Hello friends, welcome to the third episode of Health Vibes, a Facebook live chat show by Manipal Hospital. Health Vibes is an initiative by Manipal Hospital, it's a one such kind of initiative by Manipal Hospital because you can directly ask questions to your doctors, any questions related to health can be asked in this forum directly to the leading doctors of Manipal Hospital. So today's topic is A to Z of heart and Facebook live is from 3 to 4pm and in this slide you can ask any questions related to heart and to solve and answer to your queries related to heart we have one of our experienced cardiologist Dr. Ranjan Shetty. So I would like to welcome Dr. Ranjan Shetty to the show. Hello doctor. So as you know today's topic is A to Z of heart. So we all know that heart is a vital organ in our body since it pumps blood to all the parts of our body but we also know that heart is something that is a popular organ when compared to other organs in our body because maybe every film you see any language, any film, any songs may be Dilta Upagal. I never understood till now how come Dilta Upagal live because it related something to brain. Jokes apart we have many questions lined up today. We have already 46 questions lined up so without wasting time I would like to take some questions but before that to all the viewers who are watching on Facebook Health Vibes I just want to tell that this show is from 3 to 4 pm and we are here to take all the questions related to heart so you can send us questions, hands-on questions till 4 pm and doctor will try to answer all these questions. So with this I would like to ask the first question that is the question is from Meethu. What are the major types of heart diseases? You know heart is a very complex organ so since it is very complex there are lots of disease which is possible which includes disease of heart, the covering of the heart which is called very cardium, the muzzle of the heart which is called myocardium. You can also have problem with the valve of the heart but mostly when people talk about heart disease it is almost always about what we call as coronary artery disease. As you are aware although heart is a very complex organ although it is filled with blood it cannot take the blood which is there in its chamber. So it requires its own blood supply and this blood supply is called coronary artery. There are three such arteries which come from the major artery known as iota and it supplies to our heart and whenever there is a problem in these arteries it is called coronary artery disease or in other common words the so called heart attack. So when people generally talk about heart disease it is almost always about this although there are lot more you know to become a cardiologist a person rates for 11 and a half years so it is not just for one disease it is for many more diseases. And here we have next question from Anisha what are the major symptoms for heart diseases. Yes see if you see the symptom varies according to what disease we are talking about so let us talk about heart attack which is more common. You know heart attack occurs when there is a complete occlusion of the blood flow to that particular area that whatever three arteries I described if there is a complete block that is where the heart attack occurs. When that occurs generally person gets the pain which could be central all towards left it could be to both. The pain is more heaviness other than you know burning or pricking it is more heaviness it is more deeper the person also might experience a radiation to the left arm or shoulder it usually you do not get it beyond your neck or beyond your umbilical but anywhere else the pain can occur. One very important thing which people should know is that you know there could be sweating the pain the sweating is very important symptom. So if anybody has just pain with sweating please do not neglect that because when you are dealing with heart disease time is a better you need to treat within particular time do not neglect the just pain with sweating. But if you have a pain which is like this you know pointing or pricking it is very unlikely to be heart disease but if it is much deeper you know you do not know where it is you know your heaviness is something like this that is very likely to be because of the heart disease or heart attack. Doctor pain somewhere near the left hand? Yes left hand again is very important but then localize you know just one pain point that area that is very unlikely to be heart disease but it is vague it is somewhere there but you are not able to tell exactly where it is that is very very likely to be a heart disease you know heart disease. So we have a next question from Vinayak is high blood pressure related to all the heart diseases. This is a very interesting question if you see that hypertension or high BP what people call the important risk factor for heart disease but not all the heart attack it is an important risk factor but it is also important for disease called stroke where you know people get paralysis it is important for you know the kidney failure it is important for you know the occlusion in the leg vessels producing amputation but it is a very important risk factor. See something to add on with the blood pressure see blood pressure is a disease of age some people would get it in anger age some people would get it in little older age if somebody has a hypertension or blood pressure don't worry about it it's more important to to actually you know treat it get it treated and then then we can we can you know that is the most important aspect. So we have two questions from Prati Gupta the first question what Prati has asked is what are the chances of suffering a heart attack after the bypass surgery and the second question is is heart disease hereditary. Yes that is a very important question again. See bypass or angioplasty is not end of the treatment for heart disease you know the whenever you do printing or bypass that particular area is treated so there is definitely chance of having heart attack or heart disease again it's possible but although the chance is not very high it is low but it is possible it also depends on how well the person is controlled is risk factor for example if a smoker continues to smoke he will almost surely have a repeat event if a blood pressure is not very well controlled if sugar is not very well controlled then you would definitely have a recurrence if you are careful about your risk factors which most people are then the chance of having a repeat event is much much lesser but it's still possible. Coming to the question of hereditary most diseases are hereditary that's what we should realize that means genes have some way to play in most diseases it's sometimes very difficult to you know pinpoint that this is a particular gene which produces this heart disease it is very difficult but then yes there is a hereditary especially if you know parents have a heart attack less than say 50-55 years of age chance of child having a heart disease at that age becomes very very high and you see sometime all the brothers or all brothers and sisters having heart disease requiring to undergo sending or by possible there is a significant genetic component there is also environmental component so it's a combination of a genetic and environmental disease. So the percentage of getting heart attack or heart failure in hereditary is higher if there is a parent or you know sibling or a parent with a heart disease the other person the chance is definitely higher than normal population but it's not 100% higher even cholesterol if you see predominantly the cholesterol problems are so closely related to heart disease they are also actually genetic so since they are also genetic it is you know it's likely that is follow. So we have other we have two more questions from Suvidit Chandra what are the risk factors for coronary heart diseases and what recommendation safety precautions would you give to a person who has already witnessed three heart attack? This looks particular serious case. See the risk factors for heart disease once we classify them as so-called modifiable and non-modifiable risk factors. So non-modifiable are something which you can't change they are always there one of the non-modifiable is male. Male have higher risk than women so you can't change it. One more very important non-modifiable is age as people age there is more chance of heart disease. Then the third one is genetic if there is a family history which we already discussed the chance would be higher but it's very important for us to concentrate on modifiable so that's what you can control. The modifiable include diabetes if you can control diabetes of you can prevent it then yes chance of heart disease would be less hypertension which is one more thing we already discussed about that. Dislipidemia or cholesterol which is the change in cholesterol that is extremely important and you know we need to control that. Also you know regular exercise helps to reduce heart disease diet not too much but diet rich in vegetable and fruits also try to reduce. If you can avoid stress yes that can also help. Most important I think which we need to highlight is succession of smoking. Smoking is something which has a direct relation with heart disease and as much as possible it should be it should be completely stopped. That's a very important respect. It's very bad news for all the same smokers. So next question is from Prachi what dietary changes can I make to reduce my heart disease risk? Okay so in diet you know for long we used to tell don't eat cholesterol don't eat oil this was a general recommendation which we also used to give until last year but then last year the guidelines the lipids guidelines have changed that means we are not too much worried about the lipid diet that means fat in your diet or cholesterol in your diet does not matter. Blood cholesterol matters but cholesterol in diet does not matter. So that's a good news for many people but one for me. What matters is actually the sugar. So food rich in simple sugar like glucose or fructose or simple sugar these things if they are used then you know there is lots of that is considered a major factor. So nowadays we have moved from diet to exercise so that you know diet is no longer the key factor for heart disease. The next question is from Shreyaan. What type of exercise are safe for heart patients? Can they do heavy weight lifting exercises in the gym? Okay so it depends on what we are discussing if the person is already I can take it in two different ways. One what are the exercises needed to reduce heart disease and how should a person who has already had a heart disease or had a heart attack how should that person you know leave. So that's the way probably is better to take. Exercise is very important to reduce heart disease because we have already described that this was one of the modifiable risk factors. So what do we mean by exercise should we run to gym and start exercise are we talking about that kind of exercise or regular physical activity is what are we trying to tell. So it is about regular physical activity the most important exercise which we advise is walking. You know if a person walks around 30 to 40 minutes a day for 4 to 5 days a day it is more than enough. You know as we know we classify exercise into trainers and average exercise. So average exercise is one where you can you know talk to your friend and keep doing exercise like you know walking or maybe you know slow cycling walking or even some jogging can be done. So such exercise we recommend 30 to 40 minutes a day for 4 to 5 you know 4 to 5 days a week. And trainer's exercise is where you are you know you are sweating it out and you are not able to talk you know playing some vigorous sports or really running fast. Such exercise even 20 to 30 minutes 5 4 days a week is enough. So this is some kind of exercise which everybody can do we are not talking about going to gym here. Some exercise if you want to do more it's always good but this is what we recommend. Now coming back to the question proper where we ask whether what should a person with a heart attack do. So what's very important is there is some rest which is needed initially whether it's after bypass surgery or after heart attack you know there is a wound and you want it to heal. So that's what we are talking about here you want to heal that wound. So generally what we recommend is first 2 to 3 weeks that they should be in rest doesn't mean bed rest they could be walking around after that every week we advise that they increase their effort exercise by a kilometer that means by 2 to 3 months they would be doing something like 4 to 5 kilometers. Then cardio exercise is better if you want to do weight training and go to gym you can do it but you need to start slow and goes up slowly. The trick is to do it slow. See the person with heart attack or heart disease can do everything but there is a time they have to do it slowly they have to do it with time and later with the time progresses they can definitely do everything. Okay doctor how about doing yoga exercises? Yes. Do your namaskar. Yes. Yes. What I would say is yoga is good if you should be doing it but don't do it as a substitute for your exercise what we recommend to our patients all of them is do all your exercise 30 minutes or 40 minutes also do yoga because yoga again is not controlled you know people can be just shaking their hand and calling it yoga which may not be enough exercise what we recommend so do your walking and also do yoga so it's like don't take it as a alternative. Do both. So we have next question from Prachi. Yes. Do I have to stop exercising after my bypass? I guess Dr. Anjanshtri has already answered this question. Yes. And next question is what you recommend jogging as morning exercise to a heart patient. Yes that's very important as I repeatedly I keep telling you need to start slow and slowly increase now you can do it in the morning or you can do it in the evening that is up to you and whatever time you have the cardiac benefit of morning and evening is almost same but just for people who have hypertension or high BP which we already discussed a morning exercise is considered better because in which case the whole day BP would actually be lower so morning unit is up to you but some exercise is what we recommend. I had a question like if you see majority of the cases of heart failure. Yes. Most of the patient goes through this heart failure early during morning. Like earlier on fire, claw, heart attack. Yes. Yes. It's early morning it happens. Yes. I just want to know why is it so. Yes there are multiple reasons this is a very important question because you know the timing of heart attack itself. The heart attack can occur anytime but you know they have some predilection to early morning.  So some hormones you know get activated way before something like 2 o'clock 3 o'clock they're getting you ready for 6 o'clock 7 o'clock so they would get activated and the blood if you have to put it in very simple word I can tell you that blood is tickets in the morning and heart attack is something like a clock so in simple terms that is what happens. So there is a diurnal variation the key point here is what we should probably emphasize is not wait till morning if you have a problem in the night better visit in night because in heart disease or heart attack there is a concept of golden hour. Golden hour is nothing but the first hour the maximum death occurs in first hour. The greatest benefit if you do a procedure which is angioplasty or stenting or giving some you know the 5 million lightening or some less inner medicine the best benefit occurs if you do it in one hour. What we see in our practice most of the time that people you know sleep over it because they think they have to wake up one more person and it is very difficult. It is not so if you have a problem you need to visit fast because the benefit will be the maximum. Any person who can take an ECG can diagnose the heart attack or heart disease so it's very important they get it and in cities like Bangalore traveling at night is much easier so we strongly recommend if there is a symptom you should reach the hospital. So to all the viewers I just want to say like in case if you get any kind of heart pain in your chest or pain in your left hand just don't ignore it just move to your nearby hospitals and just get it checked. I guess ECG would yeah anywhere was the ECG is done you know I mean not that ECG doesn't mean heart attack it does mean but the chance that's a small percentage but it would still pick something like 90 to 95 percent of the heart attack. So moving towards the next question from Arvind Angadi can heart patient walk in steps what is the medicine you prescribe to increase the LVF so yeah so heart patients by meaning people with heart attack can definitely walk in step but slowly that's what we recommend so they should probably be starting taking one flight maybe after two weeks unless it is absolutely necessary if your house is in second floor and you have undergone angioplasty you have no choice in which bladder to you know take breaks in between therefore heart failure is a different disease that's what we should understand when we talk about heart failure your heart muscle is weak so there are many reasons for that one important reason or 70 percent of the reason is actually heart attack you know your blockage and that's why the mother is weak so that's one one disease which needs to be take but there are other reason also where the heart becomes weak so the other could be you know intrinsic problem of the mother could be the well leakage which is producing it if you have to tell it like end result of many many many disease including some infection some inflammation hypertension the VP itself diabetes itself all this can produce a weaker heart to improve it first you know we have to identify why there is weak heart if it is you know because of the block you treat the block if it is because of VP you control maybe if it is because of you know blood sugar you know try to control it you need to manage most of them once you have managed all these it's better if we add some medicines like beta blockers and as inhibitors and there are some drugs which can help there are also devices which can help which are like pacemakers and it can be put those these are the things which can help these people okay so there is a next question from Diane and this is one such interesting question I guess you might get to any kind of the question is can a heart patient drink alcohol is it true that a glass of red wine daily is good for heart very controversial question in a social media what we yeah what we you have to you know be very I should say there should be a warning that this is only for a select subject what we should realize is what we advise is limit alcohol so the amount of alcohol which is say allowed for a heart disease patient or any other patient is 60 ml of hard liquor or 100 ml of wine now this is a very small amount and non-addictive dose not most people cannot stop at this so this dose whatever we are recommending is shown to have some benefit but any excess is shown to have half what we say don't start drinking alcohol to protect anything it's probably definitely not worth it but if you're already drinking limited to 60 ml that is just you know one large bank or two small fact something which most people are definitely not happy about but that's what you should do to protect yourself so it's 60 ml in a day 60 ml in a day and very important thing is you can't drink 240 at the end of a week or Saturday it's not you can't add it up it is just 60 ml a day if you're drinking only on Saturday again it's just 60 ml a day yeah so we was just 60 ml a day you can't add up my weekends you can't know mathematics so the next question is he has asked two questions it's from Karan Kundani can he prevent heart disorder can we how can we stay protected from heart disorder yes there are many ways the prevention as all of us know it's always better and it definitely has a value the prevention depends on the disease which we have. As I told in the beginning there is non-modifiable and modifiable. So prevention aims at modifiable responses. Now what are the modifiable ones? Hypertension, diabetes, lack of you know stop smoking, limit your alcohol, start your exercise, be careful on your diet, see that you don't put on weight. So this is how you you know limit. So by doing this you might be either preventing it or at least postponing your heart disease and that works it. That's what we are talking about when we talk about prevention. Whether a complete stopage is possible I'm not very sure but if you can postpone it by a decade or two it is definitely worth it. Now what should we do is the symptoms for heart disorder comes very fast. Yeah heart attack is like earthquake so it's definitely far. There are two types of heart disease when you talk about coronavirus disease. One is heart attack. Second is a stable disease or stable blockage. So in stable blockage I already described about three coronary artery. In stable blockage the block starts developing and that person gets chest pain while walking when he exerts. When he goes to climb stairs he gets chest pain radiating to arm or neck and when that person takes rest it is it's subside. This is a stable heart disease. This is the minor of the two problems. It is not okay but you can get a treadmill test and get angiogram and you know find out what it is and get treated. The other one the most important one is a heart attack. We already described the symptom of heart attack in sinus. It occurs on chest or you know radiating. It occurs at rest. It continues for more than 5 to 10 minutes. There is associated sweating. When this occurs time is sufficient. That's what this is a reputation we have been already telling talking about this. Golden hour concept hold true if you have to. Anyway go to doctor do it then and if it is night do it night or anytime. Get a ECG done consult a medical professional. It can make lot of difference because as I said majority of the problem you know people who survive are anyway going to survive. The people who will succumb will be the ones who will succumb very early in the disease. So they should get the medical help as soon as possible. It's really very unpredictable. Yes. Like in the previous day of the heart attack the person can be normal. Even if you do angio it could actually be normal. There is no need to have block on the previous day. But at the time of heart attack there will be a block. Now what happens there is good if you can understand this. This is already discussed about coronary arteries which supply the heart. The arteries have little cholesterol deposits what we know and what we described as plaque which are small deposits which are there. During this period the plaque breaks. There is a break in plaque which we call as plaque rupture. It ruptures and then you know body anyway if you have a cut response is to clot. So the blood starts getting plotted. So artery which was 10 percent 20 percent or 70 percent blocked. Now suddenly because of blood clot becomes 100 percent blocked. That's heart attack. So now the heart is actually crying for blood. The pain what you are seeing is the cry of the heart. So you can't neglect it. As soon as possible we need to open it and you know make the channel there and it can be done. Today you know with advanced therapy all this can be done. But your response, your benefit is time sensitive. So that is our essence here. Okay. So next question is from Surendra. He is having a very good question. It goes like I am a cardiology patient and at times I face situations where I can't breathe properly and major shivering happens. This thing is kind of weird. So I am making grammar correctly and I am saying okay and major shivering happens that time. Can you suggest what could be the reason? He means to say that he shivers he is a cardiology patient and he shivers in some instances. And also I am a big fan of having good physics but I can't work out because I am not supposed to work out since I am a cardiology patient and he wants to know what kind of food he can eat if he wants to go to gym. The concept of gym is good here. So what we should do is first of all we should realize what problem he has because it is very difficult to tell exactly what problem he is having. He is definitely a person who has had a heart attack and I feel from the explanation that heart could be weak. That is the possibility here. If your heart is weak, if you are not getting symptomatic at rest, you are not able to do anything, then you need to take some medicines and stabilize it and after that after stabilizing yourself start with minimal activity. Walking or just low intensity cardio. Once we know that you are able to do it and you are better with that that is the time you switch to some gym and muscle but should not try too much trainer activity especially if your heart is weak, should not try too much trainer activity. But gradually you can do and that wise as I told earlier we are not very strict about diet. We just advise to avoid sugar and simple sugar and this fat can be taken, protein can be taken, X can be taken. So diet is not a major issue even when you are doing it. So the next question is from Amisha. How important is diabetes as a risk factor for heart disease? Yes. Diabetes is an extremely important factor. There is no doubt. People believe that diabetes you know if you have diabetes it is as good or as bad as having a heart attack is considered that bad earlier. Nowadays it is considered not that bad but it is still a very important factor. So diabetics tend to get heart attack much earlier. Their heart is much weaker. They tend to have much more heart. It is very difficult to treat them by angioplasty. Most of them require bypass surgery. So it is a very bad risk factor. But luckily if you control it well the things can be better. It is not about being diabetic. The control also does matter. So early on if you pick up and if you control you can actually do better. So the next question is from Sheen. What she is saying is I have my cholesterol level under control through medicine and now in recent report my blood sugar HBA1C is 7. What can you advise me on diet, exercise and look-off age? Yeah. I think this person is probably diabetic and also has a cholesterol problem. So it is very important that 7 is not a bad gly-HB. It is reasonably okay but it is good to get it down maybe to 6.5 if possible. And then you know any exercise is better. The thing about exercise is first step is to do exercise. If you start doing exercise that is much better than not doing at all. So my advice to most people is just start doing exercise. That will be the maximum benefit. And when you do if you can do it for 30 to 40 minutes it is very good. Now the gly-HB phase is a drug which is used for sugar control and it is one of the metformin is a drug and it is one of the very good drugs. And you know it should be if it is prescribed to you you should take it and control your blood sugar. And also diet, diabetic diet is nothing but a healthy diet. It is not the diet which only diabetic should have. I think if the whole world has diabetic diet it is better. Now it is simply telling that you know eat what you can digest. Don't eat too much, pace it out. See that you don't put on weight, decrease your sugar intake. That is all the diabetic diet is. So you just have to follow the diet advice. The next question is from Geet. How common is heart disease among women? Also can children get heart disease? Yes, the women do get heart disease. There is no doubt about that. But there is a difference. That is probably what we are trying to see. Generally women are considered protective during their reproductive age group. But they do get, but they get one decade later. Like if men get it, say 50, if the women get it, they get 60. That is what happens. But if there are rich factors in a woman like if they become hypertensive, diabetes or if there is more. So if any such factor is present all the benefit of being a woman actually goes. There is no benefit then. They behave worse than men. So one other way is in women the symptoms are very very atypical. They have you know little different. Whatever we describe that classical symptom may not be present. Sometimes because of this the presentation will be delayed. So women should not neglect if they have a symptom. And it's important for women also. It's the number one killer even in women. That's what we should realize in western world and it's catching up in India. So children having heart disease is a different story altogether. When we talk about children having a heart disease, we do not describe it's not the same heart disease what we are talking. It's not coronary artery blockage or coronary artery disease. When they have heart disease it is more to do with something called as hole in the heart which is a communication between a left side and right side. As you are aware heart has a left sided chamber and right side has a chamber and they don't mix with each other. There is a separate. You can take it as two hearts which are put together. The left side doesn't mix. If there is a hole then the blood from left comes to right and in which case they have hole and then they have breathing difficulties. They have repeated pneumonia and they don't gain weight and they become very thick children. Infants as well as newness very thick one and they need some therapy. The holes can be closed by surgery or pulmonary. The way we do angiograms the holes can be closed. The other kind of heart disease which children have is the mixing of impure and pure blood. The right sided blood now goes to left. Such babies are called blue babies. Children appear blue. That's again one more disease. If there is a blue baby it needs to be treated early. It should not be neglected at all. The holes also needs to be treated but you get some time to treat them. Do they actually go blue? Yeah, the blue babies actually go blue.  The mother can. It's not blue only when the child cries it's blue all the time. Some kids become blue the whole day of breast and become blue. That's called breast holding spell. They just hold their breath but that's okay. That's not a serious disease. But the child who is tired all the time, which is blue in the face and blue in the arm, their fingers are generally swollen. That's called the blue. That's the symptom and that needs to be treated. So the next question is from Aminash. How is cholesterol linked to heart? Is red meat bad for your cholesterol? Yes, again a good question. Cholesterol is definitely linked to heart. But to specify it is blood cholesterol which is linked to heart. That means anybody who is above 21 should get their cholesterol set and if it is high you need to be treated. 90% of the blood cholesterol is actually genetic. It's not from what you eat but it is what you are made of. It's genetic. Hence it's very important for you to get it treated and just diet may not work. So since diet is not important the red meat does not matter. Now people if they want to consume they can. Egg white was anyway considered good. Egg yellow is also okay. Because whatever extra cholesterol you take your body can digest it. If you are not eating cholesterol, body can as well produce cholesterol. So dietary cholesterol does not matter. Blood cholesterol does matter. So doctor I had a question. I wanted to know what exactly is the bad cholesterol and what is the good cholesterol. If you see lipid profile, if you get a lipid profile then if you multiple reports and some of them give it in red then people get scared looking at the red. It's difficult to interpret. Red circle and red but not all reds are bad and not all blue are okay. There is some science into it. But then generally your LDL cholesterol or low dense cholesterol is considered a bad cholesterol. So higher value of this is definitely bad. So anything about 190 is definitely bad and anything less than 100 is good. That's where we go with LDL. Low dense. The other cholesterol which we talk is called HDL. Or high dense lipoprotein HDL cholesterol. HDL cholesterol is considered good. That means higher the value, it is better. So that's where we are. One more cholesterol which is very common in Indians and which you get is called triglyceride. So if your triglyceride is high then it is intermediate cholesterol. It's not bad, not good but definitely it's not good. But it's not that bad. That's how we can put that triglyceride. So related to what you take. HDL and LDL cannot be modified that triglyceride can be. Diabetics will have higher value. If you eat lots of sweets, lots of fats, your value will be higher. That's where triglyceride is. Triglyceride above 500 produces pancreatitis. Hence it is bad. The lower value you need to correlate with other reports and treat it. So it's not just a knee jerk reaction, not looking at a value and treating. It's more about treating the whole patient rather than just the value. So next question is from Rajat. What cholesterol level is recommended for a heart attack patient? Yes that's very important. Again as we discussed there are multiple types of cholesterol. LDL less than 70. Very good for a heart attack patient. If the patient has a heart attack or a bypass surgery or is under one angioplasty then it's preferable to have LDL less than 70. But less than 100 is also okay. More than 100 is not acceptable. So that's what you do. And to do this it's not possible with diet as we repeatedly discuss. It's important we do it with drugs. So most of the time people with heart attack or heart disease will be on lifelong medicines for cholesterol lowering. Which is good for them. They should take it. So the next question is from Mudit. Does smoking can cause heart disease? Can the heart rebuild its strength of quitting smoking? How long before it gets back to normal? Yes. It's a very serious question. Smoking is definitely associated with heart disease. It's the process of repetition we are just telling it. You know person who is perfectly normal one cigarette can produce heart attack. And you know you have done the enjoy it normal. Because it is one of the important factors for plaque rupture. So stopping it definitely helps. So the benefits are immediately but some harm might be left. You know it's like a scar. So scars heal but you know they leave some marks. So something remains. But definitely as the time passes from the event like 5 years quit smoking, 10 years quit smoking is definitely better than not. So whoever is thinking of quitting should quit it now. So for the viewers quit smoking. Smoking is injurious to health. Just keep this in mind and start smoking. Are both control pills a contributor to heart disease? It's a very important interesting question. Yes there is you know earlier they were considered extremely safe. They are not that safe. They can increase heart disease or heart attack which is there. They also increase thrombus formation. But not in everybody it is a little susceptible. HRT on the other way which is called hormone replacement therapy which is given in older individuals after their menopause to prevent symptoms. There are hormones which are known as HRT. They are also quite harmful. More than you know oral contraceptives HRTs are much more harmful because you give it to older subjects and it's taken for a much longer time. They are more harmful. So you need to discuss with your doctor before you start. That's a very good question. The next question is from Avinash. Do most overweight people develop heart disease? There is an interesting question. Overweight people do get more heart disease compared to the lesser weight people. That is true. But one good part is that they do better than the thinner people. When they get heart attack or heart disease the obese people do better than their counterpart. That is called obesity paradox. Although they get more disease when the disease actually comes they do better. It's true for many diseases. Not just heart disease. It's true for the infection. It's true for the septic infection. Some kidney disease. Most diseases are actually true. But how is it better actually? No, this is just a study that we show that they cope up with the illness better. That is what. But then obesity is not just or being sad is not just one thing. In medically we classify obesity into just obey and metabolically obey. Now these metabolically obese are ones who have so called insulin resistance. They have higher insulin level but they need not be sad. This metabolically obese do worse than real obese. There are some people who are obese but they don't have diabetes. They don't have BP. They don't do that bad. But there are some thin people with diabetes and BP and they may be actually metabolically obese as you put it. That's bad. It's a little complex when you talk about obese but losing weight helps. There it is sure. So next question is from Anish. He has two questions. First one is can stress cause heart disease? Second one is vitamin E for heart disease. Does produce heart disease? It's very difficult to quantify how exactly it does it. But it does produce heart disease. So it believed that when you have acute stress you tend to get acute heart disease like heart attack. When you have chronic stress you get more like blocks like a chronic disease. That's what happens when you have acute and chronic heart stress. Now coming to vitamin E it's never been totally proved that it is very beneficial. So if it's given to you for some reason you can take it but don't take it just to prevent heart disease. So the next question is from Dave Bali. Are diet pills bad for heart? I'm not sure what diet pills are. Yes, yes. There are lots of diet pills which are available. Some of them are caffeine, and some of them are... It's also reducing weight? Yeah, that's what they mean with diet pills. There are injections which are available. Some of them are are bad. You don't know what is there in that. That's the first thing. Some of them are not very safe. So if somebody takes it they should take it for a short time rather than a long time and try other pills. So diet pills is something, supplement what we take protein shakes or something? No, I don't think so. I think it's more like instead of diet you take a pill that's how it looks like from the question. Probably trying to, you know, pill to reduce weight and you see lots of them in internet anyway. How about taking supplements? Supplements like you take a breakfast and have some bar which contains all the nutrition. I think it's not very useful the idea because see what we realize is when naturally when you take something there's a lot more than what you... you know, you can't take glucose, I mean you can't take protein just like that. These fibers do have their role. You need to take natural things than supplements. Maybe we can leave the supplement to astronauts who need to take it. Others should probably take natural things. So the next question is from Anisha. Are cardiac scans a good way of treating heart disease? What exactly is a cardiac scan? Yeah. So yeah, there are lots of cardiac scans. I think the person is probably referring to echocardiogram. Now echocardiogram is a test which is just like ultrasound of the heart. Just like you do ultrasound anywhere, you do ultrasound of the heart. When you do that, you get lots of information which includes the pumping, whether the heart is pumping well, whether the heart well has a problem, whether your heart is thick because of this one or the other person has had a previous heart attack. So you get all this good information. But then blockage cannot be picked by that. See, that's what people are interested in, whether I have a heart block. The echo is not a good test for that because the rest thing, when you are resting, you are fine and you take an echo, it's a resting echo. It's not very good. To pick up blockage, you need test like TMT or a treadmill test which pick up. There are also other heart scans like taliums and such taliums and such tests which are available. They are also useful in getting some picking of heart blockage. So there are lots of tests available. Each of them have their advantage and their limitations. So probably they should be done when your doctor advises you rather than you opting for it without considering it. Better if somebody sees this. So the next question is from Vaigo Sharnam. How to spot a mini or harmless heart attack? He has one more question that is, does heart disorder have any specific prone age? Yes. And I think there's one more question which I can see that whether aspirin should be taken every day. This must be from the same person. So I think we can answer all of them, all of Vaigo's questions. So what is the first question? The first question is how to spot a mini or harmless heart attack. This is something which people talk about a heart attack as a major heart attack and minor heart attack. See, what we need by major heart attack is, you know, where there is a complete block with the one which I explained at that time, where the treatment has to be done immediately, that is major heart attack. Minor heart attack is where you have or mini heart attack is where you have a small blockage, you know, small changes and then, you know, sometimes it is closing sometimes it is closing. So we tend to describe this as a minor heart attack. But there is nothing minor about a minor heart attack. So what does the minor heart attack tell us is that, you know, we don't have to do angiogram that night. You might do it next morning. It gives us some time. You know, if it is a major heart attack, if it is night, we have to do it in the night. There is no choice. I can't say, you know, I'll do it tomorrow. That's not possible for a major. But minor, we know that with medicine you can stabilize and you can do. What's very important is untreated minor heart attack. It's worse than a major heart attack or as bad as major. If you don't take a heart attack as minor or as major, you need to treat it well. That is very important. About aspirin question, which Vaibhava has asked again, see, everybody needs not take aspirin. Take it only if it is recommended. No drug is absolutely safe. There are issues with the heat of the drug. So if it, you know, the aspirin also produces the gastric blade. Sometimes it produces brain blade. The benefit is not high. But there are subgroups where we give aspirin but everybody need not take it. I guess Vaibhava Sharma has got answers to all three questions. One more, I think about that pill, which we have already answered. Yes, yes. I guess Vaibhava has lots of questions regarding heart. When it comes to heart, everyone is concerned. I don't know why is this. When it comes to heart, everyone is concerned. Next question is from Gulharsan. Is it true that higher the age, higher is the risk of heart disease? Yes, yes. It's definitely true. Age is important for heart disease. Age is definitely true. But just to share with you the sad state of our country, that anger also gets harder. You see, in western world, they get heart attack in 50, 55. Or maybe even 60, 70. That's what they get in western world. But in India, we have been having heart attack two decade earlier. That means 30, 35 and 40 people have heart attack. Although older get it. But our country, the anger get it. This produces tremendous economic burden on our growing economy. Because now, there is an anger person with a bread winner who has a heart disease. And you know, some of them change their profession. They have to, you know, their lifestyle changes. It's very sad. But that most people do have some respect for smoking being the most important one in anger in future. It's very important that, you know, people control it. We have seen people having heart attack even at the age of 20 and 21. The age is an important factor. Doesn't mean anger are protected. They are not protected. But older tend to get more. That's where it is. Next question is from Ayushree. Should one eat different foods if he has heart disorder? To put, I think we have discussed, it's more about limiting your sugar. Not really about your fat and oil. See, one question which we tend to get all the time is what oil to take. Whether coconut oil is okay. Whether, you know, that olive oil and all that. Now, we can tell you, it doesn't matter. Whatever oil you take, it doesn't matter. Don't take too much. See that you don't gain weight every day. Just limit it. That's what we choose. And yellow is okay. That's one more common thing which is that. So, whole egg can be taken if you want to take it. Any amount of egg? Any amount of egg is okay. Again, I think the most important thing is maintaining a balance. Just because something is okay doesn't mean we need to take it too much. Or something is bad we don't have to stop it. The balance is the key thing. You know, it has to be balanced. So, there is a next question from, she has three questions from Josie Choi. Should I start any exercise to make my heart stronger? I guess your heart is especially strong. How often do I need to visit doctor? What can I do to feel less stress during heart problems? Okay. So, I'm sure you don't have a heart problem. So, there's no this one. So, what's important is the visit to doctor is little controversial. It can vary. If there is, see one, it's very important. After age of 21, it's better to get one cholesterol done. After 40, better to get your sugar done. So, this is something we must get done. So, during this time, you can actually have your health checkup what you're doing. Otherwise, if you're not very symptomatic, you don't have to visit your doctor. Do visit if you have symptoms. If you're perfectly fine, you may not visit your doctor. And stress, as you rightly pointed out, stress has a role. But stress is individual. That means it comes from within. It's not the outside people who make a stress. We are stress. So, we have to control it yourself. We have realized sports and yoga and relaxation exercises do help itself. People should opt for it if they are stress. So, the next question is from Vivien Kumar. Is heart disorder, can be cancer if we don't take precautions off? What he means to say is, will heart disorder turn into cancer? No. That's a good part probably. That heart disease do not turn into cancer. But they're as bad as cancer. If you see, in today's era, some cancer people do survive more than 5 years. Maybe 60%, 70% survival is seen. There are people who get cured of cancer. So, I'm not here to talk about cancer. But then heart disease could be equally bad. Like heart failure, some of them don't live up to 5 years. Heart attack, sometime it is very difficult. So, these are two bad diseases to manage. But they have their own way. But they don't lead to one another. Otherwise, sometimes people with cancer have heart attack. Which is also seen. And they need therapy if it is advanced. Sometimes medical therapy is given. There is one interesting question from Vinay Kipsaniya. I was expecting this question actually. I wanted to ask you this question. But Vinay has asked this already. If anyone gets a heart attack, what should we do at first to save them? Get to hospital? The key would be to go to hospital. Otherwise, if you are sure it is heart disease, then aspirin in this juncture helps. Some people have, if they already have a disease, they will have a tablet called nitrate or sorbitrate, which is there in their pocket, which can be put. But whatever said and done, the importance of early re-vascularization. The artery which is blocked 100% is not going to get open just by sitting. So it is very important for people to, they seek medical help.  So that is what we need to do if there is a heart attack. Get medical help. Don't neglect it. See what we see as you rightly pointed out. People are sometimes having neurotic. They are really worried about heart disease. But when it really happens, they don't come. They neglect it. They neglect it. They think it is not. It gets put on that particular day. But when it is atypical, when it is not, they do come and get lots of tests done. It is very important to, you know, have a balance. Do that, but do this also.  It's okay. It's not the wrong thing to do. You don't have to worry. Nobody is going to laugh at you because you have come in night for your chest pain. We all understand it is a serious symptom and we respect that. You can visit the doctor in night and get this visit. Okay. So this is a question from Rathi Gupta. Is there any avoidance or effort to be done to avoid heart disease? I guess the doctor has already answered this question. Then it's from Aigosh Sharma again. What do, if symptoms are really coming quickly in heart disorder? I think this is the answer. This is the answer. You need to read. Yes. Yes. What precautions shall I take to not give stress on heart? What she means to say is, what should she do to maintain stress or avoid stress? No, I think it's specific stress on heart. In the sense, how do I not stress my heart? She went, what precautions shall I take to not to give stress on heart? You know, people believe that some particular thing produces stress on heart. But you know, when your heart is normal, more you stress it, it's better. More you exercise, more you stress it, stress the heart. It's actually better for heart. So there should be less stress to your mind and more to heart. That means you do more exercise, but don't take tension. That's better for heart and mind both. Doctor, what heart rate is good to be rated? Heart rate is very variable. The normal heart rate varies from 60 to 100. Anybody can have it. Lower heart rate need not be bad. You know, especially lots of athletes, if they are very trained and exercising, heart rate actually comes down to something like 50. There are people with 30 and 35 also. It's considered a sign of good. The best heart rate is between 50 and 60. The maximum survival, if you see, is between 50 and 60. But then it's just one predictor. So don't go by that. Because now you'll get lots of gadgets. So see your heart rate. I think they should not panic just by your heart rate. Changed heart rate is sign of life. So there is nothing. Heart rate will change if you are living. So you accept it. And the question from Sovati Chandra, how do the symptoms of heart attack differ between men and women? Yes, but it's a very interesting question. Just to read this one. Yes, women have little atypical symptoms. The symptoms are not very specific. They should not neglect it. Just because their chances less in particular age give does not mean they won't get it. They will get it. And I mean, they can get it. And they can prevent it or protect themselves. So they should not neglect it. That's lots of atypicality. The tests which we do are also not very sensitive. You know, TMT, which we do, in men, it's very reliable. In women, it's not that reliable. So women also has to be more careful. We have some more questions. Miha got mine. It's from Nikita. My aunt, what she wants to say is, my aunt experiences severe chest pain every time she climbs the stairs. Can it be serious symptom of heart disease? What do you suggest? I think it is, Nikita. So what you're dealing with here is not a heart attack, but a stable heart disease, in which case probably there is block in our coronary arteries, the arteries which supply. And when she's walking, she's getting pain. And when she's resting, she's okay. So this is what we know as a stable heart disease.  So maybe they should get angio done, and fix the block. But again, since she's a female, it's not necessary there are block. Sometimes there are no block, but that's your lucky day. But with this symptom, you should take it very seriously and get it treated. So the next question is from Edison. I have been experiencing random left chest pain for the past two months. I also noticed my resting heart went up from 54 to 77. Should I be concerned? Yes. I mean, this Edison may not be a heart disease, but there's no way to be sure. If it's just random, comes for two minutes, three minutes, and it's just freaking or burning, it may not be. But then it's very important that you get yourself evaluated which might include an ECG and a treadmill test. A treadmill test will be very important when you have symptoms like this. And if a treadmill is normal, I don't think you have to worry. You see the first person's symptom was so classical. The second is not very classical. So heart disease symptoms keep varying. It's not about just any chest pain. When it's classical, we do know from history itself. So next question is from Rohan. What he wants to say is, I am 23 years old. My father expired because of a heart attack. I'm not an alcoholic or a smoker, but I have lived a stressful life in the last five years. I want to do a heart checkup. Which test should I do? Yes. I think, Rohan, what's important is you have a risk factor, but it's not a must that it gets transferred. One important thing to get it done is your lipid profile. You need to get your lipid profile and locate your LDL cholesterol. Because one way it passes genetically is lipid test itself. If lipid test is abnormal, you need to treat it. It's also worthwhile for you to get one equal. And that means just to be sure there is nothing much. And trust as we keep discussing is very indigenous. So you need to, you know, find out a way that, you know, trust you for a life. The next question is from Shreya. Does depression increase the risk of cardiovascular disease? I think so. Yes, it does. Because depression itself is a very stressful condition. We already discussed the stress as a direct relation with the heart disease. So it's very important that people, you know, all these diseases needs to be treated. They need to be taken seriously and they need to be treated. There is a depression treated. There is a way to get it treated.  But some of them do affect heart really. So coming towards the end of this episode, we have the last and final question that's from Nasreen. Is pacemaker really helpful in heart failure cases? Yes. This is an interesting question. It's not really called a pacemaker, but the therapy is almost the same. If the ejection fraction is less than 35%, if you're pumping normally 60, it's less than 35. And you have certain features in VTG. Then a pacemaker-like device called a CRT, cardiac resynchronization device helps them. The way to put it is just put like pacemaker. Normal pacemakers have two leaves, but this has third leaves. It has three leaves. So you just put that and it does help in a select group of patients. So there is a role for these devices. These are called device therapy. And there is a role for this. There is also a role for medicines as well as this. So Doctor, we have come to the end of the show and questions are done. So I would really like to thank you on behalf of all the viewers because you have given a valuable time to us and enlightened us with your knowledge and given us some vital facts about heart disorders and heart problems. So I'd like to really thank you once again for coming and being the part of the show Health Vibes and making it a successful one. And also I want to thank all the viewers who have been the part of this Health Vibes Facebook Live Chat. And I would like to tell you one more thing that will be coming up with the next episode of Health Vibes very soon. And meanwhile, please like this video and share this post on your Facebook and also like our page Manipal Hospital on Facebook. So with this I would like to tell thank you.  Signing off, it's Nisha. Thank you. Thank you.


I want to begin again by expressing my appreciation for the tremendous assistance that the ABA has provided us as we have advanced this issue of the need for criminal justice reform and in addition to the need for reform the specific legislation that we put forward and appreciate the article that was written earlier on this point by Bill Richardson and Janet Levine the chair of the criminal justice section and all the hard work that's been done by Steve Salzburg, Jack Hannah, Bruce Nicholson and many others and I would really be remiss in talking on this issue about criminal justice reform if I did not mention the incredible heavy lift that one particular member of my staff Doug Ireland has made on this. Doug Ireland are you in the back room? Please stand up. As those who have worked with us know I'm not on the judiciary committee. The legislation that we've been working on has been done completely out of our office and it's involved four and a half years of really hard work by our staff including meetings with representatives of more than a hundred different organizations across the country and when we introduced this legislation for a vote last week which we lost as Steve mentioned but we're not done. We had the support of 70 different organizations from across the philosophical spectrum and it's a real rarity when you're working in this area of criminal justice reform when you can put a piece of legislation up that has the endorsement of the National Sheriff's Association, the International Association of Chiefs of Police all the way across the spectrum to the ACOU, the sentencing project. This is something that is wide recognition in the country that needs to be addressed and we're going to continue to work on that. Also like again to mention I'm glad that my wife was able to be with us today.  I have to say I think I don't think she got better education than I do but people light up when they hear Cornell so definitely went to a very good school and I'm sitting here in the shadow of Georgetown where the years that I was at Georgetown I don't know if there are any other people who graduated from Georgetown who are here today. I see a couple of hands, Richard Allen Gordon to Harry Hand and contracts all these great memories but I got to Georgetown Law School right after the Watergate break end in 1972 and I graduated right after the fall of South Vietnam in 1975 and if you were a Vietnam veteran that was not a fun time to be in Washington D.C. I would say I've told people I'd rather spend three more years in Vietnam than go through three years again at Georgetown Law School during that break. But I want to talk to you today about why I became so interested in this issue of criminal justice reform. What our journey has been since I announced for the Senate I've been working on off and on in the area of criminal law for a long time as a journalist, as a pro bono attorney at one point and what we did to prepare this legislation and what happened and what we're going to do because what happened last week was a total surprise when after four and a half years of work and as Steve mentioned bringing people in from all philosophical viewpoints, listening to them, working across the aisle, adapting the legislation just to be able to say for the first time since 1965 we are going to get a top to bottom look at the quite frankly broken criminal justice system in the United States. We're going to get the best advice from people who have spent their professional lives in this area. We're going to have them make recommendations to the Congress and we're going to sit down and we're going to think about it and we're going to try to adopt the types of measures that will allow the system to work again. That's that was our objective. It was not a political it was not political at its base it was it was a leadership based effort. One of the great things I learned from the Marine Corps was that you have to have accountability in a system but you a system cannot function without fairness you have to have both and when I decided to run for the Senate I decided this is one issue I was going to put in front of the people in Virginia that on the one hand we over-incarcerate there's just no there's no way around that. We have by some statistics five percent of the world's population and 25 percent of the world's prison population. We have on any given day seven million people involved in this process as many people in this room know full well. We have about 2.3 to 2.38 million people in physical incarceration in one place or another. We have another nearly five million under some sort of supervision as a result of the criminal justice system and at the same time if you take a poll on any given day in the United States two thirds of the people in this country feel less safe than it a year ago in their own communities. That's clear evidence that we've got a broken system we're doing something wrong. When I first started talking about this during my campaign in Virginia my political advisors were pulling me aside and saying you know this is suicide you know you don't talk about this in Virginia have you looked at the data have you looked at the political positions but everywhere I went when I would when I would talk about this from from you know the relatively secure neighborhoods in northern Virginia that's some of the harder neighborhoods and in the Tidewater area and the Norfolk area or Richmond people would start nodding people understood the average American understands the system is broken it's not always fair and it's not doing what it was supposed to do. So when I came to the Senate even though I was not assigned to the Judiciary Committee we just took this on. I was assigned on the Joint Economic Committee which is a non legislative committee and I was very lucky that at that time Chuck Schumer was the chairman and Chuck Schumer is a pretty innovative fellow as I think all of you know. I said Chuck I'd like to hold hearings on the economic consequences of mass incarceration about the economic consequences of the economic aspects of drugs policy and he said go to it. So we use the Joint Economic Committee to hold some some really important hearings that I think helped illuminate this issue and started a debate across the country about the fact that we need to we need to speak openly and we need to fix it. So I will say victory number one and it is a victory over the past five years of putting this issue up and causing people to talk about it is it's it's put the issue of criminal justice reform into the national debate where people from all sides of the political process can now openly talk about it without fear of losing their careers or without having to worry about somebody saying hey you just solved on crime and what we've got a heritage foundation talking about it. Newt Gingrich talking about it. We have endorsements as I mentioned on this legislation from our three major law enforcement associations which were a little skeptical at the beginning when when we put the legislation forward. I had firmly believed that if I applied the same leadership model on this legislation that I had used on legislation that we put together for the GI Bill for our post 9-11 military members that this would be a no brainer a no brainer when it came to a vote. The level of debate was really high the energy level was high and all we're talking about is getting 14 of the brightest minds and criminal justice in the country to come together and give us advice and you know the energy of the discussion was extremely high. What I did when we put the GI Bill into play and and by the way that was not an easy lift you know there there are things that when they turn out right look simple in retrospect when I introduced the GI Bill my first day in office having been a as as Steve mentioned having been a committee council in a house years ago working on veterans legislation every day. I basically my point was we keep saying this group of people are the next greatest generation we're giving them a GI Bill that isn't even 14% of what the greatest generation got if you were going to go to a good school when you left the military let's give them the same educational opportunity as the people came back in World War two pay their tuition buy their books give them a month give them a monthly stipend people were saying welcome to the Senate you've been here one week wait your turn you know everybody has some kind of a veterans bill they want to put forward and we said no we developed a leadership model reached across the aisle to the other side put this legislation forward with four principal sponsors two Republican two Democrat two World War two veterans two Vietnam veterans we had John Warner with us my former senior senator we had Chuck Hagel from Nebraska Vietnam veteran Republican got Frank Lautenberg from New Jersey World War two veteran myself Vietnam veteran 16 months we educated the Congress about why this was needed we forced a vote and went and after 16 months of effort focused on policy and not on politics we passed the most important piece of veterans legislation since World War two over the op they don't like to hear this over the opposition of the Bush administration we passed it I thought this is the way we need to get things done we need to get people together who want to govern we started the same process on this criminal justice reform bill but guess what John Warner's gone Chuck Hagel's gone as a lot that's changed in the United States Congress and in the the top leadership of our legislative bodies since the election of 2010 let's just be very frank about that our legislation criminal justice legislation was developed hand-on-glove also with the House of Representatives and it's important to remember when we see what happened with this Republican filibuster last week that in the last session of Congress before those who were elected in 2010 took their seats this bill this criminal justice reform bill passed the House of Representatives by a voice vote it was not even controversial enough to have to go under suspension of the rules to see if one-third of the House would object to it Lamar Smith who's the chairman now of the House Judiciary Committee was a co-sponsor of this exact legislation we are not done as you might imagine we are going to continue to pursue ways to get this Commission enacted and to get the advice and the debate that is needed in order to fix the broken points in our criminal justice system so that we can again have a criminal justice system that holds people accountable where they need to be held accountable that makes proper sense in terms of how people or try our tribe how long their sentencing happens to be and let me just add a parenthesis in that point because I know it's something that's been discussed today in your in your gatherings I was the first American journalist allowed to go inside the Japanese prison system 1983 I spent a month doing a piece on Americans in Japanese jails it was fascinating it was it was one of the inspirations that caused me to focus on even then on the broken points in our the emerging broken points beginning in about 1980 in our criminal justice system and in the Japanese system if you are given a sentence of three years or more you've really done something extremely unusual they focus on accountability rather than the length of incarceration something we need to discuss something we need to debate what should the standards be in terms of prison administration again the Japanese system was very much like the American military and what I what I mean by that is in order to be a turnkey in a prison in Japan when I was was going through their system you had to pass you had to compete in a nationally nationally standardized test you had to go through a year of training counseling not simply the physical part of it and you could not be a warden in a Japanese jail if you didn't start as a turnkey it was a promotional system that it emphasized quality at the beginning and measurement all the way through the system and I had an American who had been in Japanese prison and had been in American prison who I had interviewed before I went over there and one of the things he said was I shed more than one tear when I said goodbye to my guard and I asked one of the wardens in Japan about about his comment he said if we are their comrade we are their tutor and we are their guard so why don't we talk about you know there's good models and there's not so good models in the United States what's wrong with having that discussion and most importantly right now and I and I think that the focus here is in your conference today is so vital on this point is what are we going to do in order to provide smarter and better reentry programs for people after they have been incarcerated as everyone in this room knows when the magnitude of incarceration has increased give you one one little key data point that we talk about a lot when we're talking about criminal justice in the Senate 1980 there were 45,000 people in prison on drugs in the United States 45,000 we got about 500,000 in prison on drugs in the United States today basically nonviolent crime when you have such a large percentage of your population that has gone through the prison environment it is in the interest of every American that the reentry process be structured and as much as possible be fair in order to allow people who have been in this process those who want to resume positive career paths and contribute to our society to give them a structured opportunity in order to do that I think it's one of the great failings in our system and then finally what are we doing what are we going to do with the ever-growing issue of gangs in the United States and particularly transnational gangs so much of it driven by incidents that are coming up from our southern border the last number I saw was that there were at least 232 cities and towns in the United States where Mexican drug cartels have been operating at one level or another those of you who live in northern Virginia are I'm sure aware of the growing problems of gangs in northern Virginia last number I saw was there about 6,000 gang members in northern Virginia so we need a system where we need to revamp our system to where we can ensure accountability but also provide fairness and adaptive thought in terms of how we are handling the problems of society that's basically that's all we're trying to do that's all we've been trying to do for the last four and a half years in terms of putting this commission online and I again like to express my appreciation for your organization for the strong support and to give you my continued pledge that we're not giving up on this I think this is one of the most vital issues in terms of how our society works and we're gonna we're gonna keep at it as long as we have the potential of getting this done and I think we will get it done thank you very much it's been good


Hello, this is the Greater Lagos vision and I'm your host, Love Ikuku Oyeduku. It's been over two years of changing lagos. Governor Babaji Desawoli has been working to transform the state into a more livable mega city where people come to do business. Across the state, from roads to housing delivery, upgrading of schools, urban renewal and rehabilitating health care facilities, there is a proof of his commitment. Recently, the multi-purpose Cow Park and Facility building are only converse commissions. This is an affirmation of the governor's resolve to ensure the completion of all inherited projects. This is the Greater Lagos vision. Welcome once again. This episode features infrastructure. Governor Sauronlu Commission's only-call multi-purpose building prized edifices on economic development. Lagos Investors Roundtable, no less than $15 billion required to meet infrastructure needs. Good governance, Sauronlu wins New Telegraph Governor of the Year 2021 award, promises to take governance to the highest level. On Saturday, Lagos State Government calls for strategic repositioning of cultural heritage. These are many more when we return. As part of measures to extend development across Lagos and grow the economy through a robust infrastructure portfolio, the Lagos State Government has commissioned the multi-purpose Cow Park and building Atuniko. The edifice, according to Governor Sauronlu, will not only speak to all the traffic issues but also ensure an ambience needed in that area. Reconstruction began in June 2013, during the tenure of now-Minister of Works and Housing, Baba Tudi Fashula, then Governor of Lagos State. It is now completed and commissioned by Governor Baba Judis Sauronlu, an affirmation and attestation to his Resolve to ensure completion of all inherited projects that fit into his film's agenda. In addition to the parking floors that we have, we have a floor dedicated for social engagements. We have two banquet halls, one in which we are in now, will accommodate easily 800 people. While the second one here on my right is to accommodate 600 people for banquet halls and also seminar use. In addition, we have a space on this side for a private exclusive clubhouse. Governor Sauronlu is convinced that with the commissioning of the multi-purpose Onikon Cow Park and facility building, traffic gridlock would become history in that area. It used to be a place where nobody could get into and so you can see that indeed our government has converted a liability onto our assets and I think we deserve a round of applause for that. And so all around here, you also see a lot of social activities and social clubs that have been here for decades. From Island Club, to Robert Tennis Club, to the Lagos Lone Club, to King George the Fifth Park, to the police area command zone two here, of course to the museum kitchen that is right next to us, but more importantly to the edifice that we're bringing right across you, which is the J. Randu Center for Eurobar and African culture. These are facilities that are in this neighborhood and we're sure that this multi-level Cow Park will speak to all of the traffic issues and all of the social integration that needs to happen around here and so that you can see that this is well conceived, is well thought out and it will help and reduce all of the gridlocks that usually happen around this place. This edifice that has over 384 parking lots that has seating capacity for over 1400 people will ensure that not only is free flow of traffic, but will also ensure that there can be an ambience that is needed in this entire neighborhood. Special advisor to Somwulu and works in infrastructure, engineer Aramidi Adeoyi said the edifice would extend development across Lagos and grow the economy of the state. In a city such as Lagos, scarcity of land is an issue, hence the multi-story Cow Park which utilizes vertical space provides an ideal solution to overcome horizontal space constraints and regulate better traffic flow. In deciding to do this, we also realize that this facility building is significantly important because of its large size parking capacity, income generation potential, and its location strategically within the heart of Onikon. Its judicious use will no doubt help absorb vehicles that would have otherwise parked on the roadside and other illegal parking spaces along the corridor with its attendant negative impact on traffic flow. They also highlighted the scope of works for the project. Five levels of parking floors with a capacity of 384 vehicles with offices for tickets and restrooms on each floor. The sixth floor is designated as multi-purpose mixed use consisting of a clubhouse of about four and ten square meters capacity. This provides additional recreation facilities for this area that has both Island Club and the Uyber Tennis Club at close proximity. The Adeyoye strongly believes another revenue for job opportunities has just been created with the commissioning of the facility, providing an aesthetically pleasing environment and more reportedly complimenting the state's efforts around tourism infrastructure within the precinct of Onikon. Legoset Govno Babagide Sawonlu has presented a budget proposal of 1.388 trillion Naira to the State House of Assembly for approval for the 2022 fiscal year. Here are some highlights of the budget estimates. The Legoset House of Assembly was filled with state executive council members, lawmakers, judges and traditional rulers who came to hear Govno Babagide Sawonlu present his 2022 budget proposal. For time came for the Govno to take to stand and presented a spending plan that is 138 billion Naira more than that of 2021. I'm privileged to be presenting to you today the year 2022 budget proposal which will have tap the budget of consolidation. For good reasons, as I noted earlier, 2022 will be the final full year budget limitation for the next general election in 2023. It is therefore an excellent opportunity for us to consolidate on what we have done so far and ensure that every effort, every investment, every partnership, every policy is translating maximally into a lucrative positive impact in the lives of our people. The challenging environment also requires that we focus our intervention in areas of the biggest social impact, achieving the greatest good for the greatest normal in the shortest possible time. He targetted the budget of consolidation. 564.9 billion Naira was budgeted for a current expenditure while 823.5 billion will be spent on capital projects. The budget size is more than analyzed as the current expenditure of what we said at 564.9 billion video and the capital expenditure of 59.6 billion at 823.35 billion. The deficit financing will be by way of combination external and domestic loans and bonds which will be within our fiscal sustainability parameters. We have clearly articulated our vision in tackling governance in the state through our teams agenda and our comments the state 30 year development plan 2021 to 2021 that will update and replace our previous plan which was from 2012 to 2025. This is necessary given the huge global challenges that are common for us as a people and as a nation. The Speaker of the Lagos State House of Assembly Honourable Mother Shiru Obasa passed a vote of confidence on Kovno Babaji's own for his achievements but he gave an advice to the governor. Because it has a highest funding tax of course this loan has been steeped behind most of the infrastructure and development we all see all over the state. Never the less we advise ourselves to focus more on the tax code that will create job opportunity and reduce bottlenecks in movement that will be jailed towards animating poverty. The Speaker also called on President Mohammad Buhari to work towards reducing unemployment insecurity and poverty. Lagos 2022 spending plan is called the budget of consolidation because it is meant to help the government perfect on the gains recorded over the years. Lagos State needs no less than 15 billion dollars to meet her infrastructure needs. Governor Sowonu stated this at the thought Lagos Investors Roundtable organized where the State's Office of Sustainable Development goes SDG and investment. He said the demand is due to the rising realities of population explosion and the state's limited geographical space. Where investment roundtable was attended by foreign diplomats, members of business communities, companies of industries and members of the State Executive Council. Governor Sowonu called for partnership with investors and the private sector. He said the implementation of the development strategies of his administration demands partnership and contributions of private investors. In education, we have creative budget financing and we're scaling up our investment in education using the private sector. We're scaling up our investment in rapid emergency services in our fire engines and all of these with the private sector. These are areas in which government usually struggles to be able to raise the funding for but because of how we've been able to creatively utilize our balance sheet, we are getting the private sector that are joining us to raise the required funding for some of these critical areas of our government. While assuring investors that Lagos State is open and ready for investments, innovation and collaboration, Governor Sowonu assured investors and private partners that the state government will create and namely policies and environment for them to thrive in Lagos. And of course what you expect from this investment, you expect guaranteed reasonable return and this are some of the things that I want to assure you. This is where as government we can come in and will certainly will come in to create the enabling environment, the right policies and the overall structure to ensure that you continue to strive and thrive in Lagos for your investment to be safe, to be secure and to be innovative and continue to excel. Indeed, we have a huge responsibility to develop critical, hard and soft infrastructure that can act as catalysts for what you do invest in. Just couple of weeks ago too, the SA, SGD were also at an investment round table talking about the green bombs and Lagos trying to also lead in conversations in that area. These are climate funds that are available that other cities are using so Lagos needs to be able to position itself to be able to also access innovative creative bonds like what the green bonds will have and what people are using to be able to develop resilient cities like the one we have in Lagos. Not only are we doing this, we'll also continue to do more and we'll also ensure that we continue to improve on our public transparency, improve on our fiscal discipline and on our depth of sustainability. We cannot just keep a lip service today. Any investor, any serious investor needs to know or wants to hear you that what are you doing with your depth of sustainability? How well are you disciplined with your fiscal issues and how well are you transparently running your government? Our performance speaks for himself. That's why FICH rating, recently an international rating agency, increased not only on our bond but also on our sustainability, increased us to a triple A plus, you know, as a subnational, as a subnational, you know, and I'm sure it's also because of the kind of things that we're doing. Speaking earlier, the special advisor to Governor Sao Wulu on Sustainable Development Goals, SDG and Investment, Sholakbe Harmond said the round table was part of shared aspiration towards making Lagos the most preferred investment destination in the world. Shiriya assured investors about the Babaji De Sao Wulu administration's determination to institute business-friendly environment and measures to boost investors' confidence and guarantee trust. As the world continues to acknowledge Lagos as a regional, financial, and commercial hub, this administration has and will continue to demonstrate commitment to reinforcing this position by strengthening regulatory frameworks, improving internal security, providing necessary infrastructure, reducing administrative bottlenecks and all that we can do to ensure that we enable business processes. Lagos is recognized as an investor haven for many reasons. Lagos is estimated to contribute 30% of the GDP or more of Nigeria and account for more than 50% of normal production GDP. Governor Sao Wulu during the event launched the Lagos Deal Book, which is a compodium of investment opportunities across the state as well as information about incentives for making the investment and the processes for doing so. Lagos generates approximately 13,000 metric tons of solid waste daily and to achieve the level of efficiency required in managing waste in a city of this size, the private sector must be front and center while the government focuses on regulation and support by way of infrastructure and technical capacity. This was a submission of Lagos State Governor Pao Pao Sao Wulu at the Nordic Nigeria Connect High-Powered Conference on Smart City Solutions and Circular Economy held in Lagos. These two events engaged Nigerian and Nordic private public stakeholders on smart and green city solutions for Lagos. The focus is on how to develop a circular and smart economy with a specific focus on waste management, green energy and transportation. Governor Pao Pao Sao Wulu listed some of the efforts being made by his government for our greener Lagos. The private sector participation, which are largely citizen focus, you know, so what we've done is indeed we'll make investment in areas that we're used to support the PSPs which are facing, you know, the general public. By building new transport loading stations for this agency and we're also wrapping up existing composite facilities where renewing our waste management fleet and we're assisting a private sector with fleet renewal as we go along. Sao Wulu also spoke on the wealth creation potential of waste. Following the huge investment we have made in waste management sector as well as the transformation of our waste management practices over the last two years, we have been able to create no fewer than 40,000 direct and indirect jobs within that period. Furthermore, with the advent of recycling and other waste management streams, we envision that we will also be creating additional 6,000 jobs annually. I think Lagos said deserve a small round of applause for that, but we're still seeing a huge opportunity coming out from there. Ultimately, seeking innovative solutions to our challenges will start with seeing ourselves more and more at the 21st century mega city, a smart city that is playing on a global stage with similar cities from around the world. The governor also helped on the need for a change of mindset among the populace, new habits regarding use and reuse and the immense possibilities of recycling. Very importantly, we have also realized that beyond just infrastructure, a mindset change amongst our populace needs to take a new dimension. And by this means, I mean introducing to our people a new way of thinking about waste and a new habit regarding the use and the reuse and immense opportunity for recycling of our waste. For those who know Lagos and Nigeria well, we know that we are heavy users of plastic materials. So there's a lot of work that's ahead of us in terms of educating our public about the responsibility and responsible use of disposal of plastic to cite one example. So Loma has therefore been actively involved in redefining his remit, expanding beyond the conventional waste management oversight to sending and building a thriving waste economy and the state. This brings to me the creation, the wealth creation potential that this over 13,000 metric tons of waste on a daily business has. Deputy Minister of International Trade Nina Vasculati told the Gadrin that her first priority is on making the COVID-19 vaccine available to everyone. Until everybody is safe. That I think is the first priority for all of us to make the world a better and a safer place to live and to work and to co-create together. This is my first trip to Africa since the start of the pandemic. It's not a coincidence that this first trip is to Lagos and Nigeria. This has been in the works for a long time. As mentioned by the Governor Lagos, it's a business powerhouse of Nigeria, the largest economy on the African continent. Lagos has roughly the population of the five Nordic countries combined together, 20-something million. But very, or most importantly, Lagos is taking giant steps in becoming a smart city. Mr. Governor, let me already at this point congratulate you on that. The term smart city is widely used and often very broadly interpreted. However, I would like to define it like this. It is use of scientific methods, data and technology to improve the life of citizens, developing the city in line, sustainable development goals that we have all agreed upon. Becoming a smart requires transformation. Nigerian economist, entrepreneur and philanthropist Tony Illumelu in his presentation commanded the forum for creating the avenue for entrepreneurs to interact with each other. I think having this approach, I call it the entrepreneurship approach to development. It's very good. You're bringing your business leaders to this place, they're interacting with our business people, they are working together and interacting and seeing how they can do more in the area that you identified are very important to drive our development in a sustainable fashion. So it's good. And final message is to the public sector, you know, you need the donor organizations, donor agencies, development partners to do, to support. You need entrepreneurs to do what they know how to do, how to do what they know how to do. And most importantly, government to create a living environment. So when Legal State Governor was speaking, I was talking about, you know, it says so much and, you know, the soft infrastructure, the hard infrastructure, the broadband connectivity, all of these things will make a difference. And so my message to our public sector leaders, those like Legal State Governor and government that's doing the right thing, let's keep doing more, let's continue, let's keep the right environment for our young ones to succeed so that what the development partners are doing is not wasted. One of the take-homes from the conference is that Legals is open for collaboration and investment. Well, that's all we have for you in this episode of the Greater Legals vision on PLUS TV Africa. I'm Lovie Kuku Oyiduku. Bye for now.


This study developed a novel method for creating customizable, thick, vascularized, and perfusible cardiac patches that matched the patient's unique anatomy, immune system, and biochemistry. First, a biopsy of momentum tissue was taken from the patient and converted into pluripotent stem cells and cardiomyocyte and endothelial cells. Next, these cells were combined with a personalized hydrogel to create a bioink parenchyma and blood vessels. The resulting patches were then printed using a 3D printer and implanted into mice. The patches were found to be viable and capable of forming new blood vessels, which allowed them to be successfully transplanted into living animals. This study demonstrates the potential of this technique for creating personalized tissues and organs or for drug testing in an appropriate anatomical structure and patient-specific biochemical environment. This article was authored by Nadav Noor, Asaf Shapira, Reuven Edry, and others.


Combat Town. Today, a notional stronghold for an enemy force. And unfortunately for my friends here, echo companies on the way. More than 60 Marines and sailors of the 31st Muze Battalion Landing Team assault a six-structure urban facility defended by a small force of guerrilla fighters. Operating in an urban environment provides unique challenges for the Marines to overcome.  So you have to watch out to feel the fire. Through battle-tested fire and maneuver tactics, the Marines secure the compound in less than 30 minutes and gain valuable experience in urban operations. Marine Sergeant Paul Robbins Jr., Central Training Area, Okinawa, Japan.


If things continue the way they are, they will not experience Makoti mangrove. Mangroves act as industries and they are a breeding ground for a lot of marine organisms such as fish and other Makoti organisms. What we all want to accomplish is to have a situation where we understand what the value of our wetlands are. We cut down the mangrove's unsustainable cutting and when we approach it, it turns out that there is nothing that you could do. People need to be held accountable. They also provide coastal and shoreline protection and stabilization during hurricanes and flooding events. People assume it's supposed to be a free-for-all that we can either dump our trash or we can squat on it and not understand that it has a significance. So the project is going to be delivered and some of the concerns that you have addressed. We have a lot of policies but we need implementation. We need these areas resolved.


Hey guys, welcome to the 30 Paintings in 30 Days project. If you choose to join me on the 30 Paintings in 30 Days journey, I hope that you do share and tag me and post like on social media and stuff, maybe film some videos, tag me in the description, something like that. I am kind of excited about the project. I do do daily drawing. I don't necessarily do daily painting, but making a daily practice out of something like this encourages you to get better at it. It encourages you to work it into your daily routine or weekly routine. It also is a way to use up supplies. So if that's your goal, maybe you don't want to do 30 paintings in 30 days, but you want to do 30 collages in 30 days. That works too. So let me know. Let's get to painting and I'll see you then. Okay, onto painting number 26. We're getting really close to the end. All right. I do have a large booklet of floral inspiration photos, but I also have a spiral bound notebook, like just a plain school notebook. I've shown this on camera before of just people and I have it open to actually an altered picture of myself because you know, masochist that way. If I'm going to screw up somebody's face, it's got to be mine, darn it. So we're going to try to do a picture of me and we'll see what happens.  So we're going to use that as inspiration.  Again, not a super huge fan of this paper because it just doesn't do what I really want it to. So it's always challenging. So one of the nice things about abstracting a photo before you paint from it is you're not tempted to try to copy the reality of the photo because you don't have any of that anymore. And in this particular photo, I changed all the colors up to be completely different than what they were and that helps even more. And I really am seeing pink and orange and yellow for my highlights and dark blues and some black and some kind of grayish bluish colors like Payne's gray for the shadows. And so that's what we're going to try to do just real quick. Again, these are study paintings.  I'm not Rembrandt, so I just like to play with paint. So I am putting now some yellow in some spots where I see it on the photo in the altered photo. Still again, like last time, I'm using the flat brush. I'm going to use the colors that are on my palette first. That's sort of my way of like cleaning up the palette. Or before I'm wiping the palette kind of using up what's there. In this picture, my hair was still dyed dark brown. So my hair is kind of dark in the photo and it made it darker when I altered the picture. My hair is gray now. So although my eyebrows are dark, like what the heck is with that? I don't know. It's very weird.  I do. Okay, now we're going to need to get some more color. So we're going to grab some of that Payne's gray color, which is my favorite color, as you all well know. I'm going to mix it with the purple just because that purple is on here. And again, we started out with the light colors, and then we're working away darker because it's easier to add color, dark colors than it is to try to take them away with watercolor paint. I'm going to switch to one of my round brushes, probably the little one. And we're going to grab some of this red that's on here. Just continuing to look at the shape, define shapes. I'm going to show you the picture at the end. You guys can tell me what you think. I'm going to go into ruby red. That's probably a little too much red. But remember what I said about this paper grabbing paint, like it grabs it really quickly. See, that's okay. We're going to go in with some Chinese white. Then we're going to actually take some of that ruby red, put it over here. I need to give myself a nostril hair. Okay, I want a bigger round brush. I'm going to grab some cadmium red light, which is a very orangey red, in my opinion. And I'm just constantly looking at the photo, which is off to my left, literally just dabbing colors in similar places that I see in the photo. Try not to get too far before I add water, rinsing my brush off in between colors, where all the shadows and highlights are and constantly refining where I'm putting my marks and where I'm putting my color. I'm going to grab some Payne's gray. I should say I'm going to grab some more Payne's gray. I'm going to grab some more lemon yellow, because I feel like in some spots we're losing some of the yellow. I'm going to take some of that cad red and mix it with some of this the orangey red, the cadmium red light, and mix it with the other red that's on here to make sort of our reddish orange color.  I'm noticing that we need to put some here shapes. Now, when I'm doing this with acrylic painting, of course, I can layer colors on top of each other. But when you're doing this with watercolor, you can't really do that because it's transparent. You can do some more layering with gouache. Maybe you're working with some more opaque or gouache-type colors like the Jane Davenport along with your watercolors. Then you want to know which ones are more opaque than others. That's another reason to do these little painting studies so that you can figure that out.   But I want to really suggest some shapes. Sometimes, despite what I've told you about shadow colors and highlight colors, for a particular painting, the best thing to do is to go into black and white. Just because you want to try doing your painting with other colors doesn't mean you can't use a black and white. Just explore the idea of doing something else before you just automatically think that you need to have black and white. I'm going to stop there because I like the way that looks. Let me give it a dry. Okay, I want to show you some one of the things I hate most about this paper besides it absorbing the paint so quickly and bleeding through. See how it buckled? Can you see that? So this paper just buckles a lot like crazy. And I do want to show you, this is the original photo that's been altered. So there you go. That was fun. Painting number 26, on to the next. How is that for today's painting? I hope you enjoyed the process and if you want instruction on the painting, you need to be over in Patreon. They are going to get the talking version here on YouTube. You're just going to get the speed food through version, sorry. If you'd like to support the free content here on Facebook or here on Facebook, holy cow. If you'd like to support the free content here on YouTube or over in the Facebook art groups, I certainly would appreciate that. You can of course join Patreon. We do have YouTube membership here for a small fee. And also I have an Etsy shop and I have PayPal tip jar and all that stuff. So check out the video description. Relevant links will also be down there. And yeah, don't forget the most important things.  Do share your work with me. I would love to see what you're doing. That's it for now. See you later. Bye guys.