Integrative Cardiology
Our Approach to Your Health Care
Comprehensive Heart Care, and its sister organizations, the EECP Center of NW Ohio and AMRI of NW Ohio, will take an Integrative Approach to your Cardiovascular Health Care. This reflects my approach, the product of my training, ongoing education, and 20 years of experience in the private practice of 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 51 year old physician. But you are not deciding whether you wished 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 20 years 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 today. Integrative Cardiology describes my practice - I understand and prescribe cardiovascular drugs, do lots of heart catheterizations, and every week I send patients on to angioplasty, stent placement, or bypass surgery, if I think that that is the best approach for them at that time. I also treat a lot of patients with what are described by others as "Alternative" techniques: EECP, MME, all aspects of Nutritional Medicine, Chelation Therapy in all of its forms, reverse cholesterol transport with Phosphatidylcholine, and many others - 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 15 years ago). Only a handful of chelating doctors do heart catheterizations 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 EECP and MME sites 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 thir 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, don't come here. 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, EECP, or MME, 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 can ignore it. 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 the other doctors in town are not aware of. They find this very annoying. Twenty 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, 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 10 years ago. We were the 30th US practice to offer EECP in 1997, but 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. 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 couldn't be helped. This attitude has not enamored me with segments of the medical community, who consider anything not in practice for 10 years or handed to them by the drug rep that brought their lunch to be "Alternative", but again, this attitude works for me and it sure works for my patients. If you feel that this inside and outside the box attitude and approach is right for you, then we at Comprehensive Heart Care are ready to help you.
James C. Roberts MD FACC
10/28/06