A-Fib

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Thanks for all the well wishes on Facebook. I’m back in sinus rhythm and wearing a heart monitor. I’ve done some running and will do a medium-long run next week. Because of being on a new medication, I decided to skip the first two marathons I was planning for October 4 and 7. I’ll decide a few days before a marathon later in October.

Things I learned from my A-Fib:

• Don’t assume a missed beat when taking your pulse is a minor inconvenience.
• Don’t forget to bring a phone charger to the ER.
• Don’t do labs or medical tests on a Friday.
• Don’t go to the ER on a Monday.

I’ve had a symptom of A-Fib or an arrhythmic heart for at least six months.

After finishing (not really running) 6 marathons in 8 weeks in April through June, I had my annual physical at the end of July.

At that appointment, I indicated I was having difficulty breathing at times, and my race times were declining faster than normal aging. I mentioned labored breathing at the Deadwood Marathon while running downhill and a significant decline in my finish time at the Fallen Heroes 5 Mile.

Dr. Prince gave me a referral to Pulmonary Associates.

After finishing the DHRT 50km, I had an appointment with Dr. Goyal and did a Pulmonary Function Test. The result of that test was my FEV1 (Forced Exhale Volume 1 second) was 65% of air inhaled. 80 to 120% is a normal range. Taking Albuterol during the test, my FEV1 improved.

Since I’ve never smoked, Dr. Goyal minimized COPD and focused on asthma as a cause. I started using Albuterol twice weekly, usually before a long run or race. It did help.

I did a sleep and walking test and had a follow-up appointment with the nurse practitioner, Chelsea Snyder, on September 22. The sleep test eliminated sleep apnea. During the examination, she heard a heart arrhythmia, told me to get an EKG, and referred me to Oracle Heart and Vascular for a consult.

I went in around 11 am on Friday to the MWHC lab to do an EKG. There I had to wait an hour to have the procedure.

Technicians are not doctors and are not supposed to provide test feedback. However, the EKG tech indicated I had A-Fib, and he would give the results to my doctor by Monday.

Around 6 pm on Monday, Chelsea called me with the results and told me to go to the ER immediately.

I arrived at the MWHC ER around 6:30 pm. Within 10 minutes, I was in triage. They did another EKG and took vitals. A doctor listened to my heart and said, “your heartbeat is all over the place.” And they sent me back out to the waiting room.

Before 9:30 pm, they took a chest x-ray and drew blood. At the blood draw, I asked about a time frame, and the tech indicated the analysis would be at least an hour.

I read a few chapters in my book. Around midnight, there seemed to be a shift change as they called back multiple patients at 12:05 am.

I started doing “I’m still waiting” posts around 12:30 am. The longer I waited, the less life-threatening the issue.

By 3:30 am, only a few of us remained in the waiting room, and I made my “still waiting after 9 hours” post. A few minutes later, I got called to a treatment room.

They hooked me to a monitor and showed me the graph of A-Fib.

By this time, I still felt good; my only issue was lack of sleep. I told the doctor, “if I were not told to go to the ER, I’d be out running 18 miles in a couple of hours.” He informed me of some of my options.

Since I already had a referral to Oracle, he contacted them to see me in the next few hours; I was started on blood thinners and moved to an Observation Room.

In the Observation Room, I was hooked to monitors and dosed with the equivalent to my Symbicort prescription through an interesting device.

My cell phone was down to a 10% battery level, and I asked if they had a Samsung charger. They have a universal charging station in a common area only.

By 10 am, Dr. Iantorno from Oracle saw me, and we decided on a treatment plan. She’s done the Lake Placid Ironman, a few half irons, and will be running MCM at the end of October. She had an understanding of endurance athletes’ motives.

What we could not figure out was when the A-Fib started. My primary care and pomologist did not hear the arrhythmia. I’ve been feeling an irregular pulse for at least six months.

If we knew when it started, we could determine the cause (i.e., dehydration, heat stroke, electrolyte imbalance). I know what to look for to isolate the reason now.

Later in the day, we did a Transesophageal Echocardiogram to look for existing blood clots in my heart and examine the heart structure. They would do an electric shock to get me back in sinus rhythm if everything was good. Since I was under sedation, I would not feel the shock.

I was back in the Observation Room by 2:30 pm and discharged by 7 pm.

I’m on blood thinners to avoid clotting if the A-Fib comes back. Clotting could cause a stroke.

I need to wear a heart monitor for 14 days. The monitor links to a one-app cell phone, which collects data. I can record on the cell phone any events (i.e., light-headed, strange pulse, shortness of breath).

Before being discharged, the nurse in the Observation Room asked me if I was feeling better. Since I didn’t feel bad on Monday, I didn’t feel any different on Tuesday.

My most significant issues were lack of sleep and not eating anything from 6 pm on Monday until I got home at 7:30 pm on Tuesday.

Looking back on the long Monday night wait, I would have been put in the Observation Room earlier if they had seen me earlier and got some sleep. The Tuesday procedure would not have been done any earlier.

Monday is a busy day at the ER as there are three days of patients arriving and waiting. I can’t tell if the issue was the lack of staff or the lack of rooms. My best option in the future is to avoid the ER on Monday nights.