Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station and today I'm delighted to have as a guest Dr. V all the way from North Carolina, United States of America. We're doing this live in two different time zones. Dr. V has about 20 years experience in OBGYN and is passionate about making a real difference by holistic, engaged medicine and helping women through obviously their unique needs. Dr. V, thanks so much for joining me today. Thank you for having me. I'm excited. Look, so am I. And before we go any further, what I'd really like to do is give some of my listeners a little bit of background about you and how you've got to where you are in your career. And obviously, I think you could do a better job of sharing that detail than I could. So a bit of a potted story of how you've really ended up to where you are today. Dr. V, thanks. Absolutely. So again, thank you for having me. talking with you about heart health or any broad issue that affects women is my joy. I finished residency. I practiced in private practice. And what I realized is that a lot of my patients were healthy. They're young. They don't have chronic disease, but their lifestyle. puts them at risk. So a lot of patients were obese or there was a lot of mental health, depression, anxiety. And so I learned about something called lifestyle medicine. Lifestyle medicine is actually a specialty now of medicine. And it helps patients use their lifestyle to treat or prevent chronic diseases. And so I said, you know, there are lots of doctors that can do a pap smear and deliver a baby and we don't have enough. physicians that are dedicated to really empowering women on how to use their diet, to use their exercise and sleep and all of these good things that will contribute to their health. So I have pivoted and I find that patients now, 2022, are very excited about getting off medications, about learning how they can kind of take the reins of their health. Look, Dr. V, I can tell you I completely resonate with what you're talking about. I'm so passionate about that preventative space. And when I listened to some of your videos on your website, before we had the chance to speak today, I knew that we would connect over this passion to sort of help people. keep well not wait until they're unwell and then try and patch things up so I'm going to make a couple of quick comments first of all can you just uh for my listeners uh tell us your website so that they can go and have a little bit more of a look about your background and I know your story is a bit longer than that and they may want to listen to that and some of your other information so give us give us that web address but before you do One of the analogies I use with people around exactly what you're talking about is that we as doctors are a little bit like the mechanic for your car. We can look after the timing, we can look after the brakes, the clutch, et cetera, et cetera. But what you're talking about is really educating people not just to have that safe car, but then drive properly and together those things give people. the best journey and that driving properly is looking after themselves spiritually being well recognizing stress recognizing eating habits recognizing ideal weight etc etc so i often use that car analogy it works for me but as i ask can you please help me with your web address uh for me okay people listening so real quickly i will steal that analogy that's perfect I'm taking that. So my website is officevisitswithdrv.com, officevisitswithdrv.com. And my podcast is the same name, Office Visits with Dr. V. Fantastic. Look, we've got a little bit of an introduction out of the way. There's no question that the people listening will realize that. We're on that same page as wanting to be proactive about health. And I want to swing around to one of the areas that's really become prominent in recent time, and that is recognising the cardiovascular risk associated with women who go through pregnancy and run through problems like high blood pressure, proteinuria, preeclampsia, low birth weight. This is becoming a really important area. I'd love your thoughts on that. Well, for me as an OBGYN, it's always been a big area. It's something that over the years I've seen occur more. So we have conditions like preeclampsia. We used to call it toxemia several years ago in America. And it's basically where the pregnancy causes the woman's blood pressure to go up. But it also affects the liver and the kidneys. And when it affects the kidneys, it has the women spill a lot of protein. So we have proteinuria. This can happen at any time. It can happen during the pregnancy, during delivery or postpartum. And so the women who are more at risk are women who are obese, who have a history of high blood pressure or kidney disease coming into the pregnancy. African-American women are more likely to have it. But again, I've seen it in all races. The other thing is, and this was always been interesting to me, is the extremes of age. So we've got really, really young women getting it or we have really older women, so our 40s and above. And so that is something that we look out for. That's why we check blood pressure and we check urine at every single obstetric visit to look for that. because at its worst, it can be life-threatening. If a woman has preeclampsia during pregnancy, after she has completed the pregnancy, her risk of having high blood pressure throughout her life increases. Look, from a perspective of a humble cardiologist who doesn't understand the processes of proteinuria, preeclampsia, Is there much understanding about what drives this? And I'm fascinated to hear that, you know, the different age, people at different ends of the age spectrum may be impacted. Can you speak to what may cause this, the so-called etiology or underlying factors? Right. So actually, I cannot. The joke in OBGYN is there is a plaque somewhere for the person who discovers what causes preeclampsia. We do think that there is something in the placenta that contributes to it because we see that women who've had it with one partner can switch partners and then not have preeclampsia. But I will tell you, as I have seen the health of women decrease coming into pregnancy, and as we're having older women have to conceive, we are seeing more and more of it. So I definitely think that the condition of your cardiovascular system coming into pregnancy, your body weight has a lot to do with how you... um proceed through the pregnancy so one of the things that's certainly being discussed at the meetings i'm attending in that preventative space is identifying these women who when they're having their children in their 20s 30s or even early 40s are probably very low risk for cardiovascular disease at that time but they carry a substantial premature increased risk compared to other women who may not have gone through the same complications in pregnancy. How do you have that conversation? How do you think about follow-up for those women in that space? And this is really important for anyone who's listening who may have had blood pressure of pregnancy, proteinuria, or preeclampsia during pregnancy. So let me just stress that I'm an obstetrician and a gynecologist. And so on the gynecology side, we have an obligation to tell women of childbearing age to prepare for pregnancy. So making sure you're exercising, making sure your diet is as clean as possible so that you can reduce that risk coming into pregnancy. So that is something that you should speak to your OBGYN about if you wish to conceive. Or if you have conceived and you're going to be thinking of a pregnancy. So, yes, so absolutely. The things that happen in pregnancy raise the risk afterwards. So I like to say we are never the same after we have our children. We're never the same physically and we're never the same physiologically. So, yes, like if you get gestational diabetes, your risk of having diabetes later on in life is increased. It's almost like it preps your body. And as you say. it puts you at risk for it. And so the same thing that we say for everybody, you really have to be on top of your cardiovascular health and getting as close to your ideal body weight. I strongly, strongly push breastfeeding for women. And I say, just be selfish, breastfeed until you get back down to your ideal body weight, because breastfeeding. can um can burn up to 800 calories a day um and so that is that is the body's way physiologically of helping you get back to your body weight the other thing that we have to realize is that older women are obese older women are grandmas who've had three kids and four kids they're obese and usually what we see is that you might gain 30 pounds during the pregnancy and you lose maybe 20. So you have 10 going forward. Then you have another pregnancy. Now you got two kids, you're tired. You've gained another 30 pounds and you don't lose all of that weight potentially. And so through the years, you're adding on with every pregnancy. So just really hitting home about lifestyle is extremely important. Look, one of the questions that just popped into my mind as I was listening is, is there a family predisposition for these sort of complications of pregnancy? As we would see, you know, family predisposition to coronary disease, for example. Do you see familial clusters for blood pressure, proteinuria and eclampsia around pregnancy? Yeah, so the proteinuria I don't see as an isolated event, but absolutely the hypertension that leads to the proteinuria and the kidney disease and the diabetes that can occur, we can see that as a cluster in families, but those are the people at risk anyway. So if you have a family member, a first degree relative who already has that particular disorder, then you're at increased risk. So, yeah, absolutely. That does contribute. And when an individual, when a mother has been identified with, for example, a clamcy or blood pressure pregnancy, does that resolve fairly quickly with delivery of the child? Is that something that is a rapid fix? You said the... placenta may well be implicated. Is removing that placenta a quick fix or does it take a while for it to all resolve? How does that work, Dr. V? Yes, absolutely. The delivery is the treatment. You can definitely get this prior to your due date. So we can see it before the baby's ready to be born at a full term. And so we are doing a really good job of being able to surveil women. who are early second trimester or not early second trimester, who are in the late second trimester or third trimester who have developed these issues. But what I will say is that at some point, we have to take into account the life of the mother. So the blood pressure can get extremely high. We're talking 200s over one teens. And ultimately, there's preeclampsia, preeclampsia, eclampsia seizures. And we never want that to happen. And so we're very aggressive. If we can't control the preeclampsia, then the baby has to be delivered. And sometimes if that's, you know, 26 weeks, 27 weeks, then that is just what has to happen because we preserve the mom's life over the baby's life. Because if we lose mom, we can lose baby, right? So absolutely, it varies in case by case. Obviously, if you have a patient who has a lot of risk factors for a particular disease, if they have a history of high blood pressure, it's harder to get their blood pressure back down after they've delivered. And so it's not uncommon for women to be on antihypertensives postpartum. And some women will have to be on it for a few weeks and they come off and then others might have to stay on it and see their primary care doctor. I usually say if you're still requiring medication to control your blood pressure at three months, then we consider that chronic high blood pressure. And you'd have to see your primary care doctor to manage that further. Look, we might wrap up in this space, but before we do, when you encounter these women who've had these perinatal problems, do you have a particular conversation or spiel you share with them about their future potential cardiovascular risk and how they should consider being followed up in that space? Absolutely. So especially when we've had outcomes that we're... um are less than optimal at the end of the pregnancy it's very important to wrap that up and to say how do we prevent this going forward and so you know just like we say okay you have diabetes we're going to follow up on that um definitely say you're going to have to watch your blood pressure um and for every woman you know definitely try to breastfeed and definitely try to exercise um i will tell you women who who have these issues, especially if we have heart failure. It's extremely scary, extremely scary. And so they have questions as well. And they are actually very motivated to make sure that it doesn't happen again. Because again, we're sometimes talking about a baby being born prematurely because of it. And so, yeah, keeping up with your wellness exams, with your primary care. Some women, I don't know if it's like this where you live, but. They only see the doctor when they get pregnant. And so making sure that you see your primary care doctor even when you are not pregnant at least once a year to make sure that we're checking up on these things that will put you at risk during a pregnancy is extremely important. Look, I think we'll wrap up this particular episode here. It's been fantastic to share. I think the take-home messages are... If you're planning on pregnancy, then be proactive. Check in with your local doctor and potentially even with your OBGYN to make sure that everything's okay. And if everything's not okay, then you've got a plan to understand if some of these things, some of these complications of pregnancy occur, that there may be a requirement for ongoing follow-up. And there are some really valuable hints and tips in there around eating. diet, exercise, and even breastfeeding around that time of delivery and returning to good health. It's been a pleasure sharing with you. Thanks so much, Dr. V. Thank you, Warrick. I appreciate it. Look, I'll wrap up there. I hope those listening found this as informative and enjoyable as I did. If you've got any queries or questions, drop us a note at... info at drWarrickbishop.com. Otherwise, till next time, I wish you the very best. Live as well as possible for as long as possible. Take care and bye for now. You have been listening to another podcast from Dr Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
