The opposite does but yeah they just they just have sick things they can't get it away isn't it I'm just it's what happened earlier they're gonna take me to a car that's okay so this is lisa hello I'm rob I'm 1 of the doctors I'm are you the medical doctor yes you're 1 of doctors I can see you had some blood tests done with the gp yes just to check up on things is that right were you having any symptoms when you had the doctor yes what were your symptoms I was I suddenly developed really swollen arms both sides yes mhmm and an absolutely awful itch itch my hands and feet were terrible it started off there and he's gonna take the blood from the eyes oh thank you and also my face and neck became a bit puffy mhmm and hot mhmm and then the itch became generalized yep it really was intense is it alright if I take you off yes absolutely yeah any pain in the tummy no okay that's good I didn't how's your weight been recently losing any weight no I haven't lost any weight nor have I cleaned down had any night sweats or good anything like that I've got and how swollen are your arms they've gone down now oh that's good it was just so when did you first notice the swelling a few just a few days ago and how long did it last for well I started taking an antibiotic mhmm which unfortunately turns out to be the 1 that's caused causing me this latest problem but at which. Do know flucloxacillin I see how long did you take it for well this time they picked up on the blood test that I wasn't really taking it at this. Because it was causing me so when did you start the flucloxacillin that would have been about 5 days ago and I only took it for 2 days before they picked up on it before you became noticed your arm swelling and then became it yeah but I had had causes of flucloxacillin several times over the last few years because of a marked tendency to cellulitis I see and how's the cellulitis that you were treated for has that settled down I mean was admitted to hospital and I was on iv antibiotics etcetera I ended up being in hospital etcetera but this wasn't last a couple of weeks no no no no that was in 2023 so the cellulitis that you're being treated for at the most that you were treated for 5 days ago penoblastic penoblastic penoxylmethylphenicine mhmm but unfortunately from time to time I still do get cellulitis yeah and and how is the cellulitis that you were treated for with the flucloxazoline has that resolved or is that still there well it mostly resolved but most recent not this 1 this time yeah and you're not talking about this time so that's this time it's all better yes because you only had 2 days of antibiotics is the reason I asked yes so it has resolved good this this time well that's good but the the last time it didn't resolve at all and I was put on a different antibiotic 1 that tackles antibiotic resistance I can't remember the name of it offhand that's fine and tell me about your life more generally does anyone live with you at home or by yourself by myself with my dog and cat with your dog and cat do out you of the house very much I haven't been able to leave the house except to come to hospital in an ambulance for 5 years goodness because I cannot do steps I've got steps to my house oh I'm sorry can't even get into my what stops you from doing the steps it's my hip I'm waiting waiting for a hip operation yeah I've been on the waiting list taken I've had it and taken off it several times because of having lymphedema mhmm in your legs yes bilateral and often leg ulcers I'm in bandage wrap and things yeah and what's the do you have diabetes is that the cause of the leg ulcers you need to treat everything I haven't actually got diabetes that's good and do you drink or smoke no no you're a clean living kind of lady and you use those chew sticks to walk around do you use them around I the always use the walker except in confined spaces when I have to transfer to the 2 subjects I see fine and at home around the house you use a walker yes okay good fine and who does the shopping and things like that oh I get it delivered delivered fine alright it's good to know thank you you and allergic to anything no but I've obviously had a you've had a yeah and possibly had a drug induced liver injury to the fluvoxamine which can happen quite commonly from our perspective as liver doctors we see that quite often and especially age and my gender not on my side for that is it that's true and it does seem to affect women more yeah more commonly than men that's what I understood I guess the other potential is for an obstruction in the bile ducts that drain the liver yes you need bile to help you digest fats yes and the liver's job is to produce bile and it does that by detoxifying your blood and it uses those waste products quite cleverly to help you digest fats in your intestine have you noticed your stools going quite light or your wheys becoming darker no you've not noticed that that's good fine and are you opening your bowels regularly any diff any problems there not becoming looser or anything like that no no good fine and any fevers or shivers and shakes or feeling hot and cold that might show an infection in the bile ducts no no good I mean I I only have shivers and shakes when I'm like sickening cellulitis I recognize it always you recognize that sort of malaise you know of course and also I've got a a fib mhmm and that makes me feel quite poorly when I'm having an actual episode yeah fine alright we can have a look at that we can get an ecg of your chest or some from your chest and see whether how your a fib's doing is obviously some blood tests is gonna be super helpful to work out what's going on yes and you know I've got cll I read briefly that you had cll yes but I haven't looked into it that much must have no you've been with lots of is that alright okay I haven't really got stuff that I would call symptoms good so I've been on watch mhmm last 3 years since so you come in that easily you do a little and you'll send a viral screen is that alright that's great fine you've been on watch and wait on no treatment yes good fine alright I saw doctor zhao think I don't know about it yeah fine very good I guess it depends what the blood test shows you today we'll do a big screen for other causes of jaundice it could be that this is a drug induced liver injury from flucloxacillin yeah but it could be also something obstructing your ducts a gallstone in the duct or narrowing in the duct for whatever reason and looking at that with some imaging whether that's an ultrasound scan or a ct scan would be really helpful isn't it I it doesn't seem like you're that we'll wait to see what your blood tests show but from looking at you it seems like we could try and get you out of here as long as we get that imaging to get and and come up come up with a plan yes does that sound alright oh definitely so we'll see your blood tests I'll chat to the ultrasound department to see whether they might be able to scan you today but if not we'll do a ct scan and look at your pancreas and bile ducts in a bit more detail and we can come up with a bit of a plan based on that does that sound alright yes yes very good 1 question of course I mean I'm sure I'll have other questions down the line because of you because of you mentioned about fat the fat issue does does that mean that I should be taking extra vitamins if your bile ducts are blocked for a long time we usually do top people's vitamins up particularly fat soluble vitamins yes however if the bile ducts are blocked for a very short amount of time it doesn't usually cause a problem oh okay yes but it's only if they're chronically blocked or the pancreas becomes dysfunctional for whatever reason yeah can I have a quick look at you do you mind if you no just look at your hands to start with that's fine nice hands what did you do for a living I work with young children with special needs in a school environment or in a home environment both both yes thoughts so instead of social work or in as a special you're a teacher like educational needs teacher I start yes exactly although I started I started off as a nurse I started off as a nursery nurse right working in a hosp well I was actually in london working in bart's hospital in the special care baby unit loved it great and then I decided to go towards a slightly different aspect yeah lovely so I retrained right cool we'll listen to your chest more heart cells have you been itchy on your chest at all oh yes I've got this awful rash you little scratch marks that's where you've been itchy right well yeah I mean I'm they they never heal mhmm that's a long standing thing for you well the community nurse thinks that it's more more than likely to be connected with the chronic lymphocytic leukemia yeah think you're right could you support and have a listen to your back absolutely big breaths whenever you're ready in and again 1 that sounds normal lovely and then these legs are dressed aren't they not worth taking them down no rest up to the knee and then you've got a brace on your knee is that right yeah I'm just do you notice any swelling in the legs is that sore sore yes I'm sorry you've got some swelling in the legs don't you there's no edema is it on both sides yeah yeah my legs are always painful alright thank you very much sorry to experience pain and things no no no I apologize do you have any more plans for the staff the lady while she's in here usually we would ecg that would be great yeah good luck thank you very much kelly and that are out there so they can come and done and oh someone else yeah the blood's hailey stallings stem so thank so you much thank you yeah okay have a lovely night I'll have a chat to ultrasound and work out how we're gonna scan bye bye you too bye other than you