Defining Success

 
 
Dr. Singer uses his personal experience as a surgeon to define success--and failure. Your circumstances do not dictate your success. Successful people bring success to everything they do. Success comes to people who are too busy to be looking for it.

Raymond L. Singer is a cardiothoracic surgeon on the medical staff at Lehigh Valley Health Network (LVHN) since 1992 and is currently the Physician in Chief for the LVHN Institute for Special Surgery. He is the former Chief of the Division of Cardiothoracic Surgery and Vice Chair of Quality and Patient Safety for the Department of Surgery.

Dr. Singer has served as the Chair of the Department of Surgery Quality Committee and the Surgical Director for the Charles Chrin Regional Heart and Vascular Center. Dr. Singer currently serves on the Executive Council of the Air Products Center for Connected Care and Innovation and the LVHN Board of Trustees Development Committee. He is a Clinical Professor of Surgery at the University of South Florida College of Medicine. Beyond his professional affiliations, Dr. Singer takes and active role in th Lehigh Valley community.

Dr. Singer is a member of the Board of Directors for Health Network Laboratories, in Allentown, Pennsylvania. He is a Past-President of the Pennsylvania Association for Thoracic Surgery and Past-President of the Lehigh County Medical Society. Dr. Singer is a member of the Muhlenberg College, President’s Advisory Council, and has served on the College’s Board of Trustees, as well as the Board of Trustees of Congregation Keneseth Israel in Allentown, Pennsylvania.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

February 22nd: National Heart Valve Disease Awareness Day

 National Heart Valve Disease Awareness Day

Heart valve disease (HVD) involves damage to one or more of the heart’s valves, which disrupts blood flow by not opening and closing properly.  While some types are not serious, others can lead to major complications—including death.  HVD becomes more common with age, and one in eight people age 75 and older are estimated to have moderate to severe HVD.

Heart valve disease awareness in the United States is shockingly low, despite the more than 5 million Americans affected by the disease. A recent survey of more than 2,000 adults found that 3 out of 4 Americans know little to nothing about HVD, and only one in four know somewhat or a great deal about the disease.  The seriousness of the disease combined with the fact that symptoms are often difficult to detect or dismissed as a normal part of aging, make this lack of awareness dangerous.

National Heart Valve Disease Awareness Day on February 22^nd—during American Heart Month—is an annual day dedicated to increasing recognition of the specific risks and symptoms of heart valve disease, improve detection and treatment, and ultimately save lives. With education and advocacy, we can reduce the number of people who lose their independence and their ability to fully participate in their lives; experience heart attacks, arrhythmias, congestive heart failure, and other heart disease; suffer from strokes; and even die from the disease.

If you or a loved one suffers from HVD, there is hope and help out there. Check out this site for more information on living with valve disease. 

To learn more about the campaign, how you can get involved, and the importance of Listening to Your Heart, visit www.ValveDiseaseDay.org.

Reflections on 7,000 Operations and 25 Years as a Surgeon

The following essay appeared in The Morning Call Website Opinion Page on Sunday, November 19, 2017

It’s hard to believe that so much time has passed. After 4 years at Muhlenberg College, 4 more years of medical school at the University of Pennsylvania, and 8 years of residency at the Thomas Jefferson University Hospital, I’ve now hit the milestone of 25 years in surgical practice and 7,000 operations at Lehigh Valley Health Network. It feels like yesterday that I was the new guy in town. And now today, the new recruits look to me for advice –the kind of sage advice that only experience and perseverance can provide.

My reflections are naturally bittersweet. Like most, I tend to dwell more on my mistakes and the things I wished I could have done differently. I think about the missed opportunities and the times that I was too cautious or too bold. The road has been long and demanding, full of speed bumps and challenges. There were many times that I wondered if I would make it through. And though I’ve persevered, my heart still knows little rest. In the quiet of night, I often think about the patients I could not save. Their memories remain with me, along with the emptiness of knowing that my best just wasn’t good enough.

One such patient is Trina Green from Ashland, Schuylkill County; her picture remains on my desk. I met Trina shortly after her 40th birthday. Just one year prior, Trina was diagnosed with breast cancer. She had undergone what was believed to be curative surgery, but sadly, the cancer returned, having spread to her lungs. Unfortunately, there was little I could do surgically. Trina was an avid Phillies fan, like me. Prior to her passing, Trina enjoyed one last Phillies game, sitting in my seats at Citizens Bank Park. The photograph on my desk was taken at that game, showing Trina so happy, as if she had not a care in the world. Her effervescent blue eyes sparkled with joy, as she cheered on her Phillies for the last time. Her memory and those beautiful eyes still haunt me.

Trina Green, holding the Phillies #1 sign, enjoying one last Phillies game with her sister-in-law and best friend, Linda Duell.
Trina passed away on March 13, 2006, at the age of 42.

Yet, there is also great satisfaction and accomplishment upon reflection. Over the years, I’ve touched many lives, more than I take the time to sometimes realize. One is Mischel Satunas of Bethlehem. At 49-years old, Mischel underwent a life-saving third-time, triple-valve open heart surgery, a procedure rarely performed. Prior to meeting me, she was turned down multiple times for surgery, saying that she was too high risk and that her symptoms were all in her head. She recently celebrated her 6-year anniversary from that successful surgery and has become a spokesperson and champion for women with heart disease in our community.

Dr. Raymond L. Singer hugs Mischel Satunas of Bethlehem at the Lehigh Valley Heart and Stroke Walk at Northampton Community College, Bethlehem Township, in 2015, four years after he performed a third-time, triple-valve open heart surgery on her.

Mischel would say that a smile, a touch of the hand, a kind, but confident word to let someone know that they’re going be fine makes all the difference. Patients cherish those personal moments the most, knowing that their doctor cares for them with respect and empathy. The lesson here is simple. Treat every patient as if they were your own family.

I’ve often said that I was lucky because I came from a family of patients, not doctors. My father had three cancers before he passed away. My amazing 94-year old mother is twice a cancer survivor and had heart surgery herself many years ago, and yet she continues to fight on. I’ve sat in many doctors’ waiting rooms.

I’ve witnessed the physical impact of cancer and chemotherapy. I’ve felt the pain that comes from surgery and I’ve endured the sadness of saying goodbye to someone I love.

Treating patients as if they were your own family is the key to enjoying a long career in medicine. In many ways, it’s all that really matters. Doctors can go to the best schools and learn every new procedure, but they will never truly succeed unless they learn to treat the patient, not just the disease.

This advice of “treating the patient, not the disease” is hardly new, nor mine, but goes back thousands of years ago to the teachings of Hippocrates and Maimonides. It’s as old as the Golden Rule, “Treat others as you would wish to be treated.”

Yes, I’ve been blessed to have enjoyed a rewarding career at a magnificent hospital, living in a wonderful community, raising two beautiful daughters with my wife. I’ve worked with the same staff, the same nurses, and the same dedicated colleagues for all 25 years. I’ve said many times that the reason I’ve never left is because I know in my heart, whatever success I enjoy, it’s because of the team that surrounds me.

I hope to keep the flame burning for years to come. When you love what you do, it’s not work, so retirement is not on my to-do list for now. Besides, I rather be in the operating room with these young, talented professionals, than chasing golf balls in the woods.

But no matter what the future holds for me, today I am filled with gratitude for my patients and their families, my colleagues and staff, and most of all, my family, for always being there for me. To all, I say with deep appreciation and love, thank you.

Link to The Morning Call Website Opinion Page Publication

Off-Pump (Beating Heart) versus On-Pump Coronary Artery Bypass Surgery

Below is a discussion of a follow-up article published in the New England Journal of Medicine by Dr. Grover and colleagues, showing favorable results for conventional coronary artery bypass over off-pump beating heart coronary bypass surgery. The same Veterans Affairs 2009 study showed similar results at one year.

No doubt, there are select times when the beating heart approach is preferred, for example, when the aorta is calcified. Most surgeons' experience, including mine, is that the conventional coronary artery bypass approach allows for more precise sewing and better protection of the heart. This would explain why the technique of beating heart coronary bypass surgery continues to drop in the U.S. to fewer than 20% of cases. I suspect it will now be used fewer than 10% of cases.

This article may have other implications. Some surgeons tout off-pump as "better" or "safer," usually under the umbrella of "less-invasive." Understandably, patients desire safer, less-invasive procedures, with quicker recoveries. In many areas of heart surgery, techniques have been developed to yield these desired results, such as trans-catheter valve procedures and aortic stents. But for patients who require multi-vessel coronary artery bypass surgery, this long-term study suggests that the beating heart technique may not be better than the conventional approach.

The most important thing for patients is to discuss all options with their surgeons. There are surgeons who have mastered a particular technique that may yield better outcomes than reported in research studies. Many excellent surgeons continue to develop better ways to improve the safety and outcomes for our patients. Ask your surgeon for his/her experience and results, no matter the technique. Patients should also research public report cards on surgeons and seek a second opinion whenever possible.

I'm grateful to our academic leaders such as Dr. Fred Grover and I'm proud to be part of the Society of Thoracic Surgeons, for their hard to improve the health and safety of our patients.

_____________________________________________________________________

Newer method of open-heart surgery carries more risks, study finds

The older method of doing open-heart surgery, in which the heart is stopped and a pump circulates blood through the body, leads to higher survival rates than a newer method of operating while the heart is beating, which doesn't require use of the pump, according to a new study. Why it matters: Coronary-artery bypass surgery is…

Team Matters

Thanks to the miracle of modern technology, I'm posting this blog from 35,000 feet up over this beautiful country of ours. I'm traveling to attend a course on minimally invasive mitral valve repair in California.

One of my favorite movies is "Up in the Air" with George Clooney. In the film, he loves being in flight, traveling across the country for his job. There is a certain serenity, a time to reflect. I agree. I find it very relaxing, one of the few times I am completely alone with my thoughts, while enjoying the view of God's work below.

Tonight, my thoughts are with my team. At the center of that team are four special women who I have had the privilege of working with for as long as I can remember --Mindy Snyder, Carol Shannon, RN, Pam Olivieri, and Lisa Garloff.

Mindy is our practice manager. Mindy is the heart and soul of our practice. Carol is one of the most experienced and talented cardiothoracic surgery nurse in the country with 35 years of experience! Pam is our office scheduler who manages thousands of patient appointments every year, somehow keeping up with emergencies and constant changes. Lisa is our O.R. scheduler, who ensures that every patient that goes to the operating room is ready and safe to proceed.

Together, they are the core of our practice. They work so hard and rarely get the recognition that they deserve.  I know that whatever success I may have enjoyed over these past 25 years, it is largely due to my team --the entire team-- exemplified by these four amazing professionals. To me, it's more than just a team, it feels like family.

Indeed, what separates our cardiothoracic team at Lehigh Valley Health Network is that we are a family. All of our surgeons, physician assistants, nurses, and staff are truly special. Patients sense this when they come to our office and when they are cared for in our operating rooms and our intensive care units.

Yes, I've been fortunate to travel far and wide for my career, as I am doing tonight. And in all my travels, I know, I'm the luckiest surgeon in the world to have the finest team at home.

"The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime." --Babe Ruth

Patients Need to Do Their Research

Be like Barry...

Barry Kanick Showing His Research on Heart Surgeons

I make it a point to tell all of my patients to get a second opinion. I often wonder why we will visit 4 or 5 car dealerships when when looking for a new car, but we often take on face value the first recommendation we receive when looking for a new doctor?

Of course, there are some important differences.  It doesn't cost you anything to visit car dealerships, whereas it often costs a lot of money to visit various doctors, especially specialists.  Moreover, when you need a specialist, you often don't have the luxury of time.  Specifically, if you need heart surgery, you may not be in an "elective" situation --you may have to make a quick decision based on limited information.  Lastly, your health insurance may not give you many choices.

That last point is an important one.  Your insurance and/or your health network may govern your choices. For example, chances are today that your doctor is employed by a health network.  Recently, many of the best health networks are merging with each other, forming larger, hopefully even better health networks. Many will even offer their own insurance product. The big buzz word in health care today is "Accountable Care Organization" or ACO, which combines the efforts of many physicians and hospitals to share in the care and cost of caring for a population of patients.

Hopefully in the long run, all of these changes will be good for our community, especially if these larger health networks provide more "value" to their patient populations. Most large, high quality programs such as Lehigh Valley Health Network define value as providing higher quality health care at a lower cost.  Therefore, patients should do their research and make sure they are aligned with a health care organization that is focused on providing value for their family's health, not just services.

The problem is... we haven't gotten there yet.  What I mean is that despite a tremendous effort to improve health care by many stakeholders --doctors, hospitals, insurance companies, and the government-- the care we provide in the U.S. remains inconsistent.  Dr. David Nash, Dean of the School of Population Health at Thomas Jefferson University refers to this phenomenon as "unexplained clinical variation."  Simply put, for any given diagnosis or surgical procedure, different doctors or surgeons may approach the exact same problem in significantly different ways, often resulting in significantly different outcome.

So what can you do if you need to find a doctor?  First, when you sign up for your health insurance or align yourself with a hospital network, you need to read the policy carefully and determine what is allowed with regards to obtaining a second opinion or seeking a specialist out of the network.

In many instances, you may have more choices than you think.  No doubt, if you need a specialist, your physician will likely select someone who they trust within their network. And that's fine. We do the same thing at Lehigh Valley Health Network.  The fact is, at LVHN we have very high standards of excellence and a long history of quality outcomes, so it would only follow that our doctors would recommend the colleagues that they trust.

And yet, even if you are at a fine hospital, with trusted, experienced physicians, it is important to do your research and ask important questions.  Moreover, if you are at an institution that doesn't have the volume of experience or the latest technologies, or the recognition for quality that you desire for your family, all the more reason to seek a second opinion.

The Internet has become a great source of information.  There are many very good educational sites, such as Adam Pick's website: www.heart-valve-surgery.com or my own: www.heartlungdoc.com.  Also, you can find a lot of important information from state and national public report cards, such as the Pennsylvania Health Care Cost Containment Council (PHC4): www.phc4.org, or the Center for Medicare and Medicaid Services (CMS) website: www.medicare.gov/physiciancompare/search.html.

Of course, the Internet is not perfect and although you can acquire a ton of information, some may be misleading or incorrect.  That's why whenever possible you should try to get a second opinion in person. You should write down a list of questions for your doctor.  For example, if you are meeting a surgeon to discuss having an operation, some things you may wish to ask include:

1. How many years have you been doing this procedure?

2. How many of these procedures have you performed in the past two years?

3. What is your success rate?  Your complication rate?  Your mortality rate?

4. Will you be taking care of me after the surgery?

5. What are the alternatives to this surgery?

6. What are the long-term expectations?  For example, will I need another operation down the road?

Two final thoughts.  It's important to "ask around."  When you find out that you need a doctor, you will be surprised to learn how many of your friends already have experience or knowledge that may help guide your decision.  And, here's a little inside tip... in addition to asking friends who may have been patients, ask friends who are doctors and nurses.  Often the best advice will come from them.

Barry Kanick was one of the most informed patients that I have ever met.  The picture above was taken the day he was discharged from Lehigh Valley Hospital after his heart valve surgery. He gave me permission to post it on my website.  Barry first came to my attention after he emailed me from my website.  He had read Adam Pick's book and had scoured the Internet but requested to see me for a second opinion.  I called him on the phone after he emailed me and we talked for quite some time.  Then we met in my office and we continued to email each other back and forth.

To be honest, I don't think Barry decided to have me do his surgery because he necessarily thought my skills were any better than the fine surgeons on his list, but rather that I was the most responsive and transparent with my experience and results.  How a doctor communicates does matter, as does bedside manners and trust.  After literally months of research, Barry felt most comfortable with me.

His surgery went very well and he was ready for discharge to go home after only a few days.  He had little to no pain and was of course the ideal patient, very motivated to get better.  He was walking the halls on the first day!

He didn't bring out his "scorecard" on surgeons until the day he went home. I had not seen it before that day. I must admit, I almost fell over when I saw his chart.  The names on that list are among the most well known heart surgeons in the country.  I was truly honored to see my name on the same page as Dr. Joseph Bavaria, Dr. Marc Gillinov, and Dr. David Adams, to name a few.  No doubt, Barry would have done just as well if he had his surgery with any of these great colleagues.

In the end, Barry had narrowed his research to a very good short list of options. True, because his condition was stable, he had the luxury of taking his time in order to make the best decision for him.  But there still is an important lesson to learn.  That is, whenever there is a question about your health, please do as much research as you can before selecting a physician.  And, even if your insurance policy or health network governs your choices, it is still equally important to do your research and ask important questions.

Be like Barry...

Beyond the Billboards: Medical Marketing Can Help Patients Decide

 

 



 

It has certainly been an interesting year for me.  It started out with a phone call from my sister.  I thought something was terribly wrong because she was crying.  Instead she was calling to say how proud she was of me, having just passed a billboard featuring our heart surgery program at LVHN.

Fast forward a year later and my billboards are coming down as the hospital continues to highlight other physicians and topics.  Alas, my time on the side of the road, the mall, and the movies will soon fade.  But what to make of all of this marketing stuff?  Sure, it is nice to see your name and hospital proudly displayed, but what does it mean for patients in our community?

 

The fact is medical marketing is playing an increasingly important role in the decision making process for patients and their families.  As just one example, due to the ongoing healthcare reforms more and more patients are being faced with high-deductible health plans.  A concern is that this may lead to some patients delaying necessary care which in turn can adversely impact their health.  On the other hand, hopefully these patients will choose instead to simply do more research and be more selective of the care they need to receive.  Put differently, patients need to become more careful consumers.

Puman Anand Keller, a professor at the Tuck School of Business at Dartmouth, published an article in Forbes in 2014 called “What marketing can do for hospitals.” Keller pointed out that hospitals are now facing the same world of transparency and competition that hotels and other service businesses have faced for years.  Just as a consumer may go to TripAdvisor to review a hotel, patients are scrutinizing hospital ads, going to their web sites, and searching doctors’ results in Consumer Reports, US News, Healthgrades, and a growing list of other sources.

Sam Kennedy of The Morning Call published a related article on July 16, “New websites rate surgeons.” What struck me about the Call article was that it was in the “Your Money” section of the newspaper. And yet, that is exactly the point. As Kennedy states, choosing a surgeon is one of the biggest decisions you can make and often patients (consumers) are not very well informed.  Websites such as surgeonratings.org look at Medicare data to determine mortality rates, complications, length of stay, readmissions, and costs. We should expect more of these websites to appear in the future.

No doubt all of this can still be very confusing for patients.  Most hospitals tout that they are “tops” in their field for certain procedures, based upon the many different report cards available to assess doctors and hospitals.  If a hospital gets an “A” grade on a particular report card, you can be sure you will see it in an ad. As a consumer you need to look beyond the billboards and do your own research to learn more about that rating and that hospital.

Way back in 1999, I saw some of this coming.  I was sitting across a retired couple, providing a second opinion for heart surgery. After an hour of what I thought was a very complete discussion, the gentleman asked me if I had a website!  Keep in mind 1999 is ancient for the Web.  Google only started in 1998, Facebook not until 2004 and Twitter in 2006.

I decided to take night classes at Penn State on web design and started my own website www.heartlungdoc.com.  It is a personal site that mixes everything from my training, surgical experience, types of operations, and most of all, my outcomes and my personal philosophy on patient care.  Sixteen years later my website gets many hits daily from all over the world and almost every new patient has found my personal website on the Internet.

 

Of course, when it is all said and done, the best advice is to stay healthy.  But if you do need guidance, think of yourself as an informed consumer, not only as a patient.  Do not rely on just one doctor’s recommendation or one source on the Internet.  Ask questions.  If able, ask for a second opinion.  Know your doctor’s results and what other patients think of that doctor’s bedside manners, responsiveness, and empathy.  You do have choices.  When it comes to your health and your healthcare, make good ones.

 

Aortic Valve Root Reconstruction and Aneurysm Repair

I am excited to post this new video of a complex aortic aneurysm and valve replacement operation.

This patient is 64-years old who was found to have a large aneurysm near the heart.  We often refer to these proximal ascending aortic aneurysms as "root aneurysms" meaning that they occur at the very beginning of the aorta.

In this instance I did not feel the patient's aortic valve could be saved and therefore I replaced the valve and root using a Medtronic Freestyle Porcine (Pig) Valve Conduit.

Turn on your speakers and listen as a describe the procedure as you watch the video!

 



We are all the same on the inside!

One of the great ironies of human diversity is that fact that for the most part, humans are less diverse as a species than most other animals on the planet.  In fact, if we compare ourselves to the other 8 million species that live on the land or beneath the seas, Homo sapiens –Latin for “wise men”—have among the least amount of genetic variation.

For example, a 2012 Oxford University study showed that groups of chimpanzees living in a relatively small area of central Africa have more genetic diversity than human beings living on different continents.  Needless to say, man’s best friend –the dog, or the cat for that matter—have a tremendous greater amount of genetic diversity than humans.  Penguins have twice the genetic diversity as humans. Fruit flies have 10 times as much, and so on.

Sure, we humans look remarkably different on the outside. Some are tall, some short. Some have blue eyes, some brown.  But these different traits are minor from a genetic standpoint and, more importantly, they are discordant, meaning they don’t match up.  You cannot tell a person’s eye color from their height and you cannot tell a person’s blood type by their skin color.  Perhaps most importantly, you cannot tell a person’s IQ, athletic abilities, or future leadership potential from any external physical characteristic because in fact beneath the skin, we are all genetically similar.

As a heart surgeon, I have had the privilege of knowing firsthand what lies beneath the skin.  After 21 years in practice and nearly 6,000 operations, I can assure you that we are all the same on the inside.  Your heart, your lungs, and your bones are all indistinguishable from race to race, person to person, man or woman.

And yet, wars continue to be fought, fences continue to be built, and children continue to die unnecessarily in the name of race, creed, ethnicity, nationality, religion, and even sexual orientation.  How can this continue to happen?  How is it that we continue to see only our superficial differences and not our human similarities?  These visual differences that we see on the surface of our bodies tell us nothing about what lies beneath the skin, nor what lies within our hearts or in our souls.

I am in awe every time I step into the operating room.  To literally hold a heart in your hand is an experience that is like no other.  No matter how many operations I perform, I will never cease to marvel at both the complexity and the efficiency of the human heart.  And, of course, even beyond the splendor of its anatomy, the heart has always represented the very essence of our thoughts –love and hate, strength and fear, passion and calm.  These metaphors are perfect. Just as our hearts are genetically similar, so are our human needs.  We all just want to survive, love our families, and live in peace.

Mother Teresa once said, “If we have no peace, it is because we have forgotten that we belong to each other.” It is undeniable that we belong to each other, not only from a philosophical or spiritual standpoint, but also because of our very DNA.

I often wonder how different things would be if everyone in the world could see into each other’s hearts as I do each day in my profession.  Imagine if we no longer saw each other as different races or countries or religions… just people, all the same on the inside.  If we all begin to see each other as one and the same, perhaps someday we can all finally live together in peace.

“You may say I’m a dreamer, but I’m not the only one. I hope someday you will join us.  And the world will live as one.” –John Lennon

 

PBS Channel 39 Tempo In-Depth on Heart Disease

This week, WLVT PBS 39 dedicated their Tempo In-Depth show to heart disease.  Below is a video of the show.  The show features a number of heart health issues such as women's health, the new trans-catheter heart valve replacement technology, and the new implantable left ventricular assist devices (LVAD) --all available at Lehigh Valley Health Network.

 

 

 

HeartMate II LVAD Implantation at LVHN --First In Region

Lehigh Valley Hospital's collaborative team of heart failure cardiologists and heart surgeons implanted the first Thoratec HeartMate II Ventricular Assist Device in our region. Our Mechanical Heart Assist Device Program is affiliated with the Hospital of the University of Pennsylvania Heart Failure and Transplantation Team. We are pleased to provide this advanced technology to our region and we are honored to be affiliated with Penn's nationally recognized transplant center.

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