JULY 29, 2010 Que sera sera

"Live life to the fullest and make the best of what today has to offer without worry and fear of what tomorrow might bring"
Thanks Karen

You see, it is one day at a time. No-- a moment at a time. One of my character defects or personality traits that has plagued me is expectation and projection. I am much better at expectations but when I fall into that mode, I get hurt. I have had, like you, days of disappointment and sadness. Why? Because I have expectations of individuals in my life. I no longer live like that! I give because I want to. I do because I want to. I try not to project what will happen tomorrow, the next week or during the year. That for me has created fear. Fear of ....anything. Fear of success, fear of intimacy, fear of financial insecurity. It is so beneficial not to project. I try to live in the moment. Sometimes easier said than done.

The quote above was aching to be discussed today as I listened to a perfect song to match the quote. The song is Que Sera, Sera (Whatever Will Be, Will Be), first published in 1956. It is a popular song which was written by the Jay Livingston and Ray Evans songwriting team. Do you remember what movie the song was featured in? It was not a musical. The song was introduced in Alfred Hitchcock's 1956 film The Man Who Knew Too Much, with Doris Day and James Stewart in the lead roles. Day's recording of the song for Columbia Records was a hit in both the United States— where it made it to number two on the Billboard charts—and the United Kingdom. I always changed the words to this song as you will see below. About 1 month ago, while with friends we had an honesty session. One question was, "Who would you like to meet that is still alive today?" My answer was Doris Day.

When I was just a little 'boy'
I asked my mother
What will I be?
Will I be handsome?
Will I be smart?
Here's what she said to me:

Que sera, sera.
Whatever will be, will be.
The future's not ours to see.
Que sera, sera.
What will be, will be.

When I grew up and fell in love
I asked my husband
What lies ahead?
Will we have rainbows
Day after day?
Here's what 'he said to me..'

Que sera, sera.
Whatever will be, will be.
The future's not ours to see.
Que sera, sera.
What will be, will be.

Now I have children of my own.
They ask their father,
What will I be?
Will I be handsome?
Will I be rich?
I tell them tenderly:

Que sera, sera.
Whatever will be, will be.
The future's not ours to see.
Que sera, sera.
What will be, will be.
Que sera, sera.

The treatment of heart disease is like Que sera sera. We will discuss the basics, but let's relate it to the song. For example, a 64 year old female has coronary artery disease (blockages of the heart arteries). She has chest pain. She has a past medical history of hypertension (high blood pressure), hyperlipidemia (high cholesterol panel), and is pre diabetic. Her nuclear stress test is abnormal. An angiogram reveals two blockages each with 65% stenosis (tightening) and an open stent in the right side artery. No NEW cardiac intervention is done. The doctor states you will need medical therapy. The patient is already on medical therapy. Does the doctor discuss dietary and exercise lifestyle changes? Does the doctor discuss stress issues at home or family problems? The answer is no. Left undiscussed the natural history of corornary artery disease is that it will get worse. The answer is "Que sera sera "

NOT if this was my patient.

So the next few weeks I want to discuss a specialty that I am keenly familiar with. I once thought that heart disease was not reversible. The problem with cardiovascular disease is that we as doctors do not teach or discuss prevention. The goal in treating any cardiovascular disease is to prevent it from ever occurring. I want to see the children and grandchildren of patients, so I can discuss, prevent and treat early as genetics are involved. If your father had high cholesterol wouldn't you as his son want to know if you have high cholesterol? If you do have high cholesterol, wouldn't you want to know treatments besides the logical, quick easy band aid of statin therapy? I know I would. Hopefully you would also.

This is why I am an integrative cardiologist. I utilize all aspects in cardiology, not only the surgical and pharmaceutical interventions. I use my common sense to discuss dietary changes. I am always leery if the intervention I use or recommend for an elderly patient will create more risks for that patient. I weigh the risks and benefits of all treatments I discuss with patients, especially for the elderly population. I also want the family involved in the decision making process. Many of my peer colleagues have grown reliant upon high technology. Technology is needed but at what expense. The pharmaceutical companies are making it more difficult for us to prescribe the medications we want to use, some of the old ones that are generic. Many of the newer and more effective medications are cost prohibitive. Then there is the insurance issue. I could blog daily about what is wrong with our health care system. Who will listen to me? Would the government listen? Would other physicians listen? Possibly the patient will listen!! What do I bring to the table when having a cardiac consult with a patient? This is what I bring to the table:
1. Conventional methodologies
2. Use of pharmaceutical therapy
3. Integrative therapies such as acupuncture and enhanced external counter pulsation

I want to caution you about taking herbs and supplements without consulting a health care professional. You will read in this blog many facts about herbs and supplements and different treatments. It is in your best interest to consult a health care professional.


Doris Day (born April 3, 1922) is an American actress, singer, and animal rights activist. Day's entertainment career began in her late teens as a big band singer. In 1945 she had her first hit recording, Sentimental Journey, and in 1948, appeared in her first film, Romance on the High Seas. During her entertainment career, she appeared in thirty-nine films, recorded more than six-hundred-fifty songs, received an Academy Award nomination, won a Golden Globe and a Grammy Award, and, in 1989, received the Cecil B. DeMille Award for lifetime achievement in motion pictures. As of 2009, Day was the top-ranking female box office star of all time
She deserves an Academy Award NOW. I have admired her ever since I was nine years old.