The Heart of The Matter

Adventures with A Fib

It’s been a few months since I published anything on my motley blog. I’ve been distracted by on going health issues that bullied their way into the tranquility of the Urbancrows e-rookery.

Almost one year ago, I walked into my doctor’s surgery with a sinus infection and came out with a heart problem. It was a Friday toward the end of October, and I was definitely not a happy camper. I was sweating. My skin was an attractive shade of corpse grey, and I was breathing hard -all of which I put down to the rivers of goop coming out of my sinuses, wending their merry way to my lungs.

My doctor, who’s Russian, was listening to my chest to see if the sinus infection had spread to my lungs. She took a listen with the stethoscope, then listened again all the while looking more and more worried. The cold end of the stethoscope was moving rapidly across my back as I breathed in an out, accompanied by the ominous sound of anxious tutting. Bloody hell, I thought, my lungs must be bad -my head flooded with images of a murky swamp full of mucus and bacteria.  She sat up, took a long look at my pallid, sweaty face and muttered:

“Listen to me carefully. You must go to hospital right now.”

The sinus infection was obviously worse than I thought.

“Isn’t hospital a bit drastic? Can’t you just give me some antibiotics? Last time I had an infection you gave me Amoxicillin.” I said, coughing and hacking and sweating a bit more for good measure.

“I think you close to heffink a heart ettack.” she replied somberly. “Also, you heff atrial fibrillation.”

“7-day course, right? …DID you say heart ettack? And what the fuck is atrial filligration?”

She was serious, insisting that I leave right then. So, I went home to my wife, dug out our Will and let her know I was off to hospital and could I maybe get a ride to emergency? She was on a business zoom call and distracted.

“Er…Darling, I’m going to the hospital because I have heart problem and the doctor’s worried I might have a heart attack.”

“That’s nice dear. I’m on a call. Bye. Have fun.”

And So It Begins

Twenty minutes later I was out at the university emergency ward. I’d caught the bus rather than drive myself, figuring that if I did have an ettack, someone on the bus would notice and once they’d cleaned out my wallet they’d either help me, or get the bus driver to help me. On the other hand, if I drove on my own and had an attack, my destiny lay in a wrecked car wrapped around a lamp post.

The good doctors at the university -God bless them- established very quickly that I wasn’t having a heart attack. Hooked up to an ECG, they told me that a) I had a sinus infection (thanks for that lads) and b) I was in the throws of a full-on attack of atrial fibrillation -whatever that was- hence the “world-hates-me-and-my-body” feeling that had come over me.

What The F*ck Is It?

I asked the obvious question. What was atrial fibrillation and why did I have it? The doctor spent 20 minutes explaining the condition very carefully and outlined my long-term treatment options, none of which sounded particularly appealing. One involved lots of electric shocks and the other great gobs of liquid nitrogen applied to the heart, and both sounded highly illegal.

A Fib causes the heart’s electrical system to misfire. Rather than sending regular pulses of electricity to the pumping muscles of the heart, the nerves send out a random jumble of signals leading to spasming of the atrial valve. In the throws of an attack, the heart rate goes up, sometimes for 12-18 hours at a time, leading to exhaustion and fainting in some people. With me, my rate was up to 100-110 bpm in the middle of an attack.

As far as the heart knows, you’re running for hours on end so eventually it’s going to say, “fuck you, no more” and exhaustion kicks in, associated with a general physical anxiety. It’s a long-term condition and the longer it goes on the higher the risk of damage to the heart muscles. There’s also a risk of stroke because of blood clots in the heart which can form in spots where the blood isn’t circulating properly. Suspected causes of A Fib include sleep apnea (which I have), excessive alcohol use (I like red wine), and miscellaneous other factors. None of this improved my mood or the sense that I now had a long-term health problem to deal with.

The Thinning Of The Blood

The doctor immediately put me on blood thinners to reduce the clotting risk and referred me to the A Fib clinic at Vancouver General. A few days later I had my first appointment. The consultant there gave me more detail on the condition, prescribed more drugs to reduce my racing heart rate, and sent me home with a 24-hour monitor so they could understand what my heart was doing and when it was doing it (fucking around all the time… it’s simple, I could’ve told them that).

Next visit they explained my treatment options. First up was cardioversion, or what I came to know as the car-battery-iron-bedframe-torture method. When I used that with my consultant he chuckled in a disturbingly sinister voice and said, “oh no… car batteries are only 12 volts, this is 220.”

Six weeks later, I had my first joyful tussle with cardioversion. Putting on a brave face -fully expecting to see one of Saddam Hussein’s henchmen clutching jump leads, leering at me from the shadows- I was wheeled into the surgical room on an insulated gurney. Under heavy sedation, with my manly chest shaved smooth (calm down, ladies), they rebooted my heart with a defibrillator, 4 shocks in the first session because mine was a stubborn case of A Fib. An hour later I came to in the recovery room to the cheery words “It didn’t work. We gave you 4 jolts but no good. We’ll try again in 6 weeks or so.”

Crispy Skin

In practice that meant I was back to square one but accompanied now by a faint smell of burning skin and sporting 4 large, red rectangular burns -2 on my chest and 2 on my back- which itched like a bastard when they started to heal. The failure was a bit of a blow although not unexpected. Most patients treated with cardioversion will revert to A Fib within 12 months.

The clinic then decided it was best to roll out the big guns for round 2 of my treatment. They prescribed a drug called Amiodarone that beats the heart into submission by brute chemical force, kicking it back to a regular beat, which is called sinus rhythm (ha ha).

Ami Noderone

Amiodarone would not be my drug of choice long term, medium term or even short term. It’s a poison that gradually accumulates in the major organs of the body. I wouldn’t wish it on my enemies. The related side effects are nasty. Failure of all of said organs, irregular heartbeat (!), weight gain (which I have, 15lbs roughly), enhanced sensitivity to the sun, and eye problems followed by all of the above again in reverse order but worse. As one website reassuringly puts it: “Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects.” After 6 months on it they start testing for thyroid issues. If you think I’m joking, here’s the list.

The chemical mugging worked after a fashion, keeping me a little more regular than before I was on it. I was now taking blood thinners, a heart rate suppressor and a heart rate stabilizer; so many pills that food was unnecessary.

Eight weeks later I had a second round of cardioversion which was initially successful, but my wonderful ticker decided to revert to A Fib yet again after only 2 weeks. By now I had my own bed in the cardio recovery ward, with a handy sign hung on the foot end “Property of Ralph Rushton. Call for bookings.”

Phase 1, 2 and 3

I had come to recognise 3 different phases to my A Fib.

1. Normal heartbeat, which was probably 80% of the time.

2. Full on A Fib with a totally erratic beat up to 100bpm for up to 10-12 hours, usually starting in the afternoon which was very exhausting.

3. A state of intense physical anxiety often leading up to an attack of A Fib. It’s like the bad feeling you get after a huge jolt of adrenaline or during a panic attack. This stage often presaged an A Fib attack for me and is extremely disconcerting.

In February of this year, I was back at the clinic.

“What’s next?”

“Catheter ablation. Six to 8 months wait.” said the consultant.

My initial thought was oh my god they plan to stick something abrasive and flexible up my johnson all the way to my heart and have a good scrape around. It didn’t sound appealing.

And that was partly true. The surgeons thread catheters in through incisions on either side of the groin, to the heart. They spend a good hour mapping the nerves in the heart with a 3D ultrasound unit they’ve stuffed down your throat and then insert either an electrode or liquid nitrogen through the catheters to zap the parts of the nerve that are spasming, killing and scarring the tissue. This is supposed to eliminate the electrical misfiring.

Its a 2–3-hour procedure done under a general anesthetic that has a long-term success rate of 70%. Last Tuesday was my first go at it, and hopefully the last.

A Pink Groin

I woke up after 3 hours with a shaved groin painted pink with antiseptic stuff -some people pay good money for that but I got it for free. I also had mild chest pain. And someone was screaming just up the corridor which was very calming. Plus my throat was sore from the ultrasound probe, either that or the Doctor did something unspeakable to me while I was under.

For the first 48 hours after you really don’t want to do much other than sleep. Then it’s a slow ease back into normal physical activity, which if you ask my wife means more lying about on the couch watching soccer.

Six days on and there’s still some remnant fatigue and I now realise I underestimated how tough the ablation is on the heart. After all, it was poked, prodded, scanned, burned and soundly abused for nearly 3 hours. The good news is my heartbeat -so far- is regular as clockwork again, slightly faster than before but that’s a transient effect that only lasts a couple of months.

I’m Regular Again

The worst effects of A Fib have gone for now. The physical anxiety hasn’t returned and I’m less aware of my ticker. During an attack I was acutely aware of my heart – you can feel it thumping away, beating out a rapid free style jazz rhythm rather than a rock steady beat. I could also feel the pulse in my hands and feet.

So now I wait. Six to 8 weeks until they can be sure it worked. I can expect the odd reversion to A Fib until the scarring fully develops on the offending piece of the heart, and I’m still on Amiodarone until the 8 weeks is up (boo hiss). If this procedure fails, then they’ll try it one more time and after that, I get a pacemaker which should provide all sorts of metal detector related hilarity at airports.

And that’s why I haven’t posted much. I wasn’t really feeling it.

PS

As a postscript, to all you Vancouverites out there, if you must have a heart problem, thank your lucky stars you live in this fair city. The VGH clinic is amazing, staffed with friendly, knowledgeable people and top-notch doctors. I can’t praise them highly enough. Every step of the way I’ve been able to talk to someone the same day, discussed meds or treatments and I’ve been given straight up answers. VGH. Word.

And Remember Folks…

If you’ve derived any sadistic enjoyment from this piece; if you’ve revelled in my physical misery, you can make up for it by subscribing to UrbanCrows using the nice, regular, steady subscription box at the top of this page. Go ahead. I’ll send you some free Amioderone if you do.