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.

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

Latest Reading: The Cairo Affair

On the flight to Istanbul last weekend I finished Oleg Steinhauer’s spy novel. The trip gave me over 9 hours of reading time. (5 hours 20 minutes flying west and 3 hours and 40 minutes flying east thanks to the jet stream) I picked up the book in the bargain bin at Barnes & Nobles this summer. Reading novels set in the world of expatriates are always interesting to me; however, spy novels are usually not on my reading table. 

The book centers around the wife of the deputy consul at the US Embassy in Budapest. Working in international schools, I’ve spent a lot of time in American embassies around the world. The book is a murder mystery as she tries to find who killed her husband as they were having dinner together in a restaurant. They had recently transferred from Cairo, where most of the action takes place. My former residence of Serbia also is featured in the book. A Serbian spy plays a prominent role in the intricate plot. There are also flashbacks to Serbia on the eve of the start of the Yugoslavian war in the early 90s. The main characters are my age. 

It was an entertaining book to read during bouts of insomnia and on the plane. The plot got a little confusing towards the end as there are a lot of characters. My general take away from the lives of spies are there is a lot of deception and lies. It would be tough to live in a world like that, always evaluating information to check for its truthfulness. Some reviews claim he is the next John Le Carre, who was recently criticized by the head of the British Secret Service. My son Owen is considering a career in the foreign service or intelligence. It would be good to have a book that depicts how it is working in the secret service. I would think most of the jobs deal with the analysis of information and not being a spy. 

Having lived in Serbia and having spent a lot of time in Vojvodina, I see that he has been to the place. I had to laugh when he mentioned how pleasant the countryside is in the Fruska Gora National Park. We spent many an afternoon having picnics and hikes around one of the monasteries. It was one of our favorite places in Serbia. That is the beauty of Flickr that I can find a photo from those picnics in a couple of clicks. Nadia and Oliver are below – lots of happy memories! 

Impressions of Istanbul

Boat Tour of the Bosphorus – Martyrs of July 15th Bridge

This was my second visit to Turkey, having visited with my family in February of 2014. This time I was here alone on business, for international school meetings. I stayed in the heart of Besiktas, one of the oldest neighborhoods in the city and many ways, the cultural heart of Istanbul. I loved the proximity to the Bosphorus Strait, the cobblestone streets and the numerous cafes, bars and restaurants. The autumn weather was perfect and I went on a couple of long walks up and down the many hills. Istanbul is one of the largest cities in the world, with a metro population of 15 million. It felt busy walking along the Bosphorus, but the stunning views of palaces, parks and water and most interestingly, the daily life of the citizens of this remarkable city were invigorating.

Dog Walker in Besiktas

It was probably the neighborhood, but I saw many more secular Turks than conservative Turks, with younger people wearing Western fashion and no headscarves on the women. This friction has always been a defining feature of Turkey. I sense President Erdogan’s popularity may be waning. My taxi driver to the new airport was quite critical of him, calling him “a thief and dangerous, similar to your president Trump”. I was impressed with the infrastructure and commercial activity in the city and think prosperity has grown in the five years I have been away. However, in speaking with the director of the international school there, he said their enrollment is down because of the recession. One negative about Istanbul is that it felt a bit like Manhattan in that you could not get away from people. Solitude is something that you will not get in Istanbul. Even in the parks, there were people everywhere. It wasn’t Asian crowded, but the traffic noise and many people made it feel hectic.

Taksim Square

We took a 3-hour boat cruise the last night going north on the Bosphorus Strait, heading towards the Black Sea. The views of the homes and apartments on the hills reminded me of the Mediterranean. The many palaces and forts on the shores were lit up to provide marvelous views. As a former Istanbul resident told me, “The Bosphorus is the main street of the city and to properly see Istanbul, one must see it from the water.”

Neighborhood Cats

I noticed this time the numerous cats that roam the streets and parks. Why so many cats? I guess that they keep the rat population down and they are sacred animals in Islam. They looked well taken care of and were passive and almost affectionate as I walked by. I wonder what their impact is on the birds of the city?

Ottoman Domes are all over the city

Istanbul is such a historic and picturesque city! I was thinking of all the many people and events that have taken place here, from the Romans and Byzantines, to the Ottomans and even today’s political scene with Erdogan trying to keep power. It was a great place to visit but a bit too much traffic and people for me to want to live. To visit though, a marvelous city with spectacular views, great restaurants, entertaining people watching, etc.

Narrow Pathways of Besiktas