July 1, 2025 • 41 mins
Besties Angella and Leslie bring you another episode in The Year of the Menopause series with the return of Dr Toni Otway, a Board Certified OB/GYN physician. She discusses that cardiovascular disease is the leading cause of death in women, yet the connection between menopause and heart health remains dangerously under-discussed. Dr. Otway explains how dropping estrogen levels during menopause dramatically increase women's heart disease risk.
• Estrogen protects cardiovascular health by keeping blood vessels flexible, reducing inflammation, and helping manage cholesterol
• Women's heart attack symptoms often differ from men's classic chest pain, presenting instead as fatigue, shortness of breath, or indigestion
• CDC reports 6% of women over 20 already show signs of cardiovascular disease
• Pregnancy complications like gestational diabetes and preeclampsia are significant risk factors for future heart disease
• Hormone replacement therapy offers cardiovascular benefits when started early in menopause transition
• Women must advocate for themselves against medical gaslighting and ensure doctors follow appropriate screening guidelines
• Prevention through lifestyle changes remains essential alongside appropriate medication when necessary
Don't forget to schedule your regular health screenings and pay attention to changes in your body – your heart health depends on it.
Resources referenced:
Get Angie’s eBook:
We’re Too Old for This Shit! The Inquisitive Older Woman’s Guide to Joy http://joystrategy.co/ebook
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Hey Ange, hey Les.
How's it going?
It's going well Good.
I'm excited to come on in today.
Speaker 2 (00:12):
That's your natural state?
Speaker 1 (00:13):
Yeah, you're right, my natural state is I'm baseline
excited.
I want you to come on and belike sad.
Like Eeyore, not sad sad but belike.
Speaker 2 (00:21):
Eeyore, I want you to be like.
Hmm, I don't know.
Speaker 1 (00:24):
Here we are again.
Another episode, anotherepisode.
Then they would really say whatthe heck has gotten into, les.
So welcome to another joyousepisode of Black Boomer.
Besties from Brooklyn.
Speaker 2 (00:42):
I'm Angella and that's Leslie, my best friend of
almost 50 years.
We are two60-something-year-old women who
have decided, we've committed,to live lives that are more bold
and joyful, and we invite youto come along with us.
So today we have Dr Tony back.
(01:03):
So today we have Dr Tony back.
We're going to be it's anotherepisode in our year of the
menopause series and we're goingto be talking about no, let me
make that, let me fix that.
They're going to be talkingabout menopause and
cardiovascular health.
You're going to talk too.
I'm going to be poking at them.
(01:23):
I'm going to be like what thehell does that mean?
I don't understand this doctortalk.
So I'm going to represent thepeople power to us and they're
going to be.
Dr Tony's going to be giving ussome insight about the
connection between menopause andcardiovascular health, which is
something that we rarely hearabout.
Speaker 1 (01:52):
And before I let Dr Tony in and introduce herself
again, what I want to say, ange,is we don't want any barriers
between people who arephysicians and non-physicians,
because one of the things that Istress to my patients and this
is something that's newer in themedical arena, but it's no
longer the age of wherephysicians are telling patients
what to do we want to continue adialogue, we want it to be a
(02:15):
back and forth and we wantreally collaboration, because
those are the types of behaviorsand relationships that foster
collaboration compliance,questioning and things like that
.
So you may be power to thepeople, but we the people too.
Speaker 2 (02:33):
I get it.
I'm just saying before I letthis point go.
I'm just saying that oftentimesdoctors don't they desire that,
but you live in a doctor world.
You live in a you know,especially when you start you to
start kind of I know getting inthe weeds I know it's not your
desire to to create barriers,but I'm just here in case you
(02:57):
slip up, okay and just thank youto you know yeah, we bring to
you dr tony outway.
Speaker 1 (03:03):
Hi everybody, thank you for joining and to you, Dr
Toni Otway.
Speaker 3 (03:05):
Hi everybody, Thank you for joining and thank you
for inviting me back.
I'm Toni Otway, I'm boardcertified OBGYN.
I no longer practice OBGYNanymore, but I do work for an
insurance company.
I'm a utilization reviewer inthe state of New Jersey.
(03:25):
So, but these kind ofdiscussions are still always
dear to my heart and trying toeducate the masses on health and
how it relates to womenespecially, and women of color
especially too.
So Well, good.
Speaker 1 (03:45):
Thank you.
Women especially, and women ofcolor especially too.
So well, good.
So you've decided to, under theumbrella of the year of
menopause, specifically talkabout the um cardiovascular
manifestations or effects, inother words, your heart and your
blood vessels, and how thatperiod of menopause affects
(04:08):
those organs.
Before you do that, let's justremind our listeners what is
menopause and why does it matter.
Speaker 3 (04:19):
Okay, so just a reminder, just to go over a few
things about menopause.
Menopause is that period inyour life when your ovaries are
no longer functioning.
Basically, our ovaries aremeant to function to reproduce
children release, born with afinite number of eggs to be
released over a number of years.
(04:40):
Once they've all been exhausted, then you go through this
period of time called menopause.
So your hormonal changes thathelp to control this whole
function suddenly starts to dropoff.
(05:03):
Whole function, um, suddenlystarts to drop off.
Um, and there's um perimenopause, which is the time that, uh,
the function of your ovaries isstarting to slow down, and
that's the time when you seechanges in your periods, um, and
other things that would, uhthat go on.
And then menopause itself youhave, you can truly call
yourself menopausal when you'vebeen a whole year without your
(05:26):
periods, so, and then you becomein the post-menopausal state
and I have said before that yourestrogen really keeps, makes
you, um who you are as a woman.
Um, you have over 400 receptorsin your body that estrogen
(05:47):
affects and it goes all the wayfrom the top of your head to
down to your toes and everythingin between.
So estrogen is a huge factor inyour body functioning as a
woman, so that's it in anutshell I have thanks for that.
Speaker 2 (06:05):
That, that was really clear.
So it reminded me that mysister-in-law some years ago did
not have a period for somethinglike 350 days.
Speaker 1 (06:28):
That's cruel.
Speaker 2 (06:29):
Yes, and then here it comes right and so according to
this definition, she was notmenopausal.
But it seems kind of arbitraryto me, right?
Can you talk to that and why?
It's kind of how it came to bethis kind of rigid in terms of
(06:58):
definition, this rigid linebetween when you are and when
you're not?
Speaker 3 (07:04):
Well, I think the way they look at it is that, even
though you are and when you'renot.
Well, I think that the the theway they look at it is that,
even though you know when shegot that period, it may be that
she's she had an egg that wasreleased, so that is still
showing you that your ovarystill has maybe one or two
things left.
Even though got you, a pregnancyprobably wouldn't have come
(07:24):
about because your eggs are somuch older now, but it's still
showing that your body is stillproducing that level of estrogen
that could produce whateverfollicles or eggs that are still
there.
I must stress that if you arecoming up to 300 and something
days and then all of a suddenyou have a period, I would
(07:48):
encourage people to go and seetheir physician, because
sometimes in a regular periodcan also be a sign of other
things too.
So don't just think that justbecause you, you know you still
get in one or two, that it's all, it's normal, it's fine that
it's normal, it's fine.
Sometimes there are issues thatcan occur that can have you to
(08:09):
still have a bleed that youshouldn't really be having.
So, if you've gone a period oftime and then all of a sudden
you get one and it starts comingback full-fledged again.
You should really just get itchecked out just to be sure that
it really truly is nothingother than you know you still
going through your changes andthose changes can take.
(08:29):
You know, it could take a year,it could take a few years.
I know people that have beengoing through those irregular
things, um, for a few years andstill hasn't stopped, and so
everybody's different.
Speaker 2 (08:41):
So well, it's all about getting to know what your
body is like.
Speaker 3 (08:44):
That's right that part.
Speaker 2 (08:46):
You know, someone mentioned just before our we
started recording that they werehaving a hot flash.
Speaker 1 (08:52):
So, um, I'm not calling any names and that's boy
, but but the one that has thetissues all the time like stuck
to her face.
I wonder who.
But you know, and that alsoreminds me, let's just you know,
I started, I would say,menopause rather late.
I was, I think, over 60.
(09:14):
Wow, when I, you know, stopped,but I'm sure I was over 60.
But what I'm wondering is, andbefore we get into the
cardiovascular part, like thesymptoms of hot flashes and
stuff, do they last very long?
Or is it like when the actualegg release or the bleeding
(09:35):
stops, should the discomfort andthe sweating and the flesh it
stopped?
Or is that also a continuumthat that can also be a
continuum.
Speaker 3 (09:46):
That can also be, I personally never experienced
anything.
My period just stopped, thatwas it, and I didn't have any
symptoms, nothing and I did Idid have one period.
I did have one period almost ayear to the day of my previous
one, and that was it Done.
(10:07):
And then it was like so long?
Yeah, I never, ever had anyissues.
Speaker 1 (10:12):
Wow.
Speaker 3 (10:13):
And then I have people who have had periods.
They stopped their periodsyears ago and they're still
having issues, hot flashes.
So everybody's different.
Speaker 1 (10:22):
I see.
Speaker 3 (10:26):
Still need more studies to figure out why?
But sure and you know, in thisday and age, who knows if that's
even going to be possible toeven study anything anymore.
So, um, but yeah, it's, it's uh.
It varies.
Different people have different, uh, different stories.
Speaker 2 (10:43):
So people have different stories.
Yeah Right, different stories.
Speaker 1 (10:48):
Yeah, that's a good way to say it.
So you mentioned that menopausehas.
Well, the body has receptorsfor estrogen all over the body,
talking about the heart and theblood vessels.
Tell me about, tell us aboutsome of the things that a person
(11:08):
being in menopause what kind ofchanges might her heart go
through?
Speaker 3 (11:12):
Okay, so the issue with cardiovascular disease, and
that's what we're going to talkabout, and I just wanted to add
something because you know Iwas going to speak about, you
know, maybe a woman going to thedoctor and saying they have
this, that the other symptom,but then, um, I don't know if
you know ann burrell, the umchef, on food network she just
passed away.
Yesterday she was 55 years oldyes, yes, and now it comes to,
(11:37):
they've come to find out theythink it might be a.
She had a heart attack.
So I just want to say that, um,you know, heart disease is
actually the leading cause ofdeath in women.
Um, it usually occurs later inlife than men.
Men on average might see heartdisease at around 45.
(11:58):
We usually see start to see itaround 55 and um, cardiovascular
disease.
The CDC has come out with thepercentage that women over 20,
there's about 6% of women overthe age of 20 that start to show
signs of cardiovascular disease.
Over 20?
Over 20.
There's 6% of women that startto show those signs.
Speaker 1 (12:21):
Wow.
Speaker 3 (12:22):
What is cardiovascular disease?
Basically, it's primarily thebuildup of plaque in the
arteries, and it's also calledatherosclerosis, it's called
peripheral artery disease.
It could be called heart musclevalve disease.
There's a whole different lotof words to describe it.
Basically, it's just thisbuildup of plaque inside your
(12:43):
blood vessels that over time,starts to narrow the blood
vessels.
And this is the issue itnarrows the blood vessels and
the flow of blood is decreased.
So it's not something you canactually see.
We know it happens but youcan't see how bad it is in you.
And usually the first sign of awoman having cardiovascular
(13:08):
disease most of the womenusually the first outcome is
because of a heart attack.
So Anne Burrell probably hadcardiovascular disease, probably
didn't have any of the normalsigns or symptoms or didn't do
any preventive measures or um,um, and then this is the first
sign of us knowing that she hadcardiovascular diseases, that
(13:29):
she had a heart attack.
And this is what happens towomen.
Um, it's usually the first signof cardiovascular disease in a
lot of women is we have thisheart attack.
And by saying that we have theworst outcomes when it comes to
heart attack, we tend to ignorethe atypical signs.
Speaker 1 (13:48):
That's what I was going to say.
She may have had signs and saidI just ignored it Because I
always associate heart diseasewith men for some reason.
Speaker 2 (13:57):
I'm not sure why that is, but that's my go-to.
And the other thing is is thisrelated to cholesterol?
And I know that that's whataffects the closing of the okay
it is related to that.
Speaker 3 (14:12):
So, um yeah, like what was that?
What was my thought?
Speaker 1 (14:16):
I think it was interesting that you were saying
that she may have had symptomsthat may not.
She may not, she may not haveassociated it with being a
problem in her heart.
But then again we all also knowthat the medical profession we
are taught that, especially in a55-year-old woman, sometimes
(14:36):
these symptoms of heart diseasepresent differently than they
would in men.
Men may come in you know,looking perhaps overweight, like
they should have some heartdisease, and then you think,
well, if you're having chestpain, let me do a workup.
A woman may come in.
She may not be overweight orobese, she may not have the
(14:56):
typical risk factors, or she mayhave.
Oh, I just have some.
You know jaw pain that this orthere's something going on, or
every time.
You know just have some.
You know jaw pain that this orthere's something going on, or
every time.
You know just a little.
You know the symptoms can bevery vague and very often it can
be missed.
Speaker 3 (15:11):
Exactly.
Speaker 1 (15:12):
And I think that we downplay our symptoms as well.
Yeah, because we're busy.
Because we're busy, we've gotmaking lunch for the kids.
Speaker 3 (15:20):
Absolutely, yeah, making lunch for the kids?
Absolutely.
And then we wait longer to seekhelp, to think that maybe this
is something that's wrong withus or because we just kind of
poo-poo our symptoms.
A lot old, associated riskfactors are diabetes, smoking,
(15:43):
obesity, overweight, physicalinactivity, high blood pressure
and abnormal lipid levels inyour blood, which are the fats,
the LDL, the HDL, thecholesterol abnormal.
So some of the newer riskfactors that they have been
finding are also things that mayeven happen in pregnancy, if
(16:04):
you have a pregnancy that hasyou have gestational diabetes or
you have high blood pressurepreeclampsia or you have preterm
labor, or if you havedepression, breast cancer
treatment and even early youknow early menopause.
These are all things that canincrease your risk, which are
things that they never used tothink of before.
(16:26):
So imagine all these women thatare having these issues in
pregnancy.
These are all risk factors foryou to have cardiovascular
disease.
Speaker 1 (16:34):
So and then how many physicians 20 years later would
ask tell me about yourobstetrics history, tell me
about your pregnancy.
I, you know that was remote.
My kids are grown, I don't whatdo I remember about?
When I was, you know, pregnant20 years ago, was my blood
(16:55):
pressure high.
I don't know Was I did.
I have diabetes.
Speaker 3 (16:59):
I don't remember, you know wow, yeah, so some of the
typical symptoms that you knowhave is the chest pain, which,
in women, is not necessaryNormally.
You know hear men say, oh, theyfeel like an elephant is
sitting on a chest or there'sthis pressure.
It may be different.
In women it may be more of, youknow, just like a little pain
(17:23):
or a little discomfort, uh,whereas with men they, they
describe this thing as you knowsomebody sitting on their chest
um, maybe you're short of breathand you probably put that down
to maybe I just walk some stairsand stuff, you know, or just
walked a little further thannormal.
Um, things like extreme fatigue,I mean, which woman is not I'm?
Speaker 1 (17:44):
always tired.
Speaker 2 (17:46):
This is actually what I was thinking and that's why I
was chuckling a little bit,because you've seen those um
videos where they put anapparatus on a man at to give
him the sensation of periodcramps, right, right, and
(18:10):
they're like on the floor, likeyou know, just cannot take it
and it's something that most ofus just go through.
Speaker 3 (18:14):
Most of us just keep walking, just keep going.
Speaker 2 (18:16):
And so I'm wondering, if women, just by the nature of
our physiology, whether we havea high threshold for pain, not
only pain but discomfort, right,and that would then put us in
this risk factor.
And then, of course, afteranswering that, like, what do we
(18:38):
do about it?
Then, wow, what do we do aboutit?
Speaker 3 (18:41):
It's very hard, it's very hard to actually say, but
again, I always truly be.
You have to really be in tunewith your body.
You have to really um try notto poo, poo those things that
are starting to change withinyour body, um, and a lot of
women will say, well, I'm justgoing to put it down to
menopause or um, you know, butother things too are just, you
(19:02):
know, just pain and discomfort.
Indigestion is one you know.
But other things too are just,you know, just pain and
discomfort.
Indigestion is one you know.
Heartburn is something nausea,vomiting, um, feeling
lightheaded, even gettingswelling in your legs, and you
know, your ankles and your feetcould be a sign of heart disease
.
Um, and which woman doesn'thave swollen legs at the end of
the?
day, you know after walkingaround or whatever.
(19:23):
So all these things, yeah, um,you just have to be in tuned
with this if these things, ifthe symptoms don't go away, if
they just progressively getworse, if you try and take
something that you know you maynormally take for maybe the
heartburn and it doesn't go away, then you need to see, you need
to seek help and then to be intune with it.
Speaker 1 (19:45):
We need to find time in our busy schedules to seek
help, and then you don't want togo to a doctor or whatever if
it's nothing you know.
Speaker 2 (19:54):
You don't want to waste your time, you don't want
to be embarrassed I have alittle something and you know
it's right yeah, yeah, it's well, I think it's difficult what
probably happens often too isyou do go and they say it's
nothing right, and then you goback and the next thing that
(20:15):
happens oh, it's probablynothing.
You know what I mean.
So it becomes frustrating cycle.
Speaker 3 (20:21):
Yeah right, yeah, yeah, I mean how many times has
a woman been to the emergencyroom and has been having a heart
attack and they've just said,well, it's just indigestion.
Speaker 1 (20:30):
That's yeah sure, because they say we've heard
those stories having a heartattack.
Speaker 3 (20:34):
Yeah, maybe you're only 45 years old, you can't
possibly be having a heartattack.
So yeah, so, um, but yes, butso a plaque itself is is usually
a build, is usually made up ofcholesterol and fats and other
substances, and what estrogenactually does is it starts, it
(20:55):
protects you basically in thisbuild-up, so it helps to
maintain, um, because our bloodvessels and women are smaller,
so it helps to maintain, becauseour blood vessels in women are
smaller, so it helps to maintainthe flexibility of blood
vessels so the blood can pumpthrough easily.
I see it helps to decrease theproduction of cholesterol from
the liver.
It helps to protect you knowthe diet that you have.
(21:20):
It helps to clear you know someof the bad fats and helps to
improve the good fats from theliver.
Speaker 1 (21:28):
Wow.
Speaker 3 (21:28):
So this is what estrogen does for you.
Good old estrogen, wow Good oldestrogen, yes.
So again, it helps to relaxyour blood vessels.
It also helps to reduceinflammation within the blood
vessels too.
Helps to reduce inflammationwithin the blood vessels too,
because the plaque can onlyadhere to your blood vessel if
there's a damage in the bloodvessel wall.
(21:49):
So if there's any inflammatorythings going on, yeah, it can't
actually attach.
So estrogen helps to reduceinflammation also.
So, um, you know all thesethings.
This is what estrogen does foryou.
So this is why you get whereyou know.
Cardiovascular issues reallystart to skyrocket once you hit
(22:13):
menopause.
Once you've lost thatprotection of the estrogen, this
is when things start to reallyramp up, which is usually around
the age of 50 55 in men.
It's much younger, it's like 45.
Um wow so.
So that's how estrogen.
You know, estrogen is good sohere.
Speaker 1 (22:35):
So, so here's what I'm wondering, though, if I were
to go to a doctor?
I don't really go to a doctorbut, if I, if, if I were to go
to, let's say, a cardiologist, aheart doctor, if I'm now 63
(22:56):
years old, should he be speakingto me in a different way than
he would have spoken to me if Iwas 43 years old?
He?
Speaker 3 (23:06):
should be Like.
Would that screening?
Speaker 1 (23:07):
or conversation be any different.
Speaker 3 (23:10):
It wouldn't be any different.
It should be the same.
He should actually be speakingto you at 45 or 40 about the
things that you need to do toprotect your heart.
It shouldn't just be when youhit menopause that you are um,
you know you're discussing thesethings.
Remember what I saidcardiovascular disease cdc has
said six percent of women overthe age of 20 have started to
(23:32):
show signs and they the um.
You know I was looking atscreening tests like blood tests
, like for the cholesterol andthat, and I was actually shocked
to see that you should actuallybe testing your children when
they're starting to turnteenagers 11 and 12 they should
be still having a baselinecholesterol really when they're
yeah, and then they repeat itevery five years, and that's
(23:56):
something that should be thoughtof from childhood.
So which kind of shocked me?
I didn't know that are these?
Speaker 1 (24:04):
are these new guidelines coming out from the
seat?
Speaker 3 (24:07):
well, I know I was going to say coming out from the
cdc.
Right now there's nonsensecoming out from the cdc.
There's nothing coming out.
Speaker 1 (24:14):
Yeah, is there yeah, which is a little scary, but, um
, I thought that a young person,like like a teenager adolescent
, should get tested forcholesterol when they have these
familial hypercholesterolemiatype issues.
You know genetic stuff and whathave you.
But there are some peoplesaying that everyone should get
(24:36):
a baseline.
It should be earlier than that,just to see.
Yeah, it's not.
Speaker 3 (24:39):
Yeah, because the other risk factors are things
like obesity and diabetes too.
Speaker 1 (24:44):
And our weights are going up at younger ages.
Speaker 3 (24:46):
Our weights are going up absolutely.
So it's not just geneticsanymore, it's hugely about
lifestyle.
Kids smoke, kids drink,teenagers- do all these things.
So these are the things.
And they have sedentarylifestyles.
They're just sitting in frontof the computer playing games.
So they're not out thererunning around anymore, like
(25:10):
they used to.
So you know, these are all riskfactors for having
cardiovascular disease.
So it's not just about thegenetics anymore.
Speaker 1 (25:20):
That's pretty scary.
Speaker 3 (25:21):
It is yes, it is yes it is no-transcript.
Speaker 1 (25:30):
More advocates for their own health and information
and I know that sounds clicheand all, but here we're
listening to if I'm a 63 orpost-menopausal.
Now I'm in menopause, you knowI need to be going into the
doctor and saying like, should Ido anything different now?
Are there different tests thatyou should look at for me in
(25:53):
addition to the cholesterol orregular EKG?
Do you need to take, like, abetter look at the heart or at
my vessels or things?
You know you hear about all ofthese different kind of studies
and what have you like?
New blood tests that peopletake?
I know I heard about that.
What is that?
Speaker 3 (26:17):
Lipo, lipoprotein A.
So you know some of the thingsyou would do on a regular basis
when you go for your routineexams.
The basic things are reallyjust the blood work, the whole
lipid profile.
You're measuring your LDL, yourHDL.
The LDL is the bad, the HDL isthe good, cholesterol is bad.
Triglycerides are bad too ifthey're too high.
(26:40):
There's always cutoffs for thebest things.
And the lipoprotein A is a new.
It's a type of LDL which is abad cholesterol that doesn't
have as much treatment to reduceit like the other LDLs.
(27:01):
So that's the thing withlipoprotein and it really is in
90% of people.
It's genetically determined, soyou have to be careful if your
lipoprotein a is is high becausethere's not a lot of treatment
to get it down.
So it's really trying to um, uhmitigate the uh the problems
(27:26):
doing other things like hislifestyle changes and stuff like
that so so that's a new that's.
it's not new, but it it's not alot of people know about it.
Um, okay, so I think they do itmore when you know you have
family history of people withsudden cardiac deaths or heart
disease or early cardiac death.
Speaker 1 (27:47):
Yeah, something like that, right.
Speaker 3 (27:49):
Um, I think they look at that more carefully in
people with strong familyhistory of cardiovascular
disease.
So it's not new, but it issomething that should be
considered if you do have strongfamily history of
cardiovascular disease.
Speaker 1 (28:07):
And that's with or without being menopausal or not.
Yes, if you have that strongfamily history, that might be
another component of testingRight.
Speaker 3 (28:17):
Exactly, exactly.
So other things.
When you start to hit 40, 50,you know you you're going to get
based like each EKGs.
If you're having some symptoms,they may give you what they
call a stress test, which iswhen they put you on a treadmill
to see how your heart reacts tostress.
Speaker 1 (28:36):
basically, yeah, exercise.
Speaker 3 (28:39):
And depending on the other things they look at are
inflammatory processes or thingslike thyroid disease.
If you have things like sarcoidlupus, they might look at you a
little bit more closely becauseall of those conditions are
(28:59):
stresses, things that stress youalso can cause cardiovascular
disease or add to the riskfactors as part of the risk
factors.
So, depending on what otherchronic diseases you may have,
they may start to look at you alittle bit more closely.
A little younger, um.
So uh yeah.
Speaker 2 (29:22):
Okay, I don't know if you're going to be able to
answer this, but this, thisquestion, is plaguing me over
here.
Okay, so the question broadlyis how do you know that you have
a good doctor?
Speaker 3 (29:38):
Oh God, right, right, I mean how do you know?
Speaker 2 (29:40):
like I know, there's certain things where you really
good doctors would say, if adoctor does this run the other
way, there are some right.
Or if your doctor doesn't dothis, run the other way.
So I know there's some thing onthis, on this, um, on on on the
(30:04):
spectrum, where you would say,yes, do this run.
So can you find a point?
on the spectrum, to say in termsof menopause and you know we're
speaking to people who haveovaries and who experience these
things where you can say, ok,do all your disclaimers that if
(30:27):
they don't check you for this orif they say this when you
present this way, find anotherdoctor.
Speaker 1 (30:34):
I have a couple of ideas about that.
First of all and you and I bothknow what makes for a good
therapist or a counselor,because we've had a lot of
experience with that right, yes,and we kind of know some of the
things that would be red flagsand make us run from them.
So, people who listen to you,right, people who are
(30:59):
approachable, right, people thatyou don't have a problem
telling the truth to, even ifit's embarrassing.
Speaker 2 (31:06):
Right, you know, as an anesthesiologist, a pre, a
kind of a bias.
It's all of those things, yes.
Speaker 1 (31:15):
I say to my patients if you got to tell the truth to
anybody, it should be me.
Right, you know, Right.
So it's all a matter of likethat trust thing, right, I see.
But the other thing, that'sreally big now.
I see it on social media, Ihear it in the news and
unfortunately I hear it frompatients Medical gaslighting.
(31:38):
When patients go in and say,doc, I've had this pain for a
couple of days, it's nothing,you don't really have pain,
that's not really a pain, or youknow, or so.
So you'll get the sense of whensomeone is listening to you.
Even in the era of, we haveonly 11 minutes to see a patient
(32:00):
, we only have a quick time toexamine a patient and very often
patients feel like we'rerushing them or cutting them off
, not with me per se, but withother primary care doctors per
se, other primary care doctorsper se, you know.
But I'm saying that thatfeeling coupled with you have to
(32:21):
have some knowledge about someof the guidelines.
For example, at 45 years old now, people recommend colonoscopies
for everybody.
If you have a strong familyhistory of GI cancers, then it
would be sooner.
Is your 46 years old?
Is your doctor recommending youget a colonoscopy.
You know you should be gettingyearly mammograms.
(32:46):
That's Dr Otway's realm.
Is your doctor recommending youget, or asking you about your
mammograms?
Are you, you know?
So those are the.
It's like is she missingsomething?
I remember years ago my mom hadan internist.
Years loved this lady.
We made her stop going to thisdoctor because she would not
(33:08):
follow the regular guidelines.
Oh, wow, it's like doesn't shecare about this?
Doesn't she care?
When is she going to order this?
When is she going to order this?
You know, and it was like thislady is not practicing good,
recognized good medicine, butmom loved her.
So it's a combination of thatfeeling of being heard and
(33:32):
respected and your personhood,and not medical gaslighting,
telling you your symptoms arenot important, and then also
following what you have somesense of being, the national
standards and the guidelines andthings like that, and somebody
that isn't defensive when youspeak up and ask questions.
Speaker 3 (33:54):
Yes, exactly.
Speaker 1 (33:55):
What were you going to say, Dr Toni?
Speaker 3 (33:58):
I think that you know back in the day I would say, oh
, I hate these people that comein with their Google searches,
dr Google.
But I think in this day and age, when it's so easy to look up
what are the standards thesedays, I think you have to do a
(34:19):
little bit of research foryourself to see is my physician
doing this, this, this for?
me at my age, or you know.
I hate to say, but I think youknow, I think people have to
look up this stuff to beadvocates for themselves these
days, because and the otherthing too, is there's so much,
(34:39):
there's so much for one doctorto have to know, you know,
especially if you're somethinglike family medicine or
internist or not, thespecialties, but there's so many
different things out there nowthat they have to understand and
learn that they have tounderstand and learn that
sometimes it shouldn't hurt foryou to bring in.
(35:03):
Well, you know, in my conditionI see that they have this test
out now.
I don't think, like you said, adoctor shouldn't be defensive
when a patient comes to them andasks them a question about a
test that they may not havestarted them or medication that
might be out there now that maywork for them better.
And I think it's the way of theworld now is you have to use to
(35:25):
be an advocate for yourself.
You have to use what's outthere, your resources, to find
out information andunfortunately, Google is one of
them.
So you know the internet is oneof them.
So I think you have to, becauseI also think that we are also
finding out more and more aboutthe biases that people have
against people of color.
(35:47):
So even more so you know you'vegot to be an advocate for
yourself.
You have to question and youhave to do your own research,
and don't be afraid to do it.
Yeah.
Speaker 1 (36:03):
In the time we have left.
So let's just say, now we knowwhat to look for or what to
think about when we go to ourdoctors.
In terms of the cardiovascularsystem and we're in menopause,
now, let's just say, we do haveheart disease.
Now we don't know if it'scaused from our lack of estrogen
(36:25):
by virtue of our being inmenopause.
We don't know if it's from allthe pizza that I love to eat on
a regular basis and my sedentarylifestyle is.
Would the treatment formenopause related heart changes
be any different, let's say,than other treat?
(36:46):
You know, high cholesterol fromother causes, let's say, or
heart disease from other causes.
Speaker 3 (36:54):
Well, I think, when we talk about menopause and
heart disease, I think if youare suffering from menopausal
symptoms, hormone replacementtherapy is one of the best
things out there right now andit helps.
It really does help withcardiovascular disease as well.
And it really does help withcardiovascular disease as well.
(37:15):
Placement therapy helps withyour weight less weight gain,
less male pattern weight gain.
It helps to reduce your bloodpressure, helps to keep your
blood vessels flexible and ithelps to keep you know.
If you're a diabetic, it helpsto keep your fasting glucose
down and helps to increase yourinsulin use.
(37:38):
And all these things are goodwith hormone replacement therapy
.
But the problem is, is thetiming?
There's this thing out callednow the timing hypothesis that
estrogen the use of or thereplacing of estrogen is more
helpful early, when the estrogenreceptors are still active and
(38:01):
you know the attack on the bloodvessels is not as severe.
So it's much better, if you'regoing to start hormone
replacement therapy, to start itas close to your menopausal
time, as opposed to being likefive or 10 years out.
Five or 10 years out, you'rereally not getting the effects
of the hormone replacementtherapy.
(38:21):
Um so along with that.
It's, it's like anything else.
It's lifestyle change.
It's uh, exercise.
It's uh, changing your diet.
It's um, uh's, um, uh smoking.
It's decreasing your smoking,decreasing your alcohol intake.
Um, eating, well, eating therainbow.
(38:43):
Alcohol, alcohol decrease.
I'm finished eating.
It's eating the rainbow, um,you know.
Low saturated fats, lowcholesterol, you know.
Speaker 1 (38:56):
All I hear right now is wah, wah, wah, wah, wah, wah.
Speaker 3 (39:01):
All of that good stuff.
Speaker 1 (39:03):
But yeah.
Speaker 3 (39:04):
And you know, getting your regular checkups, your
blood pressure, your cholesterolcheck, all these kind of things
.
So really, it's always, always,always about you, always about
prevention and trying to changeyour lifestyle, Lifestyle
medications, diet and exercise,and don't be afraid to use the
medications that they may wantto put you on.
Speaker 1 (39:24):
Yeah, I do see that a lot People say I don't want to
start taking medicines I don'tlike taking it.
It's like well, you startedgetting heart disease.
Speaker 3 (39:33):
Right, you know, and if you're not going to make the
lifestyle changes that mayreduce you having to take these
medications, then you need totake the medications Sure, sure.
So.
Speaker 2 (39:45):
Anyone feeling convicted right now?
Speaker 1 (39:47):
Oh my gosh, it's like I'm wondering if that lifestyle
modification, can it come in apill?
Oh, I know, you know, I promise.
Speaker 3 (39:58):
I'll take it every day.
Yeah, I wish.
Speaker 1 (40:01):
Wow, oh my gosh.
This was so wonderful, Dr Tony.
A lot of food for thought.
Speaker 3 (40:09):
Yep, a lot Everything is all about prevention,
modification and be aware that'sall.
That's what you need to do.
Speaker 1 (40:19):
And I have a couple of appointments coming up, so I
know that my language is goingto change a little bit based on
just what.
You know what we're talkingabout.
Speaker 2 (40:29):
Right, ok, good Excellent.
Oh, thank you.
Right Okay, good Excellent.
Oh thank you.
Speaker 1 (40:34):
So I know we're going to see you again with some
other organ systems and othereffects of low estrogen and
menopause and all of that.
So I'm really looking forwardto that.
Speaker 3 (40:46):
Okay, great, thank you so much.
Good to have you All right.
Speaker 1 (40:51):
Well, I'll say You're like a regular now.
Yeah, yeah, that's wonderful.
So this has been anotherepisode of Black Boomer Besties
from Brooklyn, brooklyn Bye.
Hey Ange, hey Les.
How's it going?
It's going well Good.
I'm excited to come on in today.
Speaker 2 (00:12):
That's your natural state?
Speaker 1 (00:13):
Yeah, you're right, my natural state is I'm baseline
excited.
I want you to come on and belike sad.
Like Eeyore, not sad sad but belike.
Speaker 2 (00:21):
Eeyore, I want you to be like.
Hmm, I don't know.
Speaker 1 (00:24):
Here we are again.
Another episode, anotherepisode.
Then they would really say whatthe heck has gotten into, les.
So welcome to another joyousepisode of Black Boomer.
Besties from Brooklyn.
Speaker 2 (00:42):
I'm Angella and that's Leslie, my best friend of
almost 50 years.
We are two60-something-year-old women who
have decided, we've committed,to live lives that are more bold
and joyful, and we invite youto come along with us.
So today we have Dr Tony back.
(01:03):
So today we have Dr Tony back.
We're going to be it's anotherepisode in our year of the
menopause series and we're goingto be talking about no, let me
make that, let me fix that.
They're going to be talkingabout menopause and
cardiovascular health.
You're going to talk too.
I'm going to be poking at them.
(01:23):
I'm going to be like what thehell does that mean?
I don't understand this doctortalk.
So I'm going to represent thepeople power to us and they're
going to be.
Dr Tony's going to be giving ussome insight about the
connection between menopause andcardiovascular health, which is
something that we rarely hearabout.
Speaker 1 (01:52):
And before I let Dr Tony in and introduce herself
again, what I want to say, ange,is we don't want any barriers
between people who arephysicians and non-physicians,
because one of the things that Istress to my patients and this
is something that's newer in themedical arena, but it's no
longer the age of wherephysicians are telling patients
what to do we want to continue adialogue, we want it to be a
(02:15):
back and forth and we wantreally collaboration, because
those are the types of behaviorsand relationships that foster
collaboration compliance,questioning and things like that
.
So you may be power to thepeople, but we the people too.
Speaker 2 (02:33):
I get it.
I'm just saying before I letthis point go.
I'm just saying that oftentimesdoctors don't they desire that,
but you live in a doctor world.
You live in a you know,especially when you start you to
start kind of I know getting inthe weeds I know it's not your
desire to to create barriers,but I'm just here in case you
(02:57):
slip up, okay and just thank youto you know yeah, we bring to
you dr tony outway.
Speaker 1 (03:03):
Hi everybody, thank you for joining and to you, Dr
Toni Otway.
Speaker 3 (03:05):
Hi everybody, Thank you for joining and thank you
for inviting me back.
I'm Toni Otway, I'm boardcertified OBGYN.
I no longer practice OBGYNanymore, but I do work for an
insurance company.
I'm a utilization reviewer inthe state of New Jersey.
(03:25):
So, but these kind ofdiscussions are still always
dear to my heart and trying toeducate the masses on health and
how it relates to womenespecially, and women of color
especially too.
So Well, good.
Speaker 1 (03:45):
Thank you.
Women especially, and women ofcolor especially too.
So well, good.
So you've decided to, under theumbrella of the year of
menopause, specifically talkabout the um cardiovascular
manifestations or effects, inother words, your heart and your
blood vessels, and how thatperiod of menopause affects
(04:08):
those organs.
Before you do that, let's justremind our listeners what is
menopause and why does it matter.
Speaker 3 (04:19):
Okay, so just a reminder, just to go over a few
things about menopause.
Menopause is that period inyour life when your ovaries are
no longer functioning.
Basically, our ovaries aremeant to function to reproduce
children release, born with afinite number of eggs to be
released over a number of years.
(04:40):
Once they've all been exhausted, then you go through this
period of time called menopause.
So your hormonal changes thathelp to control this whole
function suddenly starts to dropoff.
(05:03):
Whole function, um, suddenlystarts to drop off.
Um, and there's um perimenopause, which is the time that, uh,
the function of your ovaries isstarting to slow down, and
that's the time when you seechanges in your periods, um, and
other things that would, uhthat go on.
And then menopause itself youhave, you can truly call
yourself menopausal when you'vebeen a whole year without your
(05:26):
periods, so, and then you becomein the post-menopausal state
and I have said before that yourestrogen really keeps, makes
you, um who you are as a woman.
Um, you have over 400 receptorsin your body that estrogen
(05:47):
affects and it goes all the wayfrom the top of your head to
down to your toes and everythingin between.
So estrogen is a huge factor inyour body functioning as a
woman, so that's it in anutshell I have thanks for that.
Speaker 2 (06:05):
That, that was really clear.
So it reminded me that mysister-in-law some years ago did
not have a period for somethinglike 350 days.
Speaker 1 (06:28):
That's cruel.
Speaker 2 (06:29):
Yes, and then here it comes right and so according to
this definition, she was notmenopausal.
But it seems kind of arbitraryto me, right?
Can you talk to that and why?
It's kind of how it came to bethis kind of rigid in terms of
(06:58):
definition, this rigid linebetween when you are and when
you're not?
Speaker 3 (07:04):
Well, I think the way they look at it is that, even
though you are and when you'renot.
Well, I think that the the theway they look at it is that,
even though you know when shegot that period, it may be that
she's she had an egg that wasreleased, so that is still
showing you that your ovarystill has maybe one or two
things left.
Even though got you, a pregnancyprobably wouldn't have come
(07:24):
about because your eggs are somuch older now, but it's still
showing that your body is stillproducing that level of estrogen
that could produce whateverfollicles or eggs that are still
there.
I must stress that if you arecoming up to 300 and something
days and then all of a suddenyou have a period, I would
(07:48):
encourage people to go and seetheir physician, because
sometimes in a regular periodcan also be a sign of other
things too.
So don't just think that justbecause you, you know you still
get in one or two, that it's all, it's normal, it's fine that
it's normal, it's fine.
Sometimes there are issues thatcan occur that can have you to
(08:09):
still have a bleed that youshouldn't really be having.
So, if you've gone a period oftime and then all of a sudden
you get one and it starts comingback full-fledged again.
You should really just get itchecked out just to be sure that
it really truly is nothingother than you know you still
going through your changes andthose changes can take.
(08:29):
You know, it could take a year,it could take a few years.
I know people that have beengoing through those irregular
things, um, for a few years andstill hasn't stopped, and so
everybody's different.
Speaker 2 (08:41):
So well, it's all about getting to know what your
body is like.
Speaker 3 (08:44):
That's right that part.
Speaker 2 (08:46):
You know, someone mentioned just before our we
started recording that they werehaving a hot flash.
Speaker 1 (08:52):
So, um, I'm not calling any names and that's boy
, but but the one that has thetissues all the time like stuck
to her face.
I wonder who.
But you know, and that alsoreminds me, let's just you know,
I started, I would say,menopause rather late.
I was, I think, over 60.
(09:14):
Wow, when I, you know, stopped,but I'm sure I was over 60.
But what I'm wondering is, andbefore we get into the
cardiovascular part, like thesymptoms of hot flashes and
stuff, do they last very long?
Or is it like when the actualegg release or the bleeding
(09:35):
stops, should the discomfort andthe sweating and the flesh it
stopped?
Or is that also a continuumthat that can also be a
continuum.
Speaker 3 (09:46):
That can also be, I personally never experienced
anything.
My period just stopped, thatwas it, and I didn't have any
symptoms, nothing and I did Idid have one period.
I did have one period almost ayear to the day of my previous
one, and that was it Done.
(10:07):
And then it was like so long?
Yeah, I never, ever had anyissues.
Speaker 1 (10:12):
Wow.
Speaker 3 (10:13):
And then I have people who have had periods.
They stopped their periodsyears ago and they're still
having issues, hot flashes.
So everybody's different.
Speaker 1 (10:22):
I see.
Speaker 3 (10:26):
Still need more studies to figure out why?
But sure and you know, in thisday and age, who knows if that's
even going to be possible toeven study anything anymore.
So, um, but yeah, it's, it's uh.
It varies.
Different people have different, uh, different stories.
Speaker 2 (10:43):
So people have different stories.
Yeah Right, different stories.
Speaker 1 (10:48):
Yeah, that's a good way to say it.
So you mentioned that menopausehas.
Well, the body has receptorsfor estrogen all over the body,
talking about the heart and theblood vessels.
Tell me about, tell us aboutsome of the things that a person
(11:08):
being in menopause what kind ofchanges might her heart go
through?
Speaker 3 (11:12):
Okay, so the issue with cardiovascular disease, and
that's what we're going to talkabout, and I just wanted to add
something because you know Iwas going to speak about, you
know, maybe a woman going to thedoctor and saying they have
this, that the other symptom,but then, um, I don't know if
you know ann burrell, the umchef, on food network she just
passed away.
Yesterday she was 55 years oldyes, yes, and now it comes to,
(11:37):
they've come to find out theythink it might be a.
She had a heart attack.
So I just want to say that, um,you know, heart disease is
actually the leading cause ofdeath in women.
Um, it usually occurs later inlife than men.
Men on average might see heartdisease at around 45.
(11:58):
We usually see start to see itaround 55 and um, cardiovascular
disease.
The CDC has come out with thepercentage that women over 20,
there's about 6% of women overthe age of 20 that start to show
signs of cardiovascular disease.
Over 20?
Over 20.
There's 6% of women that startto show those signs.
Speaker 1 (12:21):
Wow.
Speaker 3 (12:22):
What is cardiovascular disease?
Basically, it's primarily thebuildup of plaque in the
arteries, and it's also calledatherosclerosis, it's called
peripheral artery disease.
It could be called heart musclevalve disease.
There's a whole different lotof words to describe it.
Basically, it's just thisbuildup of plaque inside your
(12:43):
blood vessels that over time,starts to narrow the blood
vessels.
And this is the issue itnarrows the blood vessels and
the flow of blood is decreased.
So it's not something you canactually see.
We know it happens but youcan't see how bad it is in you.
And usually the first sign of awoman having cardiovascular
(13:08):
disease most of the womenusually the first outcome is
because of a heart attack.
So Anne Burrell probably hadcardiovascular disease, probably
didn't have any of the normalsigns or symptoms or didn't do
any preventive measures or um,um, and then this is the first
sign of us knowing that she hadcardiovascular diseases, that
(13:29):
she had a heart attack.
And this is what happens towomen.
Um, it's usually the first signof cardiovascular disease in a
lot of women is we have thisheart attack.
And by saying that we have theworst outcomes when it comes to
heart attack, we tend to ignorethe atypical signs.
Speaker 1 (13:48):
That's what I was going to say.
She may have had signs and saidI just ignored it Because I
always associate heart diseasewith men for some reason.
Speaker 2 (13:57):
I'm not sure why that is, but that's my go-to.
And the other thing is is thisrelated to cholesterol?
And I know that that's whataffects the closing of the okay
it is related to that.
Speaker 3 (14:12):
So, um yeah, like what was that?
What was my thought?
Speaker 1 (14:16):
I think it was interesting that you were saying
that she may have had symptomsthat may not.
She may not, she may not haveassociated it with being a
problem in her heart.
But then again we all also knowthat the medical profession we
are taught that, especially in a55-year-old woman, sometimes
(14:36):
these symptoms of heart diseasepresent differently than they
would in men.
Men may come in you know,looking perhaps overweight, like
they should have some heartdisease, and then you think,
well, if you're having chestpain, let me do a workup.
A woman may come in.
She may not be overweight orobese, she may not have the
(14:56):
typical risk factors, or she mayhave.
Oh, I just have some.
You know jaw pain that this orthere's something going on, or
every time.
You know just have some.
You know jaw pain that this orthere's something going on, or
every time.
You know just a little.
You know the symptoms can bevery vague and very often it can
be missed.
Speaker 3 (15:11):
Exactly.
Speaker 1 (15:12):
And I think that we downplay our symptoms as well.
Yeah, because we're busy.
Because we're busy, we've gotmaking lunch for the kids.
Speaker 3 (15:20):
Absolutely, yeah, making lunch for the kids?
Absolutely.
And then we wait longer to seekhelp, to think that maybe this
is something that's wrong withus or because we just kind of
poo-poo our symptoms.
A lot old, associated riskfactors are diabetes, smoking,
(15:43):
obesity, overweight, physicalinactivity, high blood pressure
and abnormal lipid levels inyour blood, which are the fats,
the LDL, the HDL, thecholesterol abnormal.
So some of the newer riskfactors that they have been
finding are also things that mayeven happen in pregnancy, if
(16:04):
you have a pregnancy that hasyou have gestational diabetes or
you have high blood pressurepreeclampsia or you have preterm
labor, or if you havedepression, breast cancer
treatment and even early youknow early menopause.
These are all things that canincrease your risk, which are
things that they never used tothink of before.
(16:26):
So imagine all these women thatare having these issues in
pregnancy.
These are all risk factors foryou to have cardiovascular
disease.
Speaker 1 (16:34):
So and then how many physicians 20 years later would
ask tell me about yourobstetrics history, tell me
about your pregnancy.
I, you know that was remote.
My kids are grown, I don't whatdo I remember about?
When I was, you know, pregnant20 years ago, was my blood
(16:55):
pressure high.
I don't know Was I did.
I have diabetes.
Speaker 3 (16:59):
I don't remember, you know wow, yeah, so some of the
typical symptoms that you knowhave is the chest pain, which,
in women, is not necessaryNormally.
You know hear men say, oh, theyfeel like an elephant is
sitting on a chest or there'sthis pressure.
It may be different.
In women it may be more of, youknow, just like a little pain
(17:23):
or a little discomfort, uh,whereas with men they, they
describe this thing as you knowsomebody sitting on their chest
um, maybe you're short of breathand you probably put that down
to maybe I just walk some stairsand stuff, you know, or just
walked a little further thannormal.
Um, things like extreme fatigue,I mean, which woman is not I'm?
Speaker 1 (17:44):
always tired.
Speaker 2 (17:46):
This is actually what I was thinking and that's why I
was chuckling a little bit,because you've seen those um
videos where they put anapparatus on a man at to give
him the sensation of periodcramps, right, right, and
(18:10):
they're like on the floor, likeyou know, just cannot take it
and it's something that most ofus just go through.
Speaker 3 (18:14):
Most of us just keep walking, just keep going.
Speaker 2 (18:16):
And so I'm wondering, if women, just by the nature of
our physiology, whether we havea high threshold for pain, not
only pain but discomfort, right,and that would then put us in
this risk factor.
And then, of course, afteranswering that, like, what do we
(18:38):
do about it?
Then, wow, what do we do aboutit?
Speaker 3 (18:41):
It's very hard, it's very hard to actually say, but
again, I always truly be.
You have to really be in tunewith your body.
You have to really um try notto poo, poo those things that
are starting to change withinyour body, um, and a lot of
women will say, well, I'm justgoing to put it down to
menopause or um, you know, butother things too are just, you
(19:02):
know, just pain and discomfort.
Indigestion is one you know.
But other things too are just,you know, just pain and
discomfort.
Indigestion is one you know.
Heartburn is something nausea,vomiting, um, feeling
lightheaded, even gettingswelling in your legs, and you
know, your ankles and your feetcould be a sign of heart disease
.
Um, and which woman doesn'thave swollen legs at the end of
the?
day, you know after walkingaround or whatever.
(19:23):
So all these things, yeah, um,you just have to be in tuned
with this if these things, ifthe symptoms don't go away, if
they just progressively getworse, if you try and take
something that you know you maynormally take for maybe the
heartburn and it doesn't go away, then you need to see, you need
to seek help and then to be intune with it.
Speaker 1 (19:45):
We need to find time in our busy schedules to seek
help, and then you don't want togo to a doctor or whatever if
it's nothing you know.
Speaker 2 (19:54):
You don't want to waste your time, you don't want
to be embarrassed I have alittle something and you know
it's right yeah, yeah, it's well, I think it's difficult what
probably happens often too isyou do go and they say it's
nothing right, and then you goback and the next thing that
(20:15):
happens oh, it's probablynothing.
You know what I mean.
So it becomes frustrating cycle.
Speaker 3 (20:21):
Yeah right, yeah, yeah, I mean how many times has
a woman been to the emergencyroom and has been having a heart
attack and they've just said,well, it's just indigestion.
Speaker 1 (20:30):
That's yeah sure, because they say we've heard
those stories having a heartattack.
Speaker 3 (20:34):
Yeah, maybe you're only 45 years old, you can't
possibly be having a heartattack.
So yeah, so, um, but yes, butso a plaque itself is is usually
a build, is usually made up ofcholesterol and fats and other
substances, and what estrogenactually does is it starts, it
(20:55):
protects you basically in thisbuild-up, so it helps to
maintain, um, because our bloodvessels and women are smaller,
so it helps to maintain, becauseour blood vessels in women are
smaller, so it helps to maintainthe flexibility of blood
vessels so the blood can pumpthrough easily.
I see it helps to decrease theproduction of cholesterol from
the liver.
It helps to protect you knowthe diet that you have.
(21:20):
It helps to clear you know someof the bad fats and helps to
improve the good fats from theliver.
Speaker 1 (21:28):
Wow.
Speaker 3 (21:28):
So this is what estrogen does for you.
Good old estrogen, wow Good oldestrogen, yes.
So again, it helps to relaxyour blood vessels.
It also helps to reduceinflammation within the blood
vessels too.
Helps to reduce inflammationwithin the blood vessels too,
because the plaque can onlyadhere to your blood vessel if
there's a damage in the bloodvessel wall.
(21:49):
So if there's any inflammatorythings going on, yeah, it can't
actually attach.
So estrogen helps to reduceinflammation also.
So, um, you know all thesethings.
This is what estrogen does foryou.
So this is why you get whereyou know.
Cardiovascular issues reallystart to skyrocket once you hit
(22:13):
menopause.
Once you've lost thatprotection of the estrogen, this
is when things start to reallyramp up, which is usually around
the age of 50 55 in men.
It's much younger, it's like 45.
Um wow so.
So that's how estrogen.
You know, estrogen is good sohere.
Speaker 1 (22:35):
So, so here's what I'm wondering, though, if I were
to go to a doctor?
I don't really go to a doctorbut, if I, if, if I were to go
to, let's say, a cardiologist, aheart doctor, if I'm now 63
(22:56):
years old, should he be speakingto me in a different way than
he would have spoken to me if Iwas 43 years old?
He?
Speaker 3 (23:06):
should be Like.
Would that screening?
Speaker 1 (23:07):
or conversation be any different.
Speaker 3 (23:10):
It wouldn't be any different.
It should be the same.
He should actually be speakingto you at 45 or 40 about the
things that you need to do toprotect your heart.
It shouldn't just be when youhit menopause that you are um,
you know you're discussing thesethings.
Remember what I saidcardiovascular disease cdc has
said six percent of women overthe age of 20 have started to
(23:32):
show signs and they the um.
You know I was looking atscreening tests like blood tests
, like for the cholesterol andthat, and I was actually shocked
to see that you should actuallybe testing your children when
they're starting to turnteenagers 11 and 12 they should
be still having a baselinecholesterol really when they're
yeah, and then they repeat itevery five years, and that's
(23:56):
something that should be thoughtof from childhood.
So which kind of shocked me?
I didn't know that are these?
Speaker 1 (24:04):
are these new guidelines coming out from the
seat?
Speaker 3 (24:07):
well, I know I was going to say coming out from the
cdc.
Right now there's nonsensecoming out from the cdc.
There's nothing coming out.
Speaker 1 (24:14):
Yeah, is there yeah, which is a little scary, but, um
, I thought that a young person,like like a teenager adolescent
, should get tested forcholesterol when they have these
familial hypercholesterolemiatype issues.
You know genetic stuff and whathave you.
But there are some peoplesaying that everyone should get
(24:36):
a baseline.
It should be earlier than that,just to see.
Yeah, it's not.
Speaker 3 (24:39):
Yeah, because the other risk factors are things
like obesity and diabetes too.
Speaker 1 (24:44):
And our weights are going up at younger ages.
Speaker 3 (24:46):
Our weights are going up absolutely.
So it's not just geneticsanymore, it's hugely about
lifestyle.
Kids smoke, kids drink,teenagers- do all these things.
So these are the things.
And they have sedentarylifestyles.
They're just sitting in frontof the computer playing games.
So they're not out thererunning around anymore, like
(25:10):
they used to.
So you know, these are all riskfactors for having
cardiovascular disease.
So it's not just about thegenetics anymore.
Speaker 1 (25:20):
That's pretty scary.
Speaker 3 (25:21):
It is yes, it is yes it is no-transcript.
Speaker 1 (25:30):
More advocates for their own health and information
and I know that sounds clicheand all, but here we're
listening to if I'm a 63 orpost-menopausal.
Now I'm in menopause, you knowI need to be going into the
doctor and saying like, should Ido anything different now?
Are there different tests thatyou should look at for me in
(25:53):
addition to the cholesterol orregular EKG?
Do you need to take, like, abetter look at the heart or at
my vessels or things?
You know you hear about all ofthese different kind of studies
and what have you like?
New blood tests that peopletake?
I know I heard about that.
What is that?
Speaker 3 (26:17):
Lipo, lipoprotein A.
So you know some of the thingsyou would do on a regular basis
when you go for your routineexams.
The basic things are reallyjust the blood work, the whole
lipid profile.
You're measuring your LDL, yourHDL.
The LDL is the bad, the HDL isthe good, cholesterol is bad.
Triglycerides are bad too ifthey're too high.
(26:40):
There's always cutoffs for thebest things.
And the lipoprotein A is a new.
It's a type of LDL which is abad cholesterol that doesn't
have as much treatment to reduceit like the other LDLs.
(27:01):
So that's the thing withlipoprotein and it really is in
90% of people.
It's genetically determined, soyou have to be careful if your
lipoprotein a is is high becausethere's not a lot of treatment
to get it down.
So it's really trying to um, uhmitigate the uh the problems
(27:26):
doing other things like hislifestyle changes and stuff like
that so so that's a new that's.
it's not new, but it it's not alot of people know about it.
Um, okay, so I think they do itmore when you know you have
family history of people withsudden cardiac deaths or heart
disease or early cardiac death.
Speaker 1 (27:47):
Yeah, something like that, right.
Speaker 3 (27:49):
Um, I think they look at that more carefully in
people with strong familyhistory of cardiovascular
disease.
So it's not new, but it issomething that should be
considered if you do have strongfamily history of
cardiovascular disease.
Speaker 1 (28:07):
And that's with or without being menopausal or not.
Yes, if you have that strongfamily history, that might be
another component of testingRight.
Speaker 3 (28:17):
Exactly, exactly.
So other things.
When you start to hit 40, 50,you know you you're going to get
based like each EKGs.
If you're having some symptoms,they may give you what they
call a stress test, which iswhen they put you on a treadmill
to see how your heart reacts tostress.
Speaker 1 (28:36):
basically, yeah, exercise.
Speaker 3 (28:39):
And depending on the other things they look at are
inflammatory processes or thingslike thyroid disease.
If you have things like sarcoidlupus, they might look at you a
little bit more closely becauseall of those conditions are
(28:59):
stresses, things that stress youalso can cause cardiovascular
disease or add to the riskfactors as part of the risk
factors.
So, depending on what otherchronic diseases you may have,
they may start to look at you alittle bit more closely.
A little younger, um.
So uh yeah.
Speaker 2 (29:22):
Okay, I don't know if you're going to be able to
answer this, but this, thisquestion, is plaguing me over
here.
Okay, so the question broadlyis how do you know that you have
a good doctor?
Speaker 3 (29:38):
Oh God, right, right, I mean how do you know?
Speaker 2 (29:40):
like I know, there's certain things where you really
good doctors would say, if adoctor does this run the other
way, there are some right.
Or if your doctor doesn't dothis, run the other way.
So I know there's some thing onthis, on this, um, on on on the
(30:04):
spectrum, where you would say,yes, do this run.
So can you find a point?
on the spectrum, to say in termsof menopause and you know we're
speaking to people who haveovaries and who experience these
things where you can say, ok,do all your disclaimers that if
(30:27):
they don't check you for this orif they say this when you
present this way, find anotherdoctor.
Speaker 1 (30:34):
I have a couple of ideas about that.
First of all and you and I bothknow what makes for a good
therapist or a counselor,because we've had a lot of
experience with that right, yes,and we kind of know some of the
things that would be red flagsand make us run from them.
So, people who listen to you,right, people who are
(30:59):
approachable, right, people thatyou don't have a problem
telling the truth to, even ifit's embarrassing.
Speaker 2 (31:06):
Right, you know, as an anesthesiologist, a pre, a
kind of a bias.
It's all of those things, yes.
Speaker 1 (31:15):
I say to my patients if you got to tell the truth to
anybody, it should be me.
Right, you know, Right.
So it's all a matter of likethat trust thing, right, I see.
But the other thing, that'sreally big now.
I see it on social media, Ihear it in the news and
unfortunately I hear it frompatients Medical gaslighting.
(31:38):
When patients go in and say,doc, I've had this pain for a
couple of days, it's nothing,you don't really have pain,
that's not really a pain, or youknow, or so.
So you'll get the sense of whensomeone is listening to you.
Even in the era of, we haveonly 11 minutes to see a patient
(32:00):
, we only have a quick time toexamine a patient and very often
patients feel like we'rerushing them or cutting them off
, not with me per se, but withother primary care doctors per
se, other primary care doctorsper se, you know.
But I'm saying that thatfeeling coupled with you have to
(32:21):
have some knowledge about someof the guidelines.
For example, at 45 years old now, people recommend colonoscopies
for everybody.
If you have a strong familyhistory of GI cancers, then it
would be sooner.
Is your 46 years old?
Is your doctor recommending youget a colonoscopy.
You know you should be gettingyearly mammograms.
(32:46):
That's Dr Otway's realm.
Is your doctor recommending youget, or asking you about your
mammograms?
Are you, you know?
So those are the.
It's like is she missingsomething?
I remember years ago my mom hadan internist.
Years loved this lady.
We made her stop going to thisdoctor because she would not
(33:08):
follow the regular guidelines.
Oh, wow, it's like doesn't shecare about this?
Doesn't she care?
When is she going to order this?
When is she going to order this?
You know, and it was like thislady is not practicing good,
recognized good medicine, butmom loved her.
So it's a combination of thatfeeling of being heard and
(33:32):
respected and your personhood,and not medical gaslighting,
telling you your symptoms arenot important, and then also
following what you have somesense of being, the national
standards and the guidelines andthings like that, and somebody
that isn't defensive when youspeak up and ask questions.
Speaker 3 (33:54):
Yes, exactly.
Speaker 1 (33:55):
What were you going to say, Dr Toni?
Speaker 3 (33:58):
I think that you know back in the day I would say, oh
, I hate these people that comein with their Google searches,
dr Google.
But I think in this day and age, when it's so easy to look up
what are the standards thesedays, I think you have to do a
(34:19):
little bit of research foryourself to see is my physician
doing this, this, this for?
me at my age, or you know.
I hate to say, but I think youknow, I think people have to
look up this stuff to beadvocates for themselves these
days, because and the otherthing too, is there's so much,
(34:39):
there's so much for one doctorto have to know, you know,
especially if you're somethinglike family medicine or
internist or not, thespecialties, but there's so many
different things out there nowthat they have to understand and
learn that they have tounderstand and learn that
sometimes it shouldn't hurt foryou to bring in.
(35:03):
Well, you know, in my conditionI see that they have this test
out now.
I don't think, like you said, adoctor shouldn't be defensive
when a patient comes to them andasks them a question about a
test that they may not havestarted them or medication that
might be out there now that maywork for them better.
And I think it's the way of theworld now is you have to use to
(35:25):
be an advocate for yourself.
You have to use what's outthere, your resources, to find
out information andunfortunately, Google is one of
them.
So you know the internet is oneof them.
So I think you have to, becauseI also think that we are also
finding out more and more aboutthe biases that people have
against people of color.
(35:47):
So even more so you know you'vegot to be an advocate for
yourself.
You have to question and youhave to do your own research,
and don't be afraid to do it.
Yeah.
Speaker 1 (36:03):
In the time we have left.
So let's just say, now we knowwhat to look for or what to
think about when we go to ourdoctors.
In terms of the cardiovascularsystem and we're in menopause,
now, let's just say, we do haveheart disease.
Now we don't know if it'scaused from our lack of estrogen
(36:25):
by virtue of our being inmenopause.
We don't know if it's from allthe pizza that I love to eat on
a regular basis and my sedentarylifestyle is.
Would the treatment formenopause related heart changes
be any different, let's say,than other treat?
(36:46):
You know, high cholesterol fromother causes, let's say, or
heart disease from other causes.
Speaker 3 (36:54):
Well, I think, when we talk about menopause and
heart disease, I think if youare suffering from menopausal
symptoms, hormone replacementtherapy is one of the best
things out there right now andit helps.
It really does help withcardiovascular disease as well.
And it really does help withcardiovascular disease as well.
(37:15):
Placement therapy helps withyour weight less weight gain,
less male pattern weight gain.
It helps to reduce your bloodpressure, helps to keep your
blood vessels flexible and ithelps to keep you know.
If you're a diabetic, it helpsto keep your fasting glucose
down and helps to increase yourinsulin use.
(37:38):
And all these things are goodwith hormone replacement therapy
.
But the problem is, is thetiming?
There's this thing out callednow the timing hypothesis that
estrogen the use of or thereplacing of estrogen is more
helpful early, when the estrogenreceptors are still active and
(38:01):
you know the attack on the bloodvessels is not as severe.
So it's much better, if you'regoing to start hormone
replacement therapy, to start itas close to your menopausal
time, as opposed to being likefive or 10 years out.
Five or 10 years out, you'rereally not getting the effects
of the hormone replacementtherapy.
(38:21):
Um so along with that.
It's, it's like anything else.
It's lifestyle change.
It's uh, exercise.
It's uh, changing your diet.
It's um, uh's, um, uh smoking.
It's decreasing your smoking,decreasing your alcohol intake.
Um, eating, well, eating therainbow.
(38:43):
Alcohol, alcohol decrease.
I'm finished eating.
It's eating the rainbow, um,you know.
Low saturated fats, lowcholesterol, you know.
Speaker 1 (38:56):
All I hear right now is wah, wah, wah, wah, wah, wah.
Speaker 3 (39:01):
All of that good stuff.
Speaker 1 (39:03):
But yeah.
Speaker 3 (39:04):
And you know, getting your regular checkups, your
blood pressure, your cholesterolcheck, all these kind of things
.
So really, it's always, always,always about you, always about
prevention and trying to changeyour lifestyle, Lifestyle
medications, diet and exercise,and don't be afraid to use the
medications that they may wantto put you on.
Speaker 1 (39:24):
Yeah, I do see that a lot People say I don't want to
start taking medicines I don'tlike taking it.
It's like well, you startedgetting heart disease.
Speaker 3 (39:33):
Right, you know, and if you're not going to make the
lifestyle changes that mayreduce you having to take these
medications, then you need totake the medications Sure, sure.
So.
Speaker 2 (39:45):
Anyone feeling convicted right now?
Speaker 1 (39:47):
Oh my gosh, it's like I'm wondering if that lifestyle
modification, can it come in apill?
Oh, I know, you know, I promise.
Speaker 3 (39:58):
I'll take it every day.
Yeah, I wish.
Speaker 1 (40:01):
Wow, oh my gosh.
This was so wonderful, Dr Tony.
A lot of food for thought.
Speaker 3 (40:09):
Yep, a lot Everything is all about prevention,
modification and be aware that'sall.
That's what you need to do.
Speaker 1 (40:19):
And I have a couple of appointments coming up, so I
know that my language is goingto change a little bit based on
just what.
You know what we're talkingabout.
Speaker 2 (40:29):
Right, ok, good Excellent.
Oh, thank you.
Right Okay, good Excellent.
Oh thank you.
Speaker 1 (40:34):
So I know we're going to see you again with some
other organ systems and othereffects of low estrogen and
menopause and all of that.
So I'm really looking forwardto that.
Speaker 3 (40:46):
Okay, great, thank you so much.
Good to have you All right.
Speaker 1 (40:51):
Well, I'll say You're like a regular now.
Yeah, yeah, that's wonderful.
So this has been anotherepisode of Black Boomer Besties
from Brooklyn, brooklyn Bye.
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