Start low, go slow

We had an excellent tutorial from a cardiologist yesterday.  It was mostly about the various drugs that are used to treat people with heart failure.  One group of drugs, beta-blockers, work very well despite their effect seemingly being contrary to what you think you should be aiming for.  In heart failure, the heart is weak and is really struggling to get blood to where it is needed in the body.  Beta-blockers work by slowing the heart down and making it pump more weakly.  This sounds dumb, but it is good for the patient as their heart is less likely to damage itself by trying too hard.  Problem is, when you first start giving beta-blockers to these patients, it makes them feel terrible.  So the advice is to start them on very small doses and increase the dose very slowly.  The way to remember this is, "Start low, go slow".

I think that this is sound advice for many areas of medicine, and is one that I'll be offering for many common presentations.

An elderly woman presents with dizziness and fainting when getting out of bed in the morning?  "Start low, go slow".

A traveller newly returned from an overseas holiday presents with chronic diarrhoea?  "Start low, go slow".

A couple presents with difficulty conceiving?  "Start low, go slow".

It seems to work for every situation!