Big procedure in the toilet so you know you're not allergic yeah yeah yeah fine perfect he's looking great thank you I'll have to look at the notes and stuff it's 0.7 abstract make sure it's it's 1 yeah that's fine thank you gcs 15 full motion how far is this better we are in fa is that a long way yeah fine did you say you've done a bowel somebody say bowel movements has he done a bowel motion jane I can't tell from this position somebody said it because that is don't know sorry I thought somebody said that it's like an act of words yeah so should we bring the bed down the corridor and tom I can't remember okay but this is normal and typical okay so I did notice he was a bit yeah and the and the length the duration is normal how have you had the seizures well it does vary but roughly once a month or since since he's been here this is his he's been here yeah I'm gonna make sure he's here he's he's that'd be great I'll make sure everyone's getting everything together everyone's gonna be careful is that alright you guys ready everything I'll take it from rocket doctor we'll get him back in bed and then wrap him a duetomy in and let's go through alright yeah thank you you're gonna put him back in bed it's a good time it's really cool yeah so you're have a massive can you do you need a fan no no no what can I mean you know just because obviously we need to go from here to there yeah you're in there we need to go from here to nearest nearest the north of the north great so you've got the local center yep that's good yeah 6 weeks oh I'm so tired I can't believe that I'm on call this is my phone call which was a nightmare last night so I'm gonna have to hit the metro tree halfway through the day I'm gonna let you guys manage it I'll never forget about the rats yeah what you said yeah that's not my dog yeah the other day there were 5 rodents oh really yeah because they it's another 1 like shadowing so these are his bloods but they're from the sick isn't it so you should have some bloods now checking his electrolytes to just refeed the blood and all your stuff he's now gonna pulse his phosphates are low place any of them his sodium's been low before and obviously if his sodium is low he actually seems to lower his seizure threshold so he had a seizure yeah so yeah so he's on 2 minutes yeah vacant type seizure on a background of known epilepsy we just need to pull this while you're waiting out on okay right keep trying lay for me alright alright you're going this way okay good alright sweetheart just leave it to your legs leave it to me fine you're fine spell and and then what oh no was it have there was it I don't know if that was on your I know daytime is different tonight I know it was on the calendar didn't know that 6 I think it was on the right it's an f251355 she's got a researcher trisha she's a hyperactive delirium she was just using a sense but whoever was dealing with it then the sho or I don't know what number was saying I don't think the is something that lovely lovely it just scoring 3 for being less confident yes but it's over the 7 so this normal triggers but I said you don't need to be able to involve the screening g says right that's where we have normal yeah fine a 100% it's a good to know catherine yes yes yes yeah that's it so she would get 4 wouldn't she being unresponsive or should she get 3 for that I guess a bit more oxygen I think there's some oxygen in blood yeah but it was nothing okay nothing to worry about no great we've not heard about that 1 no worry about then the osmotic 1 can resus but we're gonna take it for return so you can brilliant and then meccles and arrest is the usual stuff what do you guys wanna do at the meckels and ers yeah we do it for you with zomig too meeting him yeah yeah yeah be it would be great yeah because zomig is gonna be so he can support us do I need some of that stuff no no practice here oh okay yeah yeah he's but he's still doing the same okay that's fine that's fine and you're happy prescribing yeah like useful stuff yeah brilliant and do you guys wanna learn anything to say is there anything you wanna you know get out of it there anything you wanna do I just don't do anything you can't do that please don't listen to me I'm fine I can pick it okay there's nothing you wanna do today like do you want to like is there a procedure you wanna do is there yeah a case you wanna see so yeah do you wanna try and redo it might make sense to you no don't know I'll I'll I'll see if if there's enough during the day I'll go yeah you just tell me on the way I'm yeah yeah I'm not you have my yeah mean I can start early now but you can step up and do that you can do it on the day can do the 80 whenever I feel like it's good for you to and I can do this like we can change swap yeah yeah shampoo you're starting okay yeah thanks sounds sounds good man yeah we'll we'll hear you brilliant then can you leave alright we'll have to have a baby see you on the road see you soon no thank you have a good day are you look much better in bed no that's fine I didn't introduce myself properly I'm rob I'm the medical registrar on the call nice to meet you I've heard a bit about what's going on before and some of have before we just wanted to have a quick look at you if that's alright just examine you make sure there's nothing else to find that the surgical team haven't found and I would also suggest we get some blood tests just to check your electrolytes in your blood you haven't had some for a few days and obviously your sodium's been low earlier in your admission so that's been an early seizure threshold so it'd be worth checking that is that alright yeah you've drifted off which is I think it is reasonable after the emergency yeah great a very good idea fantastic well we'll do that then thank you sure check what you can do with a lab or gamma contrast x-ray mhmm okay yeah just do more of that instead because we'll check his make sure he's he has a few glasses before his next dose if he has another seizure then we load him with we load him with atorvastatin g at the moment if it sort of matches his yeah his fat we're in a rush to do anything over and above essentially he was yeah okay 10 days in a day and he had small bowel obstruction he then went back on the you know birds getting solids from the infertility industry does a thing called peristene as a as a kind of a name in irrigation referral that can be used every other day mhmm and all that kind of uses all that tummy tea little when when he you know just on these slides when he's in the yogurt of the cross mother that was I mean was amazing a hell of a lot mhmm but he's so irritated only at times tiny bit whereabouts and so he was seen yesterday he's actually there I would say that although doctor meehan she's young I might spoke to lee and literally rare she listened to his tummy and she said it just had to be very quiet now that's quite normal well I don't know but you know because he's because he's sort of at his? Of the yeah everything sort of in the mood but he looks pretty slow yes so does he he yeah there's no need for about like 5 days days where he's really too sore just huge couple of times completely and I'm saying swamped on this morning it was just somebody feeling uncomfortable yeah so and obviously we don't want him to go back into bowel obstruction we'd put him in yeah exactly and he cleaned his own so he's he's having all sorts of things and things like that so he's being able to normally has it every other day but he has it every other and then he can't he can't drug I know that's not it's not a small 1 that is that is the normal state of affairs yeah that's right so I feel like that very much is a bit risky mhmm great it may have contributed to this certainly yeah absolutely so sure I'm not going we'll get us back to work but if there's anything what are we doing on our side we're having a look we're doing your so sonatrist going in 3 meals a day on once a day so it's young so he it has been the laxido he says we're taking pulse once and a sashays it's very frothy and really you know told him it could be morning and evening especially a bit sporadic as to where that happens and then as of yesterday I think when you started to do 5 was yeah was obviously a bulking agent which if you've had a small bowel obstruction because things aren't moving well and wouldn't help a huge amount no you might obviously there's more of a factor in it know this is what we weren't sure if that was the right test or not he's just started that I'm wondering if that's actually center just the emergency on no no you're fine 2 a day is tonight 1 1 a day is usually yeah fine so it's good to bring that up we can bring that up to 15 which it is tonight that'll be really helpful and then should we bring the laxido up a bit and I'll speak to the surgeons about what because obviously they are really managing his care and I won't change too much they're probably experts in managing small bowel obstruction well you see the thing that happened was that he basically he came off of a colorectal pain yeah because they would do everything you were right was going but he hasn't had anything he's been feel like and and does that mean in the meantime you should keep eating yeah I mean I think putting things in the top is a pretty good way to get things up bottom because the more you eat the more gut hormones you can lose to help sort of transit so you need to keep eating so in my head abstract in my head yeah what I'm thinking is if we've got to a. Where the large intestine is completely full because it starts to block the small intestine but the venules are very rare exactly so that's that's you're exactly right that's it it's mechanical it's that really that is in that sense I was thinking do put more on the top okay so we'll have to move things like that yeah I think more lax more laxity yeah more laxity on the top alongside you is gonna be really helpful loads of smoothies and yeah things things like that are really helpful because I don't have a huge amount of fiber in them doing those mornings so I'm more likely to walk here so you want to keep it wet or keep it moving yeah no the seven's gonna come up to 15 tonight which is also gonna help as well okay and I've increased the laxity day I'll speak to them about the 5 pill and see whether they wanna keep that on it's mainly laxity so I get it distended it's like all kind of processes it is alright and it's so yeah it really does bulk the stool so if you know if you have something obstructing you'll have more chance of obstructing if it's very painful no it's only just a so so yeah I would that would be my suggestion for now just go for a bit more at the top end I've increased that as I speak so we'll see thank you what they what they think about it sounds good yeah if you how long how many days is it sleeping as well it's so urologists seem to be a bit irony no I thought it was colorectal initially and then went to urology which is what she was in yeah mhmm an hpv ward bill mhmm is that a reason I think it was surgery I know they love their team based system they love their handicapped I feel like I've got balance that makes sense they thought that it was quite quite yesterday but he seems well he's got back to the bowel sounds a year well I'm great last for sure was fine do you check your labs twice a yeah increase the labs a nice and so that will increase the night work after what are you doing I'm I'm better at oh wow just came for a bit more so I've had a of okay really we've only got 1 here we've only have to remind myself about iris iris was she's a messenger like a hermes okay she was holding golden cup and she had taken water from some well mhmm and when she was trans transposing there you go so go for the ultrasound yeah yeah and then as soon as you great let's go that's happy for you done same day I was doing a I'm saturday was I'm a what are you guys doing today you're barking yeah we're here we're yeah literally it's so it's been kinda like doctor I'm a doctor okay yeah been having some air you know mine had a little bit of a like a little bit of a thing he laughed all day oh he oh always a lot of fish yeah he's really good at the flexor he's amazing he's amazing amazing I'm glad that I love that so know just gonna I think they unleash their reality and like I'm really like I'm just gonna mean yeah I was just thinking I I ran from london and just got my number I've already got me I've been using this been I've using this you no when you look at you've got the opposite mouth and say you know on the other not sure if I can know see I'm not sure don't know think it's it's attracts me like I just think that they have different priorities sadly as people that make me sexually medically fine most of them do that more than me yeah are actually think that it just came back from the pandemic differently oh true I've been totally sick in a place yeah it's like much more mechanical much more likely yeah this is a problem I need to fix it no matter to be perfect to see your numbers mhmm okay do you think seeing someone else but for example I think I'll be able see I'm a or or no like like for example this evening mhmm I don't think I lose anything by letting you do it