Well, I was right. The docs came by shortly after I finishing posting yesterday and sent me home to await scheduling for a second ablation. That will begin with check-in on Monday Oct 1 at noon at the mothership in Murray UT. (The nurses at IHC Murray are fantastic!)
Roughly 50-75% of patients profit from an initial ablation--in terms of controling irregular heart rhythms. I did. That procedure bought me a year or two, I think, before a second circuit established itself. Of those who need a second ablation again the percentages are pretty good: 40-60%, I think, profit from that one. A third is possible, too. But by that time I believe they are thinking about pacemakers. One of the PAs said he thought this one would be easy, apparently fairly well localized.
Pacemakers are primarily for supporting low heart rates but apparently can also be programmed with a lower limit and an upper limit. In that case the heart upper and lower circuits are separated and the pacemaker controls it all.
This is probably simplistic but it is what I understand right now.
My first ablation was 4 hours! I expect the same this time. By then it will be late enough that I will have to overnight once again at IHC in the Heart Institute. They pierce the groin in a couple places and don't want you oozing when you leave. So earliest home will be Tues but we might stay in SLC another night to be sure we don't need services quickly.
Notably, I have had a pretty good day today. I came home yesterday speeding along and remained speeding until I went to bed. I was free of speeding today until after lunch when I had a burst for a couple hours. Free at this time (HR 72bpm)
I should note that a maternal cuz in Canada reports that he is living in a-fib permanently since none of the foregoing worked for him at all. He is not the only person I know experiencing this.
Friday, September 28, 2018
Thursday, September 27, 2018
how I spent my 80th birthday...
How about: in hospital? Yep. I am languishing on the 4th floor of the Intermountain Health Center's Heart and Lung Institute in SLC. I am undergoing a trial of tikosyn, a medication for serious heart arrythmias. While it does its job, it is potentially dangerous in that it can increase the qt interval which is the time it takes for the heart to repolarize for another beat, Too long an interval and one can get venticular flutter and other bad things like stroke and death.
The tikosyn protocol involves a dose morning and evening for 5 doses, followed by an EKG each time. So, the possibility of an increase in qt interval means one needs to be in hospital if the worst happens. And it means a 2.5 day hospital stay. That stay began Tues afternoon after meeting with the rhythm pros next door to this building. It ends tonight.
Leading up to all of this is that I am speeding. When the high heart rates began they were of a few minutes duration and seemingly controlled by relaxation. And these speeding occurrences were fairly infrequent, like every few weeks. Two things happened: the interval between occurrences decreased and their length increased to where I felt as though I couldn't control them. (Hint on below: I am speeding right now at 153 bpm and have been for some time.) I even ended up a couple times in the ER in Logan.
So, I have had 4 of the five doses of tikosyn and from my perspective it does not seem that tikosyn is working out. I will know in an hour or so. (Aside: a respiratory guy just came in; he thinks I am getting a procedure since he announced that he will be measuring my CO2 output therein!) What I think is going to happen is that I will get a second ablation. I don't know when--could be as early as tomorrow morning.
More when I know more....
The tikosyn protocol involves a dose morning and evening for 5 doses, followed by an EKG each time. So, the possibility of an increase in qt interval means one needs to be in hospital if the worst happens. And it means a 2.5 day hospital stay. That stay began Tues afternoon after meeting with the rhythm pros next door to this building. It ends tonight.
Leading up to all of this is that I am speeding. When the high heart rates began they were of a few minutes duration and seemingly controlled by relaxation. And these speeding occurrences were fairly infrequent, like every few weeks. Two things happened: the interval between occurrences decreased and their length increased to where I felt as though I couldn't control them. (Hint on below: I am speeding right now at 153 bpm and have been for some time.) I even ended up a couple times in the ER in Logan.
So, I have had 4 of the five doses of tikosyn and from my perspective it does not seem that tikosyn is working out. I will know in an hour or so. (Aside: a respiratory guy just came in; he thinks I am getting a procedure since he announced that he will be measuring my CO2 output therein!) What I think is going to happen is that I will get a second ablation. I don't know when--could be as early as tomorrow morning.
More when I know more....
Sunday, September 23, 2018
trying to get to 80...
Did I mention coffee in the last post? I have only drunk decaf for the last 50 yr. But this past episode seemed to follow coffee somewhat and when I tried to restart tea after my heart failure I found it way too stimulative. Is that what is happening with the coffee now? I felt a little jacked after this morning's cup. Unusual.
I have been having issues with a Bose Soundtouch 300 sound bar synching with an LG-OLED TV. The latest issue is the loss of sound while streaming video on Netflix or Amazon Prime. This morning I believe I found the fix for it--note to self: cancel Geek Squad--and when the sound came on we found ourselves back into a new series that just won 8 Emmys--The Wonderful Mrs. Maisel. To us, this show has been a laugh a minute. Jan was ironing and watching and we binged the series last 3 episodes, that is about 2 hr 20 min of laughs. During the last episode we had a sandwich while we watched. After that I arose and could feel my heart rate go up. These are the exact conditions under which my last palpitation episode occurred. And the conditions mimic those of earlier episodes--digestive system working, feeling relaxed with the natural opiates produced by laughter and by digestion. Then Shazzam.
The episode went on for 15 min before it resolved--it was resistant until that point--at which I thought we had dodged another ER visit--when it shot up again. We left pretty quickly for the ER and I was still ticking at 147 when we arrived. They got the 12-leads on and got a good picture this time. The ER doc said it just looked like supra-ventricular tachycardia. He wouldn't commit to flutter vs fibulation. The rest was the same: blood assay with slightly elevated BNP--not to worry--normal chest X-ray. Lie there watch NFL and read until all the results are returned and go home with a promise to contact my electro-phys doc. Which. I. Will. Do.
He'll have the EKG tomorrow so I will call in the a.m. and get him started and see where this leads....
I am a little less sanguine.
I will complete my 80th year in two days. That means I will turn 80.
I have been having issues with a Bose Soundtouch 300 sound bar synching with an LG-OLED TV. The latest issue is the loss of sound while streaming video on Netflix or Amazon Prime. This morning I believe I found the fix for it--note to self: cancel Geek Squad--and when the sound came on we found ourselves back into a new series that just won 8 Emmys--The Wonderful Mrs. Maisel. To us, this show has been a laugh a minute. Jan was ironing and watching and we binged the series last 3 episodes, that is about 2 hr 20 min of laughs. During the last episode we had a sandwich while we watched. After that I arose and could feel my heart rate go up. These are the exact conditions under which my last palpitation episode occurred. And the conditions mimic those of earlier episodes--digestive system working, feeling relaxed with the natural opiates produced by laughter and by digestion. Then Shazzam.
The episode went on for 15 min before it resolved--it was resistant until that point--at which I thought we had dodged another ER visit--when it shot up again. We left pretty quickly for the ER and I was still ticking at 147 when we arrived. They got the 12-leads on and got a good picture this time. The ER doc said it just looked like supra-ventricular tachycardia. He wouldn't commit to flutter vs fibulation. The rest was the same: blood assay with slightly elevated BNP--not to worry--normal chest X-ray. Lie there watch NFL and read until all the results are returned and go home with a promise to contact my electro-phys doc. Which. I. Will. Do.
He'll have the EKG tomorrow so I will call in the a.m. and get him started and see where this leads....
I am a little less sanguine.
I will complete my 80th year in two days. That means I will turn 80.
Saturday, September 8, 2018
he's baaack!
Well that slightly hubristic blog from last month is out the window. Here's what has happened.
My general condition has been good. I had a brief flutter episode Aug 15 during my workout. A brief pause and it resolved and I completed my program. Then nothing until two days ago on Sept 6. That episode was in the evening after dinner. It, too, resolved quickly. But change occurred yesterday morning. I felt an adrenaline surge with my coffee (decaf) post breakfast. I waited for the high HR to come down. It did briefly, then surged again. It did this for about 6 cycles all with highs in the 147 bpm range. This went on for 2 hours. Then it resolved finally However, I had another episode after lunch which resolved on its own. I was worried because my relaxation procedures were only momentarily effective this whole time.
This continuing resurgence seemed the occasion to contact my rhythm doc. He wanted an EKG of an episode and/or a 30-day monitor. In the past each time I have gone to the ER the episode has been over and the EKG looks pretty normal.
This morning's onset was a textbook copy of yesterday's. Immediately after finishing breakfast and relaxing with the Washington Post up went the HR after an adrenaline bump. I waited to see whether it would resolve with some relaxation. It did. But it returned again in a few minutes. We headed for the ER, about 1/4 mile away.
They hooked me up quickly to an EKG, 12-lead machine. It was all normal except for a PVC. However, on the 3-lead machine to which one remains hooked a few minutes later they caught an episode. HR bumped up into the 140s. ER doc said it looked like flutter, not fib. An enzyme symbolic of heart failure, BNP: B-Type Natriuretic Peptide, was slightly elevated. ER doc suggested a much greater increase would be necessary to talk about further heart failure. But he did note that today's amount was elevated over my prior baseline.
The ER doc then consulted with my rhythm doc's on-call partner:
I am to increase my use of the beta blocker, metoprolol, from 25 mg per day to 25 mg twice a day. This ought to be fun. I had serious lightheadedness when first taking this med a few months ago but after several weeks, not so much. And, if that proves too much, I can cut the pills in half.
Stay tuned.
My general condition has been good. I had a brief flutter episode Aug 15 during my workout. A brief pause and it resolved and I completed my program. Then nothing until two days ago on Sept 6. That episode was in the evening after dinner. It, too, resolved quickly. But change occurred yesterday morning. I felt an adrenaline surge with my coffee (decaf) post breakfast. I waited for the high HR to come down. It did briefly, then surged again. It did this for about 6 cycles all with highs in the 147 bpm range. This went on for 2 hours. Then it resolved finally However, I had another episode after lunch which resolved on its own. I was worried because my relaxation procedures were only momentarily effective this whole time.
This continuing resurgence seemed the occasion to contact my rhythm doc. He wanted an EKG of an episode and/or a 30-day monitor. In the past each time I have gone to the ER the episode has been over and the EKG looks pretty normal.
This morning's onset was a textbook copy of yesterday's. Immediately after finishing breakfast and relaxing with the Washington Post up went the HR after an adrenaline bump. I waited to see whether it would resolve with some relaxation. It did. But it returned again in a few minutes. We headed for the ER, about 1/4 mile away.
They hooked me up quickly to an EKG, 12-lead machine. It was all normal except for a PVC. However, on the 3-lead machine to which one remains hooked a few minutes later they caught an episode. HR bumped up into the 140s. ER doc said it looked like flutter, not fib. An enzyme symbolic of heart failure, BNP: B-Type Natriuretic Peptide, was slightly elevated. ER doc suggested a much greater increase would be necessary to talk about further heart failure. But he did note that today's amount was elevated over my prior baseline.
The ER doc then consulted with my rhythm doc's on-call partner:
I am to increase my use of the beta blocker, metoprolol, from 25 mg per day to 25 mg twice a day. This ought to be fun. I had serious lightheadedness when first taking this med a few months ago but after several weeks, not so much. And, if that proves too much, I can cut the pills in half.
Stay tuned.
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