cardiac rehab?

Yesterday I was to start cardiac rehab. On the way to the lab at Logan Regional Hospital I received a phone call from the lab. The caller told me that Medicare would not cover any work they did with me because my last echo-cardiogram showed an ejection fraction of 50+, where 50-75% is considered normal. Apparently one's heart has to be less than efficient at no more than 35% on this variable. If I wanted to continue it would cost me about $150 per session. Since I was only 2 min away by that time we agreed that I would come in and they would provide me with information.

They were very helpful. In the discussion I really found out that I should restart the exercise program that I was doing before the pneumonia(s) commenced last fall. And it involved the usual: an aerobic component (walking; cycling), an anaerobic component (building muscle tone and new muscle), a balance component (standing on one leg), and stretching for a cool down.  In other words pretty much what any complete fitness program would like you to do.  And, of course, I could do that anywhere. So I returned to where I was working out last fall and did some light cycling, some light lifting, just to ensure that I hadn't wasted the morning. (It felt good!)

The only extra benefit, it seemed to me of the cardiac rehab lab was that all the rehabers were remotely wired to a front computer console so that the staff could monitor heart function in each. I would be working out without this feedback.

They also suggested that I start at about 60% of my max heart rate for the aerobic work. Max HR is 220 less one's age, for me, 220 - 77 = 143. 60% of that number is about 86.  Well, I had trouble keeping my HR down to that level during the cycling component of my workout. It wanted to float around 100 and that was doing a lot less than I am used to. I usually set the effort level at easiest (to start) and then pedal around 60 rpm. To keep my HR down I had to reduce that to around 40 rpm. Didn't feel like much of a workout at the time. I only did 10 min. On all of the weight bearing exercises I did a single set at much lighter weights than usual.

Today I feel a bit more tired than usual. And I don't have any serious muscle pulls or pain suggesting yesterday's workout level was about right for starters. 

Onward: a new chapter begins, getting fit once more. 

My only fear now is a return of pneumonia this fall following allergy season.

better news

We were advised to call in after 1 pm on Monday after earlier scheduling put the procedure at 9 am. We did and were told to be in hospital by 2 pm. By 3 we were all checked and by 4 I was on the table.

Several surprises along the way: first, I had converted back to a normal sinus rhythm sometime over the weekend. I could not tell, but probably it was concurrent with my HR returning to normal. Just a guess. Second, what I assumed as a conscious process that would take a few minutes was not. The procedure was described as 3-4 hours! With general anesthetic. Also I found out what kills the rock stars on over medication with the new pain killers: there is no warning. It seemed to me in the past that you could feel yourself going nighty-night and maybe get a joke or two in.  In this one, I asked the anesthesiologist if he had started and he said 2 minutes, then I was gone! Lights out immediately. No chance to say, I need to take an antidote for this. Don't mess with the fentanol family. Also, the procedure required three pokes--two groin, one each side, and one neck. When I had some similar studies done some 27 years ago, it was one poke. They also catheterized me because the procedure required plenty of water in the tools. I am getting tired of being catheterized! So quite a few things were different this time out. The surgical staff had a collective laugh about the crudity of procedures back in the day compared to the current state of the art.

My procedure lasted about 3 hours. I was back in recovery before I was conscious and don't remember the doc talking to Lisa and Jan. I found out later that he said it went well and they had blasted an area that was producing atrial flutter and an other one that was producing a-fib. I didn't know that they differentiated these two conditions. (They had described my Friday experience as atrial flutter; perhaps that was why I was able to recover normal sinus rhythm on my own?) The next day I asked about size of the blast and he said millimeters. He also is not worried about diet or exercise; I can start cardiac rehab right away. (I think I'll give it a few days,) No heavy lifting, but that was about all.

I feel pretty darn good, better than when they had got my heart back to an ejection fraction of 50+. My appetite is finally returning, making my quest to maintain my current weight of 220 more challenging. But we are determined to go low salt/sodium and count calories, and measure water intake.

So while this seems like an end, there is the matter of the heart doing its own thing. Many of these ablations take two runs when another (missed? unseen?) path shows up months or even years down the road. A friend who lives down the road in our neighborhood was out chopping weeds when I called on Friday. He had to go back for a second. The second ablation was much more successful. But my doc said he was optimistic. But who knows, he may always be optimistic.

Cautiously, it may now be time to really heal....

Thanks to all of you who follow/lurk on this blog for your best wishes. They are highly valued.

bad news

Well, I am back in a-fib. HR currently is 171 and has been fluctuating between 150 and 170. We are headed directly to SLC where they will do an ablation of whatever wonky circuits they can find. That is scheduled for sometime Monday with an over night stay in the hospital. I will be in a-fib until that time, so they must think I can manage until then. I am to take action if I get anymore "symptomatic" which I take to mean start passing out, etc.

All was going swimmingly this morning. Jan and I were preparing a down-and-back run to N SLC for her to get her hair done. I stood up from the dining room table and was immediately dizzy. I reported the symptom by telephone. Thereafter I found that my HR was up and was not coming down so I called the Clinic Nurse who suggested in light of the rapid HR that I hie to the emergency room here in Logan for an ekg. Then I recalled that I was still wearing the 30-day holter monitor so after switching extensions a few times the e-phys people were able to tell me that I was in a-fib.  Saved an ER trip here in Logan. 

The e-phys people are going directly to the ablation since I have already had two cardio-versions, the shock treatments. And I am supposedly on a rhythm drug, the amiodarone. The occurrence this morning suggests that those were temporary fixes.

Pacemaker doesn't necessarily follow ablation, but it probably puts me a step closer thereto.

So, to be close to the hospital where the procedure will be done on Monday, we will leave shortly for SLC and squat there with Lisa until Monday. After that, we'll see.

PS: I took some torsemide this morning since I gained a pound overnight. Would this have made me more susceptible to a shift in rhythm?

torsemide and me..

A quick note: Do the docs know what they are doing in my case? Oh, yes they do. Yesterday, with one day on the torsemide, I lost 6 lbs!!! Now back at 218. So, they were absolutely correct, I was starting to carry water again.

I didn't take any this morning because I don't think I have that much more to give. I will wait a day and then re-evaluate. This follows their orders fairly well: they wanted a couple days of torsemide followed by use on an as needed basis.  The only change I have made is to give it a single day.

Having to wear the compression sox. Getting them on and off is taxing, but they do the job. Not much of a fashion statement though.

mostly good news

Jan and I spent what seemed like all day--but was really only 4 hours!--at Intermountain Health Care Center today. I was scheduled for an echo-cardiogram at 10 am. We waited until 11 to be called in. Then a tech came in to give me an unordered EKG. Wires crossed we believe. The echo was (re-?)scheduled for 1 pm. (We think that was a result of the earlier EKG screwup.) So there was nothing to do, but sit outside in the sun and have a yogurt and await 1 pm. That appointment started on time! And went swimmingly.

The echo-cardiogram, as most of you who are old enough know, is where they slide a gelled up ball over your chest (or other body parts) to see inside and take 70+ pix, in this case, of the heart. I was mostly interested in the ejection fraction number. Recall that a normal echo for me last Oct showed about 55%, which is in the normal range (ie 55-70%).  Upon entering the hospital a few weeks ago in a-fib it was about 15%. Today it was 55% again! Yea! That's substantially good news. I am on no heart medication because my heart is mostly normal. (There is some subjectivity in the 55 number; the normal error range  is + or - 3, so it could be as low as 52 or as high as 58, and not be significantly different. (One cardiologist thought I was probably around 50.)
.
Then why am I still getting some trace edema? Skinny feet in the am; fat feet by evening. Well, apparently my atria are somewhat sclerotic, which means less pliable than they once were. So, whilst my heart is squeezing wonderfully (see ejection fraction above) the upper chambers don't rebound like they used to.

So, it is back on a minor dose of torsemide (20mg) for a few days along with potassium for kidney function. The clinic was concerned that I have gained about 4 pounds (219 to 223 this morning). But the weight gain has been gradual, so we weren't concerned. Since Jan makes me assiduously count calories, I know I have been under 2000 daily since we left the hospital. Ergo, there should be no weight gain. The docs think it may be water weight. Therefore, a di-uretic. If I have not lost the 4 lbs by Friday, I am to call the clinic. So, that is a fly in the ointment.

They were also going to take my heart monitor off this morning and we could have left it there with them. Jan even went to the car to get the package. However, this decision was reversed when the doc actually looked at the data and found (8 seconds!) of V-tach across the two weeks of my using the device. It occurred on a Monday night at 8:30 pm a couple weeks ago. Was I thinking impure thoughts? I have no idea what was going on at the time, but I do know that I was not symptomatic. So I have to do the complete 30 days. Oh well, that is only about a week more.

Other than the small glitches and our impatience, all-in-all, a pretty good day.

much ado...

Awoke yesterday and weighed immediately, which I usually do, on Jan's wonderful Weight Watchers' scales. Up 2.7 lbs! Alarm bells. I am supposed to call in to the Cardiac Nurse if a sudden weight gain--which in this case is over 2 lbs in a day--so I did. What amazed me most was that I got a quick call back from one of the PA's on the unit who was clearly up on my case.  Granted in the 5 min it took for her to return my call she could have (and should have) examined my file. But I remember doing case reviews as a consulting psychologist. All the ongoing cases are reviewed, say, once a week, by the complete staff, so it is highly likely that she didn't have to do much review at all. In any case,  she was back quickly.  She listened to my activity level report for the day before (a fair amount what with picking up Jan's car which still had a couple problems), getting my car gassed, and doing some driving. 

Of course the worry is about edema. As reported, when I checked into the hospital a couple weeks before, I had a bunch.  Daily, I am awakening with pretty skinny feet and ankles except that by the end of the day, my feet and ankles are swollen again. Without weight gain, and until this I was without weight gain, not a problem. As my heart gets stronger even this little bit of edema should go away. That's one theory, sure.  Another is that I might have to go on a di-uretic such as lasix on a permanent (?) basis. That also means dosing with phosphate daily. I hope not!

The PA did not want to go to di-uretics because on my first usage, in hospital and thereafter, I dehydrated to the point where one of my kidney measures showed up bad (creatin??). So:

She said, "I want you to have a quiet day". Bang, zip. There went my plans to attend the Annual Cruise In parade.  For those of you unfamiliar with this 34-yr tradition, herewith a synopsis: About 1000-1500 custom cars descend on Cache Valley every summer, about now, for a week of showing their cars (fairgrounds). There are various activities throughout the week. Judging the cars takes place on Saturday afternoon and this activity culminates with a give away (this year a juiced up 1970 Camaro SS) and a parade of the cars. In actual fact almost no one of the judged cars ever participates in the parade. The cars are too expensive to risk it. But every half-finished, half started custom job, or simply the fact that you have a new Ferrari or an old Packard is grounds to pony up the few dollars it costs to enter the parade. The police close a bunch of streets and the cars drive (rev?) through town and, we, the residents sit on our lawns and cheer them on and suck a cold one and inhale exhaust fumes.  All in good sport. 

We usually gather at the home of close friends which is located on the route and thereafter have a potluck dinner in their lovely back yard. Not this year for moi. Damn. Maybe next? 

Usually one can sit at home and watch the judging on a local TV channel. Not this year: technical difficulties (which is monopoly speak for the station has not ponied up the price to be on our cable). Rats, foiled again.

But I had a good book handy and a nice small supper, so while I missed seeing all the clan, I was and am happy.

This morning, the feet are skinny again and there is no further weight gain. In fact a 1/2 lb loss which is probably within normal daily variation.  Again, in medicine, slow wins.