Losing with Scrum – Epic Four – Coronary Bypass Edition

Note: I, the author, am neither a physician, a dietician, nor a nutritionist. I’m a scrum coach. I’m not selling or endorsing any diet, food, or procedure. I’m applying an agile methodology and mindset to my personal life and sharing it here. 

A Change of Scope

As mentioned in my previous Sprint Report, I’ve been diagnosed with a few heart problems. An angiogram performed on June 14th showed that I’ve got Coronary Artery Disease (CAD) with Coronary Artery Calcification (CAC). On June 23rd, I had a double bypass.

Because of this, I have abnormally and prematurely terminated Epic Three. Here are the reports from this Epic.

Preliminary Indications

When I started this journey, I experienced some physical limitations. During my very first walk last April, I was able to walk for about 1/4 mile before my heart started feeling like it was going to explode from my chest, Alien-style. My heart would beat something like “beat-beat-pause-BIG beat.” I had to stop, catch my breath, turn around, and slowly walk home.

I took subsequent walks slowly, and my heart would go into this off-rhythm less and less. I attributed it partly to the fact I was fat. I’d had a previous encounter with Atrial Fibrillation (A-Fib), and attributed it to that. Because of other things going on in the family and work, I put off getting it looked at.

In May, I visited my primary care physician, and told him, in my “I’m not a doctor, but I can search the internet” voice, that I was experiencing A-Fib and wanted to see a cardiologist. He had an EKG performed, and referred me to the cardiologist, not with A-Fib but because I was throwing “PVCs.” In my experience, PVC was a type of plumbing pipe, but it turns our that PVC also stands for “Premature Ventricular Contractions.”

In order to find the cause of the PVCs, my cardiologist, the excellent Dr. James Ronaldson, prescribed a Stress Test with computed tomography, and the wearing of a portable heart monitor called a Holter. I knew something bigger was wrong when, after the stress test, the testing team had me sit down because something was odd with something called my ST depressions. After the stress test, I looked up ST Depressions and found that they could indicate Coronary Artery Disease. Oh crap.

A few days after the stress test, my wife, Judi, and I were sitting with my cardiologist. To paraphrase the test results, I had a large but treatable defect. There was a bit of urgency getting this addressed. I was told, among other things, to stop exercising.

Angiogram for Mr. Moseley

The next day, three days after my 56th birthday, I was lying on a bed at the Health First Heart Center. My cardiologist was guiding a probe to my heart, waiting to inject a radioactive dye into my heart. A live x-ray was showing on a very large monitor.

The plan at this point was to find the location of the occlusions that were choking my coronary arteries. After we found them, we would place stents in my heart to compress the occlusions, in a process called an angioplasty. I’d be good as new in a few hours. Great plan!

Plans suck.

I watched the dye outlining the arteries and my heart. It was odd that I could actually see the occlusions on the screen. After a new minutes, my cardiologist told me he had to go talk to the interventionist, the doctor who would do the stents. Twenty minutes later, I was in recovery, stent-less.

Rocks in my Arteries

It turns out there’s a thing called Coronary Artery Calcification. When the plaque in the arteries is there for a long time, it can turn to calcium; my coronary arteries were clogged by calcium. Additionally, I had four occlusions, with one downstream for another.

As I understand it, and remember I’m not a doctor, to use a stent to fix a calcified artery, they use what is effectively a very small plumbing snake to get rid of it. The snake chips away of the calcium a little at a time. There are a few risks:

  1. The snake could nick the side of the artery, causing a hole. This is very bad. This could result in a need for emergency open heart surgery, and could cause death.
  2. The snake could chip off a piece of calcium that could go downstream. This could cause a heart attack and, again, emergency open-heart surgery and possible death.

It was explained to me that the overall risk of a complication was ~30%. These are NOT good odds.

The alternatives:

  • Do Nothing – Most comfortable until the occlusions result in the great Blue Screen of Death, and I go into the recycle bin.
  • A Coronary Arterial Bypass Graft (CABG, pronounced cabbage). Bypass surgery. Much more invasive, more painful. A completely different risk analysis.

It’s Bypass Time

Based on the evidence, options, and risk, I’m going to have a coronary bypass. I’m not happy about it, but it’s better than dying, or waiting until I have a heart attack to force me to have one. It’s scheduled for June 23rd.

The Impact on “Losing with Scrum”

I’d been instructed to do no exercise for the time being. At this point, I changed the scope of the Losing with Scrum Project. Specifically, the scope is now recovering from surgery, and that’s all I concentrating on; the risk of divided focus was too great. Epic Four is to recover from surgery.

Why The Emphasis On This?

So you might be asking why I spent so much time on this change of scope? Two reasons.

First, transparency. An agilest is transparent in what’s going on. If you don’t know what’s going on, you don’t know why I made the decisions I made.

Second, to show how plans don’t work. On May 30th, I wrote:

One of the statements of the Agile Manifesto is that its practitioners value responding to change over following a plan. This value statement is at the core of Agile work, and is one reason why Agility is routinely more likely to satisfy customers than a plan-driven mindset. Stuff happens.

To many, this sounds counter-intuitive, but it’s not.

Stuff Happens. There was NO way to plan for this. Before I started working out, I didn’t feel the PVC, and my heart felt normal. Without the PVCs, this would not have been discovered.

Risk Management

The same happens in just about every project on which I’ve worked. Something happens. I’ve had stakeholders replaced in the middle of work, with the new stakeholders having new ideas. I’ve had policy changes, resource changes, disasters, project reprioritization… In this industry, you work long enough, you see it all.

To accommodate this, “Traditional” methodologies will undergo rick analysis. In this process, the project team plays a huge game of “if this then that,” trying to guess things that could happen. For each of these, the team describes how they would mitigate each risk.

The Problem with Risk Management

The problem with this sort of risk management are:

  1. The team spends a good amount of time inventing and solving crises that usually never occur;
  2. The impact of any of these risks, realized, is very hard to guess;
  3. The impact of multiple cascading risks is impossible to judge; and
  4. The team can’t anticipate everything, and so the risk matrix is never complete.

In short, a Risk Matrix is just another inventory, filled far before its need. In lean terms, it’s waste.

The Agile Approach to Risk

This all leads back to the idea of Responding to Change. When things change, Agilists say “Bring It On.” The second principle behind the Agile Manifesto begins:

“Welcome changing requirements, even late in development.”

Any risk encountered can and should be treated as a change in requirements, not to be fought but embraced.

Adjusting to Change and Risk is Why Scrum Works

And this, my friends, is why Scrum is so powerful. My need for bypass surgery was just a change in requirements. I used Agile principles to adjust my personal development activities while I accounted for the new requirements. With Scrum, risk can be handled this way; the team looks at the changing requirements, adjusts, and carries on.

And so, back to the project at hand.

Epic Four Begins!

  • Date: 6/18/2017
  • Epic Definition of Done: Recovered from surgery, as determined by my surgeon.

Stories

As someone trying to lose weight as part of a healthy lifestyle transformation:

  1. I want to stop consuming calories at 8 PM, because my body stores unspent calories overnight as fat.
  2. I want to burn an extra 700 calories each day, as measured by the Watch’s “Move” measure, to ensure that I am getting exercise and maintaining a minimum level of activity. (note: this is adjusted for my recovery period).
    1. TASK: Work out enough to burn at least 200 calories per work day.
  3. I want to get at least 7 hours of sleep per night, because when I don’t my body tries to substitute calories for rest.

As someone recovering from Open Heart Surgery:

  1. I follow the instructions of my physicians to minimize the risk of complications
    1. I sleep on my back, to minimize the chance of sternum injury.
    2. A do not lift more than eight pounds.
    3. I use proper wound-care procedures.

Note that I’ve removed a few stories, notably the one regarding alcohol and diet drinks. I’m more concerned with keeping my current progress than about weight loss at this point, and sometime a soda or a glass of wine might help me through this. I could change the story to minimize them, but at this point I’m just not going to factor them in.

I’ve also left out the stories about lunch and snacks. During recovery, I’ve been told that I will be sleeping a lot. I don’t want to require myself to eat something if I’m sleeping; recovery is more important.

Sprint Results

Epic Four: In Progress

View Epic One

View Epic Two

View Epic Three

View Epic Five



Categories: Epic Four, Scrum for Weight Loss

3 replies

Trackbacks

  1. Losing with Scrum – Epic Five – Three Months Later – Agile Forth
  2. Losing (and Winning) with Scrum – Epic Two – The Scope of the Problem – 351.4 lbs. – Agile Forth
  3. Losing (and Winning) with Scrum – Epic One, 362 Pounds – Agile Forth

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