Welcome, my name is Dr. Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people Live as well as possible. for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol and the for better health. If you enjoy this podcast, I would be honoured for a 5-star review. you can share it with your family and friends. It may well save someone you love. Hi, it's Dr. Warrick here, and thank you so much for tuning in to my podcast and videocast station. Today, I thought I might share... a couple of experiences I've had over the last couple of weeks with specific patients. Now, I'm sharing this because if it's helpful for you, or helpful for someone you love when they attend the doctor, then that's great. What I'm hoping is always to give people information that could be valuable. So every time I'm speaking, I'm hoping to leave you with something that is interesting, or valuable or applicable for yourself. I'd like to thank you for tuning in. I really do appreciate that. If you would be good enough to subscribe. And if you'd be really good enough to share, I'd love that. And a favourable review would be appreciated as well. Yeah. Well, let me jump into this week's topics. Now, two different patients. The first one, a woman, Mary, 70s, in her 70s. And I was seeing her as a standard consultation. And Mary had a couple of things, cardiovascular disease, a bit of blood pressure, a bit of prediabetes. And as you might expect, I see many people with that. collection of issues and of course Mary was taking different medications for all those things pre-diabetes maybe a bit of metformin high blood pressure tablets maybe one or two cardiovascular issues a bit of aspirin together with cholesterol lowering therapies and as we were going through the consultation, Mary made reference to her medications. I was sort of talking about whether we should add something else. And she said, oh, these tablets, I can't stand taking them. And I really don't want to take any more. And grizzled about her medication. Now, A number of years ago, maybe a decade or two ago, I would have said, oh, look, just take your tablets and get on with it because they work and they'll do the right job for you. So I wouldn't have given her much space, actually. But me these days, actually, as she shared all this and her frustrations, I took a slightly different approach. And what I said to her was, look, Mary, can I tell you a quick story before we respond about, you know, any extra tablets to improve your blood pressure control, which is what I think we're talking about. So let me tell you a story. The story is this. I said, um... I have really sensitive eyes. I hate... People touching my eyes. I hate touching my eyes myself. There'll be some people out there who can relate. I said to Mary, I don't think I could possibly be someone. who wears contact lenses because it would just drive me nuts every day touching my eyes. I said, Mary, I have to let you know that as someone who's really sensitive about their eyes, a year and a half, two years ago thereabouts, I noticed some discomfort in my eyes and one of my eyes just didn't feel like it was, felt like the vision was going off. notice, which was an incredible blessing, it turned out I had... the beginnings of glaucoma. Now, when I use the word glaucoma, it's so that you know what I'm talking about, but the forerunner for glaucoma is glaucoma. called raised. intraocular pressure. So pressure within the eyeball being elevated. And I had clear, documented, significant elevation of pressure in my eyeball. Now, It was really lucky that I went and got that checked. I was seen by an ophthalmologist. I got given tablets and drops. And ever since then, I've been putting drops in my eyes, and I put drops in my eyes morning and night. And so I said to Mary, I said to Mary, look, I can relate to the frustration of pills and tablets and so forth. I said, I put drops in my eyes morning and night and... with my background of really being sensitive about my eyes. I said, what I do is every time I put these drops in my eyes, I take a moment to have a bit of gratitude and think about how lucky I am that there are actually drops available that can keep the pressure in my eye down. in both my eyes, down, and so I can reduce the risk of glaucoma and therefore keep my sight. And I said, basically, every time I put drops in my eyes, I have a moment of gratitude. And then I sat back to Mary and said, do you want to rethink? Do you want to rethink or have another thought about how you want to frame the tablets that you're taking? Anyway, I think She understood where I was coming from. And we then had a very sensible conversation about whether we needed to change anything or not. So I wanted to share that with you. And I think sometimes we forget the entire picture. So for me, the medications we use, whether it's eye drops, tablets or whatever it might be, I take a blood pressure tablet as well if you're curious. Whatever it is. we really probably should recognise and respect that we actually have modern medical technology that is giving us access. these medical advances and opportunities. So reframe the frustration with some of these things and turn it to gratitude. So, That was the first case. The second one was... Uh, Tom, so we're talking about Tom and Mary today. on this podcast, Tom, mid-60s, male. And I guess it'd be fair to say, had had high levels of anxiety off and on over the years, and was seeing me... And I... build-up of plaque story, atherosclerotic burden. No coronary disease, had not had any symptoms, but we knew there was some plaque there. We needed to treat it. When I'd seen Tom last, we put... Tom, fairly reasonable doses of cholesterol lowering therapy, because we had identified a fair bit of plaque in the arteries. Tom And this was months ago. Tom had had some side effects from the medications. Can't remember exactly what they were. They were... If I do recall exactly, I think they were possibly muscle or leg related, but there was something about them that was not... typical of what you might expect for... statin-related side effects, um... And so it wasn't 100% sure that the stat was a problem. Nonetheless, Tom had become extremely anxious and fixated by... on statin therapy. It had remained on azetimibe, which is great, and all credit to... him and meant that there was still some therapy going on, but was had a palpable apprehension, a palpable anxiety about going back on stand therapy during this consultation. Now that was really, really obvious to me. And it was really almost blocking the opportunity for us to have a sensible conversation. Now, the conversation I wanted to have with Tom, and I sort of got to it, was that when we think about side effects from medications... There's only three main ways you can have a side effect from a medication. One is in regard to an anaphylactic response, where you swell up, where your airway closes. This is terrible. We... would not ever ask someone to go back on a medication If they've had an anaphylactic response, it makes no sense. Really, we would not do that. The second way that people can have a response to a medication is what we might call anaphylactic. An idiosyncratic reaction. Now, idiosyncratic reaction is just a long medical term for something that happens with a medication, but we don't really understand why it happens, how it happens. we certainly don't understand who it might happen in. So idiosyncratic reaction Although you may not have heard that term, you may... Remember, an example of idiosyncratic reaction, which is... One from the AstraZeneca vaccine for COVID from a number of years ago. Now, quick recap, that AstraZeneca vaccine could give rise to clots in the body. So the vaccine would cause clots. Now, no one really knew that. how that happened. And... why that happened and who it would happen to. And that really is a... a reasonable example, a good example of an idiosyncratic reaction. So here's another bit of information. We are incredibly unlikely, almost zero times would we ever suggest to someone to revisit a medication that caused an idiosyncratic reaction, unless there were really specific reasons that we had to revisit that. So if you're allergic, if you have an idiosyncratic reaction, the medications are off the table. Well, what's the third way that you can have a problem with... a medication. Well, The third way is a dose related intolerance. Now, I think the easiest way to understand tolerance to a medication... or a drug is to think of alcohol as a Now, some of us might know a grandma who might have a sherry in the afternoon and be a bit tipsy. And that Sherry is all that she can cope with. But some of us, like me, may have some friends who could do five or six pints of Guinness in an afternoon and still eat. do calculus or complex mathematical equations. Now, The difference between those two people is simply... dose tolerability and that's what i want to talk to tom about tom had described some symptoms they weren't 100 clearly statin related but they did have to be respected we did have to work around them and as i was really trying to engage tom in a conversation around let's let's start with a really low dose maybe a quarter of a tablet every other day and see where we are, I could tell that this anxiety, this apprehension was still there. And there was no space for listening or hearing. At all. In fact, It got to the point where I said to Tom, look, When we think about dose, there's always a dose that someone could tolerate. Now, we're not going to cause an anaphylaxis. We're not going to cause an idiosyncratic reaction. But if we think of dosing, we could go to as little as licking the tablet and putting it in the medicine chest and doing that once a fortnight. to the extreme of taking 10 or 20 tablets in one hit every day. Whatever those medications are, 10 or 20 times the dose. Now, As you're listening, you know that if you're licking the tablet and putting it back in the medicine chest and doing that only once a fortnight, you won't have a side effect. And you know at the other extreme, if you're taking 10 or 20 times what you should be taking, of course you'll have some sort of side effect. And so the conversation is around, let's start at a low dose, a really sensible low dose. We don't want anyone to have problems. them to have side effects. to having tolerances. to be miserable from taking a drug. And when it comes to statins, I certainly don't want to see patients... living longer only to be miserable as they do it. So as we're having this conversation, Tom was still really, really... anxious. apprehensive and tired up about not wanting to go on statins and eventually I just took a deep breath and said, Tom. I want you to just pause for a moment. I want you to understand that... Right here, right now, there is too much energy going into your concern here. I don't want to hurt you. I don't want the drug to hurt you. I don't want you to feel like you're going to be hurt. This is not what the journey is. This very first journey is a simple journey. We're simply going to find out What dose? is okay for you. And I'm really happy if we start at a really low dose. At the moment, Tom, you're putting too much energy. You are overvaluing what's happening next. actually said that the amount of angst and worry that was going into this was disproportionate. We should save the angst and worry in our lives for the things that really matter. illness in a loved one. or family or friend. Accidents that occur that could hurt people. These are things that really do need us to have a response that... drives our focus, drives those emotions, But simple things... With simple solutions, can be put in context and I think at times really need to be. Of course there are circumstances in medicine where bringing some apprehension or some attention, being over vigilant is certainly beneficial. But there are many situations where that's just not the case. And I so encourage people... to take a breath. calm down and really ask, is this worth the energy? the concern, the worry, the anxiety that I'm putting into it? Or am I, maybe? needing to stand in another place and look at it slightly differently where it doesn't. cause these concerns and worries. Anyway, had a really positive chat with Tom in the end. We were able to work around a program where Tom could, uh, in the first instance, take a little bit of time. We're going to get some retesting done, some bloods done, so we had a better idea of exactly what our goals and objectives were, and work from there. By the time Tom left things, it all settled down. But I really want to share it with you. There's two Beautiful cases I saw in the last fortnight, two situations that do come up with some regularity. One of them where there's a frustration with medications when really those medications could be the very things that are giving us pain. Uh-huh. quality of life. and helping us live the best life possible. And the other situation where sometimes we just get so bent out of shape that it's disproportionate to actually what's going on. And we need to stand back and realise that, you know, nothing bad has happened yet. Let's work on the journey. Let's try and bring calm heads and let's try and get calm, sensible, calm, solutions. Well, I hope today was beneficial. Every time I jump on to share, I'm hoping to give you something that's worthwhile for your medical journey. If you've got any queries or questions, drop me a note. info at drwarecbishop.online. If you've got any suggestions for podcasts, let me know. I'd love to hear that as well. For now, though, I am going to wish you the very best. I do hope you live as well as possible. for as long as possible. Take care. and bye for now. Join the Healthy Heart Network and become part of our growing community. If you're interested in your heart health and risk of heart attack, then join the Healthy Heart Network for only $5 as a lifetime member. This represents $55 worth of value. We offer and help people understand their present state of heart Health. what their current level of risk is, and the positive steps they can take to improve their risk of heart attack in the future. go to www.healthyheartnetwork.com dot au and click the join the family button.