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

Creche

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. 

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.

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.

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.

NSR

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. 

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.

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.

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.

Cardioversion

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.

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.

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.

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 https://heart.bmj.com/content/82/5/54

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.   

http://afibbers.org/

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.

Was wondering where you were hiding

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

The Day Is Drawing Nigh

It seems just like forever since I firsT started the process to see Dr Natale and now it’s just few days away.Failed ablation in January, Medications I had been using for years stopped working. Cardioversion in April. Then starting new medications (Ticosyn) shortly after that worked spartically. Now in just a few days I will be having an ablation with Dr. Natale. 

My last dose of Ticosyn was Friday evening and I started to taper off the Metoprolol. I will continue to tale Elequis straight through. I didn't have to stop the Ticosyn until Sunday but I spoke to my nurse and asked if it would be OK to stop a day or two early as I wanted to be certain that as much of it was out of my system as possible before the ablation. She said that would be fine so I did. I'm also down to a single dose of metoprolol.

Now the weird thing is that I have had nothing but issues since starting the Ticosyn. It didn't keep in me rhythm all the time. Sometimes I would stay in NSR for several days and other times several hours. Even up until last week I was in and out of rhythm a few times. But since I stopped on Friday I have only had a few stray odd heartbeats.Now I am not complaining as I figured I would be out of rhythm and miserable until Friday.

Don't get me wrong. I am more than happy to not be miserable but it does strike me as odd. Especially with all the issues I have had up until this point. Anyway, I am leaving for the airport soon and have an appointment for a CTA and I will finally get to meet the nurses and Dr Natale tomorrow in Austin. Needless to say I am excited. 

TSA$$hole

Now it’s been a long time since I’ve flown. Actually it was before 911 and someone decided that we should give up some of our freedom for supposed safety. Do I feel safer? No. Do I feel like TSAagnts are rude and obnoxious? Of course they are. Why not? You have zero recourse for I am sure if you call them on anything your TSA experience for infinitim will be horrible.

The Waiting Is The Hardest Part

So said so said my nurse in Texas and some guy named Tom. So I wait, and wait and wait. Pretty sure you got the picture.

Still dealing with the leg pain as well. But not quite as bad. Spent the 4th with the family in Pittsburgh walking around and this afternoon staining the deck so there is improvement. Not much else has been going on otherwise unless you want me to rant about the crappy weather.

Instead I’ll leave you with this. Been a fN of this guy for a while now. Lots of metal covers of nonmetal songs.

Booked

So I booked my flights for my surgery today. Delta actually has a special medical rate that they offer to patients and the person accompanying them. I did not realize this as I had called them before inquiring about the flight and what would happen if I had to cancel or change my flight. At that time they didn't offer me. While booking my flight today I did have a question and called again. I explained the situation exactly as before but this time they offered me the special rate. Saved me about $100 so that's a win.

Still Hanging Around.....

No real changes in my Sciatic pain but the Ticosyn appears to be working better as we move along so a good sign anyway.. I'm still hanging around as well, so to speak. I'm up to -60 deg on the TEETER now. I'll hit full inversion sometime next week. It is giving me some relief but nothing permanent yet  I'm doing inverted crunches as well, which if nothing else should start getting my core back to where it should be. I did however go to the Chiropractor today. He is convinced that I am dealing with a joint issue. He didn't rule out the Piriformis Muscle but felt it was more joint related. The SI joint is where he is focusing.

He did pretty much rule out a disc issue though which made me happy. In his opinion the fact that it has gone back and forth from one side to the other, with both at one point along the way. He does not think a bulged disc would act that way. It's also a progressive pain that gets worse throughout the day which is what makes him think its a joint issue or possibly Piriformis Syndrome. Either way I'm happy that its not disc related as I have been back and forth with my self diagnosis.

So he gave me some exercises to do. Did some deep tissue massage on my glutes, worked my lower back and SI joint. He also had me walk and noticed  my gate is way off. More of a swagger than a walk right now as I am favoring my right side. It's no wonder my back is bothering me the way I have been hobbling around these days.

Getting Better

Although  I sometimes feel like this guy between my heart and sciatic nerve pain. Things do appear to be getting better daily on the pain front. The heart, not so much. As I think I stated before I am in rhythm now more than not, but still not where I hope to be someday soon.

I did hear from Texas today. The nurse that will be handling my care leading up to and after my ablation contacted me today. She sent me information on the procedure as well as a more detailed itinerary for my visit. I get more and more excited every day.

Teetering......

I received my Teeter Hang-Ups inversion table about a week ago now. I am seeing some benefits so far so hopefully it will continue. Though I must say the first days full inversion was a total failure. I really didn't think I was going to be able to walk after that one. But the pain subsided later in the day.

Finally Some Good News......

Heard from Texas Cardiac Arrhythmia the other day. I had just emailed them to make sure that being put on the cancellation list was not going to prevent me from having a hard date set. I no sooner hit the send button that I gat an Emil to confirm my appointment.

So the date is set for July 20 which is about the time back in 2009 that I had reached a point with my affib that I couldn’t ride bikes anymore. I was. Pretty much in affib all the time with hints of flutter. I had my first ablation in August of that year. I’m really excited and looking forward to the date.

Teetering......

So my sciatica is still being a pain in the ass so I broke down and purchased a Teeter Hang-up. I was going to go get a used one today but they are hard to come by. I did find one though but it was only $100 less than new and didn’t have all the bells and whistles. I’ll keep you up to date on how it works. 

Ugh.....

Spoke to my EP yesterday. I had sent him an email concerning my current state and asked him about another drug to use along with the Ticosyn. He felt it not to be a good idea for my type of arrhythmia. So I am staying the course for now. I will be seeing him next week to discuss the next move which is to see Dr. Natale in Texas for a 3rd ablation.

He did mention what he thought should be the next step which would be a Thoroscopic Maze Procedure. Which is similar to the Mini Maze or 5 Box Procedure. These are minimally invasive procedures but more invasive than Catheter Ablation and work from the outside of the heart in correlation with interior.  We shall see. On interesting note about these procedures is that they remove the Left Atrial Appendage which is thought to not only contribute to Affib but can also eliminate or reduce the formation of blood clots. Tere is also a current study being done using the LARIATE Suture System that isolates the LAA which has the same effect. This particular study is being carried out at Texas Cardiac Arrhythmia but I don't know if I am a candidate or not.

Cycling Fail........

So I did get out for a short ride the other day. Did not go so well though. High winds and torrential thunderstorm created need to cut the ride short. Te 200 plus heartrate at the end was not helpfull either.

Maintenance Outage Infinity.....

So our so called 2 week mini outage has turned into well over a month with way to many startups and shutdowns. Tonight involving yet another since the end of Infinity outage. Then we get the pleasure of putting it back on and taking the other unit of on Sunday. Assuming everything goes well which it probably won't.  This also means we will be bringing the unit back off before the heat to repair another gremlin that won't allow us to make full load when it gets really hot outside. It's a comedy of errors perpetrated by people I am pretty sure should not be in charge of the asylum.

Nothing New To Report

So its the same ole same ole with the battle between my arrhythmia and the Tikosyn. Tikosyn still has the advantage but not enough to satisfy my psyche. Of course the arrhythmia has an accomplice this week in the form of sciatica.

Now if you have never had sciatic nerve issues or God forbid your
Satorius Muscle cramp up on you on you 70 miles into a century ride, consider yourself lucky.I will add here that the Satorius Muscle cramp wins hands down in medieval torture fashion. At least with the sciatic nerve you can remain still and have the pain recede. The Satorius Muscle however, will toy with you. As you try to find relief by bending your leg it will pull tighter. If you try to stretch it pulls even tighter. It will leave you writhing on the ground wishing for death if you let it. My best advice is to keep pedaling in a smaller gear at at higher cadence. It will right itself pretty quickly.

Anyway, it became quite clear a couple days ago that I was going to be on a sciatic nerve pain train that was too late to try to derail. There are many exercises you can do to keep this from happening and or help alleviate it before it reaches the point that mine did. A pain that I hope reached its crescendo yesterday.

I was sitting on the deck last night with my wife. it was getting late and she decided to go to bed. I told her I would be along soon. About 20 minutes passed and I decided to get up. No go. I shifted around and tried again. No go with some added whimpering. So I picked up my cell and called my wife....no answer. So I called my son and asked hie to send her outside. She soon arrived to find me where she left me. She tried several times to assist me from my perch to no avail. We finally decided to try the heating pad as that had given me some relief earlier in the day. 30 minutes later I got enough relief to escape the grasp the chair had on me.

The night was no better as any bit of relief I got either from ice or heat was short lived so 3 hours sleep was all I got last night. Then when it was time to get up it took about an hour for me to get out of bed. I had an appointment with my cardiologist for an echo this morning so I had no choice but to suck it up and carry on. I did get in to see my GP this afternoon and he prescribed me some muscle relaxers and steroids and said I should be right as rain, or at least more human like come Saturday. He also said he is seeing sciatica and nerve pain in other patients that are taking Tikosyn. He promised it would go away.

The Echocardiogram went really well and no issues were immediately found. My Cardiologist said if he did find anything he would call me in a day or two and if I don't here from him then all is well. He did say that the weakness they saw on the TEE before my cardioversion was no longer present so that is good. Once he has completed his report he will send it off to Texas as this was the last piece of information that Dr. Natale requested.

Dagnabbit......

Well all was goo until Sunday evening when I went back into affib.
This weekend was our short turn and I did not get much sleep at all so I'll blame it on that. So that was a 5 day run in NSR so I'm still hopeful.

I converted back to NSR Monday afternoon and remained there until Wednesday evening. I converted sometime during the night. I remained in NSR until yesterday evening. The affib episode only lasted a couple hours though. But then this morning back out of rhythm again.

My sleep patterns the past couple days haven't been too good either. Was in bed both nights before 2200 but awake before 0200 both nights. That's got to stop.

Normalcy....

There has been some normalcy in my life though. Gabe and I hit the Hoodlebug trail on our new FUJI Jari bikes. Still need to make a couple adjustments but these are going to be great bikes for us. I was worried about mine as I had calculated some numbers wrong and thought that maybe I had bought a bike one size to large for myself but all is good. I doubt we will get to do our trip this summer due to my heart issues but should still be able to get some riding in for sure.

Worked outside all day yesterday. Got my garden started. Lettuce and onion sets are in and I'll get the rest of the plants in next week.

Turning Point?

Maybe anyway.....

Following my last post I had a run of 32 hours in NSR. Then into affib which only took 4 hours to convert back to NSR. Since that conversion I have been in NSR without a blip.

So as of now I have been in NSR for almost 48 hours. Needless to say my attitude is much improved. It's amazing what a normal heartbeat can do for your psyche. I'm not so naive to think that I will stay in rhythm all the time but this is a far cry better than it has been for sure.

The Grind......

Otherwise known as work isn't so bad. I have a good counterpart in the control room. We get along well and he is a wealth of knowledge. The rest of our crew is outstanding as well. We are a pretty cohesive group all in all and have zero qualms about helping each other out so nobody gets left out in the cold.

We currently have a Control Room Trainee on our shift right now. Unfortunately he does not mesh with the crew. He had asked me before taking the job if I thought he could do it. I have no doubt he can but he has a long way to go to gain the respect of everyone.

He has an issue with work and already has a reputation as being lazy. And that does not go over well when you are asking people to do work for you. He is also the type of person that needs constant reassurance, or in his own words needs to have his ego stroked, which can be pretty annoying at times. He's got a long row to hoe for sure.

Frustration.....

So it's been a week since I left the hospital and I am in rhythm about as much as I am out of rhythm. the longest I have gone in NSR so far is 28 hours. The shortest period of time it has taken me convert back to NSR is about 10 hours. So one migh argue that the Ticosyn is working, moderately at least. But quite frankly I'm really starting to get frustrated.

The other issue is when I am out of rhythm I take 75mg of metoprplol which really nocks me down. The 50mg I take daily nock's the snot out of me as it is. The whole thing has becom quite debilitating and depressing. It completely limits my activity and keeps me from doing th things I enjoy.

Back In The Saddle....

Got home from the hospital on Saturday afternoon and headed straight for the bike and a nice easy 20 mile ride. What a positive affect getting out in the fresh air doing something you enjoy has on your perspective. I made sure to keep my heart rate at a manageable level and just enjoy the moment.

I did the same thing on Sunday. The weather was not nearly as nice being about 20 degrees cooler but all in all a nice ride. Up until the point my heart went into affib again. It appears that my heart has gone back to its old ways by triggering the affib at low resting heart rates and recovering heart rates.

I went in to affib about 2 miles from the house. All I had left in the ride was a nice easy down hill then a decent climb before another flat stretch to home.I was just starting the downhill watching my heart rate. When my rate reduced to 85 bpm it converted to affib and shot up to 199 bpm. it then fluctuated between 199 and 100 for a while then settled in at around 150 bpm.

My heart converted back to NSR yesterday morning but went back out again just a short while ago. So we will see how long it takes me to convert back to NSR again.

That's a Relief....

Spoke with my Doctor yesterday afternoon. He called to follow up with me on my hospital stay and also my recent affib episodes. He let me know that he had spoken to his associate and that he was totally fine with me seeking out a second opinion. We had a really nice conversation and he offered up his assistance in any way he could to help me find a solution. He thought that my choice of surgeons I had chosen was top notch and referred to him as a Guru.

I actually spoke with that doctors office today and the process for seeing him is underway. They already received some of my medical records and the rest are in process for them to receive. So hopefully that will all work out and I will be going to see him. I will write more about that ast the situation progresses.

Failure.......

Well, not a complete failure. At lest not yet anyway. 

Last night when the nurse brought my evening meds. And probably about the time Brit Floyd was finishing up their first set, I went directly into affib. My heart rate was between the mid 90's  adn 150's. They called the doc and he had them give me another 25mg of metoprolol. This brought my heart down to around 105 bpm at thee high range, which he, and most importantly I could live with without concern to doing any damage to my heart. I think I mentioned that during my cardioversion TEE that it appeared that my heart may have weakened a little bit. Nothing it wont bounce back from but still not a place I want to go. 

So the options this morning were to either stay here and start another medication or go home on the Ticosyn and see how it goes. Knowing that I could still go into affib. On anecdotal note here is that yesterday for my morning meds I also to Singulair which I use for exercise induced asthma. Was this the cause for the breakthrough last night? Lord only knows. I did however communicate with a fellow affibber today and they said it took a good 3-4 weeks for the Tikosyn to fully take hold.

So now I sit here waiting on my wife to find her way to pick me up.

Breaking Up Is Hard To Do......

Like I said before one of my doctors associates was in this morning to talk to me. During our  conversation I mentioned that I had contacted Dr Andrea Natale concerning my condition. I wanted to bring this up with my regular EP but I really like the guy and I know he is doing everything within his power to help me. His partner was totally respectful of me being open and understood completely why I had such a hard time bringing this up to my regular doc. We covered some other options and his opinions on those and their success factors. He was going to talk to my doc about my current situation as well as what we talked about concerning Dr Natele.

Even though I was just speaking to one of his associates I still had that it's not you its me approach which we both laughed about. It's amazing the relationship that can be formed between a caregiver and patient. That is one of my concerns about maybe having him do another procedure. I don't want him doing or trying something he has not tried before or at the very least 100 times trying to fix teh problem.

It's A Beautiful Thing

So I started the Tikosyn yesterday morning @0900 and converted to NSR @1210. So I guess that means the medicine is going to work. For how long nobody can say. They started me out with 500 Micrograms/2x but cut me back to 250 Micrograms/2x as my QT intervals were getting too far apart. So two more days and I can get out of this place. The weather is starting to turn and I want to ride my bike.

It's been a while since I've ridden medicated. Last time I did it was back in 2009. We did a Century that day back in March of 2010. Not only was I medicated that particular day I was also wearing and event monitor. So we will see how it goes.

The Eagle Has Landed......

Back in the hospital. It was planned of course but was planning on getting here early and started on my new meds. Well I got here early but the meds aren't going to arrive until tomorrow morning. Seems I was more ready for them than them for me.

I have always lived by the creed that no good deed goes unpunished. A good Preacher friend of mine told me that a long time ago and I have found it to be true. Just like there is no such thing as gaining brownie points with your wife. The all equal a zero sum gain and usually lead to a loss.

Anyway, the good deed was for me to have my wife just bring me early this morning and drop me at the door. That way she could get on with her day as she had a pretty full schedule. And as you read from my opening paragraph I pretty much spent most of the day moving from one comfy chair to the next with the occasional stop by the cafeteria mixed in.

So tomorrow I will start on the Ticosyn and hopefully be out of here by Friday night to go see Brit Floyd.

Current State.....

Friday's activities definitely took their toll on me. I felt pretty tired that day but yesterday kicked my a$$. Got home from work and had a bite to eat. Hit the shower and in bed by 7pm. Of course that meant that I was awake by 1230am and have been up ever since.

I usually take melatonin when I want a good long sleep but was so tired I figured I would not need it. I should have known better. I do feel better than yesterday but its early yet. 12 hour days can take a toll on you, especially when your down already.

I was supposed to give Zwack a call last night to fill him on all the details form Friday but was too tired to even do that. I'll ring him tonight.

That Wasn't So Bad

I had my Cardioversion done yesterday morning so my day started at around 0345 as UPMC Shadyside is about an hour  adn a half away and I needed to be there by 0600. So we got on the road a little after 0400 and arrived at around 0530. Had X-rays done then headed to the short stay unit right outside the Cath-Lab as my procedure was scheduled for 0800.

The procedure would start with a TEE then the electricity would flow shortly after that to place my heart back into NSR. Sounds simple enough right? I have never had a bad experience at this hospital and it would turn out that this day would be no different. The nurses came for me just before 0800 to wheel me into the lab. As we entered the lab I was met with smiling faces and an upbeat vibe.

The Lab Nurses started right away both prepping me and comforting me. The Anesthesiologist and Nurse Anesthetist followed not too far behind as well as my Cardiologist. I haven't been to see him in over 9 years but has stayed in contact through my Electrophisiologist. We had a brief conversation about how long we had known each other. I started seeing him when I was 23yo. Lets just say its been pretty much a lifetime at this point. He would be performing the TEE prior to the Cardioversion.

The room was a buzz with activity with everyone talking to me, letting me know what was going on and what to expect. One thing I noticed, and I have noticed this before, is that when anyone person in the room was talking directly to me and within arms length they placed their hand on me. This is really a nice touch IMHO, it gives you a feeling of connection between you and them. Now I have no idea if this is a part of their training or if it is just a natural reaction that those in the medical field have.

My EP then entered the room and it was game time. The Nurse Anesthetis asked me one more time what my weight was? I asked if she wanted real time weight or ideal/goal weight? Everyone laughed then it was time for the TEE which I actually despise and this time would be no different. A TEE (Transesophageal Echocardiography) is done prior to proceedures pertaining to the heart to look for any formation of blood clots on the back side of the heart. It aslo gives a look at the fuction of the heart. The one thing they did see is that it appears that  being in flutter for over a week may have done some short term damage to the heart. No diferent than if you would overuse any other muscle in your body. So all should return to normal on that particular front.

The Anesthesiologist said he would start administering the sedative and as soon as I started to swallow the probe he would give me more and I would not feel any discomfort. Major fail here folks. As I was trying to swallow and gag on the probe I was wondering what he considered to be discomfort because I was definitely feeling some at this point. At some point at this juncture I remember hearing a nurse yelling at him if he was going to administer the drug as I was obviously in distress at this point. He said he was then it was lights out. I woke up some time after that, everyone was gone, and I was back in wonderful NSR. They monitored me for a time then sent me back to the short say unit to continue monitoring me for a couple hours then I was home bound.

What' Next?

The current plan is to start me on a new drug to keep in in NSR as the Flecanide does not seem to be doing the trick. The new med I will be on for now is Ticosyn. It is another antirhithmic drug that will hopefully keep my heart in NSR while waiting for the next step. In order to take this drug I need to be off of the Flecanide for a few days then back in the hospital for a few more while they start the new one. I will have to have an EKG done every two hours as the new drug is administered for several days to be sure I can tolerate it. So as of today I am off the Flecanide and still in NSR. I will be keeping my activity level at a minimum for a few days to try to keep it that way as the concensus seems to be that the ablation in January did not completely solve the problem and the Cardioversion is only a temporary fix and there is no way of telling how long my heart will stay in NSR.

I have also started the process to see Dr Andrea Natele in Texas to do my next and what I hope to be my last Ablation. He is a pioneer in this procedure and one of  the top worldwide so needless to say I am excited to have the opporatunity. It is going to be a process but well worth the effort in the end.

Confirmation

Received confirmation today for my cardioversion this Friday. I need to be at the hospital @6am and the procedure is scheduled for 8am. As of now the plan is to have me back home later that day. There is only a slight chance that they will keep me and that only depends on weather or not they decide to change my antiarrhythmic drugs.

I'm not thrilled about changing my meds even less the aspect of being on them in the first place. The whole idea of this was to be completely med free as I was back in 2009 and I will continue to seek that end.