Detangle by Kinjal
Detangle is a podcast created by health psychologist and writer, Dr Kinjal Goyal. Each episode is a conversation with an expert in their field, as they dive deep into their journerys and experiences. The conversations are full of insight and a great way to hear, first hand, how the mind plays a pivotal role in almost everything that we do. The guests range from doctors, to writers, to those in entertainment and of course, those from mental health fields.
Detangle by Kinjal
Detangle with Dr. Aditya Kapoor
Unlock the mysteries of the heart and mind with Dr. Aditya Kapoor, India's acclaimed cardiologist who takes us beyond the EKGs and into the realm where emotions and cardiac health intertwine. Our riveting conversation peels back the layers of our emotional states, revealing how they can precipitate heart attacks and cardiac arrests. Dr. Kapoor's journey from engineering to cardiology is not only inspiring but also illuminates the critical, yet often overlooked connection between our psychological well-being and heart health. As we discuss the impact of stress on the heart, you'll gain a deeper understanding of what truly makes us tick, both literally and figuratively.
Prepare to navigate the murky waters of online health information and its influence on patient behavior. We tackle the thorny issue of self-diagnosis and the perils of unverified health advice with Dr. Kapoor, whose experiences shed light on the risks associated with alternative treatments over evidence-based medical practices. Together, we'll explore the implications of healthcare misinformation and dangers of multitasking, drawing from real cases and sharing personal strategies for maintaining emotional well-being in an ever-demanding world. So, set the stage for a healthier you by crafting your own mental first aid kit, equipped with insights from this episode, to face life's challenges with confidence.
#CardiologistInsights #EmotionalHealth #CardiacWellness #DrAdityaKapoor #PsychologicalWellBeing #HeartHealth #StressManagement #OnlineHealthInformation #PatientBehavior #SelfDiagnosis #HealthcareMisinformation #EvidenceBasedMedicine #EmotionalWellBeing #MentalFirstAid #HealthAwareness #MedicalInsights #Podcast #DetangleByKinjal #HeartAndMind #InspiringConversations #HealthyLiving #ConfidenceBoost
Welcome to Detangle, where we untangle the complexities of life one conversation at a time. I'm your host, dr Kinjal Gowil, a psychologist and a writer. It is always exciting to have a friend on the podcast and today I'm especially happy to introduce one of India's leading cardiologists and a dear friend, dr Aditya Kapoor. Dr Kapoor is a professor in cardiology and currently working as head department of cardiology at Sanjay Gandhi PGIMS. This is in Lucknow and is one of India's leading tertiary care hospitals.
Speaker 1:He has a special interest in cardiac electrophysiology, which deals with the intricacies of the electrical systems of the heart. He pursued the same during his fellowship at St George's Hospital, uk. Dr Kapoor then spent one year as director of the coronary care unit at Firmantle, australia, but chose to come back to his alma mater to continue providing patient care here. He is also deeply involved with academics and is presently the president of the Indian Society of Electrocardiology. I have had the privilege of working with Dr Kapoor since three years now, where both of us have been partners in running the National Cardiac Arrest Awareness Campaign across states, across professions, but fueled with a common purpose to raise awareness and train as many people as possible in CPR. Welcome, dr Kapoor. It is my joyous honor to have you with me on the detangle today.
Speaker 2:Hi Kenjil, it's a pleasure to be here and I have been looking forward to this conversation for the last few weeks and, as you rightly said, we have been associated on this CPR awareness program for the last three years and I've been listening to your podcast, in which you have featured so many dignitaries, so many illuminaries, so it's my proud privilege to be here today. Thank you so much for the kind words. Thank you.
Speaker 1:Well, let's get started. When it comes to cardiology, I have so many questions. I always wonder whether I can fit it into 30 minutes or more, because there's so much that is right and wrong about the way we are now perceiving the heart and mind connection. Let's start with a few questions and let's see where it takes us. So tell me in the beginning what drew you into cardiology? What was your inspiration to take this up in your field of medicine?
Speaker 2:So I've always, often wondered that. You know, many people have asked me this question. My friends, even my parents, asked me this question when I took up cardiology. And when you meet strangers on the flight, you introduce yourself, they ask you this question Doc, why cardiology? So logical answers would be we are fascinated by the heart. We are fascinated by the embryology, the working of the cardiac system, how it involves the body, how it affects people. We want to save lives. It's a technologically challenging field. So these are all logical answers. But to be very honest, I have also often wondered why I took up cardiology, and you will again be fascinated to know.
Speaker 2:When I passed out my 12th class, I actually got selected into engineering in the Delhi College of Engineering. I joined engineering for some time, even gave a few terminal exams and thankfully passed in them as well, but it was always as if I think I was always. It was in my mind that I was destined to do medicine and cardiology. There was no specific mentor we used to look up to at that time. I mean, there were a lot of doils of cardiology, but I never thought that I would. I am inspired by a specific person. We had our seniors who were really skilled at what they were doing, so we were very fascinated by them. That these guys put a stethoscope on the heart and they are going to figure out murmurs, they're making diagnosis, they are doing all these, you know, high five things like echocardiography, angiography. So this is what probably inspired me that I should be doing medicine followed by cardiology.
Speaker 1:Sir, do you have? The relationship between the heart and the mind is one of the oldest in the study of psychosomatics. Was this a part of your formal training or did you have to learn this over the years?
Speaker 2:I'm so glad you asked this question because it's never been part of our formal training and, to the best of my knowledge, it is still not incorporated in the medical curricula. And it should be, because we have learned over the time that mind and heart, they have a complex relationship. There is a very close interplay and often patients come to us and the trick is to recognize these patients in clinical practice very early, because often we need to help them in ways in which we have not been trained to do so. And if you look at our folk wisdom as well, you know there are expressions and metaphors which reflect the link between the heart and the mind. You know, just kidding, but you know there are so many expressions to pours one heart out, a change of heart.
Speaker 2:Hindi mem boltein dil ha ki mantah nahi, dil ka kya kasur. So everything is between the deal and the mind. Nobody says pancreas ka kya kasur, lever ha ki mantah nahi. So you know, just apart from these jokes, there is a lot of science behind this as well. There is a heart and brain connection. We have neural networks which are intervening between the heart and the brain. Science plays a lot of role in precipitating heart disease. We'll discuss that in the subsequent questions. Real experiences, both positive and negative, can influence our heart function.
Speaker 1:True, A dog. There is this question which we are faced with all the time, whether it is a cardiac arrest or a heart attack. There's a lot of information out there which says that stress can directly cause one of the two. So do you think it is actually possible that simply stress has caused a cardiac arrest or a heart attack?
Speaker 2:Yeah. So in the past we were not really sure and people did not think stress as an associative factor of heart attack or cardiac arrest, but now we have ample data to believe that stress is indirectly, if not directly, linked to causing a heart attack or even a cardiac arrest. I'll just take you back a couple of years.
Speaker 2:There is a very famous Hollywood movie called Hereditary and this is a 2018 psychological thriller and, very interestingly, the guys who were promoting the movie they were some company called A24. So they sort of ran a screening program. When they screened the movie, they had this audience which were sitting in the hall and they had this health tracking app. So they tracked with an Apple watch, if I am not mistaken, and they documented that when the movie was screened, the people's pulse rate shot up to as high as 160, 180. There is a definite link between stress causing increased heart rates, increased blood pressure, and all these translate into more cardiac activity, more load on the heart. So there is definite data to show that stress can cause heart attacks, and there is another medical entity called the Broken Heart Syndrome or Takatsubo Cardiomyopathy, in which we have seen that emotional stress definitely causes heart attacks, precipitates heart attacks, because of adrenergic stress. Increased blood pressure, increased heart rate probably increased inflammatory markers as well. So there is a definite link.
Speaker 1:So this is like those old Hindi movies that we would see. There would be one actor in the movie getting some bad news or feeling very angry, suddenly clutching their chest and collapsing. Now is that a real possibility?
Speaker 2:So nothing as dramatic as that. But there is definite data to believe that intense emotional stress, especially in people who are predisposed to get a heart attack older people, people who have underlying heart disease, people who are not very fit, so they can get a cardiac event if they get sudden emotional outburst or sudden anger, sudden grief. So there is definite link which links this emotional stress, intense adrenergic drive, all this can lead to sudden overshoot of the pulse, sudden overshoot of the blood pressure, and heart attacks can happen. So it is not an unknown thing, right?
Speaker 1:So now tell me now, over the years, we've all noticed life has become faster, more overwhelming, it's more stressful, and this is across all age groups. Teenagers are also experiencing more stress now than ever before, but is this showing up as an increase in cardiac issues, also across age groups?
Speaker 2:Yeah. So I think in current times we are seeing a lot of people who are coming in with stress induced cardiac events and with the increasing pace of life we have seen a lot of such cases coming in more and more. Because what happens is that stress is there in everybody's life, but the risk will vary depending on the person's coping strategies, how the persons are sort of managing their stress. So you cannot completely take away stress from anybody's life. Stress is there in everybody's life, so we should not. It is walking in and out of our life every day, but we should not let stress walk all over us. So we have to learn to manage that stress. And if we manage that stress well by behavioral strategies, by changing our lifestyles, by changing our diet and taking care of ourselves, then we'll be able to reduce these events. And it's very, very important that these events be reduced because this is one preventable factor in managing heart disease or even cardiac events.
Speaker 1:All right Now, should I? Coming now into the mental health perspective, if a patient is suffering from a mental health condition has been diagnosed let's say it is clinical depression or severe anxiety neurosis can the right pharmacological treatment also help them with their heart health?
Speaker 2:So again, that's a important question and we need to address this in current era because this is again a thing which many people are not aware of. I'll just take you back in our conversations which we had, I think, some months ago. You only told me about the article that stuck in the struggle era. Because the first thing is one has to recognize that you are stressed or you are under some pressure. And for the audience I'll just quote what Kenjale had sent me, that paper.
Speaker 2:There was a very famous gymnast in 1996, terry Strug. She was injured but her coach sort of motivated her and told her that don't worry about the injury, and even if you are not okay, you compete. And you see, I think she won the gold medal and everybody was praising her a lot. But fast forward that to current era. We have example of Simon Biles, we have example of the Japanese tennis athlete, naomi Asoka, and they have said it's okay not to be okay.
Speaker 2:So we have to first realize that we are stressed. You know it is not very good to sort of keep on working hard, because what we try to tell our, at least the younger generation, now we see a lot of people coming in, young MIs, young heart attacks, because self sacrifice or obsession with work should not be confused with heroism. And it can be harmful, multitasking can be harmful, so one has to cut down on these things and if you have recognized that the underlying problem is stress, so if these guys are well managed, with appropriate medications and refer to an appropriate physician, they will do very well.
Speaker 1:True, so do you also have cases sometimes, when a patient has a significant mental health issue and also a severe cardiac ailment? So then, how do you navigate both these?
Speaker 2:So, as I said, you know, the first thing is to recognize this and unfortunately, in many of our medical curricula this has not been often highlighted the study of psychosomatics or the interplay between the heart and the mind. So many doctors don't even recognize this and either they keep giving the patient some cardiac medication when it was not required or they are failing to recognize that stress is the underlying thing. So we have to recognize that first, and if we are able to recognize that we can navigate both the conditions. We have had a couple of case examples in the past when the patient had come in with some palpitations, multiple halters or multiple ECGs done, nothing revealed. But if you just, you know, educate the patient that there could be something else which is at play in his or her lifestyle, then these things can be addressed and the problem can be solved. So one thing is to suspect and the second thing is to refer the person to an appropriate physician.
Speaker 1:True. So that brings me to this new age gadgetry that everybody is using, and also social media. Now tell me, do you see this on a daily basis, where social media has increased? You know awareness, quote unquote. Also, new age gadgets have added to this hyper vigilance, where people are constantly aware. For example, wearing an Apple Watch or a Fitbit, they know their heart rate has varied from A to B. They also do a blood test randomly. They'll find their cholesterol or triglycerides, you know, just on the border, and they'll come to you saying, oh, I need something, I need statins because I'm going to have a heart attack. So has this increased over the last few years?
Speaker 2:Yeah, it has definitely increased because this constant connect on the digital apps, the constant impact of the social media, the newer gadgets, as you say. So I think it is like a hyper vigilance and there is an increase in the you know sort of an endless anxiety. It is something which is we are all aware of the term called cyberconrea. People search for health information online and, to be very honest, it is so sad to sometimes see the people when we tell them there's nothing wrong with you, so they feel a bit bad that we have not written them medications. They expect that even for a borderline test they will want some medications and they'll only be happy if they are prescribed some medication. So that is a sad state of affairs.
Speaker 2:We try to tell them the social media platforms that you see, they'll present a very, very curated version of people's life. They'll show you the happy things of life, the positive aspects. So constant exposure to these curated images, the snapshot of, you know, say, celebrities or anybody, the social media guys, the so-called impressionists, it will just create a feeling of any adequacy. It will impact your well-being. So we try to tell these people and the more you are on the social media, the more you have that feeling of social isolation, you will get disconnected with reality.
Speaker 2:They sort of create these filter bubbles and eco chambers, these online filter bubbles and eco chambers, where they are just exposed to information that align with their thoughts. So they'll just get those social media alerts which they have been looking for. So this is a dangerous trend and we try to tell at least the young guys who are more and more getting sucked into it that you know, up to a limit it is fine, but if you constantly go for it, you will have this information overload. So we try to deter these people, try to tell them that, okay, whatever reports you have got, we have so many people who come to us with unnecessary investigations. So my favorite line to them is you know, one of my teachers taught me that line that we want to treat you, not the investigation. So that sort of deterred them to get over investigated.
Speaker 1:I think this is a problem everywhere right now. There are these bulk reports that come in, there are these. I'm not even a medical doctor myself, I'm a psychologist. But people come with these boxes and boxes of tests and investigations which have not even been recommended by a doctor, but they have these kind of descriptions of themselves in numbers.
Speaker 2:So not only the blood reports. Sometimes people go to the extreme of getting imaging reports, including CT, coronary angiograms and other invasive tests, and then they get confused as to what is to be done and many a time there are no symptoms. So the intuitive question to ask them is that who recommended? So sometimes you will be surprised to know that they say that okay, one of my relatives said a test IOS. So this is a sad state of affairs, but again we have to manage it to the best of our abilities. We try to tell them not to get these tests done and only get these tests done if they are prescribed by a qualified doctor, because many a time they will doctor shop from one doctor to another and then seek a doctor whose opinion will align with what they are actually wanted in the first place. So that is a problem, but again it needs to be addressed.
Speaker 1:So, doc, there are people are now following a lot of these health influencers online who are coming up with health tonics, heart tonics, gizmos incredulous things that people are doing in the name of heart health, diabetes care, etc. But have you ever experienced anything like this? What's the craziest thing your patient has done to take care of themselves?
Speaker 2:Yeah, we've had couple of quite crazy things. So I'll quote you one example which immediately comes to my mind. One of the patients who had known heart disease had had some stents put in and he went to some some camps somewhere and he was told to stop the cardiac modification and start some oil or some herbal medication. So not only were the herbal medication being taken orally, but even the oil was. He was instructed to take it orally. So he took it for about one month, can you imagine. And when he came back to us he said that he's feeling very short of breath.
Speaker 2:And when we investigated, the patient was found to have severe anemia and he was actually bleeding from somewhere and that was the side effect of whatever medications or whatever oil he was taking. So that is one extreme. The patient could have had a catastrophe if he hadn't come to us in time. So this was a really disastrous situation and we counseled him to stay away from those medications in future. So now he's Hale and Hearty and he's taking whatever medications he was prescribed. So that is one really incredulous thing which happened to one of our patients.
Speaker 1:So I think this kind of information sharing amongst patients is also reducing compliance with basic instructions of the doctor. Like a patient will share their medical details online in some online group, somebody will say, oh, this is rubbish, they're doing it only for their own benefit, and patients stop trusting their own health care providers and they start trusting these anonymous people online and then fall into trouble.
Speaker 2:Yeah, it happens.
Speaker 2:It does happen because sometimes it is more convenient for them to follow these so-called influencers or so-called the alternative medicines.
Speaker 2:I'm not saying that these alternative medicines are always bad, but again, whatever changes need to be done, they have to be done in compliance with what your original doctor has told you. So many a times it happens that these patients often seek alternative opinions, alternative medical opinions they take. It's not bad to take an alternative opinion, but again, everything has to be done sensibly because many a time these patients are told to get off their anti-hypertensive drugs, anti-heart disease drugs, whichever we give them post-tenting anti-diabetes drugs and it has led to very, very bad consequences, with people coming in with blood sugars through the roof, hypertension induced strokes also rarely. So we always tell these patients that whatever you need to do, at least take us into confidence because we'll be able to give you a good judgment as to what medications you need to take and what medications you need to stop. So all this information overload is affecting cardiac health in a very bad way, but again, we are trying to make whatever difference we can.
Speaker 1:Right Now, dr, is there any advice that you wished? If the juniors right now, the ones who are just starting off in cardiology, is there anything you wish to tell them so that they can avoid the simpler mistakes and go on the right path?
Speaker 2:Yeah. So as a senior person I'm just joking we like to give a lot of advice, whether people want it or not. But what we tell all our juniors now that be good in your field. That is one instinctive thing you're going to do. Be well read in your field, take good care of your patients. That is all things which we'll teach you.
Speaker 2:But one thing which we especially emphasize on in our institution, at least personally I like to do is that we are in a position of leadership, so we want we are like coaches of these next generation of physicians, so we want to tell them that at least while you're taking care of the patient, take good care of yourself as well. So what at least I try to emphasize to my juniors is try to be a good doctor, but also take out time for yourself, take out time for your family, these so-called new age doctors, I think many a time I'm not saying all of them they are into chasing numbers and becoming more and more aggressive. So we try to tell them take out time for yourself and sit back and relax. You have to take care of your mental health as well, because we are seeing so many cases of even young doctors having adverse cardiac events because they are sort of into that vicious cycle of working, working, working. So that is a very important thing which we want to pass on to our younger generation.
Speaker 1:So basically saying healer heal thyself.
Speaker 2:Healer, heal thyself. Yes, beautiful, absolutely.
Speaker 1:Doc, this is a very personal question that I asked all my guests on Detangle. We've all heard of our physical first aid box, a box in which we keep some band-aid, some painkillers, maybe some antiseptic. This is for those minor cuts and bruises when we've had a bad day, when we need to take care of ourselves. Similarly, if we were to have a mental first aid box something which would make us happy the minute we opened it, something for those emotional bad days, if you were to keep a box like that which would make you happy as soon as you opened it, what would you put in it?
Speaker 2:I think that's such a nice question and such an important question that you have asked, because this is again a mental first aid box. I don't know whether many people are aware of this concept, but this is a very, very important and proactive self-care approach. So if I had to make a mental first aid box for myself, what I would keep is some music which helps me in my running schedule, because I like running in the evenings. I would place a couple of photographs of my loved ones, my families, in that mental kit. I would also keep a couple of coloring sticks because I like to paint as well I don't get too much time, but I would like that and a small meditation guide.
Speaker 2:So this was an audio thing which I used to follow when we were posted in COVID. It was very, very nice. It was a 30-minute meditation lecture which I used to follow during the COVID times. And one more thing is something like a stress ball or something like that. So, but definitely some music and a couple of photographs, a meditation guide and perhaps a stress ball or something like that. But the important thing is that this should be personalized to your preferences and needs.
Speaker 2:There is no sort of one to one, two, three, four, which anybody can say that you have to make it. And another important thing is you might need to modify or update it according to your changing moods, according to your changing needs. So it is not a static thing and it is not a substitute for any professional help. So this is a very good thing which everybody should have, and according to your personal needs. So this is what I would keep in my sort of kit.
Speaker 1:How lovely. That gives us more of an insight into what you are as a person. So, dog, at the end of the podcast I leave the floor open to my guests. Is there a question that you have for me as a psychologist?
Speaker 2:So many, let's start with one. So one important thing, which, again, I have had discussion with you in the past, but again you educated me about it. But I would love to have the audience also, you know, see your perspective, because many a time we have this thing about stress, that you stress and de-stress. So there is a lot of myth behind that. And another thing the advantage or disadvantage of multitasking, because nowadays the younger generation is very fond of multitasking and everybody says that multitasking is good. So these two important things, although I have a hundred other questions. Maybe we'll do a reverse podcast one day. So eventually.
Speaker 2:So what about these two?
Speaker 1:But let me take your multitasking question first, because this is a question which is very, very close to my heart. I mean I tell people that if I see another image of a woman with 12 hands doing 12 different things and people are calling it, I mean I will do.
Speaker 1:It's something we have appreciated for so long that it has become almost heroic to be able to do so many things when in fact, simply neurologically speaking, we cannot do all these tasks at the same time. All that our brain is doing is flitting from one task to the other, and at a very rapid speed. So, instead of being able to do all these tasks well, what is happening is we are doing nothing well enough. No-transcript. If we mindfully do one task at a time, we'll probably be able to do more and be more efficient without the side effect of extreme fatigue or of headaches, or even palpitations, for that matter.
Speaker 1:A lot of people come with baseline anxiety or generalized anxiety disorder simply because they're doing so much that their entire body is always an overdrive. It's very important to keep the mind in a still state, doing one task at a time. As a runner, I'm sure you've experienced this. Running can be a mindful meditation, a very active meditation, because you're focused only on that one task at hand. Now, if you're running and you're also answering phones, or if you're answering messages or checking your mails, you're not going to be able to run as efficiently. In the same way, we need to take one task at a time and do that better than doing everything at once. I hope that answers your question.
Speaker 2:I think what you said makes so much sense because, to be very honest, I also felt that there was some logic in multitasking. But when I discuss these things with you and when I actually started introspecting myself, I think your attention span varies and you will not be able to do the best possible. What we are now trying to tell a couple of our young people also that multitasking is perhaps not good and you try to focus your attention on one particular thing at one particular time, you will probably be better at it. It's not really a great thing for your mental well-being. It makes a lot of sense.
Speaker 1:Yes, Absolutely, dr Dharag. That brings me to a close of this episode of Detangle. I think it has been amazing to be able to discuss so many little things about cardiology with you. A lot of people see a cardiologist when their health falters, but they get those precious three or four minutes with the doctor who has a busy OPD. But to get these answers, to be able to ask these questions, has been a true delight. When you talk about cyber-condria, when you talk about people being hyper-vigilant, when you talk about all the crazy things people are doing in the name of heart health, it simply makes me realize that things are quite simple. We are trying to over-complicate them. We need to trust our healthcare providers. We need to trust the doctor that we are going to. It's not as complicated after all, isn't it?
Speaker 2:Yes, absolutely. It's been my pleasure and privilege to be on this podcast and to be added to this long list of celebrities which you have been podcasting with. So thank you, Thank you so much. It's been an absolute pleasure.
Speaker 1:The pleasure has been totally my end. Thank you so much.
Speaker 2:Thank you, thank you, thank you.
