Meet our Docs: Dr. M. Ammar Hussieno says exercise and a good night’s sleep can help manage chronic disease
By Kristy Bleizeffer Nov 17, 2014
Growing up in Damascus, Syria, M. Ammar Hussieno often played doctor, like almost any other kid in almost any other country. He never lost his interest in helping to make people well.
“It is a great feeling when you make somebody feel better. In Syria, where there are a lot of people who do not have enough health care, being able to help was very satisfying,” said Dr. Hussieno, a pulmonologist and sleep medicine specialist with Casper Pulmonary and Wyoming Medical Center.
Lately, he’s had to watch his homeland ravaged by civil war and constant terrorist threats via news reports. He still has contact with family who live there. And while Syria and the United States can seem like they are worlds apart, the human body is the same no matter where it lives. The lifestyle choices we make have a large impact on our overall health.
The Pulse sat down with Dr. Hussieno to talk about how exercise and a good night’s sleep can help manage a lot of what ails us.
Where did you study?
I went to medical school at the University of Damascus, a really great medical school that focuses a lot on physical examination and patient histories. We saw a large number of patients, so we work hard and learned a lot. Then I came and did my internal medicine training in Pennsylvania at Guthrie Clinic. My pulmonary fellowship was in Brooklyn, New York.
Tell us how you came to Casper and Wyoming Medical Center.
I was working in North Carolina and I was doing a very demanding job working a lot of hours, and my wife and I had a baby. I realized that we had to make a change to be more with the family and with our child. I started looking for a different opportunity that would give me balance between life and work. At the same time, in 2009, I heard about this opportunity at Wyoming Medical Center.
The most important thing was that I could spend more time with my son and my family. I also love outdoor activities. When I came here, I was very excited about skiing. My first year here, the first winter, I went skiing more than I had in the past five years. This was great. Then, I got into cross-country skiing. I had never done that before, and now I am on the Casper Nordic Club board. We are always trying to promote the cross-country trail and improve it.
I also got into mountain biking also during the summer. That I had never done before Casper. I learned that here, and I am very involved with a mountain biking club called Fat Fish Biking. We have a lot of fun and enjoy it a lot.
Casper Mountain is your playground now, huh?
Yes it is. It is one of the reasons I love living in Casper. The more we live here, the more it feels like home. My son thinks he is a cowboy.
Let’s talk a little bit about pulmonary medicine. Why did you specialize in this field?
When I was doing my internal medicine residency, we did rotations in various subspecialties. We rotated in cardiology, rheumatology, pulmonary and gastroenterology. I found pulmonary fit me the most. I was good at it. Again, being able to help patients with shortness of breath feel better was very satisfying.
How does that relate to the sleep medicine?
The most common sleep disorder is respiratory sleep disorder – or sleep apnea. People stop breathing while they are sleeping. This is more of a respiratory problem during sleep. I decided to pursue that a little bit further and applied for the sleep medicine board certification.
Did you build the sleep program at Wyoming Medical Center then?
No, that was already here, but I was the first sleep specialist and board-certified sleep specialist here.
How common is sleep apnea?
It is a very common disorder, but it is under-diagnosed and not recognized. Very often I have to search for it and ask the right questions because not too many patients come to me and say, “I have sleep apnea.” I look for the red flags, for the signs and symptoms. When I have multiple red flags, I send them for a sleep study. If it is confirmed, I will treat them.
What are the signs and symptoms?
The common symptoms are feeling tired, feeling sleepy, waking up frequently at night, not feeling refreshed in the morning, having morning headaches and snoring. A risk factor is having a narrow throat or large neck. In the medical history, if somebody has high blood pressure, coronary artery disease, history of stroke; all those make me worry about the possibility of sleep apnea contributing to that.
How does a good night’s sleep affect your health?
In general, sleep is very important for your health. If you are chronically sleep deprived, it affects your memory because memory is formed during sleep; It affects your mood, so you are more likely to be anxious and be depressed the next day.
When you stop breathing at night, your body produces adrenaline hormones. It is like somebody is choking you, so your adrenalin shoots up, your blood pressure shoots up and your heart rate goes up. It is too much stress to the heart. If it is not treated, those patients eventually could develop heart failure, develop high blood pressure, and are at risk of having a stroke while sleeping. If we treat the sleep apnea, we can prevent or reduce the risk of those conditions.
As a doctor, if you had a magic wand to cure one thing or change one behavior, what would it be?
I have this reputation among my patients about making them exercise. I send them to pulmonary rehab, and we have had great success with this. We have taken patients that can hardly walk to the mailbox in their driveway, and with pulmonary rehab, we actually make them exercise and now they can go shopping.
I have one patient who thought he would never again play golf in his life, and he is now able to play. To me, that is what I like about medicine: stories like this and making that difference.
Making people exercise, in my opinion, makes the biggest difference. Smoking cessation will make a huge impact. However, nationwide, we do not have success with making people quit smoking. Somehow I have more success making people exercise. When I first started, I had some resistance. People did not want to go to pulmonary rehab. When some patients started listening to me, and they went, they noticed a huge impact. Then it became word-of-mouth. Now, I have patients coming to me saying they want to go do pulmonary rehab. We have a waiting list of 6 months to get into the program.
What is it?
Pulmonary rehab evaluates every patient individually. We have a respiratory therapist, a nurse and an exercise specialist. They develop a program for each patient, and they focus on breathing techniques, exercises and improving their lung capacity.
I have so many patients that told me that they had never been on a treadmill in their lives. They get on and they can walk maybe 2 minutes. By the end of the program, we get them to walk 10 minutes – which is about 500 percent in improvement. That, by itself, seeing that you can do better, believing that you can do better, is the biggest motivation for them to keep exercising and staying active daily. That is what helps them with their lung disease.
Of course, life-style modifications would make the biggest difference in this field, probably in medicine in general. If we can get people to quit smoking and eat healthier we would prevent a lot of disease. I am a big believer in life-style modification, more than medications.
I can tell you of a story of a patient that I met when I came here almost 5 years ago. He was in the ICU. He was in his late 40s or early 50s. He was overweight and was a smoker. He was in respiratory failure and requiring a breathing machine in the ICU, and we thought he would not make it. He made it, thanks to the great doctors at the hospital, especially the intensivists. They pulled him through. He then came to me for the second phase, the outpatient phase. I got him to quit smoking.
How did you do that?
I think he was ready. After what he went through, a big life-threatening event, that convinced him to stop smoking. He had severe sleep apnea, and we started him on treatment. We sent him to pulmonary rehab. He lost weight. He now is using his CPAP every night. He feels much more energy than he ever did in his life. He walks 2 miles every day. He has not been to the hospital in 4 years. He is doing great, and I am proud of him.
How much exercise should a normal adult get?
In general, if you can exercise 30 minutes, 3 times a week that would be great. However, that might be challenging for some of my patients. I tell them to exercise as much as you can, and then set up a goal to improve by 1 to 2 minutes every week until you reach a reasonable goal. Every patient is different. If I take somebody with advanced lung disease, our goal might be to make them walk 5 minutes 3 times a week, or every day for 5 minutes. If they are able to do that, it means they can walk around the house, and have activities to improve the quality of their life. Somebody with mild lung disease we might aim for 30 minutes.
I believe we can make a big change in your health in the outpatient setting and keep you out of the hospital by maintenance treatment for lung disease and life-style modifications. This is something that the patient has to be partnered in. I put the ball in their court and say, “you have to work on this,” whether it is quitting smoking, exercising or eating a healthier diet. We can achieve results, and we see results. It is always inspiring, and it keeps us going.
What resources do you offer to help people quit smoking?
We do have smoking cessation tips through Cerner (our electronic medical record). We have some pamphlets that we give about smoking cessation. But, in my opinion, if I can take a few minutes of my time to talk with them about it and remind them, it makes more of a difference than them reading papers. I experienced that in my life. There are certain brief conversations or encounters that I have had with people throughout my life. Those encounters made big differences. I am always grateful to those people who made an impact in my life, and I try to do the same with my patients.
Dr. Hussieno grew up and went to medical school in Damascus, Syria. He is board certified in pulmonary disease and sleep medicine and is medical director of Wyoming Medical Center’s Sleep Lab. He practices at Casper Pulmonary, 419 S. Washington St. For a referral or an appointment, call (307) 577-0477.
Medical School: Damascus University Hospitals, Syria
Residency: Robert Packer Hospital/Guthrie Medical Center, Sayre, Pa., Internal Medicine
Fellowship: Brookdale University Hospital and Medical Center, Brooklyn, N.Y., Pulmonary Medicine