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
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
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,"
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
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,"
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.
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
"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.