Latest / The Dr Louise Newson Podcast / 16 - Talking about our relationship and how my husband supports me

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16 - Talking about our relationship and how my husband supports me · The Dr Louise Newson Podcast

0:03
So on my podcast, by popular demand is my husband Paul
0:06
Anderson, who is a consultant urologist for the NHS.
0:10
He's a reconstructive surgeon, has done thousands upon
0:13
thousands of operations, transformed men's lives.
0:17
So we talk about his work, not my work for a change.
0:20
We talk about the impact of hormonal changes had on me and
0:24
our family. We talk about conversations with
0:26
nurses. We talk about how we can help
0:29
demystify hormones and maybe help healthcare professionals
0:33
think differently about hormones too.
0:35
So we cover a lot and it's just lovely having him here with me.
0:39
Paul, you're here in real life. Very excited that you're here
0:44
with me. 2021 apparently was the last time that you came on my
0:50
podcast, but you were downstairs and I was it.
0:52
Was much more low tech. And now yes.
0:55
Well, you've progressed, developed.
0:58
You're even more famous, infamous.
1:00
It's fantastic. It is good because actually some
1:03
of the nurses refer what do they refer you as in the hospital
1:05
pool. Well, I should probably change
1:09
my name to Mr. Newson because people I've known for years,
1:12
decades will come up to say, Oh my God, you're the reason
1:15
Newson's husband. You like that, don't you?
1:20
I've got used to it. So I want to just shine the
1:23
light onto you, actually, because lots of people know who
1:25
I am. They know exactly what I do, but
1:27
they don't know so much about. You.
1:29
That's where I like it. I want to shine light on you
1:31
because you're really, I don't know how you measure success,
1:36
but you're a very inspirational surgeon.
1:39
You're top of the game, what you do.
1:41
You're more modest than me probably, but I just think what
1:46
you do is incredible, but people don't know about it.
1:49
And actually, compared to even what you were doing 4-5 years
1:52
ago, it's got even better. And I'm telling you this because
1:56
I was at a conference recently in Perth, a urology conference,
2:01
and you were a bit annoyed because you were at the same
2:03
conference last year and you are a urologist and I am clearly
2:06
not. But I was invited to talk.
2:08
And the more drunk your colleagues got, the more they
2:11
told me how amazing you are and what a fantastic surgeon you
2:15
are. And they've never seen anyone
2:18
operating like you do. So it's not because you've told
2:22
me you've good, it's because others have.
2:25
But just explain a bit about what you do because most some
2:28
people might not know what a urologist is, but they probably
2:32
don't know what a genital urinary reconstructive urologist
2:36
does. So urology is the branch of
2:38
medicine that deals with surgical problems, as in things
2:42
that can be solved through surgery, not through drugs that
2:44
affect the kidney, the tube that drains the kidney, the ureter,
2:48
the bladder and the urethra, which is the water pipe.
2:52
And within that field there are people that deal with, say,
2:55
cancer, people that deal with kidney stones.
2:58
And I specialize in reconstruction of the male
3:01
genito urethral organs. So I spend most of my time
3:05
fixing water pipes, urethras. I do a lot of time with the
3:11
penis. You know, sometimes it's been
3:13
through peroneus disease. And certainly I just did all
3:15
those for embarrassing bodies. And I deal more commonly.
3:20
You know, these days people are getting bigger.
3:21
So I deal with buried penises. I also deal with rarities like
3:26
people have injected silicone into the genitalia, removing it,
3:30
skin grafting. Hang on a minute, injecting
3:32
silicone into the genitalia is, is that a thing?
3:35
Yeah, totally. It's pretty popular.
3:37
It makes your scrotum look larger.
3:39
It can make the shaft look bigger.
3:40
I do not recommend it. I do not condone it, but lots of
3:44
people do it and I just see the people have complications with
3:46
it. To remove that silicone.
3:48
That's a very small amount of my job.
3:50
It's mainly water pipes. Yeah, What's the biggest myth
3:54
about male genital health that drives you mad?
3:58
That having a longer penis is going to improve your life.
4:00
So it doesn't. I see so many patients who blame
4:05
the length of their penis for their current state of
4:08
unhappiness. You know, this body
4:11
dysmorphobia, you know, they're coming to me because they wanted
4:13
me to do operations to make the penis longer.
4:16
And actually it's just a symptom of not being happy and actually
4:22
making the penis longer. So surgery can give you about an
4:24
extra inch, but I would not recommend it.
4:27
You know it does nothing really. So people who have injuries as
4:31
well when the urethra has been damaged, then they can't we, I
4:37
know this sounds really obvious to you, but to many of us it's
4:39
hard to get our heads around. They can't weigh out of their
4:42
penis. So they have a catheter, don't
4:44
they? Often So I mean.
4:45
It depends in which country you're talking about because you
4:47
know the in the previous podcast because of my work in low and
4:51
middle income countries. So in a lower middle income
4:53
country, such as the ones that go to in Africa, they would just
4:56
have a catheter to you that goes straight through their stomach
4:58
into their bladder and that would be the end of it.
5:00
Whereas in the developed country, they will have
5:03
stretches, dilations, cuts to keep their water pipe open until
5:07
someone does a reconstruction. And that's the sort of thing
5:10
which I particularly specialized in.
5:12
And it could be people who are in car crashes and they have a
5:15
fracture of the pelvis and the water pipe is ripped off their
5:18
bladder, so there's no communication.
5:20
It can be people who have had injuries during other urological
5:23
operations, such As for the prostate, where the water pipe
5:26
gets damaged. It can be people who were born
5:29
without a water pipe that goes all the way to the tip of their
5:31
penis, like hypospadias. So the water pipe opens in the
5:34
wrong place further down the penis and they need that
5:37
reconstructing. And how do you make a new water
5:40
pipe? The we predominantly use the
5:44
inside of the mouth because the inside of the mouth can cope
5:46
with being wet all the time, but other parts of your skin, you
5:49
know, can't. If you spend too long in the
5:50
swimming pool of the bath, you know, your skin gets macerated,
5:53
You get like Christmas trees at the end of your fingers.
5:55
So it can't cope with being wet, especially with urine all the
5:58
time. So it's mainly the inside of the
6:00
mouth. So you do a graft from the
6:02
inside of the mouth and then put.
6:05
It and then put it into the water pipe just to make it
6:07
wider. So that's an augmentation adding
6:09
to what's there. But sometimes with, say, a
6:10
pelvic fraction, I have to join the 2 ends together, no mouth
6:14
graft. And that can involve using, you
6:16
know, a hammer and chisel to take out big pieces of bone to
6:20
reroute the water pipe to attach it back onto the bladder so that
6:24
they can weave properly. And I spend a lot of time
6:26
teaching those techniques in Africa because over there they
6:29
don't have airbags, they don't have good scaffolding, they
6:32
don't have health and Safety at Work.
6:33
You know, they're falling down whales, they've been kicked by
6:35
donkeys, they're coming off their mopeds.
6:37
If there's five head injury, they've got a pelvic fracture.
6:40
And there's lots of young men who have a catheter through
6:43
their tummy who've got a financial catastrophe.
6:47
They might be responsible for making money for a family of 15.
6:51
If they're 2225 years old and they can't work, that is a big
6:55
problem. Because they can't work when
6:56
they've got a catheter in. Well, especially poorly
6:58
maintained catheters in a hot country.
7:00
When you get to the bladder stones, urinary infections, some
7:03
people go on to kidney failure. But also there's a stigma, isn't
7:07
there, for people who have an indwelling catheter, catheter in
7:10
some communities. Definitely.
7:12
Because I remember that you've been going back and forth to
7:15
Africa for many years. And I remember one time there
7:18
was somebody who walked from an orphanage for about an hour just
7:21
to be assessed by you. And and you have, you can't
7:23
operate on everyone, but you chose this person and he wrote
7:26
to you, didn't he afterwards. Yeah, so I mean, an hour is not
7:29
bad. Some of them are travelling for
7:30
three days. You know, I'm going to places
7:33
where there may only be 1 urologist serving, you know, 40
7:36
million people. It's crazy, but this particular
7:39
gentleman was in an orphanage and then when he came back, the
7:45
owners of the orphanage, you know, who were running, it's got
7:48
in touch with the surgeon who've been training over there and
7:50
sent a video saying how grateful he was and how it changed his
7:54
life. And other peoples around him as
7:56
well. Yeah, it's OK.
7:57
Yeah. And you've also done quite a lot
8:01
of work with military in the past as well, which I remember
8:05
the first time you came back from operating on a soldier.
8:08
I've never seen you so white, I've never seen you so quiet.
8:12
And it was quite shocking. Do you remember we were in the
8:14
old house? Yeah, well, that was sort of
8:17
2008, 2011 Operation Helmand. And this is really before the
8:21
pelvic protection got going. So when the servicemen stepped
8:24
on improvised explosive devices, they would lose their legs to
8:27
get the wrecked and blown apart. They'd lose the genitalia.
8:30
Fortunately that period of time was only about 18 months maximum
8:33
two years before the pelvic protection came in.
8:36
And then they just lost their legs.
8:38
That sounds terrible, just lost their legs.
8:40
But they hadn't got the same injuries to the genitalia and
8:41
the rectum. And so there was a large cohort
8:44
of men coming back to the Queen Elizabeth Hospital in
8:46
Birmingham, which is the major military hospital which I work
8:49
nearby and have a contract with. But to see a 19 year old who was
8:53
so devastated, you know, to see these young, young men with
9:00
injuries that were, you know, so severe that they wouldn't have
9:03
survived and times gone by was emotionally very difficult.
9:08
You know, I mean, and I'm just a person who's treating them.
9:11
I'm not living with that injury. It got easier to see past that
9:15
and what I could do for them, you know, as time went by.
9:17
But you really did transform the quality of their lives.
9:21
Yes, I'd like to think so. I'd like to believe so.
9:24
Did you did Because I've heard them talk about it so.
9:27
Well, GQ did an article May 2000 and whenever it was, yeah, MMM,
9:31
talking all about the soldiers and yeah, interviewing them.
9:33
But I, as you know, when I had that hysterectomy, I had bladder
9:38
problems and I had a catheter in.
9:40
In fact, I wore your pajamas for a few weeks because then I could
9:43
have the catheter bag out. It was the most undignified
9:46
thing I had. It was horrible having a
9:48
catheter. I thought everyone could smell
9:50
me. I thought everyone can see it.
9:51
Even just, you know, having the leg bag and wearing a floaty
9:54
skirt just at night time, it's horrid.
9:57
And I don't know, there's something about urine I don't
9:59
really like. But I realized then how we just
10:03
take having a we for granted. And like, I can't imagine some
10:08
of the patients you see the stories that you tell me that
10:10
how it's gone on for so, so long.
10:12
And like, I'd like to think the work I do is transformational,
10:16
but your work is really transformational in a different
10:19
way. One of the things that attracted
10:21
me to urology in the early days before I decided to be a
10:23
urologist was how much you can improve the quality of older men
10:28
just by performing fairly straightforward prostate surgery
10:31
so they could pay on demand and not be incontinent.
10:34
And that is absolutely transformational to not be
10:36
incontinent. And I've carried on in that
10:39
vein. And you know, I strongly believe
10:41
that people should come forward with their incontinence
10:43
problems, not just suffer with pads, because somewhere out
10:46
there, there will be someone who can help you.
10:48
You know, urinary incontinence in women is really common.
10:52
Recurrent urinary tract infections are really common.
10:56
How much do you remember being taught about hormones at medical
10:59
school? Very little.
11:02
Yeah, I mean, we did train together, so you did spend some
11:06
of the lectures more hungover than me, so I'm not quite sure
11:09
how much you learnt, but your notes were always very good.
11:12
You had this really. You still have this really
11:14
annoying skill of remembering. A photographic memory.
11:16
I know you have a photographic memory because you also don't
11:21
like throwing things away, do you, darling?
11:23
So we've got like your old lecture notes and every so often
11:28
they sort of fade because you, you know, we're, I don't know,
11:32
not listening properly. And I thought, good, my notes
11:34
are going to be better. And I had my highlighter and I
11:35
had my coloured pens and you sometimes draw a little mouse on
11:39
my notes. And I thought you're not
11:40
concentrating. And then you did really well and
11:42
got distinction in the exams and you just remember everything,
11:46
don't you? But isn't it interesting that
11:49
you remember that we weren't thought about hormones at
11:52
medical school? And I don't think it's really
11:55
improved. You know, the junior doctors
11:57
that come through, are they talking to you about hormones in
12:00
respect to urinary incontinence in women?
12:02
No, no, not at all. What do you think of that?
12:07
Well, I think I think we should all be thinking about it a bit
12:09
more. I think about it more because of
12:10
you and I've proved read so much of your work over the years.
12:14
So if I, you know, so even if I see when I do my week on call
12:18
and I see children, I see women, I see men, you know, if someone,
12:21
if I see a lady who's got a fragility fracture, I'm often
12:25
saying to them, you know, why aren't you an HRT who's thinking
12:29
about your bone density? You know, it's not just about
12:32
HRT to improve the urinary health, but it's just about
12:36
general health. And so you've educated me and
12:39
I've read around it a bit. And it's also there in the
12:42
European Association of Urology guidelines that we should always
12:46
be considering HRT or at least topical estrogen to the
12:48
introitus, you know, vagina for infections.
12:52
So we are thinking about it more and it gets more coverage in our
12:55
conferences. And of course, you've been to
12:56
those conferences and lectured on it yourself.
12:58
I know I was really nervous actually lecturing in front of
13:00
you and your colleagues last year.
13:03
I was actually really struck how friendly urologists are.
13:07
And I say that because different doctors are not always as
13:11
friendly and you've been to conferences where they're not
13:13
all urologists are not quite as friendly.
13:15
But urologists are such a great group.
13:17
And what I've found about them is that they've got this sort of
13:21
professional curiosity. They want to ask, they want to
13:23
challenge, they want to learn. They're not just, and I say just
13:27
inverted commas, surgeons. They actually want to learn
13:29
about the whole person. So it's great that they're
13:33
talking about it more. But there's still very few
13:35
people who have recurrent urinary tract infections who are
13:38
given vaginal hormones to continue in the future.
13:42
And it's so simplistic, isn't it?
13:44
Yeah, totally, totally. I know that that, you know, when
13:47
I was passing through the surgical specialties and
13:49
deciding what to do and going through orthopaedics and dermal
13:51
surgery and plastic surgery, you know, by far and away the nicest
13:55
bosses were the urologists. And that in the end, that's what
13:58
made my mind on. It is important to have good
14:01
colleagues because it's not easy, is it?
14:03
And mentors. Yeah, absolutely.
14:05
You need someone you want to, you know, you need someone you
14:07
want to be like, to aspire to be like, you know, that's what's
14:10
that drives or drove me forward. Well, you've had especially a
14:13
couple I could think straight off, but you've had some great.
14:16
We still have great mentors. Yeah, someone who's been on your
14:18
podcast, you know, a few times, Steve Payne.
14:20
Yeah, I know. And I've really struggled to
14:23
find mentors who, you know, who I want to be like.
14:26
There's bits that I want to be like, but it, I think maybe it's
14:30
just the area that I'm in. Maybe it's because I'm a woman,
14:32
but I I, it's, it is hard finding the right mentor.
14:37
But when you were doing embarrassing bodies, so so we
14:41
did embarrassing bodies. When I say way, I was just more
14:44
of a advisor, but you did a lot in Embarrassing bodies.
14:47
I was the most prolific contributor.
14:49
Say that again, sorry. I was the most prolific
14:51
contributor. I had more sections on that show
14:56
than anyone else. And why is that?
14:59
Because if you're going to think about things which are
15:01
embarrassing, it's usually the penis, isn't it?
15:04
So I was doing loads of penis surgery, genital surgery all the
15:06
time. And from the second season,
15:09
because the first season was embarrassing illnesses and then
15:11
it was embarrassing bodies. And for ten seasons I was in
15:15
every single one, often multiple times.
15:18
It was great. It raised awareness amongst
15:21
patients. You know, I had people coming to
15:23
my clinic saying I saw you on television.
15:24
I didn't know something could be done for this condition because
15:27
the thing about my area of urology, it's not cancer, it's
15:30
not quantity of life, it's about quality of life.
15:33
So there's lots of things that decrease your quality of life.
15:36
You know, a bent penis making penetration difficult or painful
15:39
for the partner. You know, if I can correct that
15:42
for them, you know, they're delighted their wife is
15:43
delighted, their partner's, you know, So I did all sorts of
15:47
operations and improved people's quality of life and came
15:49
forward. And even now there are repeats
15:52
on You know, Dave and Channel 4, and people can find me on
15:55
YouTube and they say, oh, I saw you on television.
15:58
Well, it's interesting because I was thinking it was a long time
16:00
ago now and social media wasn't such a thing, so it's quite hard
16:04
to find information. So that programme was really out
16:08
there, wasn't it? Really just.
16:10
I think they should be commended and they, their, their website
16:12
was fantastic as well. And they, you know, they were
16:15
one of the first websites to put up pictures of the whole variety
16:18
of what penises look like, what nipples look like, what breasts
16:21
look like. So instead of people going to,
16:23
you know, adult entertainment sites and trying to compare
16:25
their their own penis to something that's absolutely
16:28
perfect and really long, they could go on to embarrassing
16:31
bodies website and look at all these penis and think, well, I'm
16:33
just normal, you know, I'm just normal.
16:36
You know, I think they did a great job of that programme.
16:38
Yeah. And and, you know, people really
16:40
like the way that you are very direct, but also can be a bit
16:44
funny as well, the way, you know, surgery, but also the way
16:48
that you say transforming and improving people's lives.
16:51
Yeah, certainly. But it does make you think,
16:54
'cause even back then I was, do you remember on the studios I
16:57
was people would phone in and I would do some sort of Zoom, like
17:02
not consultations, but just conversations.
17:04
And I was really shocked then actually thinking about how hard
17:08
it was for people to be listened to.
17:10
So people would say, oh, I've got this rash and I've had it
17:12
for seven years and the doctor keeps dismissing me or I've had
17:16
migraine and I'm not on any treatment.
17:17
Just lots of things. And I remember then just
17:20
thinking, wow, gosh, I don't understand.
17:23
Like even as a doctor, if I don't know how to treat, I would
17:26
always ask someone else's opinion or I'll try and find
17:28
out. But these people were just being
17:30
told they're a bit of a nuisance.
17:32
And so that was interesting. But also the fact that it was a
17:36
Zoom, like a remote because because this was all pre COVID,
17:39
long time before COVID. So we didn't really do remote
17:42
consultations then. No, not at all.
17:44
But that's that's open and changed the way we practice
17:46
medicine as well, hasn't it? Yeah, I mean for so much of our
17:50
follow up, you know, from a hospital perspective, we can
17:53
deal with it now either through a Zoom style consultation,
17:58
although I still don't get them to share the genitalia to me.
18:01
You know, on Zoom consultations, they will send in photos in
18:03
advance which we can then discuss or just telephone call.
18:07
And it makes life much easier because you don't want to do a 2
18:09
hour round trip. So then speak to the doctor for
18:11
10 minutes, everything's going fine.
18:13
Yeah. So I think some good things came
18:15
out of COVID, you know, and those Teams and Zoom meetings we
18:17
have all the time. Yeah, that's part of it.
18:19
Yeah, and I think just just the way within various bodies and
18:24
social media, it's made us as doctors more accessible and also
18:29
the knowledge that they have. So I know some of the people
18:31
that come to see you, they've spoken to other people who have
18:34
been operated on by you. They know what to expect.
18:37
They know what you're like. They they they know about
18:40
previous results and that probably didn't happen quite so
18:43
much in the past. I.
18:44
Mean the younger patients are operating on who could be you
18:48
know, 16/20/21 they will go on to forums discussing their
18:52
problem and they'll often, you know, have chat with someone
18:55
who's been dealt with by me. But you know you're saying about
18:58
people living with these problems.
19:00
Even now I see people who have problems for decades that never
19:03
get referred on. I know I think the doctors who
19:05
just keep passing them on the head and just repeating the same
19:08
treatment doesn't really work all that well have not got a
19:10
haven't got a professional curiosity to find that way you
19:13
could refer on to why is that do?
19:16
You think? I don't know, it might just be
19:19
the amount of workload they're dealing with doesn't give you
19:21
that sort of chance to think about how you can improve what
19:26
you're doing. Sometimes you need time at your
19:29
desk doing nothing to think about how to improve your
19:32
service and how you can do a better job.
19:34
But when you're just at Hampson and Reel, dealing with so many
19:37
referrals and so many patients, you just tend to do the same
19:39
thing over and over. So interesting.
19:42
I mean, I, I often think about our training and I think we were
19:45
really lucky with some of the people that we were trying.
19:48
We both were in Manchester, obviously, but people really
19:51
took a long time, like teaching us how to take a good history,
19:56
how to really learn from the patients.
19:58
Do you remember? We spent hours, literally hours.
20:01
And then we went with Professor McGuire down in Willington, who
20:06
was a psychiatrist who worked with oncologists and tried to.
20:10
Talk and not be scared of asking questions.
20:13
Do you remember? Yeah, I do.
20:15
And even psychiatry, that was really good.
20:17
You know, if someone's got really poor mental health issues
20:20
or they've got dark thoughts, how to really ask those
20:24
questions and not be scared. I mean, looking back, that was
20:27
quite unique I think. It's hard because I've stayed
20:31
much more narrow than you, but I do remember my psychiatric
20:34
attachment has been fascinating. I learnt a lot.
20:36
It makes you much better at asking questions, getting that
20:38
information from patients. But I've got very little house
20:41
to compare it to because I've not used it well.
20:43
I've not gone down that. You can hear like sometimes I
20:47
hear you and you've made the diagnosis, like you made a
20:51
diagnosis of endometriosis not that long ago, Somebody who had
20:55
it in their urethra. And you were saying, it's so
20:57
obvious. And I said how you never see
20:59
people with endometriosis. And you were saying, well, it's,
21:03
it's obvious when you take the history because it changes.
21:05
Throughout the cycle. Yeah, but you think that's
21:08
really obvious to ask about a period and if symptoms are
21:11
changing with a period. But I tell you what, most
21:14
doctors don't ask at all. Yeah, but.
21:19
You're trying to change that, aren't you?
21:21
I am, you're right. But thinking about, you know,
21:24
PMS, premencial syndrome, PMDD, premenstrual disorder, you know,
21:28
we see people with these awful mental health symptoms and
21:31
they've been on these psychiatric medications and no
21:34
one has said, do does your mood change with your cycle?
21:39
It's really not hard. But because we've had good
21:41
training, that's what I mean. I think we just take it that
21:44
everyone else does the same. Yeah.
21:45
I mean, I think one of the most upsetting and some of the most
21:49
rewarding bits of your practice is dealing with the severe
21:53
mental health illness that comes along with hormones fluctuating.
21:58
And I know that you have given up your own time and driven to
22:01
see patients who've been sectioned to assess them, you
22:05
know, on a Sunday or on a Saturday.
22:06
And when you've spoken to them, it's obvious it's related to
22:09
their hormones and putting them HRT has really improved them.
22:13
And then the psychiatrist who have a body as a body of doctors
22:17
being really receptive to what you're doing, have then
22:20
contacted you and thanked you and said we need to know more
22:22
about this because some of that really refractory depression,
22:27
suicidal ideation, you know, is related to hormones.
22:31
And there's been some fairly high profile and tragic stories
22:33
that you've covered, you know, and we'll cover in future
22:36
podcasts. So I think that the I know
22:40
because you know, I talk to you a lot and you tell me things,
22:43
but I think that the severe mental health aspects of
22:46
perimenopause and menopause is just not appreciated.
22:49
No, it's not. And, and just to go on about hot
22:51
flushes and, and, and, you know, rubbish drugs that just deal
22:56
with hot flushes, it's just wrong.
22:58
It's wrong for women. Yeah, well, in fact, we've just
23:01
looked at our symptoms of people coming to the clinic.
23:04
You know, we've got that new symptom questionnaire and hot
23:07
flushes isn't even in the top 20.
23:10
So obviously we've got three daughters and we're quite open
23:13
as a family. I think maybe being medical,
23:15
nothing phases us at all. We don't judge the children.
23:17
We're really open in our conversations.
23:19
But obviously we've been doing, we've talked a lot about
23:22
hormones, don't we? Yeah, you do.
23:24
We do. But you know what?
23:27
I'm still a bit annoyed. Should I tell you why?
23:30
You're going to. Because I had symptoms for about
23:34
6 months that were and when I was clearly perimenopausal age
23:38
45 and you didn't recognize them and they did they I.
23:42
Was too busy trying to avoid you.
23:46
But you know, you help the nurses at work now, but you
23:49
probably didn't then. But you know what?
23:51
I remember waking up every night dripping in sweat and I'm not a
23:55
sweaty person and I was too scared to wake you up so I'd get
23:59
a towel out of the airing cupboard and then lie on the
24:01
towel. But I thought I had lymphoma.
24:03
But I just thought there was a phase and hoped it would end.
24:08
But it's hard, isn't it? Because what?
24:12
How do you know what is related to hormones or not?
24:16
Well, looking back, I'm surprised I didn't think about
24:19
it because it's, you know, you've spoken about this on the
24:20
tour, Sophie, who picked up on it.
24:22
Because there's no doubt that I would have no longer wanted to
24:25
live with you if you carried on like that.
24:28
But then that'd be really hard for the family.
24:30
So I can see why families broke up.
24:31
Yeah, I. Remember that argument in
24:34
London? Yeah.
24:36
If our relationship wasn't so strong, you would have left me,
24:39
I would have left you and I'd be broken without you because
24:42
you've put me up more than you realise.
24:44
But like, it's really sad actually, because so many
24:47
relationships break up and they don't.
24:50
And you? Can see exactly what happens,
24:52
Exactly what. Happens, but it shouldn't,
24:55
Should it? No.
24:57
Well, I suppose that's why you've got to also educate the
24:59
wives, the husbands, you know, or the partners of the women who
25:03
were going through menopause and perimenopausal.
25:06
Yeah, and the children. Because, like I say, it was it
25:08
was Sophie who picked up on the fact that you were actually
25:10
perimenopausal. But you know it.
25:11
Scares me because I I love our children so much, but then I
25:15
didn't, I didn't love anything. And so many women are bringing
25:20
up children in in homes without love because they don't have the
25:24
right hormones. But again, it's not being picked
25:26
up. It's been blamed on the
25:28
circumstances or mental health or whatever else.
25:31
And you know, we see it and the children when they've got step
25:34
parents, maybe step mothers who aren't being nice.
25:37
And then they thank me after their feeling better.
25:39
But the children thank me because they go to the people's
25:41
houses. And they say it's just so much
25:43
karma. Just feels so wrong when there's
25:46
such an easy solution. But you've got to think of it
25:49
first. Yeah.
25:50
And often times these people might be in situations which are
25:53
which you can't fix and one component of the problem of the
25:57
hormones. But if you don't try and fix
25:58
that one component, you know, it's a shame.
26:02
It's a shame. So the good thing is that I take
26:04
hormones and we're very happily married.
26:06
But I don't think other areas like in urology, they don't
26:09
challenge in the same way. They embrace new operations or
26:13
new treatments, don't they? And try them totally.
26:17
I don't know why it's is it because it's women or is it
26:19
because it's that area of medicine that's so still
26:22
misunderstood by so many people? I don't know.
26:25
I like I said earlier and you've mentioned as well, I think
26:27
urologists are a friendlier than average group of surgeons who
26:32
look out for each other and want to see everyone, you know, do
26:36
well and bring them on. You know, at the conferences,
26:38
we're not really cutting people down to size or criticizing a
26:41
lot. You know, someone presents
26:43
something interesting. I think, oh, I'll try that.
26:46
I'll look into that. Which is great, isn't it?
26:48
Rather than trying to think, well, no, they're getting too
26:52
big for their boots, we need to see them, you know, cut down to
26:54
size. Now we're not getting any
26:56
younger and when when the girls were younger, I spent a lot of
27:01
time working part time to really look after them.
27:03
And now my work's really increased and you very kindly
27:07
are doing a lot more. But Nate, you're super busy.
27:11
You do a lot NHSA, little bit private.
27:13
You do a lot abroad, you do a lot of teaching.
27:16
And you know when you go abroad, sometimes it's showcase
27:19
operating where people will watch what you do.
27:21
Are you thinking about retiring? No, Jesus, no, not at all.
27:27
I don't have to prize the scalpel for my cold, dead hands.
27:32
I mean, we're, we're really lucky, aren't we to, to have
27:35
jobs that. We do.
27:36
You got the job that you love. You know, you don't work for the
27:38
rest of your life, do you? Or whatever the saying is.
27:40
So yes, I, I still really enjoy my job.
27:43
I'd like to shave off, you know, maybe half a day during the week
27:47
or something. But no, I just don't see myself
27:52
stopping. I don't want to be one of these
27:53
really old surgeons who's a bit doddery in this area, is past
27:56
his prime and don't get operated on by Mr. Anderson anymore.
27:59
He used to be great 10 years ago, so I've got to listen to my
28:02
younger peers and look at my outcomes.
28:05
Yeah, absolutely. But you know, if I'm not going
28:07
to spend time with the family or going out with friends, then
28:10
choice #3 for me to pass the time of day would just be
28:14
operating. And where you work in NHS is
28:18
such a wonderful place in the Black Country.
28:21
The nurses mostly are just incredible.
28:25
All this stuff are, you know, Joe, everyone is just brilliant.
28:28
But you've worked there for quite a few years and you have
28:31
watched them change some of them when they've had hormonal
28:34
changes, haven't you? You've seen the differences.
28:37
Totally. But you've had, yeah, we've had
28:39
conversations, you know, whilst operating, just talking about,
28:44
you know, if they're clearly not what they used to be, if they're
28:49
not quite as sharp or as good as they were.
28:50
And you ask them, you know, what's going on.
28:52
And it's just that time of life. And then having a conversation
28:55
about HRT because they all know that I'm married to you.
28:58
Getting them to download your app and then maybe, you know,
29:03
talking to them again. And then for some of them, as
29:05
you know, you've had, you know, chats with them and it's been
29:08
well, transformation is the word, isn't it?
29:10
You know, they've gone back to being much more their normal
29:13
self again. But there is loads of scam
29:16
angering, you know, I would say to one of the nurses I think
29:19
should be an HRT. They're just worried about
29:21
breast cancer straight away. And it's absolute rubbish.
29:24
We know that that Million Women study was completely flawed and
29:29
there's been a fantastic, you know, dissection of it by that
29:32
professor. I wasn't Guiney from Washington
29:34
who came over. It's a great lecture and it's
29:37
disgusting how it just set Women's Health back.
29:39
Well, the Million Women study and the women's, the, the, the
29:43
WHI, the Women's Health Initiative study, both of them
29:45
terrible. But it's been amazing because
29:48
you've really helped these people.
29:49
And I, I like to think if I hadn't done that work, well, I,
29:53
I wouldn't like to think because you wouldn't have helped them.
29:55
But this is where like the conversations can't just be
29:59
about women who are suffering. It has to be people in work, men
30:03
as well as women, because you're very frank and outspoken and the
30:07
nurses know you for that. So actually for you to tell them
30:11
in a non judgmental way that you're changing.
30:13
Could it be your hormones? No, you just, you just need HRT.
30:16
Yeah, but they're grateful for you, aren't they?
30:18
Sometimes. Most of the time, yeah.
30:22
But who else is going to talk to them like that?
30:26
Yeah, good point. And I'm sure you can see people
30:29
are leaving, taking time off not.
30:32
Well, they're wanting often. The classic thing is they want
30:34
to reduce their hours. Yeah, but how can?
30:37
The it's difficult to reduce your hours because if a nurse
30:38
wants to shave 10 hours off a working week, you can't employ
30:41
someone for 10 hours to backfill.
30:44
So it's very difficult for them that either goes, you know, I've
30:47
had these chats with them. Yeah, so we need to keep going
30:51
and keep helping people. So three take home tips I always
30:57
ask for. I'm just keen to ask three
31:01
things that you think going forwards is going to make the
31:05
biggest difference to women. Actually knowing what I do and
31:07
knowing sometimes the battles that I have, blockages that I
31:11
have for the work that is detrimental to women.
31:14
What three things do you think is going to make the biggest
31:17
difference to Women's Health going forwards?
31:20
I think you've got to keep on putting out that message that
31:25
HRT does not 'cause breast cancer.
31:28
And actually in those studies, pure estrogen, proper estradiol
31:32
actually reduced your instance breast cancer because no one
31:34
knows that. So if people weren't so scared
31:37
of HRT, they'd take it, you know, more easily.
31:40
The other thing is that, you know, with dosing of HRT and
31:45
again, you know, I completely agree with you because I see
31:47
this in dosing of testosterone as well, that some people just
31:51
need more than the recommended guideline.
31:54
And it's just a bloody guideline.
31:56
It's not the law, it's not the rule.
31:59
You know, if people need more patches, then another, you know,
32:03
group decrees, you're not doing anything wrong, especially when
32:06
your back is up with blood levels.
32:08
So people shouldn't be afraid of having more than, you know, 100
32:11
micrograms. And finally, just to make people
32:14
think about hormones, not just in the context of psychiatric
32:18
illness, where I think it can be most disastrous if it's missed,
32:22
but just in terms of general health.
32:24
I'm always thinking it in terms of UTI, urinary tract infections
32:27
with gentle urinary syndrome of the menopause.
32:29
Now I think I'm even better because I see the older ladies
32:33
who've got fragility fractures, such as osteoporotic fractures,
32:36
and I'm thinking, oh, you're on HRT, why aren't you on HRT?
32:39
But I think if all doctors start to think could hormones play a
32:42
role in this person's illness, then that would be fantastic.
32:47
Wouldn't that be nice? Then I might retire.
32:52
Thank you very much for joining me today, Paula.
32:54
It's been a pleasure. Enjoyed it?
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