It’s the last week of the summer holidays, which for me means the European Society of Cardiology meeting (and also my wife’s celebration that our children go back to school this week!). Why it runs over a weekend is anyone’s guess, but so be it.
This year it is in Madrid, and I’m actually writing this on the plane. As per last year, I plan to record my research video live from the conference, so at the time of writing I have no idea what I will be discussing! I will schedule this blog in advance and dive into the research from the conference next week. The meeting is one of the largest medical conferences on the planet, with tens of thousands of delegates. I’m anticipating a big focus on blood pressure, cholesterol, and weight loss medications. I’ve never been to Madrid before, and hope I get at least a few hours to see the city as well. Real Madrid are playing Mallorca on Saturday so I expect that could be pretty lively. I did try, but sadly couldn’t get a ticket.
Sometimes in medicine, you’ve got to see the bigger picture, and look outside of the narrow bit of the body that you’ve specialised in. We are not just hearts, lungs, livers and kidneys, funnily enough they are all linked. This week I saw a lady in her 50s, who I’ve known for years, and has had all sorts of heart problems in the past. Thankfully despite those, she has been pretty well, bar the occasional palpitation. Her GP asked me to see her because of an increase in those palpitations.
Chatting with her, it quickly became clear that whilst she had more palpitations than previously, her main issue was overwhelming fatigue, weight gain, and generally feeling awful. Of course, these are common symptoms, and have a multitude of causes. As regular readers will know, I’m really interested in women’s health, and the inequities women face in particular. It’s common for me to ask about menopause, peri-menopause, which would never have crossed my mind 10 years ago.
‘Funny you should ask that’ she said, and went on to explain she had convinced her GP to run a battery of hormone tests. I looked them up, and the answer was screaming at me from the computer screen. THIS WOMAN NEEDS HRT AND TESTOSTERONE! By the way, the fact that many women, in addition to men, are low in testosterone may come as a surprise but is very much the case. It’s often given as a cream.
Unfortunately for her, no HRT or testosterone had been forthcoming. I’m convinced many doctors are still running scared of the now utterly debunked women’s health initiative study many years ago and are concerned about breast cancer and heart risks. In the overwhelming majority of cases, healthcare systems the world over have denied women simple effective medicine that can transform their quality of life. In my opinion, there is a window of about 10 years post menopause where in most cases it can be safely administered (a delay of >10 years can potentially have downsides), and thankfully my patient is within that. We know that heart attack risk in women ramps up after the menopause, related to a number of factors, including hormones, but also worsening cholesterol profiles.
If you’re male and reading this, the so-called andropause (male equivalent where testosterone levels fall) is also hugely under-recognised and under-treated (yet doesn’t have the excuse of a wrongly reported study behind it).
I’m sure with adequate hormone levels my patient will be absolutely fine, but it did make me reflect on how many other women must be out there similarly suffering, many with heart symptoms such as palpitations when the cause and treatment have nothing to do with the heart (well, apart from reducing cardiovascular risk with appropriate HRT…!)
I’m conscious I’ve written about HRT twice in recent months, but make no apologies for it. We’ve got mothers, sisters, girlfriends, wives, daughters, and If my words help any of these, job well done. As my patient this week shows, there is much work to do in this space.
Yes it’s great that doctors have their specialist subjects, but I do believe we should also know enough about common conditions that even if we can’t help ourselves, we can point our patients in the right direction to someone that can.