During this holiday week, I’m republishing a few favorites from the past year or two that many of you may not have seen. Enjoy and in the spirit… feel free to share – especially friends and family who either have had or are “in the waiting room” for open heart valve replacement.

Originally published, June 2023.

If you've ever had a new knee, hip, or maybe a stent to open clogged arteries in your heart, you probably never thought about what company made it...

Let alone who made it.

I know, because it was the last thing on my mind when I had surgery three years ago to replace my aortic valve.

I knew the valve I would be receiving was made by Edwards Lifesciences , which is the largest manufacturer of biologic heart valves. That's only because I spent years researching the inevitable… reading every study, story and forum I could find regarding heart valves.

Beyond that, I never gave a thought to how the valve was made, or even more granularly, the people who actually made it.

That was until fairly recently, when I made the hour-long drive from my home in San Diego up to the Orange County headquarters of Edwards...

I was there for something the company calls the "Patient Experience."

This is an annual two-day event, bringing in about 60 patients from across the country who have received all types of valves... either by open-heart surgery or by one of Edwards' transcatheter procedures.

A transcatheter replacement, as its name implies, involves a valve replacement done by snaking a catheter through the groin to the heart.

The procedure, pioneered by Edwards, doesn't require your heart to be stopped, which in turn means you don't need to be hooked up to a heart-lung machine. There's no question it has revolutionized the way valves are replaced, in the process revitalizing the valve industry.

As luck would have it, I wasn't a candidate for a transcatheter aortic valve replacement, or TAVR as it is more commonly called. That’s because I hit the jackpot and needed a bigger overhaul. As a result, mine was done the old-fashioned way, with a nine-inch incision so my ribs could be pried apart.

But Here's the Thing...

It doesn't matter how the procedure is done... the valve is made pretty much the same way.

And as much as I researched valves and the procedures before my surgery, reading anything and everything – including ever study I could find and watching videos of surgeries – I was humbled to learn what I didn't know...

And by the stories of others I met whose lives in all likelihood would have been cut short if artificial valves didn't exist...

• Like my new friend Dennis, who owns a large date farm just south of Palm Springs, California and flies his own plane. His heart valve had been damaged by endocarditis – an infection – and he had no choice but to have a new valve surgically implanted...

• Or the woman I met at lunch who had a repair of her mitral valve via a robot, but wound up getting a rare complication in the form of a blood disease that almost killed her. She ultimately needed a full surgery to replace the valve. She looked as good as new, even though six weeks earlier she was on her deathbed...

• Or the 71-year-old guy from Massachusetts who runs a small packaging business, but whose real passion is playing wind instruments. His tricuspid valve, one of the four valves we all have, had been malfunctioning. He was having trouble putting one foot ahead of the other, let alone playing his instruments. He became the 20th person to have transcatheter replacement of his tricuspid valve as part of an Edwards trial. He said he felt like new the next day, and could play wind instruments again. When I last saw him, he was on his way to the airport in Los Angeles to take a red eye back to the East Coast for a meeting the next day.

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What we all had in common was that we all were satisfied owners of an Edwards valve, which was made either in California, Singapore, or Costa Rica.

And we were all there for the same reason... to see how our valves were made, but more importantly, to meet (either virtually or in person) the actual people who physically made them.

That’s the part of this entire visit that resonated the most...

Visiting the ‘Factory’

Artificial valves are not produced on machines. It's all a very hands-on process, with zero automation. Each valve is hand-sewn using around 1,000 stitches in a clean room assembly line (like the one below in Irvine) by a team of around 10 people, who pass it along in process and quality control that can take five to 15 hours. Training takes six months.

Most of the sewers are from Southeast Asia... and some are second and even third generation. All of the sewing is done while looking through a powerful microscope.

As we were taken through the process, I took photos...

The first step is sewing together three leaflets made from a processed pericardium of a single cow. (In the pictures below, those hands are of a trainer who started as a sewer 30 years ago. I was matched with her to get an up-close look of how the sewing is done.)

Those leaflet pieces are then sewn onto a fabric base, which is then sewn onto a fabric-covered frame and base made from alloy wire.

The result is a heart valve like the one below, which is the same model as the one beating inside of me.

It's Tedious Work...

Edwards holds these events in large part as a morale booster, so employees can put a face and person to the work they do.

It's also good PR. It's one thing to meet the person who worked on the world's tallest skyscraper or perhaps made your car, but it's another to meet the people who made the heart valve that's keeping you alive.

The highlight, of course, was meeting the three wonderfully talented and kind women who were part of the team that sewed mine. We were matched by the serial number on my valve.

Being able to look them in the eyes and personally thank them and tell them about me, my family, my grandkids... I'm not sure who was more emotional, them or me.

The Backstory…

I first learned of my heart issues more than 40 years ago, when I was told I had a heart murmur during a routine physical. That’s when the doctor, using his stethoscope, hears a click, which indicates blood is leaking back into your heart. Like many people, I was told “not to worry,” but I demanded an echocardiogram to get more information. At the time I was in an HMO and had to fight the system, which I did…

From that point on, I had my valve checked every year with an echo, which is a painless ultrasound.

My advice is that if you are ever told you have a murmur and “not to worry,” get yourself a second opinion… preferably from a cardiologist.

Here’s Why…

While most people who have murmurs don’t or won’t eventually need surgery, it’s important to know exactly what kind of valve you have. Unfortunately, heart valve disease is woefully under-treated. That’s because not everybody has symptoms, yet with or without symptoms, damaged and untreated valves can lead to heart failure.

I was in the asymptomatic group, but thanks to annual echos I watched the slow and silent deterioration of my heart’s performance over the years, hoping to catch things before there was any irreversible damage.

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But there’s something else that you need to know…

It’s not just knowing you have a murmur; if your aortic valve is the “leaky” one, it’s important to know how many leaflets your valve has. You’re supposed to have three, but 2% of the population has two.

I was told I was in that exclusive group, and I’m sure glad I knew because as it turns out, anybody with a bicuspid valve is more prone to having an aneurysm of your ascending aorta. That’s the hose blood pumps through after leaving your heart on its way to the rest of your body. An aneurysm means it’s staring to expand, and if it gets too big… kaboom!

Lucky me, in addition to the bad valve, I had an aneurysm!

To lower the chances of it bursting, for years I would get MRI scans measuring the size of my aorta… watching it slowly grow and grow.

Then Came the Magic Moment…

Thanks to Dr. Eric Topol at Scripps Clinic in San Diego, who writes Ground Truths on Substack, I had been sending the results of my echos and MRIs to the Cleveland Clinic for several years to get a second pair of eyes. Eric used to be at Cleveland, and I had interviewed him several times during my journalism career. When I realized where things were likely headed it was only natural that I included him as a consulting cardiologist. He suggested that “when the time comes” I include Cleveland in the mix.

“Not yet,” was always the response from Cleveland, until January 2020, when I had my annual in San Diego. This time, I was noticing some things and starting to feel a little off. I was getting tired of hearing my cardiologist say, “let’s check it again in three months.”

By then I was on what I like to call the “every three month scan plan.” My wife and I like to travel, and the wildcard of “not if, but when” I would need heart surgery was starting to get in the way.

Turns out, that was about to change. I’m a big fan of listening to your body, and this time the message from Cleveland was that I should fly out for an in-person consultation and have additional tests.

A month later I did just that and met with Dr. Lars Svensson – the chairman of the clinic’s Heart and Lung Institute... and a surgeon's surgeon, if there ever was one.

‘Do It Now’

After reviewing everything, he told me my valve was failing and should be replaced.

I wondered if we could wait until August, after my first grandchild was born. Dr. Svensson, who would never be mistaken for a comedian, looked me straight in the eyes and said calmly but sternly, "I would do it now."

I was back in a month, just before the pandemic hit.

Lights out time in the operating room was around five hours. At some point they stopped my heart to replace the valve. During that time, I was on the heart-lung machine for a little over an hour.

The biggest surprise: I didn’t have a bicuspid valve, after all; instead, I had an even rarer unicuspid valve… that means my aortic valve had just one flap. At the time I was 67; those are usually found and replaced by the time somebody is in their 30s, at the latest.

Had I not been keeping tabs on this, by now I would probably be on my way to heart failure.

The very concept of how somebody conjured up the idea of an artificial heart valve remains a baffling marvel, but so is the fact that I have an artificial valve, a new artificial aortic root, and a Dacron repair of my ascending aorta... none of which I would even think about if I didn't have the faded scar as souvenir.

I now have two grandkids and as corny as it sounds, I consider myself one of the lucky ones who found out I had a problem… before that problem found me.

Onward…

DISCLAIMER: This is solely my opinion based on my observations and interpretations of events, based on published facts and filings, and should not be construed as personal investment advice. (Because it isn’t!) As of this publication, I own shares of Edwards.

I can be reached at herb@herbgreenberg.com.

There was a story the other day that Friday was going to be the latest in a series of “the busiest travel days” of the year.

I’m here to tell you… it’s true.

After two weeks mostly in southern France, it’s true what everybody says: It’s crowded out there.

Regardless of what the economy may be doing, people are traveling... en masse.

We take international vacations once or twice a year and have been doing so for years… including during Covid.

Arriving in Hell

On this last one, the flights were packed both ways on British Airways out of San Diego, where there are two nonstops to London every day. Ditto for our puddle jumps to Paris, and then from Lyon to London ... and back home.

Transferring through Heathrow was as intense as always and remains the international version of that old joke about the Atlanta airport – you know, the one that went: "Whether you go to heaven or hell, you have to change planes in Atlanta." Except with security lines when you make that change, even airside and in the same terminal, Heathrow is more like you’ve already arrived in hell.

The river boat that took us down the Rhône was at capacity, with 81 people. It looked like the boats with bigger capacity were packed, as well.

Pre-Olympics Paris

With one month to go before the Olympics, the crowds in Paris were what you would expect. (We escaped the madness in the peaceful Latin Quarter.)

But it wasn’t just Paris...

I took the photo below during a casual stroll along the main shopping street last Saturday in Lyon, a two-hour train ride south of Paris...

And this one, a bit later, on the street most famous for its restaurants...

It didn’t hurt that Cold Play had three sold-out nearly back-to-back concerts over the weekend at the 59,000-seat Groupama Stadium in Lyon, where the rack rate for tickets ranged well into hundreds of euros. (You do the math.)

It also didn’t hurt that Lyon, with its bouchons and Lyonesse cuisine, is known as the gastronomy capital of France.

Lasting Reminder

The best news, cheese and wine and baguettes and pastries notwithstanding... I didn’t gain a pound.

Along with a few souvenirs, the only other thing my wife and I brought back – as it seems is commonplace these days – was a mild case of Covid. There was so much hacking and sneezing everywhere we went that we were bound to catch something, as we did on our last international trip in November.

Was it a cold or Covid? We tested for the fun of it and because we had a big family event coming up this weekend. The red lines on both of our tests flashed boldly the second the liquid hit them.

The good news: Thanks to jet lag, we would have been feeling crummy regardless. When my wife asks, “Is this Covid or jet lag?” I answer: “Doesn’t matter.”

What matters is that we’re back. I’ve already got a backlog of things to work on. Stay tuned.

P.S.: If you want to follow our trip, make sure to check out my wife’s travel blog and labor of love, The Modern Postcard, where she chronicles all of our trips.

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From the early days, I’ve taken career risk.

Each job change was a step to something new, almost always taking me out of my comfort zone… and at times, letting me rise to the level of my incompetence.

This is not for everybody, and if you do it, expect people to tell you you’re making a mistake.

‘You’re Nuts’

Such as the time I left my job as a columnist for the San Francisco Chronicle to join TheStreet.com. I was one of the first mainstream “columnists” with a following to take that leap… leaving print for online, back in the days when there were still “deadlines,” when stories were held for publication until the next morning.

This was when newspapers had separate online operations, which were more like the farm team than the A-team.

I loved working at The Chronicle, where I wrote a six-day-a-week business column for 10 years, almost to the day. I bridged the world of pre-and-post creation of the Internet. That was back when you could write almost anything about any company without worrying whether anybody was reading it because nobody was counting “eyeballs.”

It was, without question, the best job I ever had. When I announced I was leaving, the typical response was something along the lines of, “You’re nuts.”

That turned out to be a risk worth taking because it changed the course of my career.

I’m a firm believer that switching things up is the only way to grow. For some people, it’s within an organization. For me, it was going elsewhere.

Notable Blunders

But it wasn’t without a few notable blunders, which I discuss in this interview with my friend and former colleague Enrique Abeyta, who recruited me to what turned out to be one of the worst. To watch or listen, just click on the image above.

When Enrique invited me to do his podcast, I told him that it was only under the condition that I could discuss what went wrong there… and why it didn’t work for me.

As it turns out, it was highly cathartic.

Enrique himself – a Wharton triple major who grew up as far from the Ivy Leagues as you can get – has also taken a lot of career risk… and has been through hell and back in the process. He recently launched his own newsletter company, HX Research.

One day maybe he’ll put in writing the lessons he learned… so others can benefit from his experience.

If nothing else, it’s healing.

Enjoy.

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I can be reached at herb@herbgreenberg.com.

I saw the news earlier today that that Ivan Boesky has died…

Back in the 1980s Boesky was a controversial risk arbitrageur who bet on the outcome of mergers.

His book, “Merger Mania,” came at the peak of his celebrity in 1985. I still have an autographed copy on my bookshelf.

As the New York Times said in its obituary..

He came to symbolize Wall Street greed as a central figure of the 1980s insider trading scandals, and who went to prison for his misdeeds…

I hadn’t thought much about Ivan until one day in October 2021 when I was dropping our grand-dog off at the groomer here in San Diego. It was at a small strip center with just a handful of stores and the kind of cramped single-lane parking lot you have to back out of.

‘Do I Know You?’

I was wearing sunglasses and shorts. While I was about to walk the dog the brief distance to the groomer, I waited for a car to drive by. But it stopped, the window went down and the driver said, “Herb Greenberg?”

I didn’t recognize the person, and I said, “Do I know you?”

“Ivan Boesky,” he said, flashing a smile.

Last time I saw Ivan was during a VERY contentious interview I had with him in the 1980s. It was after a speech he gave at the University of Chicago… when he clearly was not happy with my line of questioning.

I had never met him before that interview… and never talked to him after.

Let’s Do Lunch

Now, here we were in a chance meeting in a small parking lot in San Diego. After chatting a few minutes, I suggested we grab lunch sometime.

So we did, at The Cottage in La Jolla, not far from his house. Obviously I raised the issue that I wanted to write about our lunch, but he preferred it just be private, which was fine with me. I was just so curious…

As it turns out, the lunch was fairly unremarkable and friendly. He clearly did not want to dredge up the past, or “the event,” as he called it.

He preferred to talk about his family and his current life…. and how much he still loves investing.

I don’t remember much else from the lunch, but while we were setting it up we swapped a few emails.

I had just joined my prior employer, a newsletter company, and sent him something I wrote about how I was rethinking life and priorities as I closed in on 70, while not retiring. He responded..

I empathize with your idea of retiring versus the pull of the arena.

I have had that dilemma a number of times but after 55 years in the business you will find me at my desk each morning at 4:30 eager to see what the day will bring.

As it turns out, and as I told him, that’s around when I get going, too.

After lunch, we shook hands and said “let’s do this again.”

We never did.

R.I.P.

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DISCLAIMER: This is solely my opinion based on my observations and interpretations of events, based on published facts and filings, and should not be construed as personal investment advice. (Because it isn’t!)

I can be reached at herb@herbgreenberg.com.

Where did you go on your first airplane ride? Do you even remember? (I do - an Eastern Airlines DC 9 from Miami to Atlanta to go to summer camp.)

My wife Mary has written a bunch since launching The Modern Postcard eight years ago. It's always elegantly entertaining and informational.

But her "Notes from Home: A Window to the World" from today is special... and goes down as one of my favorites. Enjoy.

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(Updated on August 27, 2024.)

When I was in my 50s, I shifted careers to join a friend and start a business…

I kept telling myself that Ray Kroc was in his 50s when he started McDonald’s... so it was okay.

Then, when I did it again in my 60s with another friend, I reminded myself that the Colonel was in his 60s when he started Kentucky Fried Chicken.

Now, here I am in my 70s and I tried it again with another venture. And while it didn’t quite work out, my inspiration to give it a try was Warren Titus...

Who is Warren Titus?

Chances are you’ve never heard of Warren Titus, but he should serve as an inspiration to all of us 70-somethings who aren’t about to hang it up....

Titus died in 2009 at the age of 94, but it’s what he did 22 years earlier that I find so inspiring – especially now that I’m launching yet another business with somebody else when all I keep hearing is that I’m supposed to be retired.

Think about it...

Here was a guy who was a pioneer of the modern cruise ship industry... who had founded Royal Viking cruise lines and is widely regarded as the innovative father of the industry’s luxury cruising segment. Royal Viking was so successful that as Carl Nolte wrote in his obituary of Titus in the San Francisco Chronicle, it became “a staple of the upscale market in the 1970s and ’80s.”

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One More Try

But Royal Viking ran into financial trouble and was sold in the early 1980s. Titus stayed on briefly, but left in 1987. As Nolte wrote...

Mr. Titus, who was then 72, figured his career was over. But he got a call from Atle Brynestad, a Norwegian millionaire who asked him to start another cruise ship company. It was the beginning of Seabourn Cruise Lines.

Byrnestad wasn’t just any Norwegian millionaire, but had been an investor in Royal Viking... so he knew what Titus was capable of doing. The kicker, as Nolte wrote...

Within four years Seabourn had been named the top cruise line in the world by Condé Nast Traveler magazine.

Titus retired 15 years later, but his legacy lives on – as does the cruise line he founded, which is now owned by Carnival. (And Brynestad, now 70, owns the ultra-luxury SeaDream Yacht Club cruise line.)

I think of Warren Titus every time I’m asked, “So, when are you going to retire?”

I get that a lot these days...

It’s Up To My Brain

And I always answer, “I can’t imagine stopping... as long as my brain is still functioning.”

And now that I’m just a few months away from being the same age as Warren Titus was when he started Seabourn, and hardly feel “old,” I usually also tell the story of Titus.

It’s hard to explain what motivates people to keep working. For some people it’s financial. For others, it’s the joy or even inner-competitiveness and drive to keep moving forward... or merely the need for something intellectually stimulating to keep their focus.

As The Economist put it in an article earlier this year...

Some simply won’t quit. Giorgio Armani refuses to relinquish his role as chief executive of his fashion house at the age of 89. Being Italy’s second-richest man has not dampened his work ethic. Charlie Munger, Warren Buffett’s sidekick at Berkshire Hathaway, worked for the investment powerhouse until he died late last year at the age of 99. Mr. Buffett himself is going strong at 93.

The number of highly successful people I personally know who could retire many times over but continue to work is extraordinary....

Staying Relevant

People like 83-year old Chicago attorney Lloyd Shefsky, a former clinical professor of entrepreneurship & family business at Northwestern’s Kellogg School of Management, who has written multiple books on entrepreneurs...

Full disclosure: Given my age and the fact that I figured there would be no more business partnerships in my future, I sought Lloyd’s counsel before I launched into my latest venture… this time with an entrepreneur I met last year. After all, Lloyd has seen and heard it all. He still counsels tech startups and consults with large family businesses regarding such things as succession, governance, hiring and compensation. (He gave me a checklist.)

In Lloyd’s view, the thread among people who don’t retire – if there is one – boils down to two things: That it feels good for them to continue working, and that they’re looking for a way to stay relevant. “Those mean different things to different people,” he says, “but the principles are common.”

I’ll add something else, which I believe is true especially for anybody with even an ounce of creativity in their DNA, but certainly with the likes of writers, artists – even scientists...

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Can’t Flip a Switch

It’s not like you turn a certain age and can simply flip off that creative switch. You can’t. Your brain is always firing.

That’s why Norman Lear was working until the day he died at 101. Or why at the age of 90, composer John Williams called off his retirement. “I can’t retire from music,” he said. “A day without music is a mistake.”

Or 80-year-old R.L. Stine, known for the Goosebumps series of kids’ books that I used to read to my kids, once told an interviewer....

I don’t think writers retire. They just drop dead on their keyboards.

One of my favorite lines about retirement comes from this Wall Street Journal story, which is part of a series of special reports they have been doing on retirement. This one was headlined, “When Will I Retire? How About Never.”

It was the first line of an interview with a 70-year-old that grabbed my attention:

I’ll retire at my funeral.

I fully get it!

I understand why people look forward to retiring and never look back. The most successful and happiest, it seems, have a myriad of hobbies and activities and have always been good at playing. I wish I had that gene, but I’ve been working since my teens – first for pocket or gas money… and as I got older, sometimes for free, just to get the exposure.

I’ve taken enormous risks with my professional career, always trying to put myself out of my comfort zone with a willingness to rise to the level of my incompetence. I’ve mostly won. A few times I’ve lost. That’s how you grow and evolve and keep from getting bored.

Learning How to Throttle Back

I’m just now trying to learn how to throttle back, but I’m also still at my desk by 4:30 most weekday mornings and generally continue until 5 in the afternoon. (“At 5-O, is when I go,” has been my mantra for decades.) I create my own deadlines, and on days when I don’t feel like writing… I don’t. Sometimes I work on the weekends.

I also take time out to exercise and feel less guilty than I once did – even when I ran my own businesses – about taking time off during the day... even if to just run an errand. And I have no problem driving seven hours on a weekday every few months to spend a week with our grandkids. The good news about writing for a living... you can do it anywhere.

No, I don’t play golf, even though I’m surrounded here in San Diego by golf courses. But my wife and I travel, which feeds her hobby and passion – writing a travel blog, which you can read here.

She spends hours, days and even months researching our next destination and planning out the trips. Then, elegant writer that she is, once we return she spends hours and days glued to her keyboard writing. She quit work in public relations 40 years ago to raise a family, but like our kids and me, she’s a hard-wired right brain. The ideas simply don’t stop flowing.

And that’s the point...

Why stop if you still have the drive to keep going? As R.L. Stine told an interviewer a few years ago...

I’m having fun. That’s the weird thing.

At this stage, that’s the only thing that matters.

As usual, if you like this please click the heart button below and feel free to share it with friends.

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And while remaining active is key, getting injured is a given.

That was the message from reader feedback to the “Reality of Longevity” essay here last week, when I discussed how I was spending a few weeks in a walking boot to help heal a foot issue.

The boot has since come off, but away from the noise of Wall Street – my usual topic here – the comments were inspiring.

What struck me was the number of comments from folks considerably older than I am.

A few are quite long, but if you need some inspiration, I highly urge you to scroll through them.

None stuck out more than this one, from Gurnam B., who wrote…

Herb: I remember you as a writer with a good mind and high integrity when you worked at the San Francisco Chronicle a few decades ago. When I was young, I thought running meant jogging 100 or two hundred yards.

"But after an early retirement I ran my first marathon at the age of 57, because an old lady next door said she had run a marathon.

Then I ran a total of 32 marathons, including the Boston marathon in 2005 (It was easier in old age to qualify to enter the race.)

The last one was the San Francisco marathon at the age of 84. Then I had to quit because of various issues.

Last year I was able to walk 19 miles, from the flats of Oakland to Skyline Blvd (see below), then toward the Tunnel Road in Berkeley and back.

But soon after that I went with a friend from Berkeley to climb the back side of Mt. Tam. I had no fall or injury but developed pain in one leg during the following days and weeks. Doctors said OVERSTRESSED HAMSTRING, and nothing can be done except PT or if I want steroid shots.

At the age of 93, I don't want to try anything. But I take my 100-year old brother for a walk three times a week, and in the process I get some exercise.

My brother was in the British Indian army during WWII. I asked the other day if he had any kind of pain in the body at this age; and he said "Oh, NOT YET." I don't think I am that lucky.

I’m in awe.

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I also wanted to share this, from Mitch S., who writes..

Hi Herb: I have been reading you since I started as a sell-side analyst in San Francisco in 1995 following enterprise software.

Back then, I appreciated your skepticism of many stocks and perhaps that was a part of my journey to the hedge fund business in New York, where I became a successful portfolio manager, with particular success shorting internet stocks in 2001-2002 – along with shorting the market into the GFC. Shorting since then has been all of zero fun.

It's been an on and off relationship over time, but glad you've made it back into my inbox. Your reads are always welcome.

In 2008, right before everything crashed, I tried to explain to the guy who ran the hedge fund I worked at that the banks were going to zero and we were all going to be living in mud huts :-)

He didn't like my ideas very much. So I quit and went to live in the south of France to work on my French and 'figure out life,' whatever that means. I thought I would be out of finance for a year. It's now been 15 and it's been a joyful journey.

In these 15 years, I have survived cancer, a horrific 25-year back injury, and unbelievably painful 18-year hip injury and countless others. My greatest joy was always riding my bike. I even reached for a bit. But I wasn't able to ride for 15 of those years of the 18 year hip injury.

At 58, I am now healthier than I've ever been in my entire life, including childhood. I have almost completely healed the hip, I have completely healed the back, I overcame the cancer and at worst, has some relatively minor aches and pains. And, I bike 200 miles a week, often doing 50-70 mile rides, solo, in the midday sun of Miami in the middle of summer (I do not recommend this. I have had to learn a great deal about hydration... . the hard way. Cramping is not fun!).

I have studied the mind and body extensively, applying the same analytical rigor to these studies that I applied to achieving an excellent track record as a hedge fund manager. Perhaps more importantly, I have opened and softened and done very deep spiritual work. And here's what I can tell you and what I teach others as a coach, corporate trainer and public speaker. I'm also writing some books by the way:

It's all about emotions.

All physical sufferings come from emotional dysregulation, IMHO.

I know that sounds like a pretty bold statement, but I can tell you I healed my hip after 18 years in all of 4 days. It was never about the torn labrum. It was about when my father left when I was a kid. And when I figured that out and worked with the emotional energy, my hip healed by itself. No surgery (I had had surgery 9 years prior, which failed almost immediately and became even more painful).

I healed my back without the surgery that I was told was absolutely necessary by the heads of surgery at two hospitals. Without the surgery, I hiked three mountain passes in Colorado with a 30 lb. backpack one year later (I did have ozone injected into my discs which I think helped a lot). I also do a lot of biohacking. Some of it works, some of it doesn't.

The body and mind are the most complex things in the known universe. In my humble opinion, we don't understand them all that well, especially when we treat them as though they are mechanical. They are not and this is where medicine goes wrong, IMHO.

Should you ever wish to discuss, feel free to reach out. I'm writing books about this experience and my experiences in helping others.

Mitch, have your people call mine.

Here’s what I know: My “Reality of Longevity” essay was the best read of anything I’ve done on Substack. .

Maybe I’m missing the boat and and should ditch this whole investing nonsense and focus on all things longevity.

On the other hand, I plan on ramping up and rebranding my Red Flag Alerts.

Let me know what you think.

Feel free to contact me at herbgreenberg@substack.com. You can follow me on Twitter and Threads @herbgreenberg.

I'm sitting here writing this with a walking boot on my foot...

It's been there most of the day going on two weeks. As strange as it may sound, for me, recovering from heart surgery was easier than this, because the goal was to walk.

With this, while there are no restrictions, walking – as in walking... the kind of walking I like to do every day – is impossible.

Yet, here I am, and I see this New York Times article headlined, "My Running Club, My Everything."

And there's this photo by Ben Rayner of the Times showing all these smiling people running...

I saw it and sighed...

As anybody who knows me can attest, unless I'm deeply engrossed in writing, I like to keep moving.

In my teens and though college – even a few years later – I biked everywhere. Growing up in Miami will do that. It was routine for me, during college, to bike though Coconut Grove over the Rickenbacker Causeway down to the lighthouse at the tip of Key Biscayne.

As I started moving north as a journalist, to hillier areas, it became clear to me that biking in hills wasn't as fun as it looked growing up in Miami.

That's when I ditched the bike for my feet and legs...

I was never a runner, with a runner's body or build, and I was never fast. My leaky heart valve always acted like a governor, keeping me from true running, but that didn't matter.

I enjoyed the faster pace of running over walking.

Unless it was one of those days when it felt I was running in quicksand with lead weights on my legs, I always felt better after a jog, and felt worse the days I didn't.

In Minnesota, I'd run around Lake of the Isles...

In Chicago, at lunch, if I wasn't running on the god-awful monotonous track at the gym a block away from the Tribune Tower where I worked, I'd run near the lake.

In San Francisco, between my early morning TV stints and my day job as a daily newspaper columnist at the San Francisco Chronicle, I'd run in Pacific Heights.

In New Jersey, well, I tried...

San Diego was (and is) the ultimate, with its low humidity, ocean breezes, and a mix of hills and flat streets.

Running (and ultimately, walking) has always been my way to start the day...

Or as the perfect break between my early morning writing and everything else...

It helps get rid of morning brain fog, is good for blood pressure, and for somebody whose weight is exercise-dependent, it helps burn calories.

The tap on the shoulder that my running days might be limited came when I was 50.

I was doing an annual stress echocardiogram on a treadmill, and as they ramped up the speed to get my heart rate going, my cardiologist said...

By your age most of my patients have stopped running. Usually, they start having knee issues.

I felt smug as he had to turn the speed even higher, and even more thrilled I could go the distance.

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But being smug will get you nowhere...

Within two years, after an especially fast end to a good run, my knee started hurting. It got worse and worse...

Those were in the days when it was routine to do a laparoscopic meniscus "clean out."

So ended my days of routine running...

That led to years on a low-impact elliptical trainer until I could no longer take the boredom of being on a machine and a need to be outside.

That led to walking...

And when I was in the zone, fast walking.

And after my heart valve replacement, thinking all along that I was asymptomatic, remarkably faster and easily longer walking.

I live in a very hilly area, so half the route is mostly uphill...

I took to occasionally starting to jog up those hills, in spurts, when the mood (or music) would strike.

My brain said I was 40, but as I've learned, you can't fool your feet...

Not only is my body not a runner's body, but without getting into detail, my feet have their own... peculiarities.

For years, my left foot has been the focus of study, and a goldmine for my podiatrist...

Splinting, MRIs, this shoe, and that shoe. Orthotics. No orthotics.

Through it all, this one area has always been the hot spot, but it would come and go and I'd get on with my life.

Finally, that chronically challenged area between the second and third metatarsal wouldn't stop acting up.

As my podiatrist keeps explaining, on its good days a foot has a bunch that can go wrong...

On its bad days, as my friend Paul puts it...

Feet suck. Bad design... optimized for a world we no longer inhabit.

He may be right, but intentionally or not, they're also the ultimate reality check on aging. Unless, of course, the knees get there first.

The truth about longevity is that we may be living longer, but some body parts on some people simply weren't designed to go the distance, at least not without intervention.

For me, the lesson is clear: You don't have to feel your age, but no matter how hard you may try, you can’t ignore it.

Note: If you’re new to Herb on the Street, welcome! I tend to focus on business, investing and finance, but from time-to-time I like stray and share other parts of my life. This is a revised version of one of my favorites.

Please share with friends who have artificial valves, especially those who joke about being part cow or pig. I’m sure they’ll enjoy it.

– Herb

If you've ever had a new knee, hip, or maybe a stent to open clogged arteries in your heart, you probably never thought about what company made it...

Let alone who made it.

I know, because it was the last thing on my mind when I had surgery three years ago to replace my aortic valve.

I knew the valve I would be receiving was made by Edwards Lifesciences, which is the largest manufacturer of biologic heart valves. That's only because I spent years researching the inevitable… reading every study, story and forum I could find regarding heart valves.

Beyond that, I never gave a thought to how the valve was made, or even more granularly, the people who actually made it.

That was until fairly recently, when I made the hour-long drive from my home in San Diego up to the Orange County headquarters of Edwards...

I was there for something the company calls the "Patient Experience."

This is an annual two-day event, bringing in about 60 patients from across the country who have received all types of valves... either by open-heart surgery or by one of Edwards' transcatheter procedures.

A transcatheter replacement, as its name implies, involves a valve replacement done by snaking a catheter through the groin to the heart.

The procedure, pioneered by Edwards, doesn't require your heart to be stopped, which in turn means you don't need to be hooked up to a heart-lung machine. There's no question it has revolutionized the way valves are replaced, in the process revitalizing the valve industry.

As luck would have it, I wasn't a candidate for a transcatheter aortic valve replacement, or TAVR as it is more commonly called. That’s because I hit the jackpot and needed a bigger overhaul. As a result, mine was done the old-fashioned way, with a nine-inch incision so my ribs could be pried apart.

But here's the thing...

It doesn't matter how the procedure is done... the valve is made pretty much the same way.

And as much as I researched valves and the procedures before my surgery, reading anything and everything – including ever study I could find and watching videos of surgeries – I was humbled to learn what I didn't know...

And by the stories of others I met whose lives in all likelihood would have been cut short if artificial valves didn't exist...

• Like my new friend Dennis, who owns a large date farm just south of Palm Springs, California and flies his own plane. His heart valve had been damaged by endocarditis – an infection – and he had no choice but to have a new valve surgically implanted...

• Or the woman I met at lunch who had a repair of her mitral valve via a robot, but wound up getting a rare complication in the form of a blood disease that almost killed her. She ultimately needed a full surgery to replace the valve. She looked as good as new, even though six weeks earlier she was on her deathbed...

• Or the 71-year-old guy from Massachusetts who runs a small packaging business, but whose real passion is playing wind instruments. His tricuspid valve, one of the four valves we all have, had been malfunctioning. He was having trouble putting one foot ahead of the other, let alone playing his instruments. He became the 20th person to have transcatheter replacement of his tricuspid valve as part of an Edwards trial. He said he felt like new the next day, and could play wind instruments again. When I last saw him, he was on his way to the airport in Los Angeles to take a red eye back to the East Coast for a meeting the next day.

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What we all had in common was that we all were satisfied owners of an Edwards valve, which was made either in California, Singapore, or Costa Rica.

And we were all there for the same reason... to see how our valves were made, but more importantly, to meet (either virtually or in person) the actual people who physically made them.

And that's the part of this entire visit that resonated the most...

Artificial valves are not produced on machines. It's all a very hands-on process, with zero automation. Each valve is hand-sewn using around 1,000 stitches in a clean room assembly line (like the one below in Irvine) by a team of around 10 people, who pass it along in process and quality control that can take five to 15 hours. Training takes six months.

Most of the sewers are from Southeast Asia... and some are second and even third generation. All of the sewing is done while looking through a powerful microscope.

As we were taken through the process, I took photos...

The first step is sewing together three leaflets made from a processed pericardium of a single cow. (In the pictures below, those hands are of a trainer who started as a sewer 30 years ago. I was matched with her to get an up-close look of how the sewing is done.)

Those leaflet pieces are then sewn onto a fabric base, which is then sewn onto a fabric-covered frame and base made from alloy wire.

The result is a heart valve like the one below, which is the same model as the one beating inside of me.

It's tedious work...

Edwards holds these events in large part as a morale booster, so employees can put a face and person to the work they do.

It's also good PR. It's one thing to meet the person who worked on the world's tallest skyscraper or perhaps made your car, but it's another to meet the people who made the heart valve that's keeping you alive.

The highlight, of course, was meeting the three wonderfully talented and kind women who were part of the team that sewed mine. We were matched by the serial number on my valve.

Being able to look them in the eyes and personally thank them and tell them about me, my family, my grandkids... I'm not sure who was more emotional, them or me.

The Backstory…

I first learned of my heart issues more than 40 years ago, when I was told I had a heart murmur during a routine physical. That’s when the doctor, using his stethoscope, hears a click, which indicates blood is leaking back into your heart. Like many people, I was told “not to worry,” but I demanded an echocardiogram to get more information. At the time I was in an HMO and had to fight the system, which I did…

From that point on, I had my valve checked every year with an echo, which is a painless ultrasound.

My advice is that if you are ever told you have a murmur and “not to worry,” get yourself a second opinion… preferably from a cardiologist.

Here’s why…

While most people who have murmurs don’t or won’t eventually need surgery, it’s important to know exactly what kind of valve you have. Unfortunately, heart valve disease is woefully under-treated. That’s because not everybody has symptoms, yet with or without symptoms, damaged and untreated valves can lead to heart failure.

I was in the asymptomatic group, but thanks to annual echos I watched the slow and silent deterioration of my heart’s performance over the years, hoping to catch things before there was any irreversible damage.

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But there’s something else that you need to know…

It’s not just knowing you have a murmur; if your aortic valve is the “leaky” one, it’s important to know how many leaflets your valve has. You’re supposed to have three, but 2% of the population has two.

I was told I was in that exclusive group, and I’m sure glad I knew because as it turns out, anybody with a bicuspid valve is more prone to having an aneurysm of your ascending aorta. That’s the hose blood pumps through after leaving your heart on its way to the rest of your body. An aneurysm means it’s staring to expand, and if it gets too big… kaboom!

Lucky me, in addition to the bad valve, I had an aneurysm!

To lower the chances of it bursting, for years I would get MRI scans measuring the size of my aorta… watching it slowly grow and grow.

Then came the magic moment…

Thanks to Dr. Eric Topol at Scripps Clinic in San Diego, who writes Ground Truths on Substack, I had been sending the results of my echos and MRIs to the Cleveland Clinic for several years to get a second pair of eyes. Eric used to be at Cleveland, and I had interviewed him several times during my journalism career. When I realized where things were likely headed it was only natural that I included him as a consulting cardiologist. He suggested that “when the time comes” I include Cleveland in the mix.

“Not yet,” was always the response from Cleveland, until January 2020, when I had my annual in San Diego. This time, I was noticing some things and starting to feel a little off. I was getting tired of hearing my cardiologist say, “let’s check it again in three months.”

By then I was on what I like to call the “every three month scan plan.” My wife and I like to travel, and the wildcard of “not if, but when” I would need heart surgery was starting to get in the way.

Turns out, that was about to change. I’m a big fan of listening to your body, and this time the message from Cleveland was that I should fly out for an in-person consultation and have additional tests.

A month later I did just that and met with Dr. Lars Svensson – the chairman of the Cleveland’s Heart and Lung Institute... and a surgeon's surgeon, if there ever was one.

After reviewing everything, he told me my valve was failing and should be replaced.

I wondered if we could wait until August, after my first grandchild was born. Dr. Svensson, who would never be mistaken for a comedian, looked me straight in the eyes and said calmly but sternly, "I would do it now."

I was back in a month, just before the pandemic hit.

Lights out time in the operating room was around five hours. At some point they stopped my heart to replace the valve. During that time, I was on the heart-lung machine for a little over an hour.

The biggest surprise: I didn’t have a bicuspid valve, after all; instead, I had an even rarer unicuspid valve… that means my aortic valve had just one flap. At the time I was 67; those are usually found and replaced by the time somebody is in their 30s, at the latest.

Had I not been keeping tabs on this, by now I would probably be on my way to heart failure.

The very concept of how somebody conjured up the idea of an artificial heart valve remains a baffling marvel, but so is the fact that I have an artificial valve, a new artificial aortic root, and a Dacron repair of my ascending aorta... none of which I would even think about if I didn't have the faded scar as souvenir.

I now have two grandkids and as corny as it sounds, I consider myself one of the lucky ones who found out I had a problem… before that problem found me.

Onward…