( By Dr Ramesh Kapadia )

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Author's Letter To Dr.Larry Dossey

This communication throws light on the views of the author on the problem of CHD.

24 Dec., 1992

My dear Larry,
Thank you very much for your loving letter of November 11, 1992. I was overwhelmed by your generous estimate of our modest effort of Primer of Universal Healing. This brings to you and Barbara our cart-load of best wishes for Xmas and New Year.

Even since 1958, the days of my post-graduate training in UK, enigmatic coronary heart disease has fascinated me. I have been very fortunate to study it in a vast variety of individuals - quite a few during acute episode of myocardial infarction and a formidable follow-up of patients with stable ischoemic heart disease. The disease has earned notoriety of being highly unpredictable. It is my experience that a lot depends on the attitude of the patient and his attending physician towards the disease rather than on the actual extent of the disease. The variable element, spasm in an atherosclerotic coronary artery and increased viscosity of blood are greater culprits than the fixed narrowing of the coronary arteries due to atherosclerosis. The fixed lesions are probably responsible for chronic stable disease which is rarely fatal. When the symptoms due to the chronic stable disease are disabling, preventing patient from enjoying normal life, surgical intervention may become necessary. Nevertheless, it is observed that in a large number of patients adequate drug therapy assisted by attention to hygienic details such as low far vegetarian diet, weight control, about 40 minute walk daily and in-depth stress management with progressive deep relaxation, meditation, and the sharing of feeling through group discussion bring about amazingly good results. Particularly, meditation motivates healthy life-style changes. In some cases even the reversal of atherosclerotic changes has also been noted. Very encouraging results of this approach in case of patients with severe CHD are most heartening. In the treatment of acute myocardial infarction, the crucial factor, it seems to me, is the reassuring capacity and confidence of the attending physician.

Larry, I certainly do not underrate the value of intensive care monitoring and investigations such as computerized treadmill test, 2 D Echo studies, scanning (Thallium, PET, etc.) , coronary angiography and palliative procedures like angioplasty, CABG, and even cardiomyplasty when LV function is severely compromised. However, in a large majority of CHD patients a cost effective simple approach of judicious use of drugs along with hygienic measures by a skilled physician well versed in art and science of medicine is all that is required. That will prove far more fruitful than the routine run of the mill approach which might be forbiddingly expensive and yet not quite effective.

A very vexed and intriguing aspect of CHD is the sudden death due to acute myocardial infarction. This is not always related to the extent of infarcted area but it is due to sudden occurrence of ventricular fibrillation due to acute ischoemia. It is probably due to the response of the whole individual to acute ischoemic insult. I have a feeling that the incidence of sudden death may also diminish in the wake of altered healthier response to the stress of ischoemia by in-depth stress management.

Almost all the participants of our programme within a matter of six to eight weeks admit to a changed attitutde of confidence as against the fear of sudden death. Thier outlook towards life circumstances, family as well as work-life becomes healthier and their world-view becomes one of cooperation and compassion as against competition and survival.

Conviction about effectiveness of this approach occurred to me fourteen years ago when I read my paper on " Rehabilitation after Myocardial Infarction" at the International meet held in Bombay in 1978.

Larry, allow me to extend a bit my rambling: utter selfishness, greed, hatred, vicious rivalries, terrorism, drug addiction! Are not these ills stemming from a sense of isolation, a false sense of ego and the lack of real identity? The precious human existence is frittered away in petty squabbles and misdirected ambitions and goals. With extraordinary technological leaps and all- round information and communication explosion, it is natural to be carried off one's fee unless one's inner moorings are firmly set on the rock of the belief that love, compassion, and altruism are the only attributes which distinguish the human from the animal. Without these human attributes all the treasures of world pale into insignificance. They become a liability instead of an asset. Quiet comforting is the evidence that the human attributes blossom forth as the individual experiences an infinite dimension to his temporal existence during meditation, hence my prescription of simple technique of shavasana and meditation for the ills of mankind. Such are my ruminations while pursuing my efforts to tackle the problem of CHD. These thoughts have taken hold of me during all my waking moments. I have shared them with you.

I wonder whether such thoughts should not be published in our reputed medical journals. I feel, it is time physicians with similar thinking came forward to voice their feelings for a cardiac problem of such magnitude and importance in a year of "Heart -beat - The Rhythm of Life " celebrated by WHO.

With most affectionate regards,
Yours very lovingly,

Dr. Ramesh I. Kapadia

With such a vegetarian diet they will live a peaceful and healthy life till ripe old age and pass on the heritage of such a life to their children.

- Socrates
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