[speaker001:] What can I do for you this morning?
[speaker002:] Well I'm still getting myself in a tangle, like I was when I came.
[speaker001:] Right.
[speaker002:] But I didn't take those tablets, I tried not to do.
[speaker001:] That's the low dose Dizapac
[speaker002:] Yeah, whatever it is.
[speaker001:] Yeah.
[speaker002:] And also I keep getting a pain in my arm just here, it's a
[speaker001:] Mm.
[speaker002:] bit of a
[speaker001:] Right in there.
[speaker002:] As if If I press it,
[speaker001:] Yeah.
[speaker002:] and if I put any weight on it.
[speaker001:] Aha. Any idea what's brought that on?
[speaker002:] I don't really know, I've had it for about three week. I keep trying one of those lamps.
[speaker001:] Yeah. Okay, let's have a closer look at that arm.
[speaker002:] But it's er It's noting You know I can move it alright, there's
[speaker001:] Yeah.
[speaker002:] no problem [beeping] want to go.
[speaker001:] Ah.
[speaker002:] Are you jogging?
[speaker001:] No no. Just normal summer ware.
[speaker002:] I'd thought you'd been getting exercise in.
[speaker001:] No no no no no no no, no just casual ware this summer. It's too hot otherwise. It's hot enough as it is in this place. I've got three internal walls and the wall's about eighteen inches thick with a double glazed window. I mean there's You know what
[speaker002:] [LAUGHTER]
[speaker001:] What's it like up the fore arm? Is that er
[speaker002:] I it's alright, but it seems if I if I press in there
[speaker001:] Yeah.
[speaker002:] somewhere.
[speaker001:] Okay. you okay in this area here?
[speaker002:] Yeah.
[speaker001:] No problems there?
[speaker002:] Nothing at all.
[speaker001:] Nothing on the
[speaker002:] No.
[speaker001:] backside of the elbow. You're okay there. Now let me just Is that okay?
[speaker002:] Mm.
[speaker001:] Okay, just pull your hand in towards your face a bit. Okay, you haven't ruptured the tendon. Is that tender?
[speaker002:] Not really no.
[speaker001:] In there. Under there?
[speaker002:] No.
[speaker001:] So it is Really is on and off cos there's nothing much there now, is there?
[speaker002:] No, no.
[speaker001:] It's funny that isn't it?
[speaker002:] I don't know It's
[speaker001:] Okay.
[speaker002:] comes on and it
[speaker001:] Push out for me, push that.
[speaker002:] To you?
[speaker001:] Yeah. Well that's okay when you do that? Nothing
[speaker002:] Hmm, feel a little bit, nothing at the back.
[speaker001:] Yeah.
[speaker002:] It seems if it's
[speaker001:] okay. Just hold my hand and turn as if you were turning a door handle. Okay. And the other way. Does that hurt there?
[speaker002:] No.
[speaker001:] Er... not sure what's causing that
[speaker002:] But i mean it's
[speaker001:] Well yes I mean it's it's it's more likely to have been a muscle than anything else, with pain that comes and goes. Certainly won't be a bone that's causing it. But what's irritated the muscle in the first place is Your guess is as good as mine, cos it all works perfectly. Now.
[speaker002:] Is it stress related?
[speaker001:] Well can make anything worse and will often make a lot of things carry on longer than they otherwise would normally. I don't think stress would cause this sort of pain but it'll certainly make it feel worse, there's no doubt about that....
[speaker002:] what I'm think if I do get
[speaker001:] Yeah.
[speaker002:] a little bit up tight, it
[speaker001:] Yeah.
[speaker002:] seems as if that.
[speaker001:] Yeah. Oh it'll make it worse.
[speaker002:] So I don't know but er
[speaker001:] Mm. How are you managing er things when you get up tight?
[speaker002:] Well I'm doing things, you know I'm not...
[speaker001:] Yeah. So you're keeping yourself occupied?
[speaker002:] avoiding th I've never had I mean me I'm
[speaker001:] But if you I mean if you do get very anxious what do you do?
[speaker002:] I just carry on.
[speaker001:] You just carry on. And it wears off?
[speaker002:] Mm.
[speaker001:] Well that's probably a good a way of managing it as anything really.
[speaker002:] I mean I'm not the sort of person who can sit down and watch telly all day, you know
[speaker001:] [LAUGHTER] I didn't think so.
[speaker002:] Erm
[speaker001:] Er and you haven't been taking any of those Diazepam at all?
[speaker002:] I didn't take them because
[speaker001:] No.
[speaker002:] I I know
[speaker001:] Well
[speaker002:] I tried to I probably made myself a bit of a nuisance when I came in last time but,
[speaker001:] No.
[speaker002:] as I told you before I'd been like it before and it
[speaker001:] Yeah.
[speaker002:] it's er
[speaker001:] The advantage of those Diazepam is, they're there if you need them. You've still got them there if you need them. Er it's a very low dose, if you just take them every now and again you'll have no problems with them at all. And if you do feel things are overwhelming you then they may just help to bring you down again.
[speaker002:] Yeah.
[speaker001:] And that's what they're there for. Sometimes, just knowing you've got something else you can turn to is all you need cos you don't need
[speaker002:] Yeah.
[speaker001:] to take to anything,
[speaker002:] Mm.
[speaker001:] you just know they're there.
[speaker002:] I mean i it's it's it's funny thing this i It's a thing what seems to creep up on you isn't it?
[speaker001:] Yeah. Yeah. It's very common.
[speaker002:] I I really know I mean it it's not that I'm I'm no where near like I was before, I know because I was You know reservoir treatment before, but er
[speaker001:] Yeah....
[speaker002:] Doc er Dr, Colin, he
[speaker001:] Yeah.
[speaker002:] would call men a silly bugger he did. [LAUGHTER]
[speaker001:] I know him, I know him well, yeah.
[speaker002:] [LAUGHTER]
[speaker001:] Well he would say that yes. [LAUGHTER]
[speaker002:] He's alright though, I mean
[speaker001:] Oh yes, yes he was a
[speaker002:] Not meant offensive or anything like that.
[speaker001:] Yeah, he were a great bloke. Yeah. not taking Diazepam. Well I th I sus I suspect you will ma co continue to manage yourself. And I think for you that may be the best way of doing things.
[speaker002:] Mm. And I've got [break in recording] This one
[speaker001:] Yeah.
[speaker002:] Ta.
[speaker001:] But this pain, I'm not sure what that is, I mean your arm seems to be in perfect working order, so
[speaker002:] Er
[speaker001:] keep an open mind on that. It'll probably go now I've had a look at it. Like it does.
[speaker003:] [LAUGHTER]
[speaker001:] This' ll squeeze your arm a bit, okay? [pumping up blood pressure armband] Still smoking?
[speaker002:] Mm.
[speaker001:] Drinking?
[speaker002:] No....
[speaker001:] Smoking's bad for you of course but I mean
[speaker002:] You r you really think I ought to stop? Be honest, give me a real
[speaker001:] Well,
[speaker002:] professional.
[speaker001:] smoking will help stress... but smoking is much more likely to cause serious physical problems, than stress is. That's the catch. Er And it it's reckoned a hundred and sixty thousand people die a year, of smoking related diseases. Er I don't know how many people die of stress related diseases but it's probably under a hundredth. Er And I think that puts it into context. Overall your health would be a lot better off your cigarette. And if you find then things like stress and anxiety come through, there are other ways of treating that and sorting that out. I can't think of any case where people are better off smoking than none smoking,
[speaker003:] really
[speaker002:] what about a pipe?
[speaker001:] Well pipes are better than cigarettes because you don't inhale so much.
[speaker002:] Mm.
[speaker001:] fact if you don't inhale at all you're doing yourself a big favour, but you nearly always get some down ion to the system and really the o the only thing I could ethically recommend as a doctor, is stopping. Difficult to be ethically safe, this is safer than that, you know. I mean the decision is yours and you may find You may wish to sort of take take things very slowly and very gradually....
[speaker002:] Mm.
[speaker001:] I'm not going to tell you to do anything, that's not what I'm here for, but er
[speaker002:] Well I mean er we have to take notice of you don't we?
[speaker001:] Yeah. Well no you don't actually, I mean y you are free to [LAUGHTER] ignore our advice and [] Yeah I I know that,
[speaker002:] Yeah, but I mean
[speaker001:] but I mean that would be my advice as a doctor, to stop smoking, in the long term.
[speaker002:] Mm.
[speaker001:] Certainly. Your blood pressure's absolutely fine. Impressive, it's better than mine.
[speaker002:] Bet you tell everybody.
[speaker001:] No it's true. It's true. Mine is er It's not high but it's higher than I would like but er
[speaker002:] So what am I going to do? Just carry on?
[speaker001:] Yes I think so.
[speaker002:] Do you think I ought to take anything or?
[speaker001:] No I don't think you need to take anything at all. You've got the Diazepam if you need them
[speaker002:] No, I haven't got it.
[speaker001:] Oh you haven't Oh Oh Oh you never got it. Oh, well the p Oh yes well it's now seven months old that prescription so that that'll now be invalid so ache in left arm
[speaker002:] I don't know what this is, whether it's something with work or
[speaker001:] Yeah.
[speaker002:] Comes and goes,y y y and sometimes
[speaker001:] wait and see would be the right approach for that. Cos it certainly isn't anything obviously serious, so I think we'll just see how things go,
[speaker002:] Yeah, prescription?
[speaker001:] No, not unless you want one.
[speaker002:] [LAUGHTER] [] [LAUGHTER]
[speaker001:] I think that's the answer to that one isn't it? You don't really want I'm certainly not going to give you something you don't want, so
[speaker002:] Well let me put it to you like this, I feel sometimes that I need something,
[speaker001:] Yeah.
[speaker002:] ... to settle me down.
[speaker001:] Yeah.
[speaker002:] Er but sometimes I'm alright.
[speaker001:] Right, well what I could do is I could give you another prescription now, that you can go and get if you feel you are going to need something.
[speaker002:] L let me let me do that.
[speaker001:] Yeah,
[speaker002:] Let me let me do that
[speaker001:] And if it expires
[speaker002:] that's alright.
[speaker001:] Yeah, if it expires like the last one, that's okay, just chuck it on the fire.
[speaker002:] I think what I'll do I'll er I'll get the prescription.
[speaker001:] Okay.... You can have one up to three times a day, er you're never going to take that I'm sure. As required.
[speaker002:] Yeah.
[speaker001:] okay? And I think what you'll find is you just need one you know, perhaps even one every three or four months, that's okay. It's just there to take the edge off things when it's not settling on it's own. And that is entirely the appropriate way to use these and they really can make a huge difference like that.
[speaker002:] Okay, thank you for your time.
[speaker001:] There you go. That's okay. Nice to see you again.
[speaker002:] Well it's nice to see you but I hate It's not personal but I
[speaker001:] I know I know I know.
[speaker002:] I really do it
[speaker001:] You don't like coming to doctors. [tape change]