Thursday, December 03, 2020

Procedure change

It feels like I’ve been talking forever about the procedure that may/hopefully will fix my atrial fibrillation so I can have a more normal life. I’ve been aware of the procedure for a couple years, and keen to get it for around a year and half. So, yeah, practically forever.

This week there was yet another leap forward.

On Monday of this week I got a call from the DHB to tell me that they had an opening to get the procedure done, and it was Thursday, December 8. I rang them back to confirm, and it was all go fom there.

This quick change meant I needed to get some blood tests done, and because mail is only delivered three days a week now, they needed to email me a scan of the order. I got that yesterday.

I’d planned on getting the blood tests this morning before my dentist appointment today, but I ran out of time. I wanted to get that done before I wrote this post so the information could be as up to dat as possible. I did that this afternoon.

The nurse in the elective cardiology procedure department sent me a brochure/booklet on the procedure which reiterated what I already knew, while adding details I didn’t. Better still, it was clear and easy to understand (whoever the technical writer for that project was, they did an awesome job). The most important part for me is that it explained in some details of what to expect, including sensations I may feel. It also spelled out what I need to do after the procedure to look after myself, and what will happen afterward.

The important thing to know is that the risk of dying from the procedure is less than 1:1000, which is pretty good for something involving the heart. For comparison, the procedure is less likely to kill me than the chance a motorcyclist has of dying or the chances of dying from drowning, or dying in from fire or smoke (2018 data from the USA). The main risks are:
…stroke, pericardial tamponade (bleeding around the heart), narrowing of pulmonary veins, damage to the phrenic nerve, damage to the blood vessels in your groin, and a serious but rare risk of atrio-oesophageal fistula.
None of which, including death, is likely to happen. But, it could kill me, and I’m both clear about that and perfectly okay with wearing the risk, and for a number of reasons (a topic in itself). I was actually more interested in what happens during the procedure and afterward. The booklet explains it this way:

During the procedure you will receive fluids and any necessary medication through your IV line. You may be sedated for the procedure or alternatively your doctor may choose to anaesthetise you (‘put you to sleep’).

A local anaesthetic will be applied to the site where the ablation catheters will be inserted. In most cases the vein in your right groin is used.

In this procedure the doctor will put one or more sheaths into the vein in your groin so catheters can be inserted. The doctor then threads the catheter to the right atrium of the heart. Then he or she will cross the wall (septum) that separates the left and right sides of the heart. This provides access to the left atrium. You will receive anticoagulants (blood thinners) to help prevent clots during the procedure.

The Cryoballoon catheter enters the left atrium. The doctor inflates the balloon and moves it to the opening of the pulmonary vein. The goal is to close off the opening of the pulmonary vein completely, which temporarily stops the flow of blood between the vein and the atrium (this is called occlusion).

Once Occlusion is confirmed the doctor will introduce liquid refrigerant into the balloon. The refrigerant evaporates and removes heat from the heart tissue at the opening of the pulmonary vein where the balloon is in contact with it. As a result, the tissue is scarred and may no longer spread the electrical currents that cause atrial fibrillation. Each Freeze lasts between 3-4 minutes and at least two freezes are applied to each of the four pulmonary veins. There should be minimal or no discomfort during the process although sometimes you may experience an “ice-cream” headache. Also, during some necessary pacing manoeuvres, you may also experience a hiccup sensation. Neither of these are harmful and will stop quickly once the Cryoballoon has finished freezing the vein.
I’ll see the doctor six to 12 weeks after the procedure is completed, possibly after a 24-hour monitoring of my heart to see what what it’s doing. My medication will be reviewed at that appointment.

Between 20 and 30% of patients need another procedure, however, the cardiologist I saw in Auckland said the procedure is 87% effective, especially for people with my specific cause. Which suggests to me that I have really good odds of having it fixed in one attempt, but it still may not work that well.

Best-case scenario, the procedure will be a success, and sometime at or before early March they may change my prescriptions, and between those two things, I may get to have a more normal life. That’s the whole point of doing this, after all. As I’ve so often said, I’m too young to feel this old.

Worst-case scenario, I’ll die or have a stroke, or second-worst case, I’d need another procedure. I don’t take those risks and possible bad outcomes lightly, and I certainly can’t ignore them (this IS 2020 after all…). but I’m optimistic that things will go well. Besides, if I’m to have any shot at a normal life, this is vitally important, despite the risks.

It’s the possibility of getting my life back that excites me (weird to say I’m “excited” about a medical procedure, but there it is). I’m also nervous, of course, but having gone though a very similar sort of thing when they inserted my cardiac stent, I at least kind of know what it’ll feel like, which helps. A little.

And yet, I am scared—not about the procedure as much as I am about going through it without Nigel. He’d have been there with me every step of the way, including keeping me company during the four hours I have to lie there after the procedure is done. He’d have looked after me when he brought me home that afternoon, and for the week or two following the procedure. But he’s not here, and this is the most frightening thing I’ve faced since he died.

My family is organising to support me—to drive me to and from the hospital, and to stay here with me the night after the procedure. I’m incredibly lucky to have such an awesome family who will look after me since Nigel can’t. I know that, and I’m so deeply grateful to them. But I know they’ll understand when I say I’d much rather have Nigel here to help me and look after me. He was the source of my strength, and without him I feel like Superman in the presence of kryptonite.

Having this procedure, and having the family look after me in Nigel’s place, all means that I’ll have my first chance at a normal life since Nigel died, to truly begin to rebuild my life without him.

Risks? Yes. Worth the risks? Absolutely. I know that Nigel would think so, too.


Roger Owen Green said...

Yow. well, wishing you good luck with this seems rather insufficient.

Arthur Schenck said...

While I’m completely relaxed about the risks, I expect to have a good outcome, if only because the vast majority of people do, or, at least, don’t have a bad one. Still, a little added luck can’t be bad.