I started writing a version of this blog entry months ago, but I’ve been struggling with some mental/emotional health issues and kept putting this off, unsure of how much to share.

Thanks to the many friends and family who have been reaching out, it’s clear that there are quite a few people who actually care about me and want to know about my health. Thank you! It continues to help me pull through some challenges with depression and uncertainty.

Sunset from my bivy in the Fisher Towers on Dec. 4, 2021, during my vision quest to come to grips with my mortality.

Here’s the basic info:

My prosthetic (bovine) aortic valve that was installed in 2014 is failing. Another surgery to install a new valve is scheduled for March 30.

At first I was hopeful it would be scheduled for the end of January, then it was February, then early March, then that had to be rescheduled. Going through the scheduling hoops and pre-op procedures to get the operation on the calendar has been a saga in itself.

The plan is to do a transcatheter aortic valve replacement (TAVR) through an artery in my leg. I’ve been told that I will probably be conscious during the procedure and likely only spend one night in the hospital afterwards, with a projected recovery of about one week.

The catch is that this is a short-term fix. I expect it to last only another five to seven years. Eventually I will need another open-heart surgery to install a mechanical valve, which should see me through the rest of my life—but that will require me to be on Coumadin (a hardcore blood thinner requiring regular blood testing and diet monitoring) for the remainder of my days, and there will be additional risks for my outdoor-adventure lifestyle, such as a higher chance of bleeding to death.

It’s been just over seven years since my first open-heart operation in October 2014. The projected lifespan of the animal valve installed then was 10 to 15 years. I always had a pessimistic feeling that I would be lucky if it lasted that long. Apparently my instincts were correct.

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Here are the facts that we know: the bovine valve started showing signs of deterioration on an echocardiogram in February 2021. Until then, my heart had been so strong that my cardiologist told me not to worry about coming in for checkups more than once a year unless I felt any changes. Then, 13 months ago, the checkup revealed that stenosis (hardening/thickening) was developing; once again the valve was no longer opening and closing all the way.

I started noticing the symptoms in August 2021. My fitness had been building consistently, getting stronger through the climbing season, then out of the blue I felt like I hit a wall. Suddenly my body wasn’t recovering as usual, during or after exercise. There was a lot of smoke in the air from all the wildfires burning around the West. I told myself that was probably the reason, but my friends didn’t seem to be affected nearly as much as I was. I just couldn’t seem to replenish the oxygen in my body.

Competing in the Rifle Rendezspew Day At the Office competition in September 2021, where I won the advanced division with my partner Madalaine Sorkin and placed seventh overall, just behind the world-famous climber Emily Harrington in sixth place. In the weeks leading up to the competition I was already noticing a decline in my aerobic fitness. [Photo] Courtesy of Matt Blake (@crux_captures)

One day, in August, I was on a routine trail run outside town with the dog. It was a 30-minute uphill workout that I’d been doing regularly through much of the summer. But this time, a few minutes before reaching my peak heart rate, I suddenly felt like I was having a heart attack. It was like my heart had a bad case of the hiccups. My stride dropped to a slowing shuffle and I gripped my chest. I was totally alone on a quiet trail surrounded by tall brush. No one knew where I was and there was no cell phone service. Visions of collapsing and dying in the bushes along the trail—just a short distance from the little creek crossing where the dog was already lapping water—started to feel very, very real. I decided right then it was time to schedule another checkup with my doctor even though it had not quite been six months since my last visit.

At the time I seemed to be about as fit as ever. I’d been rope soloing desert towers (rope soloing is three times as much work as climbing something with a partner, because the soloist has to shuttle multiple loads to the route, then rig, lead, rappel and follow every pitch, then also haul gear up if spending nights on the wall). I’d also been free climbing consistently, regularly sending 5.13 routes within a few tries, and I had spent nearly a month in Yosemite during the spring, where I slept more than 20 nights on the ground while climbing and hiking almost every day. This included my first one-day ascent of El Capitan, via Lurking Fear, a 20 pitch aid route that my partner and I finished in 24 hours car-to-car after getting lost on the descent in the dark. Back home, I’d also taken up stand-up paddle boarding (SUP) on the Roaring Fork and Colorado rivers near our house. And of course I was doing daily home workouts to keep up with all that stuff.

By September, now aware that my heart valve was no longer opening and closing all the way, restricting blood flow, I noticed the beginning of a slow decline in my aerobic capacity. I’ve been keeping journals of my exercise for years. It helps me gauge where I’m at in a fitness cycle and to track how I’ve been feeling, monitoring muscle tweaks and such before they become full-blown injuries. This also proved helpful when describing symptoms to my doctors. By September I noticed that I was consistently feeling weaker and more out of breath when I should have been getting stronger. It became apparent that I was no longer recovering as well during or after exercise.

By early November, days after the seven-year anniversary of my open-heart surgery, my cardiologist was telling me that I should have the valve replaced within six months or I’d be risking permanent damage to other parts of my heart. Not only that, I was faced with a heavy decision: to follow doctors’ advice and undergo another open-heart surgery to install a mechanical valve, or investigate the feasibility of the TAVR operation through the leg.

From the doctors’ perspective, the issue has been, Why put off the inevitable? You’re not getting any younger and the sooner you get the second open-heart over with, the better the odds will be. Each surgery only complicates the situation for the next one.

The answer that my wife and I have arrived at, after much heavy consideration, is that I specifically avoided getting the mechanical valve on the first go-round so that I could stay off Coumadin and continue my lifestyle as long as possible, with the hope that the next operation would be a TAVR. If I were to renege now, just because the first valve didn’t last as long as we’d hoped, it seems to me I would be putting myself through that hell twice in a row for nothing; I might as well have just accepted the mechanical valve from the start. Maybe that is what I should’ve done, but here I am.

After learning more about the TAVR options, it sounds hopeful that the new valve won’t complicate the third surgery too much. One of my surgeons, the guy who oversaw my first surgery, said that at my relatively young age of 39, there just isn’t much data from previous patients to indicate what the best course of action may be. Lucky me, I get to be a datapoint for science!

I didn’t easily arrive at the decision to go against general medical advice. I wasn’t sure of my answer until after a vision quest to the Fisher Towers near Moab, Utah, during the first week of December 2021. I drove out on a Friday and spent three long, cold nights alone under the stars to climb the King Fisher. I carried loads to and from the tower, nestling into a bivy sack with my journal to wait out the darkness when I wasn’t climbing or hiking. Afterward, I wrote on Instagram:

I can feel a painful throb in my chest with damn near every heartbeat…. I often wake up with a tingling numbness in my arms and legs; I get headaches and feel sluggish or dizzy. When I lie in bed, I can hear how fucked-up my heart is. In the Fisher Towers a couple of weekends ago, I even started noticing the sound—like scrunching a balloon filled with pea gravel—while climbing in a squeeze chimney….

At the time, I honestly thought I would just get the second open-heart surgery over with. By the end of the climb, however, as I carried gear back to the car, the thought of sawing my chest open again at this time just felt wrong. Then after I returned home and talked about it more with friends and family, hearing myself describe the options repeatedly, my answer coalesced: I would stick to the plan we had decided on back in 2014. I’d come full circle, as I noted in the Instagram post:

During recovery from my first heart surgery in 2014, Mandi and I walked slowly along the main trail in the Fishers [which I wrote about here]. I sat at the base of Cottontail Tower, and that was when I first felt a real desire to experience the bigger climbs there beyond the small summits of Ancient Art and Lizard Rock, which I'd climbed years before. Until then, I hadn't felt a pull to spend time aid climbing on "mud." But now I know, we come here for the otherworldly experience, the special energy that feels like tapping into another dimension. Which is exactly what I needed to help me move forward with Surgery #2. It was good to complete the circle that began in 2014.

On top of the King Fisher after soloing the Northeast Ridge (aka Colorado Ridge) on Dec. 5, 2021.

The King Fisher at sunset on Dec. 4 with the route I climbed drawn in yellow.

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Even if the TAVR valve only lasts another five to seven years, the minimally invasive procedure and fast recovery will give me a better chance to realize more of my dream goals. Instead of spending the better part of a year rebuilding the fitness I have now, I can continue building on the foundation I already have. As I approach age 40, I know the opportunity to make athletic gains is already diminishing.

How much farther will I be able to go if I postpone the full pit stop just a bit longer, allowing me to maintain most of the fitness I’ve built to this point?

We’ll see.

Preparing for Heart Surgery #2