This picture remains one of my favorites. It was unplanned, employed a method never used before by me (eraser), and captured a beauty within the background, resulting in an innovative creation.
Figure 6: Toscanini
The Unforeseen Road
The hunt for scientific answers can take similar and often equally unanticipated pathways. We just have to be willing to go where the journey leads us.
Take, for example, my search to understand the helical heart. This new knowledge overcame prior voids in our understanding of previously unsolved cardiac problems. It led to development of innovative ways to remedy heart failure in the dilated heart, understand diastolic dysfunction, recognize right ventricle and septum issues, as well as improve pacemaker function. The vibrancy of knowledge gained from this new look at the heart will continue to open doorways… provided we traverse these new portals.
Discovery takes tenacity. Such doggedness to finish a process we believe is correct is really a lifestyle attitude. Training for my running and swimming marathons drew upon the same determination that guided me through the pictures just described, and propelled the scientific journeys detailed within this memoir.
That’s not to say it is easy. I found that even with the immense satisfaction of finishing each race, sporting endurance events take their toll. I recall running my first of three Los Angeles Marathons, and realizing that big people like myself may be better suited for swimming, as my only focus after crossing the finish line was to relax. I placed my back against a large nearby tree and shimmied down to a prone position. My daughter Gia, then nearing twenty years old, found me splayed out, eyes closed, completely still. Her natural thought — “Oh my, Daddy’s dead” — caused her to douse me with the contents of two water bottles. It was the perfect antidote, as I sprung to life to join my loving family to celebrate.
Similar amusing scenarios occurred when I did my ten-mile marathon swims on 11 different occasions. A person is always needed to paddle on a surfboard near each swimmer to guide them along the Pacific Coast ocean waters between Huntington Beach where we entered, and Seal Beach where we finished. The son of a colleague was my first paddler. As we approached the finish, he said, “Dr. B, do you want the good news or bad news? Well, the good news is we beat someone. The bad news is he only had one leg.”
One year, I was delayed because my paddler that day could not finish (he developed gastrointestinal distress and went ashore). I had to follow a sailboat while swimming along my ocean route to finally arrive at Seal Beach. Gia, who has my sense of humor, said, “Daddy, I am so proud of you. The one-legged man finished only 12 minutes ago, then a blind man came to the end of his swim 7 minutes ago, and just before you emerged from the ocean, a 76-year-old man completed the ten-mile swim. We are so happy you finally got here!”
The Thirst to Grow
Humor aside, persistence is required with science projects for a reason that goes well beyond discovery: it must confront the barriers established by critics. Yet these roadblocks are false, and they must be overcome by the truth that prevails in science. Doing only what is expected is the true obstacle to progress. The need to overcome such rigid barriers also exists with art. Van Gogh’s innovative ways departed from expectations, and for that reason he was rewarded with initial rejection. Yet our current culture is so much better off now because his truth eventually won.
As I complete this final chapter, which sets parallels between art and science, it becomes ever clearer to me that creativity in both disciplines has been my source of stimulation. They share the exciting allure of challenging goals, unbridled energy to evolve new ideas, joy in finding answers amid early futile attempts, and the thrills of giving to others (patient or art viewer). Ultimately, they bestow the most coveted gift of having accomplished: meaningful work.
For me, “My art is my science, and my science is my art.”
EPILOGUE
My Journey
Looking back at my life story makes me consider what may have been my guiding lights. Two come primarily to mind. The first is an attitude about life, and the second is the scientific springboard that launched and steered so many of my voyages.
I learned early from my family that the world is made by giving and not by taking. This principle has led to my greatest joys. The highest reward is to help someone — to see them happy, smiling, and comfortable. Givers are the truly rich people. I complete this memoir with the hope that I have accomplished meaningful work, for this prize of helping others remains my grandest goal.
For many, the bible is the main guide. Claude Bernard’s Introduction to the Study of Experimental Medicine is my medical and scientific equivalent, and second guiding light. I buy numerous copies and liberally distribute them to other physicians. Simplicity is my mainstay, and his illumination of the movement between observer and experimenter and back to observer identifies how we must learn and grow. It is understanding nature, not affirming our preconceived beliefs, that is the centerpiece of our search, and curiosity is my driving force. Bernard’s exasperations with rigidity — the never-ending barrier to growth — would continue today. I suspect that rigid people remain rigid… because their curiosity is absent.
I’ve learned that frustration and anger can never be the counterforce to such obstacles. Instead, I’m led by a steadfast commitment to make the truth even clearer. This memoir confirms that each scientific answer is correct, as each passed through the steps of making an observation of abnormality, testing it experimentally, reinforcing it by application in patients, and then making efforts to teach these new ideas to create a fundamental shift in how to care for these disastrous diseases.
Despite reporting solid evidence for these novel and successful treatments — for acute heart attack, sudden death (cardiac arrest), congestive heart failure, re-oxygenation injury in babies, lung and leg problems after blood flow restoration, damage to the heart’s septum, utilizing pacemakers to restore normal cardiac twisting, and the potential for greatly improved treatments linked to a deep understanding of the structure / function relationship within the helical heart — the promise of these breakthroughs remains unfulfilled. Ongoing inflexibility prevents the blossoming of the seeds that underlie a major revolution in thinking about health care.
Tragically, progress remains hampered by medical community rigidity, just as it was for my hero Claude Bernard, and for Semmelweis, who in the 1800s told the titans of medicine to wash their hands to avoid childbed fever — but they refused.
Today’s losers are the patients, whose diseases have not been cured.
Considering this further leads to a fascinating insight into the oftentimes adversarial views of cardiology and cardiac surgery. Let’s look at the noninvasive methods that have evolved in the cardiologist’s catheterization lab — ones that try to match what occurs during heart surgery operations. At first, intense resistance to the goals of innovative surgical treatments are expressed by the cardiology community. Yet as soon as those same treatment objectives become achievable by the development of catheter-based (cardiology) approaches that they can use — this rigidity suddenly turns into vigorous enthusiasm.
Evidence of this goes back to the introduction of coronary angioplasty — to replace surgical coronary artery bypass grafting. Then catheter-based mitral procedures became all the rage to replace using surgical procedures to repair or replace the mitral valve.
Today, cardiology’s resistance to the concept of treating congestive heart failure by restoring the heart’s normal form is finally turning into advocacy — as the cardiologists now are investigating how to insert a cone-shaped ventricular device in the cath lab — to reshape the spherical ventricle back into its natural elliptical form.
These winning changes will bring new blood flow beyond narrowed arteries, restore leaky valves, and rebuild natural form in stretched dilated failing hearts. Yet the patients have borne the brunt of this dilemma, for while their disease can now be treated by using either non-invasive (cardi
ology-based) or surgical methods… the ability for them to receive this benefit has been delayed by resistance. They had to wait until the cardiologists had their own new tool to deliver it. Providing life-saving treatments must be everyone’s goal — regardless of who supplies it.
“Scientific truth wins, but only God knows the timing.” Galileo taught us this lesson, after obstructionists let 500 years pass before his findings were finally accepted. In 2016, science “discovered” and acknowledged the truth about Einstein’s 1916 theories on gravitational waves. My sincerest hope is that exploration and testing of the revelations described in my book will take only a fraction of this time.
I’m frequently asked, “What is your stimulus to never stop ‘fighting the fight’ of transmitting new ideas, when rejection has prevailed for so long?” My answer is that the excitement of uncovering nature’s secrets and using these discoveries to help others, ignites a thrill and vigor that consistently rewards such useful contributions. Yet this prize can never overshadow the sheer joy that the cardiac surgeon experiences after someone is directly improved by his or her surgical skills. …But there is more.
Many years ago, I visited a dear friend. I helped him do four operative procedures in one day, and he shared his gratefulness for being able to work in a medical center that had sufficient patients to support such a busy practice. I concurred, but advised him that I also want my surgical contribution to touch people in numbers that extends beyond my operating room. I recently received a book written by a legendary heart surgeon, whose fame and talent allowed him to individually operate on “100,000 hearts.” I marveled at his astonishing accomplishment. Then I thought about blood cardioplegia, which has been used in 25 million patients, and realized that part of my dream has already happened.
My life’s purpose has been, and remains, to powerfully overturn the stagnant barriers against new thinking. Patients will greatly benefit, as adopting these new approaches will offset the devastating symptoms and shortened lifetimes caused by these major diseases whose remedies are revealed in this memoir.
My discoveries happened because of the collaborative efforts of many research fellows, colleagues, and especially my mentors, upon whose shoulders I stood to see the next peak ahead. Now my memoir reaches out to those most affected by our current inability to counter major heart diseases — those of you reading these pages. My wish is that your passionate concern for your health and the health of your loved ones will motivate you to share the information contained in this book with those you turn to for your medical care.
The answers exist now. So please join me on this quest.
RESOURCES / OVERVIEW
Brief Summaries of the life-saving answers discovered during my lifelong journey are available in PDF format on a “Summaries of Discovery” page at www.GeraldBuckberg.com.
These may help the non-medical reader better understand each chapter’s contents, so they may also more easily share them with others.
The summaries include:
Blood Cardioplegia: Protecting Hearts During Surgical Operations (Chs. 6 & 7)
Acute Heart Attacks: New Treatment to Avoid Lasting Injury (Chs. 8 & 9)
Re-oxygenation Injury: Protecting Vulnerable Babies (Ch. 10)
Sudden Death: Bringing the Dead Back to Life (Ch. 11)
Unwitnessed Arrest: Beating the Unbeatable Foe (Chs. 12 & 13)
Heart Failure: Solving the Unsolvable Challenge (Chs. 16 & 17)
Paco Torrent-Guasp’s Amazing Discovery: Why the Heart Works (Ch. 18)
The Helical Heart: Solving Heart Failure’s Unanswered Puzzles (Ch. 20)
Diastolic Dysfunction: Uncovering its Cause and Finding its Solution (Ch. 22)
The Septum: Preventing Unnecessary Damage during Cardiac Operations (Ch. 24)
Pacemakers: The Riddle Solved (Ch. 26)
REFERENCE LIST
1. Buckberg GD, Luck JC, Payne DB et al. Some sources of error in measuring regional blood flow with radioactive microspheres. J Appl Physiol. 1971;31:598–615.
2. Buckberg GD, Olinger GN, Mulder DG et al. Depressed postoperative cardiac performance. J Thorac Cardiovasc Surg. 1975;70:974–988.
3. Melrose DG, Dreyer B, Bentall HH. Elective cardiac arrest. Lancet. 1955;2:21.
4. Kirsch U, Rodewald G, Kalmar P. Induced ischemic arrest. Clinical experience with cardioplegia in open-heart surgery. J Thorac Cardiovasc Surg. 1972;63:121–130.
5. Tyers GFO, Todd GJ, Niebauer IM. The mechanism of myocardial damage following potassium citrate (Melrose) cardioplegia. surg. 1975;78:45.
6. Gay WA, Ebert PA. Functional, metabolic, and morphologic effects of potassium-induced cardioplegia. surg. 1973;74:284–293.
7. O’Blenes SB, Friesen CH, Ali A et al. Protecting the aged heart during cardiac surgery: the potential benefits of del Nido cardioplegia. J Thorac Cardiovasc Surg. 2011;141:762–770.
8. Domanski MJ, Mahaffey K, Hasselblad V et al. Association of myocardial enzyme elevation and survival following coronary artery bypass graft surgery. JAMA. 2011;305:585–591.
9. Khuri SF, Healey NA, Hossain M et al. Intraoperative regional myocardial acidosis and reduction in long-term survival after cardiac surgery. J Thorac Cardiovasc Surg. 2005;129:372–381.
10. Cooley DA, Reul GJ, Wukasch DC. Ischemic contracture of the heart: “stone heart.”. Am J Cardiol. 1972;29:575–577.
11. Shumway NE, Lower RR. Hypothermia for extended periods of anoxic arrest. Surg Forum. 1959;10:563.
12. Piper HM, Garcia-Dorado D, Ovize M. Review: A fresh look at reperfusion injury. Cardiovascular Research. 1998;38:291–300.
13. Bernard C. An Introduction to the Study of Experimental Medicine. New York: Dover Publications, 1957.
14. Brazier J, Hottenrott C, Buckberg GD. Noncoronary collateral myocardial blood flow. Ann Thorac Surg. 1975;19:425–435.
15. Nelson RL, Fey KH, Follette DM et al. Intermittent infusion of cardioplegic solution during aortic cross-clamping. Surg Forum. 1976;27:241–243.
16. Follette DM, Steed DL, Foglia RP et al. Advantages of intermittent blood cardioplegia over intermittent ischemia during prolonged hypothermic aortic clamping. Cardiovasc Surg. 1978;58:1–200.
17. Follette DM, Mulder DG, Maloney JVJr et al. Advantages of blood cardioplegia over continuous coronary perfusion or intermittent ischemia. J Thorac Cardiovasc Surg. 1978;76:604–619.
18. Buckberg GD, Brazier JR, Nelson RL et al. Studies of the effects of hypothermia on regional myocardial blood flow and metabolism during cardiopulmonary bypass. I. The adequately perfused beating, fibrillating and arrested heart. J Thorac Cardiovasc Surg. 1977;78:87–94.
19. Rosenkranz ER, Okamoto F, Buckberg GD et al. Safety of prolonged aortic clamping with blood cardioplegia. III. Aspartate enrichment of glutamate-blood cardioplegia in energy-depleted hearts after ischemic and reperfusion injury. J Thorac Cardiovasc Surg. 1986;91:428–435.
20. Lazar HL, Buckberg GD, Manganaro AM et al. Myocardial energy replenishment and reversal of ischemic damage by substrate enhancement of secondary blood cardioplegia with amino acids during reperfusion. J Thorac Cardiovasc Surg. 1980;80:350–359.
21. Loop FD, Higgins TL, Panda R et al. Myocardial protection during cardiac operations. J Thorac Cardiovasc Surg. 1992;104:608–618.
22. Mahrholdt H, Wagner A, Parker M et al. Relationship of contractile function to transmural extent of infarction in patients with chronic coronary artery disease. J Am Coll Cardiol. 2003;42:505–512.
23. Gaudron P, Eilles C, Kugler I et al. Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation. 1993;87:755–762.
24. Torabi A, Cleland JG, Rigby AS et al. Development and course of heart failure after a myocardial infarction in younger and older people. J Geriatr Cardiol. 2014;11:1–12.
25. Gerber Y, Weston SA, Enriquez-Sarano M et al. Atherosclerotic Burden and Heart Failure After Myocardial Infarction. JAMA Cardiol. 2016;1:156–162.
26. Bolognese L, Neskovic AN, Parodi G et al. Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation. 2002;106:2351–2357.
27. Allen BS, Rosenkranz ER, Buckberg GD et al. Studies on prolonged regional ischemia. VI. Myocardial infarction with LV power failure: A medical/surgical emergency requiring urgent revascularization with maximal protection of remote muscle. J Thorac Cardiovasc Surg. 1989;98:691–703.
28. Sjostrand F, Allen BS, Buckberg GD et al. Studies of controlled reperfusion after ischemia: IV. Electron microscopic studies: Importance of embedding techniques in quantitative evaluation of cardiac mitochondrial structure during regional ischemia and reperfusion. J Thorac Cardiovasc Surg. 1986;92/3:512–524.
29. Allen BS, Rosenkranz ER, Buckberg GD et al. Studies of controlled reperfusion after ischemia: VII. The high oxygen requirements of dyskinetic cardiac muscle. J Thorac Cardiovasc Surg. 1986;92:543–552.
30. Buckberg GD, et al. Studies of controlled reperfusion after ischemia. Journal of Thoracic and Cardiovascular Surgery. 1986;92:483–648.
31. Okamoto F, Allen BS, Buckberg GD et al. Studies of controlled reperfusion after ischemia: VIII. Regional blood cardioplegic reperfusion on total vented bypass without thoracotomy: A new concept. J Thorac Cardiovasc Surg. 1986;92/3:553–563.
32. Allen BS, Okamoto F, Buckberg GD et al. Studies of controlled reperfusion after ischemia. XV. Immediate functional recovery after six hours of regional ischemia by careful control of conditions of reperfusion and composition of reperfusate. J Thorac Cardiovasc Surg. 1986;92:621–635.
33. Vinten-Johansen J, Buckberg GD, Okamoto F et al. Studies of controlled reperfusion after ischemia: V. Superiority of surgical vs medical reperfusion after regional ischemia. J Thorac Cardiovasc Surg. 1986;92:525–534.
Solving the Mysteries of Heart Disease Page 50