Latest Reading – "State of the Heart: History, Science and the Future of Cardiac Disease"

Photo courtesy of Aga Khan University

Both my father and grandfather died of heart disease. My grandfather had rheumatic fever as a child which weakened his valves. He died in his 40s, peacefully while taking a nap after lunch. My father told me he had an argument at work, a factory where he was the foreman. He came home for lunch and my father thinks that the stress from work, may have been what pushed his heart over the brink. My father, Charles Kralovec, survived his first heart attack. He had bypass surgery and a surgical stent placed in one of his arteries. He lived for another 10 years and passed away from a heart attack while serving as a lector at a funeral at St. Cecilia’s Church in my hometown of Caspian, Michigan at the age of 78. Even though I am not biologically related to them (I am adopted) I’ve always been aware of heart disease.

I really enjoyed reading Dr. Haider Warraich’s State of the Heart: Exploring the History, Science and Future of Cardiac Disease. Dr. Warraich is a Harvard Medical School cardiologist and Pakistani immigrant to the USA. He uses his patients to introduce all aspects of heart disease. It is amazing the medical advances that have prolonged the lives of millions of people. Cardiovascular diseases are the leading cause of death in the USA and worldwide. Heart disease is almost double the rate of cancer as a cause of death worldwide and slightly higher than the rate of cancer in the USA.

Heart disease has been on my mind lately because my doctor and I decided for me to start taking statins after my yearly physical this summer. I always score “borderline” risk when it comes to total cholesterol with a 14-year average score of 225. Warraich made me feel much better about this choice as he is very enthusiastic about the wonders of this class of lipid-lowering medications. It is the most commonly prescribed medication in America with soon, 1/3 of all Americans older than 40 will be taking a statin. Atorvastatin, Lipitor is the bestselling drug of all time. I liked that a Japanese doctor, Akira Endo, was one of the key researchers to discover statins. Warraich ranks Endo’s discovery with Fleming’s discovery of penicillin.

“…the most important means to improve and prolong life we have ever developed as a species”

I hope my daily 10mg tablet will lower my LDL cholesterol, which commonly leads to atherosclerotic plaques lining blood vessels. I was glad to see that Warriach’s research showed raising HDL likely doesn’t change risk for heart disease. My average score of 38 for HDL is just below the at-risk range (>40). I will continue to watch my weight, exercise and not smoke to see if my HDL can stay above 40. Some other aspects from the book I would like to remember are as follows:

  • Heart disease is just as common in women as men. Estrogen does offer protection to women, so they experience more heart disease post-menopause.
  • High blood pressure is the real threat for heart attacks, more so than cholesterol as a risk factor.
  • Work stress is linked to higher rates of heart disease.
  • The coronary arteries, the vessels that feed oxygenated blood to the heart are the most common vessels for heart attacks.
  • Cardiology is the most competitive field among internal medicine specialties.
  • Often medical research is just as flawed as educational research. I think it is for the same reason. It is difficult to treat humans like lab rats and conduct unbiased experiments.
  • Chest pain is the most common symptom of a heart attack. Doctors also can do an EKG or check for troponin levels in the blood.
  • “Patients older than 65 with heart failure in the USA admitted to the hospital live for only an average of 2 years.”

The book helped me realize the amazing structure and role of the heart. It is amazing that the heart can generate electricity. The pacemaker section in the lining of the heart is controlled by a small electrical charge that is transported cell-to-cell. It is such a small amount that it would take 70 hours of heart operation to collect enough energy to charge an iPhone. The heart is also one of the few organs that you can see working. Most organs do their business on the microscopic level.

The future of treating heart disease will be very interesting. Warraich predicts we will eventually have a 100% artificial heart that distributes blood through the body. Doctors are advancing in this area, with Left Ventricular Assist Devices (LVADs) a battery-powered implant that pumps a damaged heart.

I suggest listening to the interview Dr. Warraich did with NPR’s Terry Gross to learn more about the book.

Final Thoughts on Turkmenistan

View to my hotel during my run

Ashgabat was such an interesting and distinct place. The topography and climate reminded me of Nevada and Utah. It felt much drier than Tashkent and the hills and ravines at sunset and sunrise were quite beautiful. It was just so odd to look over at the futuristic buildings on this landscape. The city is close to the Iranian border, which could be seen in the distant mountains

Lobby of the Yyldyz Hotel

The city was built to impress visitors. As you can see from the hotel lobby above, no expense is spared in these huge public monuments and facilities. For example, below the hotel on the road leading down the hill towards the city, was an 18-hole, Jack Nicholson-designed golf course. We never saw anyone play during our three days at the hotel. However, the grounds were immaculately maintained.

The international airport is shaped like a bird. Many of the buildings shape match their function. The national library looks like two books.
A sample of Turkmen TV

One of the negative aspects of Ashgabat that really struck me was the lack of outside influences. Most of the most popular internet sites are blocked. There is absolutely no advertising found in the city. I read where only about 10% of the population accesses the internet. The government actively controls internet access and even my Express VPN did not work there.

Panoramic View from the hotel restaurant balcony

I didn’t spend enough time exploring this fascinating city and country. I’ll never forget country #67 on my life list.

Bill’s take on the 2019 NFL

I enjoy following the NFL and it is something that Owen and I can bond over. More than other professional sports, the regular season matters and the talent is more evenly spread throughout the league. Most of the games are decided by one touchdown or less. I also think coaching in football is more important than other sports as well, so I put emphasis in analyzing teams on the coach. The other important factor for me is the quarterback. I also like the fact I can watch the highlights of a game in 10 minutes. My biggest complaint with the NFL is the use of instant replay to officiate the game and all of the stoppages in a game. I use the NFL to calm my mind and fall asleep at night, I think about the games and teams. Good meditation.

Tier 1 – Championship Contenders (Top 5) – Favorites to make it to the Super Bowl.

New England Patriots – best coach in any sport, automatic #1 or #2 seed annually

Baltimore Ravens – love Lamar Jackson, wish Lions picked him, good coach, hard-hitting team

Green Bay Packers – Rodgers with strong running game, good change with coach, home field advantage

Minnesota Vikings – talented roster, decent coach

New Orleans Saints – coach and QB smart and experienced, better defense this year

Tier 2 – Good Solid Teams (9 teams) – Can win a playoff game or two, would be a surprise team to make it to the Super Bowl, but not out of the reach with some luck.

San Francisco 49ers – great coach, roster improved through draft, Garapalo overrated

Kansas City Chiefs – Mahomes and playcalling brilliant, defense needs more

Buffalo Bills – solid defense, lots of players, I think a good coach

Houston Texans – DeShaun Watson great QB, mediocre coach

Indianapolis Colts – really good coach, good roster,

Dallas Cowboys – lots of talent, defense their weakness

Philadelphia Eagles – injuries drop them to Tier 2

Seattle Seahawks – very lucky in close games this year, Wilson great QB, great at home

Los Angeles Rams – good roster, average QB, good coach

Tier 3 – Average to Slightly Below Average (not bad) 13 teams that can have their moments

Cleveland Browns – lots of speed, undisciplined, poorly coached

Pittsburgh Steelers – tough defense, solid, bad QB

Tennessee Titans – frustratingly inconsistent, nice uniforms

Jacksonville Jaguars – I don’t like Jacksonville having a NFL franchise, hard-hitting team

Los Angeles Chargers – carried my fantasy football team last year, give games away in 4th quarter; regretting choice to move to LA

Denver Broncos – really good defense, need a QB

Chicago Bears – see Denver

Detroit Lions – my favorite team, can score points, not sure well-coached, bad front 7 on defense

Carolina Panthers – solid all-around team but nothing spectacular

Atlanta Falcons – recent resurgence brought to Tier 3

Tampa Bay Buccaneers – exciting offense players (ballers), Bruce Arena needs time to straighten out

Arizona Cardinals – surprisingly solid team this year, Murray a good QB

Oakland Raiders – Gruden a good coach, will win games they are supposed to win

Tier 4 – Bad Teams (5 teams with no chance, fighting for draft rankings)

New York Jets – could be decent, poor GM/owner

Miami Dolphins – have some fight, loved them as a kid, need QB and more talent

Cincinnati Bengals – years of first-round playoff exit era over, heading further down

Washington Redskins – bad owner, no talent, no direction

New York Giants – love Sequon Barkley, will move up next year, Jones not bad

Visit to Ashgabat, Turkmenistan

View from our hotel towards the city (wedding hall in background)

Earlier this month, I had a rare opportunity to visit one of the most difficult countries to see, Turkmenistan. Since its independence from the Soviet Union in 1991, the country has been ruled by two successive eccentric presidents that limit the outside influences. Approximately 6,000 visitors visit Turkmenistan per year as it is difficult to get a visa and there are limited airlines flying into the capital, Ashgabat. The US Embassy in Ashgabat sponsored an Emergency Preparedness & Communications workshop and invited international school directors from Central Asia to the conference.

Dozens of white marble buildings are lit up on the lightly travelled city streets

Ashgabat is a special city in Turkmenistan. It has been described as Pyongyang (capital of North Korea) meets Las Vegas. The entire city consists of hundreds of huge monuments and buildings made of white marble. The government’s natural gas and oil revenues have been used to build a perfect city that looks like something out of a science fiction novel. There is no advertising, no litter, lots of neon lights and very few people. Every structure, from telephone booths to bus stops, has the white marble and gold-trim futuristic theme.

White marble and gold telephone booths

I stayed at the Yyldyz Hotel, a magnificent natural gas flame/rocket ship-shaped building on a hill overlooking the city. I took several evening walks along lighted sidewalks through the desert hills down to the city. It was so odd to be walking in unique landscape that naturally looks like Utah or Nevada, but a futuristic Utopian architecture. There were some bits of normalcy I encountered, like kids practicing soccer outside the national stadium and a supermarket, which was comparable to supermarkets here in Tashkent.

The city landscape from the 1976 science fiction movie, Logan’s Run – Ashgabat looks like this place (courtesy, Moria, Sci Fi film review website)

The embassy arranged two outings to local restaurants which were quite pleasant. It felt like Central Asia, with good food, plenty of alcohol and loud music. I would have never found the restaurants as there are no signs, but once inside the decor was quite normal, like most restaurants. Due to the currency exchange controls, a big meal, with drinks cost each of at the table $5 USD.

Hundreds of monuments can be found around the city.

Family Journal: Autumn Break Continues

Ocean is not happy about our training run this afternoon

It was a monumental effort to get Ocean, Oliver and Nadia out for a training run along the Ankhor Canal. There is a picturesque 5 kilometer trail running along the canal. We ran from the parking lot of La Terasse Restaurant to the Menor Mosque and back for a 10 kilometer training run. We are preparing for the Samarkand 10KM in two weeks. This was the furthest Ocean has ever run, normally she runs up to 5 kilometers on her cross country team. Oliver was the strongest and he is such a good runner! He and our friend Shannon, finished well ahead of Nadia, Ocean and I. It was a perfect autumn afternoon as we are soaking up the final luxurious days of Fall Break.

Nadia motivates Ocean to the finish!

Yesterday we drove up to the Charvak Reservoir and the Chimgan and Beldersoy Mountains. I wanted Nadia to get out of the city a bit and it reminded her of the mountains of Sucre, Cochabamba and Potosi of her native Bolivia. We checked out a couple of the hotels in Beldersoy in anticipation of ski season. The views were beautiful and it was nice to spend time with Owen, Nadia and Ocean’s friend Josh during the drive. I really want to ride my bike around the reservoir!

The blue reservoir contrasts with the dry desert mountains of the lower Chatkal Range

On Thursday I went on a 50 kilometer ride with my friend Matt. It was a bit busy as we got off to a late start, but the route back was quite pleasant. I love cycling and am happy to get out occasionally for morning rides.

Riding by one of the many mosques in the city.

Nadia and I also played several tennis games this week. We also took a lesson from Jasur, the tennis pro at the Yoshlik Sports Center.

Unorthodox Filming from Nadia

Family Journal: Autumn Break Begins

Dr. Jan is taking good care of the Kralovec

One of the nice things about our school is it is adjacent to an international medical clinic. It feels like our personal medical facility. They have international doctors there and it gives Nadia the peace of mind that she we are being looked after. Dr. Jan Reimers-Flattun, the former director of the clinic and former embassy doctor, is in residence at the clinic this fall. She has been so helpful in getting our immunization schedules documented and up to date for the children. She also is very caring with my family and we will miss her when she leaves next month. On Monday, we got our flu vaccines and Owen got his final MMR booster shot.

Yoshlik Tennis Centre – NBU Stadium

We are enjoying our Autumn Break in Tashkent. I am mixing work with family this week. Yesterday afternoon Nadia and I played tennis. It was such a gorgeous day and with many courts available for $5 / hour, playing tennis here is so easy and accessible. Owen and I are taking a lesson this afternoon.

Ocean with her friends at Ice City

We dropped off Ocean yesterday at Ice City, an amusement arena. One can speed skate, ski, bobsled, etc. in an indoor, chilled venue. She had a sleepover last night. Oliver injured himself walking home from the supermarket, cutting his leg. He seemed to have almost a full range of motion last night.

Nadia found this cool Russian language Pepsi bottle at a bakery. It is nice to have time to reconnect with family!

Beldersoy Mountain Climb

Oliver resting with Beldersoy Ski Resort Piste in the background

This past Sunday, Owen, Oliver and I went hiking in the Ugam-Chatkal National Park. This was my second visit to the park and we were led by the famous guide Boris. The Chatkal Range, part of the western Tian Shan Mountains, covers “the finger” in far Eastern Uzbekistan. It is only about a 90-minute drive from Tashkent.

We climbed a steep ridge running parallel to the Beldersoy Ski Resort to begin the hike. The ski piste and hotel was below as we scrambled over rocky outcrops. Boris is known for not using trails, instead going for more difficult routes and he didn’t disappoint. We made it to the top (2,000 meters / 6,500 feet) of Beldersoy and had gorgeous views of the Beldersoy River valley and several peaks. After a rest, we walked through the Urttakumbel Pass down to the Marble River. We had lunch along the river and surveyed a 30-meter waterfall in the narrow canyon.

Big Chimgan in the background

Walking back up a side trail we saw hundreds of fossilized cockle shells. It is awesome to think about geological time scales. Those shells were once living mollusks living on the bottom of a sea and today they are found on a mountain in the middle of a double-landlocked desert nation of Uzbekistan. I collected a bunch of nice specimens to display in my office.

Cockle Shell Fossils in the Marble River Canyon

We finished the hike by going over to a “solar glade” an open pasture on the way back to our car. The glade reminded me of a desert Sound of Music mountain meadow. It would also have been a great place for a medieval battle scene. Oliver is reading Game of Thrones and is re-watching some of the later episodes. It would be a perfect spot for filming.

The “solar” glade

Of course the best part of any hike for me is spending time with my family. Being able to talk and explore with my sons gives me so much pleasure. They are two really good guys and we enjoyed each other’s company, despite the early start on a Sunday morning.

The initial ascent from the parking lot

The one aspect of hiking in the park that bothers me is the ubiquitous livestock grazing. We didn’t see any horses, cows, sheep or goats on this walk, but we did see plenty of evidence (feces) of ruminants. I wonder what the mountains would look like without the pressure of grazing? I know people have to make a living, but it makes me want to forgo meat all together when I see the impact of livestock on the environment.

I am looking forward to seeing the mountains change as the seasons change. My two hikes so far were during the driest part of the year.

Marble River Canyon