Women's Health Shouldn't be Deemed 'Atypical'! Cardiology Talks with Dr Jayne Morgan

Transcript

0:00

The following is brought to you by the committee to protect healthcare.

Chris: 0:05

In the emergency department, we see real time consequences of people not having access to health care. Expansion of Medicaid in Wisconsin would mean less cases to the emergency department. It would prevent closures of hospitals in our communities, and most importantly, save lives. The majority of states in the country have expanded Medicaid with bipartisan support, yet legislators in Wisconsin are blocking expansion of Medicaid. They're blocking the opportunity for our patients to have a healthier life. Tell your legislator to save lives and pass Medicaid expansion.

0:36

Welcome to pulse check, Wisconsin. Good morning. Good afternoon. Good evening. Whatever it may be for you. This is Dr. Ford again with Pulse Check Wisconsin. I want to welcome everybody back for season two now which is very exciting to get into. I hope you guys had a good summer. I know that my crew did here for all the kids out there. Welcome back to another school year. I wish you all the best specifically all the kids that are starting on the date of this recording which is September 3rd. I believe all the Milwaukee Public schools are back in session. So best of luck to you guys this year. You're going to do amazing things Looking forward to all the things that you will accomplish all the bright minds here in Milwaukee and throughout, Wisconsin We got a good episode for you here today. We are going to have with us a cardiologist who is also a contributor to to a number of news outlets. Her name is Dr. Morgan She is a cardiologist. She's an African American cardiologist who specializes in being an outlet to the public. and sharing with us some of her expertise, some of her specialty specifics as well. And we're very fortunate to have her here today. We're going to get into a couple of topics regarding cardiology in general. Cardiology affects multiple populations throughout the state of Wisconsin specifically underserved minority populations as well. We see a disproportionate amount of bad outcomes related to heart failure related to heart attacks, exacerbations associated with high blood pressure, diabetes, things of that nature. So I want to do everything that we can to skew these numbers so. With that being said what we're going to do is we're going to get started with one of our cases. This case will be a case that I saw in the emergency department. This was right around the time of COVID 19. So the hospitals had been seeing less volume at the very beginning of the pandemic. Because a lot of folks stayed home. So I won't give too much away. We'll go ahead and get into our first case. Patient is a 64 year old female who is presenting to the emergency department with concerns of nausea, vomiting and some tooth pain along the left jawline. The patient states that this pain started Roughly a couple days ago she was at home and noted that she had some pain. She was going to make an appointment with her dentist coming up. Patient denies any fevers at home. She denies any chest pain. She denies any difficulty breathing. But states that today she started to get increasingly nauseous. And felt as though she was going to throw up. And as such, thought that she could be having an infection of a tooth. That may be causing these symptoms. When patient came back to the emergency department room she was noted to be afebrile, meaning she didn't have a fever. She was still nauseated and she just appeared to be not well. Her skin color was a little bit grayish. She looked as though she was volume down, meaning that she looked dehydrated. She had a tachycardic heart rate to the 120s. Usually heart rate normally is sitting somewhere between 60s and 90s. Anything above a hundred, we consider it to be a fast heart rate or tachycardic heart rate. She had a blood pressure which was lower. Her blood pressure was in the 80s systolic. We usually want to see that above 90 Again, this was during the pandemic. So in the very beginning, family members were allowed in the room towards kind of the middle of the pandemic family members were not allowed, but in this case, we brought the family members back just how unwell that she looked and the fact they could provide a little bit more history. Patient had no cardiac history. She was only taking medications for blood pressure, but that was about it. I noticed that her heart rate was fluctuating. It was going from 120 to 140 to 160. And again, the striking thing was, was that her blood pressure was exceptionally low. As such, we got an EKG for her that showed an irregular heart rhythm, which was atrial fibrillation. With the patient's blood pressure being low, we placed some pace pads on her. We got a formal EKG performed for the patient as well to determine, aside from the atrial fibrillation, if there was anything else going on. We explained all this to the patient and why we were placing these pads, because in some cases you will see that an irregular heart rate itself can cause the blood pressure to be low, and in those cases sometimes we need to shock the heart back into a normal rhythm. As I was taking a look at her condition, EKG. I noted that it was something familiar, but it's something that looked to be concerning outright. It looked as though she had what we call ST elevation or a segment of the EKG that looks concerning for heart attack. I went back and talked to the patient again. The patient stated again that she had no chest pain, she had no difficulty breathing, and was just a tooth pain and the nausea. We ordered some labs for the patient, and while we were waiting on that, after her fluid was completed, I didn't like the fact that the patient's blood pressure still was low, so we ended up placing a central line for the patient a central line is a line that we can use in order to provide some medication to the patient to bring the blood pressure up. We had discussion with the patient if she would want to be Cardioverted meaning to shock the heart and she did not want to do that and with this ST elevation My concern was that there was something else going on as well I took a look with an ultrasound at bedside for the patient. We're able to do this in the emergency departments just with a Bedside ultrasound we're able to take a look at your heart in real time And what it looked like was a portion of her heart, her right ventricle, was not beating as well as the left side of her heart, and it appeared to be dilated as well. After we placed the central line, we ended up having our cardiology colleagues come down and see the patient. We started the patient on what we call vasopressors or medications to improve the blood pressure. I shared with our cardiology colleagues that I was concerned that this patient may have had a heart attack. And after talking with her again in the beginning of the story, it seems as though her symptoms started a couple of days ago. The cardiologist agreed with this and was also concerned that the patient not only had a heart attack, but may have had this heart attack two days prior when the symptoms first began. What we were seeing in this patient's case was what the eventual diagnosis was. Not only did she have a heart attack, but she also had what we know as cardiogenic shock. So this patient's case is really interesting, and it really underlines one of the things that we talk about in cardiology as well as in emergency medicine. Both cardiology and emergency medicine doctors see an exorbitant amount of EKGs every day. Cardiologists may see more in the clinic. However, in the emergency department, you know, the average ER doctor that's at a level one center or at a large metropolitan area center may see up to 30, 40 plus EKGs every day. In those cases, we have to be really good at picking up things that are concerning because in these cases you only have seconds to minutes in order to make a decision as to what to do with those patients next. And if a patient is at increased risk, if we need to move on it. In this patient's case, again, she did not have any typical chest pain and this is something in recent years, I would say in the last 10, 15 years that we have harped on as a medical discipline as well as educators in medicine that women typically don't have the typical crushing chest pain, stabbing chest pain with radiation up through the jaw or down the arm. In fact, in this patient's case, the chest pain actually had an equivalent, or we call it chest pain equivalent which was nausea, and in addition she had that tooth pain on the left. It's been well documented in recent years that women will have different presentations to heart attacks than men. And in this case this was Similar to what we're seeing in multiple chart reviews that we've done this atypical pain to the jaw or to the tooth or You know could even be just feeling fatigued or feeling weak or feeling nauseated in this patient's case Again, because COVID hit us so hard folks were afraid to come to the emergency department. In some cases, folks were told to not come to the emergency department unless they felt as though there was an emergency, just given how overran we were at the beginning of the pandemic and how little we actually knew about COVID 19. In her case, we were told What happened was she actually had a heart attack two days prior. And what happens commonly is if you have that heart attack, Over time, that heart muscle, will be affected. A heart attack effectively is when you have a portion of your heart that is not getting enough blood supply through a thrombus or, or some blockage that's causing that decreased blood flow. In her case, she had decreased blockage to that right heart. And that was the abnormality that we were seeing on the ultrasound. What happens is, the muscle becomes what we call ischemic, or doesn't get blood to it. And so over time that muscle begins to break down. And with it, the functionality of the heart begins to erode as well. We were seeing, on the formal ultrasound that we were able to get at bedside, she had some valvular abnormalities. Subsequently, what happened was this affected not only what we call the ionotropy or the squeeze of the heart, but also affected some of the chronotropy or how fast the heart was going. It affected the electrical signal pathway that the heart typically undergoes, which was why she was in that dysrhythmia, that atrial fibrillation. In addition, as we mentioned before This patient had what we call cardiogenic shock or essentially the heart not functioning as well as it can and so you can see fluctuations in blood pressure. She had a very low blood pressure. And this is a condition that can be exceptionally dangerous. In fact, this patient not only was taken to the cath lab, she was admitted to a cardiac ICU following. Fortunately for this patient, she had a great outcome. She was able to have cardiac stents placed. She was able to follow up as an outpatient with our cardiologist and our electrophysiologist. And as of the last access that I had to her chart, she was back at home. So this case in itself underlines the importance of a couple things. So first off, for all women who have a family history of heart disorder or any cardiac disorders, diabetes, hypertension if you have a strong family history as well, You want to make sure that you're looking out for when things are not feeling well because again, you know A lot of times you're not going to have that typical crushing chest pain typical radiation of the pain up the jaw or down the arm There may be more subtle presentations like in this this patient's case when she had some Nausea associated with it. And there are some contextual. Reasons for this that we'll get into. When we speak with Dr. Morgan as to why. We are just now taking a look at the differences between men and women and their presentations with heart attacks. So make sure that you're On the lookout for those symptoms, make sure that you are checking in either with your doctor or go to the emergency department. If you're experiencing something that just doesn't feel right. Secondarily you want to make sure that you're seeing your cardiologist or seeing your doctor regularly as much as possible. during the season, we're going to talk about the importance of primary care, a couple of good primary care clinics in the Milwaukee area to make sure that we get to you before. Your presentation gets to this point, making sure that we're optimizing your health care as much as possible. So that was our case. Now I want to open up the conversation with our special guest for the day, Dr. Morgan, who is going to discuss with us some very high yield concepts in cardiology. We're so lucky to have her here and we'll go ahead and start. Hi, welcome back to my channel.

Dr Morgan: 15:43

My name is Dr. Jane Morgan. I'm a cardiologist. A lot of my background has been really in research that came up through the industry really pharma industry device industry doing real R. and D. heart, you know, research and development, writing protocols and rolling people in trials. Traveling, identifying study sites. So that bread and butter grunt work of how drugs come to market. I did that for a number of years. I practiced both before that and after that. And And then even was at Piedmont Healthcare, which is largest healthcare system in the state of Georgia for 9 years leading their cardiovascular research program. And then for COVID being the head of the COVID task force, and then really branching off quite a bit into brand growth and marketing. Currently, I'm the vice president of medical affairs for Hello Heart, which is a digital health company focused on hypertension, reducing heart disease. It is an app that you use to control your blood pressure, but also interact with that app, get real data and information. And we're looking to really close the gap, especially in health care for women and for minority populations, who oftentimes are not getting accurate information, not getting timely information. We don't feel empowered to ask the questions. Well, now we've got an app. that can help guide you through all of that and even direct you for when you need to go to the, to the physician. I do a lot on social media. I have a series called the stairwell chronicles which I usually post on Wednesdays and I sit on my stairs and give One piece of medical advice in 60 seconds or less. I usually ask a question of myself and answer it in 60 seconds. I like to say that's my house because it is those are my stairs. Those are my clothes. That's my question. So if you ever submit questions, I might answer your questions as well. I talk a lot about cardiology and clinical trials and research and health equity and women's health, but also all kinds of other things as well. And then other places you may see me is I do quite a bit of media interviews doing medical analysis. I do that for CNN, for Scripps News. for the weather channel even for ABC News affiliates, WSB TV. So you may see me doing those as well. Just kind of breaking down complex science information, making it relatable to the public and explaining it on media.

Chris: 18:10

Yeah. And, and, you know, I, I initially came across you just, you know, like you said, it's through some of those media interviews, especially, your state staircase series as well. And just some of the questions that you were answering and some of the information that you were given out, I thought would be perfect for our audience because I often get asked in the emergency department, some of these very same questions. And so, you know, I appreciate all the amazing things that you're doing, both in the community. I'm sure the state of Georgia would say the same as well, but but I want to thank you.

Dr Morgan: 18:37

Yeah, no, thank you, Dr. Ford. And I appreciate being on today. And if people If anybody wants to follow me, I'm at Dr. Jane Morgan. It's just D R D R J a Y N E. I've got a Y in my first name and M O R G A N. I had nothing to do with it. I was born. That's the way it was. Instagram, you know, X threads, Tick Tock, and I'm on LinkedIn as well. Please. I do a lot of professional posts, Jane Morgan, MD.

Chris: 19:05

Definitely. And definitely follow So, you know, we'll go ahead and kick off here. What inspired you to pursue a career in cardiology? And before we get in that you know, happy women in healthcare month as well.

Dr Morgan: 19:19

You know, how I came into medicine, you know, maybe it was kind of interesting. And even before I went into cardiology I, you know, I was growing up and my neighbors on either side of us, we had a family practitioner lived on one side of us. The other side of us was a dermatologist across the street was an orthopedic surgeon. And then the next house down was another orthopedic surgeon, and then around the corner with a dentist and I babysat for them. And so we had so many professionals just right there in our environment. I was playing with their children. My parents were not physicians. My mother was a tenured professor at Spelman College. And my father was sort of upper level management at the U. S. Post office. Both of my parents worked. and worked full time in order for us to live there in that neighborhood. Whereas the other homes with the physicians they were all male physicians. The men worked and the wives were stay at home wives, and many of them also had housekeepers. So we lived there as well. But both of my parents worked. We were latchkey kids. I came home. There was no housekeeper waiting for me. But what I would say in that is that my best friend across the street, her name is Gina Scott, I would go to their house and play. Her father was an orthopedic surgeon. He would have all these books down in his office and we were never supposed to go in there. So of course, we love sneaking in there. And I would like to open his books and look at all those really icky, icky pictures of those weird diseases and those people. And I think it was there that I started to develop an interest because those books, as much as they kind of repulsed me, they were fascinating. I always wanted to kind of look at them and I wasn't reading them. I just was looking at the pictures. I had never seen people that looked like this and diseases like that. So when I went to med school, I actually went to medical school to become an orthopedic surgeon. Okay. Because I don't know, that's all I knew, right? Doctors are orthopedic surgeons. And then of course, you know, your world opens and your world expands. You start learning about things you never heard of, rheumatology and psychiatry. And so I started going through these rotations. Every time I went through rotation, I was thinking, I think I want to be that. Oh, that's interesting. So I was changing my mind. I was all over the place. I was a chameleon. So I ended up going into internal medicine because. You know, who could make a decision, right? So

Chris: 21:42

I

Dr Morgan: 21:43

did internal medicine and I was there and I was kind of thinking maybe I'll just be a general practitioner, be able to be an internist. And I started doing critical care rotations and I liked critical care a lot. I liked the ICU. I wasn't so in love with pulmonary though, but I liked critical care. And then I did cardiology and cardiology. I really like cardiology and it combined the critical care. And so really, I went into cardiology just by being open to exploring my world and exploring my profession and learning and not being set in one thing and being able to grow and being willing to grow. And in doing so, I discovered Cardiology. So I went to med school to become an orthopedic surgeon and hello, I am a research cardiologist.

Chris: 22:34

And we see that so often, right? Especially there's a lot of medical students. We just had someone that are participating in a program where They're taking kids from the inner city of Milwaukee and they're doing a pathway to medical school just to kind of get that representation there. And you see it in so many medical students. You come in with the idea that you're going to be one thing. And it's not until you kind of walk that walk and you kind of see what you want to do. My story was the same way personally. I love to see, I love everything that I saw. Like, oh, pediatrics. Oh, I love that. Oh, surgery. Oh yeah, I want to do all that. And it wasn't until third or fourth year where I was like, Oh, I really like just going to the emergency department for all the consults. So why don't I just do that? Right. So, yeah, that's a good, that's a good point. You know, you guys just don't, don't come fixing your ways, just be open and you never know where you may end up.

Dr Morgan: 23:20

That's right. Because you know, it's a great example of life. Sometimes you only know what, you know, you don't know what you don't know. So always be willing. I like to say even today that I am a forever student of medicine. There's always something to learn. I'm never a master. I'm always a student and I came to cardiology from orthopedic surgery because I was always a student. And as long as you're always willing to learn and evolve, then you don't really know where you will end up in life.

Chris: 23:53

You got it. And you know, one of the things you brought up there too was, you know, the ability to see right, the ability to grow up in a neighborhood where you could see folks who were orthopedic surgeons or see folks who were physicians coming up as a cardiologist or at least a cardiologist in training. You know, our numbers in terms of african americans in general, as well as african american women are very finite. What, what if any challenges did you experience just being an african american woman coming up through the cardiology range? Did you experience and you know, what how did you overcome them in those, in those, in those roles?

Dr Morgan: 24:29

You know, and I recognize, you know, after I had grown up that my upbringing was somewhat unusual just to be surrounded by homes of, of physicians and and it was only then when looking back, when I started to make comparisons, as I said, that we were there, but both of our parents were working a lot of those kids in the other houses were in private schools. I went to public school. But the fact of the matter is we were still living in that neighborhood and it, and it shaped you. And it was only when I became older that I realized there were some people who had never even met a black doctor, who had never even seen a black doctor. And then when I look back on it, I didn't see any female doctors. Every physician in our neighborhood, including the dentist, were all men.

Chris: 25:15

So

Dr Morgan: 25:15

in that way, I had no role model. And in fact, when I look back on it, I originally was thinking I wanted to be a nurse because I thought men were doctors and women were nurses. I don't know where I got that in my head, but maybe TV or society somehow. I didn't see it. So sometimes you can't be, if you can't see it.

Chris: 25:35

Right.

Dr Morgan: 25:36

So in that way, my, my neighborhood was very helpful in shaping the idea that I could be something, and I didn't realize that. It wasn't something that I could be and that there were people in the world who've never even seen black doctors and here I am living in a whole neighborhood of them. I didn't know that. And this is what I'm saying. You don't know what you don't know. And so later when I became a cardiologist there when I say there are very few black female cardiologists, I really didn't know any. I knew myself. I didn't know anybody else. I joined an organization called the Association of Black Cardiologists and met some others. And then I'll tell you an eye opening experience. I came to Piedmont Healthcare and that was in 2015. And when I walked in, there were Oh my gosh, were there six black physicians? Like you could have knocked me over with a feather. I don't even know if I've ever in my life even been in a room with that many. Did I even know that many? We had let's see, Tara Hrabowski was in heart failure. There we had another male there in heart failure, we had a, a surgeon, a female cardiac surgeon. Let's see, David Montgomery was there in cardiology out of Morehouse. I came out to Spelman. So, you know, we are connected.

Chris: 26:53

I

Dr Morgan: 26:55

was amazed at the richness of that environment. And, you know, just a mini topic that maybe we'll get into today. None of those doctors are even there today and in medical environments. are not conducive to support the black physician, the black specialist physician, even the rarity, the rarity of seeing black cardiologists and having a cluster of them at one institution. It was not even recognized as something that was so special and abnormal. And one by one, all of those doctors have gone and gone on to do other things when there was an opportunity for there to be something so incredibly special there at that time of cardiologists. Black female cardiologists make up less than 1%. Of the profession. And at the time, I think there were three or four at one institution. I never even seen that many institutions have them, but the value wasn't there. I don't think people recognize that this was something, you know, it was something that had happened by happenstance. It was not intentional, just by happenstance, all of these physicians were there. We recognized it amongst each other, but the big institution didn't recognize how rare and what a very special cluster of physicians they had and how rare it was to have them. And so that's a great example of they're all gone. It's hard. It is difficult. You're not valued. You're not seen as something special. You are othered and you're othered in very subtle ways that erode your ability to have a great quality of life that interfere with your ability to give your patients the care that you really know they need. And that sometimes only you can give them from a congruent perspective. probably stay longer than you should because you're dedicated to your patients, even though it's not working for you. So these are all things that we grapple with all the time. Our our commitment and dedication to our community versus What commitment do I have to myself if it's not moving forward? And so, you know, I think black physicians in particular, always in that sort of quagmire of the yin and the yang.

Chris: 29:36

Yeah. And you brought up a couple of good points there. You know, one thing is, is that a lot of those physicians were losing them. Right? Like we're losing them to other institutions if they feel as though that pressure is too much or if they feel unsupported, you know, a lot of times we see, I mean, when I started at my hospital and that currently we have maybe three or four African American doctors, period. Period, not even period. Right. And so and so, and

Dr Morgan: 30:03

not to mention cardiologist. And then I will say, I'm sorry, I forgot the No, no, no. Go for it. Yeah. Blanking on the names. Dr. Kelly McCants was there. Dr. Africa Wallace was there. Tara David Montgomery. They, we were all black. Dr. Jane Morgan showed up in research and lemme tell you something. The black cardiologists who were there when I arrived had never seen a black cardiology researcher. Like they all came over to go, Oh my gosh, you're doing research. We've never met somebody who's doing research. It was so special. And yet we recognize how hard it was because the bigger institution didn't value how special it really was. And all of us were having such challenges just maintaining what we were doing. And here you are, just as you said, Dr. Ford, you're at your institution, let alone specialists. You all didn't even have four. That's

Chris: 30:54

it. Right. And it's so rare because one of the other things that we'll kind of segue into our next question is, How important that is not only from a physician, just having you there to see right for patients to see for kids to see in the community, et cetera, et cetera, but taking away, you know, even the color aspect is the cultural aspect, right? And you made mention of that to understanding the culture, understanding where people are coming from has been shown objectively to improve patient outcomes in a lot of situations. And so it just, it going from that. How has your background and how have, you know, where you come from kind of from a cultural standpoint, how do you feel that that's influenced your approach to, you know, your perspective on medicine, you being a cardiologist and taking that extra step for your patients?

Dr Morgan: 31:42

You know, I thought originally it wasn't an impact and I think because I was determined to say I'm not going to be othered. I am a physician and I deserve to be here and I'm going to be in the mainstream and this is how it is. And I'm not going to look at everything from a black lens because. I have arrived and I am not going to be othered. So I'm not going to raise my hand. But yet there are things that you can't unsee as you're going. You can not speak on them, but you can't unsee them.

Chris: 32:16

And.

Dr Morgan: 32:18

You know, dermatology. I mean, that was just insane. I mean, at one point I asked my professor, What does this look like on black skin? And I answer was, just like this. No, just like this is not the answer. That's not what it's going to look like on our skin. I mean, just everything. The formulas that we were dealing with, the why is there a race factor in there? Well, because, you know, we know blacks retain water, but what do you mean they retain? What does that mean? I mean, and I was just allowing the system to give me these non answer answers. Mostly in my defense, I'm going to defend myself a little bit, You're powerless. You're, you're a cog in the wheel. I need these people so I can finish my degree. I need to finish my medicine rotation, my medicine residence. I've got to do my cardiology. You know, I'm not trying to argue with people or, you know, look as if you're the angry black female or you're challenging. So you're constantly stepping back. When you really should be stepping forward and you have a reason to step forward. You have a reason to challenge the system and just say, Hey, this isn't right. This is not going to work. This is going to triage my people to lower levels of care and concern. I see that and I know that and yet the exact same situation. Myself and other physicians found ourselves in, we're at this big medical institution that doesn't really value the specialness of having all of us together. Do you stay for your patients because you know, they're not going to get that lens if you leave. But on the other hand is killing your soul. What do you do? Do you leave and leave your patients and you know that they will be abandoned or do you know, so we're always in that and in that situation, even all through medical school for me, do I speak up and risk looking like the angry black male or I mean, like female, or they start to, You know, marginalized me, or it becomes more difficult for me to graduate. I need these people to get through. Let me just go along to get along and keep my mouth quiet. So, and yet you can't unsee it, right? So here we are.

Chris: 34:41

Here we are. And that's so true. You know, one time I remember the very first time I spoke out in training was during an M and M conference. For those that are listening, we have a morbidity and mortality conference where we kind of talk about cases that we can learn from or cases that didn't go well, et cetera. And so during that conversation, there was someone who was presenting who was not African American. Again, I was one of maybe maybe a handful in the, in the, the hospital and during that it was brought up right before the case, you know, African American male comes in, get shot you know, of course he was going to Bible study. Of course he was doing this. And of course he was, you know, he was totally innocent. And then everybody chuckled and they went on. Right. And so it, it, it, it was brutal. Exactly. Exactly. And so it was brewing inside of me the whole time because, you know, I grew up on the south side of Chicago. I've been out with friends, you know, when I was growing up that either got shot at or got shot and we were going to football practice, right? Like we were, we were going to X, Y, and Z, right? We weren't involved in anything. And so, you know, It wasn't until the very end that I could not hold it in anymore. Because like you said, this is through all through college, through medical school when you're powerless. And I said, you know what? To hell with it. If I get in trouble, I get in trouble. And I stood up and I said, you know, I don't know if this is, you know, if I can say this in this, in this fashion, but I cannot stand for this anymore. The way that we interpret and the way that we walk around and speak trickles down to our patients. It trickles down to our nurses, to our tech. And you have that African American male in the trauma bay and you're moving slower or you're not giving pain medication or you're not doing the followup care. You're not doing X, Y, and Z.

Dr Morgan: 36:19

Because you know, the system and the culture will support it. Chuckle about it.

Chris: 36:25

That's why

Dr Morgan: 36:26

black doctors stay in jobs longer than they should

Chris: 36:30

because

Dr Morgan: 36:31

you're worried about your patients More than yourself. And we're the only race that has to deal with that. Should I stay or should I go?

Chris: 36:41

Yeah. Yeah. And you know, I will say I was very fortunate to be in a program that that was applauded and, you know, they, we actually did a couple of series after that, talking about, you know, cultural competency, et cetera, but that is in the minority. those institutions. And so you always have to be looking over your shoulder and saying, am I going to do

Dr Morgan: 37:00

to have to speak up and know you're taking a risk,

Chris: 37:06

right? Exactly.

Dr Morgan: 37:08

That a risk. You have to take a risk. We're the only race that constantly as physicians, are having to balance that risk benefit ratio with ourselves versus our patients. And where's our commitment today? And if I take this risk and I am penalized, then what service am I to my patients if I no longer can serve them because I've been whatever, dismissed or disciplined, or, you know, so maybe I keep my mouth shut just so I can keep seeing my patients, but then the system doesn't change. And that's what, you know, so we just go round and round. And the fact of the matter is you speaking up meant that you were taking a personal and professional risk.

Chris: 37:58

Absolutely.

Dr Morgan: 37:58

That is not how it should be. It worked out for you, But it was a risk

Chris: 38:04

she

Dr Morgan: 38:04

decided to take, and it could have gone badly.

Chris: 38:07

Mm hmm. Well, you know, this podcast, I apprecia for coming out so we can you know, because that ca is how we get through a l we see in health care. On I wanted to touch on is j perspective on cardiology You talked about the app and we'll, we'll make sure that we get it on our, on our website as well as, you know, pass it out to all of our of our listeners, but involving minority communities with cardiology specifically what are some of the most pressing issues that you see as a cardiologist today?

Dr Morgan: 38:44

Yeah. Regarding minority, the biggest issues are obesity and hypertension. I mean, it's just, it's just bread and butter, right? And we know now that inflammatory conditions are actually the predicators of developing heart disease. Obesity causes chronic inflammation in the body. And yet, you know, obesity is so complicated that Because it is often driven by money, it costs money to eat fruits and vegetables, to eat organic foods. If you haven't gotten a good education, you don't have a good job, or let's just say, You do have an education and you've been able to get a job, but you haven't been able to get promoted. You're not going to be moved up in the ranks. You always will stay where you are and people will move beyond you. It limits your ability to make choices. And those choices include kinds of foods you eat. Those choices will include the type of neighborhood you live in and whether or not you'll be able to. Exercise outside and have access to parks and walkable areas. It will impact your choices that will then impact your longevity. And those are the things, those are the connections that we have to start to make. Obesity is driven not only by overconsumption of calories, but by cheap foods, processed foods, readily available foods. Tasty foods, foods loaded with chemicals. Why are those chemicals there? Those chemicals there to improve the texture, make it more palatable, give it a nice color. You know, you crave it more. And so then this, these are empty, we call those empty calories, and they just kind of feed on themselves. I think obesity is huge. And then hypertension is the next one. Hypertension, because it is the most undiagnosed disease. condition, not only in the United States within our community, but also in the United States can most can still be easily treated, but listen, I have never treated a blood pressure that wasn't first diagnosed.

Chris: 41:10

And

Dr Morgan: 41:10

most of them are still undiagnosed. So now we're back to kind of the app that I'm dealing with, but also just if you're seeing your physician and you have been prescribed medications, take your medication. And then. Get your follow up appointments and make certain we can treat your blood pressure to goal. When we say to goal, that means that top number needs to be 120 or ideally maybe even a little less. Not 140, 133. Oh, it's good enough. It's okay. If your doctor tells you it's okay, that's No bueno.

Chris: 41:52

No.

Dr Morgan: 41:52

We don't want somebody to tell you. It's okay. Okay. Is code for good enough for you?

Chris: 41:57

Mm-Hmm. Mm-Hmm? Okay.

Dr Morgan: 42:01

You think Okay. Means that it's okay, but Doctor Speak means it's good enough for you. It needs to be 120 or less. That top number, and that's what you need to say. But Doctor, it's only, it's 133. I was listening. To a podcast with Dr. Ford and Dr. Morgan. And they told me that you were supposed to treat me until I got to 120. So I need you to do that. And that's the top number and the bottom number needs to be 80. We need to stop accepting okay. And it's not our fault, because okay generally means that it's okay. But in science, that's not what it means when someone's telling you that.

Chris: 42:39

It's a zero or a one, right? It's a yes or a no.

Dr Morgan: 42:43

Right.

Chris: 42:44

No, and that's so true. And a lot of times, too, what folks don't understand is that especially in the cases of hypertension, it's that silent killer, right? And so until it becomes an issue where you come and see me in the emergency department then I counsel, you know, Dr Morgan to come down and check on you. If something's going on, you, you, you are walking around day to day and not feeling any effects from it, or maybe every now and then, but, but not every day. And so it's very important to take those medications. It's important. If you don't have. Exactly. If you don't have access to those medications, there are programs especially now with, you know, we have been doing a couple of things with the inflation reduction act that some medications have become more affordable. So, so make sure that you're checking all those lists. If you can't afford your medication, do not skip them. Please, please, please don't skip them.

Dr Morgan: 43:29

And the single most important thing you can do for yourself is if you're smoking cigarettes to stop smoking. And it's especially important for women because, you know, The deleterious or bad effects of cigarette smoking have a higher propensity, we call that propensity index, in women than in men for the same number of cigarette smoking. And there are about four traditional cardiac, meaning heart factors, four traditional risk factors for heart disease, that actually, if you have them as a woman, You've got a higher propensity index, meaning they are going to have more of a negative effect on you than they will on your brother with the exact same numbers. Obesity is one of them, the other is cigarette smoking, the other one is diabetes. In fact, Men who are diagnosed with diabetes have twice the risk of dying from heart disease, but women diagnosed with diabetes have three times the risk. And then the last one is cholesterol. These are traditional risk factors for everybody, but they have a higher pensity index. They have a higher A higher rate of having bad outcomes in women than in men. And so we need to make certain that these are things that we really try to modify. We talk about that diet all the time. Exercise, things that you can do with your lifestyle and avoid medications. But if you're a prescribed medications, please take them. Don't say, Oh, I'm not going to take it. I'm just going to exercise. No, take it because for some reason you're being diagnosed now. Go ahead and exercise. And then later, if you don't need them, we can remove

Chris: 45:10

them. You're done. Exactly. Exactly. Exactly. One of the things that we talked about here are those risk factors. So you said obesity smoking can put you at higher risk of some cardiovascular conditions. What are some of the cardiovascular conditions that you're seeing that are disproportionately affecting the African American community?

Dr Morgan: 45:28

Yeah. Hey, let's talk about it. Hypertensive diseases of pregnancy. Talk about that. If you have been diagnosed with hypertension in pregnancies, sometimes they use these terms like preeclampsia or eclampsia or something like that, or even diabetes. Do you know that if you are diagnosed with diabetes during your pregnancy, your risk of heart disease is higher than a woman who has not been diagnosed for the next 25 years after, after the delivery of that baby? Not only that. If you have been diagnosed with any hypertensive disorders, you should follow up with a cardiologist because your long term risk is going to be higher. And what we've seen as in the entire biochemical milieu is that if you're diagnosed with hypertension, you end up with an aberration in your cholesterol profile, your triglycerides, your LDL, your HDL. So for some reason, that hypertension or preeclampsia is a marker. For other things that are happening in your body, that is a wake up call. The stress test is actually the very, the pregnancy is actually the very first stress test that a woman will have. So here is something, if you all don't get anything else from our talk today, I want you to make certain, especially women, that whenever you go to the physician, Between now and the rest of your life, you give them your obstetric history, meaning your pregnancy history. And if they don't ask before the doctor leaves room, say, doctor, don't you want to hear my pregnancy history?

Chris: 47:08

Be your advocate.

Dr Morgan: 47:10

And then you give it to them because That can drive and determine the type of care and concern that you receive later. Pregnancy is your first stress test and it can mark you for things and cardiac events that could happen later. And we have an opportunity to intervene early and whenever you go to the doctor, that doctor needs to know your obstetrical history because it will guide, it should guide their thought process. If they don't ask, you need to just give it to them. I'm just gonna help you, I'm gonna, let me help you help me.

Chris: 47:48

Absolutely. Absolutely. And to drive that home for listeners here in Milwaukee, we recently, a couple of years back, I believe it was right before the pandemic. We had a African American young lady who had a cardiac condition, a heart failure associated with her pregnancy. They ended up dying in one of our emergency departments here and they did not know. That until after the fact, they went back through her chart and saw that someone had diagnosed her with a cardiomyopathy or cardiac condition associated with her pregnancy. So, that's just driving Dr. Morgan's point home to say, this happens often and again, these are things that, you know, your doctor, if you bring it up. They can look into it. They can do those tests as an outpatient so they can schedule you. You go to a clinic, you know, office during the day and get that ultrasound done and then you know, or you don't know, but it's key that you have that evaluation done before it's too late.

Dr Morgan: 48:42

Right.

Chris: 48:43

Yeah. So Dr. Morgan,

Dr Morgan: 48:44

take that, take that with you.

Chris: 48:47

Exactly. Take it with you. One of the things that we talked about, we did a case beforehand. And in that case it was a case of a 60 year old woman who came in with Tooth pain as well as some nausea associated with it. At the end of the day, it ended up being that she had a, am I a heart attack? And actually stayed home for a while. So she was actually unfortunately in cardiogenic shock. A lot of that point was to drive home. The fact that for women, more myocardial infarctions or heart attacks present a lot differently than they do typically for men. Could you talk about that a little bit and what your experience has been in those, in those differences of presentation?

Dr Morgan: 49:25

You know, and that's right. And then, you know, and let me, and, and, you know, and women can also present with, with the, you know,

Chris: 49:31

absolutely.

Dr Morgan: 49:33

But then we can have this other stuff too.

Chris: 49:35

And

Dr Morgan: 49:36

here's something I want to go back to our med school. When I talk about things where we were just like, pressing our lips together, but not saying,

Chris: 49:42

yeah,

Dr Morgan: 49:45

I don't even know how to start this when. What Dr. Ford is talking about, these symptoms of jaw pain, tooth pain, nausea, back pain, flu like symptoms which actually could be symptoms of heart disease in women in medical school and in training. And even in my cardiology fellowship, those symptoms are referred to as atypical. They are assigned the word atypical. This is how you chart it. It is the standard. Nomenclature. Now just think about how words and descriptions drive thoughts and actions. And by describing it as atypical, it's another way to other it. Not as important. Something additional. If we have time, we might learn it, but we're not going to be tested. It's going to be the main thing. We're going to other that. Well, here, here's my thought on that. Women are 51 percent of the population. We are the majority of the population. How did our symptoms get to be atypical, right? So, maybe we're having the more standard symptoms, and it's like the men who need to be othered.

Chris: 51:06

No, no, no, no. I agree.

Dr Morgan: 51:11

I'm just saying another example. I could give you hundreds as I know, Dr. Ford could going through medical school and training where you're just like, Oh, I'm just going to keep my mouth shut. I'm not going to say anything. You know, you're, you're, you know, I didn't go into gynecology for a number of reasons, but one of them is that. No, they named things like your cervix and incompetent cervix, the shy bladder that all these, I just was like, Oh, does anybody not feeling nauseous as we're going through? Right. Why does a woman's cervix have to be incompetent? There's nothing, there's no part of the man's body, nor condition that we term as being incompetent. So words matter.

Chris: 51:57

All

Dr Morgan: 51:58

right, I'm back to chest pain. I've gone. No,

Chris: 52:00

no, no. Thank you.

Dr Morgan: 52:03

Caught up on another, another thing.

Chris: 52:05

And so

Dr Morgan: 52:06

atypical. So don't forget it's atypical. And that also means that you as a woman and as a man, and as society. You also haven't learned these symptoms, right? We watch TV, we watch things, everybody has crushing chest pain, shortness of breath, they fall on the floor, we call 911, they have sweating, whatever, right? Nobody ever tells us that, hey, you might just feel run down, or you might feel tired, you might have nausea, or you might have jaw pain, it sends you to the dentist to check a tooth. Nobody tells you that. And then when you come to see your physician, They may not even recognize it because atypical really means, eh, might be hysteria, might be anxiety, might be, you know, I don't know, it's a little nebulous, that kind of thing. That's why I say words drive thoughts and they drive people. Actions and the things that we are tested on the things that are reproducible are the things that we will act on and that we will remember we are not tested on that. In other words, we are not held to accountability. On those types of atypical things. And so, the health system is also at fault. And so, here a woman has these symptoms. She stays home for hours, days, weeks, longer than she should. Then when she finally comes to the medical establishment, They're giving the proverbial pat on the back that they're there they're there. Here's an anti anxiety medicine Here's a panic or you know, whatever Every now and and I'm giving you this example because this is why? physicians stay in bad situations longer than they should because they know if they leave people might die. They are. They recognize and it is such a hard and unfortunate position to place minority positions in and to place women positions in when we're looking and treating patients from a different lens. And, you know, had that patient not come to you, but For the sake of God, that patient may have perished or had a worse outcome that would have impacted them for the rest of their life. How can I leave and let that happen to people, even though other things are happening to me? that are making my life miserable. We have this all of the time. And so back to atypical chest pain. This

Chris: 54:33

is what

Dr Morgan: 54:34

happened. I

Chris: 54:34

know. Everything you're saying right now, I'm telling you, it's the word. That's what we need to hear, absolutely.

Dr Morgan: 54:42

And so then when you come to the physician, what happens? you have a delay in getting to the cath lab. We know that every 30 minutes of a delay increases your risk of having a heart attack and losing more heart muscle. There is a longer and longer delay. Women's time getting to the cath lab is much longer than men's time. And then even after that, let's say you had a heart attack, you end up with revascularization, meaning they opened your arteries, all of these things. for joining us. Only 72 percent of women will even be offered high intensity cholesterol therapy or high intensity blood pressure therapy, only 72 percent even after your event. Yeah, so we have a long way to go. This is, I talk about these kinds of things all the time. There is the system doesn't Work for women. It doesn't work for minorities and you only have to be a minority woman and a physician in the system to see it so glaringly. And, you know, I reached a point in my career where I just felt that I couldn't not, not speak anymore. But I will say this, that it was too long. And the reason I didn't speak earlier is because I didn't. Want to take the risk. I'm doing the risk balance ratio. If, if I speak up and they banish me, then I'm no good to anybody. And so there was at some point where I got to my career, I just had to, you know, speak up. So, you know, and it may be you get to a point where you're just like, what are you going to do to me now? Or it may be that you find your tribe, that you find and an organization and people who are like minded whose values align with your own and you have the support to continue to do the right things because we came into this to heal people,

Chris: 56:45

right?

Dr Morgan: 56:45

We're here to preserve life. And what happens in medicine oftentimes to minorities and women's is the antithesis of that.

Chris: 56:58

Yeah, absolutely. So better more, what we're going to do is I'm gonna ask you just a couple of questions to close this out here. Do you, what do you think the healthcare system can do better to address these disparities that we talked about? Cause we talked about it from the standpoint of minority health, from the standpoint of social determinants, as well as, you know, gender inequities too. What are some things that you think the in moving forward that we all can do, I can do, patients can do, et cetera.

Dr Morgan: 57:24

Yeah, we need to have more principal investigators of research clinical trials who are black. That means that the drug companies and research and pharma and biotech companies need to train Physicians we they don't recruit see there's so many parts of this They don't recruit black physicians to lead trials. We know the number one reason that a patient will enroll in a clinical trial is if she or he is approached by a trusted physician. That's any race, any creed, any culture. 80 percent of African American patients are seen by African Americans physicians here. in this country for all the reasons I just named, right? We first picked people where we can trust them. We can trust that they will not first do us harm, that we can believe what they're saying. So if 80 percent of the black population is seen by black physicians and almost 0 percent of black physicians Our trial is Stanley clinical trial. And we know that the number one reason that a patient will enroll in a clinical trials. If they're approached by a physician, you can see where I'm going where we end up with medications. We don't really know if they work for us or not. You know, we don't really know what's happening. You know, currently there's a blood pressure medicine that I'm looking at more carefully because it seems to me I continue to hear better. Testimony and anecdotes that black women, when they're taking it, start to lose their hair. Well, that's not a part of the side effects from the clinical trial profile. But when you look into it, Oh, they didn't really enroll black women. So now here we are out in real world use. And we're losing our hair when we take the medication, you talk to your doctor about it. What does your doctor say? Well, it's not one of the side effects.

Chris: 59:09

Yep. It's in your mouth,

Dr Morgan: 59:12

which is correct, right? So they're treating you to the top of evidence based medicine.

Chris: 59:17

Right.

Dr Morgan: 59:17

But if you're with a black doctor, a black doctor will say, Hmm,

Chris: 59:24

that's a big deal. Is

Dr Morgan: 59:28

a big deal. And so we really need to have people in research. We need to have people who are leading research, like at these big medical centers, the chief scientific officer, the chief research officer. These are positions that need to be held by women, by people of color. It doesn't mean that white men can't have them. They can also have them, but your team needs to have people who have a 360 degree lens on your patient population in that hospital and not just led by group thing. The chief medical officer reinforces with the chief scientific officer saying, we reinforce it with chief research officer and nobody has any different ideas. So they just all congratulate themselves and never, not in a mean way, They just didn't know that there was another something else to think about because nobody brought it to their attention and nobody brought it to their attention because there's nobody sitting at the table who's in power, that they have been powered to bring it to their attention. And the last thing that I'll say is the most educated demographic in this country is the black woman. Black women have the highest level of education and the most degrees in this country. And that certainly is not represented in the jobs that we hold in the places that we go in the seats that we have. We don't have a place that the table work hard to get to the middle. And we can never get further than the middle. So listen to me, listen closely to what I'm saying. If you need to leave, you leave and go get your black job and you continue to maximize all of your achievements because every place won't value you. wherever you are. And even though I know you say, if you leave, this is going to happen in my patients, this, but once you can get out and achieve more power and more independence, you have the ability to influence externally. So don't stay for the sake of staying. Many of us do that. I get it. But just Think about how all of that works because we work very hard. We don't have the ability to pass down generational wealth. We never are promoted in jobs that are higher, high paying enough. It determines the schools that your children will go to, the education they will receive, the housing that you can provide, the foods that you can choose, whether you can have organic or not, it's going to impact your longevity. Let me tell you something. Number one, Factor in the United States of America for long life. It's not good cardiac health. It's not, you know breast cancer. It's not, if you're a runner, a long distance runner, the number one indicator for living a long life is how much money you make. So, when you look at Jeff Bezos, And the heads of Microsoft, you don't have to know any of their medical history, but just the fact of their financial standing, they're going to live longer than you are. That's how America works.

Chris: 1:02:31

Yeah, absolutely. Dr. Morgan, you know, I, I appreciate you coming out and talking to us. I hope to have you on again, more so just, just for my own edification. I feel like I've been healed from this conversation, but definitely thank you so much for our listeners. Absolutely. Please be sure to check out stairwell chronicles Dr. Morgan. Again, I'll post your your app'cause I definitely want to get that out to our listeners too. Yeah. The Hello,

Dr Morgan: 1:02:59

hello Heart app and hypertension. We are here to really solve that problem and to stand in the gap especially for women's health, especially women in menopause. We didn't even talk about that today and how your risk of heart disease increases. But get a chance. Look at the Hello Heart app. And follow HelloHeart and you can follow me as well at Dr. Jane Morgan, D R J A Y N E M O R G A N. Submit a question. I might, I might put it on my stairwell chronicle, answer the question for you.

Chris: 1:03:28

Absolutely. Absolutely. Well, thank you so much, Dr. Morgan. We'll, we'll, we'll be sure to talk about it next time. Thank you very much. All

Dr Morgan: 1:03:33

right.

Chris: 1:03:34

Bye. All

1:03:35

So that's it. I want to thank Dr. Jane Morgan for coming out and speaking with us. I hope she comes out again and speaks further because there's much more we need to get into. Um, and I know I speak for a lot of folks out there to say that a lot of what she had to offer. Was very eyeopening was very much what a lot of folks needed to hear. Especially younger doctors in the beginning of their career, folks that are just now coming into knowing they have diabetes or high blood pressure, et cetera. And how we can utilize the medications that we take. And some of the actions that we do in our day to day choices in terms of exercise, in terms of foods that we choose. If we have the choice to do so. That may affect our health in the long run. Please feel free to check out her. Feature content, which is the stairwell Chronicles. You can check that out on Instagram. On Tik TOK on X. Now the former Twitter. So feel free to check that out. Also check out her app as well. I will place a link to her app for everyone out there. Because I think that it's really good at terms of increasing our awareness. And our health and keeping us on top of everything. That app is called. Hello, heart. And again, I'll place a link to Hello Heart that you all can get that on your devices. This is a first episode of season two. This is your warning things about to get real to season. We're going to continue to bring you content of this same ilk. I want to make sure that we get to the core of some of the issues. And to be honest with you, the only way to do that is to talk about these issues. It's not to skirt around them. And we're going to continue to do that in the next several episodes, just because we can't keep doing the same thing over and over again, we have to come up with. Some meaningful resolutions to some of the issues that we're seeing over and over and over again. Here in the state of Wisconsin. Next month will be our next episode. And because we have. Some pretty monumental elections coming up. What we're going to do is we're going to bring you some topics that are going to affect your health in the state of Wisconsin. And so we'll have some very special guests that are going to be coming on to talk a little bit more about some of the public health issues and some of the public health legislation that is affecting the health of Wisconsinites throughout the state. So. Feel free to reach out to me if you have any other questions. About this episode or about other episodes as you've been doing in the past, and we're looking forward to presenting that information. As an aside. What we'll be doing also is we will be. Putting information out there for anyone who wants to donate To a great cause for the brain tumor foundation.. There is a nurse that I work with. Her name is Chelsea. I'll put her information out there too, but she. Is, you know, one of these. Superheroes amongst us that Runs marathons. And so, you know, my. Support goes out to her. She'll be running for the brain tumor foundation. And essentially what this is, is a group of runners who come out and they will dedicate, their run to increasing awareness of brain tumors, as well as trying to garner support for research garner funds for research, et cetera. And so. Brain tumors and cancers are things that affect. Pretty much anyone that, you know, if you're not affected yourself personally, having. Had a friend of mine in college. My good friend, Rashaun Black or Beau as we call them. Hu. Was a teammate of mine in college. Unfortunately died secondary to. Glioblastoma multiforme I want to make sure that we do all that we can to support brain tumor. Research and make sure that we do all we can to support folks who are doing things in the community in order to eradicate, you know, this, disease process. So. Feel free to support her link. I'll put that out there as much as we can. As always, thank you so much for joining us. we're looking forward to seeing you. In the next couple of weeks and as always take care of yourselves, take care of each other. And if you need me. Come and see me.