Transcription:
Heart Surgery and Valve Replacement

Carl Maronich (Host): We are joined by Dr. Arshad Yousuf. Dr. Yousuf, thanks for joining us today.

Dr. Arshad Yousuf, MD (Guest): Oh, thank you very much for inviting me. It’s an honor and privilege to be here and to be with you in this hospital.

Carl: Well, we appreciate all that. And I would like to start by asking some personal questions, not too personal but tell us a little bit about your family and where you – maybe first start with where you grew up.

Dr. Yousuf: Well I was born in Pakistan and had my medical education in Pakistan. I came to the US about 20 years ago and got trained in Jones’ Surgery first in New York and then went on to Cleveland Clinic where I had my training in cardiothoracic surgery. I have been in practice for about 15 years and currently I am a faculty at the University of Chicago and for the last one year, we have been coming to Riverside and we have a very good relationship with Riverside and we have been coming over and providing care to the patients in Kankakee area and it has been a pleasure. Enjoying taking care of the patients and working with the physicians in this area and the experiences have been wonderful.

Carl: Yeah, well I know Riverside is very glad to have you as are the patients in the area. You have done some great work in the time you have been here. But, family, do you have family?

Dr. Yousuf: Okay, yeah me and my wife live in Frankfort area and we have two kids. They go to college. My daughter has just been accepted to University of Indiana to do law and my son plans to go into medicine and so he still has some ways to go. He’s in college as well.

Carl: Now speaking about the decision to go into medicine; what prompted you to go into medicine?

Dr. Yousuf: Well, I’m from a very big family. I have three brothers and two sisters and to everybody’s surprise, everybody is a physician. So, my oldest brother is a pediatrician, then we have an ophthalmologist and a gastroenterologist, so my father is not a physician at all, but he never pushed me to be a surgeon. But I just had the feeling that there should be a surgeon in the family, so that led me to surgery residency and during my training, I had the chance to work with some of the top surgeons in the country and thought about going into cardiac surgery and it has been a wonderful experience ever since.

Carl: So, the family got a surgeon out of the deal. So, you have a lot of areas represented.

Dr. Yousuf: That’s true and my two sisters I have a sister and she is a radiologist and I have a sister she is a pulmonologist. So, we have got physicians in the whole family.

Carl: Well the family gatherings must be interesting conversation.

Dr. Yousuf: We try not to talk about medicine. Otherwise with difference of opinion we would get into a fight.

Carl: Ah, you wouldn’t want that. We are not going to fight today. I promise you that. But as a cardiothoracic surgeon, you – surgery you perform on the heart, but also the chest and other areas, so it’s not just heart surgeon. Talk a little bit about some of the variety of surgeries that you do as a cardiothoracic surgeon.

Dr. Yousuf: So, at Riverside, we provide cardiovascular and thoracic surgery. That means anything to do with heart. It could be a blocked artery, giving rise to a heart attack, and patients present to our hospital with chest pain and they usually are seen by a cardiologist who does an angiogram and then when the patient is referred to us we do what’s called a bypass operation. Some patients have a leaking valve in the heart and those present with shortness of breath. They have difficulty breathing and those need to be fixed. So, that requires valve repair or replacement and sometimes the arteries from the heart get swollen, we call it aneurysm and the normal size is about inch and a half it becomes two and a half inches, those arteries need to be fixed we call that aneurysm repair. So, those are all done at the Riverside Hospital. Then the thoracic part is to do with lungs. If somebody has been a smoker and unfortunately presents with a mass in the lung that turns out to be a cancer; then it needs to be dealt with surgery, that will require removing a part of the lung called a lobectomy. And sometimes we do – we treat people with pneumonia and we call that pus collected around the heart or the lungs called empyema, that needed to be treated and we are doing what we call as minimally invasive surgery without doing a thoracotomy. We can make keyhole incisions and put a little camera and clean out infection and the third part is vascular surgery and blood vessels supply blood to the brain and to the lower extremities and because of smoking or other reasons, if those get blocked some of the patients present with a stroke because the arteries to the brain have been clogged up, so those arteries need to be cleaned up. That will require surgery and sometimes the arteries in the lower leg gets clogged off so that needs bypass in the leg. The other part is we call it aneurysm and the arteries become dilated. It can dilate in the abdomen as well. And today, in partnership with cardiology Dr. Patel, we did what we call EVAR which is endoscopic repair of an aneurysm in which we put a stented graft through the groin and repaired an aneurysm in the abdomen which is the abnormal dilatation of an artery that supplies blood.

Carl: So, you work with the invasive cardiologist to

Dr. Yousuf: We have a heart team approach meaning we have cardiologist, cardiac surgeons, nurses, anesthesiologists. We always discuss cases and we do what’s best for the patient.

Carl: Sure, yeah. I am going to back up a little bit. You mentioned leaky valves and that is one in the heart. If a patient Is not feeling right, maybe you mentioned fatigue or some other things, generally oftentimes, they would go to their primary care doctor to get a diagnosis who might then send them to a cardiologist, is that normally kind of how the process would go?

Dr. Yousuf: This is what normally happens and sometimes it’s not easy and I remember a patient from Watseka and he presented with shortness of breath and they have a leaking valve and the blood backs up into the lungs. So, the lungs appear like they are full of blood. Sometimes they are diagnosed as pneumonia and this patient shows up to the emergency room, he was initially treated with antibiotics, but the doctor was smart enough to know that it’s out of his limit and sent the patient to Riverside, so he shows up at our emergency room. We did an echocardiogram which is ultrasound of the heart. We put a little camera close to the heart and we take pictures and we found one of the valves has ruptured and the blood was leaking back up into the lungs. So, what they initially thought it was pneumonia. It was not pneumonia it was pulmonary edema. Meaning the lungs were full of blood. So, we went in and fixed his valve and he did great and went home and he is doing great now.

Carl: Really, with all the things that you talked about, there’s quite a variety of procedures that you have the potential to do. And let’s talk a little bit about how the patients from the range of those procedures, what the patient might expect say in that valve surgery. And you have been in medicine a few years now, just in the time you have been – you have probably seen a difference in how you are performing these and the recovery time for the patient. The protocols for recovery, how much time they can expect to be laid up if you will. So, let’s talk about a valve surgery and what might a patient expect from that kind of procedure?

Dr. Yousuf: Well if a patient comes to my clinic, and presents with a valve which is either leaking or is not opening completely and I try to explain to them that heart has four chambers and they are connected through a double door and if the door doesn’t open, so the blood doesn’t flow through the heart, that needs to be fixed or sometimes if the door opens in both directions and that’s we call is a leaking valve. So, they come for surgery in the morning and they show up at 6 o’clock, 7:30 they go to the operating room. We start around 9, it takes about three to four hours, so by 1 o’clock, we are done with surgery, they go to the intensive care unit, they are still sleepy. We wait three to four hours when they are fully awake, the breathing tube comes out. The next morning, they are in the chair starting to walk. The following day they are out of ICU and the tubes come out and in three to four days, they are ready to go home. Depending on the home circumstances, if they live by themselves, not much support at home; then we suggest they go to a small rehab which is available at our hospital until they are strong enough to go home. Some patients want to go home and go back to their beds. So, we try to arrange visiting nurse service to go visit them a couple of times a week. So, it really takes about four days in the hospital plus the recovery period is about four weeks. Even when they go home, sometimes they feel weak and tired. So, it takes about four weeks before they get back to normal. The only precautions I tell them is not to drive. If they get into an accident, and the front of the chest hits the steering wheel that’s not good or lift anything heavy. Other than that, they can do anything. Some of them bounce back so well that in two weeks the want to get back to work and get back to their life. And so, but normally, it takes about four weeks.

Carl: But the prognosis after those four weeks for most patients is really a normal life again.

Dr. Yousuf: Oh yeah. I mean I tell you this story about another patient over this weekend. Not at Riverside or Watseka, at another hospital, had the same leaking valve and if treatment is not provided to the patient, they can expire. And this unfortunate patient was in a different hospital, I was called over the weekend and then I got another call within ten to fifteen minutes, the patient passed away. So, this is serious disease a leaking valve. And this needs to be treated aggressively and the only unfortunate treatment is surgical.

Carl: So, let’s talk again about the symptoms. What should people look for is their health might change a little bit that could maybe alert them to look into this?

Dr. Yousuf: The valve can either get stenotic, meaning the door doesn’t open completely or it can leak. It can happen over a period of time. It can happen and so they notice progressively they are getting more tired or they are getting more short of breath. Or it can happen suddenly. Suddenly they just can’t breathe. So, if it happens suddenly, that’s life threatening. So, they should go to emergency room right away. And then in the emergency room, should assess the patient and see if they have the capacity to take care of such a patient. If not, they should be flown to a center like our hospital. If it happens over a period of time, then they have more time. They can go to their primary care physician, from there should be referred to a cardiologist or at least get an echocardiogram which is doing an ultrasound of the heart to see how the heart function is and valve function is and just take it from there.

Carl: Sure. That always makes me think of the importance of getting regular checkups. So, if there is a change in your condition or a change in some of these things from year to year, your primary care doctor is going to see that, notice that and it could alert you to some of these things. Is that good advice?

Dr. Yousuf: That’s very good advice. Plus, in this area, I have noticed some patients that put off going to a doctor. And that’s common which is unfortunate because if they are not feeling well, they are being tired for a while, short of breath, they shouldn’t put off going to a doctor. I think it’s time and almost all primary care physicians in this area are very good so if they go I’m sure they get the proper care. But they should not put off going to a doctor. That’s very important particularly in this day and age when we have all this care and treatments available, just next door and not to use it, it is kind of unfortunate.

Carl: Yeah. That makes me think of a couple cases I know of that you have been involved in since the time you have been here at Riverside a couple of patients that and I thought well I’m going to say the procedure right, the descending aorta that a very emergent situation that fortunately you were here, able to take care and treat a couple of these patients who really wouldn’t have survived otherwise. And I know after that, you spoke to the idea of you being in the community, having these services available here where in some cases, if they are not available that locally, it could mean the difference between life and death. It’s got to be very rewarding for you to be in that kind of position.

Dr. Yousuf: And it’s kind of good that you talked about it because I did meet with a couple of folks from the University of Chicago today and they were looking at what we have been doing here and they were kind of surprised because in the past, those patients were flown to the University of Chicago and you know I remember at least two such patients one was a dear friend of – he has become a friend now, he shows up in the emergency room with the aorta which is the big artery from the heart takes blood to the whole body. That ruptured. And luckily the rupture was very contained. If it would have ruptured, he would have died and not made it to the emergency room. And he looked like a very normal, healthy nice family, and we were able to do an echocardiogram which is again, the ultrasound of the heart and a CT scan of the chest. We found that rupture, we took him to the operating room right away. He had a great repair and he did fantastic. He continues to do well. That’s one patient. Another one was an older lady who had an aneurysm which is a slowly the artery had become bigger and shows up with one of the aortic valves on which the artery sits had become tight, it’s called stenotic, didn’t open completely. So, she needed that valve replaced and also the ascending aorta repaired. Big operation in an older lady. She did very well. We operated here, and she is doing great. So, you know these are a couple of cases which were very challenging but I’m so happy we have at Riverside, we have the facility, the not just physicians but nursing wise, anesthesiologists, support from the administration, and the people in the operating room, the equipment and everything. And the other thing I noticed that a lot of patients, they don’t want to drive north. And they are happy that all this is available here you know cutting edge, top notch services and I’m happy for them and I’m happy that we are able to do this at this institution.

Carl: Sure, well it makes a difference I’m sure for the patient if their family is able to be close and come and see them it has to help their recovery and just help the whole process for them.

Dr. Yousuf: Sure, sure. It’s very. They are very thankful at the end and I see them all the time. The come in for rehab which is after heart surgery, they go through a process of exercise and training again and I see them everyday and it’s nice to see them doing well. People who were brought here in ambulances on a stretcher now walking like normal people. They have lost weight. They are in great shape. It is good to see that. And they are so grateful and so thankful.

Carl: And I hope when you get together for family reunions you tell all your brothers and sisters about those great stories.

Dr. Yousuf: Well, we try not to talk about medicine. Because they all come from different specialties. But we do talk once in a while.

Carl: Well those are rewarding stories to tell, and they can’t argue with that kind of

Dr. Yousuf: That’s true and we have had a couple of videos of patient testimonies and I did send to my brothers and sisters and they were very proud.

Carl: Very good. Dr. Yousuf, we appreciate your time today. The time has gone quickly. But we appreciate you joining us and sharing all this with the folks who are listening to the podcast.

Dr. Yousuf: Oh, thank you very much. Thank you for your time. Enjoyed it.