“Metabolomics is going to be a revolution”

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Paula Villares (León, 1976) is from an Asturian family, although she was born in León due to a displacement of her father. Her destiny undoubtedly decides some parts of her biography, but not others: in her family they say that “When I was two years old I wanted to be a doctor”.

Villares describes her first encounters with medicine, “when I signed up for camps to be the one to put on the Band-Aids: many years ago I was already a human medicine cabinet. And she was also a volunteer before university… It is totally a vocational thing!”.

Where does such an early vocation come from? “Not for having experienced any illness of a relative. I had a very happy childhood, a united family and no medical relatives, but it always seemed to me that it was a profession that helped you take care of the other”.

Dr. Paula Villares.

Dr. Paula Villares.

The head of internal medicine at HM Sanchinarro for five years –after more than fifteen years of singular relevance in this university hospital group– she has been a tireless worker, and one of the great experts in our country in internal medicine, “a specialty that, if it cannot cure, can always take care of ”.

What is internal medicine? “Well, from the beginning it must be made clear that an internist is not a family doctor. Internal medicine encompasses the comprehensive study of the human body and the relationship of all systems. It is a global specialty, which encompasses the human being as a whole and is a diagnostic and therapeutic entity”.

For her, a thoughtful and profound woman, “Suffering equalizes rich and poor, you do not have to differentiate in the treatment, all your patients are your recommended ones, as I say. Without a doubt, what most disrupts the human being is going through an illness that prevents you from carrying out your normal life: as an internist you can always contribute something”.

“We are getting sick many times due to pathologies related to what we eat”

In his years as a student at the Autonomous University, he remembers “a very demanding environment, so I would say that it was the first blow to enhance my humility, and take away uncontrolled aspirations. I was shocked to learn about the children’s oncology at the Niño Jesús Hospital and the suffering in childhood, I did not count on that. I soon had to understand what resources might exist with a child or young adult to deal with death”.

Villares mentions three key names in his formative years, “Dr. Luis Madero, Dr. Carmen Suárez, when I was a student, and Martínez López de Letona, teacher of many. All had the ability to address the human being in its entirety, with all the systems involved. It was a time when very complete clinical histories were made and put in a folder”.

internal medicine

What are the most common pathologies in your specialty?

Cardiovascular, infectious, thromboembolic, cancer and then the whole group of chronic diseases.

Could one speak of a common key for internal medicine?

A good internist has to be someone with a lot of medical history skills. Patience to listen and be able to integrate symptoms and signs to arrive at the diagnosis of a pathology, because humans are an integrating and relational entity, also preventive. You have to relate symptoms and signs with pathologies. Be a lifelong scholar with a very broad academic background. And follow up, of course, on the patient.

How has the Covid era changed this specialty?

Covid has been a paradigm, I hope it will bring us good things such as being more aware of approaching everything from a more global perspective of health, care and relationship with others.

Any recent progress?

Various. Robotic surgery, the technology applied to medicine, is incredible. The way of approaching surgery is changing because of it. Also the world around the macrobiota and microbiota and metabolomics, is a change that is going to revolutionize medicine, and many pathologies will be treated with changes in diet, this is anti-inflammatory nutrition. We continue to fight against cancer… And the approach of molecular medicine, early diagnosis based on genetic study.

The diet

That is to say, that internists return to the importance of food…

We are getting sick many times due to pathologies related to what we eat. We need natural fresh foods, not proteins that are not healthy, but those with a high nutritional value. Do not get carried away by any product that is advertised. And it is important to eat in a more orderly way, with rich and quality food.

“To die well you have to live well, a good ending has a lot to do with the way the person has lived”

Are you referring to the Mediterranean diet?

To avoid saturated fats and to have a fresh and healthy diet, more similar to that of a lifetime. For children, for school, we can give them yogurt, nuts and fruit, avoid what those packed bags carry, and it’s not so complicated to do it better again…

What role does the anti-inflammatory diet have?

In patients who develop pathologies such as cancer, rheumatism… the analysis can be perfectly normal, but the process that triggers it can be very useful to balance the probiotic. We now have an internal project that will confirm that favoring the probiotic mechanism in patients helps with certain diseases and prevent pathologies.

Are supplements advisable?

We are not talking about supplements but about what to eat and even more, what we should eat. A patient quality of life questionnaire is necessary. Anti-inflammatory nutrition and probiotics are not only in the form of capsules, but through the raw material, foods you eat such as vegetables and fruits, some meat and fish are also healthy. Maybe we are taking supplements… and with a yogurt of kefir and chia it would serve us well.

Are there the superfoods?

We began to discover that there are foods with special properties such as ginger or turmeric. During the pandemic, Asian and Latin American culture has taught us a lot. In these two areas, a lot of natural products are consumed. In general, not everything is valid nor does everyone feel the same, that is clear. In the pandemic there were people who misread the webs and drank bleach and died from disinformation. By taking too much seaweed you can have thyroid problems. The information on the websites can be dangerous, you have to have knowledge of food, but really, and of each specific case.

Anti-inflammatory food pyramid.

Anti-inflammatory food pyramid.

The diagnosis

How can a wrong diagnosis be given?

When you are younger as a doctor, perhaps you are more blunt with diagnoses. A diagnosis can be devastating news, you have to know what the patient is like, you should never start talking about the prognosis, if you don’t ask, for example.

What would you say is the key to dying well?

To die well you have to live well, a good ending has a lot to do with the way the person has lived. And I’m not talking about not having suffered. There are people who have experienced a lot of suffering and yet have been happy and have been able to understand that life is transitory and that one day it will end. Then there is the need to deal with the subject of death, to face it with time: that end is the only thing that we have for sure and it is the subject that is least talked about.

Have you integrated that theme into your life?

I talk to my children about death since they were born. I think it is better to do it. These are conversations we avoid and must have.

Do you think beliefs influence this?

Heaven is not improvised. It’s not stardust or eternity that falls when you’re in the front row. You live to earn everything. And we’re going fast. My grandmother used to say that ‘even those who want to go to heaven don’t want to die’. There is always that fear of not knowing. But death is very different according to people, according to their beliefs and their preparation for that moment.

“When it cannot be cured, it can be taken care of. But we have to make an effort to recover the pure sense of joy”

Would you say that there are more people who do not want to die or who do when their time comes?

For those who are approached by death at an early age, the suffering for them and their families is greater. But it depends a lot, there is a very large population that perfectly accepts his death.

What are the most common questions heard at the end of life?

How much time do I have left to live? How will my end be? Is it going to hurt? What is my probability of dying? And there are also many people who do not ask any questions. Or who asks something very everyday like what is there to eat. Many times where the head turns is to questions of this type.

Does not having pending issues also influence?

Yes, it is important to locate what things worry them, what they had pending, especially what can be fixed. “I can die,” Victoria Prego told me one day with incredible clarity, “because I am not indebted to life.”

Have you had a bad moment in your profession?

When I started to get frustrated that I couldn’t heal a lot of things. I work long hours and I don’t cure many people. At least I can try to help them and accompany them. That said, when it cannot be cured, it can be taken care of. But we have to strive to recover the pure sense of joy. Life is a precious commodity, being alive, despite illness and suffering, is a true privilege.

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