Where Care Becomes Quiet Understanding
I am William Conway, a concierge physician in Nashville. To us, “concierge” means that I know you, I’m available to you, and I keep your story private and safe. When you speak, I hear what you say and what you do not say. I understand both the conscious and the unconscious, the quiet meaning that is the essence of you. Understanding this quiet essence allows us to share space which is meaningful to us both. Our professional relationship means that I am your doctor, with all that entails.
Our relationship will be both professional and spiritual. I’m a person, not a system, and so are you. My promise, as a healthcare professional committed to helping people, is to be your point person each and every time we meet. When you make an appointment with me in my clinic, I will be the person to shake your hand and look you in the eye, and together we will make decisions that will help you in your journey towards health.
In my practices- Nashville Suboxone+Primary Care™ and Nashville Concierge Medicines- I study constantly so that your care is well-informed. And I write constantly, so that your care is understandable. In our shared space, we will meet together and discuss whatever matters most to you, and we will share your future with joy.
Executive Summary
- Polycystic Ovarian Syndrome in adolescence requires preemptive treatment for pre-diabetes.
- Hypertension in pregnancy is a life-threatening cardiovascular disease.
- Menopause increases the risk of serious adverse cardiovascular events.
- Heart attacks (Myocardial Infarctions) often present differently in women than in men.
- Future cancer is often associated with heart attacks in women.
Case Study: Maria
Maria is the bright only child of John and Susan Jones. Born in the University Hospital of a large midwestern city, Maria had a wonderful childhood. Her mother was a professional chef who took a decade-long work sabbatical to devote her time entirely to Maria. Maria was an excellent student in elementary school and was accepted into a well-established Catholic high school. Her family moved to Nashville when she turned twelve.
A Hairy Upper Lip is Understandably Upsetting to Maria
Maria began menstruation at age 13. One year later, her periods were still erratic. Maria began to grow male pattern hair on her lips and chin. I, William Conway, MD, referred Maria to an endocrinologist who diagnosed Maria as having Polycystic Ovarian Syndrome (PCOS). Other serious endocrine diseases were ruled out at this time.
Maria felt awkward about the hair on her face. Though she was generally treated nicely at school, she knew that she looked different. Her mother took her for electrolysis hair removal treatment. These treatments were expensive, and required two years to be effective, but eventually Maria felt better about herself.
At my office at Nashville Concierge Medicines, I started Maria on metformin. This is a medication that is used to treat early-stage glucose issues. I chose this medication because of the risk of diabetes that’s associated with PCOS, which Maria had been diagnosed with earlier.
Unfortunately, even on the lowest dose of metformin, Maria had daily nausea with frequent vomiting. I, Dr. Conway, switched her to the extended-release type of the medication, which she tolerated.
Preeclampsia in Pregnancy is an Early Sign of Heart Disease
Maria graduated from high school, and she was accepted into the Honors program at a major state university. An accounting major, Maria was also fascinated by art history. After graduation, while working for a major accounting firm, Maria married a very promising accounting manager. Two years later, Maria discovered she was pregnant.
The pregnancy was difficult, with persistent nausea in the first trimester. In her final trimester- at 36 weeks gestation- Maria became acutely ill with headaches, blurred vision, swelling, and shortness of breath. Upon admission to the University Hospital ER, her blood pressure was found to be a dangerous 220/120. Maria underwent an emergency C-section for preservation of her life and was grateful that both she and her baby survived. Her baby spent two weeks in the Neonatal ICU.
Menopause Increases Risk of Diabetes and Major Coronary Events
At age 42, Maria’s periods became irregular and, after a few years of erratic hormonal fluctuations, her periods eventually finally stopped. She experienced hot flashes and brain fog during the time when her periods were irregular.
Heart Attacks Can Present Without Chest Pain, Especially in Women
At age 45, Maria awoke in the wee hours of the morning with shortness of breath, feeling distinctly ill. Her husband found her ashen gray and he called 911. Maria was again transported to the University Hospital, where the diagnosis of acute myocardial infarction (heart attack) was made. Her angiogram showed no obstruction. The diagnosis was Acute Myocardial Infarction with Normal Coronary Arteries.
Heart attacks in women tend to look different that they do in men. We think about a heart attack and a vision of a middle-aged man springs to mind. He’s clutching his chest of left arm in serious pain. He’s probably overweight, maybe red-faced with ill-temper. He’s in crushing pain and struggling to breathe. Often he falls to the ground in agony. It’s dramatic, and it happens, but not all the time. And certainly not all the time in women.
Women, with their different anatomy and biological makeup, just experience heart attacks differently. Sometimes heart attacks occur with little to no pain. There is also an issue known as Acute Myocardial Infarction with Normal Coronary Arteries, or MINOCA. This diagnosis in women requires an approach that’s different from the more common approach used in people who have heart attacks because of coronary artery obstruction.
Cardiovascular Disease in Women Versus Men
Cardiovascular Disease (CVD) includes both heart disease (like heart failure) and vascular disease (like stroke). Even though the stereotype of CVD is an overweight man having a dramatically painful heart attack, CVD is actually a more severe disease for women than for men. More women die suddenly of CVD more often than men, even when they had no previous symptoms. And more women die within a year of having their first heart attack than men do. After a heart attack, more women than men will have a stroke or develop heart failure.
This is surprising to a lot of people because of stereotypes surrounding heart disease. Those stereotypes come from the reality that women generally don’t develop heart disease until later in life than men. The hormone estrogen in women has a protective effect on the heart. This is why women’s risk of heart disease begins to “catch up” to men’s risk once they reach menopause. It’s also the reason taking hormone replacement therapy during peri-menopause or soon after menopause can keep up that protective effect on a woman’s heart.
In spite of her earlier meeting with an endocrinologist, Maria had assumed that menopause- being a “natural” transition- was something she just had to deal with. I approached her treatment with the care that it deserved. We discussed how, going forward, Maria would need to be proactive about her health. Having had a heart attack, for example, Maria was at a higher risk for cancer. I made sure she scheduled her regular mammograms and met with her regularly to keep her on the right path to wellness.
Conclusion
If what you’ve read here resonates with you- if you’re ready for care that feels personal, private, and encouraging- I, Dr. Conway, would be honored to be your physician.
At Nashville Concierge Medicines, every visit is unhurried and every patient is remembered. I listen carefully and respond thoughtfully. I stay available between visits, whether in the office or by secure telemedicine.
The bottom line is that you deserve care that is intelligent, kind, and consistent. Let’s get started!
Every woman has a story — and every story deserves excellent care.
If you want a physician who listens deeply and respects your identity,
➡️ reach out and let’s begin.
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Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine. No doctor/patient relationship is formed from reading this blog. The use of information on this blog or materials linked to this blog is at your own risk. The content of this blog is not intended to be a substitute for your physician’s advice. You should not disregard, or delay in obtaining, medical advice for any medical condition you may have. You should seek the assistance of your health care professionals for any such conditions.
