Cardiac Surgery Repairs Rescue Swimmer’s Mitral Valve

May 4, 2009
Robotic surgery gets patient back to his active lifestyle

San Diego – As a military rescue swimmer, 36-year-old Ronny German was in the best shape of his life and had no previous health problems. However, shortly after a routine dental cleaning, Ronny began to experience significant swelling in his joints, which his doctors initially diagnosed as rheumatoid arthritis — a condition that runs in his family. As his symptoms worsened, further examinations and testing revealed a heavily leaking mitral valve in Ronny’s heart.

Ronny was told that he would need an operation to repair his mitral valve and chose to have the procedure using minimally invasive robotic surgery. During the robot-assisted surgery, his surgeon discovered that Ronny’s mitral valve was extensively infected.

After surgery Ronny was informed that the infection was the cause of his leaking mitral valve, and it was likely the result of the dental cleaning he received before the onset of his symptoms.

“I was shocked to learn that a routine dental cleaning could have such a serious complication,” said German. “When I was diagnosed with a heart murmur, I was never told that I should be taking antibiotics when I was having even simple dental work done.”

A recent study from the University at Buffalo in New York linked bacteria commonly found in the mouth to an increased risk of coronary heart disease and other cardiac complications.

After a successful robot-assisted mitral valve repair, Ronny recuperated at home, and within two weeks was back at his job with the U.S. Coast Guard. He received medical clearance three months after returning to work and quickly passed his rigorous monthly fitness test. Since his surgery Ronny has taken up paddle surfing and currently participates in five- to nine-mile races, with hopes to complete the Catalina Crossing in the future.

Minimally-invasive surgery offers quicker recovery
“A leaking mitral valve is more common in older adults, but we do see patients with the condition as a result of infection,” said James Hemp, M.D., cardiothoracic surgeon with the Scripps Minimally Invasive Robotic Surgery Program. “Open cardiac surgery requires a significant amount of recovery time, but we were fortunate to be able to offer Ronny an option that would allow him to continue his very active career and lifestyle.”

Minimally invasive robot-assisted surgery provides access to the heart through five small incisions, eliminating the need for surgeons to split the breastbone and spread open the ribcage in order to gain access to the heart. During robot-assisted surgery, tiny instruments and a three-dimensional camera are inserted through the incisions, and the surgeon controls the instruments from a console that provides a magnified view of the surgical field.

This system enhances surgical capabilities by offering even greater precision during surgery. A patient typically stays in the hospital for three to five days after minimally invasive cardiac surgery, compared to five days or more after traditional heart surgery. While the average recovery time after open-heart surgery is six to eight weeks, recovery time with robot-assisted cardiac surgery is between two and four weeks.

About Scripps Health
Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $2 billion nonprofit community health system based in San Diego, Calif. Scripps treats a half-million patients annually through the dedication of 2,600 affiliated physicians and 12,300 employees among its five acute-care hospital campuses, home health care services, and an ambulatory care network of clinics, physician offices and outpatient centers.

Recognized as a leader in the prevention, diagnosis and treatment of disease, Scripps is also at the forefront of clinical research and graduate medical education.

Contact: Kristin Reinhardt
Phone: 619-686-3787

Scripps Mercy Hospital, Scripps Clinic, Minimally Invasive Robotic Surgery, Minimally Invasive Robotic Surgery


Riding Ave of The Oaks Century after Heart Attack

This Saturday is the Ave of the Oaks metric century ride. I choose this one because while riding 63 miles is not that hard for me at this point, doing it and 6000′ plus of climbing is. I’d say that’s a pretty decent climb for someone without a heart attack so it would be a good goal for me. I try just to be happy that I can ride at all but it’s hard not to compare myself with someone who has no heart problems and I love riding up hills, always have, even though I’m not good at it I’m just persistent that way. Below is the elevation chart.

Ave of the Oaks Century elevation chart.

Ave of the Oaks Century elevation chart.

I’ll be riding it with my PT from my old cardiac rehab program and one of my cardiologist. Which makes my wife extremely happy, even though she wishes I didn’t do it at all. I think I’m ready. While I haven’t ridden that distance in a while I have been riding lots of hills and doing 3,000′ climbs in 28-30 miles rides and some hill repeats so I feel ready and the best riding shape since my heart attack.

I’ll do my best to keep track of my ride and bring you a crank by crank report.


Please Tell Your Cardiac Story.

I’d (and I assume many others) would love to hear how you have dealt with, conquered or beaten heart disease. Do you still ride a bike, surf, mountain bike, bmx, skateboard, ski or snowboard since your heart attack or heart disease started? Any little story you have can go a long way in providing motivation for others who struggle with wanting to ride.

After you write your story here I’ll make a special page for it so other can communicate about it.



heartATTACKrider is now on twitter

But they limit the number of characters in your name so my twitter is heartattackride NOT heartattackrider…..oh well close enough and still kinda makes sense. Why twitter? I come across little things that I want to post and instead of having a zillion little bits and pieces here a thought it would be easier just to do it there and I can hopefully reach more people that way.

Controlling My Heart Rate While Riding.

“Mindfulness is built around the premise of disengaging from overly emotional responses and extraneous thoughts that clutter the mind’s ability to think clearly. By using techniques such as breathing, visual imagery and meditation to slow down and focus on the present, the theory goes, a person can tap into a higher level of awareness. The more acute awareness is the byproduct of more active brain waves brought on by meditation, studies have shown.”

Can I really control my heart rate? On Friday I didn’t have much time to ride (preparing for the Avenue of The Oaks) so I decided to do some hill repeats in preparation for April 4th. After warming up for about 1/2 hour I started riding a hill I like that is 0.6 miles/205′. S0 for me that was 5min 30sec – 6min 30sec with a coast back down of 2min 30sec ‘ish. My goal was to do 10, I made it to 8 before I limped home. My heart rate would range in the 145-150bpm range at it’s peak and by the time I recovered back down the hill and turned around to go at it again I’d be around 107-110bpm. After my 5th uphill battle I was approaching 155bpm a little too easy for my liking  my doc doesn’t like me to go more than 155 bpm for very long)  so I concentrated very hard and focused on my breathing pattern, almost a meditative trance if you will. I made deliberately strong exhales and inhales while imagining (invisioning) in a very real time way that my heart was very relaxed and barely working to pump. I also imagined every artery in my body was widening open as I had to make through the steepest section. When I glanced at my heart rate on my Garmin after 20-30 seconds my heart rate was 4-7 beats lower every time I did this. Now this isn’t scientific but I did make sure my cadence was same on each of the last 3 hill climbs as a reference. I was now able to maintain 147-148bpm. Whenever I stopped this “technique” I would instantly raise my bpm.

I learned this technique of controlled breathing soon after my heart attack. I got terrible panic attacks and would “freak out” that I was going to have another one. I started listening to Jon Kabat Zinn’s cd made with Dr. Andrew Weil,  Meditation for Optimum Health. Also through Pranayama yoga classes where breath awareness is a major component of your practice.

I really started to utilize Mindfulness Meditation when I first started riding again after my heart attacks. I was terrified to go too far, to hard, too fast etc…so I decided to use what I had been listening to at home and what I was earning in yoga while pedaling. It seems like such and obvious think now but I still forget about it. But, when I see a hill coming up or my heart starts to get a little out of range for my liking I try these techniques and they work for me.

My 3rd Cardiac Rehab Program

Below is a chart (click on it to view it larger)showing my routine during phase 3 & maintinence of my cardiac rehab at Scripps Integrative Medicine.

After 30 minutes of either stationary cycling or running on the treadmill or track I would perform the following pictured workout. While cycling or running I was allowed to maintain a heart rate of 140-145 maximum. On the stationary bike I would usually do a 3 minute warmup, 3x 8 minute intervals then a 3 minute cool down before starting the rest of the work out. The intervals might be 120-125bpm then 125-135 bpm and finish with 135-145bpm.  I would up my heart rate by either a low cadence hard gear or just by me regulating high cadence efforts and the occasional standing up to peddle. The runs were on their outdoor track (still monitored). It was a mix of walking fast, no lower than 125bpm and a slow jog which I would be able to hold 145-150bpm without a problem. My treadmill work was also done as intervals. Again, a 3 minute warm up then 3x 8 minute jog and 3 minute cool down.

I also will be posting notes and comments on 2 other programs I participated in over the next few months.

If you have any questions please feel free to post them here. I’d be glad to pass on my experiences.


This was my personal program reviewed by my doctor, nurses and exercise physiologist based on my health. DO NOT COPY this program with out first consulting your doctor(s).

My best riding since my heart attack…

YTD Riding Total- 576.93 miles / 38,524′

  • Road – Geared: 440.55mi / 34,363′ 
  • Road – Fixie: 136.38mi / 4,161′ )    
  • Dirt: 0

Not that any workout I do is worthy of publishing, bragging about or keeping track of but, I think it might be of help to some. Plus, it helps motivate me. Those of you who have had heart surgery and want to know what someone else is doing who has had 7 stents and 2 heart attack (5 years ago+ as of this posting) is doing. 

So. I’ll post what workout. I do, riding or otherwise, with pertinent info; heart rates, blood oxygen etc…

February has me out more so far but it has been tough with our new baby to get more than 2 hours in.

Goals for the year:

1. Feb 14, Palm Springs Century, full length – bailed out due to rain interrupting training and new baby duties.

2. April 4, Avenue of the Oaks Century (metric)

3. Sept 12, Amtrak Century, full length

4. Ride a BMX race again…..TBD

5. Ride 100 miles on my fixed gear….TBD

6. Do 10,000′ climbing in 1 day….

7. End the year with 150,000′ feet.

Riding Log- As of 04.1.09

04.01.09:  Road Ride-Fixed

  • 1:35 min  
  • 19.52 miles 
  • 875′ climbing 
  • 129 ave BPM / 156 max BPM (ave)

03.30.09:  Road Ride-Fixed+ Rehab work out

Warm up/(5)x 2.15sec effort at 8 out of 10, 145bpm-155bpm  & 4min recovery inbetween/ recovery home/cardiac rehab leg and weight program

  • 51.20 min  
  • 10.59 miles 
  • 260′ climbing 
  • 120 ave BPM / 154 max BPM (ave)

03.29.09:  Road Ride-

Felt amazing. My best ride since my heart attack. Climbed ober 2000′ in first 18 miles. My highest ave heart rate to date.

  • 2:38 
  • 32.63 miles 
  • 3047′ climbing 
  • 141 ave BPM / 160 max BPM (ave)
  • Blood oxygen levels: Before ride 78/98%. After ride 109/98%
  • BP after stretch and cool down-111/74/86bpm

03.26.09:  Road Ride-

  • 2:22 
  • 39.50miles 
  • 3049′ climbing 
  • 139 ave BPM / 157 max BPM (ave)
  • BP after stretch and cool down-119/79/90bpm

03.23.09:  Road Ride-Fixed+ Rehab work out

Warm up/(5)x 2.30sec effort at 8 out of 10, 145bpm-155bpm  & 4min recovery inbetween/ recovery home/cardiac rehab leg and weight program

  • 55.42 min  
  • 11.57 miles 
  • 358′ climbing 
  • 126 ave BPM / 148 max BPM (ave)

03.21.09:  Road Ride-

  • 2:43 
  • 35.02 miles 
  • 2513′ climbing 
  • 134 ave BPM / 158 max BPM (ave)

03.20.09:  Road Ride

Hill repeats- 30 min warm up/(8) x 6.30min x0.7mi hill with 2.30-45min recover in between and recovery home.

  • 1:39 min  
  • 15.66 miles 
  • 2,1111′ climbing 
  • 126 ave BPM / 159 max BPM (ave)
  • BP after stretching/cool down 110/77/86bpm


03.17.09:  Road Ride

  • 55.42 min  
  • 11.57 miles 
  • 890′ climbing 
  • 126 ave BPM / 148 max BPM (ave)

03.15.09:  Road Ride

  • 3:53 min  
  • 43.76 miles 
  • 2,212′ climbing 
  • 121 ave BPM / 158 max BPM (ave)

03.11.09:  Road Ride

  • 1:07 min  
  • 14.74 miles 
  • 1,113′ climbing 
  • 131 ave BPM / 147 max BPM (ave)

02.24.09 – 03.10.09

03.04.09:  Road Ride-fixie + Scripps weight program

  • 40.01 min  (5) x .75mi efforts at 145-155bpm with 4 1/2 – 5 min recover spin in between.
  • 9.29miles 
  • 278′ climbing 
  • 130 ave BPM / 155 max BPM (ave)

03.06.09:  Road Ride 

  • 1 hr 49 min. 
  • 23.24 miles 
  • 2125′ climbing 
  • 129 ave BPM / 151 max BPM

03.04.09:  Road Ride-fixie + Scripps weight program

  • 30.37 min 
  • 7.16 miles 
  • 214′ climbing 
  • 138 ave BPM / 155 max BPM

03.01.09:  Road Ride 

  • 2 hr 06 min. 
  • 24.88 miles 
  • 2,233′ climbing 
  • 138 ave BPM / 155 max BPM

02.25.09:  Road Ride 

  • 1 hr 16 min. 
  • 17.41 miles 
  • 867′ climbing 

02.6.09 – 02.23.09

02.23.09:  Road Ride -Fixie 

  • 56.53 min. 
  • 12.74 miles 
  • 400′ climbing 
  • 130 ave BPM / 148 max BPM
  • bp before ride 129/70 71bpm – bp after cool down 114/76 81bpm

02.21.09:  Road Ride 

  • 2:11 min. 
  • 27.47 miles 
  • 2251′ climbing 
  • 137 ave BPM / 150 max BPM

02.19.09:  Road Ride 

  • I felt good but my hr seemed to be 12-15 higher than normal so I cut my ride short.
  • 35.10 min. 
  • 6.90 miles 
  • 597′ climbing
  • 145 ave BPM / 169 max BPM

02.14.09:  Road Ride 

  • 2:09 min. 

  • 25.32 miles 

  • 2325′ climbing 

  • 137 ave BPM / 152 max BPM
  • bp before ride 127/76 75bpm 

02.11.09:  Road Ride 

I had just stared some hill repeats when I flatted and ran out of air and no pump, so I came home and did my Scripps Rehab workout.

  • 24.09 min. 

  • 5.57 miles 

  • 1397′ climbing 

  • 134 ave BPM / 153 max BPM

02.08.09:  Road Ride 

  • 1:13 min. 

  • 14.59 miles 

  • 1274′ climbing

  • 135 ave BPM / 152 max BPM

01.28.09 – 02.05.09

02.05.09:  Road Ride -Fixie (quick one before the rain)

  • 43.44 min. 

  • 9.93 miles 

  • 371′ climbing 

  • 131 ave BPM / 151 max BPM

02.03.09:  Road Ride -Fixie

  • I tired hard to make it 50 miles but my butt got sore and the winds tired out my legs.

  • 2:43 min. 

  • 36.33 miles 

  • 507′ climbing 

  • 125 ave BPM / 150 max BPM

01.28.09:  Road Ride 

  • 1:34 min. 

  • 18.77 miles 

  • 1431′ climbing / 1502′ decend


    142 ave BPM / 160 max BPM


01.05.09 – 01.25.09

01.25.09:  Road Ride – Fixie 

  • 1:39 min. 

  • 20.32 miles 

  • 957′ climbing / 962′ decend

  • 130 ave BPM / 141 max BPM

01.22.09:  Road Ride 

  • 1:41:00 min. 

  • 23.07 miles 

  • 1473′ climbing / 1362′ decend

  • 131 ave BPM / 151 max BPM

  • After cool down 115 BPM at 97% oxygen.

01.17.09:  Road Ride 

  • 1:35:00 min. 

  • 21.62 miles 

  • 1150′ climbing / 1267′ decend

  • 137 ave BPM / 154 max BPM

01.13.09:  Road Ride 

  • 1:14:00 min. 

  • 17.39 miles 

  • 824′ climbing / 898′ decend

  • 142 ave BPM / 161 max BPM

01.12.09:  Random at home workout 

12×16 stairs / Medicine Ball 200 ( did most of it) / 3×8 8# chest flys / 3×8 8# standing flys / 1×12 stationary lunge per leg
no hr monitor on

01.08.09:  Road Ride 

  • 49.37 min.

  • 10.49 miles  

  • 854′ climbing

  • 138 ave BPM / 161 max BPM 

01.06.09:  Walking / Hill Repeats

  • 50 min. 

  • 5 hills with park bench work out in between-3x 10 steps ups / 3x 10 push ups / 3x 10 tricep dips

  • 50 crunches on a stability ball.

01.01.09 – 01.04.09

01.03.09:  Road Ride 

  •  8.41 miles 

  •  34.47 min. 

  • 630′ climbing

  • 139 ave BPM / 161 max BPM 

  • (2x) 45sec with 60sec rest between -full body plank,  back plank ( I forget what it is called but pretend your Superman), (2x) 15  slow girlie pushups , 10 minutes of strecthing.