Saturday, May 18, 2019

Unexpected reboot

Some days you’re just minding your own business and things happen that were utterly unexpected, even if they’re familiar. When that happens, it can change everything. That was how my week started.

Monday I ended up in hospital after having another episode of racing heartbeat. Sunday night, I thought I could feel my heart fluttering in afib (atrial fibrillation), which actually wasn’t unusual. I had to go to the periodontist for treatment the next day, the first this year, and I thought I might be feeling a bit anxious about it, in part because the feeling seemed a bit stronger than usual.

The next morning started out normally enough, though I was tired from poor sleep the prior night. Around 9:20, I felt odd, and checked my pulse on my watch and it was around 109bpm, which is quite fast for a resting heart rate for me, since I’m on drugs to keep my heart rate slow. It went up from there.

I lay back down to rest and hoped it’d resolved itself, but it didn’t. Instead, it sometimes sped up, sometimes slowed down, and even though I dozed off, it never stabilised or returned to normal. Eventually, Nigel took me to the A&M (accident and medical) clinic that I’d been to twice before for racing heart rate. It was confirmed I was in afib, and had tachycardia (fast heart rate), and even administering a small additional dose of the drug I take to regulate my heart rate didn’t return it to normal. I was sent on to the hospital again.

First night in hospital.
I was hooked up to monitors in an observation area and they drew blood for tests. After Nigel went home for the night, they took me for a chest x-ray, then moved me to a room in a different evaluation unit, where I stayed that night. I didn’t sleep well.

In the morning, I was visited by the doctors, and they suggested using electrical cardioversion to reset my heart rhythm and heart rate to normal. This involves administering an electric shock to the heart, similar to, but weaker than, the shock they give to someone in cardiac arrest. It’s done under a mild general anaesthetic. Nigel and I referred to it as "rebooting" my heart.

This would mean another night in hospital, since I’d already eaten breakfast. They transferred me to a different room that evening, just in time for dinner. I didn’t choose my own dinner, since I wasn’t there at the time they took orders, but I didn’t mind: It reminded me of church dinners I’d had as a kid. Later that evening, they moved me to yet another room because of a problem with a patient in the adjoining room (which shares a bathroom/toilet with the room I was in).

The dinner I didn't choose,
but didn't mind.
The older man in the new room snored and breathed roughly, but I still slept slightly better, though still not well. I got no breakfast, of course, and just a little water to take my morning pills with. At the time, that didn’t bother me. They took some more blood for benchmark tests, among other things.

Nigel arrived not long after that, and by then it was obvious it was likely to be early afternoon before my procedure was done. It was a long and boring wait, and I was getting hungry (not helped when they stopped by and had me order the next meals). Worse, though, I was exhausted—not just from the lack of sleep, but also from more than 48 hours in afib with a racing heart rate. I occasionally dozed off.

Intellectually, I wasn’t worried. I was in the hospital, and if anything went wrong, they could deal with it without delay. On the other hand, they were going to shock my heart! I was scared it’d stop and they wouldn’t be able to restart it, even though I knew that was unlikely and improbable. Fear is often irrational.

Early in the afternoon, they came and got me after hooking me up to a mobile monitor. First stop was a room just outside the operating theatre, where they confirmed paperwork, my identity, asked yet again whether I had any allergies, and had me sign the consent form. They said normally they did one jolt, but if it was unsuccessful, they may do a second one. I was then given a mild sedative.

Inside the operating theatre, they put an oxygen mask on me, and gave me the drug that made me fall asleep. I woke up—just a moment later, it seemed to me—in the recovery area, a huge brightly lit, thoroughly modern room with maybe ten or twelve beds I could see, with maybe that many in an identical area behind me. They asked if I wanted them to ring anyone, and I asked them to let Nigel know I was okay and all went well, which they did.

The procedure was a success, and I converted to sinus rhythm with only one jolt. I’d felt nothing, and afterward I felt good. I didn’t even feel dopey from the anaesthetic, since it was a mild version of it.

They took me back to the room, and the clinical doctor visited me to go over what happened, what was going to happen next, and asked me if I wanted to go home (duh!). He then went off to do the paperwork. The dinner I’d ordered arrived while we were waiting, and I inhaled it—I was very hungry by then.

The first thing they did was put me on a new drug, Amiodarone, to control my heart rhythm. This drug potentially has a lot of harsh and harmful side-effects, which require close monitoring, so much so that New Zealand’s Medsafe advises doctors to “Keep an Eye on Amiodarone Patients”. My first blood tests will be in six weeks, then again at three months. They also reduced my dose of Diltiazem, the drug I take to control my heart rate.

This new drug regime is a bridge. In a few weeks I’ll see a cardiologist, both for follow up, and to see where we go next. By then I’ll have had one or more blood tests, which will tell them if I have any side effects. The likely plan is to do the ablation procedure to deal with the cause of the afib and, hopefully, take care of the problem permanently. According to the doctors, it may not turn out that way, because in some cases more procedures are required, or they’re not completely successful. But, best-case scenario, it will mean I can be taken off some of the drugs I’m on at the moment.

All of this is necessary because I don’t respond to the available medicines. I couldn’t tolerate beta-blockers, as I’ve documented in these Health Journey series of posts, and—obviously—Diltiazem didn’t keep me out of tachycardia or afib. This means that drug therapy probably isn’t an option for me.

An interesting thing that came out of all this was that one doctor pointed out that it’s impossible to know for sure whether it’s the Diltiazem or the afib that’s causing my ongoing fatigue. But whatever the cause, I’ve been deeply tired ever since this tachycardia business started, so much so that I don’t feel I have my life. I told the doctors that I’m too young to feel this old, and I feel I’m being robbed of what should be good, productive, active years. I think our mutual goal is to change that.

The tests done already have shown one really good thing: My heart is healthy and functioning normally, apart from the afib. The stent is unrelated in that it was for a cardiac artery problem, not the heart itself, and that was fixed. With proper care and monitoring, is unlikely to recur.

I slept 12 hours Wednesday night, and spent Thursday mostly relaxing. The main thing I did was that Nigel took me to get my new prescriptions (I don’t think I was supposed to drive for like 48 hours because I’d had a general anaesthetic), and he took me to lunch while we were out. Friday and today I’ve similarly kept quiet. But, I feel fine.

So, a problem I’ve dealt with before, the tachycardia and the afib, took a new twist this week, and required more aggressive treatment. Doing that actually points to a way forward, though it may turn out there are more twists and turns in this road yet. This week was stressful, and very tiring, but otherwise not as big a drama, fortunately, as it could have been, nor as bad as others have faced.

Some days you’re just minding your own business and things happen that were utterly unexpected, even if they’re familiar. When that happens, it can change everything. That was how my week started. Fortunately, it ended much more predictably.

Oh, and, of course, I left hospital without a bill.

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