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Integrative Cardiology and Metabolic Medicine

Our Approach to Your Health Care

            Comprehensive Heart Care provides an Integrative Approach to Cardiovascular Health Care.  This reflects my approach, the product of my training, ongoing education, and 32 years of experience in the practice of Clinical Cardiology.  These principles are described in Reverse Heart Disease Now, written by myself and Stephen Sinatra MD FACC, and these are the principles that my staff and I will follow.  I want you to understand these principles, because if we are going to work together, if we are to optimize your health, then you will need to embrace these principles yourself.  Before you decide to see me, please decide if our approach is the health care approach that you wish to take.

            My Curriculum Vitae is attached for your review; it contains the usual credentials and letters-behind-the-name of a 62 year old physician.  Stated otherwise, Phi Beta Kappa, Phi Kappa Phi, and Alpha Omega Alpha means that I was at or near the top of the class in every science class I took in college and medical school (well, maybe not in Pediatrics or Psychiatry, but definitely in the Internal Medicine-related courses).  But you are not deciding whether you wish to be treated by my credentials; you are deciding whether you wish to be treated by me.  I have a certain philosophy that has evolved over my three decades of clinical practice.  It works for me and it works for my patients; it works a lot better than when I confined myself to invasive procedures and drug therapy alone, and it is how I chose to practice.  Integrative Cardiology and Metabolic Medicine describes my practice - I understand and prescribe cardiovascular drugs.  I have carried out thousands of heart catheterizations and coronary care unit emergency procedures.  My patients are referred for bypass surgery, stent placement, and fib ablation whenever I think that that is the best approach for them at that time.  I am not against anything.  I also utilize a number of approaches that are pejoratively described by others as "Alternative" techniques:  EECP, all aspects of Nutritional Medicine, Chelation Therapy in all of its forms, reverse cholesterol transport with Phosphatidylcholine, and many others.  These methods work, and I can back up their utilization with science (please review our AV presentations - I will present study after study to support my positions), but I never use these techniques in isolation.  After the bypass patients recover from their bypasses, and the stent patients from their stenting procedures, they are advised to follow an integrated program of pharmacologic and nutritional therapy, designed to keep their grafts and native vessels open.  This is a little unusual.  Other invasive cardiologists don't practice Chelation Therapy, and when it comes to nutritional supplementation, some still ascribe to the "expensive urine" doctrine (as I did 25 years ago).  Only a handful of chelating doctors go along with heart catheterization and bypass surgery  and many eschew pharmacologic therapy.  The worlds of "Invasive Cardiology" and "Alternative Medicine" really aren't on speaking terms, not a constructive arrangement.  Well, I speak to both groups, and I work with both groups, because I am both groups.  I reject the "Alternative Medicine" label.  The patients discussed in the outcome sections of the EECP pages all had received the best drugs of standard medicine.  They had been evaluated with invasive diagnostic procedures (often carried out by myself), and they had undergone revascularization procedures, often several rounds of revascularization procedures, and this alone hadn't worked.  They came to me or were referred to me, and I continued, and in many cases added to, their standard medical regimen, and then I added what I had learned outside the box, at meetings given by the professional societies listed on my CV - and these patients got better.  Standard medicine alone hadn't worked, non-standard medicine alone probably would not have worked, but combining these two approaches did.  I reject the label "Alternative Medicine" - for if you describe what I do to be "Alternative", then you have to describe "Standard Medicine", the drugs and procedures that these patients received before they came to see me, as "Ineffective Medicine".  Well, standard medicine is not ineffective medicine; millions of people benefit every day from the advice of their doctors, and my own patients benefit from drugs and surgery, but when a physician, or a society of physicians, confines themselves to one particular approach, and refuses to read or even consider the science published by other groups, when they insist of practicing only in their box medicine, then they are hastening the need for their patients to require a pine box. 

            I am not going to practice "Standard Medicine" nor am I willing to practice only "Alternative Medicine", and if you want to confine yourself to just one of these approaches, you won't be happy with me.  If you are financially strapped, and can take only the drugs on your insurer's preferred list, then I will emphasize drug therapy, but I'll also push you to follow a low-cost basic nutritional program.  If drugs haven't worked for you or if you can't take them, then I'll emphasize nutritional approaches, but if I think you need a given drug, then I'll push you to take that drug.  It doesn't make sense for you to devote 35 hours over 35 days to EECP, and then not get a good result because your BP was out of control, because on principle you weren't willing to take a drug that would have controlled your BP, and given you a better EECP outcome.  I also think it is insane to send you for bypass surgery or stent placement, without also advising you to take nutritional supplements that have been shown to improve short and long-term outcome following these procedures.  If you do not want this kind of medicine, Integrative Medicine, then you'd do best to work with another physician. 

            If you want this kind of medicine, then see us.  We will knock ourselves out to help you, and will ask you to knock yourself out, at least a little, to help yourself.  If your personal physician is hostile to my approach, then you might do better to receive your cardiovascular care or EECP somewhere else.  In the HMO-style medicine that seems to be the fashion today, patients are referred to specialists like myself by their primary care physicians.  If we want the referrals to keep coming, we need to please the referring doctor.  If the primary doctor is not enthusiastic or supportive of the specialist's approach, then the specialist must either compromise on his recommendations, or risk alienating a referral source.  Young physicians have little choice but to struggle with this dilemma, but I have enough grey in my hair that I do not have.  Don't expect me to compromise if I feel that compromise will compromise your outcome.  Now, if you are referred to me for EECP and an important decision needs to be made, or if I want to radically alter your treatment program, then I am going to discuss the situation with your primary cardiologist, and I will defer to their judgment - they know your condition better than I do.  But if a physician with considerably less training and experience than myself, one not ultimately responsible for your outcome, tells you, for no apparent reason, to stop a treatment that has science to support it, or if they push you to do something that I feel to be dangerous, then don't expect me to back down.  I do not need to trade patient outcomes for political brownie points.  I'll do my best to work with your physician, but if he or she is hostile or unwilling to consider new a new approach when old approaches have failed, please think things through before deciding to see us. 

            Most of the criticism that I receive has to do with this habit I have of introducing techniques that other doctors in town are not aware of.  They find this very annoying.  Thirty years ago I took criticism for prescribing statin cholesterol lowering therapy to patients with a (then) only "mild to moderate" elevation in cholesterol, between 300 and 325 mg/dl, or for asking family physicians to aim for a blood sugar below 150 in their diabetic patients with coronary artery disease.  Nobody was really excited when I brought the technique of cardiac doppler ultrasound to Toledo.  I picked out the first machine at my primary hospital and taught doppler echocardiography to the techs.  One year later I got involved with intraoperative echo and soon after that color doppler echo.  In my second year of practice a colleague and I put the "Cardiology" into Nuclear Cardiology - before this the studies were read exclusively by radiologists - we formed a combined panel composed of ourselves and a group of radiologists.  The first Persantine Cardiolite and Dobutamine stress echo studies (chemical stress tests) carried out at my primary hospital (back then cardiologists only went to one hospital) were done by myself.  Transesophageal echo (TEE) was another of my early projects (I'm pretty sure that I was the first Cardiologist in Ohio to carry out a TEE), and the first mitral valve and aortic aneurysm repair procedures under transesophageal guidance were carried out in my presence, because I was the only guy in town that knew the TEE technique.  The major cardiology journals now publish articles extolling the virtues of fish oil and the evils of oxidative stress, homocysteine, Lp(a), etc., but I was lecturing to the public on these topics 25 years ago.  We were the 30th US practice to offer EECP in 1997, and two years later we were the leading contributor to the International EECP Registry Study, which tracked patient outcomes following EECP therapy.  Today there are hundreds of EECP centers in the US.  I am or have been involved in new drug (Dalcetapib, Edoxaban, Methotrexate in coronary disease), new device (MME), and new integrative therapy (Relox stroke recovery and EDTA in heart attack survivors) research.  I put more patients in to the Trial to Asses Chelation Therapy than did any other US cardiologist.  Somewhere in my training or in my upbringing I learned to keep an open mind and to keep looking for new ways to solve difficult problems or to help patients who previously could not be helped.  This attitude has not enamored me with my local medical community, but has led to wonderful interactions with like-minded practitioners around the world, opening up new intellectual doors for me to explore. I teach Integrative Cardiology within the Fellowship in Anti-Aging and Regenerative Medicine physician training program and within other Integrative Medicine training programs.  Twenty five years ago, I practiced just as the community and medical community expected, as I had been taught. I did a lot of invasive procedures and spent no time or energy addressing the factors that made my patients sick.  Tied with two older practitioners as the leading admitter of cardiac patients at my primary hospital (my personal patients or consults from the emergency room), I was assigned privileges to co-read 50% of the nuclear cardiology studies and to solo read 40% of the cardiac echoes (for which I was over paid - I found out and made them stop).  I made a lot of money and was well treated, but in retrospect, I was an incomplete doctor (and kind of a jerk).  These days I think of myself as a complete doctor. I am practicing a better form of medicine.  Your other doctors are not happy about it, and if you present to the hospital that used to over pay me for reading all those cardiac echoes, I will likely not get a call (thus we will just have to keep you healthy and out of that hospital).  If my approach is what you want for your health care, and you are able to ignore the politics in favor of science, and if you are willing to take charge of your health, then we are more than willing to work with you.

                                                                                                                                                                                                                                James C. Roberts MD FACC  FAARFM 2/10/18