Michael jordan oh super super thank you come on in mister john have a seat anywhere you like alright I'm rob I'm 1 of the medical registrars nice to meet you nice to meet you too tell me all about it what's been happening so I had a seat back in august mhmm so I learned it's called an acute lacuna stroke in my basal ganglia the first thing I did actually in bed was in bed in the hospital working in it as I do I went on to chat gpt to tell what symptoms were and what had happened and it built me a plan to recover don't know if it's right but I thought the quicker I get on with it the better it was so wouldn't have to go into and go mostly it seems to be quite successful okay and if you look last only last week mhmm I was I I always had this 1 with me as a backup but I didn't really need to use it right so I was I was walking pretty much happening today well pretty much overnight I was I've been under the weather for the last couple of days so I was a bit wobbly than ever and today I've got up and I just can hardly stand up I can hardly walk around pour and eat so as worries anything mhmm and it was just it's like I'd gone back to not quite the same but almost slightly worse than the first time around could because I felt like it was on both sides I don't know how much this is subjective mean I know the physical symptoms are very real but working out what's going on was hard and so I could hardly walk certainly I needed this I was all over the place when did it all start when I woke up this morning you woke up with the symptoms oh god but subjectively they've been getting worse the last few days is right well it's I've just had a couple of I've been under the weather I'm diabetic I noticed usually because I usually I can tell because we basically our diet is mostly I don't know if you know riverford I know riverford yeah so we we just I live in darlington oh I see okay yeah yeah so we just live off of that mostly lovely that's fine and I I never smoked hardly if I drink a lot where is it well it's so the the. There was nothing particular that was different but I have been under the weather and 1 thing I noticed with the diabetes is that my sugar level goes really up when I've got an infection mhmm so I put it down to that and because I was a bit more wobbly than the 1 and and actually the improve it had been like that you know I improved a bit and then a bit down and improved a bit and a bit down so I just put it down to being a bit down again and then this morning it was just it you was like a binary thing I'd gone right back to the beginning and and when you first had your stroke which side were you weak well the first time I had it it was just the left side so it was leg and arm and hands and now your arm movement looks excellent and I saw you walk in here yeah so I think that was the most successful thing because I couldn't type mhmm so I did this weird thing I learned all piano scales with my left hand and I learned every scale it because I had and piano it was really successful so I was back to doing that and I've seen a neuro physio a couple of times now which has been helpful and they've given me some good exercises and and the physio was actually quite quite like the chatty pt recommendations yeah fine like that so you know so but but it's yeah like I said it today it's just absolutely well desco I mean and I'm still feeling under the weather but it you know it was a big big drop today yeah and I was just a bit worried and yeah and in what way was it a drop you symptoms on both sides is that right yeah so it feels like I was walking on both sides and the other thing that feels and this is really subjective is nee 1 of our stroke nurses okay hi I was thinking about this that's why we didn't ask the question the 1 thing when I had a stroke in august I didn't actually feel weaker so when I first had the stroke I couldn't stand without holding on to something but if I was moving I was absolutely fine and I could walk a long way with no problem it's like being on a bicycle if you're if you're on a bike and you've got your feet are up on the the pedals and you're not moving you fall over but as soon as you're moving you're fine it it felt like like that yeah this time I I actually feel like my muscles subjectively feel like they're weaker don't know that's true mhmm and it's on both sides more than just the left hand side exactly so but certainly the symptoms you feel a bit weaker on your left hand side residually and then that feels a little bit weaker than yes yeah exactly or but I've been I mean I'm pretty stubborn so for months and months and months I've been working hard on trying to do everything I can to try and improve it and it seemed to be going debbie any problems with your speech well not that I noticed really I can't detect any problems with your speech seems very good well I'm I the thing is my I don't know if there's anything cognitive I mean I my job is very brain based so so I don't think I don't think no 1 said to me it's got worse any problems with your vision well I've had problems with my vision for a long time because of I'm I'm diabetic I've got a couple of things going on so 1 because of the diabetes again this is you know it's crazy with my lifestyle but they they always at the surgery they used to joke that it was type 1.5 because it didn't fit mhmm because my diet and and I I I try to get out walk around the hills and bricks them every day because otherwise I'm sat on my back side too often staring at a computer mhmm but I I've had sort of macular thing and diabetes related stuff I've also I've got cataracts which are developing mhmm which is frustrating because they said once it gets you know a bit worse then they can do something about it but not for a while yeah and so I I'm not even sure if I'm not noticing something but my my eyes are are great so I I I know all the tricks on windows laptops bet well you know I've got a big screen and I can make the whole thing move around mhmm so I have to use all those tricks but it that doesn't seem to have changed overnight as mhmm you know yeah of course it did seem to change quite so the the 2 things that happened in the past which really caused quite a step change in in in in my vision 1 was in 2018 I had sepsis but no parts of your vision are missing is is my is my no good fine and have you had cough and cold with this feeling generally unwell I've been a little bit coughing it seems like you've had a kind of cough yeah yeah but not coughing but you just well I I was a bit more snotty yeah was a bit snotty yeah and and I was flemmy yeah fine and yeah things like that but it was I just kind of took it as you know 1 of those things you know yeah and and I and the I problem is because I feel like I've been hammered by quite a few different things I almost like don't wanna make a fuss too much because the thing is something else and well we should check your glucose to make sure that's not high because that's what we call high this morning know was it high how high was it it was 15 15 yeah you've a leeway you got sorry you've got a leeway yes see I used to pace them myself you see because I I now luckily the nhs pays them but because I 1 of the in my crazy life is I used to teach data science to master students at exeter university right so I thought let's try and see if I can model you know all my so what's your blood sugar now then well today it was quite high last few minutes yeah I think it's checked it before we came out and it was I was think probably about 16 or 17 sometimes that can cause funny symptoms and make you feel a bit like having a viral infection or whatever might be going on in the background well that it's gonna make your muscles feel weak well the 2 things that I may be talking absolutely nonsense but the 2 things that seem most closely correlated to when it goes crazy are it's rare you know I I usually unfortunately when I get diabetic reviews if there if it has been back usually it it feels like the underlying assumption in what they're talking to me about is stop eating so many donuts and you know I'm just not that yeah no I'm not saying that no no I know you're not no no but I just that's the challenge but the the 2 things that seem to be mostly correlated with bad numbers are infection I've noticed and lack of sleep which has been my constant problem and it's been I've never it's very very rare that I sleep well so but I think it's very common to see exacerbation of stroke symptoms when you've got a weakness on 1 side of your brain when you're stressed by anything else so any kind of physiologic stress an infection hyperglycemia anything like this can cause a slight exacerbation in symptoms but what you described doesn't sound like a new stroke at all because the symptoms are bilateral both sides as opposed to 1 side and it's not disabling your speech and vision or your arms and legs as far as I can tell and I saw you walk in here which is good I guess in terms of acute treatment the reason I've come to see you acutely is because we can provide immediate treatment for stroke given you've had a recent stroke a) and b) the symptoms aren't disabling and c) the fact that we don't know the clear onset time because it happened overnight means that there's no role for any significant rush to do lots of serious treatments here if this were a stroke and I don't think it is so I think we should look for other things that are making your stroke your old stroke symptoms be exacerbated look for infection check a viral screen check your glucose levels again bring those down do you take insulin for your diabetes I do I have 1 I'm not sure if you've that successful actually because they changed me to 1 that I only take once a day in the morning and and then it's it seems to be not so great during the day when I'm not eating so much when I have a bigger meal and in the evening and in the night it seems to go down quite nicely what insulin do you take tresiba is it can check it on my email and it's yeah hello tell me maybe I can find you on the computer I think we can find the air are we we're not going do anything if you want to stay in more than welcome but I'm just going to tink around the edges it does sound like exacerbation to pre a recent straight line into the virus I suppose the thing is girl I've I've had these different things like you know sepsis at 1 of I almost didn't leave the hospital in the end and it's I feel like I'm I don't know if I'm you know I'm always worried I'm not being honest with myself about all this sort of stuff but I feel like I've tried to do every bloody thing you can do and so I'm never quite sure that's okay I've got it here actually I've got you on 2jo is that right yeah that sounds right it was with a j yeah how many minutes do take I say 38 38 not severely in the evening yes no in the morning that's fine and urinary symptoms at all sure they pass it over to few days I've I've I've my bladder's been a bit weak I've I've just been dripping a little bit which is mhmm again that's new and so you rush into the toilet more than normal the last few days yeah I guess with the blood sugar's high that could contribute well I I can't get a urine yeah although if I've other periods when you know I've been have an infection but I and I haven't had that I when early on when I got the diabetes I clearly was something I didn't know anything about it be honest with you so I I I was going to the loo quite a lot and drinking quite a lot it's the classic symptoms to do but this time you know it's it's unusual for terf so let's dip your urine and send it off to the lab yeah right thank you neu bring me up the urine thank you neu just comes along to facilitate doing urgent things which we don't think we need to do I think dip your urine and see if you've got a urine infection a lot of glucose is we'd give you a bit of insulin if required to bring it down yeah that's really high 0.9 yeah can make you feel a bit wizzy and funny and make your muscles feel weak certainly check a viral screen to see if you've got anything going on there as a cause for muscle weakness on both sides and should we give you a little bit of insulin to bring it down when you you've had your tgo this morning is that right yes I did mhmm so yeah yeah fine that's the first thing I normally do and your dapagliflozin have you had that as well no not yet so I I yeah my I've I've set up habits so I don't forget so I have I have the insulin mhmm then I have breakfast and easy mix a super healthy nuts and seeds thing for me yes and then I have the clopidogrel I know you can have that with or without food but clopidogrel and then my insulin not my insulin my metformin yeah afterwards because so I've got something in my stomach and and I take the statin at the the end of the day mhmm does reading that that's a better time to take it but yeah I know that's true overnight is better you make most of your cholesterol overnight right so it's the most active then can I have a quick look at you do you mind of course you're only allowed to get up or move right I don't know where you are just move your hands to show me if that's okay thank you turn them over for me that's lovely my fingers are squeezed on both sides really tightly tight again that's lovely can you pick your arms up like this now awesome that's great push me away pull me towards you very good the hands like this for me lovely push me away I mean the 1 thing that used to be strong about me was my arms to the hands because I've I've spent 45 years playing guitar so strong still it should be yeah but gonna progress into your heart lean forward I've got you guys to your back okay think that's in the front of me breathe back for me now tap that side in then again and then down turn the last 1 that's fine pain in the tummy at all no no actually 1 thing I can't say about I I haven't even said anything to this last week I noticed when I was trying to go to sleep mhmm my breathing sounded raspy that it wasn't difficult for you it was just that I felt like you were going to be some kind of you know there was a flap on your chest or something like that can I touch your tummy do you mind painful at all sometimes people get little infections and cellulitis around where they inject can their I have a little bit of yeah of course thank you no nothing okay thank you very much what kind of treatment are you out there well for oh a big cyst and they gave it's me just underneath unfortunately the doctors were away and the locum didn't they just said oh don't worry about it and it became the size of a grapefruit so I ended up having that was my first experience at all the hospitals yeah it's true maybe a lot of because you've had diabetes and stuff is that right well could yes that's true I don't think we knew any time exactly so can we x-ray your chest is that alright yes of course yeah so we'll get you a bit of insulin to bring it down and see if it makes you feel better great we'll get an x-ray of your chest and see if you've a nasty chest infection check your urine see if you've got a urine infection check some blood tests to see if there's anything that jumps out there as a cause to exacerbate symptoms it and might be totally irrelevant but when I had the sepsis it was a urinary thing renal sepsis so certainly when you've got high glucose levels you wee more and people sometimes find it a bit uncomfortable because there's lots of glucose in the wee but it could also be a urine infection as you say so that can exacerbate constricts do you know what people really I mean I know this is in your area is just to be able to talk to somebody who could because I I I like to think I'm doing as much as I I can to try and control it and and it feels slightly depressing to put it mildly because you know I don't think it's your fault that your glucose is high I don't think it's because of something you've done I think it's because you've got an infection do know what I mean that's what I think is going on I think you've got a viral infection probably a viral probably yeah and you've got a viral respiratory tract infection that's made you feel a bit snotty it's given you that horrible sputum y feeling on your chest when your body responds to an infection it drives your glucose levels up to give your body cells more substrate to work with more energy that they can use to fight an infection and that makes you feel weird and a bit off because your blood sugars are high and it also makes your muscles achy in the context of having slightly weakness anyway because of your previous stroke it makes you feel much more weak and that's why I think 99% has happened but I'll do some tests to make sure that's definitely right and I'm not missing anything else does that make sense it makes total sense it kind of explains all the different bits that are going on this may be 1 of those stupid patients who read too much but stuff in 1 of the things I was reading in some articles is that if not sleeping you're well no I I had a private my company pushed me through a medical once every couple of years mhmm and for the first time they measured my heart rate variability mhmm and so there was a bupa thing and so they said you are the lowest of somebody your age for anybody and they so and I said what does that mean and they said basically even though you might think you're okay and all that your body is physiologically in fight or flight all the time and so they recommended I deal with that without telling me what that means what does that mean 1 of the things I was reading is when you're in fight or flight you produce a lot of cortisol all the time and the cortisol keeps sugar in your blood because it's because it wants to you know have it available to to use very quickly and and given the fact that it it I wondered if there's I've kind of wondered if there's some kind of connection between all that sort of stuff that you and my lack of sleep and that that sort of stuff yeah just a strict call okay yeah so I I don't know if if there could be a a connection there because I've I've tried everything to help with my sleep and it's never really what I do all the I I know all the kind of sleep hygiene things and and and so I wonder if not getting enough sleep is going to be of course not if not getting enough sleep it will of course I mean it must in some way have some impact that I'm not aware of it will won't it I think all these things are complex and multifactorial they feed into each other that there's a clear this causes this causes exactly it's all feedback based exactly you have high blood sugar which leads to the change in your heart rate variability which also causes you to retain more sugar and it's they're complicated feedback loops aren't they and we're messing with things we don't really understand yeah but it makes our numbers look better so we're about that but no exactly but I do think I would I would pay save up as much money to to try and deal with this thing because I I've read the books and done all sorts of things because that's been a I feel like I think if there is something which is a major cause of a lot of these things I wonder if or at least a contributory factor that sleep thing is is a god I've never slept well I might need to and that obviously affects your affects everything doesn't it it it does I mean I do you snore when you sleep no it's not that's the thing I don't snore honest it's so quiet sometimes it scares me yeah really I'd like you to snore she pokes me sometimes to say are you deed it's because she's because I'm quite I I you know I if you smell if you smell yeah but it's it's but I I've looked anywhere where I could go and find out about it or get some advice or something like that I talked to people and they had no clue very strange I mean I'd be happy if someone said no mike that's not the cause everything I kind of read as an amateur is saying that a lack of sleep can have a lot of oh yeah definitely impacts but I don't know where to go with that information I don't know either I'm afraid I'm gonna bummed up my question so for some reason I'm not saying it's not a different end of the body but I think a sleep study could be helpful things to think and that means that's where they watch you in a room and see how much you actually sleep and monitor your levels I'd like to do that yeah that would be a good thing wouldn't it so I request some blood tests for you super insulin you normally just take the tga you just insulin you don't take any other insulin I should have asked them but they just changed me from the twice a day which seemed to be reasonably effective to this 1 which just seems to be a bit more hit and miss but I don't so how many units again 38 8 once a day fine does that sound no sounds like it helps me dose how much insulin to give you now to bring your good sugar back to a normal age when I work just to have an idea of how sensitive you are to insulin again this won't be a super question I've I've heard of people who have their normal insulin and they have a sort of emergency 1 that can drop in quickly don't that'd be a sensible thing if if I'm I mean I know how to I mean I'm I am a mister data sort of guy I'm very so I'm I'm very careful like I said I used to build I was building excel models when I used to pay for these myself to try and track sleep food exercise doing all this trying to see where the correlations were yeah and food was almost there was correlation when I make silly mistakes like discovering the cornflakes of a disaster yeah because of the carbs yeah but most of the time it wasn't to do with food at all it was you know so would it it make sense to have is that a thing you know that people have emergency insulin for when so some people use a different insulin regime where they have a long acting insulin right which works over 24 and then they use boluses of insulin to which they use based upon how much they eat and they carb count and then use insulin as required to bring their blood sugar is that what type 1 exactly right yeah which is what which is a different pathophysiology insulin deficiency as opposed to what we think about in type 2 insulin resistance and so but we're often wrong you know is what I should say about diabetes is we don't have a good test for it even the antibodies that we test for type 1 diabetes don't cover all of the spectrum people with type 1 diabetes and it's incredibly complicated and there are all these it's insulin interesting it's to say oh it's time too it's fascinating amount of time and nurse said that we called you on type 1.5 yeah you're very early insulin dependent oh yeah and nothing about my lifestyle seemed to make sense I was sent on this cooking course and what they were telling us to cook was much worse than what we already eat you know and and in in pain center and to be honest with you everyone else quite unnumb was pretty huge she's obese yeah and but is it is it a primary thing or is it a secondary thing do you get obese because you can't mobilize glucose because you have no insulin right or is it that you were obese before we don't know that yeah exactly so let's get let's get you feeling better the nurse I'll get 1 of the hts to come in and take your bloods from you and then give you a bit of insulin to try and bring your blood sugars down and then we'll get an x-ray of your chest and I'll see the result of your blood tests and take it to the super does that sound alright that's awesome cool thanks for listening guys yeah you too thanks they can come in just stay in here because oh okay I reckon no this is where the uni gloves stay oh I see okay pretty nice no worries that's the view