Started the amiodarone and Eliquis--the blood thinner--yesterday with breakfast. They made me a little whiffy, that is airy-fairy, that is, light-headed. But that soon passed and the day went normally. In fact, we pushed back to our regular routine of getting a load of boxes into the 4Runner and out to the storage unit. No problem with palpitations last night from that exertion, or the excitement of a good piano lesson, or lunch with a bud. Not so much whiffiness with the second dose at supper. And, maybe not so much this morning, either. Also, seemingly slept quite well. But I can feel it. The next goal is to get back to my regular workouts.
More as it happens...
Thursday, May 25, 2017
Tuesday, May 23, 2017
some clarity?
Since I last posted I have seen two docs--one in the heart failure unit of IHC and the other from the Heart Rhythm group in the same shop. Neither of them (plus the new heart doc in Logan) seem too concerned. The heart failure doc said I will probably be dealing with this the rest of my life in some form or another. Once a dicky ticker, always a dicky ticker. But there are, as we earlier hypothesized, a couple alternatives left. One is to go back to some heart rhythm medicine--amiodarone in particular, along with a blood thinner. The other is to go back on the table. Chances of going right to a pacemaker: pretty low. Rhythm doc said they probably created this new short circuit with the scar tissue from last year's ablation. He owned it! We had a nice long discussion and with Jan's help, settled on the least invasive procedure, for now, the meds. The discussion included the amiodarone's side effects: it is toxic to lungs, liver, kidneys in the long run. But he thinks that after a full dose for a month I can try a half dose and see whether that keeps the gallops away. There was an alternative drug but one had to spend a couple days in hospital to make sure that it didn't become fatal. Apparently some people don't tolerate it well. But what if the two days weren't enough and one went home and then it was fatal? Didn't bear thinking about that too long. The upside apparently was that if one could tolerate it, in the long run it had fewer side effects than the amiodarone. So, I picked up the drugs on the way home, and had a cold draft with lunch. What me worry?
Sunday, May 21, 2017
positive bad news?
Another episode last evening. I was changing into some lounge pajama pants for the evening's TV fare and in so doing felt my let-down reflex occur. That is, all of a sudden my body just relaxed. Almost immediately my heart kicked into high gear. The first reading showed 160 bpm. I did several val salva maneuvers to little effect. Then Jan tried lifting my legs straight up from a prone position while I bore down. Still no change. Readings around 174. Oxygen levels still good. So I tried sitting on the toilet--fully clothed--since that is the position we are almost all in when we val salva every day. Instant conversion! HR dropped into the low 100s and then into the 90s. Yahoo! So, the bad news is the recurrence. The good news is that I (we) were able to stop it from continuing and thereby avoided another ER journey. It may be notable that these incidents are seemingly related to the parasympathetic branch of the autonomic nervous system. They usually start when I am relaxing in the evening. Perhaps the inhibitory nature of the sympathetic nervous system which keeps one alert and humming prevents the heart from speeding too much? For example, I have yet to have a tachycardia episode during a workout. They always occur sometime later when I am not active.
I was told by the last ER doc not to exert and Friday I was good--hung out, showered, puttered a bit, practiced, read--a nice day. And nothing happened, but then I have, to this point, not had these as a daily occurrence. Yesterday, I stepped it up a little, very little I thought. A local concern had a warehouse sale of linens they manufacture. Included were their gel foam beds. We bought a bunch of stuff that was knocked down 70% to make way for new product lines: a queen mattress, pad, frame, sheets, pillow cases, etc. Since these were all beautifully boxed they could just fit them into the Mazda. We drove directly to the storage unit and schlepped the boxes into it. We shared each box and even scooted one of them. It was really very little exertion. I hope this level of involvement is not too much for me henceforth since it will make me a virtual invalid. But--see above--the inevitable seemed to follow.
On the way to SLC today to begin the med rounds tomorrow a.m.
I was told by the last ER doc not to exert and Friday I was good--hung out, showered, puttered a bit, practiced, read--a nice day. And nothing happened, but then I have, to this point, not had these as a daily occurrence. Yesterday, I stepped it up a little, very little I thought. A local concern had a warehouse sale of linens they manufacture. Included were their gel foam beds. We bought a bunch of stuff that was knocked down 70% to make way for new product lines: a queen mattress, pad, frame, sheets, pillow cases, etc. Since these were all beautifully boxed they could just fit them into the Mazda. We drove directly to the storage unit and schlepped the boxes into it. We shared each box and even scooted one of them. It was really very little exertion. I hope this level of involvement is not too much for me henceforth since it will make me a virtual invalid. But--see above--the inevitable seemed to follow.
On the way to SLC today to begin the med rounds tomorrow a.m.
Friday, May 19, 2017
..ad nauseum
Yesterday's episode began as I was finishing a snack of hummus and a cracker before dinner. I felt the now familiar adrenalin surge followed by my heart beginning to palpitate. I walked quickly to the bedroom where my oximeter/pulse meter was and read a 174 bpm. I tried several val salva maneuvers including the imitation of a person blowing up a balloon. No clear result. We got in the car and headed for the ER--again. They reacted quickly. This time, alarmingly, they strapped on shock electrodes for possible use. EKG showed the high rate with lots of PVCs, but they said the rhythm looked stable, though fast. The ER doc had me lie flat, take a breath and hold while exerting the downward abdominal pressure of the val salva maneuver. At the same time, he lifted both my legs straight up as though he was stretching my hamstrings (which he did a little). Down came the HR! Everyone was happy. An X-ray to see whether there was anything about lung condition contributing to this was negative. Blood lab was normal. 90 min after arrival, I was on the way home, with the admonition not to exert myself. Didn't seem as though I was before the onset of the PSVT. I did have a stimulating lunch with friends and this seems to correlate with an attack later on only because I am always lunching with friends. Yesterday I had a good morning at the piano and did no lifting, so exertion seemed minimal.
I did find out that on the prior ER visit I was given adenosine. It is quick acting and stops the heart for a second or two. They also administered a rate stabilizer (diltiazem) and as I mentioned in a prior post, some Xanax (alprazolam)
Cardiology Consult
I wanted to establish a relationship with a local cardiologist in the same clinic in which my primary care occurs. A new doc replaced the cardiologist I started seeing the prior year just before he retired. We had a good discussion. His analysis: I am headed for another ablation. He will watch from the sidelines. As it happens, I am scheduled next week for a session with the doc who did the prior ablations. He moved very quickly with those when my heart was cleared by the heart failure team last year and I expect he will move quickly again. That appointment is 4 days hence. The day before that I meet with the heart failure clinic.
There are risks with an ablation for recurrent PSVT. Apparently there are two pathways close together that communicate from ventricles to atria. One needs to go. But sometimes both are inadvertently ablated because they are so close. At this point ventricles and atria cannot communicate leading to a pacemaker implant. The new doc was surprised that they didn't do a PSVT ablation at the same time they did the atrial flutter and atrial fibrilation ablations last year. He said that while atrial ablations are about 70% effective, about 90% of PSVT ablations are usually effective. We'll see about all of this on Tuesday in consultation with the experts.
I did find out that on the prior ER visit I was given adenosine. It is quick acting and stops the heart for a second or two. They also administered a rate stabilizer (diltiazem) and as I mentioned in a prior post, some Xanax (alprazolam)
Cardiology Consult
I wanted to establish a relationship with a local cardiologist in the same clinic in which my primary care occurs. A new doc replaced the cardiologist I started seeing the prior year just before he retired. We had a good discussion. His analysis: I am headed for another ablation. He will watch from the sidelines. As it happens, I am scheduled next week for a session with the doc who did the prior ablations. He moved very quickly with those when my heart was cleared by the heart failure team last year and I expect he will move quickly again. That appointment is 4 days hence. The day before that I meet with the heart failure clinic.
There are risks with an ablation for recurrent PSVT. Apparently there are two pathways close together that communicate from ventricles to atria. One needs to go. But sometimes both are inadvertently ablated because they are so close. At this point ventricles and atria cannot communicate leading to a pacemaker implant. The new doc was surprised that they didn't do a PSVT ablation at the same time they did the atrial flutter and atrial fibrilation ablations last year. He said that while atrial ablations are about 70% effective, about 90% of PSVT ablations are usually effective. We'll see about all of this on Tuesday in consultation with the experts.
Tuesday, May 16, 2017
..and, again!
Almost identical precursors for this week's episode. Watching TV--we just started to stream The Americans. This is a spy drama about two Soviet-era spies posing as a happy family (which they are) while Mom and Dad do their nefarious business. Half way into the first episode I felt the now familiar palpitations of my heart doing more than pitty-pat. The sensation seems to move my body away from the back of my easy chair--it is that strong. My oximeter read 174 bpm. I tried some val salva maneuvers in place to little effect. So, off we went once again to the ER. The receptionist saw me coming and said, high heart rate? And I said yes. (The joys of small town living.)
This time the episode continued into the ECG. The ER doc decided to administer a med via IV that would briefly pause the heart--within a couple seconds--to allow the heart's own pacemaker to re-assert itself. This worked. The rest was the usual. Blood draw to check for unusual stuff. None detected. Lie there until vitals are stable. Home after a couple hours. Call the regular doc this morning to see how to proceed. The night's sleep was foreshortened but good, probably assisted by a small dose of Xanax administered in the ER to aid my anxiety.
Self-Analysis
We had a pretty big weekend prior to this. It involved a couple large meals and more than usual alcohol intake. We did our annual pilgrimage to Jackson WY to visit Signal Mountain Lodge where Lisa and Stephanie used to work. This meant dinner at the Blue Lion in Jackson where I ingested a full rack of lamb chops. This meal was preceded by a Manhattan and appetizers and accompanied by a bottle of wine shared with my wife and daughter. Of course it was followed by a shared desert. Later at our cabin by the lake I drank a beer with our host. I slept well on the usual BIBPAP and O2 combination, unlike the preceding year when we left in the middle of the night and my downward slide into heart failure really began.
Breakfast was a granola bar and oj in the cabin. Lunch was back in Jackson at the Wort where we all had their superb corn chowder and I followed that cup with a beef pot pie. No alcohol. We walked the streets a little and then I repaired to the car to read while the women shopped.
Dinner was in the bar at Signal. It consisted of appetizers--wings and nachos accompanied by a couple margaritas which were followed by fish and chips. You can see that this is a seriously compromising nutritional set of affairs.
Sunday morning was the full breakfast in the Lodge--eggs, sausage, hash browns, etc. The big meal at 3 pm in the dining room is their seasonal opener. Appetizers were a cheese board and trout cakes followed by prime rib and a shared desert. The three of us shared a bottle and a half of wine while our host confined himself to beer.
Monday morning on the way home we had breakfast at The Bunnery in Jackson and that again involved the full meal deal: eggs, sausage and pancakes.
All of this detail is provided to show that I was seriously off the rails in many respects. But the weekend was relaxing overall. We read and slept. I felt little anxiety.
We all had a look at our new property upon return to Logan and watched the beehive of construction activity on the development. Wow! Lunch was a Cuban sandwich at Even Stevens. Thereafter I had a good one hour nap.
Late afternoon I sat at the piano and started to practice. Almost immediately things did not go as well as I would have liked and I felt frustrated and angry. Since I have a lesson on Wednesday I could feel anxiety well up inside. I continued to play. Jan was packing boxes around me and I was tasked with deciding which of a number of generations of cords, computer parts and etc we should keep and which should be sold and which should be given away. I did it, though I could still feel the frustration and anger.
We had a pleasant supper of a couple croissant sandwiches we had brought from The Bunnery with a glass of wine. I watched an hour of Rachel Maddow on the daily Trump miscues and didn't feel especially energized by it. Then came the Americans and the rest is history.
So what in all of this is relevant to my condition? Who the fuck knows? I have not had this internal welling up of frustration and anger that seems to follow or is caused by an adrenalin bump before. Somehow this appears to set the stage for a later trigger--hot news or a thrilling program or some such to lead to the PSVT.
And it is not at all good that the interval between these events is decreasing and the events are lasting longer.
Stopping now and calling my regular doc, though I expect little help. I am on schedule for the Heart Failure Clinic and the Rhythm Specialists early next week in SLC. Can't be soon enough.
This time the episode continued into the ECG. The ER doc decided to administer a med via IV that would briefly pause the heart--within a couple seconds--to allow the heart's own pacemaker to re-assert itself. This worked. The rest was the usual. Blood draw to check for unusual stuff. None detected. Lie there until vitals are stable. Home after a couple hours. Call the regular doc this morning to see how to proceed. The night's sleep was foreshortened but good, probably assisted by a small dose of Xanax administered in the ER to aid my anxiety.
Self-Analysis
We had a pretty big weekend prior to this. It involved a couple large meals and more than usual alcohol intake. We did our annual pilgrimage to Jackson WY to visit Signal Mountain Lodge where Lisa and Stephanie used to work. This meant dinner at the Blue Lion in Jackson where I ingested a full rack of lamb chops. This meal was preceded by a Manhattan and appetizers and accompanied by a bottle of wine shared with my wife and daughter. Of course it was followed by a shared desert. Later at our cabin by the lake I drank a beer with our host. I slept well on the usual BIBPAP and O2 combination, unlike the preceding year when we left in the middle of the night and my downward slide into heart failure really began.
Breakfast was a granola bar and oj in the cabin. Lunch was back in Jackson at the Wort where we all had their superb corn chowder and I followed that cup with a beef pot pie. No alcohol. We walked the streets a little and then I repaired to the car to read while the women shopped.
Dinner was in the bar at Signal. It consisted of appetizers--wings and nachos accompanied by a couple margaritas which were followed by fish and chips. You can see that this is a seriously compromising nutritional set of affairs.
Sunday morning was the full breakfast in the Lodge--eggs, sausage, hash browns, etc. The big meal at 3 pm in the dining room is their seasonal opener. Appetizers were a cheese board and trout cakes followed by prime rib and a shared desert. The three of us shared a bottle and a half of wine while our host confined himself to beer.
Monday morning on the way home we had breakfast at The Bunnery in Jackson and that again involved the full meal deal: eggs, sausage and pancakes.
All of this detail is provided to show that I was seriously off the rails in many respects. But the weekend was relaxing overall. We read and slept. I felt little anxiety.
We all had a look at our new property upon return to Logan and watched the beehive of construction activity on the development. Wow! Lunch was a Cuban sandwich at Even Stevens. Thereafter I had a good one hour nap.
Late afternoon I sat at the piano and started to practice. Almost immediately things did not go as well as I would have liked and I felt frustrated and angry. Since I have a lesson on Wednesday I could feel anxiety well up inside. I continued to play. Jan was packing boxes around me and I was tasked with deciding which of a number of generations of cords, computer parts and etc we should keep and which should be sold and which should be given away. I did it, though I could still feel the frustration and anger.
We had a pleasant supper of a couple croissant sandwiches we had brought from The Bunnery with a glass of wine. I watched an hour of Rachel Maddow on the daily Trump miscues and didn't feel especially energized by it. Then came the Americans and the rest is history.
So what in all of this is relevant to my condition? Who the fuck knows? I have not had this internal welling up of frustration and anger that seems to follow or is caused by an adrenalin bump before. Somehow this appears to set the stage for a later trigger--hot news or a thrilling program or some such to lead to the PSVT.
And it is not at all good that the interval between these events is decreasing and the events are lasting longer.
Stopping now and calling my regular doc, though I expect little help. I am on schedule for the Heart Failure Clinic and the Rhythm Specialists early next week in SLC. Can't be soon enough.
Wednesday, May 10, 2017
one more, once?
Honey, it happened again! Last night I was watching the brouhaha following the James Comey firing and I felt my heart pounding. I quickly took my pulse with my oximeter and recorded a 160 bpm. Jan was at a book club session. I tidied up around me and prepared to drive myself to the ER--about a 12-min shot--and took one more reading. 174 bpm! So I got in the car started down the road and called Jan who met me at the hospital.
The ER was somewhat busy. A life flight helicopter was on the pad spooling down and an ambulance was in the loading bay. People were standing in the seating area. The admit-person always alerts when one presents with a high HR, but no one came to get me for a good 5 min. Once in the room I joked how they better hurry with the ECG otherwise they could miss the event. The ECG cart was there quickly and they wired me up. A joke happened. I don't know whether I cracked it or someone else did. But I had a good laugh and my heart rate came crashing down to normal. They all gasped because it happened quickly. And once again the ECG missed most of the event.
The rest was routine: heart in normal sinus rhythm; blood draw; wait for labs; find out labs are perfect; wait for paperwork; go home.
They label this presentation PSVT for Paroxysmal Supra-Ventricular Tachycardia. That = above the ventricles; high HR. I think it is a post-endocrine dump event. The interesting thing is that it appears to occur sometime after the stress that produces the endocrine dump, almost like a rebound effect. The dumper here is undoubtedly the adrenal system. Can I point to stress before both of these events? Oh yes. Let me count yesterday's ways.
1. Yesterday (Tu) was a day after my work out on Mon--which was the same sequence in the prior event. In fact, the day of the week was the same. The event occurred in the evening in both occurrences. Both times I was sedentary when the event began. Last night's was earlier in the evening. During the day I did some lifting of boxes. I practiced my piano for several hours. I had lunch with my same buds as the prior event. (What is it about them?)
2. Psychological stress is high right now. The famous scale that shows the levels of stress in uncommon human environments ranks death of a close family member as first, divorce as second, and moving as third. WE ARE MOVING.
We have accepted an offer on our home and the deal will close August 1, all else equal. We have chosen a lot and a home to build. All of this took much mental energy. The home will require at least 5 months of construction. We will be homeless for several months. We have been looking for an apartment in an extremely tight market. We have been working our finances hard. We are packing daily and moving non-essentials to a storage unit. There are discussion tensions between Jan and me owing to the known unknowns. Many plates are spinning in the air.
Yesterday, the contractor resolved many financial questions when he offered to build the home for us on spec. We will make a down payment to get construction going with the remainder of the home's cost due when our house closes. Our down payment will be returned to us if our house fails to sell. This is all win-win. I think we felt immense relief. We are accepting this deal. Tension should should decrease, no?
3. I got engrossed in the drama of the Washington Follies, ie, the James Comey firing, yesterday late afternoon and was still watching the analysis when the attack occurred. I was highly stimulated by what was occurring, especially by the thought that our democratic system was being tested, and had been so stimulated for several hours.
This is different from the prior event as there was concurrent stimulation, so this might have been a direct response to a high adrenalin flow, rather than some sort of rebound effect.
I will have to reflect: I don't recall the prior time, but last night there was no pre-prandial alcohol. One wonders. It may have been ameliorative.
Wiki says that stimulants such as caffeine and nicotine and psychological stress may be involved. So, I am at least one out of three. I did drink quite a bit of tea yesterday--a couple cups with breakfast and several at a sushi lunch. One can apparently try the valsalva maneuver which is pressing down as though trying to have a bowel movement. Or pretend to blow up a balloon. Quickly, pass me a trumpet! Next time I will try one of these methods to see if they have any effect. Because if this continues the rhythm docs will want to get involved again with their cardio-versions (shocks) and ablations.
Probably not the end of this.....
The ER was somewhat busy. A life flight helicopter was on the pad spooling down and an ambulance was in the loading bay. People were standing in the seating area. The admit-person always alerts when one presents with a high HR, but no one came to get me for a good 5 min. Once in the room I joked how they better hurry with the ECG otherwise they could miss the event. The ECG cart was there quickly and they wired me up. A joke happened. I don't know whether I cracked it or someone else did. But I had a good laugh and my heart rate came crashing down to normal. They all gasped because it happened quickly. And once again the ECG missed most of the event.
The rest was routine: heart in normal sinus rhythm; blood draw; wait for labs; find out labs are perfect; wait for paperwork; go home.
They label this presentation PSVT for Paroxysmal Supra-Ventricular Tachycardia. That = above the ventricles; high HR. I think it is a post-endocrine dump event. The interesting thing is that it appears to occur sometime after the stress that produces the endocrine dump, almost like a rebound effect. The dumper here is undoubtedly the adrenal system. Can I point to stress before both of these events? Oh yes. Let me count yesterday's ways.
1. Yesterday (Tu) was a day after my work out on Mon--which was the same sequence in the prior event. In fact, the day of the week was the same. The event occurred in the evening in both occurrences. Both times I was sedentary when the event began. Last night's was earlier in the evening. During the day I did some lifting of boxes. I practiced my piano for several hours. I had lunch with my same buds as the prior event. (What is it about them?)
2. Psychological stress is high right now. The famous scale that shows the levels of stress in uncommon human environments ranks death of a close family member as first, divorce as second, and moving as third. WE ARE MOVING.
We have accepted an offer on our home and the deal will close August 1, all else equal. We have chosen a lot and a home to build. All of this took much mental energy. The home will require at least 5 months of construction. We will be homeless for several months. We have been looking for an apartment in an extremely tight market. We have been working our finances hard. We are packing daily and moving non-essentials to a storage unit. There are discussion tensions between Jan and me owing to the known unknowns. Many plates are spinning in the air.
Yesterday, the contractor resolved many financial questions when he offered to build the home for us on spec. We will make a down payment to get construction going with the remainder of the home's cost due when our house closes. Our down payment will be returned to us if our house fails to sell. This is all win-win. I think we felt immense relief. We are accepting this deal. Tension should should decrease, no?
3. I got engrossed in the drama of the Washington Follies, ie, the James Comey firing, yesterday late afternoon and was still watching the analysis when the attack occurred. I was highly stimulated by what was occurring, especially by the thought that our democratic system was being tested, and had been so stimulated for several hours.
This is different from the prior event as there was concurrent stimulation, so this might have been a direct response to a high adrenalin flow, rather than some sort of rebound effect.
I will have to reflect: I don't recall the prior time, but last night there was no pre-prandial alcohol. One wonders. It may have been ameliorative.
Wiki says that stimulants such as caffeine and nicotine and psychological stress may be involved. So, I am at least one out of three. I did drink quite a bit of tea yesterday--a couple cups with breakfast and several at a sushi lunch. One can apparently try the valsalva maneuver which is pressing down as though trying to have a bowel movement. Or pretend to blow up a balloon. Quickly, pass me a trumpet! Next time I will try one of these methods to see if they have any effect. Because if this continues the rhythm docs will want to get involved again with their cardio-versions (shocks) and ablations.
Probably not the end of this.....
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