Baystate Health's Dr. Amir Lotfi takes a team approach to helping his patients stay healthy.
Baystate Health cardiologist Amir S. Lotfi believes in exercise both for his patients and himself. A married father of two young children, he is up mornings at 5:30 exercising on his elliptical in his Westfield home before heading to the Davis Family Heart & Vascular Center at Baystate Medical Center.
Lotfi is medical director for the inpatient heart and vascular program as well as the Baystate Regional Heart Attack Program.
The 47-year old physician became an interventional cardiologist out of a passion for the science of medicine and the hands-on satisfaction of unblocking patients' clogged arteries through such procedures as insertion of coronary stents. His interest in the science began to meld along the way with a deeper understanding of the emotional and situational challenges patients face after a cardiac event and in staying healthy long-term.
He likes to build what he calls 'partnerships' with patients to help them on their way to healthier lifestyles. It is a collaborative approach where he tries to get to know his patient beyond the cardiac event that initiated treatment, so they can address obstacles to changing unhealthy habits together and what support is needed to overcome them.
"You can't just say, Amir, you had a heart attack. Here are five pills, go home. That does not really address the bigger question. We don't just want people to survive a heart attack. We want them to go back and live a full functional life with their family," said Lotfi, who will give a free talk on "The Science and Art of Medicine" today, Feb. 19, from noon to 2 p.m., at the Baystate Health Education Center, 361 Whitney Ave., Holyoke.
In addressing lifestyle changes, Lotfi said he tries "to connect with patients on what is the most important thing, and usually what is most important to people is their family."
"Their partner, if they have children, their children. I say to them, when you do all this hard work and it is so stressful and you are finally ready to retire, do you want to be a person who sees 10 different doctors because that is what you have to do," Lotfi said.
"Do you want to be someone who goes in and out of the hospital. Or, do you want to be spending time with the grand kids and taking your partner on vacation. That is an easy choice."
For many patients who need to lose weight, he says, "Here is the question."
"You and I spend 20 minutes with each other. You have the rest of your life. If we don't figure out a way for you to lose weight, you increase your chances for diabetes. With diabetes, you increase your chances of being on dialysis, blockages in your legs and heart. With a high-salt diet, you end up with a high likelihood of high blood pressure. Combine that together and you are setting yourself up to be on 10 different medications and multiple physician visits," Lotfi said.
"The ball now is in your court. It took you 20 years to get to this point, but if you are willing to work together, let's try in five years to get you to where you want to be. That is how I work with people. What I say is this is our partnership. It is not 'I will see you two times and I won't see you again.' Our partnership is we build our partnership together until we reach our goals."
Lotfi said he picked the topic of his talk, part of Baystate Health's Heart & Vascular Lecture Series, to explain what "changes occur when you have a heart attack," as well as "when people have heart attacks or heart problems, it affects them in a psychological way."
"Their body, their mind goes through a trauma and it has this effect of how they relate to others, how they relate or see themselves and how that can have an impact on their future health and their future needs," Lotfi said.
"Think about being in an environment where every time you have a twinge you think 'I could die.' How that works everyday. That is not a good quality of life, especially for younger people who have heart attacks. You notice that the anxiety level goes up because they are always in constant fear of their health. The other thing that happens is that because it is sometimes so fearful to think about it, sometimes people go into denial. They say, 'I don't have any problems.' They don't take their medications."
In talking to his patients, Lotfi said he "explains what is going on with the heart from a scientific point of view and why you are on these medications," but also stresses the goal of getting back to a "functional life."
"I am a true believer in cardiac rehabilitation. In a controlled environment, people get to exercise and see how well they are doing. They talk about their medication, their lifestyle and it is immediately after the heart attack, so they are around people who have had heart attacks 10 years ago and they still enjoy going there," said Lotfi of the benefits of participating in a medically supervised work-out program after a cardiac event.
"One thing I hear commonly from patients in the program is, 'I see this guy who had bypass surgery and he is doing fantastically.' Suddenly, they realize, 'I am OK. This is not the end of the world.' They also see people are taking their medications and doing well."
This acknowledgement of a patient's psychological states helps, Lotfi said, "set up the doctor-patient relationship of trust, where it does not become a uni-directional partnership where I just give you information, but really understand the fears of what happens."
Lotfi said such a relationship can help a doctor help a patient not return to habits that contributed to the cardiac event. He said he has seen patients regain weight and return to smoking in the aftermath of a near fatal cardiac event as a result of going "back to the same environment."
"It is something that happens to all of us. Something bad happens to someone and you say we need to slow down and spend more time with our families. This may last anywhere from 24 hours to a week, depending on how close that person was to us, and then we get back to our own routine," Lotfi said.
"We go back to the same environment. We forget what happened to us."
As a physician, Lotfi said he "realized that there is that short-term event when you fix a valve. You put in stent. But, if you really want to have a long-term impact, you have to change behavior and that takes building relationships and confidence with each other."
"You can't ever predict the future, but you make the trauma that happened less likely to happen," said Lotfi, adding that a key approach is finding one that a patient will be able to sustain or commit to over time for permanent results.
Besides talking to his patients about cardiac rehab, Lotfi said he encourages them to "work with their family, talk with their peers."
"'I don't want to tell my wife I am anxious about this because I don't want to worry her,'" Lotfi said of what he hears from patients.
"That doesn't help. Talk to your wife. Talk to your husband. Talk to your partner and let them know what your fears are. If you are going to stop smoking, but your partner still smokes, the chances of you stopping smoking are almost zero. Go to your partner and say, 'I am really worried about my health, I want to stop smoking and I want you to help me. Can we do it together?'"
Lotfi said some of his patient success stories have involved a creative approach on his part.
"I had a mother and daughter who smoked about two packs a day each. I said, 'I just want you to do this for three months, if you can, cut it down to a pack a day and after you buy a pack at the store, put the other money in a jar and come back to me in three months and tell me how much you have in that jar.' They were shocked. Now both of them have stopped smoking and they are planning their cruise with the money they saved," Lotfi said.
Lotfi said he had another patient, in his 30s, who came to see him for shortness of breath and being grossly overweight.
"The 45-minute visit turned into an hour and 20 minutes," Lotfi said.
"We examined his life and why he gained weight. He had two daughters and I said if you really want to see your daughters graduate from high school, go to college and walk them down the aisle if they decide to get married, you know what you have to do. There is nothing that is going to alter that. In three years, he lost 250 pounds," Lotfi said.
"At the age of 39, he has another 50 years of life in front of him. I know that made him feel good, and it made me feel good."
Lotfi added, "It is these stories that motivate me and make me want to not only want to do the mechanical part -- putting in stents, talking about the physiology and all that -- but also the part that these are real human beings with real human lives and the heart is just one organ."