Speaker 1: This is the best health podcast brought to you by wake forest Baptist health in partnership with MedCost. Good day. Welcome back to the latest episode of the best health podcast brought to you by way forest Baptist health. I'm Justin Gomez. I'll be hanging out with you for this episode. Um, as usual, we are very blessed and, uh, to have another great guest with us for this episode. Like most of our other episodes. Um, we'll be talking with Dr. Olivia Gilbert today. So welcome Dr. Gilbert, how enrolled are you doing?
Speaker 2: I'm doing great. Happy to be here with you today.
Speaker 1: Thank you. Thank you. Um, so Dr. Gilbert, uh, is part of our cardiology team here at wake forest Baptist health and she has lots of really great information to talk to us about today, um, surrounding heart health. And specifically we're going to get into a little bit of information, a little bit more detail about heart failure and, um, you know, some information about heart failure and, and how, um, you all might be able to navigate that. Um, should that come up in, in your, um, healthcare conversations with any of your providers? For anyone that's listening? Um, but before we do Dr. Gilbert, um, tell us a little bit about yourself, um, a little bit of background and why you decided to become a doctor.
Speaker 2: Great. So, uh, I am mostly from Virginia. Growing up had done most of my medical training in Virginia. Uh, went to Georgetown university for my residency and was drawn to this area for fellowship, uh, because this is where my husband is from and boy did I feel lucky to discover wake forest. Uh, we, we joke that I, I felt I died and came to heaven when I moved to Winston Salem from DC. So have, have really enjoyed this community and Winston Salem and wake forest very much, uh, since I came in 2013 to this area. Uh, what, what got me interested in medicine and specifically, uh, in heart failure. Uh, like a lot of physicians had a personal experience or family experiences with specific conditions. Uh, I actually had an arrhythmia, uh, growing up, meaning I had some irregular heartbeats that landed me in the emergency room and with medical procedures during my teenage years.
Speaker 2: Uh, and then actually my stepfather had numerous heart attacks and ultimately ended up with heart failure and struggled with it for a prolonged period of time. I will say I was very inspired by him as a minister, very positive, proactive human being, didn't let anything hold him back and continued missions work even up until the year that he passed away. He was, he was very active and so you very much inspired me and I try to use that with my patients now, uh, to encourage them to stay active, to stay motivated, engaged, and that this is, uh, an important part of, uh, surviving and thriving with the heart failure diagnosis.
Speaker 1: Sure. Well, um, you know, that's, thank you. That's a great scrape. That's a great answer. That's very inspirational. Uh, Dr. Gilbert, um, you know, as we get into, you mentioned heart failure. So, um, I'll try and start at a kind of a baseline for listeners cause there's some listeners that, um, maybe have been around, uh, doctors or healthcare more so than other listeners. So we hear basic definitions around the doctor's office or around our heart, right? So if I go to my primary care doctor, hopefully everyone listening has a primary care doctor. If you don't get one, uh, shameless plug. So if you go to your primary care doctor and you hear, you know, you get some blood work done for your physical, you'll, you might hear high blood pressure, you might hear high cholesterol. Um, you know, maybe several of us have experienced, um, a loved one that has had quote unquote a heart attack. Um, so there's all these heart terms are around, um, and then there's a heart failure term. So just if you want to lay it out on a foundational level of what heart failure is in, um, how someone might come to experience heart failure, I think that'll give us a good jumping off point.
Speaker 2: Sure. And I will say off the bat, I wish there were a different word or description for it because if I had a nickel for every time a patient says to me, why does it have to be called heart failure? Right. Uh, just, it seems to have this negative connotation. It sounds ominous. Um, and so hopefully I can, uh, provide some reassurance regarding that. But essentially what heart failure is an, and what may be a better way to say is inefficiency. So it's an inefficiency of the pumping function of the heart. So, uh, there's two basic types, um, one where the heart doesn't squeeze as strong as it should. The other where the hardest stiff. So it doesn't relax the way it should. Yes. Reminding people that the heart has eye muscle. That's exactly correct. Stiff muscle. It can be a stiff muscle. Exactly. And so if we think about, um, efficiency being the ability to squeeze blood out of the heart, if the pump is not strong, we can't squeeze enough blood. If the hardest stiff, we can't squeeze enough blood. So two totally different types of heart failure, um, that fall under that broad term, but essentially result in the same outcome, which is less efficient blood production to the body output to the body.
Speaker 1: Gotcha. So I'm with this heart muscle, I'm doing its job, can't really take a break. It's gotta always be pumping blood around. Um, how does one, um, get, uh, diagnosed with heart failure? Is it automatic? Like if I have a heart attack in my automatically, uh, thrown into the heart failure category now or do I have to have heart attack to have heart failure or can I have heart failure without a heart attack? How, how does one maybe become diagnosed with heart failure? Um, is it just genetics or what has to happen?
Speaker 2: So it's a clinical diagnosis and what is meant by that is that there are not automatic labs imaging results that immediately provide this diagnosis. So it is diagnosed with a combination of labs, imaging and symptoms. So with this combination of findings, I should also throw physical exam in there. Sure. That that physicians can paint a picture, so to speak, based on what the patient's body is telling them. So it's not a necessarily one item or another slam dunk. It's a picture, a clinical picture.
Speaker 1: Okay. So, um, if someone is feeling not at 100%, um, what are some of the signs or symptoms that maybe they would need to talk to one of their doctors about, about this?
Speaker 2: Sure. So some of the Cardinal symptoms would be shortness of breath, especially when walking around or even when sleeping. People will find that they need to prop themselves up to sleep comfortably or even wake up short of breath in the middle of the night. Things like leg swelling or another very frequent finding. Along with that, people can have swelling in their abdomen, that can affect their appetite. They can also be a light headed and have the feeling of extra heartbeats as well. Sometimes less commonly, people can feel a sense of discomfort in their chest. Perhaps if fluid is accumulated in their body or in their lungs, that can give that sensation as well. So that spectrum of symptoms could raise suspicion.
Speaker 1: Dr. Gilbert, that's really great information. Um, you know, as a followup to what you were saying, some people, um, have varying stages of, of heart failure, um, and in the more extreme cases, um, we do have the capability and the expertise here, um, to facilitate a heart transplant. Um, so if you wouldn't mind just touching base about that since it is such a, uh, an advanced program that we have here at wake forest Baptist health with the heart transplant program and, um, just touch base about that real quick. I think that'd be interesting for listeners to hear.
Speaker 2: Absolutely. Absolutely. So it is certainly a, a tremendous thing to ever have to think about a heart transplant. And so I, I take great pride in, in our team and the level of care and attention to detail that we provide and we're very, uh, proud of the fact that we are the only center for transplant in North Carolina with 100% one year survival and something that we truly cherish and intend to preserve. So, uh, I think it speaks highly of our entire team and the level of commitment required to maintain that.
Speaker 1: With you being in clinic and seeing your patients, um, for several years now, does heart failure, do you see its, um, track with a certain demographic with older versus younger women versus men or, or can it happen pretty much across the spectrum?
Speaker 2: So it is certainly more common in the older population with a frequency of about five to 10% in those greater than age 80. So certainly it is more prevalent with age. Uh, that being said, um, we are seeing it in younger populations, um, due to a number of uh, poor lifestyle factors, uh, obesity, high blood pressure, all of these sorts of issues, um, that can lead to that stiffening process that I talked about. Um, so what we are seeing, uh, these days actually is a much faster increase in the stiffness, kind of heart failure than the weak kind of heart failure. And that's because of lifestyle issues with so many folks these days.
Speaker 1: I'm not a doctor, you're a doctor, but I think, you know, I was talking with one of your colleagues, dr Shapiro, and
Speaker 2: he said, you know, just getting out and doing any sort of activity, going back to what you said earlier at the beginning, being active, that might be some of the best medicine. Um, and you know, you don't have to go out and run a marathon, but just some sort of a regular activity, physical activity can, can help keep you on track. Correct. And that is absolutely correct. Um, this stiffening process of the heart can be almost part of the normal aging process for a lot of people. But the best way to combat it, um, like any other muscle in your body is you've pointed out if you don't use it, it gets stiff and weak. And the same with the hearts, uh, it tends to stiffen, uh, without adequate, uh, use and exercise. So exercise is absolutely one of the best ways to combat, uh, heart failure in general, but specifically the type where the heart gets stiff.
Speaker 2: Okay. So, uh, that's great advice, Dr. Gilbert. Uh, so let's say I've, I've experienced some of these symptoms. I come to you or one of your colleagues and okay, so it's, it's the diagnosis is made. I have heart failure. So now, now what now, what would, what would I be doing to treat it and help manage it? What would be the next steps? So it's important to go back to talk about the two types of heart failure because they have two totally different approaches. The one where the hardest stiff, the management of that revolves around lifestyle factors. So doing everything in our power to manage someone's high blood pressure, diabetes, sleep apnea, excessive weight on their body, lack of exercise, all of these issues can contribute to that stiffening. And so we focus on changing those lifestyle parameters. Exercise in the form of rehabilitation to uh, cardiac rehabilitation can be beneficial for a lot of folks.
Speaker 2: Uh, so focusing on those lifestyle management sides of treatment are the best way to go. Now, I will say we do use diuretics for those individuals as well, but I would want to emphasize that they are not actually improving the condition. They are just treating the symptoms. So to get to the root of the costs, we would really want to focus on all of those lifestyle issues. As far as the heart failure, where the pumping function is weekend, uh, we have a much broader array of treatment options and that partially depends on if there are specific things causing it. So we always want to look for reversible causes. The most common cause for the weekend pumping function is coronary artery disease, clogs in the arteries you referred to heart attacks before. So that sort of coronary disease would be the most common reason to have a weekend pumping function.
Speaker 2: Now if we address clogs obstructions, blockages in the arteries, we can actually improve and reverse heart failure. Okay. So there's other circumstances similar to that though less common things like fast heart rhythms for prolonged periods of time can cause fatigue to the heart. And so by addressing those fast rhythms, we can in fact reverse the heart failure. Sure. Things like cocaine and alcohol use that can cause heart failure. Cessation of those can lead to improvement as well. Uh, as far as the actual therapies that we have, we have options for an array of medications that have led to improve survival of this disease process over recent times. Uh, also, uh, we have a number of surgical options available for those who don't respond to medical therapies, things like heart transplantation, heart pumps, uh, those sorts of options. And in severe cases where people are frail and of advanced age in their quality of life is compromised by the disease. We can talk about options for things like palliative care to be able to help people really focus and optimize that quality of life in the later stages of the disease process.
Speaker 3: Well, I'm glad that you, you just went through kind of a spectrum there. That was going to be one of my questions and you kind of answered it already of just if someone, if a doctor tells you heart failure, that doesn't automatically mean you have to get a scalpel and, and go operated on me. There's lots of different options depending on your specific circumstances. Absolutely. I don't want people to, and we've, we've talked about this in previous podcasts with different conditions that we, that we bring up, but you know, and I've experienced to some degree to myself and I think other people out there do as well there. I'm afraid of what the answer might be. So I'm just not going to go to the doctor for a while. Right. Um, but we want to kind of dispel that and say if you're feeling any sort of symptoms or not 100%, you would encourage going in and visiting a provider to get checked out. Correct? Absolutely.
Speaker 2: Absolutely. Because as I mentioned, there are so many opportunities to identify reversible causes and if we neglect those, um, the disease can progress to where, uh, it may not be as reversible as it would have been if someone had sought earlier care. Sure. And I think that, um, you know, being here at wake forest Baptist health, and I've talked about this with doctor Shapiro and others, there's this really great team, comprehensive team approach. Um, I don't know if you want to touch on just, um, the benefits of, of working here at wake forest Baptist health and being, being seen here at wake forest about this health of, of some of the benefits of if someone is having some of these symptoms that the treatment that they can receive here is, is pretty amazing based on some of what y'all are doing here. Absolutely. So, uh, we, we have a tremendous heart failure team, uh, here with five heart failure providers.
Speaker 2: Um, so I have four wonderful partners that I work with and we have made a tremendous effort to establish a presence in each of the five hospitals that are associated with wake forest proper. That's fantastic. In Winston Salem as well as the other sites, Wilks Lexington high point Davey so that we have an established presence across the system. Yeah, absolutely. And so we've worked very hard to standardize our care processes for heart failure on inpatient and outpatient basis, um, at all of those facilities and to be able to rapidly accelerate care for those who may be sicker in an efficient fashion, um, to where we can sort of cover this broad geographic area, but all collaborate and work together to provide accelerated care for those who need it most, but also just to be able to be present in the community, um, to be able to provide service locally for individuals.
Speaker 2: I'll also say that we are very closely tied with the veterans facilities. Um, in Kernersville we actually have a heart failure clinic, uh, which is unique. There are not many, um, VA facilities with dedicated heart failure clinics, which was a, an honor to be, is an honor to be a part of something that we all take great pride in participating in, but just an additional, um, community touch that we have to be able to share care with the VA and, uh, with our providers here so that patients can have the more advanced imaging and procedures, uh, through our Winston campus that may not be offered through the VA. and so, uh, through this geographic and collaborative care, uh, we work really hard to keep patients local to meet them where they are and to only have to bring them to the bigger facility as needed for specific reasons
Speaker 3: that helps the patient and the family as well, keeping them closer to home. That's great that y'all have this standardized care across all the campuses. Um, we're talking with Dr. Olivia Gilbert today. Um, we'll be wrapping up here in just a second. Uh, if, if you have more questions or interested in learning more, um, just a quick, uh, information, you can go to wake health.edu/heart and there's more information on the websites. Um, if you want to see a doctor, you need to make an appointments or a, just want more information. Y'all can also call three, three, six, seven, one six week and um, they can guide you to the proper place as well. Um, so as we're wrapping up Dr. Gilbert, um, heart failure, you know, if you had to give one piece of advice as we're closing out just to, to help keep people on the right, the healthy track, um, so that they don't have to come to your doorstep too often. Um, what would you recommend to people?
Speaker 2: I would recommend exercise, weight regulation and dietary optimization. Okay. So just watch her cheat and exercise, right? Yeah, pretty much. I think it's very comforting
Speaker 3: that, uh, you, you and your team are here. Uh, should anyone need to see you? Um, if, if anyone is having any of the symptoms that Dr. Gilbert mentioned, please, um, make an appointment and get checked out. And, um, you know, they're, they're here to take care of you if you need it. So, Dr. Gilbert, I appreciate you joining us. It's been a lot of fun talking with you today. Um, I hope that you have a great rest of your week and weekend coming up.
Speaker 2: Absolutely. Thank you very much. You as well. All right, well, um, thanks everyone for listening to this episode of the best health podcast and until we talk next time,
Speaker 4: be well, thanks for listening to this episode of the best health podcast brought to you by wake forest Baptist health. For more wellness info, check out wake help.edu and follow us on social media, wake forest Baptist health, the gold standard of health care.