next these could be all undertaken as an outpatient and there's nothing here that needs to keep her in hospital she will discuss with her daughter about what she wishes to do and let us know the post op wardrobe if being admitted should have a tep form not for escalation given significant smoking history