Nimeet K 00:11
Hello, Welcome to Adventist HealthCare & You podcast. I'm, Nimeet.

Shanna M 00:14
I'm Shanna,

Nimeet K 00:15
and we are excited to welcome Dr. Bobby Ghosh to talk about heart care. Dr. Bobby Ghosh is a interventional cardiologist through our Adventist HealthCare Cardiac Associates Group. So we're very excited to have him here.

Shanna M 00:27
Welcome Dr. Ghosh. We're happy to have you.

Bobby Ghosh, MD 00:29
Hi, thanks for having me.

Nimeet K 00:31
So we're, you know, why don't we start with what type of doctor are you? I know there's different types of heart doctors. So what kind of doctor is an interventional cardiologist?

Bobby Ghosh, MD 00:37
I'm a cardiologist first. So you know, we all go through our internal medicine training, and then we do our cardiology training. And then after general cardiology, there are multiple sub specialties of cardiology. So one of those is interventional cardiology, which is what I do a lot of my practices general cardiology, but I also do interventions meaning procedures, the most common of which people know of are angiograms, angioplasty and stenting. So we hear about stents a lot, I think that's probably where people are most familiar with interventional cardiologists.

Bobby Ghosh, MD 01:12
So if someone's having, for instance, a heart attack, we take them to a procedure in the room called the cath lab. And we we do this procedure through the arteries, and we put in stents to get blockages open, we do some other things as well. So we may sometimes if there's fluid around the heart, we may put in a catheter to drain that, you know, that's a different access than we do for stents. And then we may also sometimes put in some devices to help support the heart. And then finally, there's kind of a newer area of interventional cardiology called structural interventional cardiology, and that is largely working on valve issues or other congenital holes in the heart or things like that.

Shanna M 01:52
So someone may see a general cardiologist if they have heart disease, or are at high risk for heart disease, and then they may come to you for a procedure or for help, and then they may stay with their general cardiologist, or they may stay with you

Bobby Ghosh, MD 02:06
Exactly! A lot of patients that I see are also general cardiology patients. So yes, you can go in both directions.

Shanna M 02:13
Okay, health care is so hard to navigate. And there's so many different people as part of a care team. And it's good to know that there are multiple physicians that may see you. The nice thing about cardiac Associates is they're all in one practice. And you can just come to one place and see everybody that you may need to see

Nimeet K 02:30
Exactly as you were talking, i'm like, you know, a regular listener may not know what angioplasty is, or stent is or valve replacements, like, what are they going to need? So it's good to go to one person say, you know, what, what do I need to do? And what are my options? And when do I need to do it? So so when they're coming to you, you know, how can they prepare for their appointment?

Bobby Ghosh, MD 02:48
You know, first of all, I think it should just be a natural and open conversation. And I think that's kind of one of the most important things is just to be very open and honest about any symptoms that you may have. You know, one thing I think that has changed in cardiology, over the last couple of decades is we do a lot of our testing based on symptoms. So we look for symptoms as a reason to do a test, rather than just doing a test just because you've come to see me, or just to do a checkup. And there are many reasons for that, we've discovered that there are always complications of tests, there are downstream consequences of tests. And sometimes you find things you don't want to find, things like that. So we try not to do the routine stress testing that was done maybe, you know, many years ago, every, every single year, everyone got a stress test. And that has changed with guidelines nowadays. But that said, if you are sort of, you know, not sharing that you do have a little bit of chest discomfort or something that we may miss out on doing that test to look for blockages in one example.

Shanna M 03:51
Yeah, and that's something we've actually emphasized quite often on this podcast is finding a doctor that that you can have a relationship with. And we've talked about that in terms of a primary care physician that it's really important to find one that you can talk to and have a relationship and have long term, if they're really a partner. Finding the right cardiologist is the same thing. It sounds like that you want to find one that you feel comfortable with and that you have a relationship with.

Bobby Ghosh, MD 04:16
Yeah, no, I agree. There's a field of cardiology called preventative cardiology also. And that is one in which I think it's almost like a primary care for just the heart area. You know, maybe I may see a 35 year old patient with no symptoms, but maybe some family history and someone who wants to be proactive, and keep following up and checking on things right. And just to make sure, and what we do there is basically look at risk factors and try to understand what your risk factors may be. And sometimes there may be some decision making that we can do about how aggressive should we be about your cholesterol, how aggressive should we be about your blood pressure, and things like that, and that's a real place where I think you have longitudinal care, you know, and you might see someone for for many years,

Shanna M 05:07
Long term.

Bobby Ghosh, MD 05:07
Yeah,

Nimeet K 05:08
That's, that's great. I mean, I'll take a note of that, because I think the preventative cardic that I did not know about. As a 35 year old myself, with some family history and some cardiac history, I think it's very good for our listeners to know that there's this aspect of it that you don't have to have a severe cardiac disease to see a cardiac specialist.

Nimeet K 05:26
So how can family member or friends support somebody with a heart disease or a potential heart disease?

Shanna M 05:32
I was about to say we ask that question, because we often know it's not just the patient sitting there that's a caregiver too or a family member that's helping them and they need to kind of know how to support them and what to look for and what to watch for, and what to ask.

Bobby Ghosh, MD 05:45
Absolutely, that's a really critical part of probably all medical conditions is that social support that family support, not everyone has great social support or family support. But the more that you have, the better you're going to do, just even medically speaking. And so yeah, I think being supportive, obviously, if you're in a situation where you're taking care of a person who can't manage all of the aspects, even maybe just taking their medications or keeping the medications straight, which is not easy. Sometimes they may be on many medications and getting them correct. And the right timings, you know, that can be very helpful to have family members help with that.

Bobby Ghosh, MD 06:25
But also just supporting from a psychological standpoint, we only see patients that one visit, often it may be maybe as frequently as one month, but maybe less, but in the interim, you know, you really need positive encouragement. For of course, we're talking very general, but let's say someone has just had a major procedure or a heart attack or heart surgery, obviously, within the guidelines of what they're allowed to do, we want them to get up and get out of the chair, get out of the bed, walk outside, get exercise, and things like that. And sometimes there's a very big mental component to getting those things accomplished. But physically, we recover a lot better when we can do that.

Shanna M 07:07
Yeah.

Bobby Ghosh, MD 07:08
I think family plays a huge role in that.

Shanna M 07:10
Yes, I find myself reminding my husband to take his medicine all the time. That's my job with him. So it's February, Dr. Ghosh, which is always Heart Month,

Bobby Ghosh, MD 07:20
right?

Shanna M 07:21
What are some common myths about heart care that we can dispel here today?

Bobby Ghosh, MD 07:26
That's a great question. I'll say one thing is, sometimes people feel there's nothing they can do, or that they're, they're stuck with certain genes. And that's it. But there really is a lot that you can do with regards to lifestyle changes or lifestyle modification, being active, you know, obviously, exercise and diet and things like that. That's one thing that's I think, very important. Take control of your health as much as you can, there are things you won't be able to control. But definitely don't feel like you're stuck with what you've got.

Shanna M 07:58
We've heard that before too. And there are so many things that people can do. As you say, take control of their health and make small changes, and that can make a difference.

Nimeet K 08:06
There's so much going on with health care and just cardiac heart care in general. What are some of the new treatments or techniques that I know you mentioned some earlier? But what are some of the new treatments that you're doing currently, that people may not be aware about?

Bobby Ghosh, MD 08:19
Yeah, well, that's a big area.

Shanna M 08:22
Well, I think when people think about cardiology, there's this thought or myth that oh, they're just going to operate on my heart and

Nimeet K 08:29
open up my chest.

Shanna M 08:30
Yeah, exactly, yes. But there's actually a lot more to it that can be done minimally invasive, or, or even preventive.

Bobby Ghosh, MD 08:38
So we can go in many directions on this, but actually we kind of touched on earlier. But there's so many sub segments of cardiology, in the interventional side, which I'm largely focused on, we've had the stents around for a long time. And you know, at this point, I guess, 25 years or more, they have been common, and that's great, but they're always evolving, and they're always getting better. And the longevity of stances really improved with each generation. So that's really important that people know that because sometimes you get stuck with news from the past, I think.

Bobby Ghosh, MD 09:10
And then there's all kinds of new equipment that we're using. I think a somewhat recent thing is sometimes the plaques, the blockages that build up in the arteries can be very hard, they get hard, they get we call it calcified, almost like bone, we actually have a balloon now that works just in the same way that urology doctors used to break up kidney stones with sound waves. We have a balloon that delivers those same sound waves, it's called lithotripsy. And that breaks down that calcium inside the coronary artery. So that's kind of a cool new technique.

Shanna M 09:40
Yeah, that sounds interesting.

Bobby Ghosh, MD 09:42
And then in the structure, we took mentioned kind of the structural cardiology side, and it's been a huge shift in the way we treat for instance, aortic valve stenosis, which is a common condition for patients typically in their 70s, 80s and 90s. And we now can basically deliver a new valve without opening up the chest, we just go through the artery in the leg, deliver essentially a stent with a new valve on the inside of the stent that once you deliver it begins functioning like a valve, or it is a valve.

Nimeet K 10:13
And that's minimally invasive? Like it's not opening up the chest or anything.

Bobby Ghosh, MD 10:16
It's not, yeah, it's quite amazing. In fact, I can say that I heard about this technology sitting I remember the moment quite distinctly because I was a first year medical student in 2005, and it was in the very early days of the trials for this technology. It's called TAVR, Transcatheter Aortic Valve Replacement. And I just remember thinking that this person who was talking to us was, you know, a little bit delusional. You know, how can you possibly deliver a valve inside the old valve, push the leaflets out of the way and just leave it there as a functioning new valve? And now, I guess 18 years later?

Shanna M 10:53
Yeah. Wow yup! You dated yourself Dr. Ghosh.

Bobby Ghosh, MD 10:59
So and now it's, it's commonplace to the point where all high risk, moderate risk and even low risk patients are being treated this way as opposed to surgery. Not in every case, there's still definitely a role for surgery. But a large proportion of patients are being treated with TAVR for aortic valve stenosis.

Shanna M 11:19
Well, thank you Dr. Ghosh for for sharing all of that. We've started asking our guests if they would like to share one tip for people to live a healthy life and in this case, a heart healthy life.

Bobby Ghosh, MD 11:32
Right? Well,

Shanna M 11:33
it's probably hard to narrow it down to one. So maybe two or three, if you can't come up with just one.

Bobby Ghosh, MD 11:38
Well, I think in the big picture, the way we need to think about our heart healthy decisions and lifestyle changes, really, is not to think of it necessarily as a change. But as an incorporation into day to day life, you know, you can make shifts that are sustainable. So if we look at, for instance, in the exercise realm, okay, the you know, the recommendation is 30 minutes of aerobic activity five days a week, which is very formulaic, but it gives you something to go off of, but I think what's important is not to say, okay, I have to go onto that treadmill, do you enjoy the treadmill? Absolutely. But you should do something that is fun. And that is enjoyable for you. And that fits naturally with your life, but still brings you that healthy aspect, right? So if going on the treadmill seems like a chore, then you should think about do you like to play tennis or basketball? Or would you like to join a yoga class or just have a walking group with your friends and make that a standing weekly thing, things like that, where you're basically incorporating it into your life in a sustainable way, because it's not only healthy, but it's enjoyable.

Shanna M 12:53
I like that it doesn't become a chore where you start it and then a couple of days later, you drop it.

Nimeet K 12:58
You regret doing as opposed to enjoy?

Bobby Ghosh, MD 13:01
Yeah and the same thing goes in in terms of food in terms of diet, I almost don't like the word diet, because it feels like a temporary change, where you really, you're not looking to say, Okay, I mean, sure you can for 30 days or 60 days, or do some kind of a, you know, an intense diet. But I think the long term sustainability is really where it's saying, oh, you want to say, okay, i'm gonna make a shift in the way I eat in this way, which will be healthier, but it's still enjoyable. So if I enjoy eating a certain type of food, maybe I'll cook it in a different way. Maybe I'll eat it less times a week, rather than cutting it out. Just slight shifts, but still in a way that is sustainable and there for your long term health and wellness.

Shanna M 13:47
I love that it doesn't make it seem hard, or this big change. It seems it's like a small thing that you can do that will have benefits over time that again, just isn't a chore and you're just it's a moderation thing. Well, thank you, Dr. Ghosh for coming on. I hope you'll come back and talk to us again another time.

Bobby Ghosh, MD 14:06
Sure. Yeah, this was fun.

Shanna M 14:08
To our listeners, if you'd like to find Dr. Ghosh, you can visit AdventistHealthCare.com. Click on find a doctor and you can search for him. And if you'd like to learn more about Adventist HealthCare also visit AdventistHealthCare.com. Don't forget to subscribe to our podcasts, you can always get our new episodes. Also, if you're listening in February, don't forget to take our online health risk assessment at AdventistHealthCare.com/loveyourheart. We have a little contest during the month of February where you can learn your heart age, learn your risk for heart disease and if you take it during February, you could win a dinner and a movie. So yeah, right, a good incentive to learn your risk for heart disease and maybe make some of those small changes.

Bobby Ghosh, MD 14:51
I should do that too.

Shanna M 14:53
Yes, please do, we always encourage everybody to do that. Thank you to our listeners and be well.