Former diving champion brushed off symptoms that turned out to be heart valve disease

By AMERICAN HEART ASSOCIATION NEWS

Len Rapkins (left), with his son Marc Faux, attributed his fatigue and shortness of breath to getting older. The symptoms were actually caused by heart valve disease. (Photo courtesy of Len Rapkins)

Len Rapkins can barely remember a time when he wasn’t fit.

As a teen growing up in Great Britain, he trained as a boxer, gymnast and diver, and earned a silver medal in the 1961 World Student Games, the world’s second-largest multi-sport event after the Olympic Games.

He went on to serve as a military pilot before flying for British Airways, eventually settling down to run a golf course in Scotland, walking 36 holes most days.

In 2001, at age 60, Rapkins moved to the United States, where work as a golf pro meant riding in a golf cart rather than walking. And unlike his home in Scotland, errands were done by car rather than walking.

“It was a whole different lifestyle, and after a few years, I noticed I was getting tired quicker and huffing and panting,” said Rapkins, who now lives in Monroe, North Carolina. “I thought it was because I was getting older and driving so much more.”

Len Rapkins (far right) won a silver medal in diving for Great Britain at the 1961 World Student Games. (Photo courtesy of Len Rapkins)

In February of 2017, he finally complained to his doctor about his declining stamina and testing revealed his breathlessness and fatigue were caused by heart valve disease.

About 2.5 percent of Americans have heart valve disease, which occurs when one or more of the heart valves have been damaged, disrupting blood flow by not opening or closing properly. The condition becomes more prevalent with age, affecting one in 10 people age 75 and older.

Because symptoms such as feeling short of breath and fatigue are vague and can come on slowly, they often aren’t noticed, said cardiologist Dr. Vuyisile T. Nkomo, director of the Valvular Heart Disease Clinic at Mayo Clinic in Rochester, Minnesota. Some people, even those with severe valve disease, may have no symptoms, leaving many cases undetected, he said.

“If you find yourself unable to keep up with your peers, then something may be wrong,” Nkomo said. “It’s not just a normal part of aging.”

Although Rapkins had been told two decades earlier that he had a heart murmur – a sign of heart valve disease – the diagnosis came as a surprise.

“My doctor told me it wasn’t anything I should worry about back then,” he said. “I wished I had known it was something I needed to pay attention to.”

Rapkins was diagnosed with severe aortic stenosis, a narrowing of the aortic valve opening that restricts blood flow, and one of the most common and most serious valve disease problems.

By August, his symptoms had worsened. He struggled to drag his trash can to the end of the street.

“I felt bloody awful,” he said. “It was like I was in a deep hole.”

Rapkins shared his symptoms with his daughter, Tina Allenby, a longtime nurse and midwife who lives in England, and she urged him to contact his cardiologist.

More testing revealed Rapkins’ condition had deteriorated and he’d need a new valve and also a stent to reopen a previously blocked heart artery.

Rapkins learned all he could about his condition and the treatment options, including a less invasive procedure called transcatheter aortic valve replacement, or TAVR, in which a replacement valve is positioned into the aortic valve’s place through a catheter in the groin, similar to how stents are placed. The American Heart Association offers an online treatment explorer tool to help patients understand the treatment options for their specific type of heart valve disease.

Initially, Rapkins wasn’t eligible for TAVR and would need open-heart surgery. That terrified him.

“I wasn’t sleeping and had terrible nightmares,” he said. “The more I learned about open-heart surgery, the more horrified I became of complications and the pain of recovery.”

After consulting with another doctor, Rapkins eventually gained approval for TAVR, undergoing the procedure last December.

“When I woke up, it was like someone flicking a switch,” Rapkins said. “I felt energy through my whole body and couldn’t wait to get up and do stuff.”

A few days later, he was already walking his dogs. Allenby said the change in her father was “startling.”

“Within two weeks, he was back to his old self, with much more energy and vigor,” she said.

Rapkins, now 76, walks 3 miles a day and swims every other day.

“I should have listened to my body more and talked to my doctor, rather than sitting back and assuming is was just a natural progression of getting old,” he said. “It really is a stealthy illness that creeps up on you.”

If you have questions or comments about this story, please email editor@heart.org.

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VIDEO – Quick Hits: 2018 Rangefinders

As we touched on in our 2018 Rangefinder Buyer's Guide, in just one year, technology has taken a massive leap forward. In previous years, features like Bushnell's Jolt technology and the slope adjustment were considered differentiators. This year, however, manufacturers stepped up their game with things like onboard GPS, mobile app integration, and vibration reduction technology that finally makes the rangefinder a viable choice for those with less than steady hands.

In today's Quick Hits, our Harry Nodwell gives you an overview of some of the more compelling new rangefinder models and the unique technologies that differentiate them from the field.

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The 5 Signs of a Struggling Startup, and How to Reverse the Trend

Entrepreneurs are actually proven to be happier and healthier than employees who work for someone else. It is uniquely rewarding to own and grow a business.

That said, there are plenty of obstacles in the way. This is why failures are so common. As a business owner, it’s important to monitor the health of your growing company to spot warning signs—a fractured team, negative customer reviews, poor customer retention, and a lack of creative innovation.

In this article, I’ll explore these how to spot and reverse these problems.

1. A fractured team

Hiring is a minefield for startups, but with the right approach, you can recruit top talent. No matter how carefully you consider recruitment, the team can become fractured under pressure. If the culture doesn’t feel right and your team isn’t synchronized, this may highlight a dysfunctional workforce.

Some of the indicators of a dysfunctional team include:

Communication breakdowns

Communication channels themselves can foster a toxic culture. With the wealth of tools at your disposal, bad practice will fester if you don’t set guidelines for how and why to communicate. The team must buy into company messaging systems (e.g. Slack), and know the policies for communicating on email and project management systems.

Low morale, lack of understanding, or even bullying might happen within a fractured team. You must be fully aware of the landscape by talking to team members regularly, on a one-to-one basis, and providing a safe space for honest conversations.

Lack of trust

If your team doesn’t trust you as a leader or they don’t trust each other, don’t share workloads, or if they dread spending time together, this is a problem. In this case, you need to cultivate a better team culture. Scott Gerber’s useful article about building team culture features 13 tips by business leaders, from hosting out of office meals to improving transparency.

High turnover rates

Losing talent is one of the clearest indications of a dysfunctional team. If multiple employees are leaving, this needs to be addressed. Their reasons for departure may be unrelated, but they might also be related to dissatisfaction with pay, stress levels, lack of direction, poisonous culture, or something else entirely. Collect candid feedback from outbound staff to get a handle on their true reasons for departure so you can recognize and address trends.

In an article on the Forbes magazine, leadership expert David Kruse points to organizational psychologist Liane Davey’s advice on how to counter dysfunctional team dynamics. Davey says it’s important to take steps to recognize and appreciate your team on a regular basis. But she also says healthy, respectful disagreements that consider multiple viewpoints can actually build a culture of collaboration and openness.

2. Negative customer reviews

Sometimes your business, product, or service is going to receive bad reviews. They don’t mean all is lost and you should close your doors immediately, but you should pay attention and respond to negative feedback. As Emily Washcovick of Yelp points out, 53 percent of customers expect a reply when they write an online review.

Analyzing your bad reviews will help identify patterns and see where you fall below expectations. A study in 2016 by Capterra revealed that 52 percent of customers are actually more likely to trust of a product or brand if it has a few negative reviews. However, it’s not a good sign if the majority are bad reviews—this indicates a fundamental problem that needs to be addressed immediately or it will affect your sales.

So, what should you do if you notice that your reviews are increasingly negative? First, you should respond to all reviews, positive and negative. This highlights great customer service and protects your brand’s reputation.

Simultaneously, identify the reason(s) why you’re getting the bad reviews. Are your customers complaining about the same issue? Does this signify a bug in the software? Are the complaints isolated incidents, or do they reflect a pattern? Aim to take the detailed conversation off the public forums and always provide satisfactory compensation when appropriate.

Too many startups ignore them and suffer the consequences. Whether or not all the negative feedback is valid (and fair), your customers’ feelings of disappointment are real. This might mean that you’re framing your value proposition wrong, setting unrealistic expectations, or not delivering on promises. Don’t take the bad reviews at face value. Look deeper into whether they reflect a broader problem with your product, your positioning, and your customer service.

3. Depleted cash reserves

Cash flow is critical. According to studies, 90 percent of failed small businesses closed their doors due to poor cash flow management.

To build a fiscally strong business, you’ll need robust invoicing processes so you can avoid situations where you’re not getting paid on time or at all. Depleted cash reserves are a signal of difficult times, but are often avoidable.

How can you keep on top of the finances from the start of your startup journey?

Document projections

Document all financial projections, and record all transactions so you can compare and address any gaps quickly. Seek the advice of a financial professional to create accurate cash flow projections and determine where you can make the most impact. You can stay on top of your financials, comparing your forecast to actuals using simple Excel spreadsheets, but a financial dashboard tool that integrates with your cloud accounting solution can make it easier and save you time.

Maintain strict budgets

And stick to them. As a startup, you will need to factor in the possibility of unforeseen situations so delayed payments or extra expenses aren’t catastrophic. There’s always a risk, especially when investing in recruitment and marketing, but staying within your means will minimize the impact of mistakes.

Save for a rainy day

Plan the quiet times of the season when revenue drops. Also, prepare for emergencies. This could be a natural disaster like flooding, storms, or a technical failure. An unplanned pivot will drain cash quickly, so it’s important to have reserves.

How can you reverse cash flow problems when they hit acutely?

Find the source

Determine the source of your pain, and plan targeted action against it. Are late payments hurting you? Has there been an unexpected expense? Have you been affected by fraud? Are you paying more recruitment fees than expected? Is there a downturn in new customers?

Change your terms

If you invoice customers or clients, look at whether the terms are too generous. Be proactive with payment collection. Offer a discount for early payment as an incentive. Streamline the payment process; automate if possible. If you’re on a subscription model, determine whether this is working for you in the long-term.

Maintain lender relationships

Lenders are important for businesses in their earliest stages. In most cases, lenders are brought on board in a timely and considered manner. However, sometimes they come into play when a startup needs urgent cash. Build trust over time, and keep solid relationships.

Reduce overheads

Audit your current outgoings and determine where to make short-term cuts. This doesn’t always need to be drastic, but unnecessary expenses add pressure.

4. Poor customer retention

For a startup, it’s critical to work on customer retention to ensure repeat revenue. If you notice that the number of happy repeat customers is dropping, it’s time to investigate where and why.

Customer service is a key player here; perhaps more influential than marketing. It’s normal to have some unsatisfied customers. However, these can be turned around into loyal long-term advocates. Avoid long waiting times, train support staff to an expert level, and invest in great CRM and customer service communication software.

Poor customer service combined with a lack of added value will undoubtedly result in bad retention levels. You must have a retention strategy in place, delivered with the sole focus of keeping customers on board for the long-term.

Consider incentives such as a loyalty program. Exclusive discounts, cumulative benefits, gifts, or random rewards need to be put into the mix. Be sure to acknowledge customer loyalty milestones. Use your loyalty programs to foster direct communication with your customers so you can hear what they really think straight from the source.

Ask your customers what they think using surveys, social media, or even formal interviews. These insights are critical to planning product or service updates and will help you improve the quality of your offering. Transparent communication is key here.

5. A lack of innovation and agility

Startups are known for their innovative and agile approach to business. Creativity, thinking outside the box, and a modern mindset is essential. If you’re not innovating, you’re probably in trouble. Think about how you can make your internal processes more efficient and less costly. But don’t forget that innovation doesn’t have to be earthshaking—it can be the long-term commitment to evolving your product or service into the best it can be for your customers.

Innovation starts with your capable team. Give them space to discuss new ideas, products, and methodologies. Your team will feel more empowered, excited, and like you trust them to help you make the best decisions for your company. Micromanaging will lower morale, erode trust, and shrink thinking space.

Especially encourage new team members to bring fresh ideas to the table and commit to diversity in terms of expertise, cultural backgrounds, and experience.

Not every idea can be executed. But everybody should feel safe to push innovative thoughts forward. If there is a fear of embarrassment or shutdown, fewer people will be willing to take the risk to speak up.

Consider new methods of working. Perhaps one or two days of remote working will provide more innovative thinking space for team members? Or maybe a more streamlined and efficient process for project management would alleviate stress and allow for more creative conversation.

Summary

With the wealth of data at your fingertips, there is no better time to track the health of your startup business—look for patterns that indicate opportunities or issues that need to be addressed. Potentially fatal problems can be spotted early, and mitigated before they threaten the success of your enterprise.

Above all, it is key that you focus on your customers’ pain points. With a customer-centric approach, you will increase retention, improve reviews, and generate new revenue. You will be able to develop your product or service to meet the needs of the most valuable customers. This success will breed a positive atmosphere on your team, and allow for time and space to think creatively. In the end, addressing the needs of your customers will reverse negative trends.

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Vacuuming Mistakes You Need to Stop Doing

Cleaning your carpet is a task that you should always include in your to-do list. However, no matter how much you clean, your vacuuming may not be as effective as intended if you keep making the following mistakes:

Photo by The Creative Exchange on Unsplash

Vacuuming too quickly

If you perform a rushed vacuum job, your results simply won’t be as satisfying. Do it right by first scanning the room to pick up anything that may get stuck in the machine, such as coins, paper clips, small toys, or other items that may be hiding in plain sight. Then, push the vacuum slowly so that the machine’s brushes can properly agitate the carpet fibers and pick up the most dirt possible. Source: BobVila

Not adjusting the height

Make sure to adjust your vacuum’s height as you move from carpet to rug to hardwood! Some vacuums do this automatically, but if yours doesn’t, make sure to take the time to make the appropriate adjustments. It will make a huge difference in the cleanliness of your home’s different surfaces.

Vacuuming only when carpet looks dirty

Don’t wait until you can see the dust to start cleaning. Dirt can pile up underneath the fibers at the bottom of the rug long before you notice it, causing sniffles and allergies to flare. Set a regular vacuuming schedule and stick to it—even if you don’t think it’s necessary. Source: HouseBeautiful

Waiting until the bag is full to empty it

Even though some vacuums have “check bag” indicator lights, check the bag yourself and change it when it’s three-quarters full. This keeps your vacuum’s suction strong. And if you have a bagless vac, don’t forget the dust cup — dirt collects there, too. Source: GoodHousekeeping

Have your carpet deep-cleaned every once in a while to ensure the safety of your family from allergens. Call us for more information!

The post Vacuuming Mistakes You Need to Stop Doing appeared first on Curlys Carpet Repair.

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California ban on soda taxes worries health experts

By AMERICAN HEART ASSOCIATION NEWS

California’s new law banning taxes on sugary drinks in the nation’s most populated state handed the beverage industry a major victory.

Health advocates, however, say it’s a major defeat for the public’s well-being.

They’re already looking into options to repeal the law that passed Thursday after a swift and dramatic political fight. Experts worry the law puts millions of people at higher risk for obesity, diabetes and other major health problems linked to sugary drinks. When soda, sports drinks and other sugar-packed beverages are more expensive, people drink fewer of them, tax supporters say.

The American Cancer Society, American Diabetes Association, American Heart Association and about 20 other groups issued a joint statement earlier this week opposing the measure.

“This is one of the worst pieces of legislation I have seen in more than 30 years spent fighting for better health for kids and families,” American Heart Association CEO Nancy Brown said in a news release.

The law forbids new local taxes on sugary drinks for the next 12 years. And while the soda industry is expected to try to duplicate its triumph elsewhere, one public policy expert warned that what happened in California might actually backfire in other states.

The legislation was part of a last-minute political deal to stop a different tax initiative that the beverage industry helped place on California’s November ballot. That measure would have prevented local communities from raising any kind of tax without first getting two-thirds “supermajority” approval from voters.

The beverage industry withdrew that initiative from the ballot after California Gov. Jerry Brown signed the local-tax moratorium into law. The Sacramento Bee reported this week that Brown met with top soda industry officials weeks before signing the bill.

The American Beverage Association, which poured tens of millions of dollars into anti-soda tax efforts in California and elsewhere, declined to comment beyond issuing a statement that said its legislation is helping local communities. “Our aim is to help working families by preventing unfair increases in their grocery bills,” the statement said.

California joins Arizona and Michigan as states with laws blocking local governments from passing sugary drink taxes. In Oregon, voters will decide the issue in November.

The California law represents a reversal for a state that boasted four cities, including the nation’s first, to have passed a sugary drink tax. Berkeley, San Francisco, Oakland and Albany each impose a one cent-per-ounce levy on sugary beverages, which have been linked to obesity, diabetes, stroke, heart disease and tooth decay. The new law will not affect any of the taxes already in place.

“This is a tragic day for both public health and democracy,” said Dr. John Maa, a general surgeon and president of the San Francisco Marin Medical Society.

Healthcare costs related to treating chronic conditions worsened by drinking sugary drinks have taken “an enormous toll on communities,” Maa said.

“To do something as shortsighted as banning soda taxes for an entire decade without understanding the science and economic implications is an error, a dreadful error,” he said.

The taxes have proven to be effective, Maa said. He pointed to a study that found purchases of sugary drinks in Berkeley dropped 10 percent in its first year of the tax, while sales of bottled water increased nearly 16 percent.

“People see the advertisements, they learn about obesity, diabetes and tooth decay, and then make a conscious decision,” Maa said. “Even in areas where a soda tax doesn’t pass, the campaign educates people.”

Outside California, Philadelphia, Seattle and Boulder, Colorado, also have sugary drink taxes. They’re also being considered in other jurisdictions. That’s partly why the beverage industry has started funding efforts at the state capitol level rather than the local level.

“It’s not surprising that the industry will have its periodic victories because they’re spending tens of millions of dollars to fight them, compared to very little money for the public health community,” said Kelly Brownell, dean of the Sanford School of Public Policy at Duke University.

Because the science linking sugary beverage consumption to negative health outcomes is “rock solid,” Brownell said California’s action may prompt other state legislatures to propose statewide excise taxes on sugary drinks.

“So far, the only taxes have been at the city level, at least in the U.S., but there are places where they’re countrywide,” he said, noting Mexico, France and the United Kingdom are among roughly 25 countries and territories with national taxes.

“The science is so clear that taxes have established benefits. I wouldn’t be surprised if some other states don’t start to think about passing taxes statewide, rather than just leave it up to the cities.”

If you have questions or comments about this story, please email editor@heart.org.

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(3) TESTERS WANTED: ARCCOS 360 with Caddie 2.0

Yeah, yeah, it's all about the data, but wouldn't it be cool, I mean really cool, to have a personal caddie following you around for the rest of the summer?

No, you won't have Cheech Marin telling you to forget immortality and start thinking about hitting the 7-iron, but you can have ARCCOS 360 help you understand your game better through analytics, and its new, dramatically improved Caddie 2.0 help you think your way through your round.

Now that's a defining moment.

TESTERS WANTED

ARCCOS believes if you allow Caddie 2.0 to be your on-course companion, you can avoid those bad shots that result from bad decisions and, ultimately, shoot lower scores. It's artificial intelligence, but it's based on your game, your strengths, your weakness and can be fine-tuned to the way you want to play.

But can a virtual caddie really help you shoot lower scores? For that, we need you.

Win a 1-Year Supply of Snell Golf Balls!

SNELL MTB BLACK or RED

Enter MyGolfSpy’s Giveaway!

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MyGolfSpy is looking for three hardcore, dedicated and tech-savvy golfers to use ARCCOS 360 and Caddie 2.0 for the rest of the golf season and determine if analytics plus using Caddie 2.0 on-course will help you improve your game and lower your scores.

This review opportunity is open to any golfer on the Planet Earth who uses an iPhone (sorry Android users - Caddie 2.0 is iPhone only at this time).

HOW TO APPLY:

This review opportunity is a little different from others we've done. We're asking for a serious commitment to use and evaluate ARCCOS 360 and Caddie 2.0 for the remainder of the golf season. Reviewers will need to be motivated, detail oriented and tech-savvy, so please make sure you read the following instructions carefully and apply in the proper place.

All of our member reviews are published in our Community Forum (click here to check them out). We expect a lot from our reviewers - writing a thorough, detailed and honest review is a lot of work. You'll be writing detailed reviews of your journey, as well as participating in the MyGolfSpy Community Forum itself to answer questions and discuss product performance with other golfers.

That means to be a potential reviewer you must be a registered member of the MyGolfSpy Community Forum, where you'll find tens of thousands of like-minded golfers from all over the world anxious to talk about golf equipment.

To apply to test, review and keep an ARCCOS 360 kit with Caddie 2.0, here's what you have to do:

- First, sign up for the MyGolfSpy Community Forum (click here to register).

- Second, apply ONLY in the Official ARCCOS 360/Caddie 2.0 Review Application thread in the MyGolfSpy Forum (click here).

We'll be announcing our testers next week in the Forum, so please check back there to see if you've been selected.

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How quickly electrical currents move through the legs may help predict heart failure

By AMERICAN HEART ASSOCIATION NEWS

Imagine stepping onto a scale – not to measure your weight, but the chance of your heart failing.

That’s the potential scenario envisioned by researchers who may have discovered a new risk factor for heart failure: leg bioimpedance.

More frequently used to calculate body fat, bioimpedance uses low electrical currents to measure resistance within tissue. In a study published Friday in the Journal of the American Heart Association, researchers at Stanford University School of Medicine found that people who had lower leg bioimpedance were at higher risk for heart failure. The discovery could potentially lead to earlier diagnosis and preemptive treatment of the condition.

The study’s authors examined data on more than 500,000 U.K. patients between the ages of 49 and 69 in a search to find new risk factors for heart failure, a condition in which the heart fails to pump blood efficiently enough to meet the body’s needs.

Researchers used computer-assisted techniques to weed through 3,646 variables reflecting lifestyle, health and disease-related factors for each patient. The results did not surprise – among the top predictors of heart failure were having a previous heart attack, chronic heart disease and a history of diabetes.

But then came leg bioimpedance.

“We homed in on that because the other risk factors are well established for heart failure, whereas [leg] bioimpedance was one of the novel risk factors and one that is easily measurable,” said the study’s senior author, Dr. Erik Ingelsson, a professor of medicine at Stanford University.

Bioimpedance was measured using a body composition analyzer, which looks like a standard scale but with handlebars. Electrodes beneath each foot send small electric currents and measure impedance, or resistance, met in the tissue.

Water, blood and other fluids easily conduct electricity and have lower bioimpedance than something more solid such as muscle tissue, which has higher resistance.

Ingelsson said it’s possible that people who had lower leg bioimpedance in the study had early stages of fluid buildup in their legs, a very common symptom of heart failure. The low bioimpedance may have identified a level of water retention that had yet to be detected by health care providers and before the appearance of other heart failure signs, such as fatigue or shortness of breath.

Dr. Barry Borlaug, a Mayo Clinic cardiologist and medical professor who was not involved in the study, said more research is necessary, but he sees potential for how leg bioimpedance could be used to predict heart failure, particularly among people who lead inactive lifestyles.

“A number of people might have the abnormalities in their hearts and lungs that cause symptomatic heart failure, but they don’t experience these symptoms because they are so sedentary,” said Borlaug, director of Circulatory Failure Research at Mayo Clinic. “Something like this might function like a canary in the coal mine.”

Borlaug said the findings need to be validated within another population to ensure the results can be reproduced, although he admitted that since there were more than 500,000 patients in the study, “the risk that this finding is spurious or due to play of chance is fairly low.”

The study’s authors suggest that a simple algorithm they developed based on their findings could provide an accurate prediction of developing heart failure within eight years. The formula combines leg bioimpedance with a patient’s age, sex and whether the person has had a heart attack or not.

Ingelsson said he’d like to see companies that manufacture body composition analyzers incorporate that algorithm into software for their scales.

“The ideal scenario would really be that you stand on the scale, and in addition to getting your body fat percentage, you also get your risk for heart failure within the next eight years,” he said.

If you have questions or comments about this story, please email editor@heart.org.

The post How quickly electrical currents move through the legs may help predict heart failure appeared first on News on Heart.org.

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