Philip birkin shaw 74 year old man 1476690 yeah I'm just laying in front of me yeah yeah okay yeah it I'm just I'm just gonna in in yeah yes something to do I'm not gonna it oh thank you bye hi charlie no past medical history on gp record investigations tsh naught0.33 t411.6 b 12 normal but folate hemolyzed bone profile normal yehs and knees normal potassium 5.4 baclofen 78 lfts normal crp 2 urea 4.9 magnesium normal ferritin 73 ct head large area of encephalomalacia on the left with no evidence of acute hemorrhage or hydrocephalus no bony injury full blood count normal venous blood gas normal hi hello I'm rob I'm 1 of the medical registrars nice to meet you hi ms rachel is this another line with absent seizures again there is I'm not coming out wait you to just touch your head try to take a bit of time I'm here to look you can oh but you don't hello I'm rob nice to meet you how are you 10 minutes just doing that really happy can you look over here for me yeah just here like a bit like another absence seizure doesn't it you see this is very it can be yeah it can be all the time not there's never been I mean you'll just get bad luck said never as bad as this is happening I mean sometimes when it goes out it can be it goes out like that and he's he's as unconscious about 10 15 minutes now really and it goes on but this 1 I but then I think well maybe this stuff begin in making him more sleepier yeah maybe but now it's it's just not alright because when I woke up this morning he got up he was a bit you know kind of bit not really well or not no and then I say he got some back to us and he said well you know and so he's it what is what he's doing now like an absent seizure or not it is yeah is yeah is it can do yeah mhmm he can have got you know these quick ones around these kind of things yeah okay it's just a bit worrying I mean I don't so do you guys have hop north is that right yeah north think it's yeah right come on a down a train come down on a coach tour on monday yesterday I'm going back thursday hopefully okay but have you been to tallade before no you're fine well I can to our lovely party yeah it is a lovely party yeah it's a very lovely party you are it's beautiful but lancia's also beautiful sorry lancia's also beautiful well yeah yeah but no I just don't know what family evening so far away from home means we don't have any records or anything like that no I'm checking I get onto a new team no like is very disorganized yeah so I just need to call someone in lancashire in lincolnshire so lincolnshire sorry it's lincolnshire in lincolnshire and what hospital does he go to stunthorpe general stunthorpe general and he sees a he sees a neurologist he does yes yeah he does yeah okay and you normally take carbamazepine is that right which is an anti epileptic medicine yes I can't take tegretol yeah that's right I can't leave that yeah that's right and you take that and he's be taking that regularly as a minister of doses out every and then he yes in the morning for me and then at night at 80 is 4 mhmm and then I take a statin at night as well mhmm yeah yeah okay wednesday morning but yeah that's fine so what could you have a list of his meds at march and I'll just write them on his drug charts so that we know what they are no they're not I'll carry 1 with me just in case very clever because I couldn't tell you what the you're allergic to any medicines no much as I know of let me just if this is for that what's the new 1 wow that's very helpful for this saturday yeah but january 21 thanks so much so atorvastatin milligrams at night clopidogrel 75 mg per minute 2 mg 1 capsule then the line of lichen 5 mg morning metformin 1000 mg ocitabine and tegretol a long release 200 mg times 3 to 600 mg in the morning and oh that's better isn't it so that's april is that alright thank you that's really helpful thank you and we've got all of those written up and so you've got has he got type 2 diabetes is that right yes yes and there's blood thinner and the antiplatelet medicine after a previous stroke is that right he had a stroke 12 years ago 12 years ago so 12 years ago yeah and after that he's had these seizures after that 5 6 years he felt cold just before he started having seizures mhmm like what I call that some seizures yep you know but so he goes he goes completely out so he's then walking to the distance yeah just 2 or 3 separate now yeah over the years they've just got really bad really bad and so this has been going on bad like this for a while yeah it's like this was 1 of the worst of that lifetime but it then falls it can he can walk in and fall I see because of his rash so before this when's the last time he had a varicose seizure he had he had a little 1 just about december time mhmm and it was only a small 1 if you know what I mean it was alright but he had a bigger 1 in september october time and they had to take it off and you went to hospital yeah what do you normally do in the hospital yeah scan and everything and then he usually but his and then he'll come around a bit sometimes he'll him in because sometimes when he has 1 his heart beat and his oxygen they were just they're off yeah so they keep him in and then next time I can normally bring him on to you've that know we've got we're giving this thing I don't know whether this is I mean it's all part of it or or not you know you know what it is yeah yeah I that's from about you know what it I'm hungry matt has he been well recently yeah yeah did I saw him earlier he had a urine infection out in march but they said the blood had come back alright there was nothing okay he was alright and he I took him to the doctors and they gave him and he was he'd been fine mhmm but nothing no not been off otherwise like we're looking forward to coming down on holiday and I think I need to do a bit of research don't I about work out what's going on back up who's gunthorpe who's gunthorpe general and work out what's going on there I'll speak to my colleague my other partner up there and they'll send they can send me over some documents that I can work out what's going on that would be good yeah yeah enjoy getting you feeling better you've had some medicine which makes you very sleepy and you can probably have another type of anti seizure medicine called keppra or levetiracetam have you ever had that before no no that's fine that's good it works really well so is within being like this long know what you would like you would really would like how much do think he weighs you're a big man aren't you yeah about 14 14 still I know about that good to know it's only for it's a weight based dose yeah about that I should say great that's fine evict some of that to try and stop these episodes just happening yeah your blood test they don't show any clear sign of infection or no salts in blood or anything like that that can drive this I've added on a few more tests some more uncommon salts in the blood that can go low as well as another few really wacky things that can cause seizures and we'll find out what they showed and your ct scan of your head didn't show anything or worry about as a cause of this but it did show the old stroke that you saw before yeah yeah this is I think it's just just as easy as it was where were you last I think you were having another seizure you just told us oh you you were small echo the jaw there really are this is most striking of it yeah it shuts like that you you cannot and that'll happen normally oh normally I could sit there because they normally I it's it's in the hotel room as 1 of them round rolls heals oh he comes into it yeah you know yeah exactly and he has a wheelchair mhmm and he can walk a little bit yeah thankfully he has a wheelchair because he's just too much fine and yeah so tell me about more about his life more generally say normally he walks around he can walk but he can't walk far because he just it just gets so tight it's just unbelievable and I'm frightened he's gonna fall of course so when we do go out I have a I have a wheelchair wheelchair when you go out any reasonable distance yeah and in the house he walks around walk around but with a stick with a yeah a stick there oh this stick with 4 feet on it yeah no that's almost that's okay but then it you know can just fall it's sort of 2 or 3 falls I see and that's anyhow because I said oh lily you're having x what you know well I'm seizures yeah but I don't know mhmm and does he drink or smoke now and again he doesn't smoke he's never smoked since he has his c his his the stroke stroke he does have a a drink but not once a week maybe only once in a month or twice a month yeah but and he does like a tug of the skin I'm not lying yeah think that but not regularly doesn't it and how long did he smoke for do you ever know what size oh probably 74 60 and then 40 on years 40 years pack date at that time it probably was in them days yeah and then suddenly he had a stroke he he was on pint he he didn't smoke a lot but he he went fast about there or 89 he had a pint okay but but after that you must know a few years oh that's good no yeah no so and you live together I assume oh we do in a house or a flat or house yeah a house yeah so up upside down actually so we've had a I've had the bathroom changed yeah into a wet wet room yeah I don't know we know and then we've had a stair stairlift fitted yeah so we can walk them down there and see alright yeah fine just make life easier really cool hello again you alright I'm okay how are you doing hello hello how are you I'm rob I'm 1 of the doctors you're in torbay hospital yeah yeah she she she got a fever well yeah you haven't got anything on the ceiling sometimes in the base you've got shit on the ceiling that says where you are but not in this 1 because it's in the big case just stumbled around a little bit now very that's better has anyone told you where you are at the moment I wasn't quite sure yet and then she she said can you squeeze my hand you want me that 1 no okay can you squeeze my hand with your left could you glute your eyes oh god yeah gonna have a quick look at the ed light you've got good regular pulses on this side and you've had a tracing of your heart I think since you've been in here I hope anyway which is lovely she's first degree av block nothing else quick listen to your heart okay he's he's got a 5.3% of cases he's week to have a 7 day. Of time he's got a severe and he's got a fever he's he's fever he's a got a he's good do anything I don't even know what I'm gonna do with his time right right keep him all out in the day the last thing to talk about is about resuscitation I talked to all my patients yeah yeah but I have some talk about it about it and we are just we haven't done any form of putting to lie mhmm but if it then I've got to think now yeah you know we have tried to talk about it it's just not the most things talking about you no it's like a lot of things we do but our family oh mom dad you know it's they don't like to tell me about it right you've got big guns right as I was always saying part of living is death yeah maybe it sounds oh my god that's how we are you're pragmatic quite fran we are you've got to be it's just part of life isn't it and I don't I think I would do it of course not but no it wouldn't want to be taking it back it won't no it wouldn't be jumping up down your chest you're going to a fence no it really won't be down yeah well I'm sweating but no there's no life I I think we'll do it because after something like that there's no chance of coming out as you were no you're kinda out of the bush well we'll know you're all in jenny and you are you know I'm gonna show you because of the thing that's good and she says some 1 day might not come right and she it'd be lovely because she I can talk to her she's a lovely nurse we talk and and I've I said well somebody tell me they're not mhmm and she said and I'm not know sometimes you might not yeah I don't know I do I do that kind of thing but no we have yeah we have yeah yeah we we have got pages again let me get him some medicine to stop him from having any more seizures I'll chat to my colleague in stamford general if I need to stop there yeah and then I can come and let him know if I can lovely oh that's lovely thank you so much no worries take care pleasure to meet you yeah and I'll prescribe this if you've got it as well okay so classmate goes to type 2 diabetes on metformin previous stroke vitamin d deficiency low mood and post stroke seizures medications there's atorvastatin 40 mg at night clopidogrel 75 mg in the morning glimepiride 2 mg in the morning invita d3 1 tablet once in the morning linagliptin 5 mg in the morning metformin modified release 1000 mg twice per day ramipril 1.25 mg in the morning add hypertension to the past medical history list sertraline 50 mg in the morning tegretol prolonged release 600 mg in the morning and 800 mg at 8pm observations heart rate 78 blood pressure 135 over 76 that's 98% on air respiratory rate 18 the impression is flare of post stroke seizures of uncertain underlying cause investigation is reassuring so plan is collateral history so I've discussed with the medical registrar in scunthorpe general hospital who was last she tells me he was last seen in 2019 by the jerry's neurology specialist doctor he had a previous left total anterior circulation infarct in 2015 which was thrombolized and he has post stroke seizures and he was on carbamazepine at that time in terms of his previous admissions he was admitted in february 2026 with a collapse and had a normal ct head at that time and was discharged after that with no change to his medication he was admitted in december 2025 with chest pain he also had a ct head at that time which was normal and in august 2025 he was admitted with absent seizures at that time it was discussed with neurology and they made the plan to increase the carbamazepine to 800 mg twice per day if the seizures recurred but that he was mostly under the care of the epilepsy nurse and neurology team in hull hospital and the epilepsy nurse last saw him on the 01/26/2026 I'm going to put his most recent clinic letters from the team in hull in the notes so the plan is to load with levetiracetam increase tegretol to 800 mg twice per day admit to the acute medical unit for observation and seizure charting if seizure is resolved then can go home escalation not for itu or cpr but may benefit from niv if required so it's ward based care the ceiling of niv discussed with the wife at the bedside and vte prophylaxis with enoxaparin ward is acute medical unit oral neurology / short stay on dual gel