Episode 2 Doctor in the House

What would a doctor discover if they lived with you 24 hours a day?

-Hello.

-Hello.

Come and meet the doctor.

How much would you be willing to reveal?

I'm scared that I might get bullied for how I look and my weight.

I feel like I'm drugged.

But Nicola, you're right, you are drugged.

Would they be shocked by what they find?

Nobody has explained to her,

in language that she understands,

how to manage the condition.

It's not acceptable.

Most GPs only get about ten minutes with each patient.

Dr Rangan Chatterjee wants to try a different approach.

All the time in my consultation room,

I'm seeing problems that are lifestyle problems.

And they don't need a pill - they need a lifestyle change.

He's about to spend time with families

who struggle with their health.

Everything they've tried has basically failed.

PAINED GROANING

He'll gain insight into every aspect of his patients' lives.

How do they eat? How do they sleep?

How do they move and exercise and how do they switch off and relax?

He'll detect undiagnosed illnesses...

It probably puts you at high risk of early death.

..deliver some home truths...

I think this fear is holding you back.

Please don't turn it into this is...

this is because I'm mentally fearful.

..and discover ways we could all live longer, healthier lives.

It's amazing how many times, when you get those basics right,

all the other problems get so much better.

Feeling good, energy up,

I can even dance.

-Can I have a dance with you?

-LAUGHTER

I forgot the poo bags.

Right, come on, then, let's go, let's go.

Tonight, Rangan will meet two families blighted by illness.

The first are the Gleesons from Wirral near Liverpool -

Dad, 35-year-old Trevor...

There you go, grab him for me.

..13-year-old Gina-Louise...

No, don't chew your hair.

I chew my hair. What's wrong with chewing your hair?

Everything.

..Marley, who is 12,

and Mum, 34-year-old Emma.

I would explain you as...

-..overprotective...

-But really energetic.

Energetic, but overprotective

and it's, like, nice to see how much you love us,

but sometimes, it's a bit like, you know...

-Too much.

-"Calm down."

Yeah, well, you never know whether there's a kidnapper or paedophile. That's all I'm saying.

Emma has been suffering from severe anxiety,

panic attacks and depression since she was 19.

It's escalated over the years.

I can have three or four a day, so it varies.

It just depends, and it's been quite hard to deal with.

It affects our family life, what we can do as a family.

The kids have seen them as well, which must be scary for them,

if their mum's screaming in terror.

No-one wants to see the strongest figure in their life

sad or upset or see them...

I don't want to say "weak", but...

not in their usual state, really.

She's trying to stop herself from having panic attacks every day now

or a few times a day.

I feel like I'm unfixable. I just feel like I'm a big mess.

You'll be fine, come here, you'll be fine. Don't worry.

-We'll be all right. OK.

-SHE SOBS

In the surgery, it can be really difficult

managing patients with anxiety because you don't have much time

and there are so many different causes.

It's very, very hard to get to the bottom of it

in just a few minutes.

Emma has been battling anxiety for 15 years,

but her symptoms are getting worse and she's now at breaking point.

She's turned to Dr Rangan Chatterjee for help.

He'll devote the next two months

trying to get to the root of the problem.

-Hi.

-ALL: Hi.

-How are you guys? Are you well?

-Very well, yeah.

-Yeah?

Well, obviously not great, cos that's why you are here.

-LAUGHTER

-Yes, absolutely.

We're going to have to...spend a bit of time together

and really try and understand what's going on.

So, yeah...

-And try and fix us.

-Try my best, I'll try my best.

Certainly, the more information I can get, the more it helps me.

Yeah.

Can you tell me a little bit more about what happens

when you have a panic attack?

Just an immense fear of death.

It's just an overwhelming, horrible fear,

right in the pit of my stomach

and I can either try and control it, and shake instead,

or I can just end up screaming and screaming

and screaming and screaming.

So what happens in all of the panic attacks

is that you have this fear that you're going to die?

It's the thing. I can't go too far

cos I don't want to start screaming in front of everyone

but it's just that - "What happens after you die?"

I wish I could just die for ten minutes so I could know,

-and then come back.

-Yeah.

-And you already have.

-I didn't die. I didn't die.

She was in intensive care, in a coma, for a while,

and that might have had something to do with it.

That's got everything to do with it.

So can you tell me a little bit about that?

When I was 19, I had pneumonia,

which instantly sent me into panic mode

because my nan's husband had not long died from pneumonia.

Then they had to take me into intensive care

and I was out for about three-and-a-half, four weeks,

and then I woke up with the tracheotomy thing in.

It sounds really quite terrifying

and likely to be hugely significant here.

Anxiety is one of the most common mental health problems in the UK.

It's thought that around one in 20 people

are living with generalised anxiety.

I've got the same thing, but they're in different bags.

To help her cope, Emma takes antidepressants.

The citalopram has definitely helped with my mood

because before I had that, I was an absolute mess, wasn't I?

One of your doctors has in the past referred you to a counsellor.

-I've seen a few.

-You've seen a few counsellors

but you found they're not very useful.

I've never seen it through. With this whole fear of death thing,

I'm scared that I'll go to it and they'll say,

"You'll have to face up to it, won't you?"

I'm scared of someone saying that to me, so I've gone...

Further to the fact that they give me the thing and say,

"You make the appointment,"

I'll tell you I'll make the appointment,

but I'm not going to make the appointment.

Rangan wants to find out how the rest of the family

are affected by Emma's condition.

-What are you guys up to?

-We're just hanging out, really.

What are the main things you would like me to help your mum with?

Her panic attacks because it makes us a bit apprehensive

when we are at school or, in my dad's instance, at work,

cos we never know if she's 100% OK.

She doesn't really know how to take her mind off it

unless she is at home and she can tell us

that she's not feeling great or she is close to having a panic attack.

And you're able to...

You're the only one there, but you know how to handle it.

-Has that happened before?

-When I was going to her work with her,

it was on the bus then,

she got a bit stressed and I just calmed her down.

I got a few glances off people on the bus,

but I didn't care, as long as she was OK.

Understanding Emma's routine could give Rangan valuable information.

How often do you come to the shop, normally?

Um... Well, for beer, it'll be daily.

-Daily? Every day?

-Yeah.

-Right, so they know you.

Yeah, or I'd send Trev.

How much do you drink?

It depends what day it is. So, you have...

Monday, Tuesday, will be two cans of beer.

-Wednesday is normally a bottle of wine.

-Yeah.

Thursday, bottle of wine.

Friday, two cans of beer, bottle of wine.

Saturday, two cans of beer and a bottle of wine

and Sunday, a few beers or a couple of glasses of wine.

OK. That's quite a lot, isn't it?

Yeah.

I was trying to clock it up

and it's not far off 60 to 70 units...a week

and the government actually recommend,

and the NHS recommend,

that we don't drink more than 14 units per week.

-Four to five times over, so...

-Yeah.

-It is a lot.

-So, OK, you normally have Prosecco or Cava.

-Yeah.

Three lots of that, so 12 of those, five of these. Yeah. OK.

You've got problems with anxiety, OK?

And when you drink alcohol,

alcohol increases the level of a chemical in our brains

called GABA, and GABA actually dampens down things in the brain,

slows down the way our brain cells talk to each other,

so, actually, if you're feeling anxious

and you have a glass of Prosecco,

in the short term, it's going to make you feel better.

The more you drink, the more alcohol you then need

to have the same effects, because you become

a little bit tolerant to the alcohol.

You make me feel like I'm some alcoholic!

-Made me feel a little bit upset.

-Oh...!

I'm just trying to explain what's going on at the moment.

-OK.

-I do understand why you've started

because, in the short term,

it will be like a crutch and it will calm you down.

-Yeah.

-But in the long term, it just makes the problem worse.

-Yeah.

Emma also drinks two litres of caffeine-filled Diet Coke every day

and relies on nicotine.

How often do you have takeaways every week?

Two or three.

It's just easier and, you know, obviously it's not ideal,

but at the same time, it's just like,

"Here you go, here you go, here you go."

Everyone's happy, eat your food

then let's start doing bedtime routines, so...

She's got her chips, cheese and gravy.

My God, you're doing much more than you should be.

No, it's fine. My pleasure.

Where are we going? Whose is this?

Oh, that's yours.

Sorry, I'm walking off with it.

-Tortillas.

-Nachos.

-Nachos.

-With refried beans

and sour cream

and little bits of coriander

and onions and stuff.

'As a GP in standard surgery,'

there's just no way you could get the bottom of this.

It's just simply not going to be possible

and...now that I've got more time and I'm starting to pick things up,

frankly, I am so far outside my comfort zone,

I cannot even tell you.

There is so much information coming in.

I actually don't know what I'm going to do with it all.

In the morning, Rangan commutes with Emma to Liverpool city centre,

where she works as a PA.

He wants to see if he can identify potential triggers for her anxiety.

OK, so we go round here, and this is where my office is, round here.

Hey, guys, how are you doing? All right?

-This is Phil.

-Hey, Phil. Rangan, nice to meet you, are you all right?

-And that's Peter. Hey, Peter.

-Rangan, how are you doing?

All right? Nice to meet you.

Is there anything you do on the computer or the phone

that can ever make you anxious or panicky?

Only if I go onto the news pages

and someone has been murdered or something

and it's a horrible story, then I'll start thinking...

-SHE GASPS

-Yeah.

Have you guys seen any of this at all?

Yeah, you mention space, death,

anything that is outside of just the realms of average day-to-day

-and Missy has a panic attack.

-Oh, really?

Oh, yeah. Or, "Stop talking about it," or something.

If I feel like I am about to go and have a proper panic attack,

I'll either go and speak to him or I'll just leave

and go and try and calm myself down.

I've got up and walked out a couple of times.

If we're having a terrible day and I'm having a meltdown,

this is where I go for my wine.

"Right, let's go get some emergency wine."

Re-evaluate the situation

then go back to work in a bit of a calmer state.

So they're quite understanding. They know that, actually,

you can sometimes get quite anxious and panicky

so you need to sometimes come and the wine helps you calm down.

Yeah. It takes the edge off that...

-GASPING

-..feeling.

In Britain, people who experience anxiety or depression

are twice as likely to be heavy drinkers.

I'll tell you how I see things that are going on with you, Emma.

I know that you...

..have said to me that what happened at 19,

that whole experience is a big part of this

but I think, since then,

in order to try and deal with those symptoms,

you've probably started to do things

that actually are making that a lot worse.

Does that make sense?

-Go on.

-OK.

So what I'm saying is I think that was a big...a significant incident

and what that did is probably cause you to have a lot of anxiety attacks

and these panic attacks,

but then, because of those panic attacks,

I think you needed to do things to help you cope with them

and I think that the things that you're using to cope

are actually driving the panic attacks to be worse

and I think it's a vicious cycle that you are in now.

I think it's going to be very, very hard to unwind this whole...

..these whole patterns that you've got going on in you.

I don't think your body's in a state

where we can even tackle that just yet.

The two things are - what you're eating

and how much you're drinking.

So this is the sort of food that...is not going to be ideal,

because this is going to put you on a blood sugar roller-coaster.

It's full of sugar and... Yeah.

Yeah, it is, and if your blood sugar goes low, OK, just a smidgen low,

your body goes back in fight or flight.

You release something called cortisol

which is a stress hormone, you release adrenaline

and actually, alcohol will do this as well,

because it spikes your blood sugar and then you crash.

That will drive you more into fight or flight

so we want a diet for you

that actually stabilises your blood sugar.

Rangan wants Emma to stop eating sugar,

processed foods and slowly reduce the amount she drinks by nearly 75%.

-What do you think, Emma?

-I feel like I'm doing it to myself.

You're not. You'll be all right.

But, like, that's what I didn't want to hear.

"You'd be fine if you weren't drinking too much and eating shit."

It's hardly... You're not eating sweets.

-No, it's not that.

-Eating what normal people eat.

It's like, "None of this would be happening if I wasn't doing that."

It's not about blame. I do not think you're doing this to yourself.

I absolutely understand why you're doing this.

I'm not criticising, I promise you.

I would, you know... What I'm asking for

is to see if you're willing and if you are willing,

then we can reassess in seven days.

Re-assess and see, actually, has it made any difference?

Or has it not? You know?

And normally, it makes a big difference.

That was really, really intense.

I feel quite drained, actually, just from that...

from that conversation.

I'm...

I'm starting to tread on eggshells a little bit because I am feeling

that I can't... say what I need to say

because I think Emma feels as though I'm blaming her

and I'm genuinely not blaming her.

I do understand why she's making the choices she's making

but, actually, I think that's a reflection of where she is.

She is so locked into this fight or flight

that actually, whatever I say, she's taken that as being blame,

that she's doing it to herself.

I actually think that's part of the problem.

I'll be back to see if you're all right.

-Thank you so much.

-Thank you very much.

-Take care. See you.

-See you, now, bye.

I don't think changing my eating and drinking

is going to change...my fear.

No, well, that's different, isn't it?

He said that's going to come further down the line,

but this is to prepare the body, really, for that fight.

Obviously taking away Diet Coke is going to be a massive thing

cos anyone who knows me knows

that I am basically a bottle of Diet Cola,

so I think that's going to be really, really hard.

In the meantime, Rangan travels to a second family

where another parent is struggling to deal with everyday life.

Sleaford in Lincolnshire is home to the Murray-Hardcroft family.

11-year-old Ellie and Maeve,

nine-year-old Charlie...

-Coat on.

-I don't want it on.

-It might be chilly outside.

..Mum, 39-year-old Kelly...

Right, in you get.

..and Dad, 36-year-old James.

Kelly will be back soon.

Now we can get on with our day.

Mum and Dad run an IT business together

and study in further education.

They've called the doctor for James's unexplained exhaustion.

When you see your partner at,

kind of, three or four o'clock in the afternoon,

barely able to keep their eyes open,

and you know they're not having quality of life,

it's quite upsetting.

James eats healthily, exercises regularly,

but struggles to sleep.

At night, I can go into a fever.

I just sweat profusely,

literally from the top of my scalp to the soles of my feet.

Sweats like somebody's thrown a bucket of water on him,

which isn't pleasant to sleep next to at all.

And he also, er...

He struggles with breathing sometimes through the night,

which wakes me up,

so he takes a lot of inhales, but doesn't actually exhale at all,

um...until his breathing has stopped altogether

and then kind of splutters a little bit and starts again,

but it's quite scary to be woken up like that.

James's lack of sleep has taken a toll on his life.

I can't explain...

..how every single day of life for 20 years plus

has felt just like wading through treacle.

You can't get doctors to listen.

If doctors don't listen,

nobody around you is going to listen, either.

Nothing's wrong with you. If there was something wrong with you,

you'd be on drugs, you'd be on medication,

you'd be seeing specialists,

you'd be referred for this, you know?

There would be something on paper, somewhere, to explain, actually,

you're not lazy, you're not just lethargic.

When patients feel fobbed off by their doctor,

it can be quite frustrating as a doctor

because the time constraints mean that, often, we can't actually

delve into why that is,

but actually, it's more frustrating for the patients,

because they're the ones who feel fobbed off.

James wants Rangan to solve the mystery

of why exhaustion has ruled his life for the last 20 years.

-Hello.

-Hi, I'm Dr Chatterjee.

-Hi, I'm James.

-Hi, James.

-Kelly.

-Hi, Kelly.

So you've known, inside you, for a while...

-Yeah.

-..something ain't quite right.

-Yeah.

-You've done what is the reasonable thing to do,

which is you are a busy guy, but you found time

to go and see your doctor, flag a few of these things up.

You go to your doctor and you say, "I'm tired,

"I'm sweating at night profusely.

"I stop breathing when I'm asleep."

And they just basically say, "There's nothing wrong with you."

-Yeah.

-"Go home, and if it happens again, come back."

Well, I've been doing that for years.

And how do you feel about that, now?

I'm pretty...bitter.

-Is that it? That's how you feel?

-I'm quite bitter.

You don't look like someone who is out of shape,

so doctors are already probably thinking,

"Yeah, he's in decent shape."

Rangan begins looking for clues

that could point to the cause of James's illness.

Yes, so this is just a very, very brief exam,

I just want to see if I can pick anything else up, OK?

Take your pulse.

Listen to your heart.

Deep breath in, please.

Your blood pressure.

OK, that's a little bit elevated,

it's 144/93.

Your history is making me concerned

that you may have some sleep apnoea.

The full term is obstructive sleep apnoea.

There's an obstruction in your airway,

which is basically meaning that you stop breathing

at regular intervals whilst you're asleep.

What's happening is every time you have an episode

where you stop breathing, it can often be the equivalent

of you going from sea level, up to base camp at Mount Everest,

back and forth, ten times in an hour.

-That's the strain it's putting on your body.

-OK.

-Oxygenation.

Oxygenation, yes. Does that make it a bit clearer?

Yeah. Yeah, it does.

And that potentially might explain

-why you are so tired sometimes in the day.

-Yeah.

Rangan spends the evening with the family

to see James's symptoms first-hand.

He looks exhausted to me.

Yeah, so this is actually quite normal

for James to be this tired.

He would quite happily go to bed with the kids.

-So, at eight o'clock.

-Really?

Yeah, absolutely.

Sometimes, just to have a partner on the evening,

I have to literally, kind of, not beg him, but say,

"Actually, I'd really like your company,

-"can you just stay awake a little longer?"

-Right.

What I'd like to do for you is

to have a look at exactly what's going on when you are asleep

and see if we can come up with a proper diagnosis

as to what these sleep issues are, and therefore, that will help me

determine what sort of treatment we need to give you.

Right, OK.

Rangan fits James with a device

to record his breathing and heart rate throughout the night.

How does that feel?

-Great(!)

-LAUGHTER

Keep it on all night, we'll get this back

-to the sleep clinic tomorrow.

-Yeah.

-And then, hopefully, we'll have some results very shortly.

-OK.

-OK, thanks very much.

-Sleep well. See you, Kelly. See you.

Through the night, the equipment will register

if James's throat muscles relax to the point of collapse,

blocking his airway for ten seconds or more,

which would indicate an episode of sleep apnoea.

A few days later, Rangan, James and Kelly

head to London for the results of the sleep study.

I think James just wants to know what's going on, so he can fix it.

This is having such a massive impact on his life.

His ability to be a father, interaction with his children.

I think he's really excited that we might actually

get to the bottom of this today.

-Hi.

-Hi, how are you?

-Good to see you.

-Yes, good, thanks.

Dr Singh is the consultant in charge of the sleep clinic.

He's analysed James's results.

-It was a good study.

-Excellent.

-So in spite of, sort of, concerns,

the study measured about six hours and 25 minutes.

-Terrific.

-There were no episodes in this study

where your airway closed down completely.

-Right.

-That means that, actually, this respiratory sleep study

was a normal study, meaning we can, with a degree of confidence,

rule out obstructive sleep apnoea.

-Excellent.

-Which is very good, and it's very important.

We are not looking at sleep-disordered breathing here.

-OK.

-So we've not only ruled out obstructive sleep apnoea...

-Yes.

-..we've also ruled out other conditions that fall under

-the umbrella of sleep-disordered breathing?

-In a sense, that's right.

Obviously, we need to dig a bit deeper now and find out,

actually, what is going on.

Yeah, so how do you feel?

Do you know, I'm not sure.

Nothing is cut and dry, is it?

There's no immediate answer right now.

And I think,

I think that was one of the things I was afraid of, you know,

coming in today, was that there would be no immediate solution.

We're no closer to a solution, we're further away.

That's the problem, we're still in limbo with it.

-I think we are closer, Kelly.

-Do you think?

-I know...

Closer in the sense that... you know, a few weeks ago...

..nothing was happening, this was just normality.

-This was just something we had to live with.

-Yeah.

-Yeah.

HE SIGHS

That was a little bit surprising.

I did not really think that that was going to be the outcome

of the sleep clinic today.

I think it's a good thing, I think it's a really good thing,

that James does not have sleep-disordered breathing,

I think that's brilliant.

The question is, what does he have?

I'm just in a really, really bad mood.

In Liverpool, Emma is struggling with Rangan's new diet.

The last thing I want is stupid avocado for my dinner,

I want a pasty. It's so funny and stupid at the same time.

She's been battling anxiety and has been relying on a cocktail

of antidepressants, alcohol, nicotine,

caffeine and high-sugar foods.

Eating a big bar of chocolate and a packet of crisps

would make me well happier right now than a bowl of healthy soup.

Rangan is very slowly

trying to reduce her reliance on these substances.

I'll close down if I stop drinking it.

But she's not finding it easy.

Crying over chocolate. Who cries over chocolate?

I don't even like chocolate.

I think that, basically, Emma lives in fight or flight.

I think, if I make one wrong move,

she could lose faith in me,

and I think the whole thing falls down then.

Rangan hopes that a lesson in nutrition

might give Emma the motivation she needs.

The food you eat can really affect your mood

and how your brain operates, basically.

And so I thought we could actually go through some of the foods

that might help you.

You know, healthy gut, healthy brain, basically.

It's hard, it's like your junk food is your friend, isn't it?

When you're feeling down, it's, like, your go-to thing.

To replace it... I mean, I don't know.

Maybe it will make me feel better, so it's worth trying it.

Leafy green vegetables can actually, basically,

drive the growth of good bacteria in your gut,

that can really help with your brain.

So having things like cauliflower, broccoli...

-Would you have foods like this?

-Yeah.

-What have we got here?

-Cabbage.

-Cabbage.

Look at that. That looks great to me.

I can see the snail marks on it, though.

Why is it you don't like the snail marks?

It would be like licking a snail's bum, wouldn't it?

LAUGHTER

It's just left its stuff out as it goes along.

Tell you what, I'm going to hide that, then,

cos we can wash that off.

There's another chemical that we find in food

that can be really helpful for our brain.

It's called tryptophan.

OK, so tryptophan helps us make

something called serotonin in our bodies.

Serotonin is, you know,

many scientists call it like a happy chemical in our brain.

And there's certain foods, pork contains tryptophan -

so would you ever eat pork?

-Yeah.

-Let me just go and grab something.

Emma, would you ever eat things like this, sweet potatoes?

-Yes.

-Yeah? Good, because if you have a healthy form of carbohydrate,

like sweet potatoes, it really helps you to absorb the tryptophan.

Here, Emma.

Perfect.

OK. Walnuts are like a double whammy.

OK, because walnuts contain omega 3 fats,

so these are fats that we think are really good for our brain function,

and we can't get them unless we take them in by our diets.

-Our bodies can't make them.

-OK.

-OK?

So these are full of omega 3 fats, which is absolutely brilliant.

The other thing they've got is tryptophan.

No, I've never made the connection before,

about what you eat having any form of repercussion on your mood or anything like that,

that's not something I'd ever known, especially all these fancy words

that are in stuff, you just don't realise.

I don't think it's necessarily the whole story with you,

but I think it's a great start.

I wonder what Trev will think when we come back with all this food.

He'll probably wonder where his chippy tea is.

Right, all done.

Rangan's diet plan is a world away

from takeaway dinners and bottles of Diet Coke.

What are you cooking?

So, I'm making tomato soup.

Emma perseveres with the diet...

I'm making a stewy, soupy thing.

..and Rangan keeps up the encouragement.

How have you been getting on this week?

If anything, I've been a bit more anxious because I've taken the comfort blanket away.

What's on my desk this week, Peter, that's unusual?

Pears. And water.

So, I've got boiled eggs

and home-made guacamole with chilli flakes and stuff

that I made last night.

-You made it yourself?

-Yeah, getting good at this cooking lark now.

By reducing her alcohol and changing her diet,

Rangan is slowly preparing Emma for the next stage of her treatment.

I'd love to get her to talking therapy.

The research would tell me to send her to a behavioural therapist,

a cognitive behavioural therapist.

But Emma, the patient, is telling me she doesn't want that.

So that's why I've had to go and research something else.

Instead of therapy, where Emma talks about her issues,

Rangan wants to try an alternative treatment

that combines massage with counselling.

You can, with some patients, actually help reduce stress hormones

like cortisol and adrenaline by physical touch,

and Hayley is very skilled at that,

and I thought it would be worth trying it, because then,

you don't have to think about things and talk about things.

-But we could see.

-Yeah.

-Does that...?

No, I'm willing to give it a go, cos obviously, I trust you.

So it's just a case of going and doing it.

But I've never had a massage anyway, so I'm scared of anything. Scared of new things.

You've basically been doing what I've asked you to do,

which is substantially change your diet,

substantially reduce how much you're drinking.

That's fantastic, but I do think we need to do more,

and let's go and see Hayley

and see if she may be someone who can help us.

-OK.

-Yeah?

Rangan has brought Emma to meet Hayley Stevens.

-This is Emma.

-Hi, Emma.

She specialises in biodynamic massage.

I just want you to bring your awareness to your breath right now

and I just want you to tell me what you notice.

What do you notice about your breathing right now?

-I don't know.

-OK.

I can't focus on my breathing too much

because it'll remind me that I'm alive

and then I can die and I'll have a panic attack, thanks(!)

OK, so you don't want to focus on your breathing?

-No, not really.

-OK.

There's nothing here right now that is going on,

that is happening, that is scary right now.

The whole situation is scary because I've never been here,

-I've never done this, so of course it's scary.

-It is.

What's happening on a day-to-day basis

that you say "God, I'm afraid"?

Yes, well, anything that really reminds me that I'm alive

reminds me that I'm going to die.

-OK.

-Um...I don't know, I'm going to cry again.

I've been like this all week, I don't know what my issue is.

OK.

Can you just leave us for a few moments?

-Yes, of course, definitely.

-OK, thank you.

-OK, OK...

I don't think I really appreciated

that even the small amount of chat that Hayley had to do with her

was going to be too much.

I thought, at the very least today, I would do no harm.

And there was a short period where I thought...

"I'm not so sure, I'm not so sure.

"Have I eroded trust? have I made things worse?"

If I don't find something soon

that she's going to start responding to,

I wonder how long that trust will last.

Emma leaves the session before the massage therapy even begins.

I felt like I'd let everyone down

because everyone had travelled all this way,

it was all this big thing to go for this massage

and then I just...I said to her, "I'm just too crazy for you."

That's what it is.

I'm not mentally well enough for her to start touching me

and trying to get emotions out of me with massage.

All you can do is go back to the drawing board

and think of something else.

How about some emotional support, how does that pan out for you?

Yeah, and we can watch a horror film in bed, cos you like them.

Yes, again, but what about the emotional support side of things?

Well, yeah.

Yeah, but I'm not a big talker.

But, yeah, I can be there for you.

You'll be fine, come here, you'll be fine, don't worry.

Obviously today was a little bit disappointing for her,

but now I've got to support her really more.

What happened today, it sort of brought emotions up

and things that she might not want to talk about, to me or to anyone.

She'll probably get drunk tonight

and just talk to me when she is drunk, you know?

In Lincolnshire, Rangan is trying to get to the bottom

of James's mysterious, debilitating exhaustion.

He now knows it's not a sleep disorder,

so he's sent James for blood tests,

and is hunting for more clues in his daily routine.

I think James is still a little bit of a mystery because he's exhausted,

he can't sleep, he wakes up in sweats,

but he looks fit and well, and he comes here all the time.

But it's not normal for someone in their 30s to be like this.

I need to keep digging, I think, and see,

can I detect something else?

OK, your heart rate is 120, it's regular.

What I'd call good volume, good weight,

nothing untoward from feeling your pulse.

With James appearing physically healthy,

Rangan moves his investigation to his mental health.

So, James, do you get anxious

about things in general, would you say?

Yeah.

I'm very good at covering it up.

Because I have a tendency to not become, sort of, physically irate,

I'm good at keeping a calm voice and, sort of, approaching things

from what appears to be a very level-headed perspective,

but I do, I am anxious about a lot of things.

Do you know where this comes from?

I've had some pretty unstable...points in life.

-And...

-What do you mean by that?

I ended up...not a fixed address, for a while.

-So were you sleeping on the streets?

-Yeah.

-Yeah.

Usually, I would find somewhere a bit prettier than a street,

it would be a park, you know, somewhere...

So how long were you...?

Would you say you were homeless for a while?

Yeah, I was homeless for a while.

After a fall-out with his parents,

James found himself homeless in his late teens.

There were times when I had to sleep here

and I would tuck myself away behind the shrubbery

and basically put myself, wherever I would be, out of sight.

But I did once get urinated on. The guy was drunk.

And do you think that sleeping in parks like this one

has actually contributed to anxiety about yourself,

anxiety about the next meal, anxiety...

just general anxiety in your life?

The problem is, it's kind of hard as the person in it

to be able to say for sure, but...

Um...I've described before,

there are times when I've woken up...

er, feeling cold wind.

Obviously, I can't feel cold wind - I'm in a house, the heating's on.

But there are times when I've woken up

actually feeling like the cold wind is making my joints ache.

-As if you were right here in this park?

-Yes.

-Wow.

I am still angry about it, I know I'm still angry about it,

and I know I still have trouble justifying how it happened.

The period of time before you were homeless,

do you recall having sleep issues?

-Vaguely.

-Vaguely.

But nothing on the level?

Nothing of that level.

So it's reasonable to think

that anxiety induced by you being homeless for a period of time

may be contributing to your sleep issues?

-Yeah.

-Yeah?

-Yeah, I think so. I think it's logical.

But Rangan's research into James's anxiety is interrupted

when he receives some disturbing blood results.

So I did a series of blood tests on you

and one of the markers is a little bit worrying, OK?

-Right.

-There's a marker called homocysteine,

and homocysteine... can be a risk factor

for heart attacks and strokes, if it's this elevated.

Right.

Now, ideally, we want to see it under ten.

-Yours is well above 30.

-Wow.

-Right.

That's very high, OK?

And...homocysteine is an amino acid

that we should metabolise and break down in our body,

but for some reason, that's not happening in you.

So that's accumulating in your blood

and whilst that is elevated, it can damage your blood vessels,

which, in the long term, can then put you at increased risk

of a heart attack or a stroke.

Would that be... Could that be the way it is

because of the mini-stroke James had when he was younger?

Can you tell me a little bit about that?

I woke up one day feeling very much like I had a hangover.

And after living with that for about four weeks,

went to the doctor.

It was implied I may have had a TIA.

A TIA, or mini stroke,

is when blood to the brain is temporarily disrupted.

In the UK, there are nearly 50,000 new cases every year.

So, 14 years ago, you had this incident for a few weeks that...

The doctor is saying it may well have been a mini stroke.

Yeah, that was really all they could put it down to.

OK. And since then, in this 14-year period,

has anything like that ever happened again?

I have... I've had a lot of, sort of,

physical ups and downs, haven't I?

In the last few months, you've had...

We put it down to low blood pressure,

where he would go...

You could see the blood drain from his face

and he was very light-headed and we went to the doctors

and they kind of dismissed that part of it.

The blood tests flagged something up for me.

His history flagged something up for me.

But now that I've reported it back and gone into it in depth with him,

there's so much more there.

He may have had a mini-stroke when he was 21 - I didn't know that.

That is hugely significant.

I am worried about him, really worried

that he is a walking time bomb.

With this new information,

Rangan immediately begins further research.

So, James is a 36-year-old male, extreme fatigue,

sleep quality is very poor, significant night sweats.

Breathing issues at night.

A mini-stroke when he was 21 years old.

Rangan decides the most urgent step

is to lower his very high homocysteine levels

to reduce the risk of him having a stroke.

After consulting professors of pharmacology,

he decides to use a combination of powerful vitamins.

What I've got for you is a supplement

that actually contains a few things, OK?

It contains B12, which is a vitamin.

It contains vitamin B6, and it contains folate.

OK, and they're all interlinked with pathways in the body

that can generate energy, that can potentially be linked

with a risk for heart attacks or strokes,

and so I want you to take these

and see if, by supplementing these nutrients in your body,

whether it changes the way you feel.

-OK.

-Yeah?

-Yeah.

It can't make me worse.

HE LAUGHS

And I just think, maybe, this could be part of the puzzle

with what you've been struggling with for the last 10, 15 years.

This could be part of the puzzle.

Rangan gives James a combination of B vitamins,

including 400 times the recommended daily dose of vitamin B12.

Two rump steaks, two chicken breasts...

Emma's visit to the therapist ended in failure,

and Rangan was concerned she'd lost faith in him.

But she's persevering with his diet and reducing her alcohol.

Hello, Dr Scott. It's Dr Chatterjee here.

Oh, hi.

Rangan is still searching for another treatment

that could help her.

I want to talk to lots of different therapists,

really get an understanding - what are they going to offer,

what their strategy is, and also try to make a judgment

of who I think Emma is going to get on with.

He speaks to psychiatrists, psychologists

and experts in anxiety.

I'm trying to find someone to help her deal with what happens,

but in a way that is consistent with what she wants also.

We can say a patient has tried cognitive behavioural therapy,

but what does it actually mean?

Have they seen a good therapist, first of all?

He draws up a short list.

I've got a good feeling about this, I've got a feeling that, actually,

what you're offering may be exactly what Emma needs.

-Hey, how are you doing?

-All right, yeah.

-Good to see you. You OK?

-Yeah, come in.

How are the panic attacks at the moment?

I've had more over the past couple of weeks than I was having.

That might just be because my brain is more clear

and I can hear the little thing that keep saying things to me.

I'm really very, very proud of what you have done,

I think it's amazing.

But I think we do need to think about

how am I going to get you some sort of therapy to help you.

I've spoken to quite a lot of people,

and I've narrowed it down to about three people

who, I think, offer something very different

and I'd be very keen for you to chat to them and see what you think.

-So should we go to call number one?

-OK.

But just before they start, Emma gets cold feet.

-I don't want to be a pain.

-Emma, you're not going to be a pain,

and this is not about being a pain, OK?

It doesn't matter - this has been, you know, it's been...

You have to stop worrying about being a pain, OK?

I'm here to try and help you, OK?

So, the people I've found are with that in mind.

-If I haven't found someone who you can relate to, that's OK.

-OK.

Hi, yeah, nice to see you, too. This is Emma.

-Hi, Emma.

-Emma, this is Charlotte.

Emma, this is Steve. Steve, Emma.

-Hiya.

-Hi, pleased to meet you.

Emma, Heather. Heather, Emma.

-Hiya.

-All right?

I've worked with about 5,500 people.

After an afternoon of talking with the therapists,

Emma chooses Charlotte Copeland.

I liked her. She talks like a normal person,

and some of the stuff she said made sense.

For the first time in 15 years,

Emma has found a therapist she wants to speak to.

This has been a good day.

It's probably the first time that I've actually really felt that,

you know what, we're moving in the right direction.

I'm hopeful at the moment, I'm optimistic, but I'm cautious.

A few days later, Trevor and Emma are travelling

to meet her new therapist, Charlotte.

So, are you looking forward to this or what?

Are you excited about seeing this lady, or...?

I wouldn't say excited.

I'm... Like I said, I'm apprehensive, so it's just...

It's cos it's delving into the unknown, isn't it?

And figuring out whether... she can help me,

or what ways that she'll come up with to try and help me.

You're not going to talk about,

like, your deepest, darkest feelings and stuff like that,

it's going to be just assessing each other, basically, isn't it?

-Hi.

-Hi.

-Hiya, you OK?

-You must be Emma.

-Yes.

-Hi.

It might work and it might not, we don't know,

it's just something she's going to have to try.

Obviously, Rangan thinks that it might be

the right thing for her to do.

Emma and Charlotte spend over an hour

in their first session together,

and there's a significant diagnosis.

Emma clearly has post-traumatic stress disorder

and she meets all of the criteria for that.

There has to be an event that's significant

that we feel our life, or somebody that's significant to us,

their life, was under threat.

It has to be traumatic, an unusual event.

Emma falls into that category of -

our mood changes,

how our behaviour changes.

We either feel numb or we do things to numb ourselves,

like drink, for instance.

This isn't in her imagination, it's very real and very treatable.

Where's your glass?

Post-traumatic stress disorder

is thought to affect one in three people

who've had a traumatic experience.

Once diagnosed, talking therapy is often the best treatment.

She gave me that thing where I felt she wouldn't just have me in bits

-and let me walk out on the street.

-No.

-And she even said that herself.

And other places have messed my brain up.

You've seen what I've come home from, I'm ten times worse.

So...I don't know. I'd like to be able to see her.

Yeah, see if she can do a Saturday, so I can take you, bring you back.

Or we could just kidnap her and keep her downstairs.

In Lincolnshire,

James is taking high-strength vitamin B supplements.

So, Rangan has put me on these pills.

Rangan is hoping to cure James's chronic fatigue.

-Yes, it has made a difference, hasn't it?

-Oh, huge.

It's, um...

This isn't just in my mind, this is...this is massive.

His symptoms are disappearing.

I'm sleeping well, I'm waking up well,

I'm feeling a lot better.

I am staying awake throughout the day.

But Rangan is surprised by the speed of his recovery.

He retests James's blood

and checks the results with leading professors

in vitamin B and homocysteine.

His homocysteine level was nearly 35, it was 34.53.

I mean, that's one of the highest I've ever seen, actually.

I gave him a supplement which contains B12 and folate,

and...I never expected such a dramatic improvement.

That's actually just come back, I'm just checking out.

It's just come back,

and his homocysteine has come back at seven now.

Well, look, thank you very, very much for your time,

and I will talk to you soon. Thank you.

-Hi.

-Hey, how are you doing?

-It's good to see you.

-Yeah, good to see you, too.

How are you guys getting on?

It really has snowballed.

It's been an incredible transformation.

Really, the changes have been happening almost daily

and they are so profound, I can't ignore them.

But I'm hoping to provide some answers for you.

Why such a dramatic change?

And so I've run some tests for you, OK,

to try to work out what's been going on.

So I did a genetic test

for a particular pathway in your body, OK,

that needs to function well for your body to function well.

If that pathway is not working well in your body,

-it can actually work up to 70% slower.

-Right.

So, if this car... This car is you, James, OK?

And if you need to get to where you need to go,

-ideally, if you are on a motorway, you'd be going at about 70mph.

-Yeah.

Right? You've got a genetic variation

that means yours isn't going as fast.

You are going, but you weren't function as well

-as you could have been functioning.

-Yeah.

This makes sense, because there's, sort of, lots of things

I've been able to do, just trundling along,

but actually, as time has gone on,

and there has been more pressure, there have been more places to be,

there's been more need,

there's been more requirement for me to be more alert,

for me to be more on top of things, I can't deal with it.

-That's it.

-And I physically can't deal with it.

The course of vitamin B

has helped treat the genetic defect that was sapping James's energy.

It's also reduced the chances of having a heart attack or stroke

by lowering certain chemicals in his blood.

The other thing is, your homocysteine,

when I started, was 34.5.

-Yeah.

-That's very, very high.

As I said, the highest I've ever seen.

OK, it's now down to seven.

-OK.

-That's normal. That's what it should be, isn't it?

-Yeah.

It's a massive relief.

HE LAUGHS

-I felt like shit for 20 years.

-LAUGHING:

-Yeah.

Something as simple as a B vitamin, essentially.

Yes, a combination of supplements.

-It's actually a really simple fix.

-It's remarkable.

I can't remember the last time I felt this well.

I just wondered if I just couldn't cope...

..with life, really.

-Right.

-Let's go, let's hit the beach.

It's been a long time since we've been to the beach,

and to be honest, last time, you actually took a photo

when I fell asleep on the sand.

-Yeah...

-All right, let's go and do it without falling asleep.

-This one?

-Yeah..

Right, one sec.

Argh!

What sort of differences have you noticed at home?

-James isn't that tired any more.

-He's not that tired any more?

No.

When we go to bed, he used to get really grumpy.

But now he's a lot more playful.

I really want him to stay non-grumpy.

I'm still young.

At least you haven't come, like, when I'm 20

and he's, like, really old.

James is...a different man.

It's like being given a gift.

Life has been such a hard toil lately, and, um...

he's just filled with more positivity and vibrancy and energy.

Anyone fancy a race to the pier? Hey?

Right, guys, time for me to go.

Thank you for everything. And...

I hope we'll see you again.

-Not for the same reasons, obviously.

-LAUGHING:

-Yeah!

Thank you. Life-changing.

I don't know what it feels like to have lost the last 20 years,

in many ways.

But I do know that, actually, this is the start for James.

And actually, the next 20 years could be very, very different

from the last 20 for this guy.

Emma Gleeson has suffered from years of anxiety.

She tried to suppress the feelings with alcohol, antidepressants

and high-sugar foods that only made her symptoms worse.

After two months with Emma and her family,

Rangan is making one last house call.

-What have you got in there?

-I've got the beef bones -

all you've got to do is give a little donation in the butchers

and they just give you the beef bones.

When I first asked for them, they thought they were for the dog.

They were like, "Must be a big dog."

I was like, "It's for me, cos I'm making stock.

"I'm not a dog!"

So I've got onions, head of garlic, parsnips, carrots,

-rosemary, thyme, and loads of salt and pepper.

-It looks amazing.

So, Emma, when I first came to see you,

you were drinking, you know, 60 to 70 units of alcohol a week.

What are you having at the moment?

I pretty much stuck to what I said I'd stick to,

so, wine on a Friday and Saturday, nothing Sunday, Monday, Tuesday.

I normally have one on Wednesday, nothing on a Thursday.

When you say one, what, do you have a glass?

Yes, I just buy the one-glass bottle.

Because I don't need as much to drink any more.

Yeah. It's about 15 units a week.

So I'm nearly there.

Hey!

Look, compared to being nearly 70 units a week, 60 to 70 units,

to go down to about 15 units a week, it's a massive reduction.

You've seen Charlotte this week, haven't you? In person.

Do you feel you do have a better understanding

of, actually, how things have spiralled to this point?

-Yeah.

-And, potentially, how we may begin to un-spiral it?

Yeah, yeah.

When I went to meet her,

I just thought, "She is possibly one of the only people

"I would feel safe enough talking to about that kind of stuff."

I think, once you've lived with anxiety and depression

and all that stuff for so long, it's kind of hard to envisage...

God, I've made myself cry.

-But it's hard to imagine life without that.

-Yeah.

And letting it go is hard as well,

cos, like, you're used to living like that.

Can you imagine the possibility of life without this now?

Yeah.

I don't know why I'm crying.

SHE LAUGHS

It's a big deal, isn't it?

-Sorry.

-But it's a big deal.

You've been living with this for so long,

and I think you'd almost given up that, actually...

What did you say to me?

-"I'm too ill to fix."

-Yeah, too broken to fix.

Yeah. You're not too broken to fix.

It doesn't mean it's easy,

but you've started the process off now,

you've started off the process to get yourself fixed.

How's it going, all right?

It's not only Rangan who's impressed with the change in Emma.

I'm definitely proud of you cos that was one of the main things

that I wanted you to change, was how much you did, like,

how much alcohol you consumed within a space of a week.

And I'm so glad you've cut down to how much you are having now,

and it's definitely made me happy.

-Thank you.

-I'm very proud of you for it.

Thank you. I'm proud of me, too.

-You should be proud of yourself.

-Yeah.

Cool. Me and Marley are, like, awkward now.

Where's your big speech? Come on.

LAUGHTER

You've done amazingly well, you really have.

And...it's been amazing for me to be part of that journey with you

and, um, keep up, it's just the start, it really is.

Have I made you cry now?

LAUGHTER

Thank you so much.

-It's just emotional.

-Why are you looking at me?

-I mean it, thank you.

-Yeah.

Yeah, thanks very much. Thanks, Rangan.

It's good jamming with you, and good that you sorted Emma.

We're getting there, she's on the right road, I think.

It's a long process, but, yeah.

'Something has changed, something has really changed in Emma.

'She's got this strength, she's got the resolve now,

'she can contemplate seeing a therapist now.'

This is a lady now who's got control of where her life goes.

She doesn't have to be a slave to her illness,

she can actually be its master.

It's fantastic to see.

I think the future looks really, really bright for Emma.

Next time, Rangan travels to London to help an 11-year-old schoolboy...

Get those hips moving, Mum.

..mystified by his weight problems...

It's about 11st 1lb.

That's how much I weigh.

..and tries to help a teenager overcome an eating disorder.

Do you think there was "before food" time?

-What's up?

-I'm just anxious about food, that's all.

She's not really trying to tackle this,

and I don't want to botch this up.

I really don't want to mess it up.