Heart health with Dr. Jignesh Shah

Allan: 01:00 Dr. Shah, welcome to 40+ Fitness.

Dr. Shah: 01:04 Thank you. Thank you for having me on the show.

Allan: 01:06 Now I really enjoyed reading your book, the book we're going to talk about today, Heart Health: a Guide to the Tests and Treatments You Really Need. Part of the reason is, you know, being in my fifties, this is kind of the time when a lot of the conditions that have us thinking about our heart start popping up, you know, heart attacks, and all the other things that can go wrong with your heart, stokes and things like that. We're reaching that age where we're seeing it happened to our friends and family that were right around this age. And in some cases people lost their parents around this age. So we start to think about, well, how healthy am I? You know, you would just think, well, I'll just go in and get these tests done every once in a while and then I'll know I'm good. But that isn't always the case.

Dr. Shah: 01:53 Absolutely. And that is one of the key points of the book that just because we get a test done and the test says you're fine, doesn't necessarily mean that nothing will go wrong. We have progressed quite a lot in that understanding of heart diseases. However, there are things that we can predict and things that we cannot and even after a normal test, people can have problems. And on the other side I would say just because you have a normal test doesn't mean that you are looking at an impending doom and gloom. You have a lot more control, you have lots more time and you've got to use it effectively to gather all the information before reacting to it.

Allan: 02:49 Yeah. I think that's really kind of where that when you start talking about heart disease and particularly when it's happening in the moment, it is really hard to kind of take that step back and think about it objective. Because everybody just knows when the last beat of your heart is the last beat maybe. And so people tend to want to fix it now versus taking that step back and thinking about it. And that's what's really cool about the book. As you had stories in there of individuals that were, we're going through different things and then different protocols were promoted and they either did it or they didn't. But some of them were rushed into decisions and some, you know, had the wherewithal to get the second opinion. So if I go into the doctor and the doctor tells me there's some problems and they want to do a procedure, it could be, you know, putting in a stent or do even a bypass, we should get a second opinion. Right.

Dr. Shah: 03:45 So you started off really good you said you go into a doctor's office and that is a critical thing to remember. You went walking into the doctor's office, that's a different scenario and he pointed out to be a good place that you have enough time to get a second opinion. Now if you went into the emergency with chest pain and the EKG show or showed that you have, you're having an active heart attack, that is not a time for us. So that's the book tries to give you the new one's version of it, but you're absolutely right. You go to the doctor's office, tell them, you know, I've been having chest pain when I walk but I'm under a lot of stress and the doctor says, let's go ahead and do a stress test it's a noninvasive test. They're not going to poke inside your body. They're not going to put gas.

Dr. Shah: 04:49 Very good test to start. However, even in this situation, we're trying to get a second opinion and slow down the crane. In some cases, you know, I have known 40-year-olds who have been running five, seven miles a day, no problems at all, and then they started a different exercise and now they're having chesting pain the rest to a stress test and that patient the same stress test may not be necessary. However, somebody who does not exercise that much and starts exercising and starts noticing chest pain with exercise stress test may be necessary so in either case you have enough time to get a second opinion.

Allan: 05:38 Yeah. One of the things I think that was was really important as I started going through the book and you stress this time and time again is if, if a procedure is recommended, you really want, you want one or two things to happen as a result of that procedure. You either want to know that because of this procedure I'm going to live or and or that I'm going to have a better quality of life. Can you talk a little bit about that?

Dr. Shah: 06:03 Yes. Thank you for giving me these two very critical things. As a doctor, there are only two things that we can do for you. We can either prolong your life or make the quality of life of your life better. So no matter how bad the pictures are how fabulous the technology is. As a patient, you really have to know does it need one of these two end goods live longer or live better? Then so if you went into the doctor for what I would call a well baby checkup, annual physical or a wellness check, meaning thereby you do not have any symptoms, any tests that is being recommended you really have to ask, is this going to make me live longer? Because remember, if you do not have symptoms so the patient can, the physician cannot make the quality of your life better, but if we can improve the quantity of your life, meaning that they are longevity, then you don't want to undergo that test.

Dr. Shah: 07:18 That test is not going to make a difference. You really have to question, no matter how fabulous the technology is, how convincing the logic is. If you do this, then this happens, then this happens and this happened. All of that becomes more and more farfetched at the bottom of the day. You want to know does this make me live longer and if you are having symptoms, will this take away my symptoms? Is it likely, particularly my symptoms and only then you want to undergo that and you know, I would say even with that, you do want to ask the physician is there a simpler way to accomplish the same thing and you would be surprised how often a more simpler approach can sometimes accomplish exactly the same thing. We know from studies of the studies now that in majority of the cases, medications accomplish exactly the same as a bypass surgery with medication. You know, so you always will, ask the physician, is there a simpler way to accomplish the same group?

Allan: 08:28 Right. So, you know, being older, you know, I do go in for wellness checks and if my doctor had recommended to me, Hey, you know, you're over 50 now, let's, let's do a stress test. And no, I haven't had any symptoms. I haven't had any problems. I only had one incident where I thought I had a problem, but it turned out to be basically my sodium got too low and I went into the emergency room with chest pains. And that was really because I had had an episode of a seizure. And then during that seizure kind of strained my chest. And so to me it was, you know, I was feeling really bad because my sodium was low and as soon as I went in and you say the word chest pains, it leads to a whole, a whole set of protocols.

Allan: 09:11 You're taken straight to the back. You're given a nitroglycerin and they're putting you on a drip there. They're checking your heart rate. They've got you on a machine like that. And so it turned out it was just, it was dehydration and low sodium combined was what mine was. Now had they told me after that you probably should go do a stress test. I wouldn't have known any different. I would just said, okay, well my doctor said I need to do a stress test. So I think it's important to know that, you know, do you have symptoms that are okay? There are some of the heart attack symptoms, but if I have to agree, okay. The doctor says, okay, you should go get a stress test. And I agree. Tell me about what, what does a stress test entail? You know, what does it like and what's it going to tell us in the end?

Dr. Shah: 09:52 Right. So a stress test is performed to increase the activity of the heart, so as to increase the oxygen requirement of the heart itself. And under that stressful situation, if the heart muscles which are now requiring increased oxygenation do not hold up, then it indicates to us that there are some blockages to the blood flow. To the heart itself and the way to accomplish that is ideally to walk the patient on the treadmill, well connected to the EKG machine and look at how the EKG or ECG changes take place. And if there are some changes then that is concerning. However, if the patient is able to walk 10, 11 minutes and has no chest pain whatsoever, the EKG does not show any abnormality. Then they know that their heart is able to work under this stressful situation. Beach indirectly tells us that there are no blockages.

Dr. Shah: 11:05 So the idea of stress test is where you would maybe walk on the treadmill with EKG connected to you and somebody's observing the EKG or blood pressure and your heart rate. Sometimes there are additional testing added on to it where you get injected with radio active dye which is injected when you are at the peak of your exercise and then you're put under a camera where the emission from the radioactive dye is picked up and it hurts us. Understand if there are parts of the heart that are not receiving blood supply. Once again, that indirectly tells us that may be blockages in the heart artery. That's the typical stress that is performed and it is performed to figure out if there is a chance that you have blockages in the heart artery.

Allan: 12:02 A lot of times if someone's had an issue in the past or a doctor just feels uncomfortable and you're going to go in for a surgery for something entirely unrelated, they may make you required once you to do a stress test. Should you try to get a second opinion, should you try to talk them out of it if you've had no symptoms or is this something that maybe you just want to go ahead and do?

Dr. Shah: 12:21 No, I think I'm American college of cardiology and American heart association is very clear about the fact that in rare high-risk surgery you need a cardiac clearance and a stress test prior to that. Outside of those rare surgeries for 90 to 95% of surgeries, you do not need a stress test, to undergo orthopedic surgery or a back surgery or what have you. And so for majority of the cases you do not need a stress test. And I would strongly urge you to get a second opinion before you undergo that stress test because the chances of that stress test veering you away from what you really require, which is that surgery, it will just point to a different direction. And as you've read in the book, it will lead you down a path that you will not want to go. And that is why American college of cardiology is very clear about the fact that majority, I mean the overwhelming majority, 90 to 95% of surgeries do not require a stress test prior to undergoing the surgery.

Allan: 13:37 Yeah. You had a story in the book where a woman had torn a ligament in her knee and as a result, she wasn't able to be active like she wanted to be. And obviously if you're not active, you a trophy and, and so she couldn't, she couldn't walk with her friends. So she was missing the social aspects and the fitness aspects of it because she failed a stress test.

Allan: 13:58 Then they were like, okay, well, you know, I think she went on for other procedures and, but she had to wait a year before she could come get that surgery. That's, you know, a year of, of inactivity. Scary. And so that was definitely not going to extend her life or improve the quality of her life. It was really of cause the exact opposite.

Dr. Shah: 14:17 Exactly. I mean, she been for a stress test that was not acquired then she had, she was asked to undergo this cardiac catheterization and she had complications from that. And from that point forward it just went into this cascade of negative events where she was not able to get surgery that she required for almost a year and had she not gone through stress test like it is recommended by the American college of cardiology. She would have gotten the ligament surgery and went on to be active back again, which would have done more good than all this additional testing.

Allan: 15:01 Yeah, so if I go through as far as stress test and the doctor finds something abnormal and they say, okay, we need to do this next procedure. As the cardiac catheterization you spoke about, can you talk about what that is and how they do it and what we can find out from it?

Dr. Shah: 15:15 Yes. A catherization test is an invasive procedure, meaning that the doctor is going to get inside the body, they will number the area around the groin where one of the major artery is, sometimes they can use the major artery in the arm. And once they get access into the artery, they put a catheter, a small, tiny long plastic tube that goes into the heart artery and they inject dye into it by taking pictures of the flow of the dye under the camera. And by getting several pictures we understand where the blockages in the heart arteries, based on where the blockages are we can further prescribe the right type of medicine or discuss the possibility of stints or discuss the possibility by-pass surgery, depending on the pump or not the blockages it tells us a lot about the blockages in the heart.

Allan: 16:25 And again, it's one of the things I really like about your book is after you've had that, you know, that initial test or you know, then the second follow up the catheterization test, your book goes on to say, okay, here are some of the options that you might be presented. There's medication, sometimes there's bypass with medication and it gives you the questions to ask your doctor. So as you're facing these things, I think your book's an awesome resource for someone because it answers a lot of questions very, very easily. And then you can ask your doctor the right questions, you can get your second opinions and you can make sure you're doing the right thing to increase your longevity and quality of life.

Dr. Shah: 17:02 Absolutely. And thank you for bringing that up because on the web, what I notice is that there are a lot of generic questions which may or may not apply to your specific situation. So I have wanted to equip my readers with very specific questions for that particular procedure, which is pertinent so that the patient in the position exists, that willing to be an active process. You are willing to be part of the healthcare team and not just a passive sit here.

Allan: 17:36 And let's hope, again that's your physician is a, is a main role to you having that and being a part of that team. Cause if that physician is not you, you might need to find that another physician.

Dr. Shah: 17:47 Absolutely. I agree with you completely.

Allan: 17:49 Now you, you, you kind of mentioned Dr. Google, you know, people love to go on dr Google and self-diagnose. We also love, love, love to wear these tools to measure everything. You know, so the Apple watch and some of the other things that are out there, you can know how well you sleep. You can know how many steps you take in a day. You can know your heart rate every single day, including, now I guess Apple watch does an EKG for you. If someone has one of these watches on and they start noticing and an abnormal rhythm or you know, something going on and their watch is kind of, is that something they just definitely need to walk into the doctor and start having some conversations or is it something that they should just sorta say, okay, I get it. I don't have any other symptoms but the watch is telling me there's something amiss.

Dr. Shah: 18:38 Yes. So there are a few aspects to it. I will mention. So if you are having symptoms and it correlates with the EKG section or the heart rate section of your wearable device showing abnormality, if those two concur, then there is good reason to go to the doctor and get checked out. Secondly, there is a condition called atrial fibrillation. Unfortunately, as we age, a lot of us become familiar with that term atrial fibrillation. And what we know is that people who have atrial fibrillation have an increased risk of stroke. And so if the Apple watch is talking about the possibility of atrial fibrillation based on the EKG, then you do need to get checked by a physician. Maybe get another monitoring gadget that they can look at and figure out if it is indeed interpolation. And if so, how does it need to be treated because of the increased risk of stroke.

Dr. Shah: 19:54 There are things that we can do to decrease your risk of stroke. So from that standpoint of is critical. However, the other aspect I would also say is that people don't need, to me these variable devices, the source of their anxiety. Please know that nature has given you one of the best gadgets to assess how your body's feeling and that is your own self, your own understanding of your body. If you notice that every day you've been able to walk five months and for the past two weeks at two miles, you're just getting by tells you're huffing and puffing. That is enough reason. That is more of reason to be concerned well and beyond what the Apple watch tells you. I think we understand some of the technology, we understand some aspects of how the heart functions and how our body functions, but it is all in combination.

Dr. Shah: 21:05 Just the heart rate by itself doesn't tell you the complete story. Just the EKG by itself doesn't tell you the story. That is where physicians can put things together for you and say, is this critical or is this not critical to be addressed. And sometimes the treatment can be worse than the disease itself. And I want the listeners and the readers to be open to a conversation that isn't something that is so bad that the treatment will make it better. Is if six or one and a half dozen of another well was treatment as well.

Allan: 21:46 You know another interesting thing that comes out of these wearables, it's a conversation I've had with one of my clients. He has a resting heart rate in the low 50s and I have a resting heart rate in the high 70s. And so, you know, if we go and we look at that formula where our bodies, and our watches are saying, you know, stay in this zone. He can't, he can't get to the zone. He can go 100%. His perceived effort level is 100% and his heart rate just will not get up to pass one 41 50. It just, just won't mine, I could get my heart rate up pretty quickly, but I also don't feel full exertion at 177 or 180. I can actually exert past that for a sustained period of time. And, and I try to, you know, I try to explain to folks, it's like, okay, this is a formula that works for a lot of people, but not everybody. So can you talk about where this max heart rate thing came from and how it kind of blew up into this,fitness craze of people thinking that they have to be in this magical zone all the time?

Dr. Shah: 22:48 Absolutely. so that is a very interesting story. You know, in the 1930s and 40s, doctors have promoted this idea that any kind of activity is bad for your heart. Patients with heart condition used to be told you need to rest. You can't exert yourself too much. You can't have too much stress. You can't argue with people and so on. And then as time went on in the 50s, the people started realizing that people are actually doing better when they're exercising. So the world promotion of exercise came into be a jogging was promoted and so on. And at that point in time, burning question in the physician community and cardiologist community specifically was what other heart patients who have had surgery for the heart condition, what kind of exercise can be recommend safely. So that was a burning question that was brought up time and time again.

Dr. Shah: 23:54 And the health services department knew that they would be asked this question during a certain meeting. And so at that point in time, what they did was the junior colleague was asked to collect some data regarding that. So he took into consideration 10 papers written about cardiac patients, young heart patients who had undergone heart surgery and what was the safe level of exercise and when they assessed this data in a very preliminary manner. They said, you know, there is this easy formula that we can come up with. It is 220 minus the age,based on what they observed. And so they went and spoke at the conference and when they were as expected as how much exercise can somebody do. Yeah. After having had heart surgery after having had heart disease, they said it seems that the safe level is to get to a heart rate of 220 minus age.

Dr. Shah: 25:00 Now even the people who were recommending this knew that even among the heart patients, people who had undergone heart surgery, this was a wide range. This was just a general guidance given. Just like what is an average human height. And we would say in the US it is 5'9″ or 5'8″. That doesn't mean that if I'm 5'7″ I need to get looked up about it. We immediately recognize that. And so then the experts assume that this would be recognized that this is not hard. And it's true. And this was the data only for patients who had a hand be at a young age. Father had significant heart disease. But as it happens, numbers are attractive. You know? So it just took a life of its own. So people put up posters in the fitness centers and gymnasiums and so on.

Dr. Shah: 26:07 And then there was wearable device made and show enough that industry has just exploded. So the drum beats of measurement and quantifying has just taken on a life of its own. Though this was never meant specifically for, this was never meant for the general population. So it is good to have a general guidance. However, do not let yourself be restricted just because of this. As I mentioned, nature has given us a much parameter, which is how do you feel? Are you feeling alright? Then go for it. Exert yourself a little more. If you're not feeling alright, it doesn't matter at what heart rate you are. That's body's way, nature's way of telling you that maybe there's something amiss and you need to stop.

Allan: 27:01 I define wellness as being the healthiest fittest and happiest you can be. What are three strategies or tactics to get and stay, well?

Dr. Shah: 27:11 Number one I would say look at home care more than healthcare to make you healthier. And what I mean by that is regular exercise, quitting smoking, and eating a healthy diet. That would be the first and foremost thing that you can do at home to get the most bang for the buck. Now step number two would be to get a good assessment and control of your blood pressure and if you're a diabetic, of your blood sugar. That would be my step two. And step three would be to practice optimism, mindfulness and graditude. And I see all these three based on solid research evidence, which has shown that all these three things, to give you a much healthier heart, much healthier heart than otherwise. There has been tremendous research on optimism, gratitude and mindfulness and then to live 5 to 10 years longer and happier life compared to the pessimists. So I would strongly recommend your audience to consider these home care steps before approaching the healthcare system.

Allan: 28:52 Those, those were really cool. Thank you for that. If someone wanted to learn more about you, learn more about the book, Heart Health: a guide to the tests and treatments you really need, where would you like for me to send them?

Dr. Shah: 29:04 So my book is available anywhere books are sold. Amazon.Com, Barnes and Noble, Booka a million, etc. If you want to learn more about heart and all these tests and treatments, want to explore it a little more. Want to know a little bit more about me or want to communicate with me. I have a website called JShahmd.com where I have lot of information about heart conditions, pictures with videos and even if you're being advised for procedure, you're we have videos and written material that is not difficult to understand and so it could be worth looking.

Allan: 29:57 Okay, this is episode 418 so you can go to 40plusfitnesspodcast.com/418 and I'll be sure to have those links there. So Dr. Shaw, thank you so much for being a part of 40+ Fitness.

Dr. Shah: 30:09 Thank you very much for having me. Really appreciate it.

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