original Dr. feedback for this user: It was a pleasure to speak again today. I’ve summarised our discussion below to help you remember what we covered. Topic/Issue #1: Paroxysmal Hypertension and Possible Phaeochromocytoma
During our discussion, we talked about your history of sudden, unexplained high blood pressure spikes. This means your blood pressure can rise alarmingly at times, which can have serious long-term effects on your health. It is important to investigate the cause of this, as it could be related to a rare but serious condition called phaeochromocytoma, a benign tumour on the adrenal gland that releases adrenaline. This can cause symptoms like palpitations, headaches, and anxiety. We discussed that this needs to be ruled out. Topic/Issue #2: Pre-diabetes and Insulin Resistance
Another key point we covered was your blood sugar levels. Your recent tests show you are pre-diabetic, meaning your blood sugar is higher than normal but not yet in the diabetic range. This is likely due to insulin resistance, where your body does not use insulin effectively. This can be influenced by diet, stress, and genetics. We discussed that you have been taking metformin, but it has caused bloating. The plan is to focus on diet and exercise for now, but we must keep a close eye on this. Topic/Issue #3: Menopause Management
We also discussed your hormone replacement therapy (HRT). Your current regimen includes a high dose of oestrogen (Elleste Solo 2mg) and progesterone lozenges, which may be contributing to your symptoms like anxiety and bloating. Your Mirena coil provides adequate progesterone, so the lozenges are not necessary. We agreed to change your oestrogen delivery to transdermal so it doesn't have to be metabolised through the liver and stop the progesterone lozenges. We will also introduce a small amount of testosterone to help with energy, strength, and mood balance. Topic/Issue #4: Palpitations and Cardiac History
We reviewed your cardiac history from 2024, which included a pericardial effusion (fluid around the heart) and mild aortic and mitral valve regurgitation. A follow-up scan in June 2024 did not mention the effusion, but it is unclear if it was still present on re-scanning. You also had a stress echo that showed no ischaemia but noted unexplained high blood pressure during the test. It is recommended you have a repeat echocardiogram to check on the valve function. This should be done soon. Next Steps:
Book an appointment with an endocrinologist (I will send you details) to investigate the cause of your high blood pressure and pre-diabetes.
Start home blood pressure monitoring: take three readings in the morning and three in the evening for 1 week.
Stop taking the progesterone lozenges.
Switch from Elleste Solo tablets to Sandrena gel or patches.
I will send a prescription for testosterone gel.
Focus on diet: increase protein at each meal (aiming for 30g at breakfast), include complex carbohydrates like buckwheat and quinoa, and increase fibre.
Continue with enjoyable exercise, focusing on strength training rather than high-stress cardio.
Reduce alcohol intake, have as a treat rather than regularly.
Consider trying 'Sentia Spirits' as a non-alcoholic alternative in the evening.
I will write to Dr Joe Maudsley's office to request the results of your CT scan. We need to have a follow up regarding cholesterol and the outcomes of above. The blood testing company advised we can repeat your myoglobin free of charge on a day that you haven't done excessive exercise. Let me know and I can arrange this, or we can repeat when we next meet. Blood testing for Cholesterol, HbA1c, testosterone should be done no later than 3 months time.