Again weeks 3 weeks ish mhmm and we've had 2 marvelous holidays I have lanka well well the first 1 was south africa lovely thank you that's nice great how long in in south africa well good month oh okay and I got off the plane and was amazed that I couldn't walk up the steps to the hotel oh right okay and that changed on a lot you know days when I was fine and other days when I'm through a struggle the first thing we did we stayed actually at quite high altitude pace anyway so all that happened got back home after a month to recover it and felt you know okay because they were too tough I couldn't walk far but nothing like I was able to do before christmas you had been taking steroids and doxycycline and then doctor blexley I saw a copd clinic in silkak when they had respiratory physio consultant asthma nurse they did all kinds of fantastic stuff doesn't they it's never happened in my life yeah it's great and I was there for a couple of hours just talking through how I felt and what had been done and then we went to see the respiratory physio in this car and I noticed that while I was away for both holidays my feet were swelling okay both feet yeah but you weren't sound good all the time when we went to see the lady in this car the swelling had moved up from my feet up to about 24 both legs had some surgical abducted stockings I see after 2 days that 1 disappeared completely it still swells up if I'm on the feet a lot but just around the ankle bone okay but this 1 has been much more stubborn the left 1 yeah and that's still swollen now it looks like your shoes are a bit less done up on the left than the right it's chucked on because when the feet are swelling I can't fit in something the other thing oh I missed that bit yeah I hadn't heard that bit I was prescribed let's try a different antibiotic because the doxycycline doesn't seem to be doing the issue and doing the business and at 1 stage from my local surgery they gave me amoxicillin but was in a hospital first time ever had oxygen first time ever in hospital about 18 months ago in a year and said no we want doxycycline that's the antibiotic of choice and then some of the sputum samples were analysed haemophilus influenzae came out then there was nothing it was clear then it was back again so I can't remember how I found out but I did know that that particular bacteria amoxicillin won't work it's resistant a lot of the time so I had to phone the surgery and say it's a rather that took 3 4 days before the second new prescription okay and what you went on back on doxycycline as a result that left oh you had levofloxacin and then your tendons got oh sorry and I was warned yeah but and I had 14 days where I only took 6 after 6 I just stopped but then I was aware that there was a bit of pain and so I was in here at the fracture clinic did your tendon rupture no okay good just tendonitis thank god possible possible tears oh really okay and that was it that was really painful for 24 hours and then it was all right again so I wasn't issued the big poop that keep your toes pointed down you know if you rupture yeah they gave me a flat boot which I would walk around just for support and that's 4 weeks ago so the first few days apart from in the house I'm taking the boot off and walked around was yesterday it it's the end of day okay alright the biggest issue for me is in the chest is your chest I know the last 2 weeks that's been really bad or longer than that yeah well it's been bad on and off for as I said 6 months 6 months a repeated course of antibiotics and steroids but then better it gets better and then it gets worse quite quickly you either had 5 days of 6 steroids about 10 days ago starting those okay so you've just say 5 days ago you finished that course of so looking back over the months I didn't actually think how many episodes I've had with prednisolone and don't it's got to be 3 or 4 yeah yeah it's a lot put him up to 6 because we're waiting for 9 to 5 yeah yeah I will get a face mask because it's the specs yeah I know it's a lot no nose in a minute it's a lot of spec yeah we might be able to hold in a sec you feel better now you're talking better when I was in hospital 18 months ago the first thing everybody said is you need oxygen you need it for the recovery and then I'd get told off when the consultant would go round the ward and I didn't have it in promptly for some reason but yes there's a big difference and so I just wondered whether that's what I should have had earlier in this last bout but interestingly I have the stupidity for not working it out when we flew to south africa the first day there I couldn't walk up the steps I couldn't believe it when were you in south it was christmas day and I went to dubai where our son lives the first day off the plane that was you know I was breathless I couldn't believe that was after south africa yeah there was a little break when we were staying in the uk well actually no we live in cornwall but you know what I mean 2 and a half months wasn't so then we went on this fabulous trip and the flight from dubai to sri lanka was only about 4 hours no but then we went and stayed at the place at altitude and I was struggling then and somebody said do you think the altitude effective?' I've never noticed that before but most people really do but the worst out of all was the flight home at the end of the holiday really okay because we were in sri lanka to dubai 2 hours to change planes well we didn't have 2 hours I mean we had yeah I understand and then all the way back to gatwick and I really really struggled to breathe so that's probably about 7 8 hours and what did you do in sri lanka how long were you there for 2 weeks 2 weeks did you just do touristy stuff stay at hotels or did you do other kind of things it was all hotels all hotels we moved around first thing like far from kalumba then kandy did the train ride the train was cancelled no no full up no we've done it before done it before oh have you oh good fine it is lovely I mean my son has been to sri lanka amazingly 8 times wow the first time he did he and I went on a cricket tour great I saw your hands absolutely fantastic that was 1998 '98 you know that long ago oh wow wow I was only born in '96 I don't have to rub it in 1996 yeah I'm a baby I am mhmm gracious you're you're up late aren't you I am past the bedtime yeah does it has it changed you're much better yeah you look better you look more like the colour of your t shirt now as not the colour of mine anymore you're starting to look a bit blue I mean I was diagnosed with allergic asthma when I was 16 but I've always even on wheezy days and so on it's not stopped you don't sound wheezy at all do you feel wheezy talk as well and it was struggling when I first sat down yeah but do you feel like you're wheezing coughing in the morning and things like that over the last few weeks yeah I knew today was bad but not when I first got up okay so you're having coughing but it's productive I'm coughing a lot but deliberately as opposed to it can't stop me I'm with you the reason I'm coughing is trying to shift this phlegm thanks very much that's all to the pub okay but yeah 40 steps up to the front door took me 10 minutes to get in the car yeah got to say right and do you and doctor beck said you'd never smoked before I did smoke but only for something like 3 to 5 years and and 10 a day kind of social smoking for that time no oh nothing like that fine no I think probably 5 5 a day for 3 to 5 years and how about alcohol do you drink I was a teacher so far too much okay good what did you teach primary school oh lovely fine my my wife I was gonna say partner we always think my my wife is a primary school teacher yeah so they're both primary school players oh really not the same school obviously yeah that would have been couldn't have worked yeah that's made a big difference I have to say when I saw the figures have I said this already I couldn't believe it yeah you mentioned yeah yeah I did it at school it was 88 great came up 70 but I was clinically dead mhmm are you allergic to anything nothing important just that's fine dust mite bedding dust mhmm and okay nothing we might give to you don't want any of that other antibiotic anymore yeah levofloxacin don't blame you that's fine I'll put that on in there after it happened they've more or less banned that in the united states and then look they've prescribed it so practitioners like yourself would say give unless we need to it was just look they've had all these antibiotics including 1 that usually is very effective and it's not so we could try something else but be it's very unfortunate to get out of it is really rare lucky you can I have a look at your legs you said your legs swell up at the end of the day they swell up within 5 minutes of putting them on the floor okay fine so the moment they're down because they're a little bit swollen now aren't they a little bit just up to the mid shin on the right and then on the left more and this 1 with elastic stocking went down and I've not used it again until the last couple of days it sore okay and I think I'll ask you paul what kind of stuff are you bringing up when you cough it's greeny yellow greeny yellow when it feels like I don't have an infection oh it's always greeny yellow well seems to be it got a lot lighter about 4 or 5 days ago mhmm creamy it's not very nice to talk about it anyway and I thought oh that's a good sign there's probably no infection there so when I became quite breathless again I phoned up the respiratory physio in this guy and she said just try 5 days of prednisone 6 tablets a day see if it helps so I didn't go back on doxycycline but that's what I've got with me well and in the meantime you've got support for the is it in the chest no no no you've done some work with these hands cricket cricket every single bone in my body I just I've done that off the oh sorry it was pumping up yeah every single finger's broken cricket okay fine nuns ribs twice both thumbs all these fingers that's why he's frustrated because he inflamed did a great job when I was 11 try and keep that up still just for a second shall so I think we'll I think doctor bleckley's spoken to you about it it seems very sensible get some blood tests from you book you a scan we'll do a chest x-ray first if there's no big massive pneumonia I'll book you for a scan of the blood vessels around the heart I will also look at your tummy because you say you've lost a bit of weight recently it's worth looking at your tummy while you're the scanner might as well so I'll arrange all that for you in the meantime I'll put you on some blood thinners to treat either a clot or the lungs or the leg until we get that result back I'll also put you on some antibiotics not levofloxacin but I'll put you probably on not doxycycline I'll look at all of your microbiology and find out something I think works and we can talk about it and then I'll put you on some steroids as well in the meantime while waiting for all those things to come back so we chuck everything at you glance and tests and then we can narrow things down as things come back but at the moment you're quite ill with these low saturation levels mhmm and so we should get you sorted out you sound like you're very fit and active when you're normally well I do happy to christmas I hope has anyone spoken to you about resuscitation about what you'd want if you were to deteriorate in hospital we always talk I talk to all my patients when they come into hospital about it from my perspective you're very fit and well I think we should do everything to keep you alive including jumping up and down your chest and into intensive care is that alright with you is that something you've thought about that you wouldn't want it's something I've never thought about yeah that's fair enough in that case I think that's a reasonable place to start do everything and that's good that's why I'd want alright get some beauty from you if we can and I'll make sure you're on some stuff to help you cough things up some misting masks to help you expect right 6 12 50 12 50 so you're already on max dose fine and do you use an inhaler I've got 2 inhalers 2 inhalers and I I can look that up it's fine I've need and trim those and trim aim for 95 to 96 yeah yeah above 94 95 is fine just scale 1 I think yeah yeah great and did you find eventspace page I'm just sorting it now so he'll wait with me in sydney scotland amazing thank you anything I've forgotten any questions I don't think so yes of course with all this issue with my breathing and I know that I've been told for a long long time that if you take prednisolone especially in long doses it can affect your blood sugar but my local gp surgery will also be monitoring blood principally hb1c just a medical review and then I have a phone call to say the blood sugar has gone up into the diabetic group so I've been prescribed metformin okay had a lung conversation with doctor bleckstein about that who said to be honest you won't do much to drop your blood sugars to metformin no but I mean I get a very dry mouth I get up about 5 times in the night oh really it's classic my father had it in his late 70s and 74 my maternal grandparents both had it but they were big people in portland yeah I understand so there's family history and they did tell me I was pre diabetic and the wife always said well isn't everybody here good? So you know she thought I might as well start it because it can suppress some of these other symptoms won't even control your blood sugars I was asked to bring everything I've got it all with me brilliant so I don't know it did say take me with breakfast does it matter what time of day you sleep the first time I can't imagine this it doesn't matter just take it yeah I think blood sugars that go high overnight can really irritate you as well so if you can do something to bring them down you won't be transformative to your blood sugars the metformin but you but they should do something you know as opposed to nothing whether it's a result of the chest issues or not what's been incredibly difficult for me is for months I've done absolutely nothing don't get breathless if I don't move around and I had this as well so what I do if I get up if and when I get up eventually get dressed I sit in a chair yeah it's improving I sit outside if it isn't I sit inside yeah I mean it's driving me up the hall sorry it must be awful eating nothing when's the last time you go out and did something but you know well it's happened several times on holiday I've still managed to get around but there's good days as well as bad days yeah fine but I remember distinctly in late november where we live I mean there's nowhere flack around sawdall I did a 3 mile walk which we've done regularly through probably a 1 in 5 hill and I didn't have to stop when was that I texted my son and said oh when was the last week you've had the cold yeah and then and then you've just been back to back infections the yeah you know 3 days later I've got the cold and then instantly that affects the but I recovered from that 1 in order to go away but I think the altitude issues and aeroplanes testing I don't know why I've never thought about it before I'm sure that really had quite a dramatic effect no it probably did but all the way back which was 700 I stood at the back of the plane nothing's happening yeah god I'm sorry because sitting down is just too uncomfortable I didn't bring it yeah so I nearly asked for some oxygen but I had jack daniels instead that seemed to be okay well you haven't got any oh no it'll just have to be the old fashioned stuff I'm not going to do it again well you're an inmate now yeah you are I guess the heart is the other thing to think about with the swollen legs isn't it I'll do I'll ask for a jelly scan of your heart and make sure it's moving well and I'll add on a blood test to look at the heart's moving in the mind of me because that would be sensible to do okay thank you no it's alright go and get all those things sorted you've seen me now you don't need to see anyone else until you come to the ward and see the consultant in the morning because everything's sort of sorted out I'll make sure everything's sorted for you okay you don't need to see the a and e team because we've kind of done it all I'll ask you to come straight over to the other ward the moment they can right brilliant is that alright or indeed if a bed comes up on the respiratory ward to go up there and they can see you up there in the morning if 1 comes at 08:00 that's unreasonable thank you very much pleasure doctor chambers my name is robert miller yeah it's nice to meet you both see you soon I'll make sure paige comes into tonight thank you yeah thanks a lot so the impression is most likely recurrent infective exacerbation bronchiectasis secondary to atypical bacterial or fungal pathogen to rule out concomitant ccf pulmonary embolism and malignancy as a cause of respiratory deterioration