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.

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.

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.

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.

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.

Ugh......

So as of tomorrow I will have been out of rhythm for a week. To say I'm disappointed would be an understatement, and until you have spent even 1 hour out of NSR thee is absolutely no way that you could ever understand. I emailed my doctor on Friday concerning the next step and possible cardioversion and I just got off of the phone with him a while ago. I was contacted by a nurse later today and scheduled the cardioversion for this coming Friday. This will involve me having another TEE and then electrically converting my heart back to NSR. None of this sounds like very much fun, however I am determined to get ahead of this and finally slay my demon.

After the cardioversion I will continue on the Flecanide. There is a possibility I will be changed to a new drug Tikosyn which I don't think will be an option I am personally wanting to take. The change would require a 4 day stay in the hospital to be monitored 24/7 and the medication itself is not a path I want to take.

There Is A Bright Side

Over the weekend I reached out to fellow affibers as to the process to seeing a Specialist in another state. I got lots of feedback immediately which did not surprise me in the least. There is a specialist I have known about for a while now and had the situation been different back in January  is who I would have liked to have don my second ablation.. Things moved pretty quickly that day and having had good success the first time around I had little doubt that the touch up procedure would be any less effective. Again Ill mention that wonderful thing called NSR that a majority of folks live with every day and the desire to achieve that for myself again.

So know I have wheels set into motion on two fronts. The cardioversion and the process of having the specialist have a go at my heart. I will be sure to keep a good record of what is to come so as to maybe help somebody else down the road.