The Comfort of a Simple Crayon

 

Perhaps the single most identifiable item associated with the innocence of childhood is the Crayola crayon –and has been for over 100 years.  No doubt, this holiday season millions of children all over the world will receive a box full of crayons and a coloring book that will make them smile.

 

By chance, I was asked to speak at the Crayola Factory to their employees about heart health, only days after the unspeakable tragedy in Connecticut and only a few days before Christmas. Like so many parents, I was deeply saddened by the killing of innocent children at the Sandy Hook Elementary School. How quickly the photos of families crying in pain became seared in our minds and will not be easy to forget. It was difficult to comprehend and yet in so many ways, it was so real, and hit so close to home.

 

I was literally driving around town trying to clear my mind of this sadness so that I could think of a few positive words to tell the employees at the Crayola Factory about how to live a healthy and fulfilling life.  I was clearly not in a creative mood.  All at once it dawned on me the obvious connection between the children of Connecticut and our hometown company, the Crayola Factory.  Indeed, the connection was obvious --it was the comfort, joy, and even the smell of a simple crayon and its symbolism as part of the innocence of childhood.

 

I could not help but imagine that the children who died had Crayola crayons in their little desks, or perhaps even more tragically, in their tiny hands when that evil madman ended their lives. I imagined the many colorful drawings that likely hung in those classrooms as the horror unfolded, or the unopened Christmas presents that surely included crayons and coloring books. I began to cry.

 

Just then, I heard a CNN reporter on the radio interviewing the Sandy Hook Elementary School librarian.  The librarian told the story of how she quickly shuffled the children in her classroom into a storage closet as soon as she realized that there was a shooter in the building.  The children were all so frightened, as was the librarian.  Sure enough, the librarian saw that there were boxes of crayons and coloring books in the storage closet and instructed her students to draw happy pictures, as she reassured them that “the good guys were on their way.”

 

Later that evening, I listened to the President’s remarks to families of Connecticut. After his call for peace and hope, I realized further how thousands of children from across the country –if not the world—would draw pictures to share their thoughts and well wishes for all those saddened by this national tragedy.  No doubt, these heartfelt drawings and cards of hope would be done beautifully, yet again, with the comfort of a simple crayon.

 

When the day of my talk came, I stood in front of the employees of the Crayola Factory and thanked them. I shared with them my reflections above and simply said...

 

“To think, that the very company you work for, a company that has been synonymous with childhood, was literally present at this elementary school, both in the desks and hands of those whose lives were cut short, and in the hands of those who survived. Imagine for a moment, that in so many ways, a part of each of you were present with these kids, comforting them in their last moments, helping yet others to survive. As a father of two beautiful young daughters –who I love more than life—I want to start by thanking each and every one of you at Crayola, for your quiet, but oh so important contribution to all children.”

 

It felt so surreal that my talk at Crayola, planned months prior, would happen to fall at this time. And yet, I felt so privileged to be at Crayola, to thank them in person. We joined hands, closed our eyes for a moment of reflection and simply said together, “May God bless all the children of the world.”

An Unspeakable Horror

The tragedy that has occurred in Connecticut is an unspeakable horror --one that no parent should ever have to endure.  We live in a culture of violence that seems to be getting worse each day.

It reminds us that our daily worries should not distract from the most important things in life, our families and our health.  We must all learn to focus on what we have, not what we don't have --to take each day as a blessing and to try to always look at the glass as half-full, not half-empty.  We need to let go of our useless anxiety over what is missing in our lives and learn to enjoy and appreciate all of God's blessings.

I will be speaking at the Crayola Factory this coming Tuesday, December 18.  I do so with a heavy heart thinking of all of those children who likely had their own crayons nearby, perhaps in their hands, just as their lives were taken away by an evil madman.

All we can do is pray... and hug someone we love.

Where have all our heroes gone? Astronaut Neil Armstrong and his generation were the “Right Stuff”

The following essay appeared in The Morning Call on-line September 4, 2012 and in-print on September 5, 2012.  I hope you enjoy reading my essay. It just seems to me that our country, indeed our world, could use a few more real heroes and true leaders like Astronaut Neil Armstrong.

http://www.mcall.com/news/local/parkland/mc-neil-armstrong-singer-yv-0905-20120904,0,2632745.story

(Neil A. Armstrong, the first man to walk on the moon, is shown at the lunar module on the moon in July 1969.

Considered an American hero, Armstrong died Aug. 25 at age 82. (NASA, AFP/Getty Images / September 4, 2012)

I could not help but see the irony in the fact that a true American hero, Neil Armstrong, died the same week that Lance Armstrong was forced to concede his fame due to allegations of cheating. I say “allegations” because in today’s world, until proven guilty by a court, our fake heroes rarely, if ever, hold themselves accountable for their words and actions.

Astronaut Neil Armstrong was, of course, a true hero, having been the first human to step on the moon.  Prior to becoming an astronaut he was a United States Naval Officer who served in the Korean War. He flew 78 missions over Korea and was shot down once, remarkably surviving after he was forced to eject from his crippled jet. From 1955-1962 he served as a test pilot at Edwards Air Force Base where he pushed the limits of jet propulsion technology with another American hero, Chuck Yeager.

In 1962 Neil Armstrong officially became a NASA astronaut, joining the Gemini and later, Apollo programs. Risk and challenges were all around him throughout his career.  In 1967, only two years prior to the lunar landing, three Apollo 1 astronauts lost their lives in a fire during a launch pad test.  Along with a vast collaborative team of scientists, engineers, astronauts and staff, the Apollo program participants continued their quest of putting a man on the moon nonetheless.   Their tireless efforts and selfless sacrifice under the visionary leadership of men like Armstrong led to the famous Apollo 11 landing on the moon on July 20, 1969.

Heroes of days gone by held themselves to a high standard.  Like so many of his generation, Neil Armstrong was all about service to country, devotion to family, and dedication to his craft.  And, after achieving what was undoubtedly the greatest human triumph of his time, he remained humble, decent, and generous. Though he received many awards, including the Presidential Medal of Freedom, he largely turned down opportunities to make money on his achievements but instead chose to teach aerospace engineering at the University of Cincinnati.

And while real heroes who possessed high ethical standards and self-reliance, like Neil Armstrong, were focused on service and the pursuit of dreams that benefitted humankind, the fake heroes of today seem “sold-out” on fame, fortune, and their own legacy - at any cost - even cheating.  Something is out of balance.   We seem to lack a collective personal integrity.  Long gone are the days when mediocrity was NOT rewarded.  Not only are relatively average professional athletes receiving millions of dollars in salaries and endorsements, many now even wear corporate logos on their uniforms that compete in size with the team emblem.

We may all be so desperate to “win the lottery” that we have forgotten as a society that true success comes from years of hard work, including trial AND error, and yes, winning AND losing.  Most of the world’s greatest inventors, statesmen, scientists, and artists, learned how to overcome failure before they experienced success.  One cannot succeed unless one accepts failure as an opportunity to work that much harder and smarter.

Sadly, we have seemingly all bought into a fantasyland where everyone deserves a trophy. I worry about our lack of true heroes today.  I can’t help but think it starts on the playgrounds where children are taught today that “everyone is a winner.”  I just don’t know.  When I lost a wrestling match in high school that I should have won, my father didn’t feel he had to pat me on the back and tell me everything was okay.  He instilled in me the meaning of hard work and how to overcome adversity on my own.  I looked up in the stands after that humiliating loss and as our eyes met, my father simply nodded gently, as if to say, “Ray, you know what you need to do, now do it.”

Neil Armstrong is being hailed as one of the great heroes of the 20^th century for his achievement as the Commander of Apollo 11.  He was a member of “The Greatest Generation” who survived the Great Depression, fought in World War II and Korea, and rebuilt our nation to become the most advanced and most powerful in the world.  The Greatest Generation knew how to serve and not just how to take. They didn’t have to cheat, look to a lottery for success; they didn’t feel everyone deserves a trophy.

Heroes like Neil Armstrong –and the countless others of his generation with similar qualities—are the “right stuff” that I believe our nation sorely needs today. 

New Heart Valve Procedure Kindles Memory of a Visionary Surgeon

The following article appeared in The Morning Call newspaper on Sunday, June 10, 2012:

http://www.mcall.com/news/local/parkland/mc-horace-smithy-heart-surgeon-pioneer-ray-singer--20120609,0,7032353.story



Dr. Horace Smithy (circa 1948)



I often wonder how amazing it would be if we could somehow show the great inventors of the past, just how far their ideas have come.  Imagine the faces of Orville and Wilbur Wright if they were able to see the powerful and majestic takeoff of a Boeing 747.  What would Thomas Edison think if he were able to see the Met Life Giants Stadium fully lit at night with the New York skyline lit up in the background?  Certainly Alexander Graham Bell would be in awe of cell phones and instant text messaging.

Dr. Horace Smithy was not as famous as these great inventors, but in light of the recent advancements in heart valve surgery, Dr. Smithy’s legacy is certainly worth noting.

During the early 1900’s, rheumatic heart disease caused the early death of many young people. Since antibiotics had not yet been developed, a simple strep throat infection could lead to damage of heart valves, joints, and the brain.  Typically, the heart valve damage would start as early as age 5 and progress to a point where a person’s heart valves were critically blocked in young adulthood.  Bobby Darin, the famous crooner, died from complications of rheumatic heart valve disease as late as 1973.

Dr. Smithy was a young surgical resident at the Medical College of South Carolina in 1938.  He had a keen interest in rheumatic heart valve disease because unfortunately, he was suffering from the disease as well.  Keep in mind, there was no open heart surgery in those days.  The heart-lung machine and modern heart surgery techniques wouldn’t be developed until 1953. Having your heart valve replaced was simply not an option at that time.

Therefore, Dr. Smithy performed experiments on animals whereby he would blindly insert a wire-like instrument (known as a barbed valvulotome) through the aorta, or even directly through the heart, in hopes of opening the blocked valves.  It was a very high risk idea and one third of his laboratory animals died from the procedure. Dr. Smithy persevered though and successfully performed his new procedure on a 21-year old woman on January 30, 1948.  In this operation, Dr. Smithy blindly inserted the wire device across her mitral valve –without the use of x-rays for guidance and without stopping the heart.

The New York Times reported his success on February 10, 1948, with the following headline, “New Heart Operation Saves Life of a Woman as Surgeon Cuts into Valve He Cannot See.”

New York Times Headlines Announcing Dr. Smithy's Successful Operation

Dr. Smithy went on to perform eight more successful operations that year. Sadly only a few months later, at the young age of 34, Dr. Smithy died from his own rheumatic heart valve disease on October 28, 1948.

Dr. Horace Smithy's Obituary

Almost sixty-five years later, Dr. Smithy’s vision of repairing heart valves by passing a catheter into the heart has finally come true.  A new procedure has recently been approved in the United States known as “trans-catheter aortic valve replacement” or TAVR.  This procedure uses a combination of catheters, balloons, and stents, along with fluoroscopic guidance to break open a patient’s blocked valve. The modern procedure goes one step further by actually replacing the old valve with a new one.  The beauty of this procedure is that it can be done without the need for an incision in the chest and without stopping the heart.

Edwards Lifesciences SAPIEN Valves (Sizes 26mm and 23mm)

Recently, we successfully performed this remarkable new procedure on two patients at Lehigh Valley Health Network.  Both patients were deemed too high risk for conventional surgery and were offered the trans-catheter approach instead.  The results were impressive.  Both patients were awake immediately after the procedure and were sitting up in bed just an hour later –no more shortness of breath or chest pain, and no chest incision either!

No doubt, this new technology has a long way to go.  Indeed, most patients requiring heart valve surgery today are still better served with conventional open heart surgery.  And, we shouldn’t lose sight of the fact that conventional heart valve surgery procedures have excellent outcomes, even for high risk patients according to the yearly reports from PHC4, Hospital Compare, and so on.

And yet, it is equally clear that this new catheter-based valve technology works well and will only get better.  The catheters will continue to get smaller and the techniques will get safer, thus allowing more patients to benefit from the procedure.  Currently in Europe, approximately 25% of all patients with aortic valve disease are being treated with this transformative procedure.  Just like the other great inventors, Bell, Edison and the Wright brothers, I wish that somehow the young and visionary Dr. Horace Smithy could see what has become of his vision of repairing heart valves.





Dr. Smithy Saying Goodbye to Betty Lou Wooldridge After Performing the First Successful Operation in 1948 



Mr. Check --Our First Successful TAVR Patient at LVHN (Less Than 2 Hours After Surgery)



First Trans-Catheter Patient Interviewed

Here is a video that I took of our first trans-catheter aortic valve replacment (TAVR) patient less than 2 hours after his surgery.  Mr. Check has given us permission to show you this video and tell his story.  Mr. Check was considered too high risk for conventional open heart surgery and therefore he was referred to our team for consideration of our new, minimally invasive heart valve replacement procedure known as trans-catheter aortic valve replacement (TAVR).  Mr. Check was the first patient at Lehigh Valley Health Network to undergo the new trans-catheter aortic vavle replacement surgery and thus the first patient in our region to receive the new SAPIEN valve locally!

First Successful Trans-Catheter Aortic Valve Replacement Procedures Performed in the Region

I am pleased to report that our collaborative heart valve team at Lehigh Valley Health Network successfully performed the first two trans-catheter aortic valve replacement procedures in the region on Wednesday, May 16, 2012.

Trans-catheter aortic valve surgery (http://www.trans-cathetervalve.com/) is a new procedure recently approved for commercial use in November 2011.  The technique allows us to place a bio-prosthetic (tissue) aortic valve into a patient who is considered too high risk for conventional open heart surgery.  Lehigh Valley Health Network is one of the first hospitals in the country to be trained to perform this life-saving procedure.  Many people refer to this procedure as "Percutaneous Valve Surgery" because the procedure is performed by placing catheters in the femoral arteries instead of opening the chest --similar to placing a stent to open up a blockage in the coronary arteries.

Both patients are doing very well.  Each procedure took approximately 2 hours and both patients were awake and breathing on their own in the operating room at the conclusion of the procedure.  Most of all, both patients tell us that after years of suffering, they can finally breath well and have no further chest pain.

Below is a picture of our collaborative heart valve team outside our hybrid operating room after the two successful procedures were completed.

Dr. David Cox (Interventional Cardiology), Dr. Pat Kleaveland (Interventional Cardiology), Dr. Ray Singer (Cardiac Surgery), Dr. Wilson Szeto (Cardiac Surgery from University of Pennsylvania), Dr. Bill Combs (Interventional Cardiology), Dr. Gary Szydlowski (Cardiac Surgery), Dr. Matt Martinez (Diagnostic Cardiology), and Mr. Rich Steigerwalt (Clinical Expert, Edwards Lifesciences)

We wish to thank Dr. Wilson Szeto from the Hospital of the University of Pennsylvania for proctoring these first two trans-catheter aortic valve replacement procedures at Lehigh Valley Hospital.  We appreciate the support and collaborative relationship between our colleagues at Penn and our team at Lehigh Valley Health Network.

This relationship is particularly gratifying for me, as Penn is my alma mater and I continue to enjoy a close professional and personal relationship with many colleagues and friends at Penn. Two health care leaders in our respective communities, Lehigh and Penn make a great team.

If you are a patient who has been told you are high risk for heart valve surgery, or perhaps have even been turned down for surgery, please call our heart valve nurse coordinator, Ronnie Moore at 610-402-6650 or call the hospital's main number 610-402-CARE.  You can also call the Lehigh Valley Heart and Lung Surgeons' office directly at 610-402-6890.

Go Red For Women Luncheon at DeSales University

I had the privilege of being the guest speaker at the American Heart Association's Go Red for Women Luncheon, held at DeSales University on May 1, 2012.

I want to thank Even Tannery from WFMZ Channel 69 for her warm introduction.  I would also like to thank Winnie Melinsky for serving as Chair of the event.  Special thanks to Diana Skowronski and Anne Marie Crown for organizing the event.

We had almost 300 people in attendance.  Below is a video of my talk.

Going Away Party and Celebration for David Cederberg, PA-C

David Cederberg, PA-C, one of our most beloved physician assistants, has decided to switch careers after spending almost 25 years on the cardiothoracic surgery service at Lehigh Valley Health Network.  David will now be working with our Interventional Radiologists.

David, even though you'll be right down the hall, we're going to miss you.  Below is a video from the "Going Away" celebration for David.

(Turn on your speakers to hear the nice background music)

The Hybrid Operating Room

Lehigh Valley Health Network has completed the first "hybrid operating room" in the Lehigh Valley and one of the largest and most advanced in the country.

What is a "hybrid operating room?"  As you know, a "hybrid" is a thing that is made by combining two different elements.  A hybrid operating room combines the radiographic (x-ray) equipment of a cardiac catheterization laboratory with the size, equipment, sterility, and safety of an operating room.  This allows our team of interventional cardiologists and heart surgeons to perform the new trans-catheter aortic valve replacement (TAVR) procedures.

Below are pictures of our new hybrid operating room:

The Hybrid Operating Room at Lehigh Valley Health Network, Cedar Crest Campus

View from the Computer Control Room

Trans-Catheter Aortic Valve Replacement (TAVR)

Clearly the most exciting new development in heart surgery and cardiology is the FDA approval of Trans-Catheter Aortic Valve Replacement (TAVR).  I discuss this procedure on my web site.  Just follow the links to The Heart > Heart Valve > Valve Surgery: Approaches > Percutaneous.  Or hit the following link:  http://www.heartlungdoc.com/heart/valves/approaches/percutaneous.html

In order to perform this procedure, we have build a brand new state-of-the-art operating room, known as a "hybrid operating room."  The word hybrid signifies that it combines the radiographic and computer equipment of a cardiac catheterization lab with the size, equipment, sterility, and safety of an operating room.  Recently WFMZ Channel 69 did a nice story about our new hybrid operating room and our launch of our TAVR program: http://www.wfmz.com/news/Hospital-unveils-operating-room-for-heart-valve-procedures/-/121458/8593668/-/qttt39z/-/index.html

For now, the TAVR procedure is going to be limited to patients who are so high risk for aortic valve surgery that they are actually deemed "inoperable" by the heart surgeons.  We have a TAVR team that is lead by Ronnie Moore, PhD, APN-BC, our Valve Center Nurse Coordinator.  Our team members include my surgical partner, Gary Szydlowski; our Cath Lab Director, Patrick Kleaveland, MD; and two additional Interventional Cardiologists, David Cox, MD, from the Lehigh Valley Heart Specialists; and, William Combs, MD, from The Heart Care Group.

We traveled to Dallas, Texas and visited Dr. Michael Mack's program at the Medical City Dallas Hospital.  Here's picture of our team in Dallas:

(From Left to Right: Dr. Cox, Dr. Szydlowski, Dr. Combs, Mrs. Moore, Dr. Singer (me), and Dr. Kleaveland)

Welcome to heartlungdoc blog!

Hi Everyone,

I hope you like our newly updated website.  Many thanks to my web master and friend, Valerie Schwader, who has put in countless hours to make heartlungdoc easier to navigate and provide you with more up to date and interesting information.  If you or your company would like to build a web site, you should definiately contact Valerie (valerie.schwader@rcn.com).

While our our main web site (http://www.heartlungdoc.com/) has a lot of great information on heart and lung surgery, we're hoping with our blog to provide you with the latest health news and hot topics.  We'll look at current events both in medical journals but also in the news.  Any goes!  We'll discuss many controversial topics as well and hopefully give you a behind the scenes view on issues of the day, such as health care reform, health law, marketing, and new technologies.

Looking forward to hearing your feedback.  Please send me questions and topics that you would like me to discuss.