[speaker001:] What can I do for you this mor oh well shall I do Jade first?
[speaker002:] Yeah. Well I've been up practically the best part of the night with her, just crying.
[speaker001:] Oh Jade.
[speaker002:] Pulling at her ears. But she, the last couple of days she's hardly eaten a thing
[speaker001:] Right.
[speaker002:] and she's, I notice she's got a rash coming round here.
[speaker001:] Yeah, any sickness or diarrhoea?
[speaker002:] None at all. She's had a little bit of diarrhoea, well it's not diarrhoea it's such a, I know
[speaker001:] Squidgy
[speaker002:] when she's teething, cos
[speaker001:] Yeah.
[speaker002:] she fills nearly every nappy
[speaker001:] Right.
[speaker002:] but she's just been crying nonstop.
[speaker001:] Mm. Well she seems quite content sitting there. The common problems are the n the throat and ears in kids
[speaker002:] Mm.
[speaker001:] and that'd go along both with
[speaker002:] Yeah.
[speaker001:] ears
[speaker002:] I suppose
[speaker001:] and not eating of course.
[speaker002:] couple of weeks back she got a throat infection, I just wondered whether it had come back.
[speaker001:] Now then. Shall we have a look at dolly first? Shall we look at dolly? Shall we look at dolly's ears? Look at dolly? [whispering] Ooh dolly's got nice ears []. Oh yes. Dolly's okay, isn't she? Mm. Shall we look at Jade next? Well she's certainly got a few glands coming up. Right Jade, I'm going to have a look in your ears, [whispering] and this is going to tickle a little bit []. Okay? You your mummy. Very good. There's that one. Yeah, now they're both okay.
[speaker002:] Yeah.
[speaker001:] They both look congested but not infected at all. So let's have a look down her throat, and that's likely to be the source of the problem. And there's no spots anywhere else? Mm, no. Okey-doke. Shall we have a little look, open your
[speaker002:] Open your mouth.
[speaker001:] Open your mouth. Ooh let's have a little look then, let's have a little look at these teethies. Oh good grief, what great big teeth you've got. What great big teeth you've got. You got the great big, you've got some great big tonsils too, to go along with your great big teethies. Have a look at your great big tonsils?
[speaker002:] [LAUGHTER] Come on sweetheart, open your mouth [].
[speaker001:] She will in a minute. Oh look.
[speaker002:] [LAUGHTER]
[speaker001:] have little look.
[speaker002:] Come on.
[speaker001:] [whispering] []
[speaker002:] Good girl.
[speaker001:] you hit the back of the tongue, they gag, and you can
[speaker002:] Yes.
[speaker001:] see everything.
[speaker002:] Good girl.
[speaker001:] Just a moment's discomfort. She's got a very very nasty looking throat. It really is extremely inflamed. And that I should think is a source of this.
[speaker002:] She only had one a few weeks a go as well.
[speaker001:] Yeah, I know. Well children of this age are prone to them,
[speaker002:] Yeah.
[speaker001:] they haven't met all the bugs that you and I have, so they keep coming down.
[speaker002:] Come on sweetheart.
[speaker001:] Once they hit them
[speaker002:] Yeah.
[speaker001:] so
[speaker002:] Well I used to suffer with them.
[speaker001:] Yes.
[speaker002:] My throat's...
[speaker001:] Now. What we'll do is we'll give her penicillin.
[speaker002:] Yeah.
[speaker001:] I would an for two reasons I, I'm going to give her quite a long course. The first one is, you need to give longer courses of antibiotics to clear throat infections
[speaker002:] Yeah.
[speaker001:] as a rule.
[speaker002:] Come here sweetheart.
[speaker001:] And secondly she's actually recently had one so we need to make sure we completely eradicate it. I suppose this could be a flare up of the last one. Which occasionally happens, some of them are difficult to get rid of.
[speaker002:] Yeah.
[speaker001:] So it's four times a day for ten days, it's not Amoxil
[speaker002:] Right.
[speaker001:] It's ordinary penicillin. And it must be taken on an empty stomach.
[speaker002:] Yeah.
[speaker001:] But this is the drug of choice for this sort of throat infection.
[speaker002:] Mm. Oh, come on. [intercom comes on, conversation down intercom]
[speaker001:] Hello.
[speaker003:] Hello, erm it's a Mr Brian from the for you. [intercom goes off]
[speaker001:] ?... [phone rings phonecall starts] A workload survey that the are doing, and er they they're trying to get loads of GPs to do it and of course they want me to do it next week, and I'm not here next week.
[speaker002:] [LAUGHTER]
[speaker001:] So that makes it very easy to fill in, so I don't mind doing that at all. So four times a day for ten days, on an
[speaker002:] Yeah.
[speaker001:] empty stomach, stacks to drink, Calpol if necessary.
[speaker002:] Yeah.
[speaker001:] And that'll hopefully do the trick.
[speaker002:] Right.
[speaker001:] Okay. Right. You're next.
[speaker002:] Well I just keep when I sit down, I'm tired all the while and I've got no appetite whatsoever.
[speaker001:] Mm. Interesting. Weight okay?
[speaker002:] Well I have been slimming constantly since I had Jade cos
[speaker001:] Mm.
[speaker002:] I put nearly four stone on.
[speaker001:] Yeah.
[speaker002:] And er
[speaker001:] You must be down somewhere near your target weight I should think.
[speaker002:] Well I'm about I waver now between eight stone ten and
[speaker001:] Yeah.
[speaker002:] nine stone.
[speaker001:] Are you still actually dieting?
[speaker002:] Well I just, yeah I suppose I am
[speaker001:] Mm.
[speaker002:] because I'm not eating anything if I think to myself it's fattening, I'll
[speaker001:] Yeah. Yeah, okay. Waterworks, bowels okay?
[speaker002:] Er waterworks, yeah.
[speaker001:] Yeah. Bowels?
[speaker002:] Well occasionally. I don't think I'm eating enough to actually make myself go.
[speaker001:] Mm. Yeah. Mm okay. Have you had problems before?
[speaker002:] No.
[speaker001:] Ears? Throat? Nose?
[speaker002:] Yeah I'm fine.
[speaker001:] All bits and pieces okay. Periods?
[speaker002:] Er yeah, they've been fine.
[speaker001:] Mm. You've not really had anything wrong with you in the past, have you?
[speaker002:] No.
[speaker001:] Just looking back through your notes. You've had babies.
[speaker002:] One. [LAUGHTER]
[speaker001:] Baby or appendix in ninety eighty three.
[speaker002:] Yeah. Jade
[speaker001:] And then not an awful lot has really happened to you. Is there any family history of thyroid disease or liver disease or anything exciting?
[speaker002:] Oh. Not that I can
[speaker001:] No.
[speaker002:] think of, no.
[speaker001:] Mood okay?
[speaker002:] Mood?
[speaker001:] Mood.
[speaker002:] Well when, the week before I'm due for my period I'm really really nasty, in
[speaker001:] Mm.
[speaker002:] fact I'm vicious. And er
[speaker001:] Do you feel more er active with that? Sort of, is it an active anger or do you still feel tired and...?
[speaker002:] Erm no not really I, I feel alright, it's just that I'm so nasty all the while and
[speaker001:] Mm.
[speaker002:] I can't seem to help it. As soon as he come through the [LAUGHTER] door I go for his jugular [] and take everything out on him and it, it's not fair.
[speaker001:] This is a familiar story.
[speaker002:] Now I try to avoid chocolate and I crave it when I
[speaker001:] Premenstrually?
[speaker002:] Yeah.
[speaker001:] Yeah. Yeah. Which you what er are you on the pill?
[speaker002:] Yeah. U
[speaker001:] Which one are you on?
[speaker002:] Uginon Thirty.
[speaker001:] Mm. You see in theory you shouldn't really get pe premenstrual problems on the pill but people do.
[speaker002:] It's the week before, and the week while I'm on. So it's
[speaker001:] Yeah.
[speaker002:] for two weeks.
[speaker001:] Okay. Right. How would you say you if, what are you like after that? Are you normal?
[speaker002:] Yeah. [LAUGHTER]
[speaker001:] But still tired and a bit?
[speaker002:] Oi.
[speaker001:] Or are you a fairly normal normal?
[speaker002:] No I normally bounce straight back
[speaker001:] Yeah.
[speaker002:] and I'm alright.
[speaker001:] Yeah.
[speaker002:] It's just this time I'm tired all the while.
[speaker001:] Yeah. Okay. Let me check your blood pressure. It's a more importantly to make sure it's normal rather than to look for a problem with it but... Now you're not trying to escape, are you Jade?
[speaker002:] Come on, get your
[speaker001:] You can go in the other cupboard if you want, that's a broom cupboard. That's very exciting in there, it's got a table in it. And a pair of weighing scales.... Nothing wrong with your blood pressure. Mm. I want to you look up for me. Mm, stick your tongue out. Er yes. Mm. It's difficult to tell with your make-up on but I think you look a bit pale.
[speaker002:] Yes.
[speaker001:] The eyes, your tongue and your finger nails both look
[speaker002:] Mm.
[speaker001:] rather washed out to me. And that might go along with er diet.
[speaker002:] Mm.
[speaker001:] Fairly strict diet and periods cos women tend to lose iron and certainly women who are actively dieting can actually become iron deficient. And that will really aggravate everything
[speaker002:] Yeah.
[speaker001:] that I'm w now, so what I suggest we do, is before we say we must make your premenstrual tension better with various manip various bits and bobs, and there are quite a few things we can do to help. We really ought to do some baseline blood tests, and say
[speaker002:] Yeah.
[speaker001:] are you anaemic? Check your body biochemistry, check your thyroid gland. Cos these are the things that upset women and
[speaker002:] Mm.
[speaker001:] creep in. And if you are mildly anaemic, or short of iron, that may be the clue to why this has happened now, rather than happening before.
[speaker002:] Mm.
[speaker001:] So if we arrange those. Now it's too late to do them this morning cos the van's already gone. But if we get you an appointment to see Georgina one morning at your convenience, so we can rattle those off
[speaker002:] Mm.
[speaker001:] and then do those. Is that okay?
[speaker002:] Yeah. No that's fine....
[speaker001:] You've done very well with the diet of course.
[speaker002:] I was getting a bit disheartened at one point
[speaker001:] No.
[speaker002:] and
[speaker001:] You're fine. You, you must be round your ideal weight really. So I mean you don't want to go di di down to a size eight or a size ten, cos I think you'd feel
[speaker002:] Mm.
[speaker001:] worse if you did.
[speaker002:] Mm.
[speaker001:] Now then have you found something interesting? I've got something interesting here, it's called a teddy bear sticker, and it says, no not, not a thing full of Codafiene tablets, no. They belong on the shelves knock them off. This says I was good at the doctor's today? Would you like one of those?
[speaker002:] Jade.
[speaker001:] Would you like one of these stickers? Shall I give you a sticker? Ah. Look at that. I bet there's no one else out there with a sticker today, I certainly haven't given any out so
[speaker002:] Come on.. Pick your baby up. Pick your baby up. [baby cries] Where you teddy bear look.
[speaker001:] Okay so we'll rattle, if we do those and then we'll have a chat.
[speaker002:] Yeah.
[speaker001:] See what happens. I mean if it turns out you're not anaemic and your sort of pallor is normal for you, [LAUGHTER]
[speaker002:] Yeah [LAUGHTER]
[speaker001:] then, then we can go ahead and get cracking straight away.
[speaker002:] Right.
[speaker001:] But I suspect that may be something we need to address as well. Okay?
[speaker002:] Right.
[speaker001:] Have we got some er stuff for, stuff for Jade?
[speaker002:] Come on, get your dolly.
[speaker001:] Can I pick dolly up?
[speaker002:] Come on.
[speaker001:] I'll pick her up.
[speaker002:] Come on
[speaker001:] Right see you then.