Thursday, March 7, 2019

Heart Of The Matter - The Last Chapter?

The following is hopefully the last in my series: The Heart Of The Matter. (Warning: potentially embarrassing details ahead! For me, I mean.)

Well.

Hit by a truck comes close. Okay, I've never been hit by a truck, and my apologies in making that comparison to those who actually have. But the other day when I came out of the anesthesia after a cryo-ablation to treat my atrial fibrillation, something certainly hit me. I told myself when I first got to the Cardiac Short Stay unit at Royal Jubilee Hospital, that I should be prepared for things to be different from my last procedure. I was right.

I was lucky this time, however, that I was the very first patient taken in at 7 a.m., compared to last time when I had to wait pretty much all day for my procedure. Being first meant a flurry of activity to get me prepped before they took me to the electrophisiology lab. My husband was not allowed in with me this time. But since I was first, there wouldn't have been much time to hang out anyway. I got out of my clothes and into the gown. And those weird booties. Who invented those?

Once I was in the bed, I was told that the blood tests that had been taken on Friday showed high potassium levels, and high INR levels. High INR means that your blood doesn't coagulate, or clot, quickly enough. Not really a good thing.

The high potassium I could explain. I was taking a potassium supplement. I quickly learned from the nurse that this was not a great idea. Stupidly, I didn't consult with anyone before taking them. I read something on an A-Fib forum that potassium could be helpful, and I went by that. But potassium, when it's at high levels in your body, can actually CREATE arrhythmia!

Idiot. No more potassium. Trust the doctor.

The high INR levels I couldn't explain. I was on a blood thinner, but it shouldn't have made the levels so high. So they took blood tests again. Fortunately, the new reading was much lower and within range. The only explanation, they said, was a glitch in the original findings. So thank goodness for that!

A technician came in and gave me an EKG. Then there was the shave and the washing part, which I will spare you.

Pretty soon it was time for me to put on the little blue hat and walk to the electrophysiology lab. There were two young male nurses (why did they have to be young and male?) who took my arms and lead me into the lab, one of them holding the back of my hospital gown together as we walked, saying to the other "Don't peek! Don't peek!" Yeah, he actually said that. Like there was anything worth seeing anyway. Groan.

I've described the electrophysiology lab before, but it is basically a very high tech room with numerous machines and a wall of various monitors. I was handed off to two other nurses and I got up on the edge of the gurney. One of the nurses, (another male) started placing large, rectangular stickers that would be hooked up to different monitors and machines, all over my back and sides and chest. By this time, there was no point in assuming even the slightest modesty. All was revealed.

He warned me that the stickers were cold. In fact, the whole room was kept cold because of all of the equipment. He said that some male patients actually scream when he puts the stickers on them. I laughed. Men.

"You aren't even flinching!" he said with great respect.

With a gazillion stickers and patches all over me, it was time to lie down. The anesthesiologist came into the room and I was hooked up to an IV. She told me that she was going to give me something to relax me. The other nurse placed an oxygen mask on my face. I felt the medication go in, and then I felt a little stoned. And then I felt REALLY stoned. I guess I wasss ajkkru kfja bbbbbbb  ....................

Two seconds later, I heard my name, I opened my eyes, and realized I was being wheeled back to my spot in bed #3. I had actually been out for about three hours. My chest was burning and sore, my mouth was dried out and my throat felt like someone had stuck a tree branch down it.

And then it was five hours of lying flat and barely moving. No lifting your head, no moving your legs. It used to be that they kept you flat for 3 to 4 hours, but it was discovered that the extra hour made for fewer "bleeds" as they called them. Stopping the bleeding is everything.

The five hours of lying flat is really eight when you add onto that the length of the procedure. Time enough for your back to get pretty sore. Every half hour, my nurse Ruth would cheerily come in and lift off the 20 pound weight that was kept on the incision, check out the "area", check my vitals and tell me I was doing great. I would ask for another swallow of ginger ale...I've never had such a dry mouth in my life!

I wanted to keep track of the time so I could tell when the five hours was up, and I knew that my blood pressure monitor went on automatically every half hour, so that's how I attempted to calculate it. I thought I was so clever. Near the end of my bed rest, I discovered there was a clock hanging from the ceiling just a few beds away. Duh.

They tried to get me to eat, first offering me a cookie and then a sandwich. I honestly had no appetite whatsoever, but they weren't going to let me out of there without eating something, so I tried the sandwich. Egg salad, kind of bland, on whole wheat. Eating dry bread while flat on your back is a different experience. The crust wasn't going down too well. I should've gone for the cookie.

Then, joy of joys, I was allowed to sit up. Slowly. And, finally, I was unhooked from the monitors and the IV, and allowed to walk around the ward, but only at a snail's pace. I made my way straight to the bathroom, of course. It had been awhile.

On my return, I passed the nurse's station. There were three or four nurses there, and one of them said I should check my "area". So I whipped up my gown and showed them. One of them giggled. "Oh!" exclaimed another. They all smiled at me. Maybe it was the lingering effects of the anesthesia, maybe I just didn't care anymore. It wasn't until their reaction that I realized that I had just exposed myelf in front of everyone. Including other patients.

I was encouraged to keep walking. Movement is good. Not long after, my husband returned to take me home, and we met with the doctor who did my procedure. He described everything they did, told me that it all went well, and that while they were up inside my heart, they also checked the ablation they performed on my atrial flutter almost three years ago, and found that it was in good shape.

I was given a lot of instructions and more prescriptions, I got dressed, and my husband and I walked (well, I waddled) out of the unit and down to the front entrance of the hospital. He got the car and we drove to the pharmacy to get the prescriptions filled.

A plethora of pills, information and instructions...


I was home by 7pm. Not bad for a day's work.

So. What did I learn from this latest experience?

1. Surgical procedures can take a lot out of you.
2. The nurse holding your ginger ale for you to drink from is your best friend.
3. Don't take supplements without asking your doctor. Idiot.
4. Lying flat for 5 hours gets you to thinking. A lot. About how lucky you are that it's only 5 hours.
5. I have no more dignity left. Yep. Nope.

I'm now at day 4 post-op. Still a little slow and sore, but really happy it's all done.
No a-fib yet :-)

IJ

Sunday, March 3, 2019

The Heart Of The Matter Part 4

Yesterday, like a lot of days in the past year or two, I had that old familiar feeling, like a fish flopping around in my chest off and on for a big part of my day. It often makes me dizzy, tired, and sometimes affects what I can and cannot do physically in the day. There is no pain, but I often feel a sense of anxiety, and I have to remind myself that I'm not actually anxious, it's just my heart flopping around as if I am. Then again, because I know that it can potentially knock me down for awhile, I do get anxious, especially if I am out and about trying to accomplish something.

It has been almost three years since I had an ablation to fix my atrial flutter. For those of you unfamiliar with those terms, atrial flutter is a heart condition where the heart beats rapidly because of some rogue cells that throw the electrical circuit out of whack. An ablation is a procedure where a catheter is inserted into the groin and up into the heart to essentially cauterize the area around the cells that are causing that issue. I wrote about my last procedure here, if you'd like to read more about it.

The good news is that I have had no re-occurrence of atrial flutter. The bad news is that in the last year-and-a-half, I have developed atrial fibrillation, or a-fib, which is actually a more common heart ailment. In simple terms, atrial fibrillation is more or less the same as atrial flutter, except that it occurs in a different part of the heart, the left atrium. (Note: I have had several people correct me in saying that the two are not the same. What I actually meant was that they are both arrhythmias and feel similar - IJ)

Having this condition has led me to educate myself as much as possible to understand what it is I'm dealing with and what, if anything, I can do to curtail it. As I mentioned in an earlier post, it used to be that people would simply suffer through"spells" of heart problems and that was about all they could do. How far we have come! I'm lucky to live in an age where my a-fib can be controlled either by medication or by a catheter ablation.

What I learned more recently is that an ablation is not a "cure". For some people, a-fib never returns, for others, it stops the a-fib for a period of time and then they might have to have another one. For a few people, ablation simply does not work. The ablation I had for my atrial flutter three years ago has so far prevented it from returning, which I am grateful for.

When I started to get bouts of a-fib, sometimes lasting 8 or 10 hours, back in December 2017, I made an appointment with my GP to get a referral to my electrophysiologist again. The electrophysiologist is a doctor who specializes in your heart's electrical system and he is the one who performed my last ablation. But getting in to see him wasn't so simple to do. He had left instructions with my GP that if I was to start experiencing a-fib, I was to go on medication first. This started a whole series of events that I really didn't want to have to deal with. The medication he recommended, Sotalol, was not available because there were shortages in Canada. So I had to go on another medication, Bisoprolol,  at first. It was initially prescribed as a "pill in the pocket", which meant I only took it when I experienced a-fib. I was only allowed to take so much, but I could add another pill if it wasn't working in an hour or two, and then try another. It never really worked, but I went through weeks of experimenting with that before the Sotalol finally became available.

Whenever you start a new medication, you have to go on a low dose first, and then report back to the doctor in a couple of weeks to increase the dose, and then report back...well, you get the idea. Obviously, you have to introduce it slowly to see what effects, if any, it has on your body. So it was another few months of experimenting with dosages. Sotalol is an anti-arrhythmic drug, which essentially slows the heart down and attempts to control its rhythm. I am probably over-simplifying its description, but that is the gist of it. And it comes with side effects, of course. The main one for me was basically feeling tired and out of breath at any exertion. Your metabolism goes down to about zero. I could barely manage to get up a hill that I included on my daily walks. Eventually, I started using a treadmill instead. Sometimes I'd be fine, other times I felt like I had been hit by a truck. Over time, my body has adjusted to the side effects, but I still have had bouts of a-fib, just not as long and intense. I could take more medication for that, but it's the last thing I want to do! I remember the number of meds my stepmother had to take every day for her heart issues. It was mind numbing.

No. My intention, as soon as I started having a-fib, was to get another ablation. I guess I just had to go through the protocol to get there. My GP finally gave me a referral to the electrophysiologist, but before I could meet him again, I had to have an echo cardiograph and a 24-hour holter monitor.

A holter monitor is basically a portable EKG that you wear for a period of time, to record your heart activity. You have to press a little button any time you feel a palpitation or anything like it. The thing is that every time I've worn a holter monitor, I've had no a-fib! It's terribly frustrating. My mindset was that I had to prove I was having a-fib so that I could get that darn ablation! So I bought myself something called a Kardia, which is a little unit that you put your fingers on every time you have symptoms. It sends the readings to an app on your phone and you can save the readings or print them out. You can even email the readings to your doctor. I saved a whole bunch of readings that I took over months and then printed them out when I was finally off to see the electrophysiologist. He thanked me for doing that and said it was very helpful. Finally things were going my way!

The Kardia monitor 

It has taken me 15 months to get to the point of getting a date for my procedure. Tomorrow it will finally be done. Yesterday I took my last dose of Sotalol. Today I take my last dose of a blood thinner called Xarelto because, well, you don't want to be bleeding profusely when they make that little cut!

Tomorrow I will check into the hospital at 7am, change into a hospital gown, have an EKG, get a needle inserted attached to a saline solution and lie around in bed until it's my turn for the procedure. They'll knock me out for the three or four hours it takes to do all of the "burns". Then I'll wake up, but have to lie flat on my back for another 3 or 4 hours to make sure the bleeding has stopped. Eventually, they'll let me walk around a bit before I go home. I might have a little bit of a burning sensation around my heart for a couple of days. I'll feel the effects of the tube that was down my throat during the procedure, and I'll probably be a little tired for a day or two. But that's it.

Catheter ablation procedure

When you think about it, it's a very small inconvenience for something that will hopefully take away that flopping fish in my chest for awhile. Over the last couple of years, I've "met" many a-fib sufferers online in forums who hesitate to have this procedure done. I understand that anything that involves doing something to your heart can be scary. I'm a little apprehensive, but not scared. I hope that if any of you who are reading this and are suffering from a-fib or atrial flutter, believe me when I say that as intimidating as a catheter ablation sounds, it is a very safe and effective procedure.

I can tell you that when my heart goes into NSR or normal sinus rhythm after a bout of a-fib, it feels something like a calm, glassy, peaceful ocean after a hurricane. I'm looking forward to a lot of that!

Wish me luck!
IJ