Richard Gavatin

Professional with 20+ yrs experience - 

Layout and Design: Ⓒ Richard Gavatin; 2017-2018

Updated February 18, 2018
bootstrap table

Work History

Technical Writer at Curium Pharma Nov 2017 – 1/1/2018 

Independent Contractor Self-Employed/IMS, Inc. 02/2016 - Oct/2017

Business Analyst Express-Scripts 07/2015 – 02/2016

Independent Contractor IMS, Inc 10/2014 – 06/2015

Application Specialist GBS 01/2014 – 10/2014

Vice President, Co-owner and Computer Consultant IMS, Inc. 01/1989 -12/2013

for Work History Details, please click here


SQL: Queries, Functions, Triggers, Views, Tables, Indexes, Stored Procedures, Database Management

Business Intelligence:: SSIS, Visual Studio, Power BI, Report Builder

Database: MS SQL Server 2005/2008/2012, SSMS and SSRS (Advanced) SSIS (Intermediate/Advanced), SSAS (Beginner)

: NextGen EHR (Electronic Health Records), MS Office, MS Project, MS Publisher, TRAVERSE Accounting Software (ERP system)

  Languages: Visual Studio 2010, SQL, JavaScript, HTML, Excel, PowerPivot, Access, HL7

Web Tools: Dreamweaver, ColdFusion, FrontPage, Fireworks, HTML, Mobirise, XML, CSS, Flash, JavaScript, Java Applets, Microsoft Expression Web4

Operating Systems: Windows (v. 3.1-10), (light) Unix/Linux


MSc Pharmacy University of Uppsala, Sweden 1979

Long List of IT Courses (Primarily focused on SQL)
University of MO, St. Louis UMSL 1996 -2006

Medical / Pharmaceutical Accomplishments

- Worked in the Pharmaceutical industry for 7+ years.   

- Member of Human Studies Committee at Washington University Medical Center  (IRB) Internal Review Board, where we review all applications for Clinical Trials (2001 – 2007)

- Authored book, "Current Concepts in Asthma and Bronchial Hyperreactivity" , 1989 (Copyright TXu 369-047)

Other Experiences

 Synagogue experiences:

Synagogue Accomplishments

-Hosted, arranged, educated congregation about, and introduced, Scholar in Residence programs:  
- Weekend with Rabbi Neil Gillman, z'l'  (written and lectured extensively on Rabbi Gillman’s thoughts). Also, personal friends
- Weekend with Rabbi Brad Artson, VP a the Ziegler School of Rabbinic studies at AJU (American Jewish University, LA, CA)
- Individual (several) programs with History Professor Hillel Kieval, Washington University, St. Louis. 
- Program on the CJLS Committee with one of its chairs, Rabbi Pamela Barmash, member of my Synagogue!   
- Weekend with Rabbi Pamela Barmash on the topic of Jerusalem.
Feel free to talk with them!
Authored and created an educational CD on Shemoneh Esreh 
Taught Shemoneh Esreh as a Kabbalat Shabbat presentation 
Gave Dvrai Torah in Shul in 2003, 2009, and 2012. 
Written numerous articles on Jewish topics, too many to list. Some are published in magazines and some on-line. CJ: Voices of Conservative/Masorti Judaism  
Through 2006 Chaired the PR Committee 
Gave a Kabbalat Shabbat presentation on the origins of the Torah (with 100+ attendees) 
Initiated and maintained the Synagogue’s Web site in the year 2001 and was its webmaster through January 2007. And again from the fall of 2009 through Oct 2010. 
Worked on the Board, as Secretary and Vice President of the Congregation -
President of the Men’s Club 2002 - 2004. -
Co-chair the Adult Education Committee and has in that capacity put together programs for the Synagogue -
And more……..

Other relevant Activities:

-JEI - Jewish Environmental Initiative an arm of JCRC Active member since 2001. -JUJ – Jews United for Justice. On the Steering Committee, and responsible for their Web Site: -Board Member, MEAAA – Mid-East Area Agency on Aging. A local branch of the National AAA (Area Agency on Aging) - Serving Seniors since 1973. -Board Member St. Louis Press Club. -Currently Board Member of Kol Rinah, my Synagogue 

Web Site Experiences:
For a complete list of Web Sites created, email or call!

Cultural Leadership (Cultural Leadership since 2008), AJC American Jewish Congress – STL (AJC-STL since 2008), Karen Kalish ( since 2008)

Samples of Web Sites here

I have also been working on the following no longer active sites: Shaare Shalom ( since debut 2004, volunteer), and the Hadassah ( since January 2006 volunteer) and the Great Plains Region of Hadassah!
Years and years of experience in developing Synagogue's management and communication between staff, lay leadership and clergy.
Currently Board Member at Kol Rinah and co-chair of the Adult Education Committee and active in other committees.

For other relevant experiences please see "Professional Associations"


Professional Associations:         Boards, Awards and more

Board Member of:

· The Press Club of Metropolitan St. Louis

· MEAAA – The Mid-East Area Agency on Aging Foundation – Board Member and Treasurer  (former Member and former Treasurer)

· Kol Rinah (formerly known as BSKI) (A Conservative Synagogue in St. Louis)


· The President’s Award (The Press Club of Metropolitan St. Louis) 2008

· The President’s “Above and Beyond” Award (The Press Club of Metropolitan St. Louis) 2011

Professional Associations:

Training of Journalists – for The Press Club of Metropolitan St. Louis – in Web design, blogging and WordPress.

President (for three years), Vice President, and Newsletter editor for ICCA (Independent Computer Consultants Association).

These are my awesome References:
(in alphabetical order)
Underlined First Names indicate direct professional insights

- Rabbi Sharon Brous, Spiritual Leader of IKAR, Los Angeles (323) 634-1870
- Peter Ehrenstrom, Express-Scripts, (636) 281-9502  
- Alice S. Handelman, Past President of WOA, Woman of Achievement, 314 440-2053
- Deb Jelinek, Controller, Carr Lane Roemheld (one of IMS' clients) 314-740-1557
- Gary Kodner, Partner, Nehmen-Kodner Creative Services,, 314-548-6001, Past President Jewish Light, BSKI and Shaare Zedek.   
-  Dr. Lee Lammert, Ph.D. President, Omnitec Corp., (314) 997-4600
- Gloria S. Ross, 2011-2012 President of Press Club of Metropolitan St. Louis,, (314) 550-7879

Writing Samples

Writing Samples

Samples of published articles:

Jewish/Environmental | Sermon | Medical

Article describing COEJL Conference Feb. 2004

Rabbi Shimon bar Yochai taught: 
This is like people that were sitting on a boat. 
One of them took a drill and began to drill under 
his own place. His fellow travelers said to him, 
“ What are you doing?!”

He said, “what do you care – aren't I drilling [only] 
under my own place?” 
They said, “the water will rise and cover us [all].” 
-- Midrash Leviticus Rabbah 4:6

We don't need to agree on how and why the 
world was created in order to preserve it!”

The COEJL (Coalition on the Environment and Jewish Life) held its annual, conference in conjunction with the JCPA (the national JCRC organization) Plenum 2004 on Feb. 22- 24, in Boston . The Hillel Forum was also held at the same time and place. COEJL is the umbrella organization for a number of local Jewish Environmental organizations, locally represented by the Jewish Environmental Initiative (JEI), best known to the reader for their ambitious project to plant 60,000 trees in the St. Louis area.

Approximately 100 participants from all over the US , Canada and England were treated to a very professional program at the intersection of science and faith. Most impressive were the vast array of top scientists and representatives from the scientific community that convincingly presented the facts on the environment and how it affects all aspects of life today and in the future.

The no-brainer issue: Global Warming 
The issue of global warming is no longer a debatable question. It was compared to the smoking-lung cancer connection in the 60's and 70's where, in spite of all the overwhelming evidence there were still people questioning the correlation. Today, there are no serious scientists denying the effects of the global warming. The only “debate” is how long it will take before catastrophic consequences are upon us. The McCain-Lieberman bill in the Senate [the bipartisan Climate Stewardship Act of 2003] calling for a reduction of the emission of green house gases is not going quite as far as the Kyoto protocol, but is “better than nothing”. It failed in the Senate but only by 8 votes and which is considered a giant step forward. The two Senators, John McCain (R-Ariz.) and Joe Lieberman (D-Conn.) have promised to propose it again this year and are hopeful that it will pass soon. It would require a reduction in carbon dioxide emissions to 2000 levels by the year 2010 by capping the overall greenhouse gas emissions from the electricity generation, transportation, industrial, and commercial economic sectors, and creating a market for individual companies to trade pollution credits. 
The fact that awareness on the issue has now come to the Senate is a good sign. As the US is emitting 20 – 22 % of all green house gases, a change here will have positive global effects.

As the Conference was held in Boston , some of the examples that were presented were local to that area. So, for instance, as an example of the ocean level rise (as a result of the global warming), the situation at Cape Cod, where, without change in the current trends, part of the land will be covered by the ocean in as few as 20 years, according to a great presentation by Seth Kaplan, Senior Attorney at the Conservation Law Foundation. He showed a slide where, on Feb. 14, 2002, President Bush stated that we need to address the issue of global climate change. Mr. Kaplan interpreted the fact that President Bush spoke up about this as a sign that even global climate change “deniers” no longer deny the importance of this issue.

Safe SUVs 
Following this presentation, we heard from the UCS (Union of Concerned Scientists ). This organization is best known for the report published in Mid February in national newspapers and TV, titled: “Preeminent Scientists Protest Bush Administration's Misuse of Science: Nobel Laureates, National Medal of Science Recipients, and Other Leading Researchers Call for End to Scientific Abuses”. 

Their representative at the COEJL Conference, Deborah Donovan, Senior Staff Analyst for the Clean Energy Program at UCS, presented data on more fuel efficient cars: The report from UCS is called “Building a Better SUV: A Blueprint for Saving Lives, Money, and Gasoline” and it unveils a model for an SUV that would save thousands of lives each year from rollover and crash-related accidents, and boost fuel economy so that this SUV would actually exceed the current government mandate for cars-all for a mere $600 increase in cost. 
Ms. Donovan presented the UCS plan for emissions reduction which calls for a 20% reduction of emissions by 2020 and 50% reduction by 2050. These are the same levels that have been adopted as official policy in Germany , United Kingdom , and by the EU. But, again, as pointed out before, because of the US dominance, the effects will only be significant if the US adopts similar standards.

Smog in sacred places: The Environmental Crisis in Israel 
Another session dealt with Israel . Philip Warburg, President of the Conservation Law Foundation, ( ) and Daniel Orenstein, from Brown University and the Arava Institute of Environmental Studies talked about their experiences working with different organizations and the government of Israel . IUED (Israel Union for Environmental Defense) works to lower emissions in Israel and has been especially successful with city buses; as public transportation is of greater importance in Israel , changes to buses' emissions impact the air more there than here. In July 2003 IUED managed to “encourage” the Israeli Supreme Court to enforce the usage of so called “city-diesel” in large cities; this is a fuel with lower diesel content. Working with these issues in Israel can sometimes be as frustrating as in the US , Mr. Warburg said, the Israeli Environmental ministry is a very low-budgeted department, but the success with the city-diesel project was very encouraging. 

Daniel Orenstein talked about the rapid population growth in Israel and the change of the infrastructure, especially in the Galil area of Israel . Many people who were used to living in relatively small apartments and houses with small yards now want to have larger yards and Galil has therefore become a region of choice for many formerly urban Israelis. Population growth is another concern: On average, Israeli families have 3.5 – 4 children per household. The Arab population's corresponding number is somewhere between 6 and 7.

Costs or investment? 
The most common comment one hears about environmental issues is this: “Environmental concerns are great – but we can't afford them!” This is a false contradiction, stated by several of the scientists at the COEJL Conference. “The Business of America is Business”, said one Ph.D. who is running for County Commissioner in Ohio . “If you cannot make the issues be business friendly, you cannot convince anyone”, she said. Therefore, when discussing environmental issues, it is important to remember some very amazing facts: When companies like BP (British Petroleum) and DuPont committed to cut their green house emissions a few years ago, they saved “100's of millions”; When new technology is introduced and “green” ways of manufacturing, distributing and transporting goods and services are being used, thousands of new jobs are created and there are lots of positive ripple effects to reap; This information was presented by a representative from “Environmental Defense”. This organization brings together experts in science, law and economics to tackle complex environmental issues that affect our oceans, our air, our natural resources, the livability of our man-made environment, and the species with whom we share our world.

An example of “big business” that sees financial gains in being environmentally aware is FedEx. "FedEx is continuing its history of innovation by working with Environmental Defense to create a truck that is not only cleaner but more fuel-efficient as well," says David J. Bronczek, President and CEO of FedEx Express; Another company, Entergy, plans to hold carbon dioxide emissions constant even as it increases its non-nuclear electric generating capacity by about 28%. The New Orleans-based utility will improve its power plants, increase renewable energy capacity and invest in outside projects that reduce emissions. "It is incumbent upon every business and every individual to take action to limit greenhouse gas emissions," says Entergy's CEO J. Wayne Leonard; And the list goes on and on.

Jewish Ethics and the Environment 
Rabbi Arthur Green, Professor of Jewish Thought at Brandeis University, Dean of the Rabbinical School and Visiting Professor of Jewish Mysticism, Hebrew College and Board member of COEJL gave a presentation titled “Theology, Ecology and Community: A Spiritual Call to Action”. 
Rabbi Green started by discussing Creation: Why has the Jewish view on Creation essentially not changed since the 15th Century? We need a new creation theology for the 21st Century. Although few people believe in the 7-day creation, literally, even when each day is “translated” into geological eras, we still recall the story every Friday night when we do Kiddush, (Vajecholo Hashamayim v'ha'aretz v'khol tz'va'am) which is an affirmation of Bereshit's creation story. So we have a disconnect between our practice and our belief. The reason says Rabbi Green, is that the 20th Century didn't allow for a Creation story discussion, rather we were occupied with the theology of the Holocaust and the creation of the State of Israel. According to Rabbi Green, we need to look at creation as an expression of the oneness of God. In the other cultures of the time of the writing of the Torah, the Hittites, the Canaanite's and other people in the area, had many gods, and the creation of the world - per their stories - was always a result of battles between different kinds of Gods; Sun god versus earth god, god of lightness vs. god of darkness; and so on. The author(s) of Bereshit ignored all that and started clean and said: There were no battles, only one God who started the evolution of the species; With the oneness as the central theme as in Shema, and in the Jewish Great Story, we need to ask ourselves: what does The Creation Story want from us? What makes it exclusively Jewish is that it poses that question to us. The answer, according to Rabbi Green, is that The One will be manifested in the statement that all life is holy, and that all other considerations are secondary. Whether we rest and let the land rest on a Tuesday or on Shabbat, we are constantly reminded of the Jewish view that all life is sacred. And the answer to the question whether the Torah is Divine or Human is Yes! Tikkun Olam is the realization of the core Jewish truth “All Life is Holy!”. 
Whether one uses vertical language (God is up there and we are “climbing” up to God) as well as the Internal language (God is a deeper, inner truth), God is the one who inhabits the many rather than creates; From here there is just a small step to understand how we Jews develop a love for the natural world.

Environmental Ethics 
Another session with Rabbi Lawrence Troster, of Congregation Beth Israel in New Jersey who serves on the COEJL Executive Committee, the Interfaith partnership for the Environment of UNEP (United Nations Environment Program), the Social Action Committee of the Rabbinical Assembly and much more emphasized Environmental Ethics. 
In Devarim (Deuteronomy) 20:19-20, The Torah talks about the concept of Bal Tashhit (“Do not Destroy”) and this is the foundation of the scriptural support for our efforts to preserve the earth based on Jewish theology. There have been two main trends in environmental ethics: Stewardship Ethics and Non-Anthropocentric ethics. Stewardship Ethics asserts that environmental degradation is morally wrong because human beings will be adversely affected. Human needs are, however, still privileged in this approach. If, for example there is a conflict between a human need and the survival of a species, then the human need comes first. Non-Anthropocentric environmental ethics considers stewardship ethics to be inadequate to deal with the environmental crisis because human needs will always be privileged over the survival of species or ecosystems that are not deemed to be of any use as resources for human benefit. 
The academic area of Environmental Ethics is vast and many worthwhile books have been written on this topic. (Please contact the author of this article for a list of recommended reading).

Orthodox Rabbis 
Another session was chaired by Evonne Marzouk, Executive Director of a new organization called Canfei Nesharim, (“On the wings of Eagles”) dedicated to educate the Orthodox community about environmental issues and their connection to Torah and Halacha. The session was called: “What do Orthodox Rabbis say about the Environment?”. A few years ago, the answer would have been “nothing” but not so anymore. For more information, visit .

Local activities: 
The St. Louis Jewish Environmental Initiative (JEI) is planning a two day conference in April where the COEJL program called “Greening of the Congregations” will be presented. This is a program to encourage all Synagogues to put our money where our mouth is and adopt environmentally friendly practices in the Congregation. Representatives from COEJL will meet with Rabbis and Executive Directors to share with them how Congregations in other parts of the country practice these ideas and at the same time accomplish Tikkun Olam. 
More information about the April Conference will be available soon. If you would like to be notified about the meetings of the JEI, please send an email to: or view the info at the BSKI Web Site at

Richard Gavatin 



(Note! This was a spoken presentation and the language considerations for verbal presentations are made, words in ALL CAPS serve to help the speaker mark emphasis and so on). 

D'Var Torah 
Tammuz 26, 5763 July 26, 2003 
Delivered By Richard Gavatin at BSKI Synagogue

God answers prayer through the change within us that the act of praying creates. 
God answers prayer through the change within us that the act of praying creates .

So, what does it mean? 
God answers prayer through the change within us that the act of praying creates.

It means that the act of praying - in itself - has a powerful impact upon us. It is not a Dr. Jekyll and Mr. Hyde type of change, but a slower, more gradual transformation. The act of praying, as well as meditation allows you to slow down, reflect and to examine yourself, in a way that, hopefully, will have an effect on your day, your week, and potentially even on your life.

Yes, I do believe God answers prayer through the change within us that the act of praying creates. But No, I don't think it pertains to prayers for a new job, a new house, winning the lottery or for a new car (although that may depend on what Make and Model you pray for).

I think, however, that it is true when you ask for inner stability, inner peace, or for one of the many translations of the word Shalom, namely wholeness, in all those cases I believe it is true.

Also, if you pray for integrity, for courage, for overcoming your fears, for overcoming the temptation of Lashon Hara, the evil tongue, that is, maybe the greatest of all sins, gossip, if you pray for the ability to ask others for help when you need it, if you pray for finding direction and meaning in your life, for love and patience, then, Yes, I do believe God answers those prayers.

HOWEVER, there's always a HOWEVER, and as always when five Jewish people gather in a room, there are at least 6 opinions. So, if anything being said here upsets you, just remember, it only proves that you are in a Jewish setting.

However, there are other views, and ONE of them can be illustrated by the story of Rabbi Elimelech. The story is told of an unsuccessful merchant who, after repeated prayers, approached Rabbi Elimelech and demanded to know why God didn't answer him. The Rabbi replied, "God has answered your prayer. The answer was 'No!'.

In other words, praying in itself does not guarantee a positive divine response.

I am sure all of you have asked yourselves these questions: how can I express myself with words that I didn't write? And why do I read the fixed prayers, the ones that are the same, over and over again?

There are many answers to these questions. One of the better answers to the first question is to compare it with the expression “I love you”. I doubt that anyone here actually composed that phrase but it doesn't mean that when you say it, you don't mean it, although it certainly can be said carelessly. We can undoubtedly say “I love you” and mean it, in spite of the fact that we actually plagiarized that expression. But it is only when our actions reflect these words that they ring true by themselves.

The other question: reading the same prayers over and over again. As your life evolves and you get older - and even if not wiser – but definitely filled with more experience and more points of reference, the words of the prayer may take on a new meaning. It requires that you reflect on what you actually are reading. There is an interaction between the words of the prayer and the events in my life. Reciting these words – composed so many years ago – is like looking in a scrapbook of my life. Or so, at least, writes Rabbi Paula Reimers, a California based JTS-graduated Rabbi.

So the words alone are no guarantee that they will be received the way you intended. It is the action that goes hand in hand with the words and the interaction between the words and the events of your life that matter.

I mentioned that one type of prayer that I believe God does answer is praying for personal integrity, being honest. 

And, of course, our Torah, the book that I would like to call The Source of Creative Inspiration, of course our Torah addresses this.

This week's parashah, is called Mattot-Mase'ei. It is a double portion and it is the last parashah of Bamidbar, Numbers, and it reads ---- in Chapter 30, verses 2 and 3 ---- : 
Moses spoke to the heads of the Israelite tribes, saying: This is what the Lord has commanded: 
“ If a man makes a vow to the Lord or takes an oath imposing an obligation on himself, he shall not break his pledge; he must carry out all that has crossed his lips”.

Not surprisingly, the Torah spells out, in detail, the key importance of trying to attain integrity. If you say that you will be taking on a project and you don't have a compelling reason for not fulfilling this vow, then you, quote, "must carry out all that cross" your "lips".

Words are essential in Judaism. Formulated by Rabbi Elazar Ben Shamma approx. 1900 years ago, a midrash says that at Mount Sinai "a book and a sword descended from heaven together." What God meant to say by this set of symbols was twofold: "If you abide by this written Torah, it will protect you from the sword. If you don't, the sword will smite you." 

That is, the word is the mightiest weapon of all. 

Which means that these laws – that we read about in today's Parashah - are as binding as any other commandments in the Torah.

In the Talmud, a portion of tractate Bava Metzia deals with the laws of fraud in sales. The Gemara writes that someone who makes a promise to purchase something, having fulfilled the proper acts of acquisition, but now reneges on the deal, is subject to the following curse (Bava Metzia 47b): "God who punished the generation of the flood, will punish anyone who does not stand by his word." 
And King Solomon wrote: "It is better for one not to vow at all, than for him to vow and then not fulfill" The sages extended the law of vows beyond promises made to God to include vows made to other humans. Among them are all binding oaths and promises in civil law. The Torah prohibits the practice of not fulfilling promises by stressing that one should not take on too much responsibility, by promising to fulfill an obligation, unless one is sure that it can be followed through. Now, there are always unforeseen circumstances that change the situation. The Torah, however, is speaking of making promises that one has no intention of fulfilling.

So, the bottom line, God tells Moses that it is vital to keep your word.

What is strikingly different in this portion, writes Rabbi Mordechai Kamenetsky, is the way God's words were transmitted. Normally, the Torah does NOT talk about the teaching of the law to the heads of the tribes. Instead Moses talks to the “entire” people of Israel . 

But here he talks to the heads of the tribes, which corresponds to the elders of the community, directly. Rashi explains that Moses honored the elders and the leaders because they play a vital role in the laws of vows. 

Rabbi Kamenetsky writes that "The Torah transmits the laws of oaths through the heads of each tribe because it wants to reiterate to them the importance of a leader's adherence to commitment. The eyes of the nation are focused on their words, their promises and their commitments. It is only fitting that those who bear the tremendous responsibility of assuring their tribes, their needs and requests, should be the very ones that transmit those laws".

However, politicians are not always to be trusted. Abba Eban once said: "It is our experience that politicians do not always mean the opposite of what they say".

The Torah hands the responsibility of the burden of words upon those who are faced with the greatest challenge to meet their commitments. Leaders should personify the commitment "all that crosses his lips he shall keep"

Another commentator, Rabbi Warshauer emphasizes that it is also important to remember the concept of wordiness.

He equates Wordiness to honesty.

The more details one gives of an event, the more believable it is. Not always true, but often. Sweeping generalizations should not be trusted. 
A case in point is found in the opening verses of Parashat Masei, (the second of the two Torah portions we read today) which are a recap of the journeys of the children of Israel in the wilderness. Each stop they made along the way is mentioned.

The detailed, written exposition of these events in the Torah is reliable testimony, according to Maimonides, that these miracles actually occurred.

Whatever historical comments one may make about that statement by Maimonides, the point is clear: details, like the listing of the stops the Children of Israel made in Sinai, often reflects honesty and more often comes closer to the truth.

The opposite also holds true: sweeping generalizations, may, in fact, be an attempt to mask the actual facts of an event.

And that is true in our own lives today as well. Often, not always, the more details of an event you hear, the more likely it is that that account is true.

Integrity, telling the truth is so important. Like our Rabbi Miller has said many times: Everything between you and your fellow human being, and everything between you and God is a question of contracts or deals. If I do this for you, can you do that for me? 
So, when I pray to God and in the process change my ways, God honors that deal by answering YES to my prayer.

And as we end one of the Books of Torah today, we say:


Shabbat Shalom!


Forest's experience at St. Louis' Barnes-Jewish Hospital

Being one of maybe 300,000 people in the US living with a condition called Hypertrophic Cardiomyopathy (HCM), my friend, Forest, may not have the most common medical “affliction” there is. However, it may be an under diagnosed condition as the symptoms are not that specific: shortness of breath, chest pain, palpitations, light-headedness and blackouts. It is likely that many more people, who have had this condition since birth are HCM patients. 

What is HCM? 
The main feature of HCM, hypertrophic cardiomyopathy, is an excessive thickening of the heart muscle (hypertrophy literally means to thicken). A fuller name of this condition is HOCM (hypertrophic obstructive cardiomyopathy). Obstructive means that the blood flow through the heart is hindered. This obstruction varies, but the symptoms mentioned above, most noticeably the shortness of breath, become more pronounced the more obstruction a patient displays. 

As mentioned above, this is a genetic disorder and the exact causes of why certain individuals are born with this condition are not known, but they are being studied. Washington University School of Medicine is participating in nationwide studies trying to determine the genetic make-up in patients with HCM. 

As the symptoms are so general, diagnosis of HCM is not straight forward. In Forest’s case, he was in pharmacy school in a mixed medical and pharmaceutical program, and learning how to read their own EKGs was part of the Physiology course. A teacher saw an abnormality in the readout and shrugged his shoulders and said: “Probably nothing”. When applying for a job, the presumptive employer requested a clarification. Forest was put in the hospital and a heart catheterization was performed. But the most common way to diagnose and evaluate HCM is by an echocardiogram (ultrasound). This method provides pictures of the heart's valves and chambers. 

Treatment is entirely dependent on the symptoms. For the longest time, Forest didn't have any symptoms at all and consequently there was no need for any medication or to have anything “done” to him. When shortness of breath and palpitations start to occur, the fist line of treatment is medication. Different kind of drugs are used, most common are so called beta blocker drugs, such as Toprol, Inderal, Tenormin and others. Another group of drugs are called calcium blockers such as Procardia, Norvasc, Cardizem , and Adalat but they have become less popular, especially in Europe, and it seems like this is the trend here in the US also.  

Another group is called anti-arrhythmic medications, such as Cordarone and Norpace. 

Surgical options: 
Surgical options are to be considered only if medications do not sufficiently relieve symptoms. They include surgical procedures such as alcohol (ethanol) ablation or septal myecotomy or an implantable device such as a pacemaker or Implantable Cardioverter Defibrillators (ICD). 

In Forest’s case, he had experienced palpitations that were originating in the atria (the upper, smaller chambers of the heart). These had become more and more common and it was determined that they were due to his HCM. While the so called atrial arrhythmias aren't pleasant to go through, they are not considered life threatening. A few years ago, there was an event that was unpleasant and potentially much more dangerous: he woke up early one morning with palpitations, went to the bathroom. His wife got worried, and all she heard was: “I don't feel so well”, then he fainted.  

Subsequent consultations with doctors made them conclude that Forest most likely had what's called ventricular arrhythmias, meaning the event originated in one of the ventricles (the larger, lower chambers of the heart). This is definitely much more serious. 

So, the decision was made to implant a device called an ICD in the chest. This device, a combination of pacemaker and defibrillator acts as a safeguard in case the heart would start developing irregular rhythms. The defibrillator is a device that senses the rhythms of the heart and if it notices that the heart is beating faster and more irregular than desired, it can give a shock that will force your heart into normal rhythm. This device saves lives every time it is used. 

Barnes-Jewish has a support group for people that have this device and the other members have described what it is like to have it shock you, (“like being kicked by a horse), but, as they all say, “it is better than the alternative”. 

The Pacemaker part of the device is essentially “opposite”: if the heart slows down too much, it “paces” the heart and it can be set at different heart rates. 

Alcohol ablation and septal myecotomy
As the problem with HCM is the excessive thickness of the heart muscle, researchers thought that making that muscle thinner would allow the blood to flow freer. So, knowing that a heart attack “kills” heart muscle tissue, the researchers reasoned: “what if we were to induce a very limited, controlled ‘heart attack' and thereby reduce superfluous tissue that prevents the HCM patient's blood flow”?. So the next question became: How would we go about doing that in a safe way, without risking damaging too much and still reduce the obstruction enough to improve the patient's symptoms? 

In the mid 90's researchers in Europe answered this question by using a tiny amount of alcohol to accomplish this, and in 1996 the first such procedure was performed in the US. Dr. Richard Bach has been doing this procedure for seven years with very successful results. 

The procedure in short involves a catheterization, meaning that a catheter is inserted in the groin and quickly moved to your heart muscle. At the end of the catheter, there is a tiny balloon that is controlled via the catheter. During the procedure an echocardiogram is performed so that the doctor can follow the catheter. 

When the balloon reaches the area of the heart that the doctor has determined being the best candidate for ablation, the alcohol is then released. 

Now the main advantage of this procedure is that it is essentially non-surgical, non-invasive, the recovery time is very short, and the “side-effects” are virtually non-existent. 

The issue when you are inserting the catheter into the heart muscle's arteries is to find the “correct” artery, and to “thread” it exactly to the right spot. 

What was unique with Forest’s procedure? 
The arteries in Forests’ heart – as is the case in many other patients – don't look as neat as in anatomic drawings. They are not linear or straight nor easy to get into. They are often curved, with angles and more circular looking, like noodles interspersed with each other. 

If you imagine a belt you put into your pants, you can push the belt just so much before it gets real tough. What you do, probably without thinking about it, is to switch from pushing to pulling; you switch hands and start pulling from the other side. In order to do the same with a catheter, you need to use a magnet that will be held over your chest. The tip of the catheter has been equipped with a ferrous (iron) ending and that allows the magnet to “pull” the catheter exactly where the doctor wants it to go. 

However, in Forest’s case, not only did he have the “spaghetti-looking” arteries, he also had the ICD (Defibrillator/Pacemaker) implanted. The device is literally a small computer. Everybody is familiar what happens if you take a computer disk and put it close to a magnet: all of the data disappears and the best you can do at that point is to throw away the disk. The magnet may damage the ICD and thus eliminate the protection that this device is meant to provide. 

So, the question became, can we use the magnet to guide the catheter in a patient who has a defibrillator/pacemaker implanted? 

Well, Dr. Bach and the other researchers felt that as more and more people are equipped with ICDs and more and more people have reasons to undergo tests like MRI, (which use magnets), finding out the answer to this question would be very valuable. 

So, they found Forest, who fit into the prerequisites exactly and he was asked if he were willing to be the first, the pioneer, or the guinea pig, and he realized that the “worst” possible outcome was that the ICD would need to be replaced, and he decided he could accept that risk. 
Forest was in the hands of a very competent team of the best doctors in the Midwest, maybe in the country, and he felt confident. His referring cardiologist is extremely conservative when it comes to any procedure and for him to recommend this to Forest, he knew he was safe. 
The process was totally pain free, quick and without complications, Forest reported after the procedure which took approximately 4 hours. He was under local sedation but he fell asleep after a while and was woken up when it was done and he saw some very smiling faces belonging to the doctors who had performed the procedure. They moved him to the CCU (Coronary Care Unit) where he was monitored for rhythms and for oxygen, blood pressure and such. 

The procedure took place late one afternoon, and the following day, they let him out of CCU and into a room on the regular floor. 72 hours later he was allowed to go home. 

The after effects are the reminders of the catheters in the groin and that is to be expected. But the tenderness went down and was almost entirely gone 2 days after he was home. He was able to do light work the day following his release. The instructions were to walk and try to get into shape and not be afraid to exercise - although lightly at first. 
The idea is that more regular exercise should lead to less shortness of breath than before this procedure. How much less? It varies, of course. Some patients experience dramatic improvements and very soon after the procedure. Others more gradual and less striking progress. 

The last option 
It was mentioned above that the treatment options include something called septal myecotomy. This means that part of the thickened heart muscle is removed through surgery. This obviously requires so called open heart surgery, from which the recovery time is longer and the surgical risks and after effects are much more severe. There are patients for whom there are no other alternatives than to go through this much more invasive process.

In contrast to the septal myectomy , the alcohol ablation procedure stands out as effective, “quick and painless”, with a comparatively short hospital stay and little “after effects”.