In our previous episode, Tun Dr Mahathir Mohamad reminded us that even the strongest hearts need care and that recovery begins with belief.
But behind every story of recovery stands a healer.
This week, we go behind the operating-room doors with National Heart Institute CEO and Senior Consultant Cardiothoracic Surgeon Prof Dato’ Dr Mohd Ezani Md Taib - the very heart of Malaysia’s cardiac excellence.
From open-heart surgeries to cutting-edge robotic innovations, Prof Ezani takes us through how far cardiac care has come, what everyday Malaysians can do to protect their hearts and the mindset needed to recover and thrive after surgery.
A candid, inspiring conversation about health, resilience and the future of cardiac care in Malaysia.
Watch “Matters of the Heart (Part 2)” only on Sinar Daily’s social media platforms.
#LifeStylePodcast #SinarDaily #MattersOfTheHeart #ProfEzaniMdTaib #NationalHeartInstitute #InstitutJantungNegara #IJNMalaysia #CardiacCare #HeartHealth #MalaysiaHealthcare
But behind every story of recovery stands a healer.
This week, we go behind the operating-room doors with National Heart Institute CEO and Senior Consultant Cardiothoracic Surgeon Prof Dato’ Dr Mohd Ezani Md Taib - the very heart of Malaysia’s cardiac excellence.
From open-heart surgeries to cutting-edge robotic innovations, Prof Ezani takes us through how far cardiac care has come, what everyday Malaysians can do to protect their hearts and the mindset needed to recover and thrive after surgery.
A candid, inspiring conversation about health, resilience and the future of cardiac care in Malaysia.
Watch “Matters of the Heart (Part 2)” only on Sinar Daily’s social media platforms.
#LifeStylePodcast #SinarDaily #MattersOfTheHeart #ProfEzaniMdTaib #NationalHeartInstitute #InstitutJantungNegara #IJNMalaysia #CardiacCare #HeartHealth #MalaysiaHealthcare
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LifestyleTranscript
00:00Assalamualaikum and a very well welcome. Welcome back to our part two of Matters of the Heart
00:06with Sina Daily Life and Style Podcast with me, Dr. Nur Hamidzah Zulkifli, as your host and your moderator.
00:12So in our previous episode, we have heard from the man himself who underwent two bypass surgery,
00:19Tuan Dr. Mahathir Mohamad, the story of courage, resilience and also unwavering discipline.
00:24A reminder that even the strongest heart needs care and that recovery begins with relief.
00:31But behind every successful story, sends a team of dedicated healers and at the heart of Malaysia's cardiac excellence,
00:39nonetheless, is the Institute Jantung Negara, IJN, a world-class institution that began with a vision
00:46and today continues to save thousands of lives every year.
00:50And I'm so proud to be here with me. I have Professor Dato' Dr. Izani, Mohamad Izani Mattaib,
01:00Chief Executive Officer and also Senior Consultant of Cardiothoratic Surgeon in IJN.
01:06In this part, the second part, we would dive into in terms of more technical matters,
01:11more in terms of the medical expect of cardiac surgery.
01:17So thank you so much, Dato'b.
01:18You're welcome. Assalamualaikum.
01:20So we will uncover how far cardiac surgery has come from, I think we have discussed about it,
01:28the previous episode that Tuan Dr. Mohamad mentioned that those days there was not even,
01:33IJN was not there yet.
01:35And then from open heart surgeries, then we have minimally invasive surgeries,
01:39and more importantly, what Malaysians can do to protect their own hearts before it's too late.
01:44So let's dive into the matter per se.
01:47So Dato, I just like to ask, we often hear of people who look healthy,
01:53and most of them they are young, but suddenly they suffer a heart attack or probably sudden cardiac arrest.
01:59So maybe, what are the early warning signs that sometimes it's already there or subtle,
02:04but they tend to ignore it.
02:05So maybe you could share in terms of the red flag sign and symptoms that the patient should not ignore.
02:10Sure, so first of all, thank you very much for having me.
02:13Today, it's a real privilege.
02:16I think, yes, because I've been with this profession for the last more than 30 years,
02:22and I've seen the changes that has happened both from the patient perspective
02:26and from the technology perspective.
02:29And I think first of all, with regards to younger patients getting heart disease,
02:33yes, I think that's the truth, okay.
02:36The reason, well, you mentioned about why they look healthy, but they get a heart attack, right?
02:42So, well, looks can be deceiving, as you know, right?
02:45So the thing is, most important is what do they have with them in terms of both genetics and diseases, right?
02:54So, and lifestyle.
02:56So, what you cannot avoid is your genetics.
02:59So, if you're a gene, you carry genes that have got high risk of coronary artery disease or heart disease,
03:04then unfortunately, you will have it, yeah?
03:06Secondly, males are more prone than females, right?
03:09So you're lucky, right?
03:11So then, that's the one that you can change.
03:13But the one you can change would be those that you, lifestyle.
03:18No exercise, you should exercise, smoking can stop smoking, food intake that you can cut down, right?
03:23But then, the diseases itself.
03:26So, if unfortunately, you have diabetes or hypertension or high cholesterolemia,
03:32then you should manage that and make sure that you take care of it well.
03:37So, like in Nigeria, we have a new clinic that goes for reducing risk factors, right?
03:42So, if you have diabetes, the idea is to prevent getting complication of diabetes.
03:47So, the red flags are those factors.
03:48If you have those issues, then you should be cutting them one by one.
03:54So, if you're smoking, stop smoking.
03:55If you're not exercising, exercise and so on, yeah.
03:57Okay, right.
03:58But sometimes we can see there are people who are actively doing marathons.
04:03Oh, yes, okay.
04:04And suddenly, they just collapse during the event itself.
04:08So, could you just...
04:08Right, I think, okay.
04:09So, on that note, that's a bit different.
04:12So, these are people who have been exercising and suddenly, you know, unfortunately, they die.
04:16You know, recently, as you know, at the recent school event, which was a rugby event,
04:21and there was one young boy that passed away on the field.
04:25Now, the thing is, that's why health screening is very important, right?
04:31As early as 30 years old, you should start screening, really.
04:34Especially if you want to get involved in sports.
04:37And especially if you have risk of family history of dying early.
04:43You know, high risk, yeah.
04:44So, that would be something which you have to be careful.
04:47And I think it's identifying whether you have any heart pathology.
04:51Common, common things common, which is in those that die, sportsmen especially,
04:56is when they have, their heart muscles are enlarged, right?
05:01Or, you call it hokum, obstructive cardiomyopathy, right?
05:05And also, if they've got erythmonogenic features,
05:09which means that they can get erythmias easily, right?
05:13And these are the people that you will need to do.
05:15Actually, some basic tests you should be able to identify.
05:18So, we encourage those that want to take up sports,
05:21or doing rigorous sports that this should be screened.
05:24Okay, so that is something new.
05:27I mean, because most of the time, people would have this false perception
05:30that if they are healthy, they are working out, they are good.
05:33But actually, before you actually embark in those extreme sports,
05:38I mean, or the heavy sports, you should be screened first, yeah?
05:41Yeah.
05:41Okay.
05:42Right, so going back to, in terms of the bypass surgery and also heart attack.
05:49Okay, as we all know that in this modern cardiology era,
05:53stenting is often seen as the probably simpler options.
05:57Yes.
05:57And then, because last time, those days, I think maybe decades ago,
06:01if you have heart attack, then surgery is the goal number one,
06:05I mean, treatment.
06:06But nowadays, we have stenting is have slowly,
06:09not, I wouldn't say replaced, but it's another option.
06:12But bypass is still considered the goal standard in some of the cases.
06:17Correct.
06:17Okay, which is, they are much more superior as compared to stenting.
06:20So maybe you could elaborate in terms of what are the patients
06:22which is suitable for stenting, or which one they should go for bypass surgery.
06:27Shouldn't they really try for stenting, actually?
06:29Okay, so we know for a fact that, as you know,
06:32in the heart, there are three main blood vessels, right?
06:35So the more, in principle, the more blood vessels that are blocked is more towards surgery.
06:43Okay, so if you have a single vessel that is blocked,
06:46then perhaps stenting or ballooning is the treatment of choice,
06:49or even two vessels, you know, that's number one.
06:51So I think the most important thing is when you have a heart disease,
06:55you have had a coronary angiogram done by a cardiologist,
06:58you need to ask a few questions, you know, how many vessels are blocked,
07:04you know, and whether it's amenable to PCI or stenting or surgery,
07:10and sometimes, which, some things can be done,
07:13but whether that is the best thing to be done, yeah?
07:16Yes, surgery is the gold standard, especially for triple vessel disease,
07:19disease with left main stem disease, and those with diabetic, like diabetes, yeah?
07:24So those sort of conditions, surgery is a better option.
07:29Second thing is the nature of the blockages.
07:31So if it's a diffuse disease, that means the blockage is almost the whole length of the vessel,
07:37surgery is a better option, but if it's very discreet, then perhaps stenting is better, yeah?
07:42Okay, okay.
07:43So it's best to have actually, sorry, it's best to have actually a multi-discipline discussion,
07:47right?
07:48And maybe you want a second opinion rather than straightaway having.
07:51Whether, you know, if somebody offers a straightaway surgery,
07:53you might want an opinion of whether the stenting can be done, yeah?
07:56Okay, okay.
07:57So it's not, I wouldn't say like which one, I mean, of course,
08:01you have an option between stenting and also surgery,
08:03but like Dr. Isani has mentioned, it depends on which, I mean,
08:08how many vessels are actually blocked, and whether the disease are the whole vessel
08:12are actually diffused with the disease, or also in certain group of patients
08:16where they are diabetes, they are diabetes, so surgery would be probably,
08:20would carry a better outcome as compared to stenting.
08:24So you mentioned early part before the podcast that you have been in this fraternity
08:30for 30 plus years, right?
08:31Yes, yes, I've been doing this for 30 plus years, right?
08:35So you've been performing countless hard surgeries, of course, over the years,
08:39and how has the experience evolved for patients today as compared to decades,
08:44like a few decades ago?
08:45So, I mean, are the surgeries now, because maybe the acceptance of the patients
08:50nowadays is a bit better as compared to you before?
08:52Is it because the technology, it's, it's, it's, I mean, it's much more safer nowadays
08:57because it's more common that we are seeing patients undergoing bypass surgery nowadays, right?
09:01So maybe you could share what's the difference between those days back then and now?
09:05I think experience first, yeah?
09:08So when I first was exposed to cardiac surgery, I remember it used,
09:12one bypass surgery is used to take the whole day.
09:14You start from 7 in the morning and finish at 5, you know?
09:18And it felt really complicated and difficult, you know, and time consuming.
09:25But over the years, that's, that's down to maybe 3, 4 hours, you know,
09:29some, some are even earlier, you know?
09:31And, but what has changed a lot is, of course, the general anesthesia,
09:37the intensive care management, and our understanding of patients' behavior
09:43after cardiac surgery.
09:44Okay, like for example, the case I did today, patient had a mitral valve repair done, right?
09:50Okay.
09:51In the past, right, the patient would be brought to ICU,
09:55would be on the ventilator for maybe almost 12 to 24 hours
09:59and extubated or removed from the ventilator until the next day.
10:03In this case today, the patient was extubated immediately and arrival to ICU.
10:07So that's the ERAS, the, you know, early recovery after surgery.
10:12So we do that now and, you know, it's something which it's, you won't be able to comprehend
10:17if it was like maybe 10 years ago, you know, to see a patient straightaway extubated after surgery.
10:22So things have changed.
10:24Our anesthetists are far better now, far better equipped, you know, more knowledgeable.
10:29Surgery-wise is the same.
10:31Surgery-wise is the same.
10:32You know, you do the bypass is the same.
10:33But taking care of the patient, that's what's the main difference.
10:36And I think experience a good team of nurses, paramedics, and of course the doctors.
10:44That makes the main difference here.
10:46All right.
10:47I am actually quite short because I was a cardiothoracic medical officer for almost 4 years.
10:52Normally post-operatively, what Dr. S. N. has mentioned, usually will keep the patient ventilator.
10:58I mean they have tubes for at least 12 to 24 hours and then once everything is okay,
11:02parameters are okay, then they will be extubated.
11:04But I'm quite surprised that he's dead up.
11:07Even for bypass surgery, you do that now.
11:09Yeah, that's quite common.
11:11Yeah, and last time was a long hour surgery.
11:14And I think tomorrow, Dr. Isani, he has meeting in between, he has an operation and he has meeting after that.
11:18I am like, wow.
11:19Yeah.
11:20Okay.
11:21So I just want to talk about some misconceptions that the patients might have.
11:26Because many Malaysians still fear of the heart surgery.
11:29Although, I mean like now you have mentioned regarding the is now is actually faster.
11:33I mean the teams are much more well equipped.
11:36Well, you know, I mean they have a lot of, we have advanced in terms of now we have the enhanced recovery after surgery.
11:44But some of them are still worried because they feel that surgery is the last resort.
11:48So how do you actually reassure your patients?
11:51Because sometimes there are some of them still reluctant.
11:54They keep on coming, giving TCA again and again, but they still haven't come up through the decision for surgery.
11:59Well, actually the most important thing that has, you know, is explaining to the patient, right?
12:03So most of the time they think that after cardiac surgery, they will be bed bound for weeks and, you know, they cannot do their daily activities.
12:13So when you explain they, it's very difficult for them to even actually imagine that on the second day after surgery, they are already doing their exercises, walking and they have to go to the gym.
12:24In IJN, they have to go to the gym on day four, right?
12:27So they actually go down from the ward to the gym, do their treadmill or they do their cycling especially, right?
12:34Exercise.
12:35It's a requirement.
12:36So for when they hear that, then they realize that, hey, wait a minute, this is almost like nothing lah, you know what I mean?
12:43Of course there's risk and we will always explain the risk.
12:46There are some patients that are low risk, there are some are high risk, you know.
12:50Some patients will not be able to have a quick recovery.
12:53We know, especially those with a poor heart or many risk factors.
12:57But in essence, when we explain to the patient and in Nigeria, we have what we call a pump talk, if I'm not sure you remember.
13:03So the patients will be shown videos of how the recovery is like and how the ICU is like.
13:09So when they see, they have an understanding of what happens to them.
13:13Okay, so that's the most important thing for those, I think, medical professionals is how you counsel the patient.
13:19I think not only in cardiac surgery, in any surgical fraternity is how you counsel to the patient.
13:26I mean, of course you have to tell them the risk and the complications, which of course cardiac surgery,
13:32any type, whether it's bypass, whether it's valve surgeries, I mean valve surgeries, are all major surgeries.
13:38But it's our duty to explain to the patient, to make them understand regarding the risk and complications
13:43and also the advances that now we have all this.
13:47You can actually get extubated after the surgery, a day before you're supposed to go for your exercise.
13:52So more or less like something you like a normal other surgeries as well, right?
13:56Right.
13:57Okay, so talking about that in terms of the patient per se, I just want to talk about the family support system.
14:04You know that we often say recovery takes a village.
14:07How crucial is family involvement in helping a patient to recover successfully after heart surgery?
14:13Because sometimes there are patients that the patient wants the surgery, but the family are a bit reluctant.
14:19But you also have patient who doesn't want surgery, but the family are trying to push for it.
14:24So what advice would you give to the family members to support this group of patients?
14:30Okay, so when I see the patient in the clinic preoperatively, I always insist on having a family member there.
14:36Okay, so they also understand what the patient will go through, what are the expectations, how many days they will stay before surgery, after surgery, how the patient would basically look like after surgery.
14:50So I will tell them that sometimes there's a tube in the mouth, sometimes there's none.
14:53They will have many tubes on the chest.
14:55So that helps, you know, make them understand a bit better.
14:59And of course we have counselors to help explain also in IGN to help explain, to provide them with support if they need it.
15:09And I think, but all in all, the family support is extremely crucial.
15:15So because for the patient, you know, after the surgery, if they're family members, they recover better.
15:23You know, to look at a meal, things like that.
15:25You know, so they can talk to, and actually they feel better when they can talk to the family members simply because they feel normal again.
15:32You know, so they're always uncomfortable if they're left alone.
15:35So family support is crucial, yeah.
15:37Okay, so to all those, whoever has family members who has been diagnosed with cardiac issues, for example, who has blockages, please be very supportive to them.
15:48And be with them most of the time.
15:51I mean, that is very important because they need to recover with the support from their family members.
15:57So talking about recovery per se, so we know that recovery doesn't just end with the surgery.
16:03Most of the people, they understand that, okay, once they have, I mean, like, for example, you have underwent bypass surgery,
16:11they will take a vein graft and replace it, and, you know, do a bypass surgery, and then they think that they could go back to who they were before in terms of their old habits.
16:21Because sometimes you can see patients prior to surgery, they say, okay, I've already quit smoking.
16:26But after that, they go back because they feel they're good.
16:28So they go back to their old habits.
16:31So what are the key adjustments that patients should expect in their life, especially in terms of diet, exercise, medications?
16:37Most of them will have a long list of medications, right?
16:39Okay, so, yes, no doubt that if they have risk factors, you know, first identify what's the risk factors, yeah, before that.
16:47So after surgery, once they're out of ICU in the ward, first of all, they'll be seen by our dietitian, physiotherapist, you know,
16:54and all that to explain about diet, about, you know, exercising, what to exercise, and, of course, they should not smoke.
17:02Now, the problem is that they follow this for the first three to six months.
17:07Usually, no problems.
17:08Sometimes the wife will be careful, the patient will be careful, but once the pain is gone, once they are, you know,
17:16they can't see the scar anymore, they forget, right?
17:20You know, and it's not uncommon.
17:22You'll see them smoking again or, you know, not controlling their risk factors, their blood pressure or diabetes.
17:28And sometimes it's frustrating to re-explain to them that, look, you just had a surgery last year and, you know,
17:36you know, if you're not careful, the new grafts will get blocked early and things like that.
17:40So, no doubt that explaining is important, but the gail, you know, the gail, the gail, the gail, the gail, the gail, yeah, that's right.
17:48Okay, so, you were telling us regarding that it can get blocked again because maybe some of the patients out there,
17:54they have this perception that, oh, once they have a new graft, I mean, it's like some sort of like a new heart.
18:01I mean, so, you were probably never going to get blocked again, but is it very common for you to get?
18:06Okay, so, what I do explain is that, look, if the main thing is to reduce as much risk factors as possible.
18:13So, if you are a smoker, you've got diabetes, hypertension, high cholesterol, right?
18:18So, first stop smoking, that reduces one risk factor.
18:20If you have diabetes, make sure it's well controlled.
18:23And so, so goes for hypertension and so on and so forth.
18:25So, if you try to normalise those risk factors, then you should last,
18:30the graft should last longer.
18:32If you, you know, if they are not normalised and they are high or sugars are high,
18:36then it will just come back earlier.
18:38Yes, so, that is very, very important to all the patients,
18:41other or the future post-operative patients, cardiac surgery patients.
18:45It's very important that once they have so-called repaired or probably cured your disease,
18:51you have to really take care of them.
18:52Because, first and foremost, cardiac surgery is not easy.
18:55It's a major surgery and it does not come without risk and complications.
18:58So, once it has been your, I mean, you have a new bypass graft,
19:04so you're supposed to take care and try to stop all the unnecessary or unhealthy,
19:09I would say, habits, right?
19:12Correct.
19:12Okay. So, as you all know, this, we're talking about dietary habits, our, you know, sedentary lifestyle.
19:19But, we know Malaysia is a hard-working nation, so we have long hours, long stress.
19:24I mean, like, we have high stress, little sleep.
19:26It has become some sort of, as a norm, I mean, to have to sleep like three to four hours.
19:30Even if you're at home, also, you have to work from home.
19:32So, what advice you give to patients in those who have very demanding jobs,
19:36even like as a doctor itself, on protecting their own health?
19:40And how do you personally manage your own stress and heart health?
19:45I know that IGN team, they are very, very active.
19:48They go for sometimes cycling and they're very, they look out for their heart.
19:52But, maybe you could share.
19:54Okay, I think, first of all, whatever work you choose to do or your occupation, you must enjoy it.
20:01If you find that your occupation is a chore, then you should change it.
20:06Because if you enjoy your occupation, then the stress level will come down.
20:10No doubt there will be occasional stress here and there, whether you're a doctor or you're not a doctor, right?
20:16The second thing is you must have good family time.
20:19Okay, your family, your children.
20:22Pets, you know, I think that's a good way of releasing stress.
20:26And I would encourage people to be involved actively in the exercise lifestyle, okay?
20:32Like in IGN, this week is our volleyball competition.
20:37So, I play volleyball.
20:39So, like yesterday we had the tournament and it will go on today, tomorrow.
20:43You know, so the week before was badminton.
20:45So, we frequently have this sort of programs to promote healthy lifestyle.
20:51Not just within IGN, but of course, like this Saturday, we are promoting with the RHP Banking Group, right?
20:58The Lekas Ride.
21:00And so, you know, IGN tries to promote that and encourages patients to promote that.
21:04So, if you don't have heart disease, my advice is, you know, stay healthy, enjoy your life and, you know, don't be too stressed.
21:15Because, you know, unfortunately, I mean, there will be stress all the way, but there's always a solution to a problem, right?
21:23And has a famous quote by Jack Ma, if I recall it right, right?
21:27Today might be a bad day.
21:29Tomorrow is worse, but the day after will always be better.
21:32So, you know, take it easy.
21:35Yeah, so basically you have to live your life to the fullest.
21:37Exactly.
21:37I mean, of course, work is, will never, I mean, the stress will always be there, but it's how you handle your stress and how you channel your stress.
21:44So, I'm quite surprised that they say every day they have this turno, I mean, like some activities, and I'm surprised they're working in a heart center, like the number one heart center in Malaysia, and they still do have time.
21:55So, that is what amazed me about IGN team.
21:58So, actually, what I did was when I became the CEO, we transformed some of our areas into support centers.
22:06So, we have a multi, you know, we have a volleyball court, a badminton court, a pickle court, netball court, basketball court, you know.
22:14And there's an external gym right beside, at the third floor, sorry, at the second floor.
22:19So, I really pushed forward, you know, for people to enjoy themselves.
22:23And you can see that when, you know, it's a way to release stress at 5.30 or so, I mean, the office workers usually, yeah, they will go to the court and play, and you can see them shouting, screaming, you know, happy.
22:36So, I think that's the way to let go of stress, and actually, at the same time, you stay healthy.
22:40True, because nowadays, as you know, sometimes we've needed to go home at 5 o'clock.
22:43Also, in KL, you'll be very gym.
22:45So, might as well just change your clothes to your sports attire, and just work out.
22:49It's a good way to release stress, be healthy, and hopefully to lower your risk from getting a heart attack, right?
22:56Maybe just a little bit on the, okay, I mean, like, working out, sometimes some people feel like it's, oh, I'm not a sports person.
23:04I can't keep bangku.
23:05I cannot do all these things.
23:06How would be, what are some simple daily routines or practices that Malaysians can do to adapt to the lower, to lower their risk of heart disease?
23:17Sometimes people always say, you have to go for 10,000 steps per day, and then you can see everybody will have their smartwatch together with them.
23:25And then, but some people give some advice when you park, make sure you park your car a bit far away, so that you have to walk, take the staircase.
23:31So, maybe there's a small-small tips that you could give for those who doesn't, who don't really want to enjoy themselves by paying mainland sports, but they still want to be healthy.
23:42I think, actually, you said it, walking, thoughts of walking.
23:47My team would know, I don't usually take the lift when I go with them, and I always challenge them who's fastest as you go upstairs, from second floor to the fifth floor, or the sixth floor.
23:58And I think that's important, walking and taking up the stairs, so that helps.
24:02So, if you are in a building that you have to move around a lot, try to avoid taking the lifts and do the exercises.
24:09And I think that's one, and the second thing is, I think with your, I say you're a desperate person, that means you're, you know, well, every 20 minutes, you should get out and walk a bit, so that improves the circulation, you know, stretch and things like that, yeah.
24:25How about the food?
24:26Because, you know, Malaysia is the food heaven, you have all your nasi lemak, teh tari, it's very difficult to say no to all of these things.
24:33Sometimes their breakfast is roti canai and teh tari, and it becomes more or less like a habit for the Malaysians.
24:38So, what would you have to say for those post-cardiac surgery, or even those who wants to lower the risk?
24:44Okay, I'm not sure I should say this, but resistance is futile, right?
24:49When the food is good, it's difficult to, but I think has, I'm not sure whether to mention this before, when you were talking to him in the podcast,
24:58but he would say that before you feel full stop, yeah, so I, and I, I follow that, and I, I think that you should not overeat lah,
25:06memang, memang makan nasi lemak tu, or roti yang sedap, you know, but janganlah lepas satu, satu lagi ke, atau roti, satu lagi, you know, again, so you just control lah, makan.
25:14In fact, I, recently I was in Japan, right, and it was a very interesting article.
25:19Japan has got obesity rate of about 4%, as compared to US and UK, which is about almost 40%, okay, but when Japanese migrate to America,
25:31their obesity rate goes up, so a lot has got to do with food, and I, I was just observing when they have their dinner and lunch, right,
25:38dia makan nasi satu mangkuk kecil je, kan, I did not see anyone minta a second mangkuk,
25:43eh, eh, kan, kita tambahan nasi, eh, kan, so, sometimes they offer nasi lagi, yeah, yeah, exactly, you don't see that in Japan,
25:50there's, I didn't see at all that there is a second mangkuk coming in, you know, you know.
25:54Okay, so I think that's the important thing, basically discipline, I think that our previous podcast with Tune,
26:00she, he did not mention regarding the amount, but he did mention that he was very disciplining.
26:05Yes, yes, if I can just say something about Tune, so, so, this year punya buka puasa, okay, and I was in the same table with him,
26:13he's opposite me, and there were a few other guys, and, eh, he nak buka-buka lah, kan, so,
26:19the waiter came to put the rice, and he says, no rice, so, the guy beside me, and I look at each other,
26:24so, buka puasa, ni tak ada rice, so, I said, okay, just satu-satu, but the point is, that's how disciplined it is,
26:31okay, and, and if you just look at his style of eating, he enjoys eating, not that he doesn't enjoy eating,
26:37but he controls lah, yeah, so, the key is controlling.
26:40Yeah, even, we know that, even our Prophet Muhammad said it's sunnah, it's one-third, one-third, one-third,
26:45you shouldn't feel like all your stomach should relax until the food is already here in your neck level, right?
26:51Okay, so, moving on from the, our dietary, post-operative care and all,
26:57so, we're gonna, like, just wanna ask, for, from your point of view,
27:02so, like, you have seen, inside of the human heart, and also literally and figuratively,
27:08so, how has that experience, as the cardiac surgeon changed you, because you, of course,
27:14you see people who recover, but at the same time, also, you can see death, also,
27:18I mean, those complicated cases, how things have changed, I mean, after all the years
27:23that you have become a cardiac surgeon.
27:25Okay, so, you know, when you see the heart, first of all,
27:29it's a miracle, yeah, as they say, it's God's creation, yeah, Allah's creation.
27:36So, when you stop the heart, and you release the clamp to restart, right,
27:43the heart will just beat on its own, you know, most of the time,
27:47and it's something which is really difficult to understand, you know,
27:51I mean, this is a heart that's been deprived of blood and things like that, okay.
27:56So, okay, that's on a simpler note, because I do heart transplantation,
27:59and that's even more, you know, when you imagine it,
28:02you take somebody's heart from Sayemlaka, right,
28:05put it in some cold water, cold saline, and bring it back all the way to IGN,
28:10put it back on, I mean, stitch it back on to another, the recipient,
28:15and heart starts again, you know, I mean, it's very thought-provoking
28:20when you think about how it does, and so that's the miracle of Allah,
28:23but the thing is, what it tells me is that, you know,
28:28when you see all this, you will appreciate that nature has been created
28:34in such a way that there's no way you can replicate, you know,
28:40there's no way you can replicate, that's one.
28:42But the other thing that I would like to say is that,
28:45when you see it, then you know, those that have got heart disease,
28:48how you have to take care of your heart,
28:50because you don't want you to have the same problem, you see.
28:54You don't want to be under the knife,
28:55there's someone else operating on you, right?
28:57Exactly, exactly.
28:58Okay, so, like what Datuk has mentioned, I think it's very much true,
29:02because when I was undergraduate in India,
29:04I think the first thing that actually triggers me that probably I wanted to do a cardiac,
29:08I wanted to become a cardiac surgeon was when I saw a beating heart,
29:11and then when they do the stenotomy, open up the chest,
29:14and I can see a beating heart just in front of me.
29:16I think that's something very much, there's no words to describe.
29:21Yeah, exactly.
29:21Yeah, so the feeling is different,
29:25but I think it's, I can't do cardiac surgery.
29:28I think after trying four years in cardiac thoracic,
29:30I think it's, people are very hardcore who are into cardiac.
29:34Maybe because you didn't get the right trainer.
29:37Okay, so, we just want to talk about in terms of,
29:42now, like Thun has mentioned that last time when he was operated first time,
29:47IGN was not there yet, it was in HKL,
29:51and after that he initiated, I mean, the IGN,
29:54and now we have seen IGN is already like world class,
29:57and then a lot of cardiac surgeons have graduated from IGN,
30:01they have, IGN is the main training centre,
30:04but how has IGN evolved over the times,
30:07and then maybe you could share any new upcoming innovations from IGN
30:11that will shape the future cardiac?
30:14I think in the past, cardiac surgeons were general cardiac surgeons.
30:20Okay, looking back, you know, I used to do pediatrics,
30:24you know, thoracic, adult, I mean, the whole range of surgery,
30:28every single surgery there is, you know,
30:31and then, of course, now it's no longer like that.
30:34Now you either do pediatrics or you do adult,
30:37and you go on to sub-specialize, you can be doing aiotic surgery,
30:41you can be concentrating on re-vascularization,
30:44or vial surgery, or lung surgery, and things like that.
30:48So those are the changes that has happened,
30:50and I think sub-specialization is good,
30:53but at the same time, you have to have a very good foundation
30:57in general cardiac surgery, right?
31:00Because if you don't have that, then you would be,
31:04I would say it's almost like general surgery
31:06when you're focusing a lot on, say, breast syndrome and the crime,
31:09you won't be able to deal with the GIT problem,
31:11or something like that, you know what I mean?
31:13If you do the sub-specialization too early in your career,
31:18and in Nigerian, of course,
31:20our cardiology department has progressed a lot, okay?
31:24In the past, it was just focused towards angiogram
31:27and maybe stenting.
31:28Now there's electrophysiology,
31:30there's heart failure, there's sports cardiology,
31:33there is valve cardiology, you know,
31:40and transplantation, mechanical heart.
31:42So there's so many things.
31:44And, you know, and because of that,
31:46the patient has got a better chance of getting recovery
31:51because there are more options now available to them.
31:53Okay, all right, all right.
31:55So that's the innovation that has occurred
31:57for the past decades now in IGN.
32:01Just so you mentioned regarding the heart transplant.
32:03In Malaysia, I know there's only IGN who does heart transplant, right?
32:06Maybe you could share the statistics in terms of how frequent that we do.
32:10Well, there's not many.
32:11We do an average between one to five a year,
32:14depending because we are highly dependent on donors.
32:18There's a lot of patients waiting in our list,
32:21but problem is donors, right?
32:24So we are limited by that.
32:28But what helps us is that those patients
32:31who are deteriorating on the transplant waiting list,
32:34then we will put in a left-hand glasses device
32:37or a mechanical heart system to support those patients.
32:40All right, all right, okay.
32:41So this would be a little bit sensitive questions.
32:45We are talking about the training
32:47because we're done talking about the whole cardiac surgery per se.
32:52So now we want to talk about the future cardiac surgeons.
32:54So, which is much more crucial.
32:56As you all know that the number of heart surgeons in Malaysia
33:00is still very low compared to the rising demand.
33:03Could you share where we actually stand now
33:06as compared to the other development countries
33:08and other developed countries
33:09and what needs to be changed to secure our future?
33:13I think, well, I would just say we go back
33:16maybe about seven, eight years ago.
33:19So then the nationalization of cardiac surgeons felt that,
33:24you know, and together with KKM felt NIJN,
33:27if we don't do anything, there won't be cardiac surgeons around
33:31because there's nobody interested in doing cardiac surgery.
33:33So we actually worked with the Royal College of Surgeons Edinburgh
33:37to have a parallel pathway program for cardiac surgery
33:41and at the same time, UITM also have come up with a Master's in Cardio-Tronistic Sciences
33:50followed by doctorate in cardiac surgery.
33:53And that is the first cohort is already in their third year.
33:57So next year they've been final year.
33:59So we have maybe already about 20 plus in that group
34:02and in the parallel pathway also about that number.
34:05So we have increased the number of trainees and cardiac surgeons
34:10over the last maybe six years, quite a lot.
34:13And yes, we still need more,
34:15but I think we have now a bit more comfortable
34:17compared to maybe five years ago.
34:18Okay, yes, because I remember like my colleagues
34:22when I was in Seredang that time,
34:24like most of them, they are like applying for this parallel pathway
34:26with the Royal College, right?
34:28And because those days, I think during your time
34:31that you have to do general surgery first,
34:33and only you can do sub, that will take some time.
34:35And I think to become a good surgeon,
34:38whatever surgeon that you are planning to take,
34:40that pathway is more of the skills that you have to continually practice.
34:44So actually, the faster you become a cardiac surgeon,
34:49I mean, the more cases that you'll be doing,
34:51so the better you'll become, isn't it?
34:52So I think that is a very good initiative that Malaysia has done
34:56that where they have the parallel pathway
34:58that they directly go do cardiac surgery.
35:01I mean, instead of probably have four years of general surgery,
35:04then only sub, because it's not immediately after four years
35:07you can straight away do sub, isn't it?
35:08Okay, all right.
35:10So just for the message for those maybe undergraduates
35:16or HOs, house officers, medical officers,
35:19because, you know, nowadays we have a lot of issues,
35:23a lot of, we lose a lot of our doctors,
35:27no longer staying in the government,
35:30who, that those are interested in cardiac surgery
35:32like how I was before,
35:34but maybe intimidated by its demand,
35:36because, you know, like they think that it will be a long surgery,
35:39or maybe it's very tedious work to do,
35:42and it's very demanding.
35:44I mean, they're worried that they don't have time for themselves
35:46or work-life balance.
35:48So maybe you could share in terms of that,
35:50and what have made you stay in this fraternity for a long time
35:54that makes you enjoy doing cardiac surgery day in, day out?
35:58Because cardiac surgery is my hobby,
36:00and I get paid for it.
36:02Okay, so that's the, okay, that's the good part.
36:04But the thing is, yes, there's no doubt about it,
36:06cardiac surgery is a serious business.
36:08Just like most of the surgery, you know,
36:11whether it's general surgery, neurosurgery,
36:14it's a serious business.
36:16So you cannot avoid the fact that
36:17you are going to pursue a serious occupation.
36:21It's not, you know, that you're doing it for fun.
36:24So you've got to be serious about it,
36:26you've got to be passionate about it,
36:27and you must be willing to pursue the best
36:29in that career that you want.
36:31Okay, so it would, yes, no doubt,
36:33it would take a long time,
36:34but it's worthwhile.
36:37The early years of sacrifice,
36:40you will see the fruits of labor at the end of it, you know.
36:43I know with the current generations,
36:46you know, they want things to be done quickly,
36:48you know, they want to become a surgeon,
36:50like, as soon as possible.
36:52But that's not possible.
36:54You know, the reality, that's not possible
36:56because it's not that easy to, you know,
36:59make an incision, correct incision,
37:01and then stitch it up correctly, you know.
37:05So you will need time to learn.
37:07So first of all, there's knowledge.
37:09So you gain knowledge, right,
37:10by reading, by undergoing whatever,
37:13Kursus or master's program.
37:16And then you must develop the skills.
37:18So knowledge alone is not enough
37:20because it won't give you the skills.
37:22So it will take time.
37:23So it will take time.
37:24So you have to be patient because nowadays
37:26we can see a lot of doctors, younger generation.
37:31They want it.
37:32Instant.
37:32Instant.
37:33If they can't get it the first ones
37:35or second time, third time,
37:37then that's it.
37:38Time for whoever to leave.
37:39I mean, for them to leave, you know.
37:41But like Datuk said,
37:44it takes some time
37:45and you will see the yield later,
37:48the food will come out later after that.
37:51So to all those who are interested
37:53to pursue in cardiac surgery,
37:56there are, there's a lot of advancements
37:59and also the program has also changed.
38:02Now they have the pilot program.
38:04Now they have with the UITM also.
38:06So the intake will be much more easier.
38:09I mean, because last time I think
38:10the fight between the candidates itself
38:13is quite...
38:14That's right.
38:14It was very competitive.
38:15But I should mention that IGN
38:18has its own IGN University College.
38:21So we're going to also develop
38:22postgraduate programs for
38:24cardiology, anesthesia, and cardiac surgery.
38:27InsyaAllah.
38:27InsyaAllah.
38:28Okay.
38:29So just don't forget to continue
38:30following IGN on their Instagram
38:32or on their website
38:33to see the updates on this.
38:35Okay.
38:36So I guess we are almost done
38:38for our session.
38:39Just before we close,
38:41maybe Prof can share
38:43beyond technology
38:44because we have talked about
38:45the technology,
38:45about the surgery,
38:47about post-op care,
38:48and so beyond expertise,
38:49what does heart health
38:51truly means?
38:53I mean, that you could share
38:54and what is the one message,
38:56maybe one or two, three message
38:57also it's fine
38:58that you'd like to share
38:59with the Malaysians
39:00to remember about
39:01taking care of their heart.
39:03Okay.
39:04If I can just
39:05try to take you through
39:08and imagine if
39:10if you have a car,
39:12okay,
39:13any car,
39:14it can be a BMW,
39:16Mercedes,
39:16or Toyota,
39:17anything, right?
39:18So you now have
39:20a good
39:21music system in the car.
39:24You've got good rims,
39:26fantastic tyres,
39:27you know,
39:28painted the car nicely.
39:30But if the engine
39:31is not working well,
39:33you can't go far.
39:34So at the end of the day,
39:36it's the heart
39:37that fuels
39:38your body
39:39to go wherever
39:39you want to go.
39:41So even if you have
39:42a lot of money
39:42and you've got
39:43heart failure,
39:43there's nothing much
39:44you can do.
39:45And the issue is
39:46you have only one heart,
39:47so you've got to
39:47take care of it.
39:49True,
39:49because you have
39:51no other options
39:52because heart,
39:53I mean,
39:53if there's any issues,
39:54it's not like,
39:55like if I would say
39:56in general surgery,
39:57abdomen,
39:57sometimes your bowel
39:58is very long
39:59so you can actually
39:59restart it.
40:00But heart,
40:01if it's not functioning,
40:02then you don't have
40:03any options.
40:03That's the only one thing
40:04which is maintaining
40:06the entire of your body,
40:07right?
40:08But,
40:08but if you do have
40:09heart disease,
40:10come to IJN.
40:11Come to IJN.
40:12Okay.
40:13Alright.
40:14Okay,
40:15thank you so much,
40:16Dr. Izani,
40:16for sharing such
40:17insightful perspectives.
40:19It's clear that
40:20heart health
40:20is not just a medical issue
40:22and it's a lifestyle,
40:23a mindset
40:24and a shared responsibility.
40:26This has been
40:26Methods of the Heart,
40:28a special podcast.
40:29It's an exclusive
40:29that we have this time.
40:31This is the first time
40:31actually we had two
40:32separate podcasts
40:33because we have
40:34two very exclusive guests
40:36so we need
40:38a longer duration of time
40:39where we speak
40:40to those who shape
40:41the heart of our nation
40:42from IJN Isof
40:43and also those
40:44and also the person
40:45who underwent
40:46the bypass surgery itself
40:48two times
40:49which is
40:49TUN Dr. Mahathir Mohamad.
40:51Okay,
40:51so remember
40:51take care of your heart
40:52because it takes care of you.
40:55Alright,
40:55so I'll see you guys again
40:56in our next podcast.
40:58Assalamualaikum,
40:58bye.
40:59Assalamualaikum.
41:01Assalamualaikum.
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