Beware the Broken Heart

By Mark Marchand

There is such a thing as broken heart syndrome.

This realization followed a recent New York State Writers Institute event featuring cardiac expert Sandeep Jauhar, M.D., Ph.D. I enjoy listening to and talking with scientists and doctors who have a knack for helping the masses understand science and medicine. I wasn’t disappointed by Jauhar’s talk. I came away with new appreciation for an organ so complex that it was the last holdout for organs that could be surgically repaired. For centuries, doctors found ways to operate on almost every organ in the human body—except the live heart. Stitching or cutting a tough, constantly moving and electrically stimulated muscle with a network of chambers wasn’t even attempted until the late 19^th century. In 1893 Daniel Williams of Howard University surgically repaired the heart of a man dying from a knife wound. Two months after the stabbing, the patient walked out of the hospital and lived a normal life. The march toward the last frontier of lifesaving organ surgery was on.

Dr. Jauhar, left, talks with New York State Writers Institute Assistant Director Mark Koplik

Jauhar’s new book “Heart: A History,” is filled with fascinating information about the heart—some good, and some scary—that underscores the importance of the muscular organ. Consider this: From birth to death the human heart beats about three billion times. Each heartbeat generates enough force to push blood through about 100,000 miles of vessels. And the amount of blood that passes through an average adult heart in one week could fill a swimming pool. Some bad news: Cardiovascular disease claims 18 million lives annually, earning a place as the No. 1 cause of death in America.

Jauhar became fascinated with the human heart growing up in his native India. His paternal grandfather died of a sudden heart attack at age 57, 15 years before Jauhar was born. The suddenness of the death and accompanying decades of grief became part of family lore and fueled an obsession that eventually led Jauhar to a lifetime of studying and practicing heart medicine. So many causes of death, he says, play out over time, such as cancer and Parkinsons. Not so with heart attacks, which swoop in and rob a family of a loved one in an instant. In his book, he says, “…I grew up with a fear of the heart as the executioner of men in the prime of their lives. Because of the heart, you could be healthy and still die; it seemed like such a cheat.”

Jauhar recalls lying on his bed growing up, watching the revolutions of a ceiling fan while listening to the thudding of his heart. “I’d adjust the speed of the ceiling fan to synchronize with my heartbeat, in thrall to the two competing oscillators, so grateful that mine never took a rest.”

So what about that broken heart? Jauhar loves to talk about two hearts: the biological, never-resting organ and the metaphorical heart—the center of humanness that for centuries was viewed as the core of our bodies. The metaphorical heart encompasses love, depression, a soul, character, fear, courage, and so many other aspects of our lives relating to who we are and how we live. That heart inspired poets, painters, and writers. Of course, we now know that’s not physically true, Jahaur says, but, “…we nevertheless continue to subscribe to the heart’s symbolic connotations.”

Dr. Jauhar, during his Writers Institute talk at UAlbany

Along with other heart failure specialists at Long Island Jewish Medical center, Jauhar has focused on empirical connections between the biological and metaphorical organs, especially the impact of sudden, severe stress on an otherwise healthy heart. It has a medical name: takotsubo cardiomyopathy. The word takotsubo comes from the name of a vase-shaped Japanese octopus trap. The name was chosen because sudden stress causes the left ventricle of a heart to change shape, resembling the trap. The changing form and enlargement of that heart chamber rapidly degrade heart performance. Thus, the condition results from the close intersection of the metaphorical heart with the biological one.

Jauhar says the primary mechanism for sudden cardiac arrest in someone experiencing intense emotional disturbance lies in the human autonomic nervous system, which regulates unconscious movements like heartbeat and breathing. Within that system are two divisions. The first, sympathetic, is responsible for reactions like the rising heart rate and blood pressure of “fight or flight.” The second, the parasympathetic system, has the opposite effect of slowing respiration and heartbeat. What Jauhar and others have learned over the past several decades is that intense stress causes an autonomic “storm” on the heart, emerging from the sympathetic and parasympathetic components. The result—whether it’s caused by a sudden release of adrenaline or longer-term grief—leads to cardiac events in the wake of the patient learning of a sudden death, the end of a close relationship, or another type of emotional loss or fear. In one year studied by researchers, Jauhar explains, there were 22,000 U.S. patients documented with takotsubo. These cases were traced to events ranging from widespread, destructive weather events like tornadoes and hurricanes to emotional upsets.

The link exists and heart doctors like Jauhar say they need to focus on understanding or simply recognizing patients’ emotional states, stresses, worries, and fears. “Stress management is clearly associated with a reduction in heart problems,” he told his Writers Institute audience. “It affects survival more than most realize.”

Beware the broken heart. Learn to better manage stress or your reaction to sudden fright. Your life just might depend on it.

Drawing Inspiration From a Very Old Autobiography to Tell the ‘Superbug’ Story

By Mark Marchand

Really good writers who can explain complex scientific or medical topics are rare.

Scientists and/or physicians who are really good writers are even rarer.

Ever since Columbia University physician, biologist and oncologist Siddhartha Mukherjee crafted the Pulitzer Prize-winning “The Emperor of All Maladies: A Biography of Cancer,”  I’ve been on the lookout for the next breakout scientist/physician who could help us learn more about the science of our world.

Thanks to the New York State Writers Institute and the University at Albany’s RNA Institute, I recently discovered another gem. Meet Matt McCarthy, MD. He’s a staff physician (hospitalist) at New York Presbyterian Hospital and an assistant professor of medicine at Manhattan’s Weill Cornell, a leading medical and graduate school. He recently visited the Writers Institute at the University at Albany to talk about his craft and his new book: “Superbugs: The Race to Stop an Epidemic.” It’s a scary, detailed look at the battle against new antibiotic-resistant bacteria.

Dr. Matt McCarthy during his talk at the University at Albany

Like Mukherjee, who drew on his early days at Massachusetts General Hospital and Harvard’s Stem Cell Institute, McCarthy delves into his work with patients at Presbyterian and medical college students to apply a personal touch in telling his story about the search for new treatments. I haven’t finished his new book yet, but the afternoon and evening he spent with audiences here in Albany revealed a lot about how and why a busy doctor and medical college teacher came to devote so much time to sharing his story.

I have always been fascinated about the creative process and the spark that launches a creative endeavor. Artists like Norman Rockwell and the song-writing duo of Lennon/McCartney are two that drew my recent interest.  I wasn’t disappointed with McCarthy’s story.

His decision to begin writing can be traced back to his days at Yale University and his short career as a college and minor league pitcher. Yes, he pitched in the minors and even wrote a book about it…but more on that in a bit. The lifetime musings of a famous statesman and inventor who helped found our republic kick-started McCarthy’s desire to read and then write, as he began his final year at Yale.

“The book that really changed it for me was the autobiography of Benjamin Franklin,” he explained. “Until then, I thought he was just a boring old fart. He proved to be a really provocative and interesting guy who wrote about his life in a unique way. For me, that was the first real American memoir and I’ve been fascinated with American memoirs ever since. I also started taking some survey courses (at Yale) on 19th and 20th century literature.”

After graduating from college, the left-handed McCarthy was drafted and began his minor league pitching career at the Provo, Utah, affiliate of the Anaheim (now Los Angeles) Angels. It was there, on long bus trips through Utah, Montana, Idaho and elsewhere, that his love of reading memoirs and novels grew.

“I got that list of 100 greatest novels of the 21st century and just started reading them,” he says. “There wasn’t a lot to do, so I read a lot.” McCarthy realized during his second year in the minors that he probably wouldn’t have a successful career on the baseball diamond. He decided to return to school and started along the path to become a doctor at Harvard Medical School. But he never forgot his experience in Provo or his newfound interest in reading and, now, writing—especially memoirs. In 2009, he published his first book, a successful, revealing memoir on his baseball career: “Odd Man Out: A Year on the Mound with a Minor League Misfit.”

Memoirs continue to fascinate him. “A memoir can give you something no one else has…the writer’s story. It could be some random person, but if it’s well done it’s interesting.”

As he moved through medical school, internship and residency, McCarthy remained fascinated with reading and telling “a story” through his writing. McCarthy’s approach also continued to evolve. When he started work on his newest book, he wanted to write the history of antibiotics, but decided it had already been done. Instead, he approached the topic by telling the stories of his patients at New York Presbyterian. The result is a unique look at an epidemic through the eyes of McCarthy, an infectious disease specialist, and his patients, some of whom were facing death. e also began to adapt some of what he learned in the writing world to working with patients. Today, when he finds himself talking to a difficult, upset patient, he often steps back and employs a literary approach.

“I remove myself from the situation for a few minutes and think of the patient as a sort of character in a book,” he says. “I ask myself, ‘What is the back story here? Why are they angry?’ ” The end result, he says, is a better understanding of the patient’s reason for frustration.

McCarthy also pushes writing as a creative means for medical students and physicians to cope with long hours and difficult medical situations. “As I have found, it’s a terrific way to handle the stress we face each day.”

***

I have just started to read McCarthy’s new book. I’m looking forward to learning more about how we ended up in a situation where highly effective drugs, like the battery of antibiotics developed in the 20th century, are increasingly ineffective against bacteria that have developed resistance. McCarthy takes us into the hospital and labs where he is involved in the clinical trial of a groundbreaking new drug that might have one of the answers.

Our current situation, he explains, is partially the result of over-prescription of antibiotics—especially for illness rooted in viruses, against which antibiotics are ineffective. It’s also the result of decisions by pharmaceutical companies to avoid pursuing new antibiotics in favor of other drugs that will provide steadier income streams because patients take them every day.

“But I want to make sure readers know I adopted a very hopeful approach in writing this book,” he says. “There is hope on the horizon.”

McCarthy says one source for new classes of drugs that could fight drug-resistant bacteria is in the soil around us. The ground contains thousands of microbes that many scientists believe could help us. The problem is the time and resources needed to test them.

The next time I turn over some dirt with a shovel in my backyard I might ask myself: “Is there a microbe here that could kill MRSA?”

The Creative Link Between Science Writing and Art: The ‘Story’

By Mark Marchand

Whether communicating about the complex world of science or using art to illustrate life in America, the “story” is what matters.

The connection between two vastly different worlds struck me a few weeks ago as award-winning science journalist  Ed Yong stood before a University at Albany audience. As he shared with listeners his approach to selecting topics and then writing articles about 21st century science, the slide he projected behind him spoke volumes: “Stories Matter.” In a world bursting at the seams with scientific data and research results, The Atlantic magazine writer argued, any journalist attempting to gain eyeballs as he/she explains a scientific topic needs to appeal to the basic curiosity of the masses through simple and effective story telling.

The author should endeavor, he added, to “Get people to care about things they wouldn’t otherwise care about.”

Science journalist Ed Yong discusses his craft at the University at Albany (courtesy of The RNA Institute at UAlbany)

A month earlier, I visited the Norman Rockwell Museum in Stockbridge, Mass. During a day spent gazing at the famed illustrator’s 323 Saturday Evening Post cover paintings and other original works of art that help tell the story of 20th century American life, I listened to Rockwell himself explain his approach to painting. In a video recorded shortly before his death in 1978, he said: “I love to tell stories in pictures. The story is the first thing and the last thing.” I blogged about it.

As a lifelong student of the creative process—from music to writing to art—I had within the span of four weeks had some of my long-held beliefs about that process upheld by two immensely different but talented individuals. Embed a simple story into whatever you’re crafting and, whatever your message is,  people will be drawn to it.

Yong’s Book: We. Are. Microbes

Well, maybe about half of us, according to Yong, who appeared at UAlbany Feb. 19 as part of the New York State Writers Institute spring 2019 series. It’s a well-known fact that the human body is made up of millions of living cells, composing structures ranging from our brains to our bones. But that’s only half the story.

In his book “I Contain Multitudes – The Microbes Within Us and a Grander View of Life,” Yong tells us the rest of the story. Beyond those living, pulsing cells lives a collection of trillions of tiny microbes that make up the rest of our bodies. These tiny bacteria, viruses and other organisms chugged along for millennia, out of sight and without recognition for the role they play in our lives. They finally achieved some recognition, Yong told his Albany audience, when Dutch microscope maker Anton Van Leeuwenhoek discovered their presence in the 1600s. A few centuries later, scientists including Louis Pasteur discovered their role in causing illnesses. This 19th-century development of the “germ theory,” however, gave microbes a bad name because they were associated with making us sick.

Yong discusses his book at UAlbany

Later, 20th century scientists delved deeper into the microbial world and found that microbes are constantly everywhere in our bodies, and they in fact perform useful functions that help us thrive. Over 400 species of microbes live in the human gut, for example, and aid processes like digestion. They work in sync with our cells, and we should be thankful for them.

Yong’s regular stream of articles contain similar revelations. Readers of his recently learned: Why do zebras have stripes? (follow the flies…), giraffes are close to extinction, sharks can live to 400, we’re the only animals with chins, and one of my personal favorites..how wasps use viruses to genetically engineer caterpillars.

Yong stressed that the scientific and science writing community should hold each other accountable. On the day he appeared in Albany, for example, he published a piece to help clarify a wave of science headlines and social media posts predicting impending doom for the insect population across the world. He argued that while there was some validity to the claims, “it was complicated” and they were based on very limited research.

“And if insects do die out within a century that will mean the planet has become inhospitable to all life,” he concluded.

Focusing on the “how” and Leonardo

Despite Yong’s explanations of his science writing approach at UAlbany’s D’Ambra Auditorium, students, staffers, faculty and others continued to press him to further describe his process. Finally, he answered with:

“I’m almost always led by curiosity—if something makes me go ‘huh,’ I can also convey that sense to a reader.”

Yong’s process is not that far from one aspect of the Leonardo da Vinci described in Walter Issaacson’s biography of the 15-century polymath responsible for paintings like the Mona Lisa and the early scientific foundations behind manned flight. As he drew near the end of the story of da Vinci’s life, Isaacson wrote a section called, “Learning from Leonardo.” The first heading in this segment is titled: “Be curious, relentlessly curious.”

Isaacson wrote further, “…his distinguishing and most inspiring trait was his intense curiosity. He wanted to know what causes people to yawn, how they walk over ice in Flanders (northern Belgium), methods for squaring a circle, what makes the aortic valve close, how light is processed in the eye, and what that means for the perspective in a painting.”

That’s not a bad trait to emulate, and it’s writers like Yong and artists like Rockwell who help us stay curious about the world around us.

Blog author (left) with Yong after his talk at UAlbany

Climate Change: Avoiding the ‘Natural Variations’ Pitfall

Waterfront Property: Buy Low, Sell High?

 

By Mark Marchand

 

“Everybody complains about the weather, but nobody does anything about it.”

For over a century, this comment has served as the standard retort when a friend or colleague laments hot and humid weather or complains about a massive snow storm. But when University at Albany Interim President James R. Stellar uses it to talk about work at UAlbany’s  Department of Atmospheric and Environmental Studies (DAES), he’s not grumbling. He uses it as a setup line before he talks about what he, his colleagues, and many others in academia are actually doing about the weather as the world wrestles with persistent climate change caused by humans.

Christopher Thorncroft, a UAlbany professor and DAES chair, is an ardent advocate for steering away from the political and news media musings that often cast climate change as some sort of “50-50” proposition that casually, and inaccurately, describes consensus on the topic. The actual worldwide consensus among scientists and experts, he says,  is 97 percent believe and understand that climate change is real, it’s caused by us, and we need to do something now.

The challenge, he said at a recent UAlbany conference, lies in understanding why human actions are causing the relentless warming of our planet. Next is helping the public understand what is happening — hopefully leading to greater adoption of efforts to, for example, reduce the emission of greenhouse gasses by burning fewer oil-based fuels.

What often gets in the way, Thorncroft says, are short-term variations of colder weather that embolden climate-change naysayers. The key, he says, is generating awareness and understanding of those variations, how they have been occurring for centuries, and how they will continue despite the persistent, longer-term trend of warmer temperatures.

The Nov. 10 presentations by Thorncroft and two of his UAlbany colleagues — Assistant Professor Andrea Lang and Associate Professor Paul Roundy — focused on three areas that help us understand natural events that are often misinterpreted as reversing global warming.

Natural Variations (or, one cold, snowy winter doesn’t mean climate change isn’t real)

Natural occurrences of cold weather that cause some to doubt the overall trend of warming temperatures hit home for me the day my wife and I stood on the deck of a cruise ship watching Marjerie Glacier calve into the chilly waters of Alaska’s pristine Glacier Bay. A National Park expert speaking over the ship’s PA system described how this particular glacier had been damaged by lower snowfalls and warmer temps. Instead of one long sheet of slowly moving ice, he said, it was now a series of connected, smaller glaciers. Many other glaciers, he also said, were much smaller and struggling to remain frozen. Yet a cranky,  elderly gentleman standing next to me missed the point. If Al Gore were here, he said as he gaped at the massive ice wall, he’d take a shard of ice and insert it somewhere in Al Gore’s backside, proving that once and for all the global warming brought on by climate change was not an inconvenient truth. That man is not alone in a world full of climate-change deniers.

Thorncroft builds his conclusions on evidence-based practices. The year 2015 finished with the warmest temperatures ever recorded. In fact, he told the large crowd, the top 10 warmest years since the 1880s have been the last 10 years — with the exception of 1998.

1998 and some other exceptions to the warming trend underscore the natural variability in the results we see. But they don’t deter from the alarming, overall trend of spiking temps caused by rising levels of the greenhouse gas carbon dioxide — which has occurred in synch with the rising temps.

The chart below, from our friends at NASA, helps illustrate the point. The dark line from left to right tracks deviations from average global temps over five-year periods. The “empty” circles above and below the line are shorter, annual mean temp recordings. Thus, you can see the variations Thorncroft mentioned and the general, overall spike upward.

Thorncroft and other scientists are always asked what causes these variations. Among the answers, he says, are naturally occurring phenomena like massive volcanic eruptions. Take Mount Pinatubo in the Philippines. When its cataclysmic eruption happened in 1991, tons of material were spewed into the atmosphere. Some of the ash reached as high as 22 miles and was carried over a wide area by high-level winds. The subsequent blocking of solar radiation, he explains, temporarily cooled areas of the planet, leading to short-term halts or even reductions in climbing global temps.

Here’s basically the same chart as before, but Thorncroft has added when the natural variations occurred, and why (More on El Nino in a bit.).

 

In  addition to natural variations and overall warming temps, what worries Thorncroft is the increasing intensity of routine weather events such as rainstorms. Since 1958, he says, scientists have recorded a 74 percent increase in “intense rainfall” activity. Many of the storms we’re witnessing now are more extreme because of higher temps. He likens the situation to baseball players who use steroids. The storm systems are stronger and last longer because they are fueled by artificial human actions.

“We have to understand that this is what’s happening — and we have to be prepared to deal with these extreme weather events,” he said near the end of his talk.

If the overall trend persists, Thorncroft concludes, the temperatures and overall climate in New York will become more like Georgia, and potentially even warmer.

El Nino (or, it’s been around since the dinosaurs)

Put simply, Professor Roundy says, El Nino is the periodic warming of equatorial and Pacific Ocean waters, which — when combined with the Earth’s rotation — disrupts the normal flow of the atmosphere. The result is the transfer of heat from ocean waters into the atmosphere, blowing more warm Pacific air into the western United States and beyond, leading to warmer temps.

The winter of 2015-16, he suggests, was  milder (featuring 70 degrees here last Christmas Eve) due to El Nino, reversing the trend we experienced during the long, cold, snowy winter of 2014-15. He and other scientists are already seeing evidence of colder Pacific water emerging, so they expect this coming winter here will be colder, but nowhere near as bad as two winters ago.

This pattern — or oscillation — of warming and cooling ocean waters (known as La Nina), Roundy says, has been around since dinosaurs roamed the globe. Yet every time we experience a harsh, cold winter, many people think global warming has stopped. No, he explains, it’s just the normal ebb and flow of ocean temps that naturally disrupt normal weather patterns.

The Polar Vortex (It’s not new; even Al Roker says so)

As the harsh winter of 2014-15 battered the Northeast, many of us began hearing about a new weather phenomenon called the polar vortex. It was, we thought, something novel that directly caused our terrible winter. We were half right.

According to Professor Lang, the term polar vortex term has been used by meteorologists for over a half century. Her conference presentation even included a 2014 tweet from NBC weatherman Al Roker, explaining that the National Weather Service has used the phrase as far back as 1959. He was responding to accusations that the news media had created the term to add pizzazz to explanations about and reporting on the winter of 2014-15.

What we really need to be concerned about, she says, is how changes in the vortex can alter our normal weather patterns. The polar vortex is a naturally occurring, large-scale circulation of air above and around the North Pole and surrounding region. It generally forms during the winter as the axis of the Earth tilts the northern hemisphere (us) away from the sun. This tilt causes generally cooler temps (otherwise known as winter) because solar radiation passes through much more of the atmosphere before it reaches the ground. Changes in the strength of the vortex can affect our climate.

Generally speaking, when polar vortex winds are strong, they help keep the colder air over the pole. Weaker polar vortex winds (or a “wavier” pattern) allow “dips” in the circulatory pattern, resulting in the spread of colder air south of the north pole. This is, she explains, what happened two winters ago when a weaker polar vortex allowed more colder air than normal to escape south. In 2015 to 2016, she adds, the warmer weather was aided by a stronger vortex that helped keep colder air up north.

One chart from Lang’s presentation shows us how a “wavier” polar vortex pattern (on the right) allows that chillier arctic air to temporarily move south.

 

By tracking changes in the strength of polar vortex winds, she adds, scientists and meteorologists can make better projections about winter weather up to 90 days in the future. What bears further study  are the reasons for the year-to-year variations in strong vs. weak polar vortex winds.

The point, she and her colleagues emphasize, is that El Nino/La Nina, polar vortex changes, and natural events like volcanic explosions have existed for a long time. They will always cause variations in weather — despite and during the overall, relentless elevation of temps by human-caused increases in atmospheric carbon dioxide.

Where do we go from here?

The evidence supporting climate change is stark. According to NASA, sea levels (from melting polar ice sheets and glaciers) are close to seven inches higher today than they were last century. Global temps are higher. The level of greenhouse gas carbon dioxide in the atmosphere has crossed the critical 400 parts per million threshold for the first time ever. Oceans are warmer. The overall snow cover across the planet has decreased. There are many other factors that support the conclusions of over 97 percent of scientists.

And the answers seem simple, but they are of course politically and economically unpopular: Burn fewer fuels based on hydrocarbons, expand the use of alternate energy sources such as wind and solar, and simply use less energy. All help reduce the emission of more carbon dioxide into the atmosphere. Another solution involves fighting mass-scale deforestation. As  we know from high school science, the process of photosynthesis has plants giving off oxygen as they soak up carbon dioxide. Fewer trees in our forests means a smaller “carbon sink” that can help remove some carbon dioxide from the atmosphere.

These are physical solutions that require some sacrifice. As a lifelong student of communication, I think another key factor is awareness and understanding. Great conferences (like the Nov. 10 event I attended at UAlbany, jointly sponsored by UAlbany and the Nelson A. Rockefeller Institute of Government) are important means by which more of our population can gain greater understanding of what is happening. The result, hopefully, is dragging the climate change discussion further away from the political arena and more into a world where acceptance of environmental issues becomes as common and important as taking care of one’s health.

Otherwise, as my attempt at humor in my blog headline suggests, owners of waterfront property who bought their homes during times of normal sea levels may face selling them — for a lot less — as sea levels rise.

 

 

(Editor’s note: there was more in the Nov. 10 conference from the National Weather Service – NOAA – itself. More on that in a future post)