( By Dr Ramesh Kapadia )

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Program for Coronary Healing

Every affection of the mind that is attended with pain or pleasure, hope or fear , is the cause of an agitation, who se influence extends to the heart.

- William Harvey, De Motu Cordis (1628)

The golden quotation from the treatise on ‘Circulation ’ written by Dr. William Harvey more than three hundred years ago summarises succinctly the mind-heart connection. With the passing of time, understanding of coronary atherosclerotic disease has further substantiated the observation of Dr. Harve. ‘CAD’ is no longer viewed as a static process of advancing atherosclerosis. It is rather a dynamic process, an emotional burst causing sudden spasm in an atherosclerotic coronary artery and clumping of platelets resulting in complete obstruction. Eighteen century British Surgeon John Hunter, who suffered from angina for forty years also observed, ‘ My life is at the mercy of any scoundrel who chooses to put me in a passion.’ Dr. Hunter dropped dead soon after an intense debate at the Hospital Board Meeting , emphasizing once again the effect of intense emotion on heart.

Coronary artery disease remains an enigma. Exact etilogy is not known. Tell-tale predisposing factors are heredity, hypertension, D-mellitus, high serum cholesterol with decreased concentration of H.D.L. and tobacco smoking. Medical treatment is aimed at reducing the need of oxygen by thee myocardium, prevention of spasm and clot formation in atherosclerotic coronary arteries ; surgical treatment ( Angioplasty, CABG) restores the blood supply to the myocardium. Object of this communication is to highlight the beneficial therapeutic effects of progressive deep relaxation ( shavasana ) , meditation, group discussion and sharing of feelings along with strict vegetarian diet low in fact and modest exercise like walking in the treatment of coronary heart disease.

Lately, the scientists are studying the effect of the mind on the body in a bio-feedback laboratory. The biofeedback laboratory is now an important section of many teaching hospitals of U.S.A. In this therapy, bizarre beta activity is converted to alpha activity by auto-suggestion and visualization techniques. When mind is agitated and confused, there is rapid bizarre beta activity in the EEG. When a patient is taught the mind and body relaxation technique, slow rhythmic alpha activity is recorded in EEG . Endorphins secreted during alpha activity reduce the harmful sympathetic activity ( exaggerated fight and flight reponse), thereby relieving the spasm in coronary artery, reducing the level of free fatty acids in the blood, declumping of platelets, reducing the oxygen consumption of the myocardium, an all round beneficial effect in the patient of CHD. The biofeedback therapy also teaches the patient to control certain involuntary functions like heart rate and body temperature. Moreover, endorphins secreted during alpha activity adjust the secretions of allthe glands, increasing the immune status of the individual. The biofeedback is now a recognised ancillary treatment in the management of hypertension, migranous headaches , angina, autoimmune diseases, chronic skin diseases and cancer.

The technique of progressive deep relaxation and meditation has an appreciable effect in lessening the harmful sympathetic activity and reducing the oxygen consumption of the myocardium. IN progressive deep relaxation, one directs one’s thoughts to the present by focussing one’s awareness either on breathing or on the muscle groups that onewill be stretching and relaxing. The easiest way to get one’s muscles to relax is first contracting them. Relaxing one’s body, helps to relax one’s mind. That is, the bodyaffects the mind which affects the body which further affects the mind ... and so on. Progressive deep relaxation is not just a physical relaxation, but is a form of meditation. Meditation simply means focusing one’s awareness into the present moment. Most of us live in the present only 10% of our waking hours ( only 1 1/2 hours during 16 hours of waking time ). Most emotional stress exists when our awareness is in the past or the future. ‘I should not have done that ‘, ‘I hope things turn out the way I want them to ,’ ‘I wish that, that had not happened’ and so on. In meditation, one engages one’s awareness in just observing one’s breathing. It is estimated that only 3-5 minutes of this simple technique of meditation reduces the oxygen consumption of the individual by about 20%, while six hours of deep sleep reduces the oxygen consumption by only 8%.

Dr. Dean Ornish, a young cardiologist in San Francisco is carrying out such a program with 40 patients of sever triple vessel disease for the last 4 years. He has shown objectively ( PET scan) considerably improvement in the blood supply to the myocardium of the participants. I had an opportunity to witness this program in San Francisco in June 1991. Encouraged by this unique program, we started a program in Ahmedabad from 2nd October 1991. A Yoga teacher and a dietician help us in conducting this program. About 140 patients of CHD take advantage of the program. The feedback during the span of ten months has been astonishingly encouraging. We are assessing an overall benefit of the program with simple clinical assessment and equipments like a weighing machine, sphygmomanometer, resting EKG, tread mill EKG and 2D echo cardiogram. The confidence and the morale of the participants are palpably improved. Not only that, but quite a few have experienced benefit in other complaints like hyperacidity, chronic skin disease and arthritis. Most importantly, almost all of them observe that their reactions to day-to-day stressful events have become more balanced. A spirit of brotherliness, togetherness and connectedness has been felt by them. One significant finding has been that the simple technique of meditation taught in this program has inspired the participants to adopt a healthier life style. In the choice of long standing benefit due to lifestyle modification versus surgical intervention, the observation made by the editor of the cardiac surgery section of ‘ Year Book of Cardiology 1991 ‘ is quite pertinent. "Soldiers and surgeons strive to protect their fellow citizens from aggressive foes, political or physical. Both work with little regard for clocks or calendars , sometimes with significant personal risk, and always aware of inevitable ‘collateral damage ‘, despite all possible precautions. In both disciplines, the amateurs are dazzled by strategy ( the occasional spectacular conquest) and the experienced professionals are dedicated to logistics (providing for a broad and sustained offensive.)"

In seven participants of our program , while they meditated, we could register very fine rhythmic alpha activity from the frontal lobe of the brain. This was a great surprise to the neurophysician, whose help we took to do the EEG studies. He observed that normally from the frontal lobe, only beta activity is registered even during sleep. This gave a boost to the assumption that meditation was beneficial. One participant of our program addicted to tobacco for the last thirty years, after attending only three evening sessions,decided to quit tobacco use and has not touched it since. Probably, while practicising meditation, the person came in contact with the eternal present and felt quite happy and relaxed forgetting tobacco during that time. The feeling of bliss, experienced during meditation, remained with the individual for the rest of the time, freeing him from the dependence of a thirty year old habit.

This program does not claim to be a panacea. It is not against the conventional approach in dealing with patients of CHD including angioplasty and CABG. Dr. Dean Ornish claims even reversal of atherrosclerosis in some of his patients. It is felt that such a program has its place in the vast arena of various methods to deal with the hitherto unsolved problem of CHD.