Bridging The Gap (Part 1 of 3)

Cardiology! Endocrinology! Let’s Talk!

If I had not been, dare I say, as ‘bolshie’ as I am, I would be on a plethora of cardiac drugs, NOT on HRT and still experiencing severe cyclical cardiac symptoms. I feel duty bound to explore every avenue possible, to be able to inform others living with similar experiences to myself.

The following is the main body of an email I sent to the SCAD specialist – 12/10/2021
(excluding personal information. Formatting has been altered, to improve the reader’s experience)

“Firstly, thank you for both your and Dr Wood’s prompt email replies, with regards to my referral conundrum, Scotland to England. Success has been achieved (!) thanks to an extremely competent GP.
Secondly, it was great to hear your talk at the Beat SCAD online conference a couple of weeks ago.
[25th September 2021]
It’s great to know that I am much less likely to develop ‘normal’ heart disease !

I was interested to hear the advice regarding HRT – 
‘smallest dose for the shortest period of time’  and
‘if you can get through the menopause without it, all the better’.

Having researched many papers and read the current guidelines on HRT, I would very much appreciate discussing them further with you.  
Having personally experienced the benefits of HRT in drastically reducing my cardiac symptoms, it seems that the message on HRT is contradictory and I would love to hear your expert opinion.  Maybe we could even arrange a discussion with the menopause specialist Dr Louise Newson of The Newson Health Clinic? www.newsonhealth.co.uk

I note that on the Beat SCAD website, HRT is not a contraindication for SCAD patients.
If the above advice is not specific for SCAD patients, but more general, then may I  draw your attention to the most current guidelines regarding Menopause/HRT, Breast Cancer and Cardiovascular Health, as the above advice is now outdated.

Re the breast cancer risk:
It is now known that the media reporting of the WHI study in 2002,  resulted in an over-exaggeration of the risk, leading to both the public and Healthcare professionals being mis-informed.
Yes, using HRT does slightly increase the risk of Breast Cancer but the risk is the same as for those using the combined contraceptive pill, whilst oestrogen only HRT actually reduces the risk of Breast cancer.

And, this risk is actually less than for those who drink approximately 2 glasses of wine a day – and yet there are no Breast cancer health warnings on bottles of alcohol! I have attached a pdf, dated 2017, from the British Menopause Society – Understanding the Risks of Breast cancer

HRT as a Protective Health Care Measure:
Due to the ongoing/future health implications for women living up to a third of their lives without the protective benefits of oestrogen, progesterone and testosterone, 
HRT is now regarded as a health protective strategy, rather than purely to relieve the menopausal symptoms.
I have attached a pdf of an article from Primary Care Cardiovascular Journal on the topic 
PCCJ article

The NICE guidelines state:

“Prolonged lack of oestrogen affects the bones and cardiovascular system
and postmenopausal women are at increased risk of a number of long-term conditions, such as osteoporosis.”  
https://www.nice.org.uk/guidance/ng23/chapter/Contex
Cardiovascular disease  
 https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#long-term-benefits-and-risks-of-hormone-replacement-therapy   


Menopausal symptoms include breathlessness and heart palpitations – irrespective of whether the patient has had a SCAD or not.
I note that the European Position paper on SCAD points to the fact that progesterone (in the form of the Mirena coil) has beneficial effects for women experiencing ongoing cyclical chest pain.
Also, The British Heart Foundation notes that Microvascular Angina
“occurs most commonly in women at the time of the menopause between the ages of 45-55” 
So it would appear that evidence is already out there
.

My severe ongoing chest pain continued post SCAD, until I began closely monitored HRT from a menopause specialist, Dr Hodson at –www.newsonhealth.co.uk

Without going into full details, it is now definite that the Utrogestan (progesterone) has completely relieved my ongoing chest pain.
(I tested it 3X, much to the horror of Dr Hodson – however, point proven – whilst off progesterone my cardiac symptoms return, whilst on it – I have none)
I fully appreciate that I am not a medical professional, 
so may I refer you to the work that Dr Louise Newson [and her entire team] is doing
in working with the public, the MHRA and manufacturers of hormone packaging,
to name but a few, to increase  awareness of the evidence based information on HRT and the menopause.


With the guidelines from NICE and the evidence in  journals/papers
such as European Journal of Cardiology et al, all seemingly agreeing
on the benefits of HRT for women in relation to cardio health,
plus the majority of SCAD patients being females with an average age of 44-53
(ie. potentially/probably menopausal) I feel that it is
vital that the correct information is out there
so that women can make informed decisions about their health. 

Although I have an appointment with you in May 2022, do you offer private appointments? I would dearly love to discuss this further.  I had a number of questions regarding the above, submitted for the Beat SCAD conference,  but they became very lost in translation.
As an extremely body aware Physical Therapist, who now has the good fortune to be in contact with both yourself AND a menopause specialist –

I feel duty bound to explore every avenue possible, to be able to inform others living with similar experiences.

Or maybe we could arrange a discussion with the menopause specialist Dr Louise Newson?  With that in mind, I have copied them into this email.
I look forward to hearing from you with regards to having a conversation, whenever you have time to reply.


Thank you for reading this.

Email from my wee self, to Dr Adlam, Professor of Cardiology, SCAD specialist – 12/10/2021.

STOP. THE. PRESS!!

The very next day I received an email from Dr Adlam:

“Many thanks for these very interesting insights.
I am going to take a bit of time to read through and digest this.
Your experience is certainly very interesting and thought provoking.”

“interesting and thought provoking”
I am fair chuffed tae busting*
(translation for the non-Scottish reader, this means
*proud)
Coming from Dr David Adlam, an interventional cardiologist and Honorary Senior Lecturer, this means a lot to me.
Plus, he’s just a super-cool guy.

A week later I received a letter to say that my Virtual consultation with Dr Adlam
had been brought forward from May 2022 to the beginning of December 2021.
Awesome!
I went back to my notes and pulled out the list of questions that I had prepared for my local cardiologist, which hadn’t been answered.
If you’re interested ….. here they are:

  1. I had been advised by a member of the SCAD Facebook group to have 4 aspirins in my emergency bag, as she knew that the 999 responders usually tell you to take them, should you need to call them again, with a suspected heart attack.
    She was right.
    During my 2nd severe and identical incident, I was told to chew them.
    After doing so, within a few minutes, the intense and acute pain dropped significantly.
    a) Was this pure coincidence?
    b) If not, is this what aspirin does?
    c) Can taking aspirin avert a ‘bigger’ event?
    c) If it happens again, can I just chew the aspirin, then rest for a few days?
    ‘cos that’s what ended up happening.
    Would save a bed and a lot of NHS time if this is the case.
  2. During the 2nd event, although my troponin levels were ‘tiddly’… there was still a curve within a 24 hour window
    a) What are trop levels for a healthy heart?
    b) Because there was a curve, doesn’t this indicate that something happened?
    Or can trop levels wander about of their own accord?
    c) In science we love data. Even if the trop levels indicate that there was a NOT heart attack (which is grand… obvs!) what other reason could there be for that curve?
    A Microvascular angina type thing?
    Coronary Artery Spasm?
    A mild atrial fibrillation? (See my previous post for further information on these conditions https://www.daisiesanddiamonds.co.uk/hormones-heart-health-research/

    Even if we cannot say what DID happen, acknowledging that yes, something happened, would not only validate the experience but,
    being able to say, at the very least,
    “I have had this before and there is a high/low/possible, likelihood that this has been X, Y, Z.”
    would potentially expedite my journey through A&E, saving the NHS time, money
    and, potentially, a bed for a more poorly person.

    [And WHY OH WHY is it SO hard for some to say, “we know what it was NOT, but I’m sorry we don’t know what it IS.”
    And instead, blather and waffle on about something else!
    Just say, “we don’t know!”
    Sheesh!
    I don’t know about you reader, but I can smell B.S. from a mile away, whether it’s from a builder, mechanic or medical professional!
  3. Finally.
    a) Why is there no connection/relationship/conversation about female hormone levels, in general, within cardiology?
    The question I had submitted to the Beat SCAD conference was;
    b) Do known menopausal symptoms of chest pain, breathlessness and heart palpitations, ‘muddy the waters’ of post SCAD treatment?
    c) Why are these very well known and well-documented menopausal symptoms not talked about when a mid-life female, with no known cardiac risk markers, presents in cardiology?

Aaaand I’m done!

If you have read this far – bloomin’ well done! Apologies that this post has been very ‘wordy’ and lacking in pics – has been the nature of the beast.
My heartfelt thanks must be given to my wonderful, supportive Menopause Specialist, Dr Zoe Hodson
If it had not been for her and the amazing team at the Newson Health Clinic…. well, I would still be rather unwell and unable to drive on motorways, travel on public transport, write this ‘ere blog, in case I had a ‘hot flush’ which use to result in my nearly passing out.
(A video of this can be seen in previous blog)
Yes, I have had to pay for private treatment but, £280 plus medication costs,
(from England cos we can’t get some of it in Scotland)
has been SOOOOOO well worth it.
Please do follow and support the amazing work that they are doing.
https://www.facebook.com/balanceMenopause
https://menopausesupport.co.uk/
And by the way….
They did not bat an eyelid when hearing about my monthly menopausal cardiac symptoms.
(Although, I know, I know, I did take things to the extreme….
*rolls eyes*… such a drama queen having a freakin’ heart attack!)

To end on a smile. When I talk about Dr Adlam, I refer to him as ‘The SCAD Man’… which means that I hear this – EVERY. SINGLE. TIME.
(including during my call with him….)

To sound like a radio presenter, “Tune In next time” for my continuing quest for information!
Have I have had any questions answered?
Have I been able to affect a conversation between cardiology and endocrinology (Heart doctors & menopause Specialists to you and me)
Will Jilly ever be on the Lorraine Kelly couch with Adlam and Hodson or Newson?!