[speaker001:] I had laryngitis last week, and I'm just clearing and coughing out. That's all we're doing, nothing drastic. Now then.
[Meryl:] That that It's his little treat. That that's for you and
[speaker001:] [shouting] Ooh. []
[Meryl:] your wife.
[speaker001:] [shouting] Oh. [] [LAUGHTER] Oh, you shouldn't do this all the time. Oh dear oh dear oh dear. I I'll tell you I will be I will be popular daddy when I get home.
[Meryl:] There you are you see.
[speaker004:] You can't beat that.
[Meryl:] That will that'll be nice
[speaker001:] [LAUGHTER]
[Meryl:] won't it?
[speaker004:] They will enjoy that.
[speaker001:] Yeah I Actually I'd better put these in the draw cos if I don't I can see someone else helping themselves.
[speaker004:] Aye, you never know.
[speaker001:] And I probably put Oh look at this, oh that well.
[speaker004:] [LAUGHTER]
[speaker001:] Oh well, that's nice cos my wife will like this cos it's it's not er
[Meryl:] It's very
[speaker001:] It's not er it's a sort of medium strength rather than
[Meryl:] It's like
[speaker004:] Yeah.
[Meryl:] er Asti
[speaker001:] Yeah, ooh I like Asti.
[Meryl:] Well er i you w it's ju It's just
[speaker004:] Very refreshing.
[Meryl:] the same as Asti.
[speaker001:] I like Asti, this is a this is a real something to have with a pudding. A real light pudding
[Meryl:] Yeah.
[speaker001:] summer wine, ooh yes. summer pudding
[speaker004:] [LAUGHTER]
[speaker001:] and this. I better put this in the draw as well, otherwise otherwise my antenatal, antenatal clinic later, dad's
[speaker004:] Oh yeah.
[speaker001:] er what's he up to?
[Meryl:] That's right.
[speaker001:] Anyway. Now then. Nice to see you again.
[speaker004:] er
[speaker001:] Twenty fourth.
[speaker004:] I'm getting a little bit disturbed. Now la last There's two people down here last week, they said they could hear me breathing
[speaker003:] [sneeze]
[speaker004:] They tell me they told but I don't feel any effects from it at all.
[speaker001:] Now what have they have they said they can hear you breathing more quickly or more deeply or rattly or
[speaker004:] But didn't say that. They said they could just hear me didn't they Meryl?
[Meryl:] very quick and loud.
[speaker001:] Mm.
[speaker004:] But er Yet I don't think er Don't seem to be I don't feel any
[speaker001:] Deep breaths or shallow breaths?
[Meryl:] Very small. he does about three now to me one.
[speaker001:] Okay. What are you like at night? Actually perhaps I should ask your wife.
[Meryl:] Oh well, now I don't ask him at night because Is that i is we hardly have any sleep.
[speaker001:] Oh.
[Meryl:] Because
[speaker004:] With bloody arm business.
[Meryl:] with this a arm.
[speaker001:] Oh.
[speaker004:] This is up This is upsetting me more than the breathing job really.
[speaker001:] Yeah.
[Meryl:] We we had one hour the other night.
[speaker001:] Oh dear,
[speaker004:] Now then.
[speaker001:] we'll come back to that.
[Meryl:] Mm. Now his breathing
[speaker004:] Yes yes. N now you know when I went to see Dr he said I'd got this enlarged heart?
[speaker001:] That's right, yeah.
[speaker004:] Well what er What's what detrimental is that to me anyway? What's what's the effects on meself? On me er What causes it anyway?
[speaker001:] How do How How do you put this into ho When you get when you get heart strain it's a bit like a pair of undies, okay? Who Which i which are having to cope with a bigger and bigger body. And the elastic gets stretched and stretched and stretched. And instead of being a snug fitting pair of undies they become a big baggy pair of undies that are really neither use nor ornament. And that's what the heart is like in heart failure. It gets more and more ballooned out and it just ca It gets less and less and less good as a pump. And eventually it's a bit flabby useless bag of muscle that really doesn't do anything. And that's right at the end, and that's why people die of heart failure. now you're not that bad. But there is some strain on the heart and it is rather large and it isn't working so well.
[speaker004:] What's what what's caused this?
[speaker001:] What causes it? Well it's usually because the heart itself is getting either old or tired or it's damaged in one way. And it just doesn't work as well. And then what y When it doesn't work so well you get a bit of a backlog of fluid. And you get the bit You get backlog of fluid both at the extremities, you get swollen ankles. But very commonly you get a backlog of fluid on the lungs.
[speaker004:] Mhm.
[speaker001:] And so your lungs get a bit of fluid on the lungs, you get a bit breathless with it, and that's often the first sign. Now you have had a few crackles but they've been fairly easily sorted out. And you're actually not on anything at the moment are you?
[speaker004:] Just water tablets.
[speaker001:] Yeah, just a low dose
[speaker004:] Get rid os the fluid.
[speaker001:] That's just one So you're not on much at all.
[speaker004:] But I don't er How can I put it? I mean yesterday i cut the lawn. No no after effects. No ill effects.
[Meryl:] But you home and you was on with this breathing job.
[speaker004:] That now I were j i were just er
[Meryl:] You don't know that it's there but I do.
[speaker004:] I see what you mean, yeah yeah.
[speaker001:] Well let's have a look to see what we've got. Anyhow that's what happens in heart failure. And er if you can clearly identify that in folk, it's worth treating very vigorously cos it can make a huge difference. One of the problems in your case is, we've never really been able to Cos i i When we when we've examined you from time to time, things come and gone. So erm
[speaker004:] I that er
[speaker001:] And I think what we ought to do is have another look at you now.
[speaker004:] Dr Dr when I
[speaker001:] [cough]
[speaker004:] He said he said I'd got legionnaires disease didn't he? Or did he think Or did he think it was pneumonia?
[Meryl:] Well he said legionnaires disease,
[speaker004:] Well I thought it was pneumonia.
[speaker001:] Yeah. Well legionnaires
[speaker004:] Anyway
[speaker001:] disease is a pneumonia so
[speaker004:] And er I went for an X-ray and they said I'd got two two scars or
[Meryl:] But you know when you went to see Dr you went to the park, didn't they?
[speaker004:] That's right.
[speaker001:] Yeah.
[Meryl:] Did they X-ray your heart then?
[speaker004:] Ooh aye yes, yes. I had a proper job there.
[speaker001:] Well you've had an E C G and we've done chest X-rays and erm the E the electrical tracing of your heart didn't really show an awful lot but So er Anyway let's see what we've got today. Okay? Do you want to juts pop on the couch for me? I think
[Meryl:] Has your builder started yet?
[speaker001:] The builder started a week last Monday.
[Meryl:] Did he?
[speaker001:] Yeah. and they've done ever so well cos they did all Cos of course we had fine whether last week, they got everything done, and then it poured at the weekend but they weren't there, and now they're back on site the weather's cheered up again. So it's great, perfect timing, so they're really getting going.
[Meryl:] We had a chap who'd come from Ravenshead to do o to do ours,
[speaker001:] Oh o our builders are actually from Mansfield Woodhouse.
[Meryl:] Oh. We had a Scots fencer.
[speaker001:] Oh yes yes. I know them yes.
[speaker004:] Very good, nice chap,
[Meryl:] Ah that's erm
[speaker004:] fellows.
[speaker001:] They were very nice, yeah they came round to give us a quote and my wife actually knows one of their wives very very well and er but the produced an exorbitant quote.
[speaker004:] Really?
[speaker001:] Oh yeah, it was you know a order of magnitude greater so
[speaker004:] Oh dear.
[Meryl:] we had a
[speaker001:] But when we tol When we told us they said Oh they'd have come down to match the nearest competitor, and we thought oh why did he quote up there in the first place then.
[speaker004:] Mm.
[Meryl:] Oh had
[speaker001:] The are very variable they obviously thought we could afford a
[Meryl:] Yeah.
[speaker001:] higher a higher price.
[Meryl:] It's not it's not
[speaker001:] Screen the outside world out
[Meryl:] fair is it?
[speaker004:] Yeah.
[speaker001:] Well I thought so but we've got a We think the builders we've got are excellent.
[Meryl:] Good.
[speaker001:] Er they're competitive quote and they'll do the kitchen and unlike some you know, where they get subcontractors in for the joinery, the electrics
[Meryl:] Yeah, yeah.
[speaker001:] It's their firm.
[Meryl:] Yeah.
[speaker001:] And so
[speaker004:] Yeah.
[speaker001:] we know where we are all the time, which I think is one of the huge advantages,
[Meryl:] It does I'm pleased they're getting on with it for you.
[speaker001:] They are, I mean there's only usually two or three there at a time, but you see it's all bricking at the present
[Meryl:] Yeah.
[speaker001:] I mean
[speaker004:] Aye, yeah.
[speaker001:] we can't do anything else yet.
[speaker004:] Not really.
[speaker001:] When we're away though next week, I think they'll do quite a lot of stuff inside and But they're doing some for The same team are doing some friends of ours on Main Road and of course most of the people are down there. And we'd
[speaker004:] Mm.
[speaker001:] rather they'd finished them off anyway, [LAUGHTER] before they came to us.
[speaker004:] Oh yeah.
[speaker001:] Cos they're now a a week overdue already. This' ll squeeze a little bit.... Your blood pressures fine, okay? It's a bit higher than it was last time but it's still well within the normal range, now just... How far can you walk before you get short of breath, would you say?
[speaker004:] Well the walking's no problem, it's when I start to run that's when I get
[speaker003:] [LAUGHTER]
[Meryl:] Now y you don't run.
[speaker004:] No but I'm pretty good walking a lo a hell of a way.
[Meryl:] But he's puffing and panting all the time....
[speaker001:] Okay just sit forward for me. Ta. [cough]... Really deep breaths now. Okay.... Good, okay. And once more. Yeah, that's fine. Right, okay, that's all done. Now all your vital signs are absolutely normal. Your heart sounds fine but there is evidence that there is a little bit of fluid in your on your lungs. That in itself doesn't matter cos you're coping, but I suspect what happens is every now and again you get a little blip and your your breathing starts to alter and you get a little breathless,
[speaker004:] Yeah, yeah.
[speaker001:] and then most of the rest of the time you're fine. But that's suggestive enough I think to s That's probably what's causing your breathless even if you don't notice it and you're compensating. It may have become so normal that you don't but I think
[speaker004:] Mm.
[speaker001:] we could actually make you a bit bit A lot better than this, and I think the time has come to adjust how we're treating you a little bit. Now... what we need to do is to change your water tablets and to change your er medication a little bit. [cough] And what we're going to do is to say You had your water tablet this morning haven't you?
[speaker004:] I haven't had one yet, no I
[speaker001:] Oh good.
[speaker004:] Well I don't, not yet.
[speaker001:] Brilliant. Brilliant brilliant brilliant brilliant
[speaker004:] Coming out you see.
[speaker001:] brilliant brilliant.
[speaker003:] [LAUGHTER]
[Meryl:] [LAUGHTER] He daren't with coming out. []
[speaker004:] [LAUGHTER] It's coming out you s [] You get out
[speaker001:] Okay.
[speaker004:] want to go and can't. [LAUGHTER]
[speaker001:] Yeah I know. They do acta rather promptly don't they?... Er let me see, what day is it now, Tuesday, so Wednesday. So your going to start those on Thursday.... Now what we're going to do is change your water tablets. Don't take a water tablet today.
[speaker004:] Don't take one, no.
[speaker001:] Don't take a water tablet tomorrow. And you can start on the new water tablets which are called Frusamide on Thursday. Now Frusamide is actually the stuff in Laciride that makes you wee. So we're not actually changing your water tablets as such, we're just knocking a little bit off and leaving you just on the Frusamide bit of your water tablet, okay? So you'll still
[speaker004:] Yeah.
[speaker001:] be in the same way. What we need to do is to add a drug called Anapril Which is otherwise known as Inavase and somewhere, but somewhere we have a Brilliant, it's gone again. This thing keeps moving around, it's not here. Right. We're going to put you on what's called a starter pack, now... start this tomorrow night, okay? Start on Wednesday evening.... So you don't take a water tablet today, you don't take anything tonight. You don't take a water tablet tomorrow and then you start this Inavase stuff and the first dose should be taken at night because the main potential side effect with the very first tablet, and it's the first tablet only, is your blood pressure can go Oh down a bit. So the best thing to do is to have it last thing at night as you plonk your head on the pillow. And then if your blood pressure does go down a bit it doesn't matter cos you're lying down. The important thing is that if you get up at night to have a wee, you beware that you may feel a little bit lightheaded, so you get up slowly, sit on the edge of the bed, you stand up slowly, and when you're happy you're off, off you go. Okay? Now if you don't get any problems with the first dose, then you're fine and then you can carry on. And it's one in the morning, okay? And you'll find for half the pack it's one a day and then for the second half of the pack it's two a day. And what I would quite like to do is to see you as you come to the end of the starter pack and I think the starter pack is Oh I can't remember how many days treatment is in it. I can't remember if it's two weeks or four weeks, let me just check. Cos it's important when we've got you that we we have a look at you, we listen to your chest, we check your blood pressure and we make sure there's no side effect. But this drug works in a very different way and it actually helps to take the strain off your heart er and it actually makes a huge difference. One eleven. [thinking noise] We maybe actually go on like three weeks. But if i see you at towards the end of the And the packs are all labelled, it's very
[speaker004:] Yeah.
[speaker001:] Ah so you start off start on Wednesday evening and then it's usually a daily dose and Thursday you can restart your water tablets, once again one in the morning, okay. Does that make sense?
[Meryl:] So if that
[speaker004:] Wednesday night I take the tablets.
[Meryl:] Yeah.
[speaker001:] Wednesday night you start the starter pack.
[speaker004:] Yeah,
[Meryl:] And he's got some different water tablets. yes.
[speaker001:] Different water tablets yeah. And if you're okay overnight then you can carry on with the pack as directed on Thursday morning
[Meryl:] Yeah.
[speaker001:] and you start your water tablets at the same time.
[Meryl:] Yeah.
[speaker004:] Mhm.
[speaker001:] Okay?
[Meryl:] Yeah.
[speaker001:] Now you may find you actually get a slightly more out of breath over the next thirty six hours, cos you haven't taken your water tablets. Er I'm afraid we can't do anything about that. If you're going to start this stuff you really need to ha The people off the water tablets before you start.
[speaker004:] Yeah, yeah.
[speaker001:] Er otherwise people's blood pressure does go vroom into their boots. [LAUGHTER]
[Meryl:] Mm.
[speaker001:] And you have trouble, so we can't do that. Er we'll play it safe.
[speaker004:] I can take I can take it easy
[Meryl:] Well he easy
[speaker001:] He won't he you you won't come to any harm stopping the water tablets for forty eight hours. And then hopefully you'll actually get a lot better. S you'll find there's a lot less strain on the heart, you may find you can do more without getting short of breath. [whispering] And even your wife should be happier. []
[speaker004:] I know that she's worried, that's the trouble.
[speaker001:] [LAUGHTER]
[Meryl:] I am and
[speaker001:] is there is some fluid on your lungs.
[speaker004:] She does she does worry about it
[speaker001:] And I and I think it's quite right to have you back and alter your treatment at this stage so,
[speaker004:] Mm mm.
[speaker001:] er
[Meryl:] And we'll sleep with this arm as well will we.
[speaker001:] That's right as far as the arm is concerned we've got to be cautious, there. If we start waving a lot of anti
[Meryl:] Mm.
[speaker001:] inflammatory pain killers we can actually give you We can actually make the fluid on the lungs worse. And I would recommend we just stick with something very basic to start off with like paracetamol, two four times a day Something so very very simple like that.
[speaker004:] Well actually what I've been I've been taking two before I go to bed at night.
[speaker001:] Yeah, that's fine. paracetamol doesn't interfere with any of these,
[speaker004:] Yeah, yeah.
[speaker001:] and it won't make any difference to your chest either. So I would actually do that, but if you're having pain in the day I would treat that as well.
[speaker004:] Mhm.
[speaker001:] And you may find treating the pain in the day means it's not so bad at night so you actually get more sleep anyway.
[speaker004:] It's not often it comes on during the day, but now and again
[speaker001:] Yeah.
[speaker004:] it does.
[speaker001:] Yeah.
[speaker004:] I it does and I've told you Now yesterday was
[speaker001:] Yeah, I mean we've looked
[speaker004:] was
[speaker001:] at your arm and there's nothing
[speaker004:] Yeah.
[speaker001:] Yes, yeah. We'll see. So that's that. And
[speaker004:] Yeah.
[speaker001:] it makes it important I see you before you run out of these
[speaker004:] Yes.
[speaker001:] tablets.
[speaker004:] Yes.
[speaker001:] Okay, which I think is
[speaker004:] okay.
[speaker001:] going to be round about three weeks time.
[speaker004:] Yeah.
[speaker001:] You'll have to count up. I can't it doesn't actually tell me how many days it is.
[Meryl:] Yeah well we'll make the appointment when we've got the tablets and sorted it out.
[speaker001:] Yeah, the chemist may not have those in stock but they'll be able to get you for them within twenty four hours, you're
[speaker004:] Yes.
[speaker001:] not starting them until tomorrow
[Meryl:] Oh
[speaker004:] Yes.
[Meryl:] very kind
[speaker001:] Oh he'll be able to get them in twenty four hours yes.
[speaker004:] Oh aye, yes know them very well.
[speaker001:] if he has any queries he can give me a ring but
[speaker004:] I mean
[speaker001:] Yeah.
[speaker004:] know me very well.
[speaker001:] Yeah.
[speaker004:] [LAUGHTER]
[speaker001:] So
[Meryl:] Yeah.
[speaker001:] You're blood pressure's okay. Your heart sounds fine so add Anapril and we'll have you on the starter pack. Er start on that on a Wednesday, beware of first does. So just watch it after the first dose that evening, if you g Especially if you get out of bed to have a wee. And then Frusamide for your water tablet and that's to start on Thursday and then review at end of pack.
[speaker004:] Yeah.
[speaker001:] Okay?
[Meryl:] Yes.
[speaker004:] Okay.
[speaker001:] And that should make a huge difference I hope. Er and a Even though most Sometimes you're okay, sometimes you're not. And there is some fluid on your lungs
[speaker004:] Aren't any of those in middle of the night like I use to.
[speaker001:] No we don't want those. No we don't want those. But but if
[speaker004:] I'm I'm
[speaker001:] we start this now then it'll prevent a lot of further problems.
[speaker004:] Yeah.
[Meryl:] Right then.
[speaker004:] Good,
[speaker001:] Okay and that's one of
[speaker004:] okay.
[speaker001:] the reasons I think for doing it.
[Meryl:] Erm thank you very [tape change]