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

Malta Independent - - FRONT PAGE -

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

Newspapers in English

Newspapers from Malta

© PressReader. All rights reserved.