Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. So first of all, what I'd like to do is talk about COVID-19 and where we are with that and how that relates to a cardiologist perspective for their patients. I've now had some experience, not necessarily directly involved with caring for individuals with COVID-19, but involved in trying to still deliver healthcare, that's being impacted by COVID-19. So probably the most significant thing is that we've seen the Australian government respond rapidly. And I guess to use Malcolm Turnbull's terminology in a nimble way to ensure that we're still able to communicate with patients. And one of the things that was brought forward and put in place very quickly is the opportunity to provide phone consultations. So first of all, in regard to COVID-19, great if you're staying at home, great if you're isolating, they are the recommendations and you will be fined if you're not following the guidelines or recommendations in your state or territory. From a practical perspective, if you are able to engage in phone consultations, then Let me share a couple of thoughts. First of all, just make sure you're ready at the right time. I've already had patients who have been out to lunch, who've got the time wrong, who've been busy doing something else and sort of forgotten. Sitting behind the desk and trying to make these phone consultations work in between face-to-face consultations, it's hard work. From our end, we try and run on time. From your end, if you can make sure you're available on and on time as well, then we'll have a diary that works. Remember to also try and find a nice quiet spot so that you're not going to be interrupted. And it might be valuable to have a phone that has a speaker attachment so that you and your important other, your wife, your partner, son, daughter, carer, whoever it might be, is also able to participate in that call. That could be really valuable. Remember that we're only going to have relatively short time slots. For my allocated phone calls, we've got 15 minutes, but it's rare that I've got the full 15 minutes to speak with someone because I need to also organise bits and pieces, whether it be testing that we've got to mail out. whether it's the letter back to the GP, just notifying them of that appointment. So try and recognise that there's going to be a time restraint and there may be a requirement for your doctor to guide the conversation a little bit to make sure that the important issues are covered during that time. So do respect the time and... recognize that these are very different and challenging times and sometimes communication over the phone is much harder than face-to-face where you're able to have feedback and where you can be perhaps a little bit more direct because the nonverbal cues are clearly showing that you're not being rude but you're being concerned and wanting to move on so be aware of that I had a first consultation just the other day and it was really quite a complicated case i've now done a couple of first consultations but i guess and this is a really complex issue but i guess if it's at all possible first consultations are really best done over a face-to-face traditional way so that we get to see you and we get to meet you and we get to form a rapport and we get all of those non verbal cues a very complex case the other day and really it was challenging to try and give that person the very best care that they needed because we didn't have that chance to make the connection that you're normally able to make face to face when you're uh next to someone or you know 1.5 meters away in a consulting room I think, so first consultations are difficult. I think for follow-ups, particularly for people with issues of mobility, particularly people who are frail, elderly and at high risk from this particular condition, then I believe these telephone consultations are a fantastic opportunity and really allow us some convenience as the doctor to squeeze you in but really importantly for the patient the individual it gives you some choices and some convenience as well no need to find a car park no need to walk to the consulting room no need to leave your house actually or battle the traffic or the heat or the cold or whatever it might be so I think we may well see that this crisis has put in place some opportunities that we will likely hold on to, because there certainly are a number of cases who have been simple bone follow-ups, really important to engage with, really important to see their blood test results or follow up with their Holter monitor or echocardiogram report or whatever the intervention or investigation has been, but we've been able to do it effectively and smoothly, particularly for the individual. So I think when all this time is over, it's quite likely that some of these phone consultation opportunities for certain patient subsets will remain. From your perspective, if you're on a phone hookup, please, in respect of the time, if you have issues that you'd like to raise with your doctor, write a list. It's really, really valuable. So write a short list. Make sure that whatever the issues are on your list, you let the doctor know early on in the consultation so he can deal with them. Please don't write a list. Wait till the doctor's saying goodbye and clearly toward the end of his consultation say, oh, by the way, I've got three things I want to ask you about because that just throws us into a fit of panic. We can't. Again, deal with you face to face. We're dealing with words. We know there's someone else who we're going to have to phone in just a couple of minutes. So please be aware of the importance of you being organized and structured to help us deliver what you need. So write a list, but let us know early what it is on that list that you would like us to attend. There's one other list that I'm going to suggest that you have. See if you can guess what it is. If you're a regular listener to my podcast channel or any, of my videos, you'll know that the list I'm talking about is your medication list. Please have your medication list right in front of you. So sit down in a quiet place where you won't be disturbed, possibly with a speakerphone, with someone who's really important in your life, sitting there with you, with your list of questions. with your accurate, up-to-date list of drugs so there's no confusion about what you're taking, what time of day and what dose. And these phone call consultations, I think, can be fantastic. So there you go. A couple of tips on the phone call consultations. I can tell you all about self-isolating, but I think everyone's done that. Well, done it. over and over so many times that it's like a rewarmed Christmas turkey about three weeks into February. So you don't want to hear about that. Amazingly, I even had a COVID-19 update from my gas company supplier delivering bottles of gas. So everyone's across that. I'm not going to touch on social distancing or hand washing because that's all common sense and don't hang around. people who could be at high risk if you are potentially someone who would be vulnerable. All common sense. But what I will do is I had a question about whether blood pressure tablets could be a problem for people catching COVID-19. So there was a paper released in The Lancet looking at two studies really that had collected data, I think it was around the Wuhan experience, and the data that had been collected suggested that people with hypertension and diabetes appeared to have a greater risk of mortality, morbidity with this condition. Okay, well, it turns out that the study in the Lancet was completely theoretical. It was a hypothesis. Nothing had been tested. And in fact, although they were able to document that hypertension and diabetes were linked with increased mortality and morbidity within the cohort of people suffering from this infection, the theory was that the virus attaches to a particular receptor, which is called the ACE. ACE, angiotensin-converting enzyme 2 receptor or protein, and that protein can be upregulated by particular blood pressure tablets. And by upregulating that protein, we could literally open the door to this virus attaching to that protein and coming into the body. Sounds very plausible, sounds absolutely terrible. In this particular study, they demonstrated that about 24 or 25% of their patients who had significant issues were hypertensives, but they didn't assess in their study whether those people were on angiotensin cavernic enzyme inhibitors, therefore not able to test their hypothesis at all, just throwing it out there. And if about 25% of the cases, in fact, it was about 24%, hypertension and COVID-19 well then one needs to ask the question what's the incidence of hypertension in the community if you'd like to have a guess it's somewhere between about 24 and 26 percent so without wanting to jump to any conclusions the mortality morbidity the suffering and association of hypertension diabetes really matches up with what we see in the population I don't think that we've got any clear evidence yet that angiotensin-converting enzyme inhibitors, ACE inhibitors, or their related drugs, angiotensin-2 receptor blockers, these are candasatin, nervosatin, ramipril, parenipril, these sort of agents. We have no data that really even points. to them increasing risk. And it seems, at least from my quick read of that paper, that the rates of hypertension and diabetes within the cohort that they looked at was about the same as the general population. So at this stage, no recommendation to hold those medications in this particular situation. I can also let you know that only in the last week or two, I was on a heart foundation of australia hookup where this very issue was discussed with some of the people in the space who are most across this and at that stage there was no recommendation to stop your blood pressure tablets no harm in watching this space and no harm in re-evaluating that but right at the moment you can relax take your tablets keep your blood pressure down But what I might say something about medications, which is really important, and then I'll wrap up. One of the things that's important about medications is make sure you have organized your own supply in a sensible, thoughtful and planned out way. It would be reasonable to make sure you've got that, for example, four to six weeks supply of the medications you require. And I think you need to liaise with your local pharmacist about this and make sure you put in an order for your particular medication so you know it's there. Get them to put it aside under your name. Get them potentially to deliver it. They could deliver it in a bag, put it on your front doorstep. You could leave that bag there on the doorstep for four days, knowing that this virus on hard surfaces can last. well, 48, 72 hours. If you've now left at four days, you've gone way beyond that. There should be no virus on the bag, no virus on your medications and you can whip them inside. The flip side is being really stupid, really selfish and overreacting about this. And I know this is happening because my mum, who's 83 and has had a stroke, can't get Ventolin spray because people thoughtlessly, rushed into the pharmacy and bought as much ventilant spray as they possibly could. Now, perhaps the same people were buying toilet paper. Fortunately, my mum and dad have been able to acquire some toilet paper, so that's not an emergency. But I have to say, as a human being, I was somewhat distressed to think that people were selfish enough to actually go and raid pharmacies of medication that are really important for other people. to look after themselves. But I guess we can't account for everyone's behaviour, but we can account for our own. So please, if you know people who are being silly about this, call them out. If you think they're really overreacting, talk them through being sensible, speaking with their pharmacist and putting in an order that fits their needs. Sure, this is a difficult time. No question. We do have to be ahead of the game. We do have to know what's going on. But really going in and clearing the shelf of medications, whether it's fentolin, whether it's something else, baby formula for argument's sake, at the expense of other people and taking more than you need is just not cricket. So a little bit of stuff to think about for COVID-19. And of course, wash your hands, keep away from people who have been on cruise ships. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
