Latino men face heart disease challenges

Edward Moncrief, For The Salinas Californian 10:52 a.m. PDT March 18, 2016

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In early April 2014, Faustino Orejel — at age 49 — started feeling symptoms: tension in his jaw, tightening into his chest; a burning pain in his lower back. Over the next few weeks, the symptoms recurred. In mid-May, he was mowing his lawn. Once again, he felt the tension and spreading pain. He stopped and lay on the grass, but as soon as he rose and tried to complete his chore, the symptoms returned. He couldn’t continue.

“I told my wife, Marta, ‘I want to go to the hospital.’ At first, she thought I was joking, but then she looked at me and saw how white I was.”

“Okay, let’s go,” she said.

Orejel soon found himself at Salinas Valley Memorial Hospital, admitted to the Stanford Cardiac Surgery Program and seeing Dr. Christopher Oh. The hospital has forged a partnership with Stanford which has served to put the Stanford Cardiac Surgery Program at the forefront of life-saving technology    and innovative procedures.

Looking through pictures of his children, now grown, Faustino Orejel is grateful for his health.  (Photo: Jay Dunn/The Salinas Californian)

“Dr. Oh put me through various tests,” Orejel continued, “blood work, a ‘stress test’, an echocardiogram. I started walking on the treadmill. After a few minutes, they steepened the incline just a little and within 30 seconds, I thought I was having a heart attack. They gave me a nitroglycerin tablet to calm me down.

“The doctor told me that I had to stop working immediately and rest. I couldn’t walk to the bathroom without feeling that sensation in my jaw.”

Orejel and I spoke in his North Salinas home, located a few yards from the Landmark Missionary Baptist Church where he is pastor. The living and dining room were neatly furnished and faultlessly groomed. Despite his calm demeanor, Orejel appeared strong, energetic, and eager to share his experience.

“After that first day, more tests followed. Later, they told me that I was suffering from Coronary Heart Disease (CHD). Five arteries to my heart were blocked. I was relieved when they scheduled the surgery for mid-June.”

“Weren’t you surprised at your condition, considering how young you were?” I asked.

“Actually, I had always known that someday I might have a problem because my father had quadruple bypass surgery in 1999. He had four blocked arteries. My mom died at age 53 from a heart attack when I was only 21. The disease can be hereditary. I really don’t think that I would have survived without the surgery. When I met Dr. DeFilippi, he told me that the bottom half of my heart was slowly dying for lack of blood.”

Dr. Vincent DeFilippi is director of Stanford Cardiac Surgery at Salinas Valley Memorial Health Care Systems. He is board certified in both cardiothoracic and general surgery and a magna cum laude graduate of Duke University. He earned his M.D. from Columbia University and completed a general surgery residency and research fellowship at The University of Chicago/Pritzker School of Medicine. He received his cardiothoracic training at New York/Cornell and is a clinical professor of cardiothoracic surgery at Stanford.

His list of credentials and awards is long and impressive. He has won national recognition as America’s Top Doc, Patients’ Choice, Who’s Who in American Healthcare, and numerous other awards and honors described at http/:med.stanford.edu.

I later spoke to Dr. DeFilippi at his office on San Jose Street in South Salinas.

Faustino Orejel, photographed at the Cherry Bean in Salinas on Thursday, March 17th. Orejel had quintuple-bypass heart surgery in 2014.  (Photo: Jay Dunn/The Salinas Californian)

“The social pieces, of course, are important: genes and family history. Married men live longer than unmarried men. That may be because, generally, men are apt to ignore their symptoms when something goes wrong. Frequently, it’s the wives who convince them to get healthcare.

“In Faustino’s case, he had five blocked arteries; yet, for several weeks, he was just gritting his teeth and trying to get through his day instead of thinking, maybe I’d better get this checked out. Another social piece was his age. At forty-nine, he was probably thinking, I’m too young to have a heart attack.

“When you look at social factors like a poor diet or family history, the advantage of age can be neutralized. I’ve performed heart surgery on someone who was thirty. With all the junk food and sugars we have today, more people are becoming diabetic at a younger age, which can lead to heart problems even among the young.

“Faustino had the right eating habits and exercised regularly, but his family history was against him. Still, because he was in good physical condition, his odds of success were very high.

“Frequently, to do a bypass, we harvest a vein from the leg. In Faustino’ case, we performed a minimally invasive harvesting technique. Many other hospitals harvest the vein by making a long incision down the leg. Here, we make a very small incision to take out a piece of the vein. We then attach it to the aorta and bypass the parts of the artery that are blocked. We connect the vein to a point beyond the blockage so that blood can once again flow to the heart. We leave the blockage in place. Of course, with the minimally invasive technique, the leg heals much more quickly.

“We also have a whole process in place for blood conservation. Part of that process is a machine called a cell saver. The cell saver is extremely important because if there’s bleeding during surgery, the machine collects the patient’s blood and recycles it. Many hospitals use the cell saver, but here, we go further.

“You can imagine that with Faustino’s five blockages, that’s a pretty big surgery. In addition to the blood re-cycling, we employ certain surgical techniques and specialized post-op care. The whole blood conservation process is extremely important because with it in place, patients like Faustino are able to avoid transfusions; and statistics tell us that people who don’t have transfusions live longer. About 90 percent of our patients don’t have to have blood transfusions. Nationally, for these surgeries, only something over 50 percent gets by without transfusions.

I asked the doctor why these techniques are not used more widely across the nation.

“Because they take more attention to detail; they take more time and effort; they’re a little more expensive — which is an additional cost that this hospital actually is willing to absorb. But the bottom line is that we use them because they are better for the patient. In Faustino’s case, again because of these techniques, he was up and walking three miles a day within three weeks of surgery.”

Before we parted, I asked Dr. DeFilippi, “How many of these surgeries do you do each year?”

“About 150 to 200,” he responded. “Over the years, I’ve done more than 5,000.”

Back at Faustino Orejel’s home, he talked about the need for an aggressive program of heart-care education in the Latino community.

“I’ve always been aware of health issues and I’ve known that I was at risk of having heart disease; so, I’ve never taken risks with my health. Early on, I developed good eating and exercise habits. You won’t find any junk food in the house. We made our kids very conscious of the importance of eating properly. But I know a lot of men — especially Hispanic men — who do take risks. Unfortunately, we do have our macho attitudes. My dad was that way. He didn’t go for regular check-ups. If he had a problem, he wouldn’t admit it even to my mom.

“My brother wasn’t feeling well not long ago, but he wouldn’t tell anyone or even admit it to himself. I had been urging him for years that he should get regular check-ups, but he just didn’t want to hear that. Anyway, he kept getting weaker and weaker. My sister-in-law finally realized that something was wrong. She insisted he go to the doctor. They took him immediately. He had developed a bleeding ulcer.

“Men like my dad and my brother believe that seeing a doctor somehow is a sign of weakness. They deny anything is wrong until, finally, they really are weak and have no choice. Now, at last, my brother has changed his attitude. He does what the doctor tells him to do.

“Years ago, my father-in-law had been in pain but he too said nothing. We told him to see a doctor. He said, ‘whenever people go to the doctor, he tells them they‘re sick!’ It was as if he blamed the doctor or didn’t trust that he was telling the truth. With his pain, he waited until he couldn’t stand it anymore; and then, of course, it was too late. It turned out he had a malignant tumor. He later died of the cancer. So, too often, that’s how it is. Some of my friends don’t even want their wives to see a doctor.

Later, I spoke to SVMH President and CEO Pete Delgado.

“I appreciate Faustino sharing his story and urging Latino men to listen to their bodies and get help when they need it. We’re doing a lot of outreach and education in the community, and we plan on doing even more. Men especially need to be convinced of the importance of regular check-ups, exercise, and good eating habits. It takes time to change cultural influences, but the payoff is big; people taking care of their own health and the health of their family.”

Faustino summed up his feelings, “Based on what’s happened to me, I want to find a way to spread the word about seeing the doctor regularly and eating right. You have to love your family and take care of your children. That’s really what we’re talking about. We’re so lucky here in the Salinas Valley to be surrounded by the healthy food in our fields. I tell people, ‘Look around you. Eat what you see!’”