Big Compute - At the Heart of Simulation (Part 2)

Episode Date: November 16, 2021

In the last episode, we were introduced to Tom -- a man who was flung into a medical twilight zone of heart issues and the procedures to fix them.  In this continuation of the story, meet Steve Kreuzer -- an engineer from Exponent who specializes in assisting in the development of the very kind of technology that saved Tom’s life.  Steve walks us through just what kind of technology it takes to create these life-saving devices, and how much more complex it is when you’re trying to predict how these devices will interact with human tissue. 

Fortunately, we have enough historical data to know what conditionals are typical in patients who need these. You said conditionals. Oh, I did. Did you mean to say that? No. Okay. Thank you for catching me because there are times where I only read something once and then in editing I'm like, and I have to like cut the whole sentence because I didn't realize I said something totally wrong.

Conditionals. Now I'm thinking about conditioner. Hi, everyone. I'm Jolie Hales. And I'm Ernest DeLeon. And welcome to the Big Compute podcast. Here we celebrate innovation in a world of virtually unlimited compute, and we do it one important story at a time. We talk about the stories behind scientists and engineers who are embracing the power of high-performance computing to better the lives of all of us.

From the products we use every day to the technology of tomorrow, computational engineering plays a direct role in making it all happen, whether people know it or not. Hey, Ernest. What, Jolie? Do you own any paperclips? Well, first of all, I have to ask you, what is paper? I believe that's like a 20th century technology that used to kill trees. Wait a minute, wait a minute.

Aren't you like a cybersecurity guy who doesn't trust anything online? I would think that somebody like you who will not have like a Google Home or an Alexa in their house does everything on paper. You would think, except that I don't really care for paper either. But I don't have any paper clips. However, my wife does. Oh, good. So you have one in your house. Yes.

Do you have it in a convenient location or did you read this part of the script and know that it was coming so you got one in advance? I actually have one at my desk. Oh, yay. You did read it. Hooray. I did. Okay, I have one too. So we need these paperclips for later and it'll make more sense, I swear, when we get to that point.

And for our listeners, you can also get a paperclip if you want to and join in our little experiment later. But welcome to the second part of this two-part series about how big compute technology touches the hearts of all of us. Just like a big Flavor Flav Heart Clock. Oh, no, we're back to the heart clock. If that doesn't make any sense to you, the listener, it will once you go back and listen to the previous episode, because this is part two of a two part episode series. And listening to that previous episode will help you get the whole story. And for everyone else who has already heard it, let's review what we talked about last time. If you all remember, we met Tom. My name is Tom Broussard. Who has been through some crazy health issues with his heart. He had a quadruple bypass and then he had a stroke and he lost his ability to speak and communicate

and write anything. And then he lost a kidney. And then he had a massive breathing attack that would have probably killed him if he hadn't already been under medical care at the time. And then he was finally able to get a TAVR device, which is a medical device that is implanted into his heart through an artery instead of having open heart surgery, basically. And we also met Steve. Hello. Who is an engineer who helps design these types of devices and is considered by us to be an undercover superhero. And as a side note, we learned that Ernest basically died once,

and that he had some miraculous minimally invasive medical procedure done once on his spine. So, you know, we're all better friends now. Hooray! So, to kick off part two of this series, let's go back to Steve, the engineer. Sure. And learn more about what high performance computing technology actually has to do with all of this. And we mentioned before that Steve has worked on a couple dozen or so medical devices like the ones we've been talking about. And he's been able to do that because of the company he works for. At Exponent, which is a scientific and engineering consulting company.

Exponent's website, in case you don't know much about them, they describe themselves as a multidisciplinary engineering and scientific consulting firm that brings together more than 90 different disciplines to solve engineering, science, regulatory, and business issues. So a big umbrella. I'm a managing engineer there, and what I do is help solve our clients' most difficult engineering problems. And as I understand it, Exponent basically exists to help solve a wide array of problems that either prevent something from going wrong or figure out what caused something to go wrong. Or we could even say making sure something goes right. So we either dabble in the reactive work where there's some kind of issue, some failure of some kind, and we're trying to figure out what was at fault. The other side is we're working with our clients to solve the issues before they manifest as failures in the real world.

Right. So they fill a critical gap here, right, where they are both proactive as well as reactive. And in issues or cases where human life is involved, you typically want to be proactive, but you also sometimes unfortunately need to be reactive and make sure that the same thing doesn't happen again. Right. And Steve describes Exponent as the strike force where when there's some kind of problem, we come in and look to address that problem and solve it. And we bring whatever type of specific skills might be necessary to solve that problem, whether they are, in the context of this discussion, computational tools or experimental tools or some combination thereof, we identify what the issues are, bring in the right team members,

and look to knock it out. So I guess if a toy company, for instance, made a scooter that, I don't know, had to be recalled because we'll say it spontaneously combusted at 70 degree temperatures or something, then the toy maker might call Exponent to help them figure out what was making it spontaneously combust. And so then they could fix the issue. Right. So it seems like they're good at coming in and solving engineering challenges after the fact.

Something where, for example, there's a higher than normal percentage of deaths related to people in a specific vehicle. And they bring it in and they end up determining that either the seatbelts are not functioning properly or something else causes the vehicle to lose control or something of that sort where it is important to figure it out. That way the company can fix it. And clearly, whatever the issue is, has probably eluded that company's own engineers. Yeah, I would imagine. I mean, it sounds like they do all different kinds of problem solving.

And they have engineers and scientists in all the different disciplines so that companies can approach them from industries like toys to environmental, to aerospace, to medicine, to automotive. Everywhere from the medical space, medical devices in particular, whether they're implantables or other medical devices that stay outside the body, all the way to consumer electronics. We do quite a bit of work on making sure that laptops and phones and other types of electronic devices are able to withstand the terrors that they're exposed to. Like toddlers. Absolutely. I can tell you, my daughter, when she gets a hold of things, she tends to throw them against the wall.

So we're always praying that they survive. Yeah, it's amazing how durable these toys are because our toddlers' toys have survived quite a bit. Oh, cute! And toddlers honestly comes to mind because much of Steve's non-science and engineering time these days is actually spent with a toddler. Back in the day before she was born, you know, certainly had other things that were going on and, you know, things like programming boot camps and,

you know, dabbling in things like machine learning and whatnot. But as soon as she was born, I switched from machine learning to infant learning. Which, Ernest, you and I can definitely relate to, given that we both do have toddlers. Except that instead of giving up programming boot camps and machine learning as a hobby, I pretty much just gave up time playing Final Fantasy games. Isn't that the truth? I haven't really been able to play a game in any kind of meaningful way in over a year. She's now a little over a year old, right? 17 years left!

Yeah, exactly. I don't know when I'm going to be able to get back to it, but children definitely consume all of your time. Yes, they do, but totally worth it. Yeah, absolutely. She's our first, and she is definitely an adventure. But getting back to Exponent. So they have apparently offices across the United States, Europe and Asia. And Steve himself is located in Boston.

In fact, he weathered the freezing hurricane-like conditions to come cheer for me at my Boston Marathon debut in 2018. Okay, so he might have been there to cheer for someone else, but that means that he cheered for me by default. More than 30,000 runners braved the wind, rain, and cold to make the journey from Hopkinton to Boston. One of the hardest things I've ever done, but one of the most rewarding. I didn't want to stand out in it. I cannot imagine you guys running in that thing. It's so cold! One of Exponent's offices is not too far from the Boston course. And then various Exponent offices have done investigative work on a number of high profile cases,

including the crash of commercial airlines, oil spills, the Challenger space shuttle disaster, and even the Oklahoma City bombing. And that makes perfect sense, right? Because again, they're trying to piece together an engineering situation, right? They're trying to deconstruct it in reverse. And nearly all the time, that is more difficult than the reverse. Yeah. And as for Steve, he gets to work on more of the preventative side, ensuring that new

devices or products go through the scrutiny needed so that they'll work the way they're supposed to once they're publicly released. Most of the projects that I work on and the ones that I want to work on and try to guide my activities towards are in the medical device space. Things that are ideally going to be implanted and make a big difference in patients' lives. That's something that motivates me personally. Steve's job at Exponent is to make sure that client products are reliable and are going to meet the standards of efficacy and durability by agencies like the FDA because they need these approvals, right, by the government.

So in cases of these heart devices... Personally, I get in and work with our clients in performing analyses to simulations to understand what the device is likely to experience in the body. There it is, computational simulation. You knew that we would get there eventually. We only needed the heart to get there. Indeed, but we got there.

Oh my gosh, the dad jokery from you our listeners are just gonna feel like this is i don't even know what to say uh how about that was stupid yeah it just takes a little bit of heart this is so many you gotta have heart yep exactly Yeah, exactly. All you really need is heart. When the odds are saying you'll never win, that's when the green should start. Now you're getting the idea. All right. Well, anyway, now that we've gotten to computational simulation, we've gotten away from it just about immediately afterwards. But we're back. And for Steve, he says that simulation really comes into play

in two specific areas. The first area is trying to ensure or understand or develop some mechanisms to understand how these things are going to work and the ability of a particular design to perform whatever task you've asked it to do. So if you're trying to put in a replacement valve, you want to make sure that under typical blood pressures and flow conditions and structural conditions with the beating of the heart, that that device is actually going to perform its valve function properly. In other words, is this thing going to work the way it's supposed to?

The other side of it, which I find just absolutely fantastically interesting, is the reliability and durability side of things. This isn't just will it work, but will it last? Will the components in the device and the device as a whole continue to function over time without like fracturing or deforming or spontaneously combusting like the scooter I mentioned earlier. Yeah, this part is always interesting to me, especially when we talked with Steve with reference to medical devices, because you have to think about it this way. If you're designing a medical device for implantation in

a heart, for example, the durability of that device has to be such that it is able to remain functional from an infant who may have a heart surgery of some kind to an 80-year-old person who is having one of these procedures. So you can't just design it for, say, 20 years or 30 years because that might meet the ladder of the use cases. But what if it's an infant that needs it? It's a quite unique and difficult engineering challenge to solve. So fascinating. This really gets into the structural and the solid mechanics side of things that, to me, is particularly interesting. But it also incorporates concepts of metallurgy and metals and understanding how different metals are going to perform from a fatigue perspective or in a long-term, long-duration stress state. Yeah, this is an area that I often like to talk about, even though I'm not a materials scientist, but it's materials engineering, right?

We're constantly trying to extend what current materials are able to do, but we're also trying to push the field of material science in general, because we know that, for example, with batteries, right, that if we can push the boundaries of the material science in the batteries, we can get to the point where we have batteries that are less toxic, last much longer, store much more power. But there's a limitation to the science we have today. So looking at how metallurgy and all these different things, how these things interact with the human body, the fluids inside, all of this is very simulation dependent and computationally heavy. Oh, I can only imagine. Yeah. This is something that you can only solve with high performance computing or supercomputing. It's super interesting to set up the simulations because you have all this biology running around and it's incredibly complicated. Oh my gosh, I can't imagine. Yeah, it's kind of

crazy. But you set it up and you run these analyses and there's, for certain materials, there are understandings of what types of values for some of these metrics you want to be below from a durability perspective. And he used a paperclip as an example during our discussion. So that's why I wanted you to get a paperclip, Ernest. I want to demonstrate it hands-on, even though nobody can see it and it could end up being a total fail. But Ernest, do you have your paperclip in hand? As a matter of fact, I do.

Okay, fantastic. So paperclips, in case you're wondering, are made out of galvanized steel wire. And if you don't know what that means, galvanized basically means it was dipped in a protective zinc coating that prevents rusting. So go ahead and use that in a trivia game someday. Right. And there are many, many cases for galvanized metal. And one of the obvious ones is going to be the nails that are on the roof of your house. Now, paper clips are obviously designed to keep stacks of paper held together. And for anyone younger than 18, paper is this thin writing material made from trees. Okay, hopefully

everybody knows. That has existed from essentially ancient historic times in the form of papyrus up until we determined that killing trees for it wasn't really a good thing to do yes so now we have other means but paperclips are meant to hold those papers together and in that way they do a great. What they're not meant to do is go into a heart and dramatically then like bend over and over again with each heartbeat. And the average heartbeat, I think for an adult is like 75 beats per minute or so. In fact, paperclips aren't really meant to bend much at all. And to prove this earnest, we're going to go ahead and bend a piece of the paperclip back and forth in the same location and then count how many bends it takes on the same axis before the metal fatigues and it breaks.

And I'm going to do the same with mine and we can count together. Are you ready? I guess so. Okay, here we go. One. I'm not even good at bending it. This is harder than I thought. I shouldn't have put lotion on. Okay, I am not even good at bending it. This is harder than I thought. I shouldn't have put lotion on.

Okay. I am not doing well. We'll have to go at our own pace because I'm behind you. Well, see, here's where it gets interesting. So before yours breaks, right? If you do it slow, the number will typically be longer. But if you do it rapidly, the number will be shorter. And that's simply because the metal is heating up every time

you do this to the point where it fatigues. Oh, mine just broke. It took like seven. Yeah, I did mine in four, but they were rapid. So the metal heated up very quickly and broke. But then again, these are also like the bargain bin Staples brand

paperclips. I don't know where mine came from. It probably matters how thick it is, too, I wonder. Mine's a thin one. I don't know. been staples brand uh paperclips so they're probably pretty cheaply made and it probably matters how thick it is too i wonder mine's a thin one i don't know i will tell you the the thing i have used paperclips most on in the last decade is opening sim card slots on cell phones actually me too that or trying to pick the lock when my toddler locks himself in a room yeah like they're useless to me other than opening the sim slot to get the SIM card out. Yeah, exactly. It's like, when do I need a skinny piece of wire?

Exactly. Like not actually hold paper together. And now everyone listening to this has a prize winning science fair entry eight years from now for their toddler. So Ernest, your toddler, you're welcome. For the paperclip material, there's some strength associated with that type of loading that you're applying to it.

And for most of the materials that are out there, we know something about what that strength in a durability scenario is going to be. And so we can assess whether it's likely that this device is going to make it or not. So our little paperclip demo result was pretty predictable because we have a basic general understanding of the metal that we're bending. And computational engineers in the same way have a much deeper understanding of the metals like this and all different types of other metals,

which enables them to predict using computational simulation, you know, and numbers and formulas, how a metal will respond to certain performance and conditions over time. So the next chapter in the story is to design tests that you can go and then run and at least up to the accuracy of the test, ensure that that device or that component of the device is actually going to make it out to the types of cycle numbers that you would expect for a device that's implanted into the heart, which FDA is typically looking for something that's implanted to survive 400 million cycles of loading. So not galvanized steel wire. Probably not.

And working with simulation when it comes to medical implants is pretty different, as you can imagine, and can be quite complex when compared to maybe designing a component that goes into a car or an airplane or something. And that's because when you're designing a mechanical component in a car or an airplane, you can design from a mechanical perspective forward, meaning you can pretty easily simulate how metals and other physical elements are going to react under specific conditions like air, heat, so forth, environments, you know, because we already know a lot about those physical elements and conditions. But when you're designing for devices that go into the human body,

it's significantly more complicated because every human body is totally different. I mean, if you only work from the mechanical forward, then you won't be taking into account the various different body conditions the device will inevitably encounter. So not only do you have to design from the mechanical forward, but you have to also design from the biology backwards and kind of watch how they meet in the middle, if that makes sense. When you're running these analyses and you're setting up this set of simulations and you're trying to understand the conditions that a device is going to experience you really do need to nail the

function of the biology and what it's trying to do not just when it's healthy but when it's diseased as well where the materials might perform differently so for instance if you have a heart attack what that really means is you know a portion of your heart has lost blood flow and so is no longer going to contract in the way that it normally does. It's scarred. And so that tissue is going to be very different in performance from something that is healthy and hasn't had such an issue. And so what you need to do in terms of what you're talking about, Nourish, with going backwards from the biology is you need to understand what is the biology going to look like? How do I construct a simulation of what that biology is going to do or should be doing or we think it's doing? How do I construct that sort of environment in which I can put my device and then subject the device to those conditions, that environment that the biology is creating.

So when designing a simulation for a medical implant that is meant to repair part of the body, you can't just run simulations on a healthy body because those aren't people who would be utilizing such a device. You're trying to simulate the conservative scenario for your device. And when we say conservative, we typically mean, I don't want to call it worst case, because it's not always the absolute worst thing that you can imagine, but it's pretty far along that direction. And what you want to be doing is subjecting your device to a foreseeable but challenging condition.

Fortunately, we have enough historical data to know what conditions are typical in patients who need these kind of implants. So that information is gathered and then assessed to know how to run these simulations. It's valuable to understand what a healthy heart is going to do, but it's far more valuable to understand what a diseased heart is going to do and what that's going to look like. And all of this can get pretty complicated. One of the underlying things you have to do is you have to set up what the space is, the physical space that you're trying to simulate. But it also gets into materials and biological materials are crazy complicated, but they also evolve. And, you know, in the course of somebody's life,

you're going to have different performance of your heart muscle, for instance. And if you have a disease, you're going to have a change in that performance. Or if you have some kind of heart attack or some kind of infarction, you know, that's also going to change the performance of the tissue. So it becomes pretty complicated, but what you're trying to identify is the worst or a challenging scenario. And you use what you can from the indication. Yeah. So as you can see, the complexity of the human body has made computational medicine adapt slower, right, than other computational engineering industries. But there are people like Steve who are trying to fix that. Yes, exactly. And I mean, life sciences are so critical to all of us.

And as we learn more, I mean, just think of the possibilities. And while simulation is playing an increasingly important role in medical device development, it's obviously not enough to just run simulations and then call it good. At the end of the day, we still need to do some testing. And so you run these simulations on this population of patients, whatever that might look like. And then you identify what might be the worst case out of that group. And you go and you do your testing off of that. And although physical testing is still a vital part of medical device development, the benefits of simulation in these cases really just can't be understated. The simulation advantages are huge.

And for one thing, you can expose without risk of killing somebody or causing any sort of actual harm to a person. You can expose your device to a huge range of potential conditions that the device might see. And so that allows you to get a leg up in terms of how your understanding of the device is evolving and what you think the device is going to be able to do. That's enormous. So the ability to look across a patient population. Running simulations for medical devices is actually relatively new and it continues to evolve, but its founding principles have pretty much been around for a while. Fundamentally, what we're harnessing here is the finite element method, which has been around for a long time.

In fact, its roots stem from the automotive and aerospace industries, which were some of the first to embrace computational simulations in their product development. They really got their legs under them and capabilities have been developed there. But applying it to medical devices in the biological spaces has been more of a recent thing and has certainly been a game changer because the materials that we're using and that the industry is using these days can be really complicated. One example of a complicated metal they work with is nitinol, which is a man-made metal that is a combo of nickel and titanium. And the way that it performs is often described as super elastic, which sounds awesome. And not only does this awesome metal provide a great deal of performance

benefits in the medical space, but it's not very easy to understand how it performs without computational simulation. Harnessing the computational tools allows one to design devices with this material that, make a metal device fold up small enough to be transported through an artery and then expand in its designated resting place where it will operate as designed. And as far as software goes... It's typically enterprise software. And the reason for that is those codes are further along in their verification than open source software would be. And what do they use for their high performance computing? Well, you'll probably recognize the name.

So our favorite to use is a little company called Rescale. I've heard of them! And this is where the ad drops. Yeah, for real. So if our listeners don't know by now, Rescale is the presenting sponsor of this podcast. So, you know, we like to hear them come up in a conversation. Yeah, I'd like to think that Rescale has a part in bettering the world. Yeah, that's a good way to put it.

And I mean, along with Rescale, Steve's team does run simulations on a small on-prem cluster too. We do have a local cluster that's got, I want to say, 36 CPUs and a handful of GPUs networked together that allow us to run a good bit of our analyses on there. It's still slower than we'd like it to be. So Steve and his team jumps to Rescale basically when there aren't enough on-prem resources to go around or when they have these large problems that need to be solved really quickly. It's most often, though, used when we have a big project that comes in that we know we're going to need resources over the course of many weeks, some dedicated resources. And in talking to Steve, it became clear that he was definitely a fan of having access to the cloud. And I swear we didn't pay him to say this, but he said that Rescale is... Very good at having appropriate machine architectures for the type of simulation that you're running.

And as you make these things more efficient, you really gain in a couple of ways. One, you have faster turnaround, which is its own benefit. The other aspect that I think is incredibly important, depending on the problem in particular, is the level of refinement that you can get away with on a model. So, you know, if you can run something using some really simple geometry locally, but in order to get the actual accurate simulation where you're incorporating all the physical effects that would be necessary, you need to add some level of complexity that your local resources just can't handle, then you might jump up to the cloud. And again, with respect to the licensing aspect of things,

Abacus in particular has this sort of nonlinear scaling between the number of CPUs that you're using and the tokens that they have. And so running on one or two CPUs is pretty costly with respect to CPUs per token or vice versa. But as you scale it, you really get some awesome benefits in terms of your ability to take the tokens that you have and spread them over a much larger computational set. So really taking advantage of and using the tokens as much as possible

is a big key for rescaling. I think that will make our sponsor rather happy to hear. I can actually see Yoris smiling right now while he's happy to hear. I can actually see yours smiling right now. While he's listening to this. I totally can too. Yours is the CEO of Rescale and the founder.

Hey, yours, are you smiling? From supersonic jets to personalized medicine, industry leaders are turning to Rescale to power science and engineering breakthroughs. Rescale is a full-stack automation solution for hybrid cloud that helps IT and HPC leaders deliver intelligent computing as a service and enables the enterprise transformation to digital R&D. As a proud sponsor of the Big Compute podcast, Rescale would especially like to say thank you to all the scientists and engineers out there who are working to make a difference for all of us. Rescale, intelligent computing for digital R&D. Learn more at rescale.com slash BC podcast.

Honestly, it always amazes me how much compute is needed to simulate such small increments when it comes to these medical devices, just because there's just so much data to process. If you're simulating a full heart and you want to run it for, let's say, three beats, which doesn't sound like very much, but is quite a bit, that is going to take a day or so even on a pretty networked connection because there's just so much going on. Absolutely. That's one of the things we've learned through the various stories that have been told on this podcast is that no matter how small or insignificant you think something is or how small of scale it is, the amount of high-performance computational power needed to model it accurately is incredibly high. And because of this, I mean, some jobs are just too big for a small cluster to be able to handle. With the notion of in silico trials and,

you know, looking at cohorts and trying to run these large sensitivity analyses, that very quickly requires cloud resources in order to do just the breadth of simulations. In fact, Steve is also involved in something called the Living Heart Project, if you've heard of that, which is this group of researchers, doctors, scientists, and engineers all united with this goal of creating personalized digital human heart models, which is pretty rad. You have the ability to simulate a heart. So you have the full graphics, 3D rendering of a heart, and you can get people who are comfortable using the software or just, you know,

get somebody else to drive it. And you can like, you know, show the ventricles or show the atrium or show the mitral valve and, you know, really look at in some detail what the actual anatomy of the heart is. And as a learning tool, it's incredibly powerful for people who, you know, don't necessarily and hopefully don't have access to their own, you know, hearts. Cadaver. Yeah. Steve is a team leader for the Living Heart Project's human modeling team. I don't know why they let me do that, but it's awesome. And that's why we consider Steve an undercover superhero. Undercover superhero. Cue the superhero music.

We're trying to solve some of these problems associated with exactly how you run a trial and get it through the FDA on the basis of computational tools. And the Living Heart Project provides this absolutely fantastic platform to figure out what that process looks like. Which can only help push additional innovative medical devices into the public space, sustaining life for tens of thousands of people. What we learn out of those is going to be huge. In like a decade, we're going to have just these awesome capabilities that you know replace many of the clinical trials that we run right now and it's going to be a huge game changer all because we have cloud computing yeah and as it turns out cloud computing is going to be very

critical to the future of in silico medicine and actually to be honest the future of just many things right because again trying to advance our material science, trying to advance all kinds of things relies on massive scale. And the issue with massive scale is cost. Cost is always a factor in all this. outside of large multinational corporations or maybe research institutions to be able to afford to have all of this capacity to run these simulations that they're not actively using 24-7, 365. And the beautiful thing about the cloud is it's a fractional model or a shared model where many different people are using these resources on and off throughout the day, 24-7, 365. And so the fractional cost of computing is much less than trying to have to have all of this on-premise. So I think as we've seen from several of the industry reports we've been reading lately about the future of cloud HPC, more and more workloads

are migrating to the cloud. And 10 years from now, the number of on-prem high-performance computing clusters are going to be much fewer than there are today. Yeah, it's exciting to think about because it also allows this kind of bursting to the cloud where you can really increase your speed as you need to increase it, which drives competition, which lets you try to get to market first. And when it comes to medical devices, I mean, just a few days of getting FDA approval on a device is a few days more that you might be able to save more people, you know, so you can really link it all together to human health, at least when it comes to life sciences. Yeah, days can matter in a lot of ways because for people who have some

exposure to a medical condition if you go into the doctor and they say oh there's you know there's nothing we can do you know that's obviously very deflating but if you're going into the doctor and you know that there's a possibility that there can be solutions to whatever your issue is so if you're short of breath and you think you might have a heart attack, maybe 50 years ago, you wouldn't have had any hope beyond changing your behavior. But you go in these days and you know that your cardiologist has tools at their disposal. And so the hope of getting that phone call from your parents saying, oh, I've had an issue, but the cardiologist can do something about it.

You know, that's an incredibly powerful thing beyond just the actual examples where somebody has gone in. It's just having that sort of parachute, you know, on your back to get you out of these conditions. And just like Steve says, and we kind of touched on this at the beginning of the first episode. So my grandpa died of his heart attack in 1978, right? So it makes me think that had he been born later or lived until today, I would bet that medical technology may have been able to save him. So, I mean, it's hard to say for sure, but while I may not have been able to meet my grandpa, I really think it's awesome that there are a lot of other grandpas out there, probably walking around because technology has evolved this far.

Absolutely. And this is always the case, right? Throughout human history, we're always going to look back in retrospect and think, if only we could have had this back then. But the reality is that's not the case. And that's not how it works. It's not how it works. It's never going to work that way. However, I agree. My grandfather also died of pancreatic cancer.

And while that's still not curable today, so it wouldn't have mattered in another 50, 100 years, it will be absolutely curable. Maybe it will be. Yeah. And it's because of technology. And it's because of technology. Exactly. Yeah. So, I mean, I think looking at technology and saying, oh, this could have saved somebody back when, it's more of like, there's no reason to have any regrets. There's only reason to have hope and gratitude. Right.

And those people who did pass as a result of it, at least if I had died of something, I would be happy that somebody later was able to benefit from it, even if I couldn't. We benefit from talking to surgeons who are performing these surgeries themselves, implanting these devices and talking to these surgeons. It's obvious the advantages that these types of devices provide. don't have to go in and perform open heart surgery on patients and instead can, you know, take a couple hours in the morning to deploy a device and change somebody's life. When you talk to cardiologists, it's like it's a total game changer and it makes a huge difference for their ability to care for their patients. And that's something that is just endlessly motivating for getting in and helping to develop these things.

As for our friend Tom, so his heart health journey isn't really over in a number of ways. It's actually likely that he'll eventually have to have more surgeries and procedures to help things keep ticking in his body. And like he can't visit high elevation cities like Denver because his body just can't handle it. He didn't know that till he went to Denver and then realized, oh, this is not working out so well. But one of the things that I love about Tom is his outlook on life. I continue to be incredibly lucky. I must have been born lucky. Seriously. Yeah. Tom, this man who lost his father when he was young, had open heart surgery, multiple strokes, aphasia, lost his position as dean, lost a kidney, and had other heart procedures done, says that he's lucky.

I mean, if that doesn't put things into perspective, I really don't know what does. Absolutely. It's all about perspective, right? All those things sound bad, but when you compare them to being dead, the alternative is much better. So I definitely understand his perspective. Yeah. And today, Tom does anything he can to help other people who have had similar health scares, including being part of the American Heart Association's support network. I believe he's an ambassador for them, actually. I realize why the support network that we have is so important because there's a lot of other people like me who are more than happy to explain, sometimes ad nauseum, to tell people this is what happened with me when

other people are still waiting to see what's going to happen because they think they might have to get a TAVR as an example, or kidney issues or heart issues. All of us trying to explain in a way that turns out to be highly therapeutic for the people who don't yet know what their life is going to look like at the time of needing it and then the time after they get it done. So yes, it's a huge component, I think, of my recovery. And I got to give a special shout out to the American Heart Association for introducing us to Tom. I do have to say, I've read through a lot of what they're working on and what they do, and they truly do some very special and very important work. And I can say that we are grateful for their part in all of this.

If you know something's going on with yourself, it's still difficult to find basically a friend, a peer who will just tell you the truth about what has been happening to all of us. So the American Heart has created this support network, of which I'm a member, that is a tremendous therapeutic educational platform that anybody can get to and really can ask questions that you really will get from regular humans who actually had all this happening to them. And Tom has actually written four books on his experiences and his insights on aphasia, and he has more on the way. So this guy just does not stop moving, right? And he's done a great deal of research on the human body, the brain, medical processes, all of that. I always like to tell people, realizing that I lost my ability to write at all,

I was lucky enough that my habit really what drove me to get better after my stroke, because I kept a diary after my stroke and had aphasia. And you said, but Tom, you couldn't write. And I said, yeah, I know that, but I wrote anyway. I didn't realize that for the first 200 pages of that diary were words that didn't make any sense. I had no idea. And that's really the beginning of understanding that it didn't matter if I was writing badly.

It is the activity itself and the way the brain works to actually induce what's called plasticity, which is the foundation for all learning. And to learn more about Tom and his work, including his books and even videos of his presentations, you can visit strokeeduc of precarious situations, then there's our other undercover superhero, Steve, out there playing his part in developing additional medical breakthrough technologies that will quite literally save even more lives like Tom's. It's allowing surgeons, it's allowing people in the life sciences to design interventions that are going to give patients their lives back. We've all heard stories and seen examples of folks who have encountered some medical difficulty and their life has dramatically changed. Unfortunately, most of us probably know specific people in our families, if not multiple people. And it has a big impact on everybody's life when somebody's suffering like that. And not to be too grandiose, but these types of technologies and the promise that they provide may allow us to solve many of these issues that, you know, aren't related to the hardcore biology like cancer and so forth, but are really more of a structural thing and allow those people to get their lives back so

that they can do the things that they want to do so they can spend time with their toddlers. They're these little terrors that are running around, but, you know, ultimately just get their lives back. And so what's motivating to me and what I think is really awesome about this type of work is it really does provide bit by bit. It's not a super fast process, unfortunately, but bit by bit provides people with their lives back in a way that's less invasive, in a way that's faster, in a way that is arguably more productive or better at solving problems than what classical surgical technologies might be. To learn more about this episode, you can visit bigcompute.org for photos, episode notes, and so forth. You can also see Steve Kruse on his LinkedIn account,

which we'll also link to on bigcompute.org. And you can learn more about Exponent by visiting exponent.com and learn more about Rescale by visiting rescale.com. Lots of websites to visit. Yep, it's 2021. If you want to help spread the word, you can leave us a five-star review wherever you get your podcasts, like Apple Podcasts. Or Google.

Really? Every time? Or Spotify or wherever you get them. This is like the never ending perpetual pointless argument. I just forget that there are places other than Apple Podcasts. It's all in things. It's just because your Apple Watch basically helped save your life way back when in New Orleans, right? That's why you have this like loyalty to that brand.

You know, it really, I know you said that tongue in cheek, but that is one of the reasons that I have such a loyalty to Apple. Well, I can't get mad at you for that. It's like if a device helps save your life, it's I can't be like, oh, you're such a snob for being devoted. For buying a watch. Also, please tell a friend about us or a colleague. Tell your pet if they know how to listen to podcasts, which would be pretty impressive, actually. If they got anything out of it. That really would be.

And... Maybe a smart parrot. A smart parrot. I would love a parrot to repeat this to everybody. Always remember to use multi-factor authentication and 321 backups.

Yay! Stay safe out there and take good care of your heart. Bye! You only get one of them. Some people get two, though. They have a transplant. Stay safe out there and take good care of your heart. Bye. You only get one of them. Some people get two, though. They have transplant. I guess that's true.

That's the end. People are going to be like, wow. That was climactic. That was a rapid ending. Thank you.