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“Depression is a major cause of stress and hence heart disease.”

Dr. Chandrashekhar Kulkarni is a full-time Cardiac Surgeon in Hiranandani Hospital. Having trained in Apollo Hospital and the prestigious Greenlane Hospital, Auckland NZ, Dr. Kulkarmi has more than a decade of experience. In a recent chat with My Powai, Dr. Kulkarni spoke on various topics. Excerpts:  

Can you walk down memory lane and tell our readers about your formative years? 
Being Born in Mumbai , the infectious desire to excel in life comes early. Getting admission to LTMGH (Sion Hospital) was a dream come true as you are one of the top 125 students in Mumbai. I did my MS gen surgery from TATA Memorial Hospital and Cardiac surgery qualification from KEM Hospital, Mumbai where the world's seventh heart transplant was attempted. In the academic zone, I was fortunate to earn 3 university gold medals and a number of other prizes. The best one was though finding a soulmate who is a PhD in Pharmaceutics.
A quest to excel and see one of the stalwarts of cardiac surgery led me to Apollo Hospitals, Chennai where I worked with the famous heart surgeon Dr M R Girinath. From him , I learnt the first things in life of how to preserve HUMAN values with the kind cruelty of the knife that a surgeon wields. Approach to problems was deepened by the insight that a surgeon should always NOT get in one. This lead to a further stint at the prestigious Greenlane Hospital, Auckland NZ  as a Cardiothoracic and transplant fellow with hands on training in heart and lung transplant.
My interest in preservation of normal body function in major surgery as heart surgery led me to start specialising in minimally invasive cardiac surgery where the emphasis is to do the surgery without bone cutting. This not only reduces the trauma but also makes the patient recover from the surgery psychologically. The treatment that heals body and mind at the earliest is the one that is most suited to the patient and as a doctor, I very much believe in resituating both.

When did you start thinking of becoming a heart specialist? 
I guess as I was learning more about the body in the course of MBBS, heart as an organ got me very fascinating. The heart is a mini factory that does good amount of supply chain management of blood and also generates enough electrical and mechanical activity to generate and consume energy as a whole. Being in an impressionable age, certain fascinations make the heart rule over the brain. The very time you see a 2 D echo with all the active movements, it is sure to hook you on. No reason why heart is a symbol for love and expression . 

What are the key requirements to become a successful heart specialist? 
This is where the brain finally takes control over in training and sustaining to be a heart surgeon. Long hours of training, foregoing many weekends for years together and the ability to take split second decisions under duress are the building blocks of this career. It is very difficult not to have obstacles on the way but they are the same that  wisen you and condition you for the long road ahead. One other very important requirement is the family support and an understanding partner without which the surgeon will be left with no enthusiasm. There are many instances where family takes a backseat, but seeing though thick and thin is the only source of confidence that a doctor will receive.

Do you think there is a spike of heart ailments among youngsters? What do you contribute it to?
Improved means of diagnosis can itself increase the number of heart cases but more important reason  is the structural problems in a patient. Being born in the Indian race, predisposes you to have heart disease and by not adhering to a healthy lifestyle you only add fuel to fire. A number of patients have heart disease without any risk factors due to the inherent metabolic issues of Homocysteine and Apolipoprotein deficiency . Screening for them in early age or if one has a strong family history is a wise option. I would say if either of your parents have a heart disease, one must get checked at least 10 years prior to the index case. 
With increasing smoking  in women , the protective effects of being a female are also blunted and we are now seeing many young women with heart disease.  
The youngest patient I have operated for a bypass was 28 and am sure there will be many more younger than him to get a heart attack. Aerobic exercises are the way ahead and staying away from complacency itself can save many lives.

What would your advice be to youngsters on taking care of their heart? 
Apart from the usual advice of a healthy lifestyle, the one thing that young adults must change is the approach to stress. Stress busting is a learned response and it has to be inculcated in young with zeal in order to reduce its linear and cumulative effects. Stress is not only in studies but also in peer pressure, failed relationships, rapid globalization and the feeling of being left out. Depression is a major cause of stress and hence heart disease. The overall caloric requirements need to be tempered right from the age of 18 in young adults in India and I guess regulation of food and food ingredients need to be done as a method of primary prevention. The concept of DIABESITY ( diabetes and obesity ) has to be brought to the fore and hence the emphasis on right choices, right exercises and avoiding extra sugar is very much needed. 
For patients with established heart disease, a regulated diet with fat and carbohydrate reduction and a good dose of seasonal veggies and fruits with antioxidants are essential.

What is your super-speciality or area of interest?
Small incision heart surgery is being advocated for almost 50% of the patients who undergo heart surgery . We at Hiranandani hospital have performed many challenging cases of bypass, heart valve replacement, heart valve repair, hole in the heart surgery and surgery for control of irregular heart beat with encouraging results. Restricting the length of the incision not only helps the patient acceptance but also reduces the ICU and hospital stays. Most of the patients are discharged in 5-6 days and there is no need to use any chest belt. It is also well suited for diabetic patients who otherwise have a poor profile of bone healing. Since we do not damage the bone in any way, having delayed infections and poor healing of the fracture of the bone is out of question. 
Also the patient has a faster recovery and can start his desk job in 3 weeks or so . 

What are your hobbies? 
My only hobby is to devote as much time to my kids and to be in their company. Every interaction teaches us a new approach to life and to learn from them is the best form of schooling. Hobbies are pursued to recharge your spirit and mind. What else could be better than a fun filled laughter and finding your own childhood in the kids eyes.

                                                                                               - Dr. Chandrashekhar Kulkarni