ALEX MANCHE Matters of the heart
Consultant cardiothoracic surgeon, Alex Manché gives readers some advice on how to avoid heart disease. He also plays the piano and paints. Is there anything he can’t do, asks Marie Benoît
Mr Alexander Manché really needs little introduction. He is a rock star in his field and much admired not only for his capabilities but also his devotion to his patients. Those who know him will tell you that he is a man of conscience, humane and a perfect example of C.P. Snow’s ‘The two cultures’. He is a consultant cardiothoracic surgeon and chairman of the department of Cardiac Services. He has some 100 scientific papers to his name. Few don’t know of his existence.
Mr Manché feels that he was always destined to be a doctor. “Genes certainly played a role in the matter. We have always had doctors in the family, ever since my ancestors came to Malta from France in 1751.” Six of his seven uncles were doctors . “My maternal grandfather, Salvatore, was a chest physician, and my paternal great-greatgrandfather, Lorenzo, became the first professor of ophthalmology in Malta and, with his son Charles, also an eye surgeon, founded the philanthropic Ophthalmic Institute in 1908.”
Mr Manché is also a gifted musician and artist. He explains how his father Gilbert, who was a pharmacist, took up a new post in the then Dowty Rubber Company and was asked to go to Cheltenham to study rubber technology for a year. “With my parents abroad, I spent this happy time with my paternal grandfather, a musician and artist, and he instilled in me a love for both these fields.”
He recalls that grandfather Bertie “was immensely patient, disciplined, and obsessed with the minutiae of life. We spent many long hours perfecting those scales and arpeggios on the piano, as well as copying paintings his cousin had created, down to every detail. Today I tell my patients that it is a joy for me to stitch evenly and we owe it to my days with granddad.”
Allow me to skip the years he spent studying in Malta, England and the USA and how he decided to specialize in cardiothoracic surgery. When a chance presented itself to set up the first cardiothoracic unit in Malta, after an absence of 17 years, he jumped at it. “Practicing here in Malta was a unique experience in that the work encompassed pediatric thoracic, adult cardiac, thoracic, and esophageal procedures, as well as the occasional transplant. My initial worry was that I would be underworked on a sunny island with a healthy Mediterranean diet, but add the cigarettes, stress, junk food, one of the highest incidences of diabetes, overpopulation, and three cars to every four people, and it soon becomes obvious why my phone rings incessantly. Patients have open access to me and sometimes I feel my role can be aptly described as a parish priest with a medical background.” Of course it is easy to become isolated here, “but regular contact with UK and Italian colleagues makes one feel an integral part of the small community of cardiothoracic surgeons that we are. The first years were an exercise in development: purchasing equipment, training staff, and convincing them we could do it. Being the only consultant on the island was extremely taxing, but conditions improved when, seven years into my post, two of my trainees shared the workload as independent surgeons.”
I could listen to this gentle and gifted man for many an hour. So simpatico and low key. But we had to get down to what this interview is about: problems of the heart and some solutions.
Mr Manche what exactly is the Malta Heart Foundation, what are its aims?
This is a voluntary organization that has as its principle aims the dissemination of knowledge in heart matters, and the donation of equipment for the treatment of heart disease.
What are the rules-of-thumb for a regular person to take care of his or her heart?
Avoid stress, keep active and do not indulge in bad habits such as smoking, recreational drugs, junk food and sweets. On a spiritual level strive to achieve a sense of balance and order, practice moderation, seek knowledge and share happiness.
It’s still shocking to hear of a perfectly healthy individual going into cardiac arrest. How do we put this into perspective?
Sadly some heart conditions do present suddenly with serious, sometimes fatal rhythm disturbances. Survival in such instances depends very much on who is around at the time. However cardiac arrest often happens in the context of a worsening clinical situation that is not given its due attention. Any perceived deterioration in one’s physical ability should be checked out.
Are heart diseases hereditary?
Certain electrical disturbances and muscle abnormalities of the heart are inherited. A person born with abnormal tissues in the valves and aorta can suffer stretching and rupture, with fatal consequences. A history of premature death should always alert us to investigate other family members. Many times an astute doctor will recognize subtle physical characteristics pointing to a particular inherited condition. Coronary heart disease has as much to do with heredity as to lifestyle whereas the increasingly prevalent aortic valve disease is a consequence of advancing age.
Is walking better than jogging, or is more intensive exercise required to maintain a healthy heart?
Do not run before you can walk. Jogging is OK up to a certain age but it takes its toll on our joints and may worsen arthritis later in life. I believe we can safely walk and swim well into old age.
How can one control cholesterol content without using medicines?
We can lower LDL (bad) cholesterol by consuming olive oil, avocados, walnuts and almonds, oats, red wine, tea and plant sterols. We can raise HDL (good) cholesterol by consuming salmon, sardines, herring, avocados and dark chocolate. Spinach and garlic are also beneficial to helping to reduce cholesterol plaques.
We should avoid trans fats or hydrogenated oils (found in processed and fried foods) at all costs as these lower HDL and raise LDL and triglyceride levels, which are toxic to the heart. A high-sugar diet is equally disastrous.
Exercise and stress-avoidance have been shown to improve cholesterol profile.
Which is the best and worst food for the heart?
My favourite best food is salmon sashimi, my worst soda drinks.
What is the routine check-up one should go through? Is there any specific test?
Check yourself with a daily brisk walk. Choose a family doctor who will always be there for you and be guided by this trusted confidante as to which tests you need. Remember that much self-inflicted damage, like that resulting from smoking, is not apparent on routine testing and usually presents with a catastrophic complication. Minimizing risk is our first priority, testing follows on.
What are the first aid steps to be taken when someone is having a heart attack?
Remain calm but be effective. Call 112. Comfort the victim. Attach an AED (Automated External Defibrillator) if one is at hand. Perform CPR if you cannot detect a pulse or breathing. Enroll any help you can get until the ambulance arrives.
What is an average day for you like a) in terms of work b) in terms of food and exercise?
I awake at 5am, I read, I catch up with news and emails and start seeing patients at 6.30am. On two to three days per week I operate between 9 and 4pm. I normally see patients until about 6pm, sleep about 11pm and answer calls 24/7. I am in hospital every day and do most of my writing on weekends. I love to travel and I am told I fill my day even more when abroad!
I am blessed with a delicious supper, washed down with a glass or two of good wine in the company of loved ones.
I walk as much as I can, helped by the long corridors and many stairways of Mater Dei hospital. I should do more exercise.
The Malta Heart Foundation Gala Dinner is being held at Le Méridien St Julian’s on 3 December. It has now been fully booked.
Avoid stress, keep active and do not indulge in bad habits such as smoking, recreational drugs, junk food and sweets Coronary heart disease has as much to do with heredity as to lifestyle whereas the increasingly prevalent aortic valve disease is a consequence of advancing age
Alex Manché with the love of his life, his pug Max