Lori Walsh: Most things have become more complicated during the pandemic, buying groceries, paying bills, getting home repairs, seeing your doctor, but healthcare providers warn that keeping those doctor's appointments is key to your health. Dr. Meghana Helder is a cardiovascular surgeon with the North Central Heart Institute at Avera Heart Hospital. She joins us for a look at how the biggest risk to heart patients might not be coronavirus disease. Dr. Helder, welcome. Thank you for being here.
Dr. Meghana Helder: Good afternoon. Thanks for having me.
Lori Walsh: What have you been seeing since the pandemic began in these last ... since March with people seeking care or not seeking care, have there been big changes in the numbers that would indicate people are staying away from healthcare facilities?
Dr. Meghana Helder: Yeah, we have seen quite a few changes actually. You're absolutely right that patients with heart and lung disease are among the highest at risk population for COVID-19, and I think as a society, we've done a really good job at getting that message out. I think so much so unfortunately, that patients are feeling uneasy about coming into the clinic or the hospital. In that regard, specifically at our institution, we've seen patient clinic visits drop by 50 to 60%, and our hospital volume drop by 30 to 35%. Now, of course, I think this is due to the fact that some of our physician group has actively screened their upcoming appointments and called some patients with routine followup who are doing well and ask them not to come in or have handle those things with telephone visits or virtual visits.
But also, a large factor in this, I think our patients are choosing themselves not to come in. I think mainly because they're scared of exposure to the coronavirus, and the essential impact of this is that we are seeing patients far down in the course of their heart disease. So, patients that have been having chest pain for four or five days, instead of coming in with the first day of chest pain, they're waiting until they really can't handle it anymore.
Lori Walsh: What difference does that make in how they're treated or their survivability rate that seems like it would be a pretty significant delay for many patients?
Dr. Meghana Helder: Absolutely, and that's the thing that's the worst. The longer you wait with ongoing chest pain the more muscle that's put at risk, the more heart muscle that's put at risk, which means the less that we can do as cardiologists and cardiac surgeons to give you as much heart function back as possible and give you the best quality of life after a heart attack, but also your chances of survivability from a heart attack really decrease the longer you wait to come into the hospital.
Lori Walsh: This is something that we're always trying to convince people to do, because there's always a hesitation, South Dakotans in general, don't like to trouble anyone or you're worried about the financial impact, maybe you don't quite understand how your health insurance works or you don't have health insurance, and so there's a pause there, it's got to be particularly important to get that word out. Now, when there's other barriers that people have to overcome, what do you want to tell people about when something is an emergency? Let's start with what some of those signs and symptoms are.
Dr. Meghana Helder: Sure. The most important sign and symptom not to ignore is chest pain. So, most people describe this as an elephant sitting on their chest kind of like a pressure. Sometimes it's the same type of ... a lot of people mistake this for heartburn, but the pain can not just be on your chest, it can be in your jaw, can be in your neck and go down your arm. Those are some of the atypical ways the chest pain can present. Usually I would say the first thing you need to do if that happens is, sit down if you're doing something and not exert yourself. If that goes away, that's usually a telltale sign that it's cardiac in nature or heart in nature.
The other thing even besides chest pain is shortness of breath. So, there's other parts to your heart besides the heart arteries that provide blood flow there, there's valves inside your heart, and one of the biggest symptoms associated with valvular disorders is shortness of breath. That can be a longer term issue than your normal heart attack, but it still needs to be addressed medically in order to keep you the patient in the best shape that you can be in to really deal with any sort of thing that comes your way.
Lori Walsh: How much have we seen treatment advance and through research, just the availability of treatment in South Dakota including rural areas in the last few years, what have you watched develop? Is it exciting time to be in this field?
Dr. Meghana Helder: Absolutely. I think cardiac surgery is an innovative field, it's actually not very old, but in the last 10 years we really moved the bar on minimally invasive surgery. I'm also working with our cardiology colleagues in what we can do with wires and stents and valves that can be delivered with a small puncture in the groin. Now, ultimately that has to be tailored to each patient, but we've come a long way, even with the "old fashion heart surgery" and the amount of people that we can get through surgery safely.
Usually, our risk of dying is about 1% or less, which is huge milestone for us in our profession from where it started. But also recovery is probably where we've made the most impact in the last five to six years. Usually you're in a hospital after heart surgery for four to five days, that's it. Then recovery is at home and we say full recovery is about six to eight weeks. When your grandparents went through heart surgery, we've really come a long way with pain control with getting you up and moving and taking deep breaths and learn to treat the whole person when they recover. So I think that is probably the most exciting thing as we are helping you recover from the surgery much better than we used to.
Lori Walsh: That's encouraging. I want to talk to you about stress and anxiety partially because pretty much anything that you complain of any physical symptom, somebody says it's probably just the stress of living through a pandemic. First of all, what is the impact on the heart and on cardiovascular patients who maybe already have a problem on high levels of stress? Then second question is, how do you know when something is just ... you need some deep breath and you need to sit down and when do you really need to call the doctor and say this might be stress, I don't know, but I really need someone to look at this? So, first talk a little bit about the impact on our health, what do we know about the impact of chronic stress or intense stress like many people are experiencing right now?
Dr. Meghana Helder: Sure. So, chronic stress really revs up our bodies, right? So, when we are "in a fight or flight situation more than we are normally" that makes everything in your body work harder. So your heart works harder to overcome your blood vessels being constricted down and the hormones and chemicals that you are producing are high levels that are trying to help you get out of a bad situation. But chronic stress has you in that heightened state for longer than is healthy. So just puts not only stress on your mood and your daily life, but stress on your organs. So that's a very good question about how do you know that it's just stress versus something with your heart, and there's no correct answer to that. I don't think any of us could talk to you on the phone and say, "Oh, that's absolutely nothing."
What I will say is, I think people are veering too far to the last day, are just saying, "Oh, this is nothing." And not coming in than they used to. We're seeing a lot more of those judgments being made the wrong way. In general, I would say if the pain is not going away and it's lasting for more than an hour, that's probably something that needs to be taken care of. Now, we all know our bodies, ourselves the best, and so if this has felt like a muscle strain, and it's the same muscle strain that you've had in the past or you ate really greasy pizza and then went to bed, and this feels like the reflux that you've had every time you've done that, I mean, I think that's fairly safe to say this is not heart disease.
But most people know when something feels different or something feels odd, and you know in the back of your mind, this is probably something you need to get checked out, but like all South Dakotans, you don't want to trouble anybody, you don't want to call somebody to take you into the hospital, especially with the mass and the social distancing and everything else like that, you just don't want to be a burden. Honestly, taking care of this right away is what's going to lead to you taking care of this situation most efficiently and probably being the least amount of burden on your family members and your friends.
Lori Walsh: Good advice. As a cardiovascular surgeon who sees the insides of things that most of us will never see, what do you want to tell people about behavioral changes to heart health that many of us could be thinking about right now, and I don't want to encourage or make assumptions that people can take on a whole new, I'm going to get in shape during the pandemic, but because sometimes we just have to get the groceries bought and that's good enough. But what do you know in your experience that you wish everybody knew on how important some of these lifestyle choices really are?
Dr. Meghana Helder: Sure. Again, it's no real secret, right? It's what we've been taught all along. Moderation is key, when it comes to your diet. I won't say don't have any alcohol, but if you are going to consume alcohol, do it in moderation, same thing with that. It's going to be very hard for me to say, cut every fat out of your diet, that's not healthy either, but in moderation. One thing that I would say, the absolute thing that you can do in your lifestyle and your diet that will decrease your heart risk is to quit smoking. That is the number one cause of any blood vessel honestly starting to get disease is smoking.
So, if that's what you can do with all this extra time on our hands that everybody seems to have, that would be the number one thing you can do for yourself. The smoking is not just related to lung health, but it's related to heart health and even peripheral blood vessel health.
Lori Walsh: Yeah. So many of us are thinking about our mortality in new ways, so why not think about mortality longterm once we get past our fears of COVID-19, not bad advice at all. Dr. Meghana Helder is a cardiovascular surgeon with the North Central Heart Institute at Avera Heart Hospital. Thank you so much, Dr. Helder for being with us today, we really appreciate your time.
Dr. Meghana Helder: Thank you very much.