The number of heart patients is growing rapidly across the world and India is no exception to it. Modern lifestyle and stress have only made the phenomenon worse. That only points out to the need for leading a cautious life to prevent any heart diseases.
In an exclusive chat with Sharique N Siddiquie of Zeenews.com, India born, UK trained and now Boston settled renowned Cardiac Surgeon Dr. Mukesh Hariawala spoke on a wide range of topics including new innovations in heart surgery, experiences with treating celebrity patients, growing up in India and an interesting personal insight on life.
Following are the excerpts:
Sharique: What is the better option for a heart patient: Angioplasty, Stent or Bypass Surgery?
Dr. Hariawala: After the preliminary line of treatment with drugs does not give the patient complete relief of heart related symptoms, an Angiogram is performed to visualize the coronary tree of blood vessels that maintains circulation and oxygen rich nourishment to the heart. A consensus decision in the best interest of the patient is made by the team comprising a cardiologist and cardiac surgeon.
Typically, first offering is Angioplasty, which is often accompanied by placement of a drug-coated Stent. Bypass surgery nowadays is conserved for a later stage as atherosclerosis, which is development of plaque in the lumen of the heart coronary vessels, is a progressive disease.
There will always be the occasional case where Bypass Surgery takes precedence particularly in diffused multi vessel extensive disease accompanied by diabetes, heart valve dysfunction and other co-morbid factors.
Sharique: Why has Heart Transplantation not caught up in India and rest of the world?
Dr. Hariawala: Heart Transplantation is very dependent on the availability of donor hearts- it is taken mostly from vehicular accident patients who are brain dead and other rare instances where the heart is in a good condition even if rest of the body organs of the donor have failed.
Globally, the need for a donor heart far exceeds the supply, thus increasing the long waiting list of patients. Statistically, a large number of patients die before a heart is made available to them.
However, this problem of patients suffering from end stage heart disease, who are not amicable to routine treatment options, is not unique to India and is prevalent all over the world. Fortunately, soon the need for a Heart Transplant will be obviated with the arrival of a mechanical “Total Artificial Heart”, which has a long battery life and is consistently showing good clinical trial results in the US & Europe.
Once fully approved, this will fast gain acceptance and hopefully the implant will be offered at subsidized pricing for developing country patients.
Sharique: You have received international acclaim for pioneering work in the field of “Angiogenesis” and "Stem Cells" at Harvard University. Please help us understand this piece of science and will Indians benefit from it?
Dr. Hariawala: Angiogenesis is an exciting approach of treating the failing heart by injecting, during surgery, angiogenic growth factors in the heart to stimulate the birth of new cells that help grow blood vessels. This stimulation triggers a positive response from the heart forming at a slow pace good viable myocardial tissue which eventually rejuvenates the failing heart.
This concept has now progressed to "Stem Cell Therapy", which currently is being used in conjunction with Laser Surgery on the heart. It is anticipated that as more verifiable data is accumulated on the heart healing contribution by stem cells , it will be offered to most patients at a fraction of the cost of Bypass Surgery as the stem cells are extracted from the patients own bone marrow.
Most definitely, this fast evolving option will be of great benefit to the large volume of patients suffering from heart disease in India and rest of the world.
Sharique: Is it a myth or are there real medical therapeutic benefits to the heart for indulging in “Wining & Dining “.
Dr. Hariawala: The scientific community backed by the “American Heart Association” is gradually concluding that consuming one and a maximum of two glasses of Red Wine per day, during the course of dinner may be good for the heart. It contains vital compounds, such as flavonoids and resveratrol, which may help to limit atherosclerosis or hardening the inner lining of the heart coronary arteries.
Some studies have even demonstrated that moderate drinking of Red wine reduces the risk to heart disease by boosting the levels of the "Good HDL” cholesterol and may play a role in reducing blood clot formation as it increases vasodilation causing free flow of blood in micro vessels of the heart.
Epidemiologist believe this may be the secret, why the French population lives longer than other races because Red Wine is an integral part of their dietary supplement since early adulthood.
Sharique: Stress is now a well known factor in the acceleration of heart disease sometimes leading to fatal heart attacks. What is your recommendation to keep Stress under control?
Dr. Hariawala: It is quite normal for most people to have some minimal levels of ongoing stress based on individual life circumstances. There are variations in how different people respond differently and more likely the underlying personality trait of the person plays a dominant role.
Scientific data analysis confirms that, extreme stressful emotional responses like getting overly angry accompanied with or without violent actions can lead to acute plaque rupture followed by unusual stretch, dissection and tear of heart coronary blood vessels. This can lead to dangerous emergent situations and occasionally even death before reaching the hospital.
A good self disciplined approach is to practice "Meditation & Relaxation" which reduces the stress levels and maintains heart arteries in a relaxed and efficiently functional mode. However, it is very important to understand how to get the best therapeutic value from Meditation.
There are many good books written on this subject and reading a simple well scripted book like “Calm Sutra” authored by Dr. Dilip Nadkarni may help understand the optimum scientific approach to the art of relaxation.
Sharique: Do you think Indian government needs a change in strategy to bring back top doctors from the private sector to state run hospitals?
Dr. Hariawala: As a medical student at Nair Hospital, Mumbai in the late 1970s, my generation had the luxury of the best private sector doctors offering their teaching expertise as Honorary Surgeons to the hospital. Most of them routinely performed surgery on poor patients and trained with dedicated sincerity the next generation of surgeons.
Unfortunately, this Honorary System has been abolished and thus government hospitals are now deprived of the best doctors in the profession. who are busy in private hospitals which are accessed only by the affluent class of India’s population. There are sporadic situations where the Full Time government employed doctors are very good too.
A reconsideration and early reversal of Government of India policy may bring great relief particularly to the less fortunate poor patients who normally cannot afford private sector expensive doctors.
Sharique: You have many famous patients worldwide. Do you feel undue pressure when operating on celebrities like the Indian Prime Minister Dr Manmohan Singh?
Dr. Hariawala: I have always treated all patients as equals and it is only incidental that some of them happen to be celebrities which constitute less than 1 percent of patients with the rest being common people. It was in the early 1990s when I worked in the surgical team of famed heart surgeons Dr. John Wright & Dr. "Sir" Magdi Yacoub that we operated on Dr. Singh at the Harley Street Clinic in London where he underwent his first successful Bypass Surgery.
Dr. Singh was then at his World Bank posting in Geneva, Switzerland and then took up appointment as Principal Advisor to then Prime Minister Mr. P V Narasimha Rao.
I knew of Dr. Singh as an acclaimed economist, and must honestly admit that during surgery there was no undue pressure since we regularly operated on VIP patients. I do recollect his manner before and after surgery as a “Perfect Gentleman” and an "Ideal Dream Patient" for any doctor. I still retain a card that arrived in the mail few weeks later where Dr. Manmohan Singh wrote “Dr. Mukesh - Thanks for what you did for my Heart". I believe that my bosses had conveyed to him my surgical contribution in his case.
Sharique: Tell us about the humble episode following surgery on Indian music maestro R D Burman? Did it have any impact on you?
Dr. Hariawala: Following Bypass Surgery at the Princess Grace Hospital , “Panchamda” as R D Burman is affectionately called invited me over for dinner and gifted a box of his personal collection of music CDs, which was a new technology in the early 1990s . I returned it back embarrassingly confessing that I only owned a Cassette player.
Next day, he redelivered the same box of CDs to me accompanied with a new CD player. This gesture has had a significant impact on my fundamental belief in “Generosity“ and what it means to have a "Large Heart for Others" in this material world.
Sharique: It is generally believed that Indian patients now do not go out of the country for Bypass Surgery? What are your thoughts particularly on the prospect of Medical Tourism?
Dr. Hariawala: Indian doctors are universally respected all over the world and often described as one of the very best in the profession. Earlier, affluent Indian patients always thought it was safe and risk free going abroad for Bypass Surgery with the lingering fear of infection in India.
Those days are over, and most cardiac surgeons operating in India today using newest technologies produce excellent results which are on par and often better than the skills of surgeons in the western world.
More so, Medical Tourism is gaining momentum and now American, Canadian and European patients are attracted to India for treatment. This I believe is a big opportunity for the Indian Healthcare sector and if marketed aggressively, it could help the speedily growing potential of the Indian economy.
Sharique: Tell us something about your personal life and what made you choose the medical profession?
Dr. Hariawala: I am a caring person by nature, so there could not be a better choice than the medical profession. I am somewhat spiritual, firm believer in God and fearful of the Almighty. I always leave home with a prayer for every patient`s successful operation.
Sharique: Finally, what does Dr. Mukesh Hariawala do to take care of his own heart health?
Dr. Hariawala: Growing up in a middle class family in Mumbai, I used to be a sportsman without the need of a big club membership. I participated at a high competitive level in Table Tennis and Cricket, thus staying athletically fit.
Now at the age of 50, I have an extremely busy schedule, so many lifestyle changes have been made including waking up at 5 am followed by regular gymnasium with a focus on cardiovascular fitness exercises.
In addition, I recognize it is equally important to stay happy in life, which provides for emotional stability and I derive that by spending quality fun time with my parents and my precious worldwide friends from school, medical college, hospitals, neighborhood and those out of my native place Valsad.
For relaxation, I listen to all types of music, dance at parties, go for long romantic walks with my childhood girlfriend - wife Rekha and watch Bollywood movies with our kids Mitali and Sumit.