This is getting serious

What do mountain goats, woodpeckers, and football players all have in common? Head butts. Why is it that a woodpecker can pound his head millions of times and not suffer from debilitating brain injuries, and while, we’re at it, what about rams? Heck, even their name identifies what they do.

There have been numerous studies of woodpeckers to attempt to determine what the differentiator is relative to brain injuries and their natural assignment of beating holes in trees with their beaks. These beaks, if you haven’t noticed, are attached to their heads which is where their tiny little brains hang out.

Woodpeckers have to peck pretty hard to get the bugs and insects they’re after. It was originally believed they had a special bone-like, foam material between their brain and their skull, but after dissecting a few deceased woodpeckers, according to MIT professor, Lorna Gibson, it was clear they did not have any foam lining. She and several other scientists dug in and found woodpecker facts.

The woodpecker is absolutely the headbanger of the bird world. They also peck to profess their love and to layout their territory. Their pecking speed would absolutely produce a concussion for a human. They bang their beak at 15 mph between 700 and 12,000 times a day, at up to 20 times per second. That, my friends, is a lot of pecking.

They have thick, strong neck muscles which contract just before their bill hits the surface. This allows some of the force to dissipate down through the bird’s body which protects the bird’s skull from the full blow. They also have unequal upper and lower beaks which lowers the force of the peck from hitting the brain.

Another shock absorber is their tongue. Woodpeckers have tongue supports that wrap around their brains, and work as a safety harness. Plus their brain weighs only two grams and is tightly fit in the skull.

That configuration keeps the brain from banging around inside the skull. Because their tails help brace them against the tree and their toes also are built to brace them, you can say they’ve found the proper pecking posture.

In spite of all the protections Mother Nature provides for them, woodpeckers do get brain damage, but they also have an accumulation of a protein called tau which actually protects them from suffering from neurodegenerative diseases like the chronic traumatic encephalopathy that our football players get.

Because of these studies, all kinds of technological and safety advances have been implemented in sports equipment, but it is believed that the presence of tau in woodpeckers is a protective adaptation, because in moderation, it works to stabilize brains cells.

Tau is typically found in human patients with brain diseases ranging from Alzheimer’s to traumatic head injuries. Consequently, it is now up to scientists to discover why tau is good for woodpeckers and how that protein can be adapted to protect football players and others from brain injuries.

Rams, on the other hand, typically bash their heads together at a speed ranging from 20 to 40 mph without injury. How do they do it? Rams have strong, flexible horns that absorb much of the shock of the collisions, in addition to a physical anomaly that slows the blood flow from the head to the body.

Scientists studying football players in Colorado discovered that football players at higher altitudes had 30% fewer head injuries. Their hypothesis is that higher altitudes increase the volume of fluid in the cerebral venous system which provides another layer of protection.

So, maybe the solution is to equip football helmets with horns, to genetically modify the players’ toes, tongues, neck muscles and cerebral blood flows, to make sure only those players with smaller brains take or give the hits, and for goodness sake, to move all of the teams to the mountains.

Or maybe we should study the impact of tau?

I’ve written several of these tributes over the past decade and a half, but this one has been one of my most emotionally challenging.

The first time I met Ron Vickroy, he was a board member of the Laurel Highlands Visitors Bureau, and I was a candidate for the position of President/CEO of that organization. He was working as the head of marketing for Crown American, and although he was a few years younger than me, I recognized immediately that his gifts were superior to not only his age but also to those of his peers.

I got that job, and Ron became my boss. I latched on to him as a mentor, a teacher, and quickly as a friend. Ron had one of the most fertile minds I had ever encountered. Yes, he had graduated first in his class from the Air Force Academy, and then went through the prestigious GSIA School at Carnegie Mellon University, but there was much more to Ron than IQ/EQ/QPA or any other intellectual marker. He was a compassionate, committed, community-minded leader with a nearly zero focus on materialism.

When you think about movies like “All The Right Stuff,” that’s what Ron had. After my Laurel Highlands experience, I was recruited to a VP position at the former Mercy Hospital in Johnstown and had an opportunity to recommend Ron as a member of the Foundation Board of Directors. By then Ron had made the decision to forgo his higher paying marketing job and begin work as a business professor at UPJ.
His talent was quickly recognized, and he was recruited onto the Hospital Board of Director where he served until he transitioned to the Conemaugh Board of Directors. This is where he literally found a home and served for pretty much the remainder of his life.

Ron also found his love in teaching, and no matter when you met his students, the description of his talent, dedication, knowledge, but most importantly his inspiration was their focus. Ron was not only an amazing person, a brilliant and creative individual, he was also the best of the best as an instructor, a mentor, and a leader for his students.

Besides a vacation with he and his wife, Donna, to Aruba, my fondest memories of Ron were brain-storming meetings in his family room. He filled me with hope, excitement, and commitment to progress.

There was only one exception to this. I had attempted to take up golfing in my 40’s. Ron was a scratch golfer and sometimes tolerated my presence on the golf course.

Once after a particularly awful round, I turned to him in complete frustration and asked, “Ron, do you think I’ll ever be a great golfer.”  Knowing full-well that my passion and expertise had been in music, he said, “Let me ask you, Nick, if I took up trumpet right now, would I ever be any good?”  I gave my clubs away after that game and never regretted that decision one time!

Let me close by saying there was no better board member, teacher, mentor, friend, or human being than Ron Vickroy.

Love ya, man.

At age 21, I learned a significant lesson in both humility and reality. As a musician in a pit orchestra for a very complicated musical, my job was to play an extremely difficult trumpet part perfectly. This show required every ounce of musical training, knowledge, skill, coordination and endurance I had.

After a nearly 100% flawless performance, and an above-average performance from the actors, the show ended, and the audience applauded generously in appreciation. When we gathered together after the show, all of the praise and acknowledgement of skill and talent was directed toward the actors. At first I was confused and then a little angry that not one attendee congratulated the pit musicians for their almost flawless performance, not even my own parents.

That’s when it hit me. Similar to my orchestra playing friends, but completely different from my jazz and pop musician friends, my job involved one thing only that day: perfection. Those 10,000 hours I spent practicing in my room, in practice rooms and in orchestras, bands and ensembles, were all directed toward a perfect performance. Not unlike the job of an airline pilot or a racing pit crew, it’s only when things are not perfect that you’re noticed.

Of course, that same thing was not the case when I played in lounges and clubs, but when I was hired to perform symphonic work, ice shows and shows for Disney or for other performing groups and stars, it was also about perfection. In fact, if you missed even a few important notes or  entrances in a virtual sea of notes and music, you could be fired on the spot for those minor misses.

Let’s turn our attention to health care. I’ve written about medical errors. They are a major cause of death and suffering in the United States, and I have personally experienced several incidents over the years.

It hit me today that the same rules that are applied to musicians, racing pit crews and pilots might also be directed toward the staff and teams of performers employed in our health centers and hospitals. The phrase “Close enough for jazz” definitely should not apply to medical care.

I’m not sure which personality profiles should be married to which job descriptions, but if you’ve ever spent significant time with a pharmacist, it’s pretty clear they have been inculcated with the perfection gene, and collateral damage is not in their vernacular.

On the other side of that coin, Monday mornings were eye-opening times for me in the health care CEO seat as I’d review and sign off on the recorded medical errors that could lead to eventual lawsuits or malpractice claims, even though our hospital had the lowest rate of these types of incidents of any of our peer hospitals and one of the lowest rates of error in the United States.

Let’s be clear, perfection is not always something we should strive for in every aspect of life. It can make us crazy. In fact, I love life’s imperfections, but not when it comes to someone who is cutting me open or medicating me.

What can we do to ignite our perfection gene, and how do we instill that propensity to be perfect in the right people for the right jobs? How do we create more Top Guns?

Practice works, and not unlike those musicians or pilots who sit in rehearsals and simulation labs for hours at a time, every health system should require the same.

Fifteen years ago, I performed brain surgery on a human simulation dummy, and it felt very real when I applied that scalpel to the skin and hit the skull bone beneath. It certainly got my attention.

It’s my belief we can reduce deaths from unnecessary medical accidents by building in more simulation practice to the process, by requiring periodic testing to determine skill levels, and then reassigning personnel appropriately.

Let’s stop burying our mistakes.

The past four post-op weeks have been fascinating. The skilled surgeons fixed my heart.

They replaced my aortic valve, putting the new (cow) valve perfectly in place. Plus they did it all through my femoral artery. That’s the big artery in your groin and without open-heart surgery. That was my negotiated plan.

Both Cleveland and Pittsburgh had wanted to do open-heart, but when San Diego offered to do this procedure with the new technology, and the FDA approved it, I stood my ground, and the locals agreed. Consequently, I didn’t have to fly.

That’s when the fun began. Was I nervous? Oh, heck yes. Remember I know way too much. Well, the best-laid plans are often tainted, and that’s the rest of the story. You see, I made one horrendous mistake.

On the morning of my surgery, I panicked a little and texted one of my best friends, a former administrative fellow, who now is the CEO of 10 hospitals. In my text, I asked him to reach out to his buddy at the hospital where I was being bionically altered to make sure I got the best care. This was surely a mistake on many levels.

First of all, because I was a former administrator asking for a little extra attention, it probably moved my risk-factor ratio from 1 percent to 25 percent. Then, think about it, because I asked another administrator to ask another administrator to intercede, the risk-ratio went up by a multiple of three. For those of you who are not clear about this phenomena, think about a boss asking someone to give special attention to their friend when the creed of conduct is to treat everyone with the same impeccable level of care.

I realized I may have pushed the wrong buttons when one of the physicians came to my gurney and said, “Please tell your friend to stop texting me to take good care of you. I treat all of my patients the same.” That statement confirmed all of my worst fears.

So, after fasting for a day, being poked, prodded, shaved in places that have rarely seen daylight or a razor before, and dressed in butt revealing gowns, I remembered why I wrote the book, “Taking the Hell Out of Healthcare.”

My family kissed me goodbye, they wheeled me into a cold OR and I woke up an hour later in post-op with a very nice nurse who was having trouble with one of my two groin wounds. Eventually, she called for help, and her supervisor advised her to call in the surgical physician assistants, who informed me that my stitches had not held.

At that point, they gave me a shot to numb the area and began sewing me up like a tattered Raggedy Ann doll. The result of this extra added step was a hematoma the size of a cantaloupe-and-a-half firmly planted in my groin. Consequently, the one-week recovery became two weeks, then, one of the self-dissolving stitches blew and added three more days of atrophy inducing couch-potato-laying, bandage changing.

Oh, I forgot to mention the nerve pain in my left arm from the not-so-well-placed IVs and the fact that I can’t drive for a month, but those were just extra added bonuses because I got special VIP care.

In all fairness, the doctors and nurses were amazing. And the great news is that I didn’t have a stroke, haven’t had any misplaced palpitations and, so far, I’m feeling like a new man. My family has taken care of me better than any man could have ever imagined.

My wife filled my freezer with casseroles and after the stitch blew out, I’ve stayed at my son’s house where my granddaughters have both earned their honorary nursing certifications. My daughter and her kids have visited me with gifts of food and kisses, and my Goddaughter’s family even had a picnic.

Life is good.

As an outsider who came into healthcare two decades after most of the leaders who were running things, I became immediately aware of one obvious reality, “The United States has embraced a Disease-Centric, Medical Industrial Complex model of care.”

It’s a system where, if we speak about the concepts of wellness and prevention, it’s as if that is a false god to which we should never pray.  We define health as the absence of disease, and through polygenomic tools, we can assist in preventing many diseases, but it’s difficult to embed these concepts in a pathology-based culture. 

Drs. Jeffrey Bland, Leroy Hood, Wayne Jonas, Len Wisneski, Mimi Guarneri, Tierrona Low Dog, Dean Ornish, Deepak Chopra, and many other wellness and prevention and functional medicine-oriented scientists and physicians have been a part of my life over the last thirty years, and the majority of them are oriented toward both the new and ancient ways of caring for people.

In this country, we have been relegated to modifying symptoms as a way of making people feel good, and our systems specialize in the virtual health train wrecks rather than early prevention of these catastrophes. Don’t get me wrong. I’d rather be here when dealing with extreme situations, but when it comes to preventing these health-related breakdowns, it’s safe to say our system is not the most robust when wellness and prevention is the goal.

On the personalized, precision, and personal health movement, science is moving faster than our medical school curricula and the results are sometimes mind-numbing.  A few weeks ago, I sat with a young physician who was getting his fellowship at a very prestigious medical institution, and when I began to show him the reports from my pharmacogenomics testing, his response was a cross between complete awe and total confusion.  

We have made great strides in personalized medicine, but we continue to get sucked back into our disease-based model because that’s where the reimbursements are. We now have the ability to quantify what was previously unquantifiable, and the knowledge already exists that might protect us from tens of thousands of medical errors, but it’s not main-stream yet because it’s not being reimbursed.

How do we objectify health?  How do we personalize it and arrive at a unified position of what health is?  Health is not extra-ordinary. Health is both normal and personal.  Health is a combination of  all things physical, psychological, cognitive, and behavioral.  It is essentially what is being identified as functional. Our genes interact with our environment, and we begin to realize our genomic potential when everything is in “the zone,” but it’s also safe to say that the wildcard in every disease is lifestyle.

 We can easily look at the 300 or so genes that determine our ability to metabolize medicines, and we will soon perfect that same science as it relates to our food. When that happens, we will be able to identify how we will physically react to everything that we put into our bodies. But that too is not being taught in medical schools, and it is just now beginning to be taught in some pharmacy schools.

If you were told that your children could live happier, healthier lives by having them provide one cheek swab to analyze those 300 metabolizing genes, would you consider it?  Let’s place a further caveat on this. If you knew that this swab would not be used to unlock any of their other genetic risk factors except for medicine and food sensitivities, would you then provide that swab?  Would you be interested if you saw a report that indicated that, because of your personal genetic profile, the medicine you have been prescribed could prove to be lethal to either them or to you? 

That information is available. Precision medicine is available right now, but so is the means to achieve wellness through prevention.

Yours truly,

A Disruptive Innovator

Sometimes my thoughts seem completely redundant, but that’s because I’ve had so many decades to have them.

Often, when I express these boring ideas, people are moved by their uniqueness. Usually, those people, however, are really young or have grown up not watching, reading, or caring about anything other than what they’re exposed to daily in their personal bubble. For example, family. When you mention family, reactions can be as varied as the eyes on a fly. (A fly has two compound eyes and each eye is made up of between 3,000 and 6,000 simple eyes.)

Oh, yeah, back to family. I’m pretty sure both my Italian and northern European ancestors have contributed significantly to my love of family. Recently, however, I paid about $40 to get “My Personal DNA History Book,” and, when it got to my over 1,100 DNA close relatives, it became a very revealing history indeed. If I had enough money, I’d pay for every closed-minded person in the United States to get their own version of this book. It’s not only telling, it’s humbling and a really flyeye-opener. It breaks down the geography of every relative identified through a DNA search, and let me tell ya folks, my relatives have not allowed any dust to collect under their shoes or coat tails.

Yeah, I knew that 42.5% of my relatives came from Italy, and at least 20% came from the British Isles, but that’s when it got crazy. For example, I have living 1% DNA relatives in France and Germany, Eastern Europe, Russia, Scandinavia, Iceland, Spain, Portugal, Greece, and a few other European places like the Balkans.

But here’s where it gets really fun. They have identified more than 50 Native Americans who have 1% of our DNA. I knew I had a great-great something or other relative who was kidnapped by the Seminole Indians and taken to Florida and after 10 years he became the chief, went home and decided he liked living with the Indians better.

It also traced Asian relatives who walked into North America via what is now Russia, and some relatives from the Islands showed up, too. But here’s where the closed-minded might have a problem. I have at least 45 DNA relatives from Western Africa, 55 Ashkenazi Jewish relatives, and that makes me really happy. The reason for my happiness is it proves, once again, that we’re all the same. We all bleed the same blood, and we’re all humans. My United States relatives live in California, Texas, Pennsylvania, Ohio, Florida, Michigan, Washington, Colorado, Georgia and Illinois, but that’s only 395 people. The other 4,165 of the 1% are all over the world.

Interestingly 54% of my relatives are more likely to have sky dived, 37% have learned a foreign language, 23% probably owned a dog, and 38% are less likely to have sweaty feet. But the most impressive statistic is 40% are more likely to be able to do side splits. By the way, I’ve owned dogs, but nothing else in that list applies to me. It would be great if all of my cousins had a giant reunion because at least 1/5th of us would not want to eat the cilantro because it tastes like soap.

Bottom line? All of you “pure bloods” out there need to send in your saliva, and put your prejudice in the same bag you use to get rid of the other garbage in the house because we are all one big dysfunctional family, and it’s time we started putting the fun back in dysfunctional. If you hate any group because of race or nationality, you’re missing the boat because there’s a good chance you are part whatever it is you hate. I’m afraid you’re going to be restricted to hating people because of religion only and that seems pretty ludicrous because it’s tough to define whose God is the better God.