On September 27, 2022, I went to the hospital for the first time because of A-Fib. I posted my experience in my A-Fib blog entry.
On December 19, 2023, I went back into A-Fib. I posted that experience in my A-Fib -Round 2 blog entry. Did my bout with COVID-19 cause the heart stress, or was it bound to happen anyway?
After seeing Oracle Heart and Vascular on December 20, 2023, I went back on Eliquis, and they started me on 25 mg of Metoprolol. Metoprolol reduces heart rhythm and blood pressure and may put a heart back in normal sinus rhythm.
They wanted to see if the drug would work by my follow-up appointment on January 8, 2024.
My 4-mile run changed to a 3-minute walk and a 3-minute run. The run portion was difficult, and eventually, my pattern changed to 6-minute walks and 1-minute runs. Even during some of those runs, my legs would weaken. If I did not stop running, I would crumble. Reverting to a walk kept me upright.
I continued to take the drugs, do daily Kardiamobile readings, and ran until my January 8 appointment.
By that date, all Kardiamobile readings had returned as A-Fib, and an in-office EKG showed the same. The Nurse Practitioner at Oracle prescribed a two-day monitor, which I was given in the office, and an echocardiogram.
The front desk scheduled me for the echo in May. I complained without success. I asked if there was somewhere else I could do the echo, and they told me Mary Washington’s schedule was also backed up.
The next day, I received a call from Oracle telling me my monitor was ready for pickup. I informed them I was already wearing a monitor. Realizing the situation and knowing I needed to wear the monitor for 14 days rather than 2, they changed the written agreement verbally to extend monitoring.
I’m not a lawyer, but I play one on TV. I know a written contract can not be changed verbally. On January 10, I went into the office and asked three questions: can I get more monitor connection pads, get a modified agreement, and talk to somebody about my treatment plan?
Within 10 minutes, the pads came out with a changed agreement, and another scheduler changed my echo for January 16 with a follow-up to review the monitor and echo on February 6. Things were looking better, and my blood pressure dropped by 20. I was more relaxed, understanding they were doing tests to determine actual medical conditions rather than believing my persistent A-Fib diagnosis.
My echo was scheduled for the morning of January 16. On January 15, a snowstorm was forecast to close the office on the 16th, and the technician called in unavailable to do the echo. Oracle called and rescheduled the echo for February 22.
I asked them to send a referral to Mary Washington Healthcare for an echo to see if they could see me earlier. Oracle doubted they could. I wanted Oracle to send referrals to facilities in Richmond and Charlottesville as I would travel. They did not have fax numbers, so they asked me to call them for their contact information.
I called UVA Healthcare and Bon Secour to get fax numbers. When I called Oracle back with the number, they had an opening for the following afternoon.
On the afternoon of January 16, Oracle did my echo. The technician could see that the A-Fib was still fluttering. I asked when I would get a result. She told me that if there were a serious issue, a cardiologist would already be in the room to discuss alternatives.
A couple of days later, Mary Washington Healthcare called to schedule the echo. I told them the procedure was already complete and asked when the next opening would have been. “Early next week,” they replied.
The day after I returned the monitor, I received a call from Oracle to increase my Metoprolol dose to 37.5 mg as my monitor was kicking out a rapid heart rate. I asked if my running was causing the high rate; they did not respond, so I started the increased dose.
To get a follow-up appointment on February 6, I had to drive to the Oracle Dahlgren office. A 45-minute drive to save two weeks was a good trade-off.
We conferenced Meg in on that appointment. The monitor recorded me in A-Fib 100% of the time. I asked if my running was causing the rapid heart rate the monitor recorded. Probably not; my atrium rate was above 400 bpm.
We discussed options, and the Nurse Practitioner referred me to Dr. Talreja with Premier Heart and Vascular for a cardiac ablation evaluation. Oracle had lost the doctor who performed their ablation procedures, and Dr. Talreja was taking on their workload.
Back in Fredericksburg, I called Premier and got their first appointment on March 8. I was not happy. After hanging up, I noticed on the referral a diagnosis of paroxysmal A-Fib rather than persistent A-Fib.
The following day, I called Premier and asked if they had a waitlist for patient cancellations and if I could get an earlier appointment with a persistent A-Fib diagnosis. Both answers were yes, and they rescheduled me for February 23.
When I worked with Dr. Khan in 2022, he told me that optical sensors in Fitbits and watches do not report heart rates accurately during high heart rate exercise. A chest strap using an electro sensor is the best method to gather this information.
Post-procedure, I wanted to get the best information, so I purchased a Garmin HRM-Pro Plus chest strap, which required a Garmin watch to record the data. I also purchased a Garmin Forerunner 245.
I finished the Dahlgren Trail half-marathon on February 17 to keep my Grand Prix streak going.
I started using the HRM-Pro Plus after the half-marathon. When walking, my average heart rate was 138. My run segments maxed out at 160. Similar measurements on the optical sensor were 115 and 148.
A downside to the chest strap is that it only transmits when the watch is doing an activity (run, cardio, walk, bike). If I want to wear the strap to bed, I need to create an activity called “sleep.”
At my February 23 appointment, Dr. Talreja explained the ablation procedure. A device is inserted into the heart via the femoral vein in the groin. The device burns or freezes the atrium cells that were causing the bad electrical signals. The procedure has an 80% success rate. If unsuccessful, it can be done a second time. There was only a 1% risk of a side effect.
Rather than the ablation procedure, some drugs eliminate A-Fib. However, the drugs have potentially severe side effects and work only 10% of the time.
I was hoping the procedure could be done the week after Grand Slamrock. However, due to a backlog and Easter, April 1 was the first opening.
Shortly after that, I needed a refill of my Metoprolol prescription. That drug is now a generic. On the refill, I received a version from a different manufacturer. The pharmacist told me this version contained lactose and asked if I was ok with the past version. I was.
However, I started having lactose digestive issues in the next couple of days. They also changed to another version with lactose, and matters worsened. I assumed the original version did not contain lactose because I was not informed of it at pickup. I was wrong. It, too, contained lactose.
Come to find out, all versions contained lactose, so I had to start taking 3000 IU of lactase with each pill dose. It’s always a new adventure.
Early in March, my wrists started swelling at night while asleep. So, I stopped wearing my Garmin watch to bed and lost overnight monitoring. The watch tightened on my wrist and made that hand swell more.
I finished the Grand Slamrock 5km on March 16 to keep my Grand Prix streak going.
Just before Easter, Mary Washington Healthcare called to collect my procedure co-payment. With Medicare and my Anthem Medicare Advantage, I owed $300. They would give me a 15% discount if I paid over the phone. It was a no-brainer, so I paid now to save $45.
Meg came back from Utah for Easter to see friends and her mom. She and Sandra came to Fredericksburg to help me, picking me up at 6:10 am to be at Mary Washington Hospital by 6:30 am.
The registration process went smoothly, and we played a few rolls of Farkle before going to the Cardiac Cath Lab observation rooms. I changed into the tie-in-the-back gown, and they hooked me up to the heart monitor. I showed Meg and Sandra what A-Fib waves look like.
The nurse reviewed my medications and ensured I had not eaten anything since midnight. I told them I had tried to update my meds on their online registration process and MyChart without luck. A few meds had incorrect dosing, and others were missing. It was good that I brought a printed sheet with the meds so she did not need to read my handwriting.
The Anesthesiologist came in and talked with me, and a nurse inserted an IV port in each arm. Then, the nurse had me sign three forms. Two had the double negative question of “Do not resuscitate?” that needs to be answered “No.” They rolled me down the hall to the operating room shortly after that.
Once there, the nurses started attaching pads and wires. Finally, they had me lay back. The Anesthesiologist told me she was giving me something to relax. That was the last I remember, no count back from 100. Maybe I was flirting too much with the nurses, and they needed to shut me up.
Incisions are made on both sides of the groin to access the femoral veins. While out, the nurses shaved the region but missed a few spots. They also shaved chest hair under potential paddle locations. Maybe I should have gone in for a waxing.
Before the ablation, they performed a Transesophageal Echocardiogram (TEE) to look for clots and structural defects. This process required a probe to be inserted down my throat. They also put a piece over my teeth to protect them and keep my mouth open.
As part of the procedure, a cardio inversion is done to get my heart into a normal sinus rhythm. This part of the procedure is done with defibrillator paddles on my front and back. The zaps left burns on my chest and back that itch.
I didn’t wake up until I returned to my observation room with Sandra and Meg. That was quick. I could not see the monitor. Meg told me my resting heart rate was 65.
The nurse changed the bandages and pulled out some of the hairs that were still in place.
My throat was sore, and I coughed up a little blood. A few things were rubbed the wrong way as part of the TEE.
She explained how I needed to take care of the incisions: shower on Tuesday night and put on a new bandage each night from Tuesday through Thursday. If the incision started to smell bad, swell, feel warm, ooze puss, or bleed excessively, that would be an issue.
I changed back into street clothes, and we waited for Dr. Telreja to complete another patient before he came to talk with us.
He explained that he ablated the four pulmonary veins and a spot on the back wall of the left atrium.
He put me on a 30-day prescription for Pantoprazole; this drug is for acid reflux to soothe the lining of the esophagus and will help fix the rough spots caused by the procedure.
He cut my Metoprolol back to 25 mg twice a day. And with the caveat to not take a dose if my Systolic Blood Pressure is less than 100.
I’m still on Eliquis, a blood thinner. I’m expecting to stay on Metoprolol and Eliquis for at least 90 days. When I come off the Metoprolol, I’ll need to monitor my blood pressure closely. Though I’ve never had high BP, it does run in my family, and my tracking before December 2023 was done on a wrist monitor, which tended to report low numbers.
They’ll probably put me on a monitor for a few days before stopping the Eliquis.
He wants me to stay under 70% of the maximum heart rate zone during exercise over the next eight weeks. We’ll use 153 as my maximum heart rate from the formula 220 minus my age. My monitors have kicked out higher numbers, but we’ll stay conservative. Meg saw my resting heart rate as 65 post-procedure. So, the 70% cut-off is 126 bpm (((153 – 65) * 0.7) + 65). Until my follow-up on April 19, I’m only allowed to walk. So far, my max walking heart rate has been 111 bpm for one mile.
As always, during exercise, if I need to sit down, I need to call 911.
I’ll monitor my blood pressure, weight, SpO2, pulse, and temperature each morning. If my SoP2 is < 90, I need to go to the ER. Also, I’ll do an EKG on my Kardiamobile. For the next 90 days, I may have some A-Fib. I don’t need to worry until my Kardiamobile indicates A-Fib for five days in a row.
Of course, I must take a second blood pressure and pulse reading before taking my nighttime prescriptions.
Once done, we were ready to leave and walked past the nurse’s station. I asked if I needed to do anything to check out. Oops, I had to wait for a wheelchair to take me to the curb.
Sandra drove us home. I wasn’t allowed to drive until noon on Tuesday.
Tuesday morning, I looked at the bandages for the first time. The left one was swollen. With Meg’s help, we determined the gauze absorbed a lot of blood. We changed the bandage. The incision looked good.
At about 8:45, Meg walked to the train station to start her trip back to Utah.
I still don’t know why my ribs felt pressed on both sides until mid-day Thursday. Was there a little chest pressing during the procedure?
After the procedure, my blood pressure dropped slightly, but it is still in the 106/72 range.
I have a follow-up visit with Oracle’s Nurse Practitioner on April 9 and another with Dr. Talreja on April 19.
Meg and Sandra have been a great help during this whole period. I hope I didn’t whine too much.
A big thumbs up to Mary Washington Healthcare. They were delightful through the entire process.
Lastly, when I’m back running consistently, my heart rate is higher than 153, and my perceived effort is not all out; I need to get back to my pulmonologist to see how bad my asthma has become.