Tell me all about it I it all started I couldn't get the soup mhmm or no we'll we'll we'll go back in time mhmm I've had this awful sinus problem where I haven't been there's nothing in the there's nothing in the nothing solid is coming out just water water water water it won't clear mhmm I've tried antibiotics yeah I've tried nasal sprays I've tried uncle tom copley and all head underneath the old vic and things like that absolutely nothing so bad cariasis and things for how long oh I've had that for about 5 weeks 5 weeks oh goodness alright so anyway and then what happened more recently for you to come to hospital had a coughing cold I've been having a lot of coughing and colding and a lot of getting up at 1 or 02:00 in the morning because I'm not being able to breathe and I'm upstairs and I'm having to use a sort of cup it's a spittoon oh it's a lot of scutum oh absolutely what colour is it it is quite clear when it starts off but there's a lot of effort that I'm putting into it to bring it on so I can clear it if you understand what I mean of it when it starts off it's quite thick but it's white and is that a change to your normal cough do you have a cough normally no you don't normally no why no and when did that start the coughing the coughing started about 3 weeks ago so 5 weeks of snotty nose yes 3 weeks of coughing bringing up yes clear sputum any fevers over that time have you felt short of breath or wheezing oh yes you've had more short of breath yes yes and then the last couple of days surprise surprise I get this goodness gracious not the words I was looking for actually I'm not sure what it is but I I I it started off with a little bit of a rash tear you know is it tender or painful when I'm pressing on it no and that all started over the last few days that started in the last couple of days and what happens I don't know I've been having a little bit of a problem around here right have you fallen over or hurt yourself no I haven't have you been lying in front of the radiator no no no or an electric heat lamp or anything like that no I have had heat pads on them have you on your chest yes fine sometimes you can see this after you've used heat pads have you been putting them on that part of your chest no making you're breathing better no that was your test and you've put them on I haven't I haven't been putting them on my chest not on my chest interesting no I've been putting them on my neck mhmm because I've got a I've got a sore shoulder mhmm it's it's something that physio keep on bothers me off with I'm afraid and then I understand your bowels have changed as well is that right yes I've been having a bit of a problem I'm going down I'm doing a lot of wind is coming out but I'm having to push down and zip there's no tomorrow lots of and when it comes out it absolutely reeks and it's black geoff black like the back of this chair not quite as dark as anne but it's more like this like your trousers darker darker than that yes and not brown grey or black does it stick to the toilet bowl yes yes then I feel I don't feel empty you understand what I mean I understand I feel like there's more to come mhmm but it's done what but it's done when I play any tummy pain alongside it when I push down yes mhmm and the rest of the time no no no good alright alright and how's your weight been lately losing weight I haven't put on any you know right but but I I feel I feel like this is a problem that I've had before with constipation or no with trouble here discomfort up here I saw you've had some endoscopies before yes I am yes I have and your symptoms feel similar to last time you had those absolutely if anything worse I had 1 possibly 3 months ago september it was yeah read about check oh was it like long ago it it was september according to our records I thought it was you may have another I thought I had another this year I don't know or I could be wrong can I have another look at you do you mind no I'm sure no I'm sure you haven't okay just a bit of pus coming in your fingers yeah bad bad cigarettes that's how many how much do you smoke I smoke 15 a day how long have you done that for all ages yes well not my whole life yet so far far okay that's 1 a yes bit cool put really have a look just in the front a little bit of pain up there recently I don't know if that's anything to do here bit of pain in your chest up here up here where this rash is where this yeah can I have a look at your back yeah certainly have you got any rash on your back at all yeah a little bit on your lower back k deep breaths gonna be ready and up and down again think you can see the mitral valve polyp vomiting expiratory wheeze patients with a neck and we're doing it lovely and if I touch your tummy can you tell me if you're sleeping enough no not on you that's good start I'm how are your legs pretty swelling there who lives at home with you sir me any pets no any birds no no that's fine above apart from the cigarettes you drink alcohol I haven't had a drink since september I only drink when I go on holiday twice a year home when are you going on holiday may so so you know september till may not a drop no that's fine you've had some blood tests but I can't can't remember remember seeing seeing them them have a look at them have you you've some blood tests I've had 2 months let's have a look at them together and see what they show so your chest certainly sounds slightly wheezy and this rash is ever so strange what you describe with the stools doesn't sound very much like bleeding which is what your gp was worried about because usually people will have very loose stools when that happens as opposed to straining a stool neutrophils are up and white cells are up fine shall we x-ray your chest to see if there's any signs of infection or anything like that shall we get you on some treatment for an exacerbation of copd related to infection because of problems with the breathing there yes I have a I have a inhaler at home do you what inhaler do you have oh 1 leaflet or red or green green green yes yeah and how often do you use that as and when as and when okay okay and any other past medical problems no no fine alright this rash on your chest I must say I must do it in this any idea no I have to do a bit of googling I've been in googling it be caused by an wrap it could be I've certainly seen things like that from an heat wrap before I know I know that when I but it's only just come up that's the thing I've been using the heat wrap for sort of for for quite a while mhmm but it's only now it's come up know excuse the expression raise its ugly head through my skin of course so it you know don't know if I've been teasing it and it's finally said enough's enough mate yeah fine what about hot water bottles no no no I it's a it's a heat bath water spray yeah for for a minute in the microwave and you said you put it on your neck to help your shoulders overnight it doesn't move down the bed does it to possibly be lying on it could be could be mhmm is it itchy sorry is it itchy or rash no no no that's good and have you been eating okay lately yes good yeah what do you think about that knee it looks a bit like that reticulous erythematous pattern yeah erythemiatic I knew that I was a? To make can I have another look at it is that okay oh sure you wanna take that you found oh no no you wanna take it here excited so I can have it yeah that's fine yeah I I think you spoke about water wrap right I'm pretty sure about that okay okay but I think you certainly need some treatment for an exacerbation of your copd right with the course of steroids and antibiotics and once that's for your chest no sign of pneumonia or anything like that in terms of your bowels what should we do about that can you give me anything like some laxatives to help you move I would I would because as I said I I need a good clear out yeah very good I think I do will you yeah we'll send you home with some of those as well I don't think this is bleeding because people who are bleeding describe very loose stools yes that are incredibly loose all the time no they're dark and jet black like the back of his chair it's quite it's quite the opposite mhmm it's quite the opposite yeah that's good to know and no vomiting up blood or vomiting blood no have you been feeling like you're gonna pass out or anything like that no no no very good that's fine great and how about the smoking are you gonna stop or are you gonna carry on forever I think I'm gonna carry on forever I've been doing it I've been doing it for sort of 60 years mhmm I know what they say to do to do to do to but it's I'm I'm afraid I'm too savvy but anyways man it's I've got I've got no I've got nobody at home to stop me it's very hard to stop I I I stop when I'm on a flight or you know when my daughters come around to see me travel up from wales to see me I don't have a cigarette when they're with me and things like that I feel like I haven't had a cigarette since I've come in here when you're having these exacerbations of copd where you're coughing up more and you're having infection in your chest that makes us worry that things are getting worse and when you get 1 exacerbation of ecapd you're more at risk of getting them in the future yes you're much more at risk if you keep smoking if you stop smoking you've got a good chance of your lung not becoming infected and being able to do all the things you like doing going on holiday seeing your family whereas we know that when you get these first exacerbations the more time the more you smoke the more chance you have of being hospitalised for extended periods of time and not going on holiday anymore you cracked it the first time yeah and every time you smoke and you get in that chest it's getting a little bit worse it's making it worse and worse so lots of things we can do to help if you feel like you want to stop I'd be very keen for you to stop and look at your deficits to your lungs all right right good we could ask your gp to see you to optimize your inhalers because it doesn't sound like using as and when what what is what is name that's again and what else that's good that's good good that's good know that your you're mhmm you're a specialist in gastro mhmm but while I'm here can I can I chuck something out for you on of course you can right now I've got this the reason I put this thing on my back yeah this heat pad is because I I have a major problem with my shoulder clicking no and I'm getting it in here and here that's where that shoulder that's why I'm putting that thing on here to help me I keep on going to physio and all they say is do this do that I'm afraid I've had this for 18 months and it's done absolutely I'm sorry you know how do I go past having to go to physio for them to tell me to keep on doing I think gps often recommend doing 6 weeks of physiotherapy and then if it doesn't work then they usually can refer you on to see someone else if you've tried that already I would recommend going back to your gp to get that sorted but smoking also weakens your veins and it makes you more at risk of getting osteoarthritis so another reason to quit alright fine good man we'll get you some antibiotics and we'll get an x-ray of the chest if the x-ray of the chest is okay then we can get you out of here alright yes get out of here with the epap okay yeah sure thing it was lovely to meet you and you thanks very much I'm doing fine very well alright I'm gonna get a new tube yeah that's right it's worse I'm I'm I'm in 91 I've got this under pressure at the time of the surgery okay so you've got a dummy on this here yeah he's not on any of my medications he needs to do an outpatient lab or hey gp should do lung function testing just ask the gp to do it okay because you probably don't you're on the cp don't you he's a person at the moment he's got we've got classical hi it's rob from medichresh sorry did you pick me hi you okay I am yeah yes but maybe prematurely I should have stayed I'm sorry no he should come and have be observed and have some ops and have some blood tests she's okay I I don't mind if that happens in newmeds I'll run away any you know he'll be a bit of monogamous to come to amu he'll be better for everyone later is that a that would benefit him won't it yeah no it'll be better for him the way he can move his microphone and meet me up as he speak okay yeah exactly I would I usually call the site manager to help me with things like this because they're quite atopic so I call the site manager and say please could you help me with a porta to come and move this patient from here to there we'll and if you give me his hospital number or details I'll expect him in amu I'm sorry I'm not there 500 I can ring a bit yeah end of 9 very good very good same lady I'll expect him in amu turn the wheel I'll get some oxygen you need make sure that things are for next time thank you for calling me so I'll have your session on time so you've advised about the cold but you've had low carb diet high I've diet high I've a trying to get through to me not sure I'm I'm just gonna send it through the way that actually turns out he's not far enough oh imagine you sent it to me amazing but to he sounds a lot like a vasovagal but then he just had tried to sit up he's had another syncope so is he a medication he's not what was he an mri for outpatient an mri of his prostate an outpatient only for the only to the easy way to do it and we're we're within our rights to do it but I've got a basic I think better later okay on antihypertensive why is it when you eat more I have no idea maybe you're not allowed to eat and drink before an mri of your prostate I don't know why metal okay I'm actually just gonna do it do you want a blank on them just few quick yes I've done with her x-ray okay just for the last 2 tell me the actual who I am and I'm gonna be using the absolutely we should ask the guys in ambulatory what we do oh we probably just need to get the portrait to it don't we because we so either we can go and put him on the list or we could just do it after we've seen our next patient what do you wanna do we can do it after we've seen the next patient okay medication wise so we want laxatives you need steroids yaz