Saturday, June 29, 2019

Nothing New

Noting new to report lately. I did have a short run of eptopics a day last week that I thought were surely going to lead to an event. Fortunately they were short lived and did not progress.

Tickets and reservations are made for my July trip back to Austin for my 4th and hopefully last ablation. I'm excited and ready to put this chapter of my life behind me. Hopefully forever.

I'm also excited as I will be able to see and have my ablation done @ TCAI's new Electrophysiology Center.

Tuesday, May 7, 2019

Outpacing Myself

Had another break through the other day. Came home from work and was helping with dinner when it happened. this one was the worst thus far. My heart rate reached 204 bpm which is by no means a record for me but its been a while since I have seen numbers that high. Ended up taking 200 mg of Flecanide and 7mg of Metoprolol and converted about 3 hours later.

This event really sapped it out of me. I was completely wiped out through the following day into the evening. So much so I took the elevator at work and did nothing when I got home from work. This is the issue with afib. It almost always gets worse instead of better. You may plateau but it will eventually take a stronger hold.

The Date Is Set

I took some recordings with my KARDIA and sent the best one to DR. Natale's nurse. She got back to me right away and we discussed when I was coming back for a touch-up ablation. I told her I was just waiting to hear back from his scheduler to set a date since I had passed on the last date that was offered to me. Things at that time did not seem that bad but after the other night I feel its time. His scheduler got in touch with me yesterday and I scheduled an appointment for July 18. That's 2 months away but that time will go quickly. It will also give me time to continue to regain some fitness before hand.

Friday, April 19, 2019

Afib Break Throughts

I have had a total of 3 Break Through events this year.Feb 15, April 1 and April 14. Two of them happened wile relaxed and the other at the gym. Non of these happened under any conditions I am used to. My events were always just after or during sustained cardio exercise whereas 2 of these happened in relaxed states. The latest being after being called out to work and not getting any rest.
The event happened @ the 18 hour mark of being awake and lasted for an hour. I took a Flecanide since I had so little sleep and didn't want to chance not converting on my own. This event lasted 1 hour as the other 2 about 1/2 hour.

I was able to have the April 1 event captured on a 12 lead EKG. I was at the gym when I went out of rhythm so I Gathered up my son and headed to the local ambulance service. They have 2 centers in town and I just happened on the one that only schedules transportation. After spending a few minutes trying to tell them that I didn't need an ER just a 12 lead EKG they said I should try their other office.

So back to the truck and across town the their other facility. I walk in and they are having a paramedic class. One of the instructors came out into the hall and I again start explaining my needs. Their first response was to ask if I wanted to go to the hospital. After a few minutes of explaining that all I needed was a 12 lead EKG before I convert back to NSR. That I did not need a hospital that was going to charge me $1000, maybe or maybe not get to me before I converted, then try to admit me the finally got the comfort level that I was aware of what I was doing.

They took me over to the Paramedic side of the building and they briefly explained my situation and what I needed and the manager grabbed their Portable EKG and lead me to their lounge. They hooked me up and got a recording. I thanked them and made my way back to the truck and converted back to NSR without meds, so I was out of rhythm for about 30 minutes same as last time There was allot of other conversation and banter in between, mostly them trying to tell me I should go to ER. They were also confused why the doctor would not want me to go to the ER. I tried to explain the situation but they didn't seam to understand. I did appreciate their concern though.

I am currently waiting to hear back from Dr. Natale's scheduler to set a date for a touch-up ablation. I was offered a May date but decided to wait for something a little later. Hopefully June or July at the latest. She is waiting for him to release his dates for those months.My family wants to come along so I think we will make it a road trip. My son and wife can both drive so I can relax coming home. This ablation should be a walk in the park as the main focus will be on the LAA and the completion of its isolation. I have never felt to bad following any of my ablations so all should be good. We will just meander home from Texas and pass through Nashville and Memphis. Probably catch the Blue Ridge Parkway as well.

Still Riding

I've still been doing some riding to try to find the fitness I lost somewhere along the way. My rides have been averaging a minimum of 30 miles and I have had both the Pinarello and the Jari out. I took the Jari the other day out of necessity.I broke a spoke on the last outing on the Pinarello and am waiting on MAVIC to send me the spokes to repair it. I ordered them a week ago and after speaking to them yesterday it looks like they may ship out tomorrow.

I really enjoy the Jari but it is a different animal from the Pinarello. Allot more relaxed and in by no measure a speed machine. At least it isn't with the tires it has on it now anyway. It does allow for me to get off of the beaten path which I did again the other day. I had hoped for a 40 mile day but time wasn't going to allow for that on the Jari so I opted for something a little shorter. I still ended up with 34 miles but was able to finish up on one of the local Rail To Trails in the area. It was nice as I was able to ride a portion of the trail I had never ridden before. Here is a link to the ride. I didn't set the world on fire so far as speed goes. And I didn't get the mileage I was looking for. But I did get close to 3 hours in the saddle and that is what I am looking for more than anything right now. Time in the saddle will translate to fitness soon enough.

Such a Disappointment

The shop where I bought my last bike sold out to another. I really liked Glens shop. Lots of eye candy and great customer service. Glen understood what it was to be a cyclist and also what it took to connect with the customer. I judge all bike shops on how I ran mine in another life time. Not to toot my own horn but I was good at it. Not only the mechanical side of things but also the sales side. The connecting with people and helping them find what they needed to make cycling enjoyable and hopefully become a passion for them as it is for me.

I never prejudged anyone that came though my doors. Not even the guy that came in to my store to purchase a bike to ride across the country that had only ridden some rails to trails up until that very day. That's a story in and of itself. Weather they wanted me to fix their Walmart special, purchase a comfort bike or something super high end for those that already had the passion. It didn't matter to me. I love cycling and love to share that with others and get excited to see someone interested. I got to know so many interesting people on my cycling journey and continue to to this very day.

So my wife and I ventured to the shop that had bought out Glens place. I've been three before as they sponsor a cycling team that I used to sponsor. I have never been real impressed and this time was no different. Not only did they not have the parts I needed which has happened before their customer service also sucks. 

My wife was window shopping as her interest in cycling has returned. She was unfamiliar with the store and happened in a part where they sell electric bikes which she has zero interest in. A sales person approached her and started to try to sell her on the electric bike. Her response was why would I ever want something to help me i would rather exercise. Instead of helping her he just walked away. She would have never been neglected like that at Glens place or mine for that matter. this is a woman that cycled almost 3000 miles, completing several centuries the summer leading up to the birth of our son. She actually cycled up until she was into her eighth month of pregnancy.

As we were leaving, both disgusted, she eyed a Pinarello with pink graphics hanging on the wall. She inquired about it and the salesman blurted out a price and walked away. We left even more disgusted after that. She was really interested and would have like to take a look at it but after that decided to look elsewhere.

Saturday, March 23, 2019

Lots Going On

Not much new on the heart front. Only a few eptopics hear and there but nothing sustained. I've been getting to the gym, Zwifting, riding my bike and working on the falcon.

I got out on the bike 3 days last week. First day was cool, the second day in the 70's and the third day back to the 50's with wind gusts in the 30's. That third day wasn't a whole lot of fun. I ended up with almost 80 miles over the three days. I hit the road the first 2 days and took my gravel bike on the third. Ended up in whites woods for the tail end of Fridays ride.

Tanoma Road
Five Points

Coal is alive and well in Pennsylvania. They have been talking about putting this coal loading facility in for a long time now. They finally got it up and running last year. Since I was unable to ride last year this is the first time I have been past it. They bring coal out of the mine on the right side of the road the convey it across the road to load trains.

Coal loading facility
Coal pile waiting to be loaded

Third days ride ended up in whites woods. Was supposed to be a recovery ride but the high winds put a quick end to that. The woods weren't much better since the trails are still soft from the spring thaw.

Soft ground

Me and a tree in Whites Woods

Steady As She Goes

Not a whole lot of new news to report. I did get the results of my Zio Patch and there wasn't allot to report from that. There were 17 or so recordable events, the longest lasting 17 beats. Other than that there was not much to tell. The events didn't last long enough and the Zio patch is limited in the amount of information that can be gleaned from it. In order to get any real information I will need to capture an event on a  lead EKG. and for that to happen the events are going to have to last a whole lot longer than that.

I did have a half hour long event that I converted using Flecanide. This was after I had sent the Zio back and had not yet heard from my doctor. I did get a recording of it on my Kardia but again it is indeterminable what exactly what the rhythm was. I'n not in the lease worried though as the worst case scenario is  I go back to Austin and have Dr. Natale sort it out. We discussed this possibility following my procedure and as anyone that has dealt with this knows this is not uncommon. I also talked to Shannon shortly after all of this came about and we had a nice conversation.

All of this of course has pushed back my visit to Austin to have another TEE done to ascertain the function of my LAA and see if I will be able to come off of the Elequis. So until then it will be life normal and being able to capture any oddities along the way.

Back On The Bike

I started back on the trainer a couple weeks ago and I have been back to the gym now for a couple of months. I have been pretty faithful at getting to the gym but wasn't real regular on the bike at first but I am getting to be more frequent. I always thought it was amazing how fast you lost fitness over just a few months but over a year off of the bike has really left it's mark. But I'm thankful that I can do either considering where I was this time last year.

Sunday, February 10, 2019

Monitoring My Every Move

My heart rate monitor arrived last week and its unlike any I have ever had in the past. Its called the ZIO Patch. It is the smallest monitor I have ever been prescribed by a doctor. It's pretty simple in design and has no wires. The only issue I have encountered is the adhesive does not tolerate showers and exercise real well. So I had to come up with and alternative to help hold it in place that has worked out real well. I have been using Kinesio Tape in addition to the manufactures adhesive and it is working out real well. The other issue with the patch is there is no way of knowing if it is actually working. It will flash orange if it come unattached, which it did when I removed it. I should have taken a photo of that as well as it is very noticeable when this occurs.

I have thought of some other design changes I would make as well that are geared to those wearing it who are more active. These ideas would also benefit those with skin sensitivity as it would allow for re-positioning of the device every couple days. I may send them a suggestion or two as this is what I used to do for a living at one point in my life. I also verified that my addition of the Kinesio tape was successful as when I removed the tape it basically fell off and started blinking orange. The Kinesio tape was also less irritating to my skin.

The time frame for me to wear it ended Wednesday. I will then send it back and the results will be sent to Dr. Natale for review. If all is well I will come off of the metoprolol and be scheduled for a return trip to Austin for a TEE (Trans-Esophageal Electrocardiography) to check the function of my left atrial appendage. If that is ok then I will be able to come off of the Elequis.

Cycling In Place

I finally got the trainer set up the other day. I also purchased a Smart TV and a Lightning HDMI adapter for my I-pad so I can mirror the screen to the TV. It makes Zwifting allot more entertaining. I'm not a huge Apple fan but I got the I-pad for free last year so I'll use it for now.

I' been sick now for the past several days so really haven't had much chance to use the new setup but I'm feeling better and should get back to it this week. I also start my seven day break this coming Wednesday so I'll have lots of time to focus on this as well as some other outstanding projects I have been neglecting lately. 

Tuesday, February 5, 2019

Monitor On Its Way

Heard from Dr. Natale's office the other day. They are sending a 7 day monitor for me to wear. This is the next step leading up to another trip to Texas Cardiac and Arrhythmia for a TEE. This test will let them know if the function of my LAA is good enough to come off of the Elequis. I'm hoping as well that I will also be coming off of the beta blockers as well.

The past year of life has had allot of ups and downs but in the end it has all seemed to work out. I haven't noticed any arrhythmia's and my back, though it still hurts some times, is no where near where it was.I have yet to start using the indoor trainer but I have been doing allot of walking and climbing the stairs at work. I think I may try to get on either the trainer tomorrow or the spin bike. I have been getting to the gym regularly though and that feels good.

Thursday, December 27, 2018

Feeling Great Heading Into Month #6

Merry Belated Christmas!!!!

Had a wonderful day with the family over the past week. Christmas this year fell on my seven day break from work and I tried to make the best of it. Spent several days insulating my garage and started to hang the drywall. It's made a huge difference in how warm it is out there and will make it a more inviting environment for working on the Falcon or any other project that might come my way.
I guess I never posted about my  CBG building frenzy. I would like to make some more one of these days.

We also spent part of Christmas Eve in the city. We originally planned to spend the entire day and go to midnight mass. There was a church we used to go to years ago there that has the Pittsburgh symphony orchestra playing but we not only could not remember the church but were ready to go home at 5pm since there really wasn't anything left to do.

We visited Phipps Conservatory The Cathedral Of Learning. And the Creche in Downtown. Then we headed for Ross Park Mall for some shopping and a photo with the fat man.

Phipps Conservatory

Cathedral Of Learning

Cathedral Of Learning


There is much to be thankful for this year. A steady beating heart and my back issues continue to improve. It was at this time last year that things started going south for me. 

Saturday, December 1, 2018

Heading Into Month #5

Working on month number 5 now. It seems just like yesterday I was in Austin having my ablation done. I'm still sending weekly reports to Dr. Natales office and everything continues to look good.

I've been keeping up with my Mg and K supplements and that appears to be keeping the eptopic beats at bay. I hope that things continue on that path. I suspect that one of these days soon that they will be having me stop the Metoprolol. Truth be told I have missed a dose or two lately with no ill effects.

Not much else has been happening these days. I'm going to hit the woods this morning as it is deer season in my neck of the woods. I have one more night shift so I wont spend more than a couple hours on stand today. Maybe I'll catch a woods nap if I'm lucky.

Friday, November 9, 2018

Waiting With Bated Breath

That's how I picture the 2 or 3 of you that visit this blog randomly.

Anyway, things are going well right now. I am completely off of the anti-rhythmic drugs and my heart continues to stay in rhythm. Its really nice to be off of the Flecanide, though I have never had any issues with it. I can't say the same for the Metoprolol but I'm stuck with that for a while I guess. I am assuming that Dr. Natale will have me stop that as well within the next month.

So far as the spinal issues those are on the mend as well and had my last visit to therapy last week. I would still like to keep going for a while but my script ran out. She was sending a letter to the doc so we will see what he says. I also got a bike ride in last week as well so things are looking up. Its been just a little over a month since I was unable to walk from one end of the house without stopping to take a break. The bodies ability to heal itself is truly amazing, though I am completely aware that the slightest wrong move could set me back to where I was. That right now is my biggest fear.

I also made my first visit back to the gym last night. In the same way I am in awe of the bodies ability to heal itself I am also frustrated in the way that it loses its fitness so quickly. The upside to that fitness and healing are pretty much the same so I know that in a relatively short period of time I'll be back on top of it.

Saturday, October 20, 2018

3 Months

Today marks the 3 month anniversary (blanking period) of my ablation with Dr. Natale in Texas. It has also been over a month since I have had any Arrhythmia issues so all is good. Dr. Natales office contacted me on Thursday and and said that he wants me to stop the anti-arrythmic drugs (Flecanide) to see if I my heart will maintain NSR without it.

This is the point where apprehension sets in. Of course I don't want to be on these drugs anymore, but I also don't want to have another procedure if I can help it. They said that I could just stop the Flecanide but I am going to taper off of it over the next week. I, as well as many other afibbers are firm believers in not stopping the drugs that promote NSR cold turkey as many have experienced rebound for doing so. Of course they usually convert back to NSR in a short time, but if that can be avoided, why not. Besides that, we all know that Afib begets Afib so why chance it. I've been on them since January so what is a few more days in the grand scheme of things.

The taper I will do will be to reduce my intake a little bit every 3rd day. I am currently taking 200 mg a day so I will start with 175mg for 2 days, then 150 mg for 2 days, 125 mg for 2 days....etc.

During this time and for an unknown period of time afterwards I will remain on the metoprolol and elequis.

Tuesday, October 2, 2018


That is where I have been now for a couple weeks now. Feels so good. My back pain is better too especially on days I don’t work and days after therapy. Actually spent an hour or so doing yard work today. It hurts a little but no pain pills today so that’s a good thing. 

I spoke with Shannon yesterday afternoon. It’s alway great to hear from him. He is so knowledgeable on everything afib. He is also welll versed in other subjects as well so conversation is never boring. Also had a quick trip to the shore over the weekend so I got a solid day of R&R. 

Wednesday, September 19, 2018

Like a roller coaster

That’s how my life has been the past couple of weeks. I finally got the nerve block done. Even though I only got a couple days of moderate relief, it was a turning point. Every day since has gotten a little better. I had to go off the elequis for 3 days and got to get injections in my abdomen twice. Pa day for 3 days. Good times.  I also got clarification as to what I have going on. I have a T12-L1 bulged disc and a L5-S1 herniation. Super fun times. Oh and the pain finally ended up throwing me out of rhythm the same week that I was getting abdominal injections. That particular day the pain was so bad that my chest actually hurt.

So for two weeks I literally felt like a ticking time bomb between my heart and pain. On the bright side, yes there is one, I converted back to sinus rhythm on my own after about two weeks. So I was able to cancel the cardioversion that I had scheduled for tomorrow. I have also been going to physical therapy 3 days a week which also seems to be helping with the pain.

Sunday, August 26, 2018

5 Weeks In

Its been 5 weeks since my ablation with Dr.Natale in Austin. And my heart has been quite since my Cardioversion 2 weeks ago. No PAC's, PVC's, Eptopics or any other type of arrhythmia. To say I am happy about that is an understatement and I hope that it continues. There are still a couple months to go in the blanking period.

Of course I am still dealing with the Sciatic Nerve pain from my L4-L5 disc bulge. I've been to the ER twice over the past couple weeks with it as doctors have seemed to just leave me hanging with no way to alleviate pain. However, I have had the bulged disc confirmed by an MRI ordered by the ER doc. I also spoke with a Surgeon about it who wants to wait to see if the disc heals itself. So in the mean time he has ordered a nerve block for me. But as per usual that was Wednesday and today is Saturday and as of right now I wont be getting a nerve block until September 5th.

So here I sit in pain with no immediate relief in sight. I really thought that when I left his office on Wednesday he had a full understanding of my situation. Lots of pain and recent heart surgery that I am still recovering from that requires me to have little stress. So much for that I guess. Between me and the surgeons office we have contacted every pain clinic there is and nobody can beat the September 5th date as of yet.

I did have a glitter of hope Friday though. My wife actually knows someone that works in a pain clinic not to awful far away. Its actually one that I had already contacted that said they really could not help me. But is seams that maybe they can. The do what they call direct inject. this means that my doctor refers me and I go get the shot that day or within a day or two. So I called the surgeons office again and implored them to contact this particular clinic and get the ball rolling. Which they did. I also asked if they could give me something for the pain to bridge me to the time of the injection which they also offered to do. She said that they would get me some percoset. So i was a little be more optimistic at this point.

After talking with them I headed to the Chiropractor for some traction therapy. I do have the conversion table but it didn't seem to be helping and the traction uses intermittent pressure an actually seems to help. After my time on the Rack I started heading for the surgeons office to retrieve what I thought was going to be a pain med that might help me. Unfortunately it isn't. Just more of what they gave me at the ER that doesn't even take the edge off.

The Bright side, or at least I thought, was I got a call from the pain clinic. They had received the referral from my surgeon and only needed some paperwork from my Dr. in Texas which I had already started the ball rolling on a couple days before. She got all my information and what she needed from Texas and promised she would touch base with me before the end of the day.Which she didn't.

Tuesday, August 14, 2018

PAC's, PVC's & a Cardioversion

Last week was a cluster healthwise. Of course my sciatic nerve pain is through the roof right now and I was running allot of PAC's and PVC's. I went out of rhythm Tuesday morning for a bit but converted back. Then I went to the hospital Tuesday evening to see if they could do some tests to figure out if my sciatica was being caused by a disc or some other ailment. They did some exray's and a CTA scan to rule out any clots in my leg. Everything came back normal so I still don't know 100% what's going on. Pretty sure its a bulged disc though so I'll have to wait it out.

I had sent Dr Natales office some recordings on Wednesday morning as I had gone back out of rhythm and they called and asked if I could arrange to get cardioverted within next week. I called my local EP and they scheduled me for last Friday morning. I worked Thursday night so  headed for the hospital straight from work Friday morning.


If you have been keeping up you already know that my I have
already had one cardioversion done this year back in April. You will also know that the worst part of any EP experience for me has been the TEE. I was however curious as to how this one would go. My Cardiologist retired last month so I knew that he would not be doing the procedure. Which,, even though I hold the man in high regard his TEE skills pretty much suck.

So I arrived at the hospital early and got all the pre cardioversion stuff done which basically consist of a chest x-ray and getting an IV so they can inject the propofol for sedation. They hooked me up to a monitor then decided to wait on my EP to some in and verify that I really needed a cardioversion. He came in not too long after to talk to me about what was currently going on and to also catch up on the festivities in Texas. I handed him a copy of the ablation report and he quickly took it out and looked it over. He was very pleased to find all his work was solid, as I was always confident that it was. We then talked about the cardioversion and some small talk. He said that I was in a controlled flutter and that they would be doing a TEE then cardioverting me.

It was a while before they came to get me so I was just laying there trying to catch a nap but I kept hearing this music, Kool and The Gang to be specific. I originally thought that one of the other patients in the holding areas family members was playing music but I would eventually find out it wasn't them and where the music was actually coming from.

Eventually a couple of transport girls came to get me to take me to the EP lab. I stepped from my bed to the transport table then they wheeled me out into the hall. As we approached the hall the music got louder and the girls started to dance. There was a doctor sitting right outside the room and Celebrate must have been the music his computer played when he opened his computer. What a light hearted fun moment that was. Always a great experience at UPMC.

I eventually ended up at the EP lab where I met Karl. A very animated prep guy. He made me laugh several times. Then the nurse anesthetist came on and we started talking. Now if you have never had a cardioversion before there are allot of folks involved. You have of course the EP, a cardiologist, nurse anesthetist and of course and anesthesiologist. So rangeling them all together can be a task as stated by the cardiologist that soon entered the room.

She was very friendly and animated. She introduced herself and we talked for a while. I had told her about my many experiences with TEE's, good and bad and we laughed. Finally everyone showed up, I signed a couple more forms, then off to lala land/ I never even knew that she dd the TEE. The cardioversion went well. it only took one jolt to convert me back into rhythm and I have been there ever since. Hopefully that will be it for forever. So far as weather or not I am concerned about the success of my ablation, I'm not. I am just over 3 weeks in at this point so the heart is still healing. The fact that I went into flutter does not concern me either as it was probably all the PAC's and PVC's that put me there. I also realise that I may need a touchup procedure as Dr. Natale addressed some issues that hadn't been addressed before.

Monday, August 6, 2018

Alls well

Received my KARDIA device last week. I really like new gadgets especially useful ones. The Kardia actually give me real time ECG monitoring that I can carry in my pocket. And for those of you that are Apple sheep there is the band for the apple watch that the same thing

After reviewing the strips I have taken I am pretty sure the low heart rate I thought I was experiencing in an earlier post were PAC's and PVC's instead of some low rate arrhythmia.

Tuesday, July 31, 2018

Hit And Miss

I have a great appreciation for these old machines. Its rare to actually see one of these in action but every once in a while, while out on a ride, I will here one being used for plowing or bailing.

Anyway this is just how my heart was on Sunday. Hit and miss. Mostly miss.

The weekend started out the same as its been since my ablation, nice calm NSR. I did some shopping with the family in the afternoon followed by church . Then home for a quiet evening. Sunday morning I awoke to find myself out of rhythm. This was the day I planned to start weaning myself off of the Ticosyn because the nerve pain has been creeping back. So I decided to wait until I had the opportunity to speak with my Afib nurse at TCA. Meanwhile I took some recordings throughout the day with the HEARTRAK (Kardia on its way).

The other odd thing that happened was Monday morning very early. I had woken up around 3am still out of rhythm. I got out of bed to get a drink and came back to bed, At some point shortly after I converted back to what felt like sinus rhythm. However, my heart rate was very low, 37 bpm. It stayed this way for a while then jumped back to around 70bpm. Then after a while back to 37. Now I was using a pulse oximeter to record these rates so the accuracy and interpretation of what was actually going on is up for debate. Though the rate was steady with no fluctuation at both rates. I did run back out to the kitchen to grab the recorder to try and capture the event but what I was feeling and what was recorded were two different things. This continued for the entire morning; until my heart decided to just go completely haywire for the remainder of the afternoon into the evening. I converted back to NSR early evening and have remained there ever since.

This is the first time I have ever experienced such a low hear rate. My normal resting heart rate now is 62 bpm. And has been as low as 52 bpm when I was more active. One thing I think that may have contributed to this was that I had taken 75mg of Metoprolol the previous evening to try to keep my heart rate down as the 50mg I had taken in the morning was not enough. This is only speculation though. I had been taking 75 mg of Metoprolol with the Ticosyn prior to my ablation for the same reasons when the Ticosyn was not sustaining NSR without any issues.

Saturday, July 21, 2018

My Catheter Ablation With Dr. Natale At St. Davids

Was released from St. David’s today following my procedure yesterday.  Everything went really well and my future prognosis is good.

I will be updating this blog over the next week to try to capture everything. Also, there are some links within the blog as usual for more in depth descriptions.

Thursday CTA and Consult with Dr. Natale

My CTA was scheduled for early morning so we caught a LYFT to the hospital and was early. I was impressed with St. Davids right out of the shoot. The reception area personnel were very friendly and accomodating. This would become a trend throughout my entire experience there. Once i was all checked in a I was escorted to the nuclear lab for the CTA.

Now St. Davids is a very large hospital and we were in for an unexpected long walk which was fine, The young man that was taking us was fairly new and as we approached hsi normal route we ran into a construction blockade. Long story short we finally arrived at the nuclear medicine lab with several laughs along the way.

Ater some blood testing they came and took me to the lab. There were 6 or 7 lab personnel there and all of a sudden it appeared I had assumed rock star status (this would not be the first time). The energy in the room was super positive and energetic.lots of good conversation and continual information about what they were doing along each step of the way.

I never have had a CTA scan before and I must say it was quite interesting. It did not take very long and was not stressful at all. Though some may find the warm dyes pulsing throughout your system unnerving, it felt quite pleasant to me.  Once I was done they unhooked me with the same enthusiasm as before and I returned to the waiting area to await someone to take me to see Dr. Natale.

Dr. Natale

Once I reached Dr. Natales office I checked in right away. I was no sooner checked in when a nurse came to take me back to get vitals and such. She covered all the normal pre-op stuff along with some history of my afib. Once she was done my nurse educator Jacquie, who I have been talking to via email and phone since my procedure was scheduled, came in and we went over allot of stuff. She was very knowledgeable and was able to answer many of my questions. It was a very productive visit as well. Dr. Natale was tied up in the hospital so it was a while before he came into the room

The visit with Dr. Natale wasn’t very long but informative. As I stated before my case nurse Jacquie had discussed allot of things and answered questions for me before he arrived. She also remained in the room when he was there to help with any questions that she was unable to address.So he was able to go pretty much to the nuts and bolts of  Fridays activities. I had asked if there was anything he had seen from my previous ablation notes that gave him any insight or made him suspect of any particular part of the heart that might be suspect. I will also add here that Dr. Natale has a very warm personality. He comes across as someone who has your best interest in mind and will do anything he can to help you.

He said that it probably is no longer PV (Pulmonary Vein) related as I have already had 2 ablations to address that possibility, but he wasn’t ruling that out either. He did talk some about the possibility that it could be related to the left atrial appendage.  If this is the case it may require for me to come back for a second procedure. The reason for this is two fold. One being it’s location and second being structural. I’ll explain as best I can.

The left atrial appendage lies closely to the corroded artery. So when they ablate that area they can only allow the catheter to remain in any one area for a shorter period of time. The reason fo this is to eliminate the risk of doing any damage to it. The structural issue here is that the walls of the opening to the appendage are thick and thin depending upon the area. Also the structure of the consistency of the appendage is different as well.

The other caveat with the left atrial appendage is that if they do ablate it I will have to remain on anticoagulants for life. This is due to the fact that the LAA is a major cause for stroke by itself. Ablation only increases this risk. The other option to anticoagulants would be the Watchman Device. The Watchman is block that they would implant that would isolate the LAA preventing any clots from forming within it thus eliminating the need for anticoagulants.

So far as the beneficial activity of the LAA other parts of the heart will pick up in that function. The drawback is that the LAA sort of acts as a pressure relief valve of sorts. Which being an active person I may notice.

Friday - Ablation Day

I arrived at St. Davids early again Friday morning. I checked in and was quickly taken to the cardiac unit where I met Michelle who would be the nurse to get me ready for my procedure. Her job was to get all my vitals and draw blood. She was just as upbeat and pleasant as everyone else I had met to this point. We had some great conversation and laughs during our time together. I also met Ryan at this time. He is part of their research staff and asked if I would like to participate in one of their programs which I readily agreed too. I have participated in several afib studies over the years and am always happy to help in any way that I can.

The research Ryan is having me participate in is cognitive. (face,dance,church,velvet,red). And that there folks are five words I can't get out of my head since meeting Ryan. OF course those five were part of the testing he gave me that morning. He gave me those five to remember before the litany of other questions he had for me after that. Fully expecting me to remember them at the end. Well I remembered Tew at the time, face and dance. Remembered all five upon returning to the room following the procedure and now I cant get them out of my head.

Once Michelle had me ready, Carlos, the EP Lab Coordinator came to take me to the pre-op waiting area. Carlos was great as well and made sure that I was ready to go. He got me to the waiting area and checked on me numerous times until they were ready for me. Ryan was also with me at this point helping me fill out the rest of the study paperwork.

I waited about a half hour or so before they came to get me. Carlos started wheeling me towards the lab then Matt took over. Mat was the comedy relief in the EP lab. Matt was, I'm guessing six foot with the build of a linebacker and a even bigger smile. I can't remember everyone else's name but there were six others in the room at this time to my recollection.  And again, I seemed to achieve rock star status. the energy in the room was phenomenal. Everyone was addressing me and striking up conversation and making me feel super comfortable. Of  course just when I was starting to have fun I was out.

The procedure was a 65 minute burn time. Dr Natale addressed several issues. He did some touch up work on my previous PVI Work. There was no issues there but he decided to make a pass to increase the scar tissue.  Afib Rider fun fact. As a rule there are 4 Pulmonary Veins, I have 5. He then addressed the posterior wall, Left Atrial Appendage and the coronary sinus . He also did some ablating on the right atrium septum before proceeding through the wall into the left atrium.

A few explanations of what was done:

Posterior  Wall - Roof line and Posterior Line were created to isolate the left atrium. These lines both connect to scar tissues surrounding the Pulmonary veins both above and below. Then the catheter is moved side to side to create scarring in the areas between them.

LAA -  The LAA was ablated but due to the location and construction of the LAA the ablating cannot be as aggressive. First due to the construction, thin walls in areas, of the LAA. And second is it’s proximity to the pulmonary artery. So instead of spending 10 seconds at each burn they can only spend 5. Therefore the burns aren’t as substantial as they are in other parts the heart. That being said there is a possibility that he will have to revisit that area. He actually did ablate this area twice during the procedure which I will cover later.

Coronary Sinus - The coronary sinus was ablated both posterior and inferior. The coronary sinus delivers blood to the right atrium from the lower extremities of the body. There is a flap at the end where the blood returns from these areas. The catheter is inserted through this flap and into the Coronary SInus to allow for ablating the beginning  end of the vein as it terminates at its beginning. The sinus is also ablated around the area of the flap.

Right Atrial Septum - This is the wall that separates the left and right atrium. This is also the wall that is punctured by both catheters to access the left atrium. There were some electrograms that were ablated on the wall before proceeding into the left atrium.

Right atrial Septum Puncture - As  I stated the septum is punctured by both catheters. The puncture is created by the ablating catheter. This is done as it requires very little pressure which reduces the risk of a left atrium puncture. The second advantage is that as the catheters are removed the create a burn scar that seals off the holes.

More On The LAA - The Left Atrial Appendage (LAA) as I stated before is the most worrisome part of the procedure I had. However, it was causing issues and needed to be ablated. The downside is that I will have to have a Watchman Device implanted or be on blood thinners the rest of my life. The Watchman was not done at this time for several reasons. The main reason being that there is a possibility that I will need touch up work done in this area and if the watchman is implanted the work cannot be done.  If this is indeed the case, it is at this time a Watchman would be implanted. Second issue with the Watchman is that due to my ripe young age I am not a candidate for it according to insurance. Even though I am an avid road cyclist, sometimes off-road and ride dirt bikes from time to time so I am a somewhat high bleed risk. They are working towards a solution at this time as it is a big issue for younger victims of afib. Thirly there is a new improved version of the watchman device that is currently being evaluated in clinical trials.

The LAA in itself is problematic as it is one major cause of stroke as you get older than me. Ablation only increases this risk as it reduces the pumping action of the LAA. The LAA also produces hormones that another part of the heart will take over for over about a 6 month period once the LAA is isolated. The LAA really serves no functionality beyond that, however, in our earliest stages of development it is our heart. Here is a link to more info on LAA

During the procedure my heart went out of rhythm organically. This happened as he was starting to do work on the coronary sinus after he had completed his work on the LAA. The arrhythmia organized in the LAA then proceeded to the coronary sinus. I achieved a rate of 240 bpm. This is a rate I have seen before early in my afib journey. Dr. Natale believes that since I have experienced this before, that the area of the coronary sinus has been an underlying issue since the very beginning. Afib is not a static arrhythmia. If not addressed it could continue to progress to persistent afib. Once he was done with the coronary sinus he went back to eht LAA that he had already done some work on and touched up the spots were the organic afib originated.

240 bpm = Panic In the cardiac lab Sirca 1992

The Very first time I had a recordable rate of 240 was back when my Cardiologist sent me for a stress test in the very early days so I was still in my mid to late 20’s. They put me on a treadmill (I had requested a bike) and stared pacing me. They kept increasing the speed and asking me if I felt alright I said yes and started a conversation with the tech. He was having non of that so he kept bumping it up and I kept talking. At one point after he and another technician started to look at me as if I had spiders crawling out of my ears they concluded the test. Said that was the first time they ever ran that machine that fast. They then took me to a room, had me lay down and watch my rate drop.

A Dr came in and talked to me and looked at my strip. He looked st me again then turned to the nurse and said leave me hooked up for a while longer. This whole time I had been watching the screen as my heart rate was dropping. 140,130....... 100,90,80.......BOOM........ 240. Alarms and mayhem from my nurse ensued. She looked at the monitor then at me back at the monitor then she was off like a shot as I tried to say something to her. All I could hear was here yelling Dr. DR getting further and further away. I just laid there shaking my head smiling to myself as she had left me alone.

 Finally I saw her running back up the hall towards me with the Dr trailing way behind. When he finally arrived he looked at the monitor, at this point I was below 200, then he looked at the strip, then he looked at her for a moment. He then looked back at me and said “come see me, go ahead and unhook him”, then left. She then unhooked me as I was back in sinus rhythm and led me to the discharge area. I never did see that doctor again as I had already been through several cardiologists to this point and had one I liked. So I never did get to find out what he was thinking. He may have been an EP for all I know.

Follow Up 

My follow up appointment will be with Dr Natale in January. He will do a TEE at this time to check the function of the LAA. In between I will continue on anticoagulants,a lopressor and antiarrhythmic drugs. These will be elequis, metoprolol and either Ticosyn or flecanide. He had no real preference so I have a few days to decide. I stopped the Ticosyn on Monday(07/30) and Resumed the flecanide on Friday (08/01).

In the interim I will follow up with my other EP for an EKG, and blood work and anything else Dr Natale might need. Dr. Natale will now be my go to EP for ablation and or Watchman implantation.

Final note 

If you have afib and are considering ablation go to no other than Dr Natale @ St David’s in Austin. If you can’t find an EP that has alot of ablations under his belt. Also, if you want the best information on supplementation or just want to share your experience with others or have general questions or concerns this site is a wealth of information.

Friday, July 20, 2018

T minus 24 hours and counting

Well  less than 24 hours and I should be out of surgery..

Had my CTA and consultation with Dr Natale today. This is the first CTA I have ever had. First off the staff I the MRI lab were excellent. The test itself was easy. The only odd part is when they inject the contrast. They warn you first but it is a different sensation. I found it to be relaxing but others may be disturbed by the sensation. You can literally feel it flowing throughout your body.

The visit with Dr. Natale wasn’t very long but informative. My case nurse had discussed allot of things and answered questions for me before he arrived. So he was able to go pretty much to the nuts and bolts of tomorrow’s activities. I had asked if there was anything he had seen from my previous ablation notes that gave him any insight or made him suspect of any particular part of the heart that might be suspect.

He said that it probably is no longer PVI related as I have already had 2 ablation but he wasn’t ruling that out either. He did talk some about the possibility that it could be related to the left atrial appendage.  If this is the case it may require for me to come back for a second procedure. The reason for this is two fold. One being it’s location and second being structural. I’ll explain as best I can.

The left atrial appendage lies closely to the corroded artery. So when they ablate that area they can only allow the catheter to remain in any one area for a shorter period of time. The reason fo this is to eliminate the risk of doing any damage to it. The structural issue here is that the walls of the opening to the appendage are thick and thin depending upon the area. Also the structure of the consistency of the appendage is different as well.

The other caveat with the left atrial appendage is that if they do ablate it I will have to remain on anticoagulants for life. This is due to the fact that the LAA is a major cause for stroke by itself. Ablation only increases this risk. The other option to anticoagulants would be the Watchman Device. The Watchman is like a filter that they would implant that would catch any clots that may form thus eliminating 5he need for anticoagulants.

So for right now all I can do is wait and see what tomorrow brings.

Wednesday, July 18, 2018

Was wondering where you were hiding

The demon is back.  Not with a vengeance but the arrhythmia is there. Lurking..