Sounds terrible just just and it's been coming on for a bit of time now is that right a few days few days alright but I don't get any warning when I go over until you get sudden episodes of weakness associated with it is that right well it's always weak and well beyond army because I can't hold anything level and probably let it go a bit I see fine and that's that left hand and how long has that been going on for well I it only started that started at middle of the week because I was taking my dinner over from the cooker till mhmm on the plate it just went yeah so nothing isn't it narrowed and your legs are weak as well or just 1 leg is this 1 just the left leg the right leg is fine 1 but the right 1 is so weak okay so it's only one-sided symptoms yes definitely okay any bladder and bowel disturbance well the the bladder I've got a I went to back to radiotherapy yes mhmm that sort of upset it I never you're quite urgent you need to rush to it all now I don't need to I can't rush want to rush I've got to if you look at the house I've got gutters all the way around the house I see ready for an eventual emergency room which I've replaced against your your bag yes and it doesn't so I don't know if that's far down mhmm and so nothing's coming out of there well no it didn't seem to not has anything come out over the last few days oh yeah it's been fine till yesterday just yesterday lunchtime I changed the bag and since then not much since then hardly anything and what kind of stuff normally comes out well because I take laxity as well I've had the pancrelipase it's exclusive because obviously it's nice have to come back to fenazine after it was done see right because there was a blockage and you had the cancer in your rectum removed at that time they haven't removed it they haven't removed it so they can't they can't remove it okay and it's sort of right it's about that much very close to the very close anal margin that's uncomfortable of course and I don't know so get you some of that oh yes I how much do you need about an hour each time milliliters yeah in the syringe 2 and a half in the syringe yes the the nerve's very massive in which you can pay just to measure properly mhmm very important that's what I want I'll prescribe that to you so you can have that very very good time right definitely good to have some as well yeah yeah and in terms of sensation down below any change there are you feeling yourself between your legs does that feel numb or tingly at all might be going around a little bit I a bit of discharge from what tingling which is painless but yeah and when you're wiping that you can feel it all I don't I just check it and get it to love your pain and I notice the the bag so when it pops into the bag it gets a bit crackly I guess it doesn't always do anything but it's been crackling alright okay strange mhmm mhmm and you you see the oncologist for this radiotherapy that you had to your pelvis yeah which was to try and shrink this tumor down yeah yeah doctor doctor chambers yeah I know doctor chambers mhmm yeah or so really cool then and by then I couldn't get a lift in mhmm but you said well you can try and get into work but it's completely not letting everything back down yeah so I said well yeah it's fine mhmm and then I got a phone call that I was becoming appalled yesterday to ask I mean they'd be bedside tables and they'd say maybe that and never use it to make it it was quite painful that's good really no I haven't left the door open no have you walked since no no no I did I did stand up to change but I mhmm okay so and how do you normally get around the house I've been around the furniture mhmm more like furniture on a stick yeah which is my idea right especially when I got stairs mhmm and the banisters don't put between yourself they they're on my hand and you're by yourself at home yes yep you have to buy my daughter your daughter lives closer see well yes she's into a quay and she walks and she does medical information she does my shopping and oh that's nice yeah it's difficult to do those things when you've got 2 hands already occupied well because I could hold it on the 1 hand mhmm and that's not I'd do that yeah of course I'm sorry I've got a chair but I wish she had a nap yeah got it and what's your understanding about the prognosis of your cancer and what's going on with that well me have a a clear this way yeah they've got it can cause to I'll walk past it yeah cut all over yeah and then push chemo at the early stages and what do you think about that I it could not be cancer in the lungs I read about that I think there were some other cases as well that we've used and but no thoughts on drug chemotherapy I don't know what we're fair enough fair enough leave it to the experts well of course don't think I need to alright I need to be able to sign this for the experts would you yeah of course and it's not to be taken lightly at the start so can I have a quick look at you you mind if I'm in france no listen to your chest if I'm in spanish what did you do for a living I was in the bank like in banking or in working at bank working at bank bank well did everything really from perth's to get business and then I was the manager of the business council at home and actually was in brighton in brighton wow fine so that was a and did your daughter work here no she was a dental nurse and she came back working in a hotel initially that's mhmm around a hotel chain for the great nice well that's great you'd have a cruise ship is that oh yes perfect so that's great let want a simple have a good listen to your back is that alright yeah okay hurt in the back when I fell yeah was gonna have a look at the back it's yeah you were I thought you could but it's not possible to okay nobody's normally looked at me I'm like can't actually it's benign right look yeah yeah get that out of way I can is that okay yes thank you in your back where did you hurt it it's going back really I see some scratch marks there on your back so press on your spine that's really tender isn't it yeah just go on your spine to make sure you haven't hurt it okay really sore okay and half an hour before the emergency room that's when was your report again did you say about time was saturday and you were stuck between the it's the last I fell friday saturday 2021 I've got quite glasses but I believe I didn't wear it okay and any change in your chest or your tongue no you more comfortable if I'm listening to your back yeah trying I'm to get a little bit of a stretch so look at your tummy is that alright and you can get a scan alright some stuff in there isn't it no there's a of stuff not huge enough but I know it's it's usually I've been sitting at the house and mhmm sometimes coming your waistband on these these days they've come out so they've got a little trouble with the belt the belt yeah keeping it on it was kind of magical oh that's hopeless and painful I bet with your back trying to twist around and well I I can't I couldn't sort of look down and difficulty mhmm tips don't seem to click very easily mhmm and I need to know what to do about it not not sure I have a tendency okay right right so we'll scan your back and see what's going on given you're in hospital we could make sure that you haven't got any breaks in your back or any of your right artery at all and what's your understanding of what we found so far in terms of our tests I don't know I haven't seen anything seen anybody fine okay but not to really have a checked they pulled my feet about yeah haven't read about that yeah so I haven't sort of been told anything yeah fine so you've had some blood tests you haven't shown anything concerning your markers of infection are normal and the rest of your blood tests are fine there's nothing particularly worrying yeah good you've had a scan of your head the scan of the head does show us what's going on in terms of glucose unfortunately the hand scan of your head shows there's some small dots in both parts of your brain those findings are most consistent with the potential of cancer spreading up to your brain I can't tell you that for certain but it certainly looks like that sorry not unexpected yeah but still not very good news I'm really sorry the good news is that the cancer itself is not causing your symptoms what most of your symptoms are related to is swelling around the cancer because when there's cancer there it attacks the brain tissue and causes swelling we can give a medicine a steroid medicine which reduces that swelling quite significantly and can often improve symptoms quite significantly it doesn't fix what's going on but it does improve symptoms quite a lot so I'd suggest we do that if that's okay quite a high dose of steroid they're strong medicines and they have side effects they weaken your bones so I suggest putting you on some bone strengthening medicine alongside it they irritate the stomach so I'd suggest putting some gut protective medicine next to them sometimes they can make you feel a bit wizzy sometimes they make people hallucinate and feel really weird if that happens just tell us that we can do something different but they do work really well for the stuff getting into your brain then I need to speak to the oncology team about what we're going to do about that because you can't be on steroids forever whether some radiotherapy directed at those in the brain would be helpful for them to do need to get them to see you to talk to you about that well whatever whatever you say yeah yeah how are you feeling oh well okay I suppose yeah not not brilliant no of course of course but any questions or anything that I need to ask no well I do need the toilet again that's a result of the radiotherapy I think yeah I'm sure so I never quite know I go quite a lot but bowel is normal well no I mean I've got to do what's recommended I think it will make your symptoms a lot better well anything that will help is better we'll get that sorted for you definitely now do you think it will eventually it will be okay eventually or not what do you mean well is it term or not I don't know that unfortunately when cancer spread it can be more difficult to treat and we need systemic treatments when a cancer has become systemic like this think there is incredible developments in the world of treating cancer in terms of immunotherapy and systemic counter cancer therapies like chemotherapy I think treatment for this is going to be more than radiotherapy can do because it's more generalized than that and so I think we should be talking about chemotherapy and therapy and tissue for immunotherapy if we had a look with a camera and taken some biopsies of that lesion in the rectum we wouldn't have the full right up to the you don't need to be aware of this it's only allowed up to where the tumour actually or where we thought it was we've got some tissue my? Is that there are some amazing treatments that we've got in the way of immunotherapy now which can be fantastic for cancers so I think we need to work out that didn't suit her they do was okay with that effects from things everyone expects that to be what happens when you say you do this and do that kind of thing or before of course not all of our treatments have side effects and most strong treatments have strong side effects everyone's different some people feel fantastically with them it's just the nature of it their disease and the treatments just don't get on let your oncologist know what's going immediately of these steroids you're in a and e in torbay hospital yeah you're in a and e so this is the a and e corridor 1 of the corridors is the drug group where the nurse is preparing that's the term and just enjoying it for some rest of the time so yeah you're here in a and e you need to come from here to our acute medical unit which is just across the corridor once we get there we can get you over there and look after you in a slightly nicer environment not that this is too bad it's quite miserable but it's yeah some action that's good knew it great somebody's out yeah there's some wind coming out there that's good and yeah you need to have some strong steroids as I say to dampen down any swelling around those brain and to improve those things sort of you have to use these strong steroids pack your nerves for a we can understand what we're actually seeing okay think I've got some more work alright I think I've work am I oh thank you good indeed a hand I'm the 1 to stand up because otherwise we have our own yeah shall I ask him to help you stand up yeah so okay I don't know if there's a query stand up so you can do for him is it yeah remind me okay okay symptoms are clearly red flags into 1 side which makes much more sense yeah for bilateral leg symptoms they're giving us a better chance of having a better having of having of having so that's peter francis 01/1953 76 year old man past medical history t4n2m1 metastatic low rectal adenocarcinoma with lung metastases and liver lesion completed 5 fractures of palliative radiotherapy on the 02/27/2026 he had a laparoscopic loop defunctioning colonoscopy for advanced rectal structure symptomatic of a pending impending obstruction on the 12/23/2025 and a sigmoidoscopy the 12/17/2025 which demonstrated an ulcerated tumor in the rectum 10 centimeters to the dentate line couldn't tolerate previous pr therefore gastroscope used which passed through the narrowed anus circumferential necrotic ulceration likely due to tumor discussed mdt on the 01/02/2026 presented with a 2 month history of change of bowel habit to amu loose stools 2 to 4 times a day 3 weeks of lethargy and shortness of breath and with significant symptomatic anemia ct demonstrating low rectal tumor involving the margin with lymphadenopathy lung metastases in both lungs and a suspicious liver lesion flexitig and rectal biopsy demonstrated moderately differentiated adenocarcinoma so medications list pregabalin 75 mg twice a day morphine modified release tablets 15 mg twice per day brinzolamide eye drops twice a day in both eyes latanoprost eye drops both eyes once at night torvastatin 10 mg once at night beclinethasone nasal spray 2 puffs twice per day allopurinol 100 mg once per day glaucoma january 2025 cataract january 2025 hypercholesterolemia 2011 gout 1994 in contact with rowcroft hospice nurses currently using oramor for analgesia plan is 8 mg of dexamethasone stat with gut and bone protection acute oncology referral to consider brain radiotherapy or systemic anti cancer treatment acute medical unit admission until oncology plan decided given not managing at home independently due to weakness add to the plan ct spine given significantly tender and concern of spread to spine and pathological fracture here and discuss with acute oncology discuss with the acute oncology registrar patient can come up to turner ward suggest 4 mg of dexamethasone bd 1 at 08:00 in the morning and 1 at 02:00 in the afternoon with gut protection and bone protection as previously discussed and for referral to neuro oncology mdt and for that they'll send me the referral form