Batch 3 - 1/10/14 - Consultation 3

Batch 3 - 1/10/14 - Consultation 3

Duration: 11:47

P - patient

D - doctor

(u.c.) - unclear speech

D:come in

(.)
P:good morning

D:hi [good morning yeah come in have a seat [I’m sorry I’m running a bit late

P: [you alright [thank you very muchno don’t worry it’s fine I’ve got the- (.) I’ve been excused from work for the morning (.) [so (.) (it’s cool)

D: [oh right that’s o- that’s good (.) I’m Doctor XXX I don’t think I’ve met you before [have I

P: [no I don’t think I have (.) I’m- (.) I’m XXX

D:what can I do

P:basically (.) my hands er (.) and my (.) arms have been in pain like RSI (.) repetitive strain
D:mm

P:for years cos I do drums and guitars

D:oh right

P:erm (.) I play in bands (.) do wedding gigs (.) and teach as well so I need ‘em all the time (0.5) and erm I think I’ve overdone it in my left hand

D:okay

P:so (.) it’s been about eleven days that I’ve not been able to use my thumb
D:mmhm

P:erm just really (.) it’s not a shooting pain (.) it’s just kind of (.) all that muscle there (.) and in the thumb actually

D:mmhm

P:it’s been- (.) it’s been a very sh- (.) almost like a pulsing (.) pain (.) I know something’s not right (.) although it’s not like- (.) doesn’t make me kind of like (.) shout out in [pain

D: [yeah
P:I know there’s definitely something not right in that muscle (.) erm so you know I can’t tie shoelaces or (.) open a bag of crisps (.) erm-

D:so anything where you’re needing to grip [it’s- (.) right

P: [yeah I just can’t do it because I know it’s- (.) it’s hurting me (.) er and then obviously I’m cancelling gigs (.) I can’t teach at the moment [(.)

D: [mm

P:I’m having to show people with one hand kind of put your finger there do you know what I mean

D:yeah

P:so (.) I think- I think it’s just a general case of erm (.) of RSI really but (.) just flared up in this thumb

D:has this happened a number of times before then [you seem to (.) be aware of what-

P: [yeah it flares up and then I just keep it under control (.) do regular stretching (.) i- (.) ibruprofen
D:right

P:erm (.) but I’ve- (.) I took quite a lot this week and then Thursday night I threw up (.) so

D:oh [no

P: [I think I may have overdone it on- (.) on that side so I’ve not- I’m not on any pills at the moment

D:okay

P:erm

D:d-do you get any stomach problems with a- (.) taking anti-inflammatories like ibuprofen do [you get heartburn or anything like that

P:[no I’ve never- never had any problem [with it and I know (.) you know you can’t stay on it

D: [no (.) (okay)

P:continuously

D:mm
P:so I only take it when it flares up
D:okay

P:erm (.) but I was doing (.) six a day (.) like every five hours taking two every five hours

D:two hundred milligrams

P:mm

D:yeah right (.) okay (.) have you ever seen anyone about it have you ever seen the physios to [know that yeah

P: [yeah when it first happened I think I was nineteen (1.0) erm (.) and (.) you know both- (.) I think it was both my arms locked up (.) so that the main muscle there (.) like I couldn’t really grip anything

(.)

D:right

P:and I just woke up the next day and they were both done in (.) so I had to take about six

months out of uni

D:ahh

P:erm so that was the first time and I went and got physio (.) and (.) you know had regular classes and (.) (they would) (.) you know massage the muscles and anti-inflammatory gels and all sorts of stuff (.) and then erm (.) since then it’s just kind of been a case of (.) er managing it

D:mm

P:and (.) stretching regularly (.) you know watching how much I play (.) warming up properly cooling down (.) erm (.) and then (.) it’s never been this bad since then though (.) because [like it’s been kind of eleven- (.) twelve days today I think when I can’t (.) do anything

D:[okay so you’ve not been able to do any of those things that you said

P:no
D:obviously not teaching playing

P:drumming I’m doing one-handed drumming [which you can get away with (.) erm (.) [but

D: [okay [for

P:[guitar it’s just that’s all- all your pressure’s on that thumb cos you grip the er (.) the neck (.)

D:[some stuff

P:so all the pressure goes there really

D:mm

P:so (.) guitar’s a no-no so (.) like I said I’m cancelling wedding gigs and it’s a right pain so I think I need to get some sort of [physio or something

D: [sorted yeah [no that’s (.) completely

P: [to sort it out

D:understandable there’s- there’s two things we can do (.) did you have any (.) ideas in mind of what you’d like me to do before I suggest anything [or is it just

P: [no I’m happy for suggestions I just need to try and (.) take a (.) step at getting it sorted [rather than just waiting for it to kind

D: [okay

P:of (.) calm down
D:yeah that’s fair enough I think when it affects your life like that [you just wanna get- y-you

P: [yeah

D:need to mo- [move on with it really (.) it sounds like you know enough yourself pretty much

P: [yeah

D:already that you’ve done stuff that you can do
P:mm
D:we can prescribe you another anti-inflammatory that’s- (.) sometimes just works a bit better [in other people (.) with a tablet to protect your stomach [as well

P:[mm [oh (.) right okay

D:so it’s just (.) one called omeprazole that stops you from making as much acid

P:[mm

D:[and hopefully it shouldn’t- (.) you shouldn’t have the sickness feeling with it

P:mm

D:and I’ll give you some naproxin (.) and- (.) and it’s just- (.) it- (.) some people say it’s stronger but really it’s just that one sometimes works a bit better than another

P:o[kay
D: [in people (.) and then the second thing is we can get you an appointment really quickly (.) at Sorrell Bank (.) GP Practice

P:mmhm
D:they have a physio clinic every week

P:mm
D:and they do this for people that have (.) a specific (0.5) muscular (.) joint prob[lem
P: [mmhm

D:and they will give you exercises to do (.) and then follow you up as well XXX

P:yeah that’d be really good

D:is that alright

P:I think so because (.) I think it’s gonna be something that I just live with and manage because (.) I’m never gonna be able to stop drumming and guitaring (.) to let it completely-

D:yeah [ok- yeah

P: [go away

D:the- the thing that would as you know would get rid of it (.) is (.) stopping (.) the stuff that does it but if that’s your life (.) then [you just have to learn to manage don- yeah

P: [I can’t (.) stop it haha yeah so I think yeah some regular physio would be a [massive help

D: [would it (.) the Sorrell Bank people don’t do sort of things where every single week they will see you [but they are really really quick as

P: [mmhm

D:opposed to the other physios which can take a few weeks to [come through (.) and you’ll

P: [mmm

D:have an appointment with them in the next (.) seven days
P:ah fantas[tic

D: [so- (.) and then they can refer you on (.) so if they know that you’re gonna need some regular physio [they can do that [(.) from there [(.) is that o[kay

P: [mmhm [okay [yeah [yeah really good

D:so it’s (.) just a quick way really of getting into-

P:yeah

D:getting into seeing them
P:fab that’d be really good

D:right (.) let me just find the referral form and do erm you take this with you I think- (.) we send one off and you take one with you

(0.5)

P:cool

(6.0)

D:is there anything else you wanted to ask about apart from-

P:the only other thing is I’ve been on some is it terbinafine tablets for (.) like a fungal nail infection

D:oh yeah

P:erm I think I’ve taken four months supply (.) from what I can remember

D:uhuh
P:and I just wondered if I could get the last month or two [months[KW1]

D: [couple of months yeah (.) is it on your toes

P:yeah [right foot about four nails (.) in fact (.) it’s down to about three and a half which is

D: [yeah

P:[great so it is getting better

D:[getting better okay how better is it as a comparison to how it was when you started on the medication is it sort of a- (.) half (.) as much better you know 50% better or- [(u.cs.)

P: [well when I started (.) I guess four nails were completely (.) infected (.) erm (.) and I think (.) it might even be two and a half now because (.) I think one’s good (.) and then half one’s better so (.) that’s a big [improvement

D: [so you have (.) I’m just wondering you might actually need more than another two months of medication (then)- (.) so if you stop it and you’ve still got (.) the fungal nail there it’ll just (.) come back again

P:right yeah

D:erm we did your liver (.) before and (.) when you’d started it so that was fine
P:mmhm

D:I’ll just- yeah (.) yeah you’ve had your liver since starting it so- (.) so we- (.) some- some people are on it for longer than six months [(.) is that

P: [yeah I don’t mind being on it longer (.) it’s just whatever is safe to do so

D:as long as it’s working (.) and we’ve checked that your liver is okay (.) that’s fine

P:when will be the next check that I need to have

D:you don’t (.) so (.) I mean if you’re on it for a long period of time (.) then we check it again in a year’s time but you [don’t (.) you don’t at the moment [hopefully you’ll be off it by then

P: [right [okaycool (1.5) [fab

D: [(u.c.) let me find the physio referral (.) exercise and advice clinic (3.5) so it’s both sides but obviously your left is what’s most affected at the moment isn’t it

(0.5)

P:yeah with the hand (1.5) yeah

(20.0)

D:just gonna get rid of (the other) stuff that’s not at all needed for now (26.0) have you got a- another job on top of (.) doing this as well XXX or is this your full-time stuff are you working [(.) apart from that

P:[yeah I teach five days a week
D:[ahh right
P:[so in high schools teaching guitar teaching drums
D:ahh

P:and then (.) gigging on the weekends doing weddings (.) and (.) general functions and bar work and stuff like that so (.) so unfortunately I need my hands (.) to (.) do it (.) [every day

D: [pretty much everything yeah

(3.0)

D:since you can’t- I mean (.) do you need anything like a sick note for work if you’ve now been off for that long

P:no because I am- [(.) I’m teaching I’m working (.) I’m just doing it one-handed (.) and then

D: [you’re going in you’re just-

P:for guitar doing more of a pointy technique or getting other people to demonstrate it so ah- (.) there’s ways around it

D:so you’re managing just- (.) it’s just [yeah
P: [yeah it’s just the weddings I can’t do (1.5) erm

(3.5)

D:but financially that has an impact doesn’t it then when you’re cancelling things and you’re- (.) you [nobody likes to [(.) cancel stuff that- that- (.) yeah

P:[yeah [yeah and (.) s- it’s a pain (.) and also letting bands down (.) cos you know- [(.) once you’ve got a set band that you play with they- (.)

D: [yeaah

P:they rely on you all the time (.) so it’s erm (.) it is a pain but (1.5) part of the job I guess

D:(does-) yeah these are the things that happen where you just can’t- (.) y-y-you can’t predict that can you

P:no

(6.0)

D:so the stomach tablet you take (.) on the days that you end up taking your anti-inflammatory (.) so if as it’s settling down (.) you’re only taking an anti-inflammatory once every few days (.) then (.) only take it on that day (.) [okay and it (says)- and it’s just one a day of your

P: [yep (.) okay

D:stomach tablet to protect your stomach

P:sure

D:your neproxin (1.5) is one or two tablets twice a day (.) and do have them with some food cos it just helps to (.) stop it irritating your stomach quite as much (.) and that’s your terbinafine

P:okay
D:is that okay (1.5) erm and then (.) I sign this for you (.) can I have (.) your (.) mobile number

(.)

P:oh seven eight double three (.) four five oh (.) eight oh three

(1.0)

D:lovely (7.5) so you take all that with you

P:mmhm

D:in fact let me just pop your mobile on this one as well and then I fax this to them (6.0) that form gets sent to the physio (.) yeah so I’ll send this to (Gabby) the physio

P:[mmhm

D:[so that they’re then expecting you (.) and I think that’s all you really need to do they will call you to make your appointment and they usually ring within a couple of days really (3.5) yeah (.) we send a copy of this (.) to them (.) but the main thing is they phone your mobile

P:okay

D:is that alright

P:that’s fine

D:can I do anything else this morning

P:no

D:wonderful

P:that’s everything

D:there you go (.) let me know how things are going [(.) if it’s not getting better (.) then usually

P: [yeah
D:they’re really good at referring people on
P:right [okay

D: [there’s been quite a lot of erm (.) good featu- it’s a new service this [it’s only been up

P: [is it

D:running a few [months yeah

P:[that’s really fast if they can get you in like within seven days
D:yeah

P:that’s really good

D:and that’s the- (.) the thing to try and stop people from- (.) you know it- things getting worse as they’re waiting

P:yeah I was gonna say (.) fantastic well (.) thank you very much for your help
D:no [problem
P: [I appreciate it

D:if they don’t contact you will you ring and leave me a message [and we’ll chase it

P: [yeah yeah

D:[alright

P:[seven days (.) thank you

D:thank you (.) wonderful

P:have a good day
D:you too [bye bye

P: [see ya

[KW1]5:40