Cean Geronimo, Code Ice
As a golfer with aspirations for the PGA tour, Cean Geronimo, 26, takes his workout regimen seriously. Golf is not always given the same athletic respect as other sports, but a golfer at the top of his game needs to be in peak physical shape. Last September, as Geronimo was working out and doing alternating leg bounds-one of his most strenuous exercises-he collapsed in his back yard. He didn't remember anything more until days later.
Geronimo travels frequently for his sport. When in town, he lives in the guest house of his aunt's and uncle's Redondo Beach home. His aunt was used to the sounds of him exercising, and so when all went quiet, she decided to check on him. She found him passed out and turning blue, so she called frantically for her husband.
"The emergency response team at Torrance Memorial quickly assessed Geronimo and knew he met all the specific protocol for a new treatment nickname Code ICE."
While waiting for paramedics to arrive, her husband performed his version of CPR. Having never been trained in it, he recalled the many times he saw it on television and tried his best. It worked. Emergency response personnel arrived in minutes. The paramedics recognized the absence of all vital signs as cardiac arrest and rushed Geronimo to Torrance Memorial Medical Center.
Though surprised by his cardiac arrest at age 25, Geronimo had been aware of the possibility. Several years earlier he was diagnosed with non-obstructive hypertrophic cardiomyopathy (HCM), a genetic form of heart disease that causes thickening of the heart muscle, most commonly near the septum (the dividing wall between the left and right chambers of the heart.) A thickened septum can also cause a narrowing of the outlet from the heart's main pumping chamber, which can block blood flow (obstructive).
But in Geronimo's case, blood flow was not impeded. Geronimo was very fit, optimistic and dedicated to his golf career and all it required of him. Though his cardiologist had advised against any workouts that would raise his heart rate significantly, Geronimo was driven by his goal to make golf his profession. And since he did not have the obstructive type of HCM, he felt he could proceed safely with training.
Golfers will agree that the game requires as much mental attention as it does physical skill. Geronimo prepared for that too, having earned a B.S. in cognitive psychology from the University of California at Irvine while honing his skills as a member of the university's golf team. With his commitment to personal nutrition and a healthy lifestyle, Geronimo believed he had a very low risk for emergency heart problems and gambled on it. Gamblers lose sometimes.
What a Difference a Day Makes
When Geronimo arrived at the emergency room, he was unresponsive. Comatose. The emergency response team at Torrance Memorial quickly assessed Geronimo and knew he met all the specific protocols for a new treatment nicknamed CODE ICE. "We get the best results for a patient when we initiate CODE ICE promptly," says cardiologist William K. Averill, MD. "Therapeutic hypothermia is the clinical name for this process. The patient's body is cooled down, typically for 24 hours. This helps reduce the insult to the brain and gives the person a better chance of both cerebral and cardiac recovery."
Torrance Memorial is leading the way with its use of therapeutic hypothermia. A highly skilled, multi-disciplinary team is involved with each patient during every phase of this treatment. Geronimo was transferred quickly to the Intensive Care Unit (ICU), where nurses and doctors guarded and guided each step of his care. The cardiac care team saved his life. The CODE ICE procedure helped save full functionality of his brain. Geronimo's critical care crisis was over, but his recovery would take months.
Before leaving the hospital, Geronimo's heart was attached to a small defibrillator that acts similarly to the paddles used to shock a heart and restore its function. "Sudden cardiac arrest is one of the complications for a small subset of patients with HCM. Since it happened once to Cean Geronimo, a defibrillator was implanted to help regulate his heart and try to avoid another cardiac arrest," Dr. Averill explains. Due to surgical implantation of this new device, Geronimo was told he could not raise his arms for about four months. That put a halt to his golf swing.
In the weeks following his "big chill," Geronimo spent many hours in the Delpit Cardiac Rehabilitation Program at Torrance Memorial. "I had lost my confidence and was afraid to exercise because I didn't want to cause another cardiac arrest," Geronimo remembers. "The nurses and therapists in rehab were my angels and amazing listeners. They knew I wasn't your average heart patient, due to my age and top physical condition. We discussed my goals of achieving a heart rate of 155 beats per minute, even though my cardiologist did not want my heart rate above 135. Rather than discount my goals, they communicated with my doctor and slowly allowed me to increase my heart rate to top performance level."
It took several months, but Geronimo soon regained both his strength and confidence. "I am so grateful to be alive. Everything worked in my favor that day, and the best people took care of me throughout the ordeal," Geronimo adds.
His months in cardiac rehab provided Geronimo with something he had not had since he first became driven in his youth to be a golfer: free time. "I got in touch with my wilderness side," recalls Geronimo. "I went camping, became a tree-hugger of sorts and read books for pleasure. My commitment to personal health broadened into a new understanding of global health issues." He hopes to maintain that awakening and blend it into his professional golf career.
Back in Full Swing
Just before his cardiac arrest, Geronimo had filed all the paperwork to turn pro-a distinction that would allow him to enter higher levels of golf tournaments. According to Geronimo, golf is very competitive everywhere, but particularly in the United States where there are many more golfers competing for those few coveted positions in professional tournaments. To expand his opportunities for play, he added competitions in Japan to his plans.
Geronimo speaks fluent Japanese, and though it is not a requirement for participation in Japan, he says it is an asset. The pro circuit in Japan has four qualifying levels. Geronimo had just successfully completed the first level and was scheduled to return for the second qualifying competition when he went into cardiac arrest. He now plans to return to the Japanese circuit in October, both for golf and personal reasons.
He was very moved by the recent triple catastrophes in Japan-earthquake, tsunami, nuclear plant crisis. "Watching the Japanese people on television handle such horrific disasters with their sense of dignity and honor makes me very proud to be a Japanese American. I am looking forward to spending more time in that country, surrounded by that culture," says Geronimo.
Until he leaves for Japan, Geronimo is now golfing at least five days a week. He is frequently on the Los Verdes Golf Club course. Golf is his passion and his direction. He can think of nothing else to frame his future around. However, he knows his risks are not just in making the competitive cut on the pro circuit. He understands fully that his HCM may play a role in his future physical condition.
For now, he is thrilled to be returning to competition. However, like any athlete, Geronimo has a fall-back plan should his competition plans not work out. It is one that won't take him too far from the game: "I can always coach!"
Cooling Therapy Saves Lives: CODE ICE
Local residents suffering from a cardiac arrest may receive a "cool" innovative treatment at Torrance Memorial. Nicknamed CODE ICE, this therapeutic hypothermia treatment is used with cardiac arrest patients who meet specific medical markers. Cooling an unconscious patient whose heart has stopped can increase survival and decrease cognitive disability.
Leading the way is a multi-disciplinary team of experts at Torrance Memorial. Starting with emergency department doctors and nurses, they quickly identify, through a checklist of protocols, which cardiac arrest patients might benefit from CODE ICE. Seconds matter.
During therapeutic hypothermia, a comatose patient's body temperature is cooled to between 89.6 to 93.2 degrees Fahrenheit for about 24 hours. Cooling is achieved using the Arctic Sun, which has cooling pads and a probe that is inserted in either the patient's esophagus or bladder for monitoring temperature. The patient may also receive chilled saline solution intravenously. The Arctic Sun allows the staff to set, monitor and maintain the consistent temperature crucial for the success of this treatment.
"When a person experiences a cardiac arrest and is unresponsive or comatose, injury to the brain-due to a lack of oxygen-can result," says William K. Averill, MD, a cardiologist at Torrance Memorial. "Cooling the patient down, then gradually warming the body hours later, while under careful watch of the Intensive Care team, improves significantly the chances of neurologic recovery." Medication is administered at the onset of the CODE ICE treatment so patients do not feel chilled. When they are re-warmed and awaken, they do not have any memory of the process.