Transcription of Maine Wellness 2015 #173
Speaker 1: You’re listening to Love Maine Radio with Dr. Lisa Belisle recorded in the Studio of Maine Magazine at 75 Market Street, Portland, Maine. Dr. Lisa Belisle is a physician trained in Family and Preventative Medicine, Acupuncture and Public Health. She offers medical care and acupuncture at Brunswick Family Medicine. Read more about her integrative approach to wellness in Maine Magazine. Love Maine Radio is available for download free on iTunes. See the Love Maine Radio Facebook page or www.lovemaineradio.com for details. Now here are a few highlights from this week’s program.
Dr. Ryan: At the end of the day, we have to remember we’re there to really take care of our patients and give them the best quality care and make them as healthy as we can be. We can’t get too wrapped up and too focused in clicking the right boxes and get disengaged from that.
Dr. Brett: I think people need to really understand what the effect of chronic stress is on their body because I think that’s a little under appreciated. Everybody knows stress is bad but I think the actual effects of that chronic activation and how that promotes clotting and how that may promote atherosclerosis. I think if people know what that’s doing to their body, then they may be a little bit more proactive and try to manage that as best they can.
Speaker 1: Love Maine Radio is made possible with the support of the following generous sponsors: Maine Magazine, Marci Booth of Booth Maine, Apothecary by Design, Mike LePage and Beth Franklin of ReMax Heritage, Tom Shepard of Shepard Financial, Harding Lee Smith of The Rooms, and Bangor Savings Bank.
Dr. Belisle: This is Dr. Lisa Belisle and you’re listening to Love Maine Radio, show number 173 airing for the first time on Sunday, January 4th, 2015. Today’s theme is Maine Wellness 2015. Maine Magazine begins each New Year with focus on wellness. We know that health and happiness are interwoven and we wish both for our readers. Today we speak with Dr. Lisa Ryan, pediatrician and president of the Maine Medical Association and Mercy Hospital head cardiologist Dr. Craig Brett about the ways in which they approach wellness with patients. Jump start your health in 2015 by listening in to our inspiring conversations. Thank you so much for joining us.
It’s fun for me to spend time talking with other Dr. Lisas as Dr. Lisa Belisle. I get to interview today Dr. Lisa Ryan who is a pediatrician at Bridgton Hospital which is part of central Maine Medical, Central Maine healthcare family but also she is the President of the Maine Medical Association and the mother of 2 children. She’s a busy woman but we’re really privileged to have her to talk to us today about some of the issues that I know that she and I both find fascinating and important as to the state of medicine today. Thanks for coming in.
Dr. Ryan: Thank you for having me.
Dr. Belisle: Lisa, you’ve been doing a lot of work with what we call organized medicine for quite a while. In our days medicine is going beyond clinical practice where you’re seeing patients and it is spending time, meeting with other doctors, meeting with administrators, trying to understand what patient needs are, trying to really reach out into the community and into the medical system at large and influence change.
Dr. Ryan: When I was in my residency I got interested in working with the American Academy of Pediatrics and was able to take a leadership role within our state chapter and then within our district area which was all of New England and I really got to see a little bit more about how organized medicine works and it was a great experience. I loved it. I made a lot of connections in New England so after my residency, I moved to New Hampshire. I did my residence in Burlington, Beaumont and in New Hampshire was able to really get involved with New Hampshire Pediatric Society with doing some legislative work and sitting on their legislative committee.
I was there for few years and then sort of migrated to Maine and once again continued to be involved with the state chapter of the American Academy of Pediatrics and then became involved with the Maine Medical Association. It’s been a continuum really since residency training and I find it fascinating and interesting and really an important part of medicine aside from just patient care. It’s been a wonderful experience and it takes time and it’s worthwhile. It’s definitely worth it.
Dr. Belisle: Having gone from the specialty organized medicine which was the American Academy of Pediatrics to the Maine Medical Association which was basically the American Medical Association which is more generalized representing physicians and healthcare providers, what are you seeing as the differences?
Dr. Ryan: There’s not really a lot of difference. I think in general, a lot of these organizations both on a state level or on a national level really have the same goals in terms of supporting physicians, supporting their members, improving quality, and improving health of patients. I think, I find the similarities are much more common than the dissimilarities really.
Dr. Belisle: As a doctor I understand why it would be important to have these groups. As a patient why is it important to know that our doctors are working in an organized way towards bettering medicine?
Dr. Ryan: Well I think that he organizations hold a certain level of accountability for the profession and most of the organizations look to policy, look at research, really try to guide medicine in terms of best principles and best practices and I think it’s important for physicians to be involved with organized medicine. It’s sort of the mother ship if you will that really is out therefore our profession and I think as an individual and I hear this a lot in my experience with organized medicine, individuals will say well what do they do for me? How do they know what I want? I think it’s important that my sense is that the leaders in these organizations really want to know what the individual physicians are struggling with and dealing with and how the organizations can help them.
I see it really as a 2-way street and I see it important to really make those connections and there are people in every community that are involved in some degree with organized medicine and I would encourage physicians to really think about touching base with those physicians that are involved to get their word known.
Dr. Belisle: Patients benefit from having providers part of organized medicine because it creates a higher quality of care, it creates sort of an oversight of the profession and it really … I guess the term organized really is a good one because I think for many years were able to all act independently as they cared for their communities and increasingly we are connected and to have some sense that what you call best practices or best principles. If I come in to see you as a pediatrician and my child has some sort of a respiratory illness you can see to me, “Well your child probably doesn’t need antibiotics. The best practices are that we actually give your child some supportive care and not go to antibiotics.”
It’s that sort of thing that we’re actually paying attention on a bigger level to the types of things that influence not only our patients and our families but also the communities in public health.
Dr. Ryan: Definitely.
Dr. Belisle: It’s an interesting thing to see how physicians respond to what has happened in medicine and I think it would have been easy for you as a doctor to just hunker down, do your work. You have children who are in high school now so get your job done, put them through college. It’s just a job but instead you’ve really continued to look at this as a profession and one that you have a lot of … you’re very gratified by. What keeps you excited and motivated to be in medicine and to work at a much higher level?
Dr. Ryan: I think that’s a great point and something I’ve really thought about as I assumed this role of President for the Maine Medical Association. I had mentioned … I came across a document several months ago that really I’ve embraced, it’s really influenced me in my thought process and it’s very along the lines of what you were talking about in terms of the profession and finding some excitement and some passion and some energy. My sense is as I travel around, as I meet with fellow physicians, I am sensing a lot of dissatisfaction I think. A lot of physicians are frustrated by what’s happening with healthcare and all the changes that are happening and the onus that they feel is put upon them, not only to take care of patients which I think all of us feel like we’ve always done a good job at that but now there’s much more accountability along those lines.
This document I came across was actually published in the annals of internal medicine 12 years ago and I find it so relevant today and wonder why I haven’t seen it for the past 12 years. It’s called Medical Professionalism in the New Millennium, A Physician Charter and it really looks to all of the changes and understanding the pressures that are going on right now with healthcare and trying to step back and remember 3 basic principles involved. The first principle is patient welfare and that’s really I think what we all went into medicine for is that we wanted to take good care of our patients. The second principle on the charter is looking at patient autonomy and I think that’s a relatively new phenomenon in medicine away from the days that the doctor tells the patient what to do and the patient says okay and does it.
I think we much more want to engage patients now in their healthcare. It’s their healthcare. They need to be engaged. They need to be a part of that. We as healthcare providers need to talk to them about what their disease process is, how to maintain wellness, talk about options that are out there and really engage them to be partners in that healthcare. The third principle of this charter is really social justice. I think I hadn’t necessarily thought about that a lot in the past but it really is an obligation I think of our profession and of ourselves individually to make sure that there’s equity in healthcare and that everyone is getting the same quality and the same level of healthcare.
This document has really in essence re-energized me and my passion for medicine and made me take a step back and say wait a second. This is why I’m doing what I’m doing. This is what brings me passion, and take that step back and say, “Okay. Refocus and re-energize” because we all fall under the pressures sometimes when we’re over tired and we’ve stressors in our lives and stressors in our work that it’s hard to remember. I found this … I carry it around with me everywhere.
Dr. Belisle: I think that’s really important is to know what some of your core values are because this is something that we can get very distracted away from. We can get so focused on “I have 20 patients to see today, 30 patients to see today. How do I just make it through the list to get everybody happy and try to move them towards health?” Instead if you can really be thinking in the bigger, in the grander scheme of things, is what I’m doing actually heading in the direction of social justice, making patients more autonomous and the third one.
Dr. Ryan: It’s basically just patient welfare.
Dr. Belisle: Patient welfare.
Dr. Ryan: Health and wellbeing.
Dr. Belisle: Yeah, if you can be thinking on all of those things then it gives a bigger purpose to the work that you’re doing. Isn’t that really what all of us need is some bigger purpose to the work that we do in our lives. As a patient, what types of things can I do to create a better relationship with my physician? If I’m looking to change providers for example or establish care with a new doctor, or in your case, as a pediatrician, you interact a lot with parents. What are some of the things that I can do to create a good relationship with my provider who might be a nurse practitioner, who might be a physician assistant? What are some of the questions I can ask and how can patients from their standpoint foster that all of those principles that you just mentioned?
Dr. Ryan: I think it’s really important for parents and for patients to feel that they can talk to their provider. As I’ve been around to different practices in different practice settings I hear a lot from physicians that they don’t feel like their patients talk to them and tell them about their concerns but I think on the same foot side is we as physicians need to change our mindset and change our thoughts with how we walk into a practice and how we walk into an office visit. I think for us to take the time and just say which I’ve started to do even more so in my practice, what’s really … what are you worried about? What’s really bothering you? We have to engage in those conversations and I would hope that patients take more of that responsibility for themselves to feel that they can talk to their physician or their healthcare provider about what they’re really worried about.
I get the sense that that’s a different mind shift for a lot of patients. I think it’s so important. I think it’s so important to have a conversation. Not somebody telling you what to do and what’s going on. I think when you walk in to meet someone, you’re interviewing someone as a patient, I really believe in that gut sense of your feeling and your [inaudible 00:14:50] for a person is really important. We’ve all had those experiences in different aspects where you reflect and say something just didn’t fit well with me and I should have gone with that. I think that’s really important, your level of comfort, your level of ease with not only the healthcare provider but really the setting therein, the environment therein, how their staff seems and that’s all important to say is this a place I feel welcome? Is this a place I feel safe? Is this a place I feel comfortable.
Dr. Belisle: You’re on Love Maine Radio. We’ve long recognized the link between health and wealth. Here to speak more on the topic is Tom Shepard of Shepard Financial.
Tom: Making peace with your finances is easier said than done. We’ve spent a lifetime being programed by our beliefs and behaviors, interacting with our inherited nature. Making peace with all of that is one of the biggest steps forward you can take. It’s a step that can certainly remove a lot of anxiety from your life. Consider this scenario that a lot of us have gone through or that you may be going through right now. You have money to support yourself and your family but it’s not always there at the right time or you don’t believe that you can access it. That happened to me recently and also in a big way in 2008. Like you, I have experienced these financial highs and lows. It feels as though you’re on some kind of a strange roller coaster. You’re constantly wrestling with what you want versus what you need.
If you have bills and really want to pay them off, you’re sort of living in the past so you can move forward. Finding peace in the middle of our culture can make it difficult to make good financial decisions, especially if you’re waiting for the other shoe to drop. The first step is to stop and breathe. Look around. Walk around. Talk to people. Trade and commerce are going to happen. Money is what makes it easier.
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Dr. Belisle: What about cost? I know that quality has been an important piece for you and that you’ve done a project with Maine Quality Counts and I believe consumers reports has somehow gotten involved in questions that we should be all … patients should be asking their doctors really. What’s your take on these things?
Dr. Ryan: There are 5 questions is the consumer reports quality counts message about do you really need a test or procedure. Are there other alternatives, other options? What happens if I don’t do that test or take that medicine or do that procedure? What are complications and side effects if I do and how much does that cost? I think cost is important. We’ve all sort of shied away from cost over the years but we know in this country our healthcare costs are astronomical. It really can’t continue the way it has. I think it’s important. Those are important questions and I work for a system. It’s difficult to get the answers. I know they’re looking at finding the answers and I’m hoping to at least get some of that paperwork to start to begin to look at it. I don’t have the answers all the time for patients when they come in the office right now but I think it’s my job to be able to guide them and steer them to the places that they could get the answers to those questions and it’s important. A lot of families have very high deductible insurance plans now and cost is a huge issue.
Dr. Belisle: I agree and I … when I was in private practice, I knew how much I charged for patient visit, I knew how much we billed to the insurance, I knew how much we were like to get back from an insurance plan and I had a sense from having investigated this how much it will cost, order a cholesterol test drawn, x-ray or an MRI. I think it’s gotten more and more cloudy as time has gone on and especially working within a healthcare system, it can be very confusing. There are different things called facility charges which are now added into patient visits and the clearer we can be to ourselves as to how much things are going to cost, the better off everybody is going to be because there’s nothing worse than being a patient who gets a bill for a test that they really weren’t sure they needed to have in the first place and have it be so high that they never want to go back and see their doctor again because that trust is broken.
Dr. Ryan: I think in all the changes in medicine that we’ve had to embrace and all the … actually all the good things that have come out of things like technology and electronic medical records and really this idea of justice and part of justice is public health. It’s the ability to care for people as part of a population. Make sure that people are immunized against measles, mumps, and rubella and make sure that people aren’t being exposed to other infectious problems. Proper public health.
Dr. Belisle: Tell me how you feel about what we’ve been doing in public health over the last 10 to 15 years.
Dr. Ryan: I agree wholeheartedly and I think the healthier an individual is and you had mentioned communities, I think it’s so important. Public health is so important and I think that we as healthcare providers are really at the forefront to help educate our families and our patients about the important of public health and we can certainly see over time the amazing advancements and things like infectious disease for example. I think right now everyone’s really worried about Ebola and worried about the enterovirus. There are things like that that catch our awareness and our attention in a much more acute situation and I think that I talked of patients in the office that there are hundreds of enteroviruses.
When we talk about the risk and what we look for is not any different for this particular virus. It’s the things that we always look for with respiratory infections and things that you’re worried about and things that I’m worried about. I’ve been involved with the school health program in my school district and really looking at population health. I think we don’t always think of that on an individual provider level. I think we all probably contribute to it without really realizing how much we can contribute to it. I know the public health committee of the Maine Medical Association is probably one of the most active committees within our organization who really embraced public health and looking at all aspects and how that affects Maine citizens. I think we all do it. We don’t always consciously understand how much of role we have in that.
Dr. Belisle: We had Gordon Smith on the show, I think a couple of years ago. Now, he’s the executive director of the Maine Medical Association. I was impressed with how the medical association has needed to change its focus, change the way that it outreaches. What are some of the things that the medical association has asked you to champion as the President this next year?
Dr. Ryan: I think there’s not the issue of championing anything that I get from the medical association and from the leadership. I think it’s more on an individual basis sort of what you’re passionate about and what your vision and what your hope is for your term as President. I really feel strongly about physician wellness, physician burnout, physician dissatisfaction and I think as a medical association, we really need to remember that what we do is taking care of our physicians and our health care providers and the quality piece and the patient improving the health of Maine citizens. We have to remember my goal, my vision is to really hear from members to try to re-energize members who are feeling dissatisfaction and frustration.
I think part of that comes from education in looking at how we have to function now within all these changes in terms of quality documentation, in terms of accountability, in terms of continuing medical education. I think as an organization we need to be able to support physicians and have answers and resources for them. We are trying to get out. We’ve done a couple of what we call listening sessions. We’ve done one in the Portland area, and one in the Bangor area where it’s a social event and we invite physicians and healthcare providers in the community. I’ve been to the one in the Portland area. We have one coming up next week in the [inaudible 00:24:49] area. Its’ been … it’s been grate. We’ve just started this but I see physicians that I would never see.
They don’t come to meetings. They’re not allowed committees. These were physicians out there in the trenches taking care of patents and we really get to interaction as leadership of the organization to see what concerns they have, what things they’re worried about , what they’re wondering about and my hope is to really get out there and be out there for physicians to really get a handle on what’s going on, what their concerns are, what their joys and what their satisfactions and their accomplishments are also and really try to energize the healthcare providers.
Because you had mentioned that you were faced with an onslaught of requirements and boxes to check and different things like that to hold accountable for but I think at the end of the day we have to remember we’re there to really take care of our patients and give them the best quality care and make them as healthy as we can be. We can’t get too wrapped and too focused in clicking the right boxes and get disengaged from that.
Dr. Belisle: Something that keeps coming up from me that I think comes up in many of the shows that we do and that in the end there is really is all about relationships and when I’m sitting with a patient I want to be able to work with that person and really in a team as you’ve suggested not just me but the other people who work in my office and this patient and this patient’s family and I want to have a positive relationship. I don’t want a patient to come in and feel like they have to be defensive. That seems like a harsh term but sometimes I know that when I’m sitting with people I am getting the entire medical … I am representative of all of the doctors that had ever done poorly for the patients that come through the door and that’s a heavy burden for me to lift.
I would prefer to have somebody come through the door and sit with them and say, “I’m on your side. Let’s see if we can build this relationship together. I can clearly understand that you’ve had difficulties in the past with the medical system at large or may be a particular doctor but let’s see where we can start as human beings and start with the human level and really understand it that way.” It sounds like this is something that you encourage as well.
Dr. Ryan: Definitely. I get to do that. It’s the nice thing about being a pediatrician because I just often times especially with newborn babies I’m starting that relationship for the first time with families and with children. I’ve been there long enough now that I’m starting to see the children of the children. It’s great to be in a community. It’s great to have that relationship. I don’t always make people happy. I understand that and that’s part of human nature but I think really having that conversation and not feeling like you as a healthcare provider have to justify the system or justify what’s happened to somebody in the past but with knowledge that there were issues and there were problems and things that you weren’t happy with and how can we move forward and make this a better relationship than what you had in the past. I think that’s crucial.
Dr. Belisle: Lisa, how can people find out about the Maine Medical Association?
Dr. Ryan: We have a wonderful website MaineMedical.com. You can Google it and there’s lots of information about the medical association, about all the different committees and all the activities and all the things that are going on within the medical association. Their office is located in Manchester and I certainly as President this year encourage anyone to really reach out to me. I want to hear from the members, I want to hear from healthcare providers.
Dr. Belisle: I do encourage people to find out what the medical association is doing if you are a healthcare provider or a patient. It’s a very worthwhile organization. Also reach out to Dr. Lisa Ryan who is a pediatrician at Bridgton Hospital and the President of the Maine Medical Association. Thanks so much for coming in and talking to us about what’s going on in healthcare and for being part of Love Maine Radio.
Dr. Ryan: Well thank you so much. It’s been a pleasure and it’s always a pleasure to meet with you and talk to you about things again. I’m thrilled to be here and thank you so much.
Dr. Belisle: As a physician and small business owner, I rely on Marci Booth from Booth Maine to help me with my own business and to help me with my own life fully. Here are a few thoughts from Marci.
Marci: I can’t imagine that I will ever be an artist. While I appreciate all kinds of art, I know that creating it is just something that I’m not able to do. I don’t have that kind of talent and I find myself in all of the people who do. Realizing that all of us have different and unique abilities and that we can’t be good at everything is a tough thing to admit. It’s a lesson I teach my children but it’s a lesson we all need to remind ourselves of as adults. Recognizing your strengths and talents earlier keys to happiness and success and leveraging those talents that others have is another key to success. While I may never have a gallery exhibition of my artwork, I find great joy in knowing that what I and my entire team have is the talent to help businesses run better.
We are the leverage an entrepreneur needs to be successful. I’m Marci Booth. Let’s talk about the changes you need. BoothMaine.com.
Speaker 1: This segment of Love Maine Radio is brought to you by the following generous sponsors: Mike LePage and Beth Franklin of ReMax Heritage in Yarmouth, Maine. Honesty and integrity can take you home. With ReMax Heritage it’s your move. Learn more at ourheritage.com.
Dr. Belisle: Love Maine Radio is all about loving Maine but we can’t really think about loving Maine if we don’t think about loving ourselves and really our hearts. Today we have with us Dr. Craig Brett who is the head of cardiology at Mercy Hospital and he’s also the subject of an article that I wrote the wellness issue of Maine Magazine in January. Thanks so much for coming in and talking to us today.
Dr. Brett: Thank you Lisa.
Dr. Belisle: Craig you and I have some similar backgrounds. We both went to the University of Vermont. We both have children who are roughly the same age. I think you have 4.
Dr. Brett: That’s correct.
Dr. Belisle: I have only 3.
Dr. Brett: Okay.
Dr. Belisle: You beat me on that one.
Dr. Brett: That’s many still.
Dr. Belisle: Yeah it’s still more than none. You’re busy and you’ve been living this busy life for quite a while. The thing that strikes me most about you though is that even as a busy doctor, it’s been important for you to maintain balance. Let’s talk about that. Let’s talk about how it is that moving to Maine has enabled you to create a life that is one of balance between your personal life, your professional life, your family.
Dr. Brett: It sounds like you and I both know where to be. In the north east, both in Burlington at the University of Vermont and then in Portland, Maine I think we’ve been to the nicest places in the north east. I think we’re very fortunate that here in Maine we have the ability to have balance in our lives with the recreational opportunities that are so nearby. We’re in a fantastic medical community which was a major draw for me and to have those 2 things together and be able to access those with fairly low hassle what more could you ask for?
Dr. Belisle: You’re originally from New York.
Dr. Brett: That’s correct.
Dr. Belisle: When you decided that you were going to raise your children, what was it specifically about Maine and Cape Elizabeth where you live that caused you to understand that this would be a good place for children to grow up?
Dr. Brett: My children are having a very different upbringing that what I had in much of the urban environment in New York. Although it was a great childhood, I think what my kids have here is just wonderful. They get to see their parents enjoy recreational opportunities and stay healthy as a result. I think they’ve benefited from that. I think the ability to have good schools nearby and to be around people that are motivated and want to do things with their lives so it’s just been fantastic for them.
Dr. Belisle: Why did you choose to be a cardiologist?
Dr. Brett: I knew early on I wanted to go into medicine and the cardiology interest came later and I think it was looking around and realizing that the pace of change and the pace of scientific information and knowing the best way to treat patients was just moving really quickly in cardiology compared to some other fields.
Dr. Belisle: Unlike some people perhaps who are concerned about the pace of change, you are excited by it?
Dr. Brett: Yeah, not to pick on some of my other colleagues but I just … when I look back over my, it’s now almost 20 years of practice, the advances in cardiology are just incredible. I’m not sure all of our other specialties have seen those kind of advances. They’re not all technological advances although many of them are but just basic understanding of disease processes I think we’ve done pretty well in cardiology.
Dr. Belisle: It’s also fortunate or unfortunate I guess that heart disease is the leading killer of Americans, American adults. I think that more research has gone into it. We know that this is a huge problem. It’s not only killing people but it’s also causing morbidity and long-term problems after having heart attacks and strokes and other things related to the heart. This has been of benefit to your field.
Dr. Brett: You’re right Lisa. Absolutely. Heart disease and stroke are the number 1 killer of men and women and lead the next 3 causes combined. Everyday [inaudible 00:34:49] die of heart disease so it’s clearly a major health problem, incredibly expensive health problem and one that we’ve made some strides on. The mortality rates for heart disease is declining but it’s still a major problem.
Dr. Belisle: There are various risk factors for heart disease. One of them is smoking. I assume that that has the fact that our smoking rates have declined to a certain place and now they’ve kind of leveled off but I assume that that’s had a positive impact on heart disease.
Dr. Brett: No question. The understanding of the dangers of smoking and the impact that smoking has on the health of blood vessels that’s been appreciated now for several decades, has led to some decline in the instance of heart disease. Maine is still a pretty high smoking incidence state though so there’s still work to be done but it is better than it was in years passed.
Dr. Belisle: Is it true that with smoking once you stop, you actually can reverse some of the damage that tobacco and the products that are in cigarettes and tobacco products, that they … yeah you can reverse that damage?
Dr. Brett: No question. We have patients all the time who come in who have had a cardiac event or heart attack say and may be there were smokers, may be they had other risk factors that they had some control over like they were overweight or very sedentary. When people can change those, and not everybody does, but when they can, you can really see that the course of this disease changed.
Dr. Belisle: You just mentioned another couple of risk factors for heart disease and those would be weight and sedentary lifestyle. What do we know about those? This seems to be something we’re struggling actually more with. Whereas the smoking rates have declined, the obesity rates have risen.
Dr. Brett: You’re absolutely right and for a time there was some controversy about whether obesity was actually a cardiac risk factor. That seems to be pretty much put to bed. It is and the reason it is is not just the weight that someone is carrying around, the excess weight that somebody who is obese may be carrying around but the way that that extra weight changes their metabolism. People that are obese tend to have a very characteristic profile of elevation of a certain type of lipid or a fat that’s measured in the blood stream called triglycerides. That elevation also causes risk of plaque build up in arteries that obesity … the presence of obesity also results in body’s resistance to the effect of insulin which we know can create problems in blood vessels.
There’s something about the obese state that causes these other metabolic changes that we know are directly harmful to the blood vessels.
Dr. Belisle: You’re talking about insulin resistance and that’s really related to diabetes. There’s a lot of crossover between the people who have diabetes, people who are obese, people who have heart disease. Must be an interesting thing for you to try to tease out how to manage all of these problems that are co-existing.
Dr. Brett: There are several problems that coexist as you mentioned. Being obese, having high blood cholesterol particularly these triglycerides, the insulin resistance which is the precursor of diabetes, also when the blood pressure is elevated so it’s multiple things but it really all comes back to that profile and you can correct all of those things in many cases just with getting someone’s metabolic state back to normal by significant weight loss and exercise. It still remains the best medication we have so to speak.
Dr. Belisle: You’re a big fan of exercise. You yourself are a cyclist and you enjoy skate skiing on the river in Maine in the winters. What do you talk to your patients about? Because not everybody is going to be a cyclist. Not everybody is going to enjoy going out in the snow. What do you suggest?
Dr. Brett: It’s so much easier when you just love exercise and you miss it when you don’t get it. I think for those of us that have that temperament it’s easy. Unfortunately not everybody has that temperament and for so many of my patients exercise is just … it’s work. It’s a chore. They have to drag themselves to wherever they’re going to do their exercise activity. For those people it’s a real challenge and I think these are people that may be exercise and fitness and doing these types of things has never been a big part of their life or may be it was at one point and they just lost track of it and then got to physical state that didn’t allow it anymore. For those people it is a real challenge and I don’t think there’s an easy answer. People need to find something that they like to do that burns calories hopefully in an aerobic fashion.
There are some programs locally that try to promote that, that we direct our patients to but it is a key thing to find an activity, something that will allow some fitness and hopefully weight loss for these patients.
Dr. Belisle: It really is about enjoyment. You have to find something that you’ll like to do.
Dr. Brett: I think the people that are successful at it enjoy the activity. I think people that where it’s always a chore, always a drag, they may do it for a while. It doesn’t actually become a part of their life forever and so it’s an ongoing struggle but if they can find something they like to do and do it and they get better at it and their body feels better at a certain level of that activity then it’s easy.
Dr. Belisle: We’ve been talking about things that we enjoy when it comes to physical activity. What about when it comes to eating? That’s something … you’re a lipidologist. A lipidologist is somebody who specializes in the fats that are problematic for arteries. Food is an interesting question these days isn’t it?
Dr. Brett: It is and I think everybody out there, so many of my patients out there are confused because there’s so many conflicting recommendations that come out seemingly on a weekly basis about what’s good, what’s not good. Can you eat eggs? Can you eat margarine? Is butter actually better for you? It just goes on and on and on and can drive people nuts. A lot of it comes back to just common sense and some basic, eat certain food groups in moderation. We know for certain that saturated fats and trans fats are bad. These are fats that you see in animal meats predominantly so you keep that moderate. We know that whole grains, we know vegetables, we know most fruits on the other hand are good and will lower the bad levels of the cholesterol and in some cases raise the so called good level of cholesterol.
These are not ground-breaking recommendations. These really get back to a lot of common sense and I think nit-picking about certain elements [inaudible 00:42:13] should we always use olive oil or can we sometimes use [inaudible 00:42:19], I think that’s missing the big picture. A diet moderate in saturated fats and animal fats, predominantly consuming whole grains, fruits, vegetables, keeping animal protein … you don’t have to exclude it completely but keep it moderate and try to get fish once or twice a week. These are basic recommendations that are still the cornerstone of what we tell people.
Dr. Belisle: I have in my family people who are involved in the paleo diet which I think doesn’t have to be meat. It’s definitely low carb but I know that some people interpret the paleo diet as needing to be more meat because you’re cutting out carbs and need the calories as they want the protein load. How does that impact one’s heart? Do we know?
Dr. Brett: The low carbohydrate diets definitely have their place for the right people. People that need to lose weight, that have pre-diabetes, that have triglycerides elevation, they do need to be on a low carbohydrate diet and you do replace those calories typically with protein and not animal protein. It’s interesting most people when they do that diet, if you look at their lipid profiles, they improve. Their triglycerides come down. The bad cholesterol levels don’t change too much. They might change a little bit but not too much. There are some people though that have certain genetic predisposition relating to how their liver metabolizes cholesterol that when they go on one of these low-carbohydrate high-protein diets, their bad cholesterol goes crazy and it goes real high.
I think you can do these low-carbohydrate diets can be useful but they probably should be done under some supervision and making sure at some point a lipid profile, a cholesterol profile is checked if you’re going to do that.
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Dr. Belisle: There are people in Maine and this is something that you and I talk about in the article for Maine Magazine that are genetically predisposed to having high cholesterol levels and in fact we had Dr. [inaudible 00:45:42] who’s doing a study out of Lewiston and founded a small enclave of people who have particularly high cholesterol levels. Genetics are something that we can’t really avoid if we’re going to metabolize things differently, probably more poorly that is the way that it is.
Dr. Brett: It’s true. We live in a corner of the United States that has a real spike in the incidence of this genetic abnormality that goes by the abbreviation FH, for familial hypercholesterolemia and it’s often seen in a French-Canadian population and it’s a genetic abnormality where the liver doesn’t properly clear the bad cholesterol levels. This is an incredibly frustrating condition for people because I see people that look like you live fit, in the proper way, they eat right and yet their bad cholesterol level is 300. They are so frustrated that they can’t change that with diet and exercise because they’re already eating a prudent diet and exercising and it’s terrible for them. These are people that there’s just no other option besides medication unfortunately but it is treatable. We see a fair number of these people up here.
As a lipidologist practicing in Northern England is especially interesting. When I go to my meetings I think my colleagues are all jealous that I see all these FH patients that they don’t to the same incidence.
Dr. Belisle: We’ve talked about weight and we’ve talked about not smoking, we talked about diet, sedentary lifestyle. One thing we haven’t talked about is blood pressure and pulse which is as much of a risk factor. I want to talk about stress and the relationship between stress and blood pressure and pulse and just overall cardiac health and what we know about it now because I think that this shifting and it’s a special interest of yours.
Dr. Brett: I have been fascinated with the association between stress and heart disease for sometime and there are so many anecdotes but the clinical evidence is indisputable that people that are chronically stressed have a higher incidence of cardiac events than people who don’t record chronic stressors when you evaluate them. It’s not entirely clear if chronic stress actually causes atherosclerosis which is the name of the plaque buildup in the arteries that leads to heart attack or whether chronic stress just serves as a trigger in people who already have that problem. Just to review briefly the stress response, we humans benefit greatly from the ability to generate a stress response.
When you’re faced with a stressor, you have a very immediate activation of your autonomic nervous system. Your heart rate goes up, your blood pressure goes up, your blood sugar goes up ready for fast energy, your ability to clot increases so that if you get injured in a fight or flight of state, your can heal quicker. Your body shunts blood away from more elective functions like digestion and shunts blood over to the muscles, really activates the body for action and humans have evolved this has clearly been a beneficial response and in today’s society having that ability is helpful for certain situations.
The problem is when those systems are activated chronically like people who are just stressed out of their mind and those systems are just constantly activated, then we see people with problems of hypertension or high blood pressure, diabetes from the high blood sugar. The propensity to clot makes one more susceptible to having heart attack or stoke. We’re all familiar with the symptoms people can have when they’re chronically stressed. You know they’re jittery and they have some stomach upset, poor digestion, they’re little forgetful. They may be depressed. They’re just not, they’re not functioning like they should when these systems are chronically activated.
We see the end result of this as an increased incidence of cardiovascular events like heart attack and stroke. We joke at Mercy Cardiology where I am that we know which [inaudible 00:50:08] suffering the most stress because we’ll see clusters of employees coming from certain places and during certain times and say “Things must be really bad over there” but the association is really … it’s very clear between these chronic stressors and events. There does seem to be certain stressors that may be particularly bad. Marital discord is a terrible stressor. Chronic marital discord, it’s one that’s actually been studied where this activated system really can be shown and [inaudible 00:0:41] higher caretaker stress where you’re caring for somebody who may be ill or disabled, typically a loved one at home. That generates a tremendous chronic stress response that’s quite harmful or can be quite harmful.
Workplace stress has been studied as I mentioned and particularly folks who are high-demand low-control type situation at work, you can measure real profound activation of the chronic stress systems.
Dr. Belisle: In our conversation you mentioned how important you thought it was for us to work with our children in helping them to understand what stress was, what it did to them physically and how they could mitigate the impact of stress because some of the things that we’re asking them to do are probably more stressful than we realize and you used the example of kids sports. You said this is something that we’re supposed to have as a stress reliever and if you’re an adult may be running is a stress reliever but there’s so much pressure on kids in addition to doing their school work and their school play, and playing the piano, you add sports on top of it. You are actually layering stress onto this generation that’s coming up behind us.
Dr. Brett: I totally agree. I have teenagers, you have teenagers. Their world can be so stressful and I’m always amazed at how my kids have to face that and they’ve been okay doing that so far but I do worry about that and it is very ironic as you point out that sometimes it is sports which if done right are an incredibly experience for kids but unfortunately are not done right on many occasions and can be a tremendous stressor. The kids often times will need to do something completely not sports related to find their relaxation which is little ironic, kind of opposite from what their parents may have to do.
It gets back to them finding where they can center themselves, where they can get to place where they’re not surrounded by that stress and I think for every kid that’s different but there’s no question the world that they are in right now is not what we had and I worry about how those stressors starting at this age may accumulate into adulthood when they start becoming more at risk for the vascular problems that we see later in life.
Dr. Belisle: Knowing that we as parents need to find out own way of dealing with stress. May be if we’re doing yoga or meditation, or tai chi, or xi gong or something that kind of slows everything down for us, may be our children coming up behind us can see how that would be important to integrate into their owns lives.
Dr. Brett: I think that kind of modeling is really important and I’m not so good at advising people what they should do to find that type of state of relaxation because it’s so different for different people. I know some of my friends like to get on a motorcycle and go for a ride and other people will find it enormously stressful. Some people find yoga, other activities to be [inaudible 00:54:04] I think you just have to find it yourself. You have to find what centers you and what distracts you from all those external stressors that we know can be so detrimental when they’re chronic.
Dr. Belisle: Any final thoughts as we head into 2015 about staying healthy. I love the fact that you’re a preventive cardiologist rather than an interventional cardiologist. You’re trying to keep people in a good place before anything bad happens to their hearts. What are some suggestions that you have for people?
Dr. Brett: It’s amazing. I see people everyday over at Mercy who are otherwise like totally in control of their professional life and they feel like they are all together and yet they don’t know some of the basic numbers in terms of what their own risks may be for developing heart disease. I think if I could get one word of advice out there is know your numbers. Everybody as an adult should know what their lipid profile looks like whether they have this genetic abnormality that puts them at risk for vascular disease. You should know what your blood pressure is, know what your family history is, know if you have a profile that could really benefit from very aggressive preventive measures so that my interventional colleagues don’t need to ever see them.
That continually surprises me and then I think the other thing is as we’ve been talking about, I think people need to really understand what the effect of chronic stress is on their body. I think that’s a little under appreciated. Everybody knows stress is bad but I think the actual effects of that chronic activation and how that promotes clotting and how that may promote atherosclerosis I think if people know what that’s doing to their body then they may be a little bit more proactive and trying to manage that as best they can.
Dr. Belisle: Dr. Brett I really appreciate your coming in and talking to me today. Obviously there’s someone who cares for Maine hearts. It’s important that you’re out there doing the work that you do and Maine’s hearts healthy because we are Love Maine Radio so we need to have healthy hearts so that we can keep on loving our state. We’ve been speaking with Dr. Craig Brett who is a cardiologist, the head cardiologist at Mercy Hospital. Thanks so much for coming in and being a part of our show.
Dr. Brett: Thank you Lisa. Anytime.
Dr. Belisle: You’ve been listening to Love Maine Radio, show number 173, Maine Wellness 2015. Our guests have included Dr. Lisa Ryan and Dr. Craig Brett. For more information on our guests and extended interviews visit LoveMaineRadio.com or read about them in the January issue of Maine Magazine. Love Maine Radio is downloadable for free on iTunes. For a preview of each week’s show sign up for our e-newsletter and like our Love Maine Radio Facebook page. Follow me on Twitter as Dr. Lisa and see my running travel food and wellness photos as Bountiful One on Instagram. We love to hear from you so please let us know what you think of Love Maine Radio. We welcome your suggestions for future shows.
Also, let our sponsors know that you’ve heard about them here. We are privileged that they enable us to bring Love Maine Radio to you each week. This is Dr. Lisa Belisle. I hope that you have enjoyed our Maine Wellness 2015 show. Thank you for allowing me to be a part of your day. May you have a bountiful life.