Well, it has been exactly one week since my surgery to replace my aortic valve. This is the second time I have had this open heart procedure... I am told I wore out the old valve with several of the activities that required long periods of high intensity heart effort. I am not all that inclined to agree... but it is easier than arguing from my weakened position.

So, here I am, seven days out and (typed while knocking on the wooden table) I feel wonderful. I haven't felt this good in many months. All of my body functions are in order with the exception of my hemoglobin... so I don't have the stamina back yet... but that is a matter of weeks (days if I choose to start eating lots of calves liver). I left the hospital on Sunday and have been walking a lot... stair climbing is already normal. So I can safely say that this recovery is much better than the last... perhaps I was already much sicker in 2001 and it took about a month to get where I am today.

My first replacement valve was made from a bull's heart tissue. I understand now that bovine tissue can be prone to calcification... and my hope for an 18 year valve was cut short by seven years. Of course, it isn't anticipated that an aortic valve prosthesis  is going to be worked as heard as I tend to make mine work. I do stand on my commitment that if one is in good health and shape when ultimately s/he gets sick, it is likely that recovery will go well. I will reduce my intensity and length of my cycling... but certainly will not stop.

My new valve is in fact a pig's aortic valve. It has been specially treated so that it will not be rejected by my immune system but it is roughly the same as a human valve. I can't feel it, but I do feel the difference the larger valve opening is making, especially to my mind. As the old valve was gradually shutting down, I wasn't getting the same profusion as I should have... it happened relatively slowly, so I wasn't noticing it... the surgery was abrupt, and I can clearly feel the improvement. Once my hemoglobin gets back to normal, I think my muscles will react the same way... I am looking forward to getting back into shape and rebuilding the strength/stamina to my best days.

I chose to come to Little Rock and the Arkansas Heart Hospital because I know the people who own the hospital, the physicians, nurses and others who make it work. They only work on the cardio-vascular system, and they do it incredibly well. I know that I could get the work done elsewhere, but I wanted to achieve the best heart function possible for the next 15 year window of Lynnda and my life. We have achieved that by coming here.

It is ironic that I have a pig valve now... and that I got it here in Arkansas. The University of Arkansas uses the Razorback Boar as its mascot... and the refrain "Go HOGS' is likely the most utilized in the state. They are a very successful university and the UAMS Hospital are awesome... I came here for my PET scan five years ago as well.

I believe could not have had the same work done in Canada. It is a failure of the system at home that there is no opportunity to be following the devolution of one's aortic valve, or any other vessel or organ, if you are asymptomatic. I was particularly concerned about my valve situation because there are essentially no perceptible symptoms... until sudden death... when the valve shuts down. I came to Little Rock each year to have an echo cardiogram done of the valve, because it is such a critical heart function.

For the first five years, there was no change in the valve's gradient... a key measurement. The heart was working well, and the blood velocity was normal. Four years ago we saw the first changes... about a 50% increase in the gradient, but no where near critical. It continued to increase and last summer it reached concerning levels, but still not critical. Some times as I was riding the bike I started wondering if this was my last ride, but I handled that by screaming down the other side of the hills... and all was well.

In December though, things had changed... and we scheduled the surgery. We were good to do it, since two of the three leaflets of the valve had fused and while the gradient was still less than critical... we got lucky because the valve was worse than anticipated. In this case, I am happy that it has turned out this way.

Here at the Heart Hospital I am one of 110 patients who occupied a bed each day. The numbers of patients that go through the cath labs and surgical suites is astounding. The hospital has heart failure, peripheral vascular, wound healing and diabetes clinics... all associated with integrated medicine... for a population roughly like that of Niagara and Hamilton. There are three other huge hospitals, all of which also have heart programs... but the AHH thrives through focus, excellence, research and having the best equipment and people available in the industry.

I am reminded of the Shouldice Clinic in Toronto. The excellence there is respected around the world... as is the excellence at the Arkansas Heart Hospital.

Riding Through Cancer...

In my previous posting today, I describe my new challenge with this damn heart of mine, that I try to keep big, open and happy... but my genes keep getting in the way. And in the posting I mention how important being in good physical health can be... especially when, invariably, we get sick. And I mention that in the past, I have posted regarding my challenges with oral/head and neck cancer.

I have also changed the goals of my life to reflect my aging and perhaps some wisdom that I can pass on regarding health, through my various physiological trials. I have decided to start writing a book about my cancer, using a bicycle trip I took in 2010 that started in Vancouver, British Columbia, Canada... and ended in Austin, Texas, America in an expansive metaphor for the experience. This 4,500 kilometer trip was one I took with about forty other riders and many support folks... it took a couple of weeks, and was the hardest thing I have ever done. It was also the easiest thing I have ever done!

It was especially hard on the road, when I was thinking I was doing it alone... as sometimes would happen when I wasn't feeling good on any particular day, or even just part a few moments of the day. When you are climbing a hill, starting from a couple of thousand feet, to a pass that is around 8,000 feet, there are some moments that the riding gets really, really, really hard... and lonely. Even if you really like yourself, if all you are hearing is your own voice or heart pounding, it can play tough games with your psyche.

But then someone comes along and gives you some encouragement as they go past... or maybe they slow down to ride along side and with you... maybe even put their hand on your saddle and give you a little push. Sometimes when these things happened I would get a little rush of adrenaline, and the strength would return, and my cadence would come back... it happened several times. On at least one occasion, it didn't!



( Photo Credit is to http://www.panoramio.com/photo/43505561 )

I was on Douglas Pass... it is just as you approach Utah in the Northwest corner of Colorado... our Team Five had ridden fifty-five or so kilometers that day when we approached the base of the mountain... I started up the mountain with the other four riders on our team... I had climbed poorly for about a mile and I could feel cramps in practically every muscle in my body... I got the message! It was about the hardest thing I had done on the trip so far... I got off my bike. It was so steep I had a hard time dismounting, and I was so cramped, I couldn't lift my 15 pound bike into the support van that was right there with me. My God it hurt... I had soooo wanted to climb that Pass.

In the van, we followed the riders up the pass to over 8,000 feet and at the top there was a spectacular view. I got out, it was just above freezing, but I was now rested and I didn't have any pain. I swallowed hard as the teams (a second team had done the ascent with us) prepared to descend... the whole reason in my psyche, for climbing a mountain is the thrill of the descent. Just as they were about to start off, one of the riders yelled to me... "Bruce, where's your bike?"

As I pulled it out of the van, raced to put the front wheel back on, checked the pressures, the chain, and my clips, I couldn't help think I didn't deserve to descend on my bike... I hadn't climbed it...

We crossed the cattle grate at the pass pinnacle, and the descent was on... I aimed the bike, down... the tears in my eyes were streaming, my ears were hearing an ethereal scream of delight, and when I looked at my speedometer it was at over 75km. I was wheel-to-wheel with the guy who got me there (my surgeon Chad Robertson), including up several earlier difficult climbs, and I could see the grin on his face... or was that the up-hill wind we were screaming into... a long sweeping turn to slow us down, passed, and then down again... then we looked at 80km...weeeeeeeha!

I realized that so many other people have so much to do with our big moments in life... but in the past I had, too often, not understood what was happening around me... this time, I got it!

The road flattened out after about an eight mile descent and we got to see tomorrow's mountains on the right side of the support van as we pulled away from the end of our section for the day. We had changed in a parking lot, not bothering with the other cars in the lot, with nothing but smiles pasted on our cheeks, hearts still flying... Now, we were in Utah's mountains where between us and the hot pink sunset, there were some snow crystals off in the distance... making it magical... but not so much as the descent!







( Photo Credit to http://www.motorcyclecolorado.com/douglas_pass.htm )

So, I have decided to begin writing parts of the experience and post some of them here. In a way I want to see them in print, and share some of the experiences, maybe with the details of the ride profile, or the cancer oncology plans, or other questions that I had and have about how to get through challenges... I hope they will be useful, and perhaps allow covers to one day embody them in an useful way.

My Latest Challenge

Never a dull moment in life as we age... mine has been a roller-coaster of late... to say the least. About ten years ago I was lucky to have been able to have a diagnosis of a genetic heart defect; one that was getting to the stage that it could suddenly end my life. It was a bicuspid aortic valve... and it had a calcific stenosis that had become acute. Through persistence and the help of close colleagues in the cardiology business, I was able to have a heart catheterization when I thought I had symptoms of some sort of heart problem. This led to the diagnosis of a heart valve in crisis, even though the heart itself was otherwise in great condition.

My 2001 open heart surgery that followed was a sudden experience... one that I haven't shared on this blog. This, because it has always seemed that my subsequent and unrelated cancer was something I could share to the benefit of others, by exposing the issues associated with the epidemic of cancer. In comparison, cancer takes many more lives than my heart valve problem, so I have in the past highlighted the cancer issues.

However, by annually having an echo-cardiogram, we followed the performance of the prosthetic valve that was placed at the Arkansas Heart Hospital by a fabulous team of professionals. In July this year, I became aware that again, my aortic valve was developing problems. It wasn't enough to stop me from my cycling projects, but it did cause me to be much more aware of my sagging performance over the fall months. In an echo cardiogram follow-up this month, we found that the valve is approaching acute failure at an alarming rate of speed. It is again calcified, and has to be replaced.

I want to help people understand this little understood heart ailment. I will copy below the layman details of Aortic Valve Stenosis. This is from Wiki, but is quite accurate, so worth reading. It is a silent killer most of the time, although people who 'listen' to their bodies... and are aware of their exercise output capacities can in some instances catch things like I suffer from, before being killed by them. By my continuous effort to stay in shape, listening to my body, I have been lucky enough to twice now, catch this thing. Yes, I am lucky to have made a career choice that kept me in the medical device arena, therefore close to people who can help, but first, I have had to be in shape and listening, in order to question the things I occasionally feel, about my output.

So, what does this mean. Well, "its elementary", to quote Sherlock Holmes in "The Crooked Man"... replacement can happen in two ways... First, open heart surgery is the way I was treated ten years ago, and that remains the Gold Standard today. There is a new technique, still under clinical investigation/trial here in North America. It is called TAVI, but it is yet unproven to the standards here, and it is not at all approved for "re-do" situations, like mine.

After a good deal of consultation I have decided to have the Gold Standard procedure, open heart surgery... even though the recovery period is much longer. I had seriously considered the TAVI be done 'off-label', but there was in the end no reward for the risks involved in a procedure that does not have clinical efficacy, here in North America. I have a great level of respect for the clinical trial process that is utilized to 'prove' a new technique or device... and in our decision, Lynnda and I leaned on the experience we have had at the Arkansas Heart Hospital and our friends there, who have over the years been our great care-givers to both of us.

I will keep my blog updated as to the procedure, the outcome and so on. I am very confident in my physicians and in the outcome.

For the moment, my message is, again, that it is very important to understand that when one gets sick (and with time we all will), it is important to be in the best physical condition possible. Why? Simply because it opens doors to treatments that could otherwise be closed. When we battle cancer, or trauma, or congenital diseases, our chances of success are enhanced if you are starting out with good vascular and pulmonary function. These good conditions accumulate through cardiovascular and stretching exercise; healthy eating and weight management; great dental hygiene; non-smoking; avoiding environmental hazards; and so on.

Further, it is important to have regular check-ups and listen to your body when it is telling you things... don't hang up on your 'wake-up calls'.


Here is a pretty good description of my problems...just copy this and paste into your browser... http://en.wikipedia.org/wiki/Aortic_valve_stenosis

Below is a cool video of the procedure that I will have in January... since I have had it before, I know what to look forward to... great drugs, beer on the second evening, and lots of moderate exercise for six weeks or so... then, back in the saddle!

http://www.youtube.com/watch?v=5jLfPlQBYuw

Looking Back and Forward at the Same Time

It has been a long time since I visited Spectranetics Inc. This is the company for which I toiled during the end of the last century and the first four years of the 21st... and if that sounds like a long time ago, for me, it is. In fact, it has been seven years since I worked with the team at SPNC... that's over 10% of my lifetime... and I figured I was a) over it and b) would have forgotten much of the technology and even the people.

I was wrong on both counts. As to a) above, I wasn't over it. So much happened during my tenure there that it is probably impossible to forget.

Perhaps I should explain what SPNC is about... this is a company that develops, manufactures, markets and supports interventional cardiology products. These are the tools with which specially trained physicians (we call them interventional cardiologists, electro-physiology (EP) cardiologists, vascular surgeons and interventional radiologists) might intervien when patients have had, or are about to have a heart attack; have to have a pacemaker replaced; or have clot and plaque build-ups in the lower leg, causing severe pain limited walking ability. These products are in the form of catheters that are threaded through arteries or veins into the heart or peripheral regions of the extremities. They are then attached to a cool temperature (40C) Excimer Laser which 'ablates the plaque, scar tissue or clot that is causing the critical situation for the patient.

OK, so I was wrong about being "over it". I had grown to love the action of the job and the incredible rush one gets when one sees a patient survive and then thrive because a very talented physician used our products to save a patient's life. I guess I will never be over that feeling. When I walked into Spectranetics on Monday, it was like 2004 all over again. I wanted to call my troops and customers and make things happen. More on this feeling later...

I was also wrong about b) above... I had forgotten almost nothing about the clinical aspects of the business, the motivation, the budgets, the customers and especially the team. I always understood that a sales and marketing team is only as good as the product needs analysts; the engineering in the product; the production systems from material purchasing, through manufacturing, and the built-in quality systems; the shipping and receiving teams; the installers and service team and so on... and as I met these people while walking the halls of SPNC, I realized how much they had meant and still mean to me. I also met several people in the administration and non-line organizations... Finance, Human Resources, Planning, IP, IT, Regulatory and so on. And I remembered all of them... except that there were a lot of them no longer with the company. At least I hadn't forgotten... at my age, that's a great thing to realize!

So, I had that feeling that I wanted to call the troops and customers... it was an urge... but when I thought about it afterword, I realized that I would be calling them to say... WOW! I saw a lot more than I had expected to see in the form of energy, commitment, enthusiasm and so on. I didn't need to put my hands on the current catheters... to know that they were probably as good, or better, than we had seven years ago... and those were great! The people I met, and the few that I knew, were able to convey to me that they had a product, a team, and a leadership that is capable of expanding this wonderful technology through the industry.

My experience is that the Excimer laser energized catheters in the hands of talented, experienced interventionalists; in properly triaged patients... has the potential to extend and improve the lives of tens of thousands of people who would otherwise have compromised emergent outcomes. This company has not only survived the many challenges proffered by 'executives past' it has thrived.

With the leadership of the new CEO, Scott Drake; CFO, Guy Childs; and the new Chairman of the Board of Directors, John Fletcher... I am convinced that Spectranetics is on solid ground and will keep developing innovative products in the image of Bob Golobic the founder. For certain I am not here in giving any investment advice, and I should disclose that I have recently purchased 1,000 shares... but I do wish that I still had the many thousands I once purchased as an investor.

Today, I learned I lost a new and good friend, yesterday

Its amazing to me, that in just two years, Lynnda and I became very good friends with Nick and Liz Ikonikov... our neighbors across the street. Yesterday, Nick was hiking with Liz and a group in a provincial park in South-Western Ontario. Nick was doing what he loved, in the outdoors, with friends... he had a massive heart attack and could not be revived, even though there was an experienced medically trained person on the trail.

Nick had a huge life! He was in his middle 70's, but reminded me of a robust 60 year old. He was an engineer who directed the building of several large projects like power plants, mines and oil refineries during his career. He and his wife Liz had two children who meant the world to him, and just the thought of his grand children brought a wide smile, and a chuckle to him. What a great guy!

Nick occasionally would visit with Shamus... always bringing either a cookie or a gift for him. One can always tell when someone is a great person, when the family dog thinks that person is awesome. Shamus would see Nick, even through the window across the street, and his tail would start wagging. He would be at the extreme end of the leash when Nick would start coming across the street saying in a teasing voice... "Shaaaaaamus" and then jokingly, as Shamus licked Nicks face and ears, "stay down boy! Seeeeeat boy... gooooood dog!"... and then produce a cookie. He would compare Shamus' shenanigans to his beloved Cody who passed just a year or so before we moved to NOTL.

When Nick came for dinner with Lynnda and me, it was Shamus who got center stage with Nick... until the European Beer came out... wow, did he like a great and cold beer... and his smile lit the room as did his laughter fill it with fun. We will all miss Nick Ikonokov...

To Liz, we commit our undying support, as we do to the rest of the family. Nick's Mother in Montreal will have a hard time, at 98, absorbing his passing. She lives on her own and Nick visited with her just a couple of weeks prior to his and Liz' recent three week trip to Europe where they visited Nick's homeland. He loved his Mother, as a child would... who could ask for more, yet he gave more, visiting her in Montreal several times a year, for a week at a time. Amazing to me... but that was Nick. We will all miss him... ciao Friend... BRuce and Lynnda

On washing my hands after using the restroom...

Have you ever wondered "what is the point of washing your hands after using the washroom"? For many of us, the answer is no... between 70% and 80% of us don't question it. Studies have shown that since the threat of the H1N1 virus, the washing of hands following urination or defecation by humans has gone up, from 70% to 80%, approximately (studies from 1997 and 2009 were consulted). There are actually people who do 'undercover' studies of these habits... We know that if we don't wash, we could spread various bacteria and virus from the toilet area to ourselves; or to others from our hands to food, other hands, our eyes and so on...

But what about the 20% to 30% who don't wash their hands? Certainly they have direct risk to themselves and to their acquaintances... spouse, child, friend and so on. And have we given any thought to when these people leave the public washroom where they didn't wash their hands... but used those same filthy hands to open the door to the washroom. Yes, that is the same door that everyone else will put their hands on... clean or otherwise... to escape the washroom. Yuck... makes me sick thinking about it. We wash our hands, only to contaminate them by opening the door to the washroom on the way out!

So, to fool the perpetrators of such virulent habits, there are some of us who circumvent the potential for contamination by using the towel we use to dry our hands, as a protective cloth between the door handle and our clean hands, when we open the door... this in facilities which supply towels. The tell-tale of this is when you sometimes see a pile of paper towels on the floor near the door to a washroom. It happens often enough that you may see some facilities who place the trash containers near to the door where it swings out.

But then there are the McDonalds, Tim Hortons, Burger King, and thousands of other restaurants and gas stations, who don't have towels in the washrooms... they just have 'blowers'. These companies did cost studies where they realized that by not putting towels in the washrooms, they saved money... money for towels; money to clean up the paper on the floors; money to snake the toilets when they get plugged; and so on. In these establishments, you can't escape with out getting contaminated... I hate these places, and try to avoid eating at restaurants where I know the door knobs likely have the virus and bacteria from 20% to 30% of the patrons on the door handles! Hmmmm, I wonder what would happen if more people decided on where they eat based on whether they can wash their hands before eating, or after going #1 or #2 ... and return to their food with clean hands... not touching the door handles...

And when I can't avoid it... when I enter a bathroom with no towels, and those incessant wind machines... I have a new tactic! I go back to my table, or in the case of McDonalds, to the dispensers, and grab a handful of napkins... I go into the bathroom, do my thing, and use the napkins to dry my hands, then to open the door... and then I throw the napkins back into the bathroom in order to contain any virus or bacteria that I may have wiped off the door handle, in the bathroom.

I recommend such Gorilla Tactics at every restaurant, every hospital, and every gas station restaurant which uses the wind machines, and not the towels. If these facilities want to save money on towels, start building washrooms with no doors like in airports, or doors that open out, so you can open them with your foot...

Pass this on, but not the contamination in your next pit stop... think about the millions and millions served at these restaurants... for every million served, there are between 200,000 and 300,000 patrons who don't wash their hands. If only 10% of those end up contaminating the next person through the door, that would be 20 to 30 Thousand people for every million served... that may catch a cold; or worse a flu; or a sty; or MRSA; some of them cold die. And we know that in some cases, there are billions served!

Let the Sun Shine

After reading and re-reading the letter from Jack Layton, I am convinced that there is a message in it for more than just Canadians and just young people. It was a 'large' letter that tells me that what it has meant to be a Canadian, American, Brit or what ever... won't cut it in the future. It was telling us that we have to be bigger than we have become...

His final paragraph said... "My friends, love is better than anger. Hope is better than fear. Optimism is better than despair. So let us be loving, hopeful and optimistic. And we’ll change the world." This is clearly a different tact than what we have fallen into in the western world... and without fundamental change, that comes from within, from individuals, and certainly from leadership... we will become a horrible place to live. It is time to find leaders who actually live by these credo... not just talk them.

It is possible that it will take time to have this in our political, religious and business leadership. We can however start it in the sphere that we control ourselves. I like to think of it as someone walking around with a cloud over there head... and everyone with whom they come into contact, getting wet. With a simple smile, the sun comes out!

So once again, we have control, we can start things ourselves... and once we start, and we expect others to do the same, perhaps we can change the world... we can do a Jack!