By Dr Arul D Furtado
Mangaluru, May 4: Cardiothoracic surgeons operate on diseases that affect the organs inside the chest and on the bony structures and tissues that form the chest cavity. Coronary artery disease is one of the most common diseases treated by cardiothoracic surgeons. They also treat babies and children with holes in between the heart chambers or abnormal connections within the heart, operate on the valves of the heart and perform surgeries on the lung.
Mangaluru-born Dr Arul D Furtado, an eminent heart specialist, has carried out numerous heart operations in his career. He trained in Adult Cardiac Surgery at the Brigham and Women's Hospital, Boston, USA – A Harvard Medical School Affiliate. He then spent two years at Emory University, Atlanta honing his skills in advanced cardiac surgical techniques and trained in transcatheter aortic valve replacement (TAVR/TAVI) surgery, Minimally Invasive Cardiac Surgery, aortic surgery including endovascular repair of aortic aneurysms, Robotic Cardiac Surgery and Heart Failure Surgery including cardiac transplantation and LVAD implantation. He also worked as an associate professor - Cardio-thoracic surgery at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru.
Dr Arul credits his success to education which was largely pursued in Mangaluru. He did his schooling and pre-university at the prestigious St Aloysius Institutions, basic medical training at Kasturba Medical College, Mangaluru and went on to complete his Masters in General Surgery at the same institute. He obtained his MCh in Cardio-vascular and Thoracic Surgery from Sri Chitra Tirunal Institute of Medical Sciences, Trivandrum.
Dr Arul works at Apollo Hospital, Bengaluru as a Cardiothoracic and Vascular Surgeon at present. In a quick talk with Daijiworld.com, he shares his opinion on heart ailments and more.
Heart Surgeon – A challenging profession
Dr Arul wanted to take up medicine since a young age. “My father Dr Harold Walter Furtado is a general surgeon and Urologist, whereas my mother Dr Hazel Furtado is an Obstetrician and Gynecologist. My elder brother Dr Sunil Furtado is a Neurosurgeon. The surgery gene was hence well entrenched in the family!”.
He took up heart surgery as he found it quite challenging.
Requisites to be a heart specialist
"As with every branch in medicine there are various sub-specialties in surgery. The number of specialists graduating every year from various medical institutes has gone up which is good for the patient population. Cardiothoracic and Vascular Surgery is one such specialty. It requires 6 additional years of training after obtaining MBBS and many more years to gain the proficiency and experience to carry out complex surgeries – so once actually starts his career in the late 30’s. Heart surgery has changed significantly – the patients that we encounter are sicker, older with multiple co-existing medical conditions. The profession is demanding as the expectations are high and the margin for error is non-existent– this leaves very little time for personal life. It is not as glamorous as perceived by the public – but certainly very rewarding when you are able to alleviate the patients’ symptoms" says Dr Arul.
Heart ailments in India - on the rise
"India has become a society that is adopting a Western lifestyle when it comes to diet and exercise. Cases of diabetes and obesity are on the rise. The younger generation is so engrossed in making a mark in their careers that they have very little time or energy to maintain a regular exercise schedule. This combined with a diet high in carbohydrates like fries and wafers and refined sugars in the form of aerated beverages has led us to the brink of a diabetes epidemic. A sedentary lifestyle combined with obesity is another risk factor for heart disease – the American Heart Association recommends 30 minute of moderate physical activity at least 5 days of the week. In the absence of this, along with the above-mentioned factors coronary artery disease is on the rise in India along with ailments like hypertension and metabolic syndromes," says Dr Arul.
"We are seeing younger people with heart disease. We should be able prevent them through campaigns wherein people are educated about leading a healthy lifestyle,".
Treating heart diseases
"Many years ago, while I was in medical school the most common heart valve diseasethat we used to encounter was due to rheumatic heart disease. Its incidence has gone down significantly – mainly due to primary prevention and various other health based initiatives adopted by our health services. As the average life expectancy of the Indian populationinches up we are seeing an elderly population with senile calcific aortic stenosis - where the valve that regulates the blood flow out of the heart becomes narrow leading to symptoms. The treatment for the same is a valve replacement surgery. Advances have been made on this front and in the West, at the age of 80 years and above, rather than resort to open heart surgery the valve replacement is done by making a small cut in the artery in the groin in a procedure called Transcatheter Aortic Valve Replacement (TAVR). The patient then gets discharged in a few days.
Technology in medical science is improving by the year. We are also encountering patients who have had a bypass surgery in the past who have repeat symptoms or come back to us with a failing heart.We use certain procedures to relieve the symptoms of these patients or use devices to help them recover.A case in point is LVAD’s (left ventricular assist devices) for heart failure if they are not candidates for a heart transplant and for those with heart failure where routine surgery is not feasible"
"The general notion is that heart surgery is associated with high risk and high complication rate. Yes; that used to be the scenario in the early days of heart surgery abroad and in India until a decade back. The processes have been streamlined over many years to reach a point where heart surgery is no longer associated with unacceptable risks for most patients when performed by well trained, competent surgeons" says Dr Arul.
Cost-effective treatment
"The number of patients suffering from heart related ailments is on the rise. The government has taken cognizance of the fact and is trying to make cardiac related healthcare available to the entire spectrum of the population. Various schemes have been introduced. They have worked out a mechanism where heart surgery can be done at a break-even cost for the provider and the patient gets relief from his affliction. In that way heart surgery has become cost effective."
"Not all of us are eligible for these government schemes. Currently, it would be fool-hardy for a person to not have medical insurance as medical treatment can be expensive in good, reputed centers. Not just the heart but other organ systems are bound to be affected as one ages. It would make good sense to cover the entire family under insurance."
"A lot said in the media about the cost of medical services in India. If comparisons are to be made - procedure costs are much less in India than abroad – a coronary artery bypass procedure (CABG) costs about Rs 2.5 lac in India; the same costs $60,000 in US," says Dr Arul.
“With the dawn of the digital age most of the patients would be well versed with their disease – they should seek out the best doctors for the job and place their trust in a team that delivers good results consistently.”
Challenging situations
"As people age and grow older they have multiple co-morbidities. As surgeons, we occasionally face challenges dealing with different types of patients;as have I in my 13-year career. Nearly always we come through successfully – this is all down to years of training and experience gained on the job over the course of time. There are challenges on the way, but we have to be ready for it," states Dr Arul.
Advice for young medical graduates
"By and large, you should have a passion for the profession. It isn’t just a job that you are doing but tending to a patient – a fellow human being who has reposed his trust in you. Certain specialties like surgery are physically demanding and take a toll on you on the emotional front. If you are interested in medicine, your goal is to cure patients and if you have passion for medicine, all other things are secondary. The trust and goodwill that you gain from your patients and their family members is incomparable to anything else encountered in other professional fields. It basically boils down to having patience with your patients, lending them an ear to enumerate their problems, providing them a helping hand and taking on the role of a healer by being a compassionate doctor."
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