Riding the Honda CB500X

September 24, 2013 — Chiang Mai, Thailand

Today is my 70th birthday and I'm glad to report that my life is going well. The heart surgery is in the past and the future is looking rosy from my vantage point here in northern Thailand. I'm busy, counting myself lucky to be alive and in such good health, riding my new motorcycle, and enjoying Thailand and my lovely friend and companion, Nut. I look back at the years leading up to this birthday and know I could never have planned for my life to turn out this way. Happy Birthday to me!

I've been trying to write this post for a few days but, as always, the OSM mapping projects I so enjoy consume most of my desk time. I've been working & riding in the area north of Lampang lately.  A look at the existing OSM of that region convinced me that there was a lot of exploring, and mapping work, to be done over there. We've made two day trips in the past couple of weeks and they were lots of fun, especially because the new bike is so awesome. More on mapping in later posts. This one is about the bike...

Me and Nut aboard the CB500X

The CB500X is an absolute dream. Regular readers know I loved my last bike, a 2011 Honda CBR250 that I drove 12,000 miles over the past two years, but this one is the bomb. Bigger and much more powerful, it makes driving these roads sheer pleasure, especially for a bloke my size and weight riding 2-up with my petite 110 lb girlfriend.  I can cruise along at 3 or 4 thousand RPM and when I twist the throttle, it gets up and goes. As an added bonus, it gets very respectable gas mileage. I'm running gasohol over here because it's quite a bit cheaper than gasoline ($4.60/gallon vs $5.40/gallon) and I've been getting roughly 70-75 mpg (30-32 km/liter). Not bad considering the CBR250 under generally similar conditions achieved an overall average of 78 mpg for the two years I drove it.

Mileage chart - CB500X

The CB500 isn't a superbike by any means but there is no comparison between the high-revving, single-cylinder CBR and this bike. It runs smoothly at 2500 RPM in the upper gears, a level at which the CBR's engine would shake, rattle and balk unless you were in 1st or 2nd. If I want to overtake a slow moving vehicle I often don't need to downshift - 6th gear has enough torque to pull it off. The roads here make for some gorgeous motorcycling but one doesn't need the sheer horsepower required for freeway travel in the states. I usually travel at around 50-55 mph, an absolutely pokey pace compared to the normal speeds I maintained in the U.S. on the VStrom a couple of years ago. The other thing is that while the roads in Thailand are fairly decent, they aren't billiard table smooth like those stateside. Most of them are concrete and were paved the old fashioned way, by hand, and a bunch of guys with trowels simply cannot produce as smooth a surface as our fancy paving machines. Consequently, even the best roads in Thailand are a bit lumpy — traveling at 70 mph makes for a fairly jittery ride on most highways.

The biggest plus for me is the increased comfort the larger bike provides. The CB500X is the touring model and as such, allows a very upright posture. The long-travel front forks suck up the bumps very well and the rear shock is set perfectly for riding 2-up; it's a much nicer all around ride than we're used to. The seat is higher then the CBR and the entire bike is scaled up to where I can ride all day with no wrist fatigue. The stock seat is fairly comfortable too. Nut, who has on occasion been heard to utter the Thai phrase, เจ็บตูด jep dtùut (butt hurts), after rides on my other bikes, hasn't complained about this one (yet).

As I was browsing through my images I came across some I had from when I put my 650 cc VStrom up for sale back in 2011. I was struck by their similarities. Both are in matte black, both are mid-size twins, and both extremely comfortable for long distance riding. I recall when I was selling that bike after a lovely but frustrating (and cold) tour through the southwestern states that if not for the hefty import duties it would be a wonderful bike for Thailand. Fast forward and I now have almost the same bike except this one is lighter and quicker in traffic and through the turns.

I bought Givi (knock-offs) side cases so that when we tour we can take along enough gear to be comfortable. An added plus is that all the cases are lockable and lock to their mounts. I paid about $300 USD for them and a pair of extra loud PIAA horns, installed at CNX Motosport in Nong Hoi. (N18.75368 E99.00870). I had the guys at CNX mount the Shad top box I bought in Bangkok using a bracket made for the CB500 series that they also carry at their shop. We'd be lost without that top box. We use it to carry groceries and for safekeeping valuables while we're restauranting or shopping. All the boxes are waterproof too.

CB500 dash with my Garmin Montana in its mount

The bike is powered by a smooth and lusty sounding DOHC 4-valve per cylinder, water cooled, 471cc parallel-twin engine. Either this 6-speed transmission shifts extra well or my handling of the clutch has improved radically over the past couple of years because this baby shifts sweeter than any bike I've ever driven. Honda did a great job with the CB500's stock exhaust as well because it produces a very mellow tone at all RPMs. I always get a kick out of the CBR250 owners willing to shell out 4 or 5 hundred bucks for a fancy carbon-fibre muffler in the forlorn hope that it'll make the little powerplant sound more like a big bike. (And here I am bragging up the sound of my 500cc. Boys and their toys - it never changes. LOL)

What 215,000 baht looks like

The CB500X sells in Chiang Mai for 215K baht ($6,900 USD) with ABS. Apparently the ABS on this bike isn't the same as the "combined ABS" I had on the CBR but I hope I never need to learn the differences. It was fitted with Pirelli Scorpion radial tires rather than the more common IRCs. Both are 17 inch wheels: rear 160/60, front 120/70.  (See my Notes below for more about tires.) The generous 4.5 gallon (17 liter) tank will get you 320-340 miles before filling up. Its speedometer, like all bikes I've tested, reads on the high side according to my GPS. This one is only 5% high whereas several Phantoms I've tested, my CBR250, my Suzuki VStrom all were off by +10%. That is, when the CB500X speedo reads 84 kph, you're really only going 80 kph. The odometer, on the other hand is fairly accurate. Go figure.

On the day I picked the bike up from Honda Big Wing the sales guy mentioned that he had a taller windscreen available for 1,500 baht ($45 USD), and did I want the last one in stock? Recalling the wind noise that plagued me on the VStrom tour I jumped at it. It was a great buy because with it the wind noise is quite acceptable — I don't feel the need to wear earplugs anymore. I reckon that's another reason this bike feels so much more comfortable than the CBR. I've had several inquiries on this blog about that screen and my dealer told me he got it from a local motorcycle accessory shop, Pekky Pro Superbike on Huai Kaew Road. I inquired at Pekky Pro and they told me it was made by an outfit called Ermax and that they get their stock from a wholesaler in Bangkok. A quick check on Google turned up half a dozen Ermax listings in several countries including the U.S. and Europe.

Oh, one more thing. In the topmost photo you might be able to see a gray colored vest under my jacket. No, I'm not wearing it because I'm cold but to help me stay cool. It's a cooling vest I bought on impulse at the Cyclegear shop in Springfield, Oregon, in July for $40 USD. I used it for the first time on one of those Lampang trips I mentioned. The day started out cloudy but later the sun came out strong and jacked the temp up to about 95 degrees — I thought, this is a perfect time to test my new vest. So I held it under water in a restroom sink until it got thoroughly soaked. It picked up what felt like 10 pounds of water and dripped hardly at all as I carried it outdoors to put it on. It must use some super absorbent filling because it holds a lot of water. It worked like a charm. Evaporative cooling makes for some pretty good air conditioning at 50 mph. I was quite comfy in what Alaskans would term searing heat on the 2-hour ride home. I'll be wearing that guy a lot on those hot days next spring. Hell, I'll be packing it along on our ride tomorrow. You never know when the clouds will part and ol' man Sol will come out to knock you down a peg or two.

All in all, the new Honda is an excellent bike. If you're a Thailand rider and are looking for a made-in-Thailand bike that offers decent performance for a not outrageous price, excellent comfort and good fuel economy, this bike more than fills the bill.

---

Note: April 2015: The stock Pirelli Scorpion tires ran for about 12K kilometers before they started looking thin. Replacements cost in the neighborhood of 13,000 baht so I opted for a cheaper version, Pirelli Rossas — about 10K baht for the set. Those are now needing to be replaced with about 29K kilometers on the clock. I don't push my luck and am not a fast driver so I really don't need a high performance tire with a soft sticky tread to get me through corners at the blazing speed of 65-70 kph. As IRC doesn't make a 160/60 tire, I'm going to try to locate a set of made-in-Thailand Dunlops for my next go round.

The motor is running great, no issues at all. Other than the initial setting at 1,000 km, I have yet to adjust the valves or replace the spark plugs. The bike consistently gets 70-75 mpg (30-32 km/L) for mileage. 

It's a lovely machine. After two full seasons, I am incredibly happy with it and think it is the perfect bike for Thailand.

Note: March 2017: I  recently noticed that the new CB500X bikes are coming from the factory with Dunlop tires. I was interested to see if they cost less than 12-13K baht I've been paying up to now. I was in Udon Thani last month and got a tip from a friend that Dunlops in the size I need could be had for a lot less than I paid for the Pirellis. Sure enough, a visit to Mark Superbike got me a set of Dunlop Sportmax 222 radials for 7,000 baht ($200 USD), mounted and balanced. 
The bike is still running superbly and I think it's possibly the best bike one could have for touring on Thailand's curvaceous and hilly highways. 

Note: April 2020: The CB500X is still running superbly with 75,000 km on the clock. This bike has performed without a hiccup since the day I bought it. I leave it here in Thailand for a four-month-long stretch every summer and when I return it always starts instantly. It's an amazing, super-reliable bike.
I don't do many long trips purely for motorcycling anymore. 95% of the time I'm driving in a big city with lots of traffic so I'm thinking of buying a large "scooter" with an automatic transmission, a Honda Forza or Yamaha X-Max. I'll let you know when that happens.

---

Click here for a review from RideApart in which they do a much better job of reviewing the CB500Xthan I could. Here's the bottom line from that review:

The Verdict

Want an easy-to-ride, fun, affordable bike to commute around the city during the week, then head off on a trip during the weekend? Whether you’re a novice looking for your first new bike or an experienced rider looking to save some money, you just found it.

To all my friends who’ve been waiting to hear if they should buy one: yes you should.

RideApart Rating: 10/10

I couldn't agree more.

Riding around Chiang Rai and Doi Tung

We did our first multi-day trip last week. We joined up with a riding group in Chiang Rai, a small city about 3 hours north of here, for a 250 km loop through the fine countryside discovering yet another fantastic motorcycling road in the process. The 109 runs east-west between Fang and Mae Suai and is a biker's wet dream with abundant curves, smooth pavement, and superb views of the hills and farms below you when you dare to hazard a glance away from the road in front of you.  The only disadvantage to group rides is that we didn't want to stop to take pictures because we were traveling in a peloton of other motos and didn't want to hold up the whole group.  The unofficial leaders of the monthly rides are Marty and Woraphat Bullard of Chiang Rai Saddlebags. Their shop is a friendly gathering spot for like-minded folks, expats and Thais alike and offers reasonably priced motorcycle accessories and clothing in Chiang Rai town. (N19.90202 E99.81217)

Seeing as Chiang Rai is near another favorite destination, we stayed in town for a few extra days in order to return to the gardens at Doi Tung. We rode there on the next day with some new expat friends we met on the group ride, Bruce and Kathleen, from Boston.  We did stop to take photos on this ride. The rainy season has presented two unanticipated but welcome side-effects: cool temperatures and gorgeous clouds. I've posted other pictures of the gardens at Doi Tung and views from Route 1149, the road that hugs the hilly border between Myanmar and Thailand, but the fleecy clouds suspended over the rich green fields of Myanmar on this perfect day demanded a reprise. (See this earlier post  from 2010 for more.)

Views west toward Myanmar from Route 1149 (above and below)

Just before leaving the U.S. I read about and quickly purchased a polarizing filter for my Sony RX100 camera. One of the drawbacks of point & shoot cameras is that they have no way to add filters to the front of the lens. Unlike full size dSLRs, there are no screw threads in the lens mount. The Mag Filter comes with an adhesive ring that attaches to the front of the Sony's lens housing. This ring in turn holds the filter magnetically.  It's pretty cool, goes on and off the camera easily, and as you can see it does a wonderful job with clouds and skies. (Amazon: Mag Filter)

Nut and I at Doi Tung (N20.28714 E99.80961)

Nut has been wanting to see the famous Wat Rong Khun (วัดร่องขุ่น) aka the White Temple near Chiang Rai so on the way back we stopped in for a quick visit. It's a contemporary design by Thai artist Chalermchai Kositpipat built in 1997. Everything about this site is ornate, even the restrooms.

Wat Rong Khun - the White Temple

Public restrooms at Wat Rong Khun

Another place we both wanted to visit was the Boon Rawd Farm on Route 1211 just south of the city. Well, actually not the farm so much as its associated restaurant, Bhu Bhirom (N19.86236 E99.72982).  We chanced upon the farm on our trip to Chiang Rai last March.

The food was excellent although by the time we had tallied all and sundry, we had run the bill up to about $30 USD, a huge amount for a meal in Thailand. Of course, we had consumed three fancy drinks, a Crispy Tea Leaf Salad with Shrimp, their special Chicken Roasted with Garlic and, Nut's favorite farang food, a Grilled Pork Chop with all the trimmings. We also took home two bottles of their organic Mulberry Juice, a delicious blend of mulberry and lemon juices that for me was strongly reminiscent of a fine red wine.  We ordered too much food. We ended up taking almost the entire chicken home and eating it for supper. Is it any wonder Nut and I are together? Like most of my family, she always thinks ahead to the next meal even while eating the one in front of her. She fits right in.

Crispy Tea Leaf Salad at Bhu Bhirom

Garlic Chicken, Grilled Pork Chop at Bhu Bhirom

---

Below are links to GPX files that detail our travels for those interested.

Chiang Rai Riders Group ride of September 10, 2013

Doi Tung Loop

Click on the file link and select Download from beneath the cleverly hidden "More" menu (those three blue dots), at the top right of the resulting page, browse to a folder or your desktop where you want to place the file and click on the Save button. You can open them with Google Earth or any other application that can display GPX files.

Route 3009 - a favorite ride

I first discovered this scenic byway when Nut and I traveled to the popular little hamlet of Pai a couple of years ago on the Phantom. My GPS was actually responsible for finding it because I asked it to take us to Pai by the "shortest route", rather then the usual setting of "fastest route". The quickest way to get there involves driving the traffic-choked Route 107 north to Route 1095, hanging a left and following that road to Pai for about three hours. Route 1095 is a pretty road in itself and is one I've occasionally mentioned before in this journal. Route 3009, the shortcut, traverses some very pretty farmland more or less diagonally between R 107 and R 1095. It shaves a couple of miles off the journey but is a slower ride and much more scenic than the faster route. Nut and I often drive out to a little coffee shop, Pankret Cafe, just for the fun of the ride.

Route 3009 (purple) shaves a few miles off the trip to Pai

The first few photos below have appeared in another post but I included them here because I like them so much. These scenes are from September of 2012. In order to see them best you should click on each to open in a new window. My newest camera, a Sony RX100 (which replaced my Canon G10), with its extra large sensor does an incredible job for such a small camera.

Rice field - Route 3009

Rice field - Route 3009

Rice field - Route 3009

Fast forward to August of this year and almost the first thing Nut and I did was hop on the bike and ride the 3009 for a visit to the Pankret Cafe.

It is still summer in Thailand yet the weather has been nicer than I expected. It is uncomfortably hot in the afternoons and it does rain almost every day, as you can tell from the dark clouds in the photos above, but when it does rain it cools things off nicely. Riding a motorcycle on cloudy days like these is a joy.

We had our coffee and took the obligatory photos of the beautiful orchids at the Pankret Cafe. I recently watched a Youtube video about fine photography and in it the hosts advised aspiring photographers never to include flower pictures in their portfolios because they're just too common a subject, and ahem, because all flowers are beautiful already. Even though orchids can be found literally everywhere in Thailand and despite the aforementioned sage advice to the contrary, I couldn't resist these beauties.

Oh, the new motorcycle arrived a few days ago too. It's a fantastic machine! It fits me much, much better then the CBR and it has power to spare. We've done a few rides already, the Samoeng Loop, another favorite, and a couple of mapping runs in the country north of here. I'll have more to say about the CB500X in future posts.

Danny, Ning (our landlord), me and Nut

From Alaska to Chiang Mai

Dateline: Chiang Mai

I'm back in Thailand with my dear friend Nut, quite a bit earlier than usual, and it's good to be back despite the heat. I was sitting here yesterday afternoon surfing the Internet and feeling glad to be indoors where the temperature was a comfortable 85 degrees while streetside it was pushing 100. My comfort was enhanced by a floor fan blowing directly on me, and being practically naked besides. We hardly ever use the aircon but our big fan runs all afternoon. Evenings and mornings are quite nice though and the rain, which at this time of year is an almost daily event, drops the outdoor temperature 15-20 degrees. Getting caught in a hard rain on a 40 degree day in Homer, especially on a motorbike, would be a life threatening experience while over here at 85 degrees, not so much. I must admit I love that rain.

My time in Homer was short this go-round but the summer was a record breaker in many respects, especially the weather. Warm sunny day followed warm sunny day in almost unprecedented succession. Nearby Anchorage set new records for high temperature posting several highs near 90 degrees and broke the record for most days with temperatures of 70 degrees or higher in the month of June. July continued that trend.

My first day back - Anchorage, May 18 - snow with wind and rain

May 20 - Kirk's yard is still brown

I arrived in Alaska on May 18th, obviously a trifle too early. My old buddy Kirk was in Kansas helping his parents remodel their home so he was away for six weeks during which I stayed in his beautiful little hideaway. As you can see, summer started slow. I was cold most of the time and spent a lot of time huddled in front of the oil heater trying to get warm. Things changed quickly though and by Memorial Day weekend we were basking in almost tropical, for Alaska, temperatures. The beautiful weather continued for the entire time I was there.

The path to Kirk's home 10 days later

July 21 - Kirk's yard in full summer dress

I drove around Homer and outskirts putting the finishing touches on my additions to the Open Street Map of the area and visited some places I'd known about forever but had never seen before. Beautiful Eagle Lake sits just a few yards north of Basargin Road but is hidden from view by trees and scrub. It's a true gem.

Eagle Lake (N59.82704 W151.13339)

A view north to Bear Cove across a placid Kachemak Bay

I haven't been in Bear Cove for many years but it looked so inviting it convinced me to try and make it back for another visit some time. This was one of only a few cloudy days we experienced all summer.

I also stayed a week or so at another friend's home while he was away building a new get-away cabin at Little Jakolof Bay. Dave lives in a 30 foot diameter yurt that has a fine view of Kachemak Bay and the Chugach Mountains beyond.

View from Dave's yurt

I was treated so very warmly by my many friends that it made me realize all over again that I still have roots in Homer and that I'll be returning for summers until, well, just until....

My last day was extra special. I had lunch with Janelle, a favorite tennis partner who bested me many times on the courts and whom I hadn't seen for years. It was wonderful to get to see her and catch each other up on our adventures since she moved away from Homer. Afterward I played a farewell tennis match with Homer buddies Mary Ann and Chuck.

The day ended with a gala going away party staged by my partners at Alaska Boats & Permits. The food was perfect as was the weather. And as always, I came away feeling both humbled and lucky to have been somehow blessed with such a fine collection of close friends and colleagues.

---

After a too short visit with my son Tuli and grandson Harper in Eugene I arrived in Chiang Mai on August 4th. As soon as I got back I cashed in the stash of American money I had brought along and put a down payment on a new motorcycle, a 2013 Honda CB 500X. I know I've written with fondness about the bike I have now, my CBR 250, and it is indeed a fine bike for Thailand but riding two-up on the hills, with all our gear, is a bit of a struggle that demands running the smallish 250 cc engine at 7-8,000 RPM much of the time. Plus, riding in the semi-sporty posture this bike imposes tires my wrists when driving in the city with the constant shifting and braking required. With these factors in mind I decided it was time to move up to a more comfortable, more powerful bike with higher low-end torque and a wider power band.

Honda CB 500X

This model was introduced in early 2013 and is powered by a parallel-twin 500 cc (actually 470 cc) engine that is closely related to the single-cylinder 250 on my bike. It only comes in matte black and, to my mind at least, an unattractive white-red color combo. I chose black. The X model, there are also R and F models, is the so called cross-touring style and allows for a more upright seating position. That should take the pressure off my wrists. The bike is bigger overall than my CBR at 430 lb vs 360 lb with a seat height of 32 in vs 30.5 in. The one-piece seat is more generous than that of the sportier "R" series bikes too and that should suit Nut better. I'll do a road report after I get the bike and tell you more about it then.

It's inevitable that I compare life in Chiang Mai with life in Homer. Before retirement I had often wondered just how I was going to handle my passion for tennis, a summer sport, and my love for my adopted home in Alaska. I seem to have found a way to accommodate both of these needs by living in Thailand part-time. Unlike our neighbor and good friend Danny, who left the U.S. last year after retirement and has never looked back, I am always torn when I transition from one home to another. I reckon that's just my nature. I've never been good at making decisions.

The gardens at San Kampaeng Hot Springs
(N18.81570 E99.22811)

Danny and Nut on the road to San Kampaeng

Nut and me at our apartment on Siriton Road, Chiang Mai

Now that I'm back and have some new stuff to talk about, I'll probably be writing a bit more often. I'm back to full health after my aortic valve replacement operation in April. I'm feeling fit as a fiddle and have a lot of my old energy back. In hindsight, the operation was much easier than I had thought going in to it. I was playing tennis exactly one month after having my heart stopped and the faulty valve replaced. Ah, the wonders of modern medicine! Nevertheless, I'm glad it's over.

Open Heart Surgery at the Cleveland Clinic

This a post about heart surgery. I wrote much of it when I was staying with my sister Sandy at her place in Olcott on Lake Ontario. Here's a view toward Toronto at sunset a few days ago. For those of you who prefer pictures over words, I'll include this photo and then get on with the wordy part of the post.

Lake Ontario Sunset

At this point, three weeks post-op, I'm happy to say that I'm back to blogging and back on track for continued good health thanks to aortic valve replacement surgery I recently underwent at the Cleveland Clinic. I can't say enough about the fantastic treatment I received from every single person in that organization, from greeters and housekeepers through nurses and physicians. I was so impressed with the employees' level of dedication and competence that I want to sing their praises to anybody who will listen. If you're not familiar with the circumstances that took me to the Clinic for heart surgery, you can read this blog post from last summer.

The Cleveland Clinic Guesthouse where we stayed

Sandy and I drove from Buffalo to Cleveland on Sunday the 21st of April for my aortic valve replacement (AVR) surgery scheduled for the 23rd. We stayed at the Cleveland Clinic Guesthouse which was reasonably priced and had a great restaurant downstairs, the Chicago Deli. The entire day of the 22nd was set aside for getting a chest x-ray, an EKG, echocardiogram, lung volume measurement, and blood tests. It culminated in a visit with Dr. Douglas Johnston, the surgeon who had picked up my case. I don't know how these cases are dealt out to the docs at the CC; all I know is that after I sent my records to the Clinic last summer a note came back by email telling me Dr. Johnston had offered to perform a minimally invasive AVR operation.

I quickly Googled both the technique and the doc's name. "Minimally invasive" sounded good because for it the breastbone is cut only about 4 inches to gain access to the aortic valve, which sits on top of the heart. The more common technique, the gold standard in open heart surgery, cuts through the entire breastbone from top to bottom. The rib cage is then hauled apart with clamps to allow unfettered access to the entire heart muscle. This is the sort of operation necessary for CABG (bypass) surgery or to operate on any of the other heart valves. As for Dr. Johnston -- his credentials were impressive and I learned he does over 100 AVRs every year. Most people who have OHS want to meet their surgeon and get to know him before trusting him with their lives. Considering I was to come to Cleveland more or less directly from Thailand, that wasn't possible in my case. I had to assume that he would turn out to be someone I could relate to.

Dr. Douglas Johnston

At the very end of the long day Monday I finally met Dr. Johnston. He was a friendly, soft spoken man, with the sort of haircut we would have called "collegiate" in the old days, and delicate looking hands, surgeon's hands I hoped. We had a chat and briefly discussed my options regarding whether to have surgery or not. Although we both knew the decision had already been made, this conversation was required along with my signed acknowledgment of the risks and details of the surgery ahead. I signed on the line and we continued our talk.

One measure of valvular stenosis, which is the stiffening of the valve that was affecting me, is obtained from echocardiogram tests.  It is called the mean pressure gradient and is expressed in mm of mercury (mm/Hg), a number directly proportional to the amount of energy it takes to push blood through the valve. Lower numbers are good, higher numbers bad. Coupled with the valve area, which is usually reduced because stenotic valves do not fully open, a qualitative measure of the severity of the stenosis can be derived. Normal gradients are in the range of 3-5 mm/Hg and normal aortic valve are roughly 3 sq. cm. in area. Mild stenosis is anything not exceeding 25 mm/Hg. Severe stenosis involves a mean gradient greater than 40 mm/Hg and a valve area of 1 sq. cm. or less. These last numbers characterize my valve situation when I entered the Clinic. My aortic valve was only opening 1 sq. cm., about 1/3 as much as it should, and my mean pressure gradient was just over 50 mm/Hg. This makes it very hard for the heart to deliver adequate oxygen to the rest of the body. The valve that controls the flow of freshly oxygenated blood is too constricted to be able to do its job properly.

In discussing my options Johnston told me that statistically people having my numbers eventually reach a point where mild physical exertion causes lightheadedness or even fainting and at that point I would have only a 50% chance of surviving another 3 years. I wasn't quite there yet but had already noted a reduction in endurance when playing tennis and riding my bike. Several friends upon hearing about my diagnosis last summer pooh-poohed the idea of heart surgery. They're just trying to drum up business, they claimed. In my mind, I never doubted I needed the surgery.

Next we discussed the type of valve I'd receive. Dr. Johnston recommended a newer model from St Jude Medical, the Trifecta valve, a combination porcine and bovine tissue valve that he's used extensively for the past year or so. The Trifecta  exhibited a high degree of reliability over a simulated 15 year test period (600 million cycles), has a high throughput rate and, because it's made from natural tissues, requires no blood thinners. I knew I would get some sort of tissue valve and I had no reason to prefer one over another so that's the one I ended up with.

Later that evening my daughter Carin arrived. She had driven up from North Carolina to be there during my surgery.  I was ready for the next day now that I had my support staff in place.

The big day started out in the nursing pre-op center on the first floor of the main cardiac center at the clinic. The aide who prepped me was very nice and after she learned I had come from Alaska via Thailand for my surgery, she started bringing her girlfriends in to visit the exotic guy in 2A. Who doesn't enjoy a little taste of celebrity whether deserved or not? I had some good fun talking with them about my travels and my life in Thailand. But reality soon intruded on our little gab fest.

It was a surreal journey to the operating room. I said goodbye to my daughter and sister and was wheeled away through stainless steel corridors and a stainless steel elevator to the operating room, a brightly lit and chilly room full of people and equipment. There I lay supine on my little gurney, the person for whom this technology and effort was being marshaled and the focus of all the energy in that room. It was a weird feeling. My mind was racing through various scenarios and outcomes until someone placed an oxygen mask over my mouth and asked me to take some deep breaths.

I woke up 5 hours later in the ICU. A nurse whose name tag read Cheryl said hello and asked how I felt. I signaled okay with a thumbs-up and then slipped back into semi-consciousness. Something was stuck in my throat and it felt awful. Try as I might I simply could not swallow. And I was stuck like a pin cushion with IVs, electrical leads, a drain tube in my chest and a catheter in my you-know-what. I couldn't swallow and I couldn't move. It was the most uncomfortable moment of the whole deal -- I felt so constrained and claustrophobic I wanted to scream. The feeling passed but it was never far away until those tubes came out. After a while my sister and daughter were allowed to come in to see me and soon after that the breathing tube was removed. If I never have to use one of those things again it will be just fine, thank you.

Later I scanned the surgeon’s report where I read that after I was fully anesthetized  “the upper sternum was opened and the thymus divided; the pericardium was opened and the heart and great vessels exposed …” And, “the aorta was cross-clamped and the heart arrested with a single dose of cold blood Del Nido cardioplegia antegrade. After adequate diastolic arrest the aorta was opened and a heavily calcified bicuspid valve excised … after debriding the annulus, a 27 mm Trifecta sizer was a snug fit. The valve seated well. The aortotomy was closed.”

Phew! A lot of big words having big implications. That was my heart being "arrested", my aorta he's talking about and my valve that was being "excised". I'm very glad to say I made it through all that.

After an overnight stay in the ICU I was wheeled upstairs to a very modern private room where I spent the next few days getting my strength back. My diet of drugs was extensive and included aspirin (blood thinner), acetaminophen (pain), colace (stool softener), Pacerone (heart rhythm regulator), Lasix (diuretic), heparin (blood thinner), lidocaine (pain), Lopressor (beta blocker), Protonix (proton pump inhibitor to prevent acid reflux), potassium chloride, tramodol (pain), and last but not least, a patient controlled device to administer Fentanyl to control pain and help me sleep. Fentanyl is about 100x more potent than morphine according to Wikipedia and I used 36 cc of it while I was there. Pretty good stuff!

A room at the Cleveland Clinic

Spotless corridor at Cleveland Clinic

I knew the mini-sternotomy would be less severe than the standard op, as I've said, but it was apparently a whole lot less severe judging by the folks I saw on my floor who had got the full treatment. They were walking gingerly as though their incisions still hurt quite a bit. In my case, the pain was never serious and after a couple of days the Fentanyl pump was removed along with the catheter and I was encouraged to get up and walk about. I took some of the tramodol a couple of times the third day post-op and then quit the pain meds entirely. My chest was tender but not enough to keep me awake. I slept a ton while in the hospital.

I had one minor complication that I've been told is quite common. Atrial fibrillation is an irregular heartbeat that can cause serious problems if left untreated. Fortunately, mine was corrected in a few hours though the use of the drugs Lopressor and Pacerone which help regulate and control heart arrhythmia and fibrillation. Of the drugs I was getting just after surgery, those are the only ones I'm still taking.

I'm in Eugene now and will be back in Alaska next week. I can't play tennis for a few more weeks to allow my chest to heal fully but the doctor told me to feel free to do any sort of exercise I want as soon as I was up to it, aerobic, whatever. He said, "Once we re-start a heart it either works or it doesn't. There's no in between."

Amen.

Cleveland Clinic Rooftop Patient Lounge

The Cleveland Clinic opened its doors on Feb. 28, 1921. It was a new kind of medical center for the times: a not-for-profit group practice, dedicated to patient care enhanced by research and education.

Cleveland Clinic pioneered the world's first cine-coronary angiography, first published coronary artery bypass (CABG) surgery (1967), and the first successful larynx transplant and first near-total face transplant took place there. In addition to many other achievements  the first minimally invasive AVR, the kind I got, was performed there. In other words, the Clinic pioneered the very surgical technique I had the other day.

The main campus of the Cleveland Clinic consists of 41 buildings situated on a campus of more than 140 acres in downtown Cleveland, Ohio. It was ranked as the fourth best hospital in America for complex and demanding situations according to recent U.S. News & World Report's America's Best Hospitals report and has been ranked number one for cardiac care for 16 years in a row.  This is the primary reason I chose Cleveland Clinic for my surgery. The Clinic is the largest private employer in northeast Ohio, and the third largest in the state of Ohio, with over 36,000 employees all over the United States and revenues exceeding $4.4 billion annually. It has over 1200 beds and admits about 50,000 patients every year, patients from all 50 states and all around the world.

It is an awesome hospital. Of course, I'm biased.

My room is in there somewhere

Note (August 2013): The full cost of my surgery and 6-day hospital stay was a mind boggling $220,000! I count myself fortunate to have Medicare, which paid 80% of that, and supplemental insurance from the State of Alaska that I received when I worked for the City of Homer back in the 90s, which paid the rest.