University of South Florida

USF Health cardiologist helps patient avoid surgery with lifestyle changes, cardiac rehab [video]

Leaning forward, Julio Robaina intently watched as USF Health cardiologist Bibhu Mohanty, MD, sketched a series of shapes on a piece of notebook paper. As Dr. Mohanty pulled his hand away, the sketches were revealed. It was a heart, Robaina’s heart.

Minutes earlier, Dr. Mohanty smiled and asked what had prompted Robaina to come to see him for a second opinion. In tears and obviously frightened about his health, the 57-year-old explained that days earlier he had suffered his second heart attack in seven years. Again, a stent had been placed in one of his coronary arteries, further testing had been performed, and for reasons he did not understand, his cardiologist had recommended surgery.

Dr. Mohanty then pointed to his sketch and shook his head no.

“You could tell right away he knew what he was talking about,” Robaina said.

Julio Robaina, went to USF Health cardiologist Bibhu Mohanty, MD, for a second opinion after suffering his second heart attack in seven years.

Robaina’s eyes were laser focused as his doctor pointed to the heart on the piece of paper and explained what was going on inside his chest. “‘Dr. Mohanty told me, ‘This is your heart, these are your arteries and here is where the cardiologist placed the stents after your first heart attack’,” Robaina recalled.

Then came the great news: with some necessary dietary modifications, a guided exercise program, adherence to medication and regular follow up about any changes, Dr. Mohanty told Robaina he could beat this problem without additional procedures. Robaina was relieved — a huge load was lifted off his already taxed shoulders, and he wholeheartedly agreed to making the changes.

For Robaina, the prospect of another procedure added a lot more anxiety to an already stressful situation.  Robaina had lived in Florida for 14 years after residing most of his life with his extended family in northern New Jersey.

“His fear, anxiety, lack of understanding, lifestyle and issues with medications all would have rendered any additional procedure futile, no matter how technically correct,” said Dr. Mohanty, an assistant professor in the USF Health Morsani College of Medicine Department of Cardiovascular Sciences. “This is why we devised a plan to address him — the patient. First, maximize his health status, and see where that landed us. If he needed surgery in the future, he’d be a vastly different, and better-suited candidate.”

It wasn’t easy to change his lifestyle, but with the support of wife Magaly (pictured here) and Dr. Mohanty, Robaina continues working to optimize his health to reduce the risk of future heart attacks. Dr. Mohanty developed the patient-centered care plan in consultation with Robaina.

Dr. Mohanty detailed the nutritional elements that needed to be a part of the changes. Some choices were easy: cut out sodas. Some weren’t as easy: cut out the high-fat meals, like fast food, which he grabbed on the run while working his busy customer service job.

Changing his lifestyle wasn’t easy, but with the support of Dr. Mohanty and his wife, Magaly, Robaina stuck with it. “The hardest part was getting accustomed to the different foods and getting rid of the salt shaker.  Trying to get the stress out of my life is an ongoing battle,” Robaina said.

Along with eating better, Robaina took Dr. Mohanty’s advice and began to take more time for himself.  “I’m in the customer service business so it’s not always easy. These days people want everything yesterday. The hours I work are getting longer,” Robaina said. “But we like to garden. We are doing a lot more of that.  It’s the way I relieve stress on my time off work.”

Better nutrition and guided exercise, along with medication adjustments as needed, have helped Robaina improve his blood pressure numbers.

Dr. Mohanty also recommended Robaina begin doing cardiovascular rehabilitation. It is offered to any patient with prior heart attack, stenting or bypass surgery. In the past, it was very expensive, but 36 sessions are now covered by most insurance companies. It’s tailored to the patient’s metabolic needs and ability. Blood pressure and heart rate are monitored as patients are taken through a series of exercises that pushes them but does notovertax their abilities.

Because of past knee issues, Robaina’s twice-weekly cardio sessions included a lot of time on the recumbent bike. “Exercising has become very important for me and I enjoy it,” Robaina said. “It’s helped my blood pressure and I feel a lot better. I want to live to see my four grandkids get married and go to college — that’s the whole idea.”

“Many patients going through this, that I have met, even a young “fit” 45-year-old who had a heart attack out of the blue, love it because they find that while they are moved along slowly, they reach further in their fitness goals than they otherwise would have,” Dr. Mohanty added. “In clinical studies, few of the drugs we use have as much mortality and future heart attack risk reduction than cardiac rehab. And this brings us back to Mr. Robaina – and why lifestyle change was so important.”

Dr. Mohanty, an assistant professor in the USF Health Department of Cardiovascular Sciences, specializes in structural interventional cardiology.

Robaina had suffered with high blood pressure issues for years. Following Dr. Mohanty’s advice, Robaina has seen his blood pressure numbers improve. He also made sure to report changes in blood pressure or side effects quickly to Dr. Mohanty, and they made adjustments together that have continued to yield good results.

In addition to receiving excellent medical care, Robaina also enjoys Dr. Mohanty’s sense of humor. He recalled a recent incident at the hospital cafeteria. “I had a healthy plate of food and was drinking water.  My wife Magaly had a soda,” Robaina said. “Dr. Mohanty walked in and saw the orange drink, and said ‘What? There’s a soda in the room!’”

“‘That’s my wife’s!’ I told him,” Robaina said. “Dr. Mohanty laughed and started busting her chops instead.”

“That’s the kind of guy he is. Dr. Mohanty makes you feel real comfortable — like you are one of the family. I love him,” Robaina said. “He’s going to go far in life. I want him to be around for as long as I’m around. I definitely want to keep him as my physician.”

Robaina enjoys gardening at his home, and is doing more it to help relieve the stress that accompanies his high-intensity customer service job.

-Video and photos by Torie M. Doll, USF Health Communications and Marketing

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