Transcription:
Taking Care of Your Heart

Melanie Cole (Host): According to the American Heart Association you've never too young or too old to take care of your heart. Preventing heart disease and all cardiovascular disease this means making smart choices now that will pay off for the rest of your life. My guest today is Dr. Ralph Nimcham. He's a cardiologist and the medical director of Doctors Hospital Cardiac Rehab program. Welcome to the show, Dr. Nimcham. Tell us about heart disease and what you tell people as the best advice and the first most important thing you say to them every day about taking care of their heart.

Dr. Ralph Nimcham (Guest): I'm a cardiologist and therefore I focus on the heart almost exclusively. What I do, is I see patients ranging from younger individuals in their twenties to people in their eighties and nineties. And perhaps the most important thing that I have to say to them is that so much of heart disease is preventable and so much of what you can prevent depends on your lifestyle choices. We currently have an epidemic of obesity that's plaguing our country, in some states more than others. And where we live here in Texas is particularly high. We almost see every second or third patient in my office comes in with medical conditions that are associated or secondary to their obesity. I see a lot of patients with diabetes, hypertension, hyperlipidemia; let me simplify that… patients who have problems controlling their sugar intake, fat intake in their meals and their salt intake. All three things are dietary problems that one can easily take charge of for him or herself.

Melanie: So no matter what their age, because we may go through these ages just a bit. But what do you want people to know about choosing a healthy eating plan and being physically active, no matter what their age?

Dr. Nimcham: Well, in the first place a lot of this stuff begins in childhood. I believe one of the local pediatricians is an authority on childhood obesity and has written and talked about the success. Because we do have a problem with childhood obesity. And that's the basis, the development of all these other illnesses -- diabetes, high blood pressure, high cholesterol -- that are risk factors for heart disease. So if we start early in life, and focus on our children and ourselves of course as adults, but focus mainly on our children and help our kids with initiating and respecting and continuing with good healthy lifestyle choices. Particularly the things that we give our children. The fast food industry unfortunately is a real problem for our children because a lot of parents tell me that they pick up their kids at school and take them to a fast food restaurant because it's a lot easier for them to take care of the children that way. They go home and then they get to their homework etcetera, but `instead of allowing them to make wise choices, the parents themselves making the choices for the children. And when my kids were younger 8, 9, 10 years old we made a choice that they would have low-fat milk, 1% and 2%. Initially we had some opposition from the children but they accepted it, that's all they had in the refrigerator. And we gave them crackers but they were not salty crackers, they were not crackers that had salt in them. We talked to them about choices in meats and what good proteins choosing chicken or turkey instead of other meats that have high concentrations of fats.

Melanie: So it really is up to the parents to not only be good role models but have this discussion with their children about ways to eat healthy and stay physically active. As a whole family now, what about when they turn 20 and 30 and sometimes people of that age group feel a little bit immortal, so they don't see that healthy eating and physical activity are such a necessity as you do once you hit fifties and sixties, what do you tell people in their twenties and thirties about the importance of keeping a healthy heart?

Dr. Nimchami: Well, these are college graduates for the most part coming to see you; and some of them come in because their blood pressure is borderline, elevated or they got a blood sugar reading from a lab test that says that their blood sugar is borderline, or it's a little bit elevated or that their weight BMI is in the obese range and they need to be reminded that they need to look at that. Because the obesity problem is associated with and is caused by a lot of unwise choices in their meals and because of that they gain weight. A lot of kids that are in college and all their lifestyles are a little bit less choosy and so they eat and drink things that ought not to do and studying up late at night, stuff like this. 

Melanie: It certainly is! And as they enter into their fifties and sixties do you want them to know the warning signs of heart attack and stroke? Is that when we start to think about those things? And what about Dr. Nimcham, aspirin regimen, are you still as cardiologists recommending that people take an aspirin a day to help this?

Dr. Nimcham: Absolutely. Particularly if you're overweight, particularly if you have a family history of diabetes or if you have a tendency towards developing diabetes, if your blood sugar fluctuates a little bit and we check your hemoglobin A1c and the blood studies and these are borderline or slightly elevated we try to get to you right away. Talking about heart disease in the younger individuals, I've even had patients as young as 25 and 26 years old who've had heart attacks and one of them was related to tobacco use which is a major risk factor and course something that you can deal with. You can certainly choose not to smoke, but to be addicted to cigarette smoking and not being able to control it is a bad risk factor. You have the risk of cancer, heart disease, cancer anywhere in the body, heart disease is really the worst manifestation of heart disease when one smokes as a single risk factor that is even more important than the diabetes, controlling diabetes, controlling your diet, controlling your weight and having regular exercise. As children we don't have a choice because if you're in school you've got the recreation periods, when you have to go out and do physical activity. So the majority of children get some form of exercise, but do they continue this at home? We as parents and as adults take the kids before 6 o'clock, 7 o'clock in the evening it's quiet, it's not as hot and it's easier to get everybody together to go for a walk in the park. And the more time we spend or doing this with their children is very important that we the parents set the example for our children. These are examples that they would follow hopefully through life and it's very important that they keep these practices, these healthy practices.

Melanie: So wrap it up for us in the last few minutes in what you want people to do to protect their heart through any age.

Dr. Nimcham: There are several things and this is lifestyle prevention and you can get information on this from your local physician, pharmacies sometimes, from other health entities, at clinics. You need to have the approach of prevention and the approach of personal responsibility for your lifestyle choices and once you've made these good choices; you ought to be able to stick with these choices throughout life, because if you stop most times when you backslide as it were it becomes worse to control these risk factors and to control these habits and it is more difficult to do so. So getting into an established healthy lifestyle with regards to your diet, physical activity, exercise, and watching your weight, controlling your weight. These are very important things. And not only things for ourselves as adults, but things that we can explain and exemplify to our kids and our grand kids. It is very difficult to explain to an individual who is in his seventies, that he now must make secondary choices. He had ability to make primary choices on his own and stick with this throughout life. but because they did not make these choices now see have to go to the individual at age 70 who has had a heart attack and try to rehabilitate him again utilizing these main principles. We try to get them into, if you've had a heart attack or you've had bypass surgery or you've had a procedure like stent placement done to treat coronary artery disease, which incidentally is one of the major killers in the country, coronary artery disease and fortunately for some organizations like the American Heart Association that has made in rows into the community with their programs. Educational programs are encouraging people to modify their lifestyles and seek treatment earlier, listen to their physician's recommendations. These are things that we can do by ourselves. It's very difficult when you've had an established problem with your lifestyle and cigarette smoking or eating excessively and not counting your calories, or not exercising or very sedentary. It's very easy to stay with those habits and once they become established in your life, then there are risks for you developing all these other complicated medical illnesses that become real problems for you like diabetes and high blood pressure. Each one of these things are associated with heart attacks and each one of them contributes in a major way to heart attacks.

Melanie: So, the secret is really, starting very early and learning these healthy habits and continuing them through life and Dr. Nimcham, why should they come to Doctors' Hospital of Laredo for their care?

Dr. Nimcham: Let's start at the very beginning. We have a very active heart program at Doctors hospital, in which the emphasis is education, making sure our patients are educated. When they come in here for their treatment for their heart problem it's an all-out effort in order to educate our patients and have them make major lifestyle changes. Cardiac rehabilitation for instance in which I'm deeply involved will look at the patients who have established heart disease but who has had difficulty in maintaining their weight or maintaining an exercise program or even initiating an exercise program. Because these individuals for the most part are often very scared after they are told that they have a heart condition. And so it's very important for us to let them know they can get into a program at the hospital and can provide very important information and treatment for their medical problems and particularly the heart problems. There are so many patients who've had a heart attack or who've had heart surgery or heart procedure that unfortunately is still confused as to what changes they ought to make and getting into a program like a cardiac rehabilitation program for instance its different approaches, but all are aimed at making the patient responsible for their health care in helping the patient make wise choices. Once you get started in the exercise program so many people don't know how much exercise to do, where to go for exercise and whether to do it on their own without the monitor. And it's so important that if you're in a program that's being monitored, you know your heart rate is being monitored, your heart rhythm is being monitored, you have the nurse checking your blood pressures after each stage of your exercise rehabilitation program. We make sure that we give reports to the family doctors so that they know what your status is, whether you're improving. We have a graduation program where we take each patient who is on the program and say look you've made great advances, you've done a lot, you've lost weight, you've been on an exercise program, you're taking your medications as advised and now it's in your hands whether you want to have another heart attack or whether you want to prevent another heart attack or whether you want to improve the overall quality of your heart care. So it's important that people are aware of this. Let me summarize it, so much of heart disease is preventable so much of it is dependent on a person's personal decisions and personal responsibility. So much can be prevented as well as treated when you have the right approach, the right attitude, to making wise choices and protecting your heart.

Melanie: Thank you so much Dr. Nimcham for being with us today. You're listening to Doctors Hospital Health News with Doctors Hospital of Laredo. For more information you can go to www.ichoosedoctorshospital.com. That's www.ichoosedoctorshospital.com. Physicians or independent practitioners who are not employees or agents of Doctors Hospital of Laredo the hospital shall not be liable for actions or treatments provided by physicians. Doctors Hospital of Laredo is directly or indirectly owned by a partnership that includes physician owners, including certain members of hospital medical staff. This is Melanie Cole, thanks so much for listening.