the thread of ATRIAL FIBBING

a month or so back i went for my six monthly asthma check-up: all fine -- a bit breathless, a bit overweight, but nothing to be alarmed about… except my blood pressure was unusually (tho not wildly) high… the nurse suggested i talk to the GP

a week later i saw the GP: blood pressure now more or less normal (the first reading seems to have been an anomaly)… but did i know i had an irregular heartbeat: i did not. he sends me for an ecg there and then and calls in another, more experienced colleague -- yes, atrial fibrillation, or AF, as everyone calls it. one of the chambers of the heart -- atrial is from atrium, latin for a large open space within a building -- is not pumping properly with the rest, but kind of fluttering quite fast… doing the work, but in the wrong way

quite common, in itself quite treatable -- higher risk of strokes, underlying causes can be sinister, need to look out for heart attacks

i had been feeling a little odd recently: in particular when waking up, a bit lightheaded, a but buzzy and fluttrry, as if the blood were thrilling in my fingertips (not quite tingling, i can never quite find a better word than thrilling, tho doctors look blank when i use it) -- was this related? maybe

referred off for blood tests (next day) and echo cardiogram (appointment a month away): warned to looking out for breathlessness (asthmatic, hard to spot), chest pains travelling to arms and throat -- if these occurred, call GP or at weekends go to A&E -- and keep the warning threshold low, better safe than sorry

OK: once you're advised to look out for chest pains -- for fear of a heart attack -- you notice a LOT OF SENSATIONS IN YOUR CHEST… plus i was intermittently feeling fluttery and odd, not bad exactly but not myself

the saturday following this GP visit, i felt distintictly weird with -- i don't know to call them -- not pains, certainly not shooting pains, but mild sensations of griping in my chest, mainly to the left of my heart… talking to NHS helpline (111); they asked a lot of questions abt symptoms (mostly negative) and go to A&E -- better safe than sorry

triaged at A&E (another ECG) and then a very long wait -- clinic is largely full of young people with amateur sporting injuries… i am not seen for some hours, probably because not instantly urgent. when seen, instantly given a disprin and CLOPIDOGREL to thin blood: diifferent kinds of decoagulant

describing symptoms to a doctor whose english isn't great: making her laugh when she ask "do you feel pain anywhere?" and i say "i'm 56, i feel pain everywhere"

hooked up to a heart monitor and left: monitor beeps trills with alarm whenever irregularity of beat gets too extreme; a nurse comes to turn the alarm off. One asks me if I’m breathing — I say, “What?” as I couldn’t quite believe the question and she says, “Computer says you’re not breathing but you must be, you’re talking to me,” and went off chuckling to herself.

Doctor comes back to take blood — as clumsily and painfully as I’ve ever had blood taken. Also unsuccessfully: she had to get a nurse to do it all over again (nurse rolling eyes and muttering “doctors,” at herself and a little at me). .More waiting: the curtain is drawn back so I can watch activity on the ward and occasionally hear my name mentioned. Lots of people in a desperate state: I’m feeling a bit of a fraud or a nuisance, though no one says so. Unsure if being let home that evening (main worry: I'm cat-sitting -- who do i call to dep for me and how to sort this out logistically, the key to my neighbour's flat is in my pocket). Also phone running low.

Sent for x-ray: wheeled there on my bad by a very chill and amusing porter who asks if i like going fast and pushes the bed down an empty corridor VERY fast, x-rayed by a very camp and anxious x-ray operator w/a big red hipster beard.

Shift changes: new nurse chatty comes on and explains stuff (inc.the wait). Doctor returns: all tests are negative, but my AF is fast (I was right to come in) and she prescribes DIGOXIN. Home again -- sleep better, thx to digoxin.

GP again: he affirms that all tests are negative (meaning no sign of impending or previous heart-attack, and some underlying causes ruled out). Chest x-ray also shows nothing sinister: apparently I have a blunted right angle -- but he seemed unworried by it. takes me off DIGOXIN and onto BISOPROLOL (a beta blocker, small dose at first in case it interferes w.asthma: in the event it does not) and refers me to a cardiologist. cardiologist visit is a bit of a frustrating dud imo: he talks mostly to himself, can't open his computer to see my relevant records (he's a locum), talks abt CARDIOVERSION (which the GP had been cautious about), which will need me going onto decoagulants and seems to think I shd have a much higher does of bisoprolol… mainly he's cross with me that the echo cardiogram hasn't happened yet.

(cardioversion is an electric shock to jumpstart the delinquent atrial chamber into synching with the rest of the heart: decoags bcz blood can pool in a fibbing atrial chamber and form clots, and the jumpstart can release it = risk of stroke)

so that is where i am: the beat-blockers are working well (i was a bit insomniac for a while but it's not a routine side-effect and may well have been pre-trump anxieties); echo cardiogram is next month -- then back to a cardiologist (i hope a different one) to discuss cardioversion or other treatment. i feel myself again, am sleeping properly, off all caffeine (and past the caffeine hangovers), dieting reasonably rigorously and planning to exercise more any day now (high-intensity work-outs are contraindicated lol), drinking only red wine now and then…

plus feeling a bit sorry for myself. and bcz i can't help feeling this was a bit self-inflicted (causes are various -- sometimes never determined -- but two likely ones are caffeine and being overweight and out of condition) (plus a month's stressing over that kickstater may not have helped), a bit guilty also :(

I wouldn't beat yourself up about the caffeine. The latest guidelines say it is unlikely to cause AF:

"Habitual caffeine ingestion has been investigated in several prospective cohort studies (Table 9), but these failed to show any significant relationship to incident AF.168 Also, heavy coffee drinking167 failed to demonstrate a significant relationship between caffeine and AF or flutter even in very high consumers (10 cups, 1000 mg/day). Overall, caffeine consumption on a habitual and regular basis does not seem to increase the incidence of AF."

By the way I interviewed a cardiologist who is an expert in AF the other day (I'm a medical journalist), and because both my parents have AF I asked him what I should do to maximise my odds of avoiding it. He said: control your blood pressure, control your weight, and if you have sleep apnoea get it treated.

Might talk to my GP about sleep apnoea -- not aware that it's a problem, tho i do get sleep paralysis now and then.

and thanks ZZ, i started t thread to find stuff out, not (just) to talk abt myself

good thoughts to you mark - let's hang out soon?

yes! (thank you)

good thoughts.

my father also has recently had some of those issues (faints, trips to the hospital, checks about two years ago) (there was a risk of irregular heart beat at some point too, but it was a kind of precautionary talk).

Anyway he has been lightly exercising regularly and is feeling much better, and has had to be very very disciplined about his diet (he has cut off ALL drinking)

POINT TAKEN

Atrial fibrilation is an area where "excessive" aerobic exercise appears to have harms. A number of cardiologists (most publically James O’Keefe) favor some moderation (1-20 mi/wk running equivalent, but not more) because of AF, hypertrophic fibrosis, and increased atherosclerosis in high intensity runners.

5 times more AF in athletes than non-athletes
19% more AF in those exercising more than 5 hr/wk

first reaction: i don't take tips from james o'keefe!
second: no danger here of excessive aerobic exercise tbh -- once my weight is down a bit and my asthma under better control i will explore stuff that's *gently* aerobic
(maddeningly the london fields lido is closed for refurbishment for the next few months: swimming is my usual outlet, with a nice brisk walk back and forth)

thx for links :)

I believe AF is often congenital, and many people have it all their lives and don't know it until it's diagnosed ... wondering if/whether you caused it or could have prevented it seems like a natural reaction but also a source of needless stress.

My father has been treated for AF for a long time and it seems not to have affected his quality of life very much (at 82 it's not at the top of his long list of medical problems). The blood-thinning drugs now in use seem to be much better and safer than what he was prescribed 25 years ago.

One nice aspect is that this is the one area of my life in which people routinely describe me as "young"! Admitttedly my GP -- who is literally 12 -- grinned a bit as he did so the first time, but it was still pleasing to hear, if unconvincing.

woke up at 6-ish with fingers tingling* again, first time at this degree since i went onto beta blockers -- v mild symptom in itself, but it's the one everyone i've seen seems to skip over, as in "oh, i don't know if that's linked" -- ok but something must be causing it, it only started a few weeks ago

*except this isn't the right word

consequence: tired all day, not got much work done, can't focus (this is lack of sleep but the fingers thing seems to cause that)

could maybe up my BB dose but shd probably check with a doctor first

ok so i just came back from my ECHO CARDIOGRAM

the nurse taking the reading sad: "apart from the arrhythmia nothing to worry about here, everything heathy and being kept under control, nothing running away with itself" -- i choose to read this as GOOD NEWS! the info will go back to the cardiologist i didn't take to and he will write to my GP and it will decided if/when i go onto to CARDIOVERSION

in terms of my self-care, basically the daily dose of beta blocker are effectively keeping everything chill, maybe twice a week i feel my fingers are fizzing and thriilling a bit and up the dose a bit

i am fully off coffee for three months more or less -- that one cup i had three weeks ago really made itself felt, and as it seems a bit daft to be necking beta blockers just to undo the effect of a strong cappuccino i will no repeat the experiment

alcohol: red wine seems fine (as per medico-urban-mythological factoid re heart health); beer's effect i notice a bit more so i will probably stick to red wine; anything wildly salty (like a large packet of crisps) seems to get my heart pit-pattering (though a good long slug of water seems to calm it down)

i am sleeping excellently (absence of coffee, who knew! beta blockers may also be contrbuting): literally for the first time in my life routine fast asleeply as head hits pillow -- i am more aware than i ever was of the degree to which yr heart responds to and contributes to matters emotional (which is obviously like DUH! given every document slurched out by the romantical-industrial complex but is still a surprise to notice when you have a condition novel enough to notice variation as it happens) -- life is just a never-ending forest of feels and yr organs are right in there working at that

so yes: next task, try and lose a bit of weight over xmas so the cardiologist doesn't make more unkind comments i guess

oh, also: i am definitely more physically tired at the end of the day than i'm used to being -- presumably bcz my pore wee heart is not currently able to oxygenate my blood so effieicently, one chamber is pumping much more to less effect

^^^possibly also the absence of the energy-shifting effect of coffee is contributing to this feeling -- viz i am no longer waking up tired and sluggish, which was pretty routine when i was highly caffienatated

ps you get to hear the magnified sound of yr own heart with an echo cardiogram, and in my case a more unconvincing and indolent arrhythmic squelch it is hard to imagine :\

belated update: two saturdays ago i fainted in the bathroom, banging my head quite sharply on the edge of the bath as i fell -- i spent the afternoon in A&E being checked out

conclusion: no concussion, and incident semi-unrelated to AF -- i have also suffered from VASOVAGAL SYNCOPE all my life (proneness to to faint: going through puberty i was toppling over like an automated ninepin) and apparently it has a tendency to return in middle age. it occurs bcz the body is not able to regulate blood pressure with the swift exactness it's supposed to (so e.g. it ends up in yr legs not yr head when you stand up too quick?)

probably -- this was my sister's suggestion (she also suffers from VS, plus her partner has AF) -- the beta blockers slightly exacerbate the tendency to sluggish regulation, so i shd take it seriously when i feel dizzy and not just sit down but LIE down, with legs elevated if possible…

ffs! :/

Hope you're keeping well since then, dude - a friend of mine has a proneness to proneness brought on by having a wee - this is only amusing for everyone else.

yes i've been fine since, no recurrance, and the doctor i saw talked me through the various triggers, so forewarned is forearmed (that particular one i don't seem to be cursed with)

i was actually a lot less bothered by fainting itself -- i am kind of used to it, tho it had been several years since the last time it happened -- than the fact of the bang on the head (a dimension i somehow always till then avoided)

the worst injury i sustained as a teen was fainting on the way to a music lesson with a schoolfriend after i turned my ankle stepping carelessly off a kerb (sharp pain was my primary trigger as a kid). i came to with my face pressed onto gravel and my pal kicking in the chest to "wake me up" -- he assumed i was kidding around, i think

i brushed myself off and limped into the lesson

CARDIOVERSION scheduled for 20 april: an electric shock to restore proper hearth rhythm

(i need to lose a bit of weight by then, i feel)

rescheduled for 18 may (and above post shd read "heart rhythm", my hearth is in good working order beats-wise)

mild irritation re poor communication between hospital/consultant's office and GP: when i first get an apoointment for this procedure, former tells me i need to be on anti-coagulants for a minimum of 6-8 weeks in preparation -- i get a letter (which i know also goes to my health centre bcz i copy and post it; i imagine it also arrives at my heath centre via the shared computer link but probably doesn't actually ping onto anyone particular's desk alerting them to this request re anti-coag)

after a week or so not hearing anything i call and leave my GP -- actually the trainee GP who originally saw me -- a message to call me, which he does the following day (he's not in every day). i ask him about prescribing the anti-coagulants: he says it's probably less complicated if i talk to the cardiology department about it, which i do

they say they'll send the request through to the health centre

i hear nothing for a few more days and ring up my GP again: he says "oh that.s naughty of them, what they should do is book you into the anti-coag clinic [or similar, i forget the actual term he used], where this is dealt with" he looks for and finds the request -- says "ok, maybe i should prescribe this directly from here, i'll just check with my colleagues if that's ok" -- which he does, fairly swiftly, so that's ok, i can pick the meds up the next day

we also both now spot that the 6-8 weeks has -- in all this fiff-faff -- been fairly sharply cut into (20 april is exactly six weeks from today) so if i do need to be on them the full whack, it's already too late. he says "maybe ring up the cardiologist and re-book"

which i do, and it's fine -- but basically the only reason any of this was sorted was me being the go-between between the two offices, which i feel is not how it's meant to work (viz if my english was poor or if i didn't have my mum's scepticism abt the ability of professionals to do the common-sense bits of their jobs better than me)

(tbf my gp is lovely -- if young -- and i enjoy talking to him; and ditto the person on the phone in cardiology -- the consultant was a bit of a twerp but with luck i will be under anaesthetic during my next dealings with him)

my mum's scepticism was abt the ability of professionals being to do the common-sense bits of their jobs better than HER: she generally thought i was also p bad at this kind of stuff)

update: after a suggestion from my sister's b/f -- who has the same condition and is on the same meds -- i switched the time of day i take my beta blockers from morning to evening

as a result i am MUCH LESS TIRED during the day (in fact back to normal), bcz my tired period as a consequence of the beta blockers coincides with actually being asleep (and in fact i sleep really well)

(i was told to take them in the morning initially bcz they sometimes affect ppl w/asthma, and also some ppl feel nauseous -- my GP felt i shd be fielding these reactions during the day when i could go into the health centre and not in the middle of the night when i'd have to go into A&E -- but as i am not having either reaction it seems an unnecessary precaution) (plus also switching them to evenings is clearly working better)

Glad you're feeling better; I'd missed this thread til now. I can back up the evidence that mid-50s are not for the cowardly!

switching your beta blocker to nighttime is fine -- your tiredness may be simply related to decreased exercise tolerance, a common side effect of beta-blockers (even B1 selective drugs like bisoprolol), especially in people like you with underlying pulmonary disease (asthma). as an added bonus, there is even a little bit of literature indicating a mortality benefit from nighttime vs daytime use of antihypertensives (which include beta-blockers), though the evidence is not terribly strong last i checked

the "thrill" you feel in your fingers is actually very likely due to the AF -- when the heart is in AF, the cardiac output (a measure of how well the heart pumps blood around the body, especially the sites furthest from the heart such as the fingers) is lower due to the dyssynchronous beating. do your fingers often feel cold? this also explains your recent passing out episode (blood wasn't being pumped effectively to your brain). lightheadedness is a very common symptom of AF, and it's interesting that you mention that you've had fainting spells in the past, as you've likely had paroxysmal AF for quite some time. be sure to take your bisoprolol regularly!

being put on digoxin initially is peculiar - this drug is rarely used for AF these days

honestly if half of the people in the world were as up to speed with their medical conditions as you are, we'd spend a lot less on health care. if you're looking for a good reference, UpToDate's beyond the basics series is a really good resource for patients who care to know more about their disease and have a reasonable degree of health literacy. you can check it out here: https://www.uptodate.com/contents/atrial-fibrillation-beyond-the-basics?source=see_link

cheers k3vin, that's all extremely useful :)

if anything the finger "thrill" is more like they're warmer than they ordinarily would be: it's not a numbness -- it's a bit like the way yr face sometimes feels when you're quite drunk, that you can feel it more than you should be able to (which is overdilation of capillaries maybe?)

i did used to suffer from cold fingers as a kid (not helped by living in a v cold house and having to do lots of musical instrument practice in unheated rooms) but i wouldn't especially say i do now

i also suffer from easily putting my leg to sleep by sitting on it like a kid, slightly awkward in an office when yr hobbling around trying to get the blood back into it, and everyone else in the office is younger than you

(which is overdilation of capillaries maybe?)

i mean the face is when yr drunk, i don't see how the fingers would be

after a week or so of much better response to the BBs (as taken in eve not morn) inc actually reducing my req dose to minimum suggested, a couple of days of increased fizziness and sleeplessness (necessitating, as i am on self-imposed deadline re introductory essay to my anthology, a COFFEE today, the first in maybe ten days) (i really have been good abt coffee considering the volume i've drunk in the last five decades)

cardioversion is on 18 may: everyone is saying supersafe procedure, back at work the next day etc -- even so i am trying to get the book in proper order before i go in

Best wishes for the procedure.

be supersafe, mark.

cheers guys :)

All best Mark.

Timothy Gowers, famous mathematician, blogged his mathematical reasoning as to whether or not to have catheter ablation surgery for his (much later stage) AF: https://gowers.wordpress.com/2012/11/05/mathematics-meets-real-life/

cheers mick, that's interesting and useful

(mr gower is i am pleased to see still blogging five years later, which is also reassuring)

My stepdad had that procedure in 2004 after an irregular heartbeat was diagnosed after he nearly died from pneumonia. He was a very heavy boozer and has cut it down since then, but still spends a lot of time in what he calls the fun-house (it's a casino!) playing blackjack, moderately boozing and having the odd cigar. He walks a few miles to the Town library to read the papers every morning. He is definitely in better shape now than he was 13 years ago, so it must have done him some good.

"that procedure" = cardioversion or catheter ablation? (which is next on my suggested list, if the cardioversion doesn't take after a couple of tries)

there's also an ablation where they insert a balloon into yr arteries and blow it up which is apparently 👌🏽 😜 👌🏽

meanwhile the oblique strategy i just turned up = "go to an extreme, move back to a more comfortable place" which seems on-point

He had the cardioversion, which I think caused him a lot of angst at the time. He said it was no biggie afterwards.

Good luck mark, hope yr up and at 'em again in no time

Good luck with the oblation/ablation, me and the kitten golems will be think good thoughts for you tomorrow!

thank you! i should be out again by the afternoon and able to be back at work again the following day acc.the medical profession

(tho lol to that, i am going to stay with my sister and be pampered over the weekend instead)

Good luck dude, thinking good thoughts.

Yeah good luck man

PAMPER ON MY FIBBING FRIEND

Take care! I mean, you are doing, so just keep on with that!

ok so the excellent news is that i am up from under anaesthetic, out of hospital and down in hastings being pampered by my sister and her family -- i have to do nothing strenuous for two days which is FINE BY ME :D

the more boring news >:( is that the cardioversion did not work -- they stopped and started my heart three times but like the apostle paul it three times denied me so in c.6 weeks time i have to talk to a new consultant abt the next step ("he's electrical" acc.today's cardiologist, who also told me my "heart is stubborn") (which i am not entirely astonished to discover tbf)

anyway glad to be back in one piece (i feel fine except for a routine weather headache i've had all day, not shifted by being knocked out for 60 mins or electro-jolted apparently)

congrats on remaining alive, commiserations on having to do it all again

glad yr feeling good! what's the next step likely to be mark?

the ablation thing mentioned above i think -- it scars the nerves to stop them misfiring as they are now, which causes the arryhthmia (so it's more intrusive)

but i probably need to wait until i have talked to my GP and my new consultant ("he's electrical") before i know for certain

that new consultant in full

https://static.comicvine.com/uploads/original/2/29004/982463-electrogreen.jpg

was at the cardiologist myself this week - i had some problems with dizziness and lack of breath over christmas and they've slowly been following that episode up. have had no symptoms since, but they had me do 24hr monitoring to see if there were any abnormalities in my heartbeat. they one thing they picked up on was my heart went down to 20-something bpm at around 9PM when i was probably just flopped on the sofa gawping at the tv, so next i'm going to be sent for a scan of some sort - doctor was saying something about potential thickening of my heart walls due to high levels of exercise (i run a lot). was also talking about me either cutting down on running or having a pacemaker fitted somewhere down the line. this is exactly the same thing my dad went through 20 years ago, and now he suffers from AF, which he's on some sort of medication for (sorry i forget the name). so yeah, rooting for you with a newfound sense of comradeship (and also cos you're special of course <3)

congrats on remaining alive, commiserations on having to do it all again

― Drive Your Lover Wild In Bed By Cosplaying As Jeff Lynne (bizarro gazzara), Thursday, 18 May 2017 16:02 (fifty-nine minutes ago) Bookmark Flag Post Permalink

everyday man, everyday

hadn't seen this thread, keep at it my good man

yeah, best wishes to one of ILX's alltime best threadstarters.

worst things abt recovery:

i: mild urine retention as anaesthetic wears off (it damps down yr automatic body processes for a day or two)
ii: shoulderblade really really REALLY itchy where the sticky pad was for best electrical contact and conduction -- just where i can't reach to scratch it

(it has been pointed out to me that it was the apostle PETER, not paul, who thrice denied before the cock crowed etc…: a fact-check that needed ticking off professionally speaking, and shame on your heathens for none of you noticing :D )

Ach peter is canon but I'm always up for reinterpretation

Just looked up "catheter ablation." I assume it's less daunting than its description makes it seem.

And looked up A&E, which means Arts and Entertainment in the U.S. I see it's Accident and Emergency elsewhere, "a hospital's emergency department in many countries." Note that Mark's account effectively combines the two departments (Accident and Entertainment; alternately, Arts and Emergency).

Best of luck.

re catheter ablation: on one hand, yes, YIKES :0

on the other, heart-related procedures (associated with basically healthy people) are in the main surprisingly routine these days (and if something goes awry i'm in the best place)

(ie if i have a heart attack at home alone in bed, i'm in a bad position to do something about it; if i'm in surgery (and fast asleep) others are in an excellent position to do the right things about it)

consult yesterday re next stage: a range of options, from carrying on meds as is -- fine in the short term, outlook less good in the very long term (= my heart will wear out quicker) -- to ABLATION, see above. I am up for this and so is she: if her colleagues agree it's indicated it will take place at BARTS, a fact that pleases me for some reason (I had to go google where Bart's actually is, naturally it is two buses rather than one).

Above I said the ABLATION will work by burning and sometimes they do, but this -- as the condition is very likely relatively recent -- will be by FREEZING, which also pleases me.

(I am pleased by strange things, hullo have you met me this is hardly startling news)

so anyway i'm once again waiting for a letter

St Bart's is the only place in London I've gone under the knife - I'm sure they'll take good care of you, Mark - will you be in for a while, optimally?

From googling ablation: "Your doctor uses heat, cold, or radio energy to scar some tissue inside your heart" - I assume you get to choose based on which powers you want to activate?

day patient, apparently, unless there's any leakage problems after the op

Do they leave you with an iron man window in your chest

it me, shortly:
https://www.youtube.com/watch?v=SRH-Ywpz1_I

you know who else wanted a window in his chest?

letter arrived: procedure will be CRYOBALLOON ABLATION, prep for which includes switching onto AMIODORONE once my most recent tests (liver and thyroid) come back

(not yet sure if i'm coming off anything, GP is checking)

everything fine otherwise: the tiredness got much better when i switched the times i took my meds but i'm noticing it's slightly worsened again? it's aggravating bcz i want to lose a bit of weight but being tired when i need to get stuff done that requires brainwork makes me snack unhelpfully

sending you good thoughts mark. i had an ablation procedure (for SVT) a few years ago and it went just fine - went home the same day. for mine, they had to do something (burning prob) to stop the electrical pathway that could sometimes trigger a very fast heartbeat. i was tired the next couple days after and for a while had what they told me was 'increased cardiac awareness' but it's settled down. mostly don't worry about it any more except now i hardly ever drink because that triggers it, though now i can easily get the rapid heartbeat to slow down myself so no more trips to the ER. definitely glad i had it done.

in the best version of this procedure, i wd actually be piloting the cryoballoon thru my own vascular system, like a cross between FANTASTIC VOYAGE (1966) and AGAINST THE DAY (2006)

https://www.researchgate.net/publication/225277143/figure/fig4/AS:267857774772257@1440873678562/Figure-1-Anatomy-of-a-Cryoballoon-catheter-Courtesy-Medtronic.png

I just talked with a friend who recently had this procedure. He reported that the most disturbing aspect was that whoever shaved his groin didn't just do the side where the cath was being insert, he/she also shaved the other side to "keep it even." Also that the shaving happened in such close proximity to his balls.

update observation re AMIODORONE (i assume, as it's the new med and hence the one producing the changed state?): mostly i'm fine but i do now and then get days when i'm just tired and listless (ie yesterday, despite a good night's sleep; whereas last night i had much less sleep and was restless, yet today i'm not really tired at all)

i have a provisional cryoballoon procedure date = 27 sept (sooner than i expected after my consult on mon but that's good not bad)

really starting to notice the tiredness most days now -- but my procedure is this coming wednesday so fingers x-ed it will change things somewhat

Good luck! Hope this works out.

aaaaaaamen, be well mark

the device being deployed is the ARCTIC FRONT ADVANCE CRYOBALLOON, which sounds bracingly Warfare-of-the-Near-Future

It's my party and I'll cryoballoon if I want to. See you at the FAP next Thursday.

Good luck tomorrow, man.

Good luck, Mark.

best wishes, mark, hopefully this will do the trick

All the best for today mark s

crossing furry toes

Best of luck today mark s

hope it goes well!

best wishes mark s!

Yeah good luck Mark!

i'm back baby, awoooo!

details when i'm less tired

*celebration*

\o/

unable to contain this gem from the report (which i probably shouldn't already be reading): "owing to his very difficult anatomy…"

*beams with irrational pride, like i composed a brian ferneyhough sonata or something*

see above: "your heart is very stubborn, sir"

LOLz (xp)

Raises glass: "Tuplets to you, sir, and to the chambers of your heart!"

(Had to look up "Brian Ferneyhough.)

*beams with irrational pride, like i composed a brian ferneyhough sonata or something*

v gd tick

report as promised, three weeks on

Day 1 is mostly waiting (10am-4pm), until a doctor arrives to explain the procedure: a catheter up sent from a large vein in my leg to go inside my heart, with an inflatable cryoballoon attached. This will precision-target and freeze surfaces on my pulmonary veins, to discourage and ideally stop entirely the rogue electrical signals they send off, which is the cause of the fibrillation. The procedure also involves more cardioversion: this I didn’t know. I will be under local anaesthetic and sedation: so woozily aware of everything going on. There will be freezing sensations, a possibility of headaches — if too grim I ask for more morphine, morphine is so great :) — and “twitching sensations” in my chest, which “some people dislike”.

On the way to the operation theatre, I'm asked whether I have taken APIXABAN regularly: I have to respond that — having not missed one for six months — I somehow forgot one yesterday morning. She thinks this will be OK, and the surgeons within happily concur, missing one72 hours ago probably not a problem (I've been on it for abt six months). The room is large, full of busy people, some of whom greet me, and buzzing with technology. The bed in the centre seems oddly in shadow and neglected: of course bright lights will snap on and everyone will shortly gather. The team introduce themselves: they refer to the anaesthetist as the “barman” (since he’s in charge of stuff to make me feel good). This is mildly funny the first time. I am going to be (woozily) awake so I quite enjoy the banter, and the transparent moves to make me psychologically comfortable.

Local anaesthetic and sedatives in via my upper thigh: a very slight prick, as ppl say. And it begins: without feeling especially present, I can listen to the surgeon and assistants talking their way through what’s happening and what they can see: which resembles a slow, intricate, not very exciting video-game: basically they are manoeuvring a vehicle through a maze, sometimes encountering puzzling surroundings and uncertainty of direction. At a particular point the “twitching” begins: they have undersold this, to say the least. The cardioversion — the “twitches” — in fact means a fair number of electric shocks (just as it did upthread, except I’m not under general anaesthetic this time). It’s not grimly painful or particularly scary (after all, I’m sedated, and they willingly up the morphine), but it is kind of teeth-grindingly horrible. (Literally: I realise afterwards I dislodged a filling, presumably from clamping my teeth tight.) I’m woozier now — but still vaguely aware they’ve done three of the key veins, but not the fourth. They’re debating which the fourth actually is, I assume of the visit they have in front of them. I dimly remember them deciding not to proceed after fixing the third vein, and backing the vehicle out again beep beep. Don’t remember being wheeled back to the ward — vaguely remember being wheeled to a different recovery ward (which had more free beds).

A not-very-comfy night follows (my first ever overnight in a hospital), since the meds are wearing off and my abdomen feels (is) extremely bruised, on the inside of my ribcage. I get some sleep, jolted awake every time I move. I should probably have asked for some paracetamol at this point.

In the morning, a doctor comes and tells me it went OK, except for the vein they didn't treat -- he thinks the procedure will work without its being treated, but we won't know if the cryoblation has taken for a few months (basically while scar tissue forms and blocks off the rogue signals). If I do need a further procedure, they can use a different device this time, much better suited to locating the fourth vein. Fingers crossed.

Actually getting out of the hospital was a bit of a trial -- first they wouldn't discharge me until I'd had two further ECGs (to check a "leakage" a doctor said "probably wasn't a problem at all" -- it wasn't) and then actually being in the right ward at the right time to be seen and talked to by the right person. I was maybe nine hours sat, dressed, by a bed (meaning someone else was denied this bed), until this was properly and officially sorted, and I had to make a bit of a fuss. (I was cross and bothered by then as I couldn't get a signal -- you often can't in hospitals -- to liaise with my sister about picking me up (we then had to catch a train to get to hastings in time to fetch my niece from school).

Main symptom since: some fibrillation still (to be expected whether or not the procedure was a success) and considerable fatigue (ditto). I'm a lot less tired this week -- taking care to do nothing more strenuous than fite on ilx, and getting a LOT of sleep. Thursdays continue to be the days I'm most tired.

lol the man in the bed opposite when I woke up in the morning was a very chatty 9/11 truther, obsessed with the Fall of Building 7. Luckily I was tucked away in an alcove behind a curtain and he mainly directed his obsession at the little old man in the bed next to his, doubtless setting the man's recovery back by weeks.

https://www.scholastic.com/content5/media/products/14/9780439241014_mres.jpg

keep watching the skies!

Mediterranean diet.

In this cohort of atrial fibrillation patients, gut‐derived lipopolysaccharide (LPS) levels were predictive of major adverse cardiovascular events and negatively affected by high adherence to Med‐diet. LPS may contribute to major adverse cardiovascular events incidence in atrial fibrillation by increasing platelet activation.

Italian research shocker

lol i had to read the conclusion three times before i worked out that yes, it meant the med diet is good not bad, in ref AF

(thank you for posting)

They could have used more editorial assistance on that abstract.

sanpaku are u no longer vegan???

so i went for my six-week check-up this morning and it turns out that my heart rhythm is now back to normal, so the procedure worked as intended!

i will still be on meds and under observation for a while -- the condition is known to revert now and then -- but hurrah! the consultant was very cheerful and happy and so am i

(also i quizzed him and it turns out my heart architecture is genuinely actually cap-D Difficult, in respect of the technology they were using -- this wasn't just a polite way of saying i'm overweight and it was hard to find anything in the layers of flab, which is what i'd gloomily assumed) ("don't worry! if that had been the problem we'd definitely say very clearly")

DOUBLE HURRAH!!!!

so my "difficult heart architecture" has now been behaving itself for six months which is good not bad -- the longer it stays regular the more likely it is to carry on that way

i am coming off AMIODARONE but staying on a low dose of BISOPROLOL (a beta blocker) plus APIXABAN (a blood thinner) until my next check-up, in six months time

Hurrah!

Brill!

This is good. Difficult Architecture of the Heart is a terrible song though.

Yay, mark!

I think amiodarone is one of the many drugs my stepfather is taking. Ablation was brought up a few months ago, but now it looks like he is starting the process to get a heart transplant.

long may your architecture behave, old lad. We need more like you to stick about and comment on the game as it plays out!

good to hear mark im sorry they prescribed ANILXBAN but yr health comes first

amiodarone keeps yr heartbeat regular while yr heart is learning to do this by itself: longterm it's quite toxic to the liver tho, they don't like to prescribe it for longer than a year (i was on it for six months)

i think i already said this but a thing i like abt visits to the doctor and consultations and so on is when they say to me "you're still young, so [etc etc]" -- yes, yes i AM young, quite correct

ok so my final all-clear check-up revealed instead that the AF is back >:( to everyone's surprise inc.mine, as i hadn't been aware of it

it might just be temporary -- ECG caught me on a fibbing day -- but i m going on a six week course of FELCAINIDE ACETATE to see if it can be flipped back

if not, then in six months time we decide whether to do another procedure or what exactly -- needless to say i am a bit fed up (on the plus side not suffering any problematic symptoms)

Bah, sorry to hear that, man

the thing is, it's kind of symptomless -- in the sense that if i'm aware of it at all at the moment, i just feel as i had 2 x cups of strong coffee (and did in fact have one first thing), so it's not exactly a burden?

i am going to try and give up coffee again ands generally get my caffeine intake under better control

a bit tired and achey today -- might be the FELCAINIDE, might be the five hours i spent on sat wandering round london's OPEN HOUSE DAY in the rain lol

also a bit fluttery -- which the Felc is meant to stop i think? -- but my bisoprolol ran out on friday and i haven't had the new prescription yet

Is it felcainide or flecainide? An iced elf, I.

I can vouch for the tired achy effects of giving up coffee.

i thought i was past the post-coffee aches but maybe not -- anyway i had one today (not very strong, i.e. made in the nearby hipster coffeeshop, not by me)

FLECAINIDE, sorry: it too can cause headaches of course (also anxiety, depression, nausea etc etc)

Last time I kicked coffee, it felt slightly bad for about 10 months.

Helpful mnemonic, courtesy of a new restaurant in my neighborhood:

https://cdn.dribbble.com/users/367923/screenshots/4490554/fle_fle_logo.jpg

sharp naggy headache from:
i: coming off coffee 10 days (possible but it's usually sorted by now)
ii: poor sleep last night (bcz coming down with something?)
iii: FLECAINIDE (my new temp heart-regulator meds)
iv: all the above ✔️

lol ok i unexpectedly dispelled this headache by eating apricot jam with a spoon (i can say for CERTAIN it wasn't a no-carbs headache but it sure behaved like one)

on further investigation (the very wise method of GOOGLING YOUR SYMPTOMS): it turns out that FLECAINIDE can intensify blood sugar issues caused by non-great diet so i shd actually pay a bit of attention here probably, and properly adjust my diet south-beachwards maybe (means more headaches of course)

still headachey: might just be the weather and the change of the season, don't really want to be staving this off for my six weeks medication run :(

been quite fizzy and palpy since i came off FLECAINIDE 10 days ago*: i really notice when things make my heart race and flutter -- not just caffeine, which i've decided to stop again, but actually any food at all. a big takeaway on saturday -- i shd have kept half till sunday but i was starving -- meant a sleepless night, and even though i ate quite likely i had another, worse one last night, staring into the dark convinced every little muscle pang is angina onset and considering heading off to A&E the moment i'd filed some copy this morning

this morning? i feel a bit rubbish for no sleep but i'm p sure i'm not having a heart attack -- i will pick up my prescription BISOPROLOL and see how i feel after i've eaten a little

*the plan is a chemical cardioversion next but i'm not sure when? i next see the consultant in six weeks

ok tests show all entirely well*, i shd probably just up my BISOPROLOL a bit, to counter going off FLECAINIDE (which hadn't occurred to me as i don't think the consultant explained what the flecanaide did)

*i.e. aside from fibbing my heart is behaving quite properly

good news! i wish my heart behaved properly #emo

OK i slept *so* well and deeply and easily last night that i think more was going on than just medication levels = subconscious pre-election anxiety

(which for me is often more abt the grinding torment of not knowing than any actual result)

anyway i feel both normal and (politically) somewhat more chipper today STOKED FOR THE DISAPPOINTMENT ect ect

:)

i regret to inform you i am in one piece and posting normally after my second ablation.

the first time they couldn't reach and deal with the misfiring nerve-cluster, because of my DIFFICULT HEART ARCHITECTURE, which is probably why the fibbing returned after a few months boo. anyway this time they zapped them all hurrah!

(the stern and gloomy surgeon operating advised me even this doesn't have a 100% success rate bcz they don't really know what causes AF and he very obviously also thought it was a frivolous decision for me to be going this route: "sometimes i wouldn't take the decisions some of my colleagues do!" ok dude cut the lecture and crank up the laser plz thx)

i am feeling quite internally bruised today but i was in and out in half a day and for now my heart is back in rhythm, we shall see if it stays that way :)

also i got this again on sunday:

meanwhile the oblique strategy i just turned up = "go to an extreme, move back to a more comfortable place" which seems on-point

― mark s, Saturday, May 13, 2017 1:40 PM (two years ago) bookmarkflaglink

GAH mark!

"We have IoT hearts available on the NHS now, no need for all this lasering when your heart could produce a laser that you can control with an app"

Mark: ".... go on ...."

Also good news!

time for u to embrace yr destiny, mark

https://i.pinimg.com/736x/8f/a9/95/8fa9956b8a79c1df3b1eef0d3fce564c.jpg

👍

waking in my own bed after a long weekend of being pampered at my sister's -- which not gnna lie is a nice thing to have happen, bcz everything revolves round me saying "that sounds cool but i think i'm still too tired to take part"

but i *am* still very tired, though other post-op symptoms are dwindling back: tired plus breathless after any minor exertion (like putting on a jumper)

so yes, i lay in bed and gazed out over hackney for a long time like frodo in lotr just thinking "blimey i'm allowed to lie in" and of course knowing that half a dozen things i have to get on with are already lining up to be got on with and i'm thinking abt writing a to-do list but, well, not actually writing it yet no

like i can look at the corbz n his flawz thread and think "i'm allowed not to even open that, they told me take it easy for two or three weeks"

It's full of ppl arguing on the internet not yr thing

alright elrond

*looks up elrond* that's cool I take it

so yesterday i went into my local health centre to see the nurse abt a blood pressure medication she put me on last week: RAMIPRIL

in itself this was a semi-routine check-up -- a few ppl react very strongly against it -- but as the breathlelessness was continuing (was listed as a side-effect on some website i found lol) i asked her. she said i doubt it;s the ramipril, it's not on *my* list of side-effects, you should probably talk to the cardiology nurses at barts (who i'm supposed to call if various alarming post-up symptoms emerge). i have asthma so i don't really tink of "breathlessness" as alarming, more like tiresome.

anyway i rang barts and they said "weeeeell get it checked at yr local A&E to be on the safe side"

EIGHT HOURS LATER

A&E were clearly annoyed barts didn't say "come in to barts". in fact i don't think barts has emergency facilities, and this *wasn't* an emergency like some of the poor folks i was sat beside who were (rightly) being jumped up the queue, but several tests later (inc.my first ever CT scan) it turns out the cause is "mild pleural effusion", which they are confident will sort itself out (update: it seems better again today).

still i was right to go in. pleural effusion = "water on the lungs", even if not a worrying amount, just enough to keep me a bit short of breath and give me a dry "unproductive" cough) and even if everything else is AOK, above all no clots on my lungs (which *would* have been serious) -- plus i ought to get an echocardiogram just to clear everything inside my heart (which i am trying to get sorted at barts, tho the date i have so far is ages away, and i can't get to talk to anyone with clinical knowledge (tho homerton seemed to think i would find that easy)

related: my reading matter was tristram shandy WHICH I LOVE but its well known central device -- the anticipated next step in the tale endlessly digressed away from -- gets a bit old when everyone is saying "someone will see u in a minute" and that means 90 mins minimum, it is a bit too on the nose

observation: some ppl are MUCH BETTER THAN OTHERS at taping that little blob of cottonwool onto the needle-site after you've had blood taken (clue: use tape that's sticky! and enough of it to reach the skin on BOTH sides!!)

> little blob of cottonwool

i came out of the hospital once with blood streaming down my arm where they got this wrong. luckily i noticed it on the way out and didn't subject any tube passengers to my junkie chic look.

hopefully the fricking laserbeams have done the job and you're on the mend.

> elrond

elrond hubbard

I remember the fight to save Bart’s a&e. It didn’t work, as you found out.

Glad to see that you are doing well in spite of that.

lol i just got rung up by the actual correct barts nurses i shd have been contacting all along, and it's true i did have their number! but i think the advice sheet is not very clear, esp.to the tired and bothered!!

(they're referred to as the Arrhythmia Nurses but my actual problem was breathlessness! anyway maybe i was being overthinking it or just being dim -- this slightly scary woman evidently thought so! -- but i feel i should maybe let them know this is a problem with the advice sheet)

(she also clearly thought the CT scan was completely needless)

place-marker for *serious* update lol -- tho not right now, i am v tired

(aso i am OK and have never not been, which is a curious fact to glean after exactly a week in hospital, almost to the minute -- STAY TUNED)

hope you’re doing ok. am working on the cardiology service now

“Heart rate ain’t nothin but a number”

A few days before my procedure, a nurse at my local health centre — who I was seeing to find out if I can do anything abt my mild labyrinthitis — felt my blood pressure was a bit high and put me on RAMIPRIL. Which is a medication a few people react very badly again, so I have had to go in for checks ever since (it seems to be working).

Last Thursday (12 Sept) I went in to Homerton Hospital to get a 24-hr blood-pressure device attached, as one of these checks. The nurse attaching it was concerned abt my heart rate, which was 133. She suggested I either go straight to A&E or go to my GP, who could call through to Barts and talk to the specialists there. As I was already due to see the Ramipril nurse later in the day, I opened to do the latter. She duly called in a GP — but it was too late in the day and we couldn’t raise anyone at Barts, so I ended up in A&E anyway.

A&E tried to bring the heart rate down but to no avail, so I was admitted to ACU overnight (without any preparation, nearly no battery left on my phone and no lead or plug to charge it).
The next day was a Friday. While they were concerned about the heart rate, I was showing no other symptoms of cardiac distress (no chest-pains, no nausea, no shortness of breath or chest tightness, no dizziness: I felt fine, in fact, despite being a bit stressed how hard it was to let ppl know where I was). I was not an emergency, so no decisions were made: I was on my normal meds and I guess they hoped it would right itself. It did not, and that evening I was moved to the cardiology ward and put on a monitor.

I still felt fine physically, though definitely now somewhat stressed about how long I’d be in, what anyone was thinking or deciding, whether my medication should be being changed and so on. The monitor was a portable one, and none of the night nurses seemed to know how to set it properly — its alarm was responding more to respiration issues than heart, which seemed bizarre to me, and indeed aggravating: every time I dozed off it bingbonged and woke me up, as my breathing had slowed (as it does when you go to sleep). Eventually after an argument with a couple of nurses, one of them took executive pity and switched off the respiration alarm. So I got some sleep.

Sat-Sun no decisions are made: the ward doctors basically keep things on hold and field emergencies, the cardiology doctors aren’t in till Monday. My dose of BISOPROLIL was tinkered with a little, and it was suggested I would be going onto DIGOXIN, but this didn’t happen yet. I still felt fine, and my sister had tracked me down and spoken to me on the ward phone: a friend was able to bring various things I needed, including the means to keep my phone charged. So this element of stress had dissipated – I still had no symptoms apart from raised heart rate, I was learning to fend myself on the ward. I somehow managed to extricate myself from the monitor all Saturday as well, which was probably inadvisable but meant I could move around freely and wash and generally feel less hemmed in. A new ward sister insisted I went back on it on Sun but by them I was confident about unplugging myself when I needed the bathroom or to wander around for a bit.

Mon-Thur: short version is that titration of Bisoprolil and Digoxin gradually did bring the rate under control. An actual real heart doctor talked things through with me on Mon morn, explaining that he wasn’t hugely worried by the fact that this had taken place ("Heart rate is nbothing but a number"; alsoi see below), but did want to bring the rate down before I was discharged. Which finally happened on Thursday (everything takes ages if you’re not an emergency): the correct dose put me down to 65 or so. Hurrah. At no point did any other symptoms manifest — except maybe by Wed, when my heart had been bumping up into the 140s for several days, I sometimes was feeling a very mildly bruised aching in my heart region: like slightly weary muscles after a long walk? But not a pain (“you’ll know when it’s chest pains”).

After it had been at 65 for a few hours they sent me home. By then I was resigned to another night on the ward so I was delighted. This is the longest by some way I've ever been in hospital, and in the end I was at Homerton for exactly a week almost to the minute :)

WHY DID THIS HAPPEN?

I don’t see my consultant till Monday (23 Sept), but one theory is that this is a not-unheard-of but transitional after-effect of the ablation. The rogue nerve ends are cauterised so the arrhythmia is gone: the ablation was a success. But in the weeks after, they try and re-assert themselves — a path is burnt and can re-emerge — and some may do so before the scar tissue that muffles them properly develops. And sometimes they re-assert into unintended resonating patterns that confuse the poor old heart into thinking it’s being told to beat nicely rhythmically but needlessly fast. I was warned I would feel occasional palpitations as things were healing: well this is a version of that, except the palpitations organised themselves into an unwanted system.

downsides: the first couple of days -- when i didn't know what was up and couldn't get hold of ppl outside -- were pretty stressy, even tho i knew the seeming sluggishness of response meant i wasn't an emergency. after that the issue was really mainly waiting, and potential boredom.

upsides: the ward nurses were mostly fine and sensible, and some of them were funny and lovely. with notable exceptions the other patients were also fine, mostly quiet, the chatty ones friendly and interesting. i was witness to a bunch of intriguing beef (patient-on-patient, patient-on-staff, staff-on-staff) which i enjoyed bcz i am nosy. once i could charge my phone i had access to email and twitter, and thus to friends. i had visitors. i had books. once i got hold of some headphones i could watch TV (= a fvckton of OG law & order, as an actor steven hill is a comedy god). the food was generally edible, including much more raspberry jelly than i imagined i wd spend september consuming.

oh i forgot, the name of the unintended resonating pattern and hence higher heart rate is ATRIAL FLUTTER -- apparently my "P-waves" were poor

I remember thinking "hmm mark isn't about" when you were off the radar for those two days. Everyone is too online.

Good luck on the 23rd!

this is all very good.

of course i don’t mean the fact of the a-fib or your hospitalisation.

i mean - i love reading about hospitals and being in hospital. so i enjoyed this.

it had some key elements:

* the kafka feel of being entangled in a complex institution - the rules shore getting in are opaque or hard, but once you’re in the rules for getting out or disentangling are difficult. you can insist in your wellness or your ability to do something - like unhooking the machine - but you are *not* in charge of that decision (for obvious reasons)

* the relation of numbers to existence (what numbers are ok, what numbers aren’t) and the sense of your body. the uncertainty this produces but also the sense that its possible that people in this institution (especially when not reassuring “experts”) might be *wrong*

* other patients - “notable exceptions” plz.

* “waiting and boredom“ - the sensations of institutionalisation.

* the switching of staff (here the more draconian ward sister) and the need to communicate afresh our uncertainty that something hasn’t been understood.

That is stressful! What do they do if the incommunicado inmate has e.g. an important iguana at home that requires nightly feedings?

we arranged last week for a dog sitter to stop by the house of one of our patients who was very concerned about his pup :)

I will say that mark and fizzles have impressively sharp insight into the little details of hospital routine that often get taken for granted. I try my best to make sure my patients are as comfortable as possible (scheduling lab draws for later in the morning, avoiding monitors unless necessary, letting people eat ffs) because it matters a lot to patients and I am a sap, but generally the hospital experience is awful and too few staff seem to care, and it is sad

I actually this morning was just forwarded by my attending cardiologist (who of course has saturday off) an email sent by one of my patients to the dean of the medical college (probably the wrong addressee, but it reached us anyway) who thanked us i’m frankly overly generous terms for attention and care he received while on our service. to be honest we did jack shit for him but it really goes to show what patients care about, which is being treated like human beings

glad you’re doing ok!

meals are regular and plentiful if not exactly cordon bleu -- but food is very clearly a sticking point for some patients, what they're allowed and what they're not allowed )especially if they have trouble swallowing and are having to stick with soup and mush, and are getting fed up with it: the patient opposite me in cardiology was getting very sovereign citizen abt his human rights to proper chewy food now and then. he'd been in for weeks, i never found out what for, and could do very little for himself -- he was very kind and friendly to me though, giving me lots of helpful advice i didn't really need

on my first night in ACU the person opposite me (no idea what he was in for, this was ACU) was getting extremely belligerently complainy bcz he'd been served a jacket potato with tuna: "what kind of food is that for a man??" so he'd trekked across the hospital (or possibly out of it into hackney proper) to buy some soup and now wished to warm this up… but was not allowed to use the microwave in the staff mini-kitchen attached to the ward, and (partly bcz belligerence) cd not find anyone on staff who wd spare time to do it for him. anyway eventually the ward sister arranged for him to be moved to another ward where this was apparently possible -- and then she got grief from staff on that ward bcz (a) he was still belligerent (possibly his natural state) and (b) the other ward was fine with soup being warmed up but not with soup being transferred with a patient from ACU

on the saturday on the nurse i liked best -- hijab, very north london, calmly unflappable to the point of zen -- told me (after my friend had brought me all the stuff i needed) that if i'd asked they'd have let me go get it all myself (i only live three streets from the hospital). "just ask!" she said: "just ask!"

so next time i will :)

a thing i was a bit startled by was visitors coming in to see one person then going and sitting for a while with someone different -- as if everyone already knew everyone else!

but of course if ppl have been in for several weeks, they DO get to know each other and so do their visitors and friends and relatives etc. and ppl with similar conditions will have encountered one another elsewhere sometimes too

it was all very hackney in its cultural and class mix, staff and patients and visitors, which i liked a lot

Glad you’re out and hope they’re right about this being transitional so you don’t have to go through this again. Glad also you had a good experience with the nurses :)

When I’ve been in hospital I almost always sign up for halal meals because you’re given dal, rice and a basic but perfect main eg keema peas, rogan josh or chicken curry. In London, these are prepared in Southall and they don’t skimp in seasoning.

Except for Friday, which is fish, chips and peas day.

Glad to know you’re out, Mark!

My Mon's had a-fib since her 30s, now in her 90s, finally recently consented to pacemaker--might've been wise to wait so long, 'til most of the bugs are gone. Lightest possible anesthetic, in and out in a few hrs---although she did get a slight lung leak, but back to the hospital for a day or two, and it was re-inflated, soon healed. Seems worth it, since she'd been tending to weak spells for several years, related to low heart rate. No more.

Yadda yadda but anyway hell yes glad you're out, Mark!

was missing you and didn't realise where you were almost until they let you out because I am oblivious. Glad you're street legal again, extended term hospital is a weird combination of inconveniences and looking after which I sometimes pine for cos big baby

I've got a friend who's going thru this at the moment, has just had an ablation and is struggling with avoiding alcohol and feeling knackered at the moment, telling him about your experiences has felt helpful so thanks

Glad to hear all of this (from the ended end of the experience) - I'm sure you've got more local contact, but I'm a 15-minute cycle away if you need a stuff-carrier at any point.

Good to hear you're out & the staff and other patients provided ample entertainment and there was raspbery jelly. lol @ the soup nazi - a jacket potato with tuna: "what kind of food is that for a man??" - one of my go-to cheap caff meals, I'm obviously not a real man :(

i cd've understand it if he'd gone out and bought a doner tbf

yes that was a double take - "this mound of carbs and flesh is unmanly, i must have... soup".

Nah, I’m with potato guy because canned tuna is VILE, and jacket potatoes have a place in the universe beside a really nice steak. The topped jacket you people call lunch, pffffft.

"really nice steak" was definitely not on the menu

Canned tuna is a big part of my diet. Feeling seen rn.

Wish I could get with canned tuna, because it would be so convenient and healthy. But the taste is just to strong and unpleasant to me, and bears no relation as far as I can tell to a home-cooked tuna steak

with notable exceptions the other patients were also fine

— anti-tuna soup-guy is one notable exception: he was fine with me (he entirely ignored me) but he was a pain in the neck for the nursing staff
— the other was a cartoonishly glaswegian* alcoholic, in i think to dry out (tho why on the cardiology ward i can't say)? anyway his approach to this was to get dressed every morning and go out drinking in nearby pubs or the park, and then come back to the ward late evenings extremely aggressive and wanting an argument. after a few days he was persuaded that the experiment wasn't working and he truculently discharged himself

*language-wise i hasten to add, glaswegians are lovely when they're not notable exceptions: with him everything was threatened batterings and cunt and "who are you looking at?" followed by unconvincing apologies when staff pointed out this was unacceptable behaviour

My canned tuna hate comes direct from someone trying to feed me either tuna salad or tuna casserole when I was a kid having chemotherapy. Tuna and sweetcorn on a jacket potato is not a food concept that brings me comfort; it looks like puketato.

never fancy tuna on a jacket potato tbf but a good tuna mayo sandwich is sometimes just the thing

they give you a menu and take orders, so you only end up with something you absolutely don't want via delivery error or via arriving too late to order and being given a meal that was cooked but not wanted (my guess is soup guy was the latter)

post-consultant update:

— it wasn't my consultant it was a flunky >:(
— none of the info had come thru from homerton to barts yet so i had to fill them in on the whole thing (luckily i also had a copy of the post-homerton report)
— in conclusion, steady as she goes viz

(i) my heart's rhythm is now reliably regular, so the ablation did actually do what it was meant to
(ii) i seem to be experiencing ATRIAL TACHYCARDIA, i.e. my atrial chambers are beating fast they they shd be
(iii) when they were in there zapping the misfiring nerves they may have missed some, bcz the relevant area is dilated
(iv) i am still in the "blanking period" after the ablation, the 12-ish weeks when things can actually get worse rather than better lol (i don't think 'd been told this quite so bluntly before now, just that "you may experience palpitations") (i threw my version of the homerton's doctor's theory outlined above at him, and he didn't demur)
(v) so this may just sort itself out without further intervention (tho meds stay raised for now)
(vi) see the consultant again in december to decide future action, including possibly coming off digoxin and reducing bisoprolil again
(vii) if i do have further episodes while on these damping meds, then maybe another ablation? except there will once again be "blanking period" risks, so this has to be taken into account
(viii) none of this wiil actually kill me, and i'm on blood thinners which will fend off strokes
(ix) so here we are -- me paying attention and them aware is a good combo, apparently

all fine as it goes -- i went to check up with the nurse abt my blood pressure meds (and in fact adjust them) and she noted that the excellent set of bloods i had from my stay in the hospital made clear that everything else, kidneys, platelets, cholesterol levels, i forget what else, is EXCELLENT. So that was nice.

We also discovered that the humming noise of the blood-pressure reading machine actually makes me tense and anxious and drives up my heart rate -- without me being aware of this (I assumed I was totally chill about everything all the time but this entire adventure has revealed to me I'm actually quite stressed much of the time -- and that taking my own blood pressure is one of the things* that stresses me)

anyway there's a another machine with a squeezy bulb which for some reason stresses me less so we used that

*being on-line is almost certainly another thing that stresses me but i will never log off :(

i loved the squeezy bulb as a child, do they still put the armband on you

mark supplies his own armband AND jackboots iirc

gold spiked helmet

Thank you for this thread, my boyfriend had what was probably a bit of atrial flutter last weekend and it really freaked us both out.

His health insurance is a very low level of coverage, so he refused to go to the ER on the basis that it would probably end up costing him his full deductible of $4000 and the med stop nearest his town doesn't accept his insurance at all. So, so far he's done nothing. Which doesn't seem satisfactory.

"Atrial fibbing" is something your cheating heart would do.

first full pot of coffee made in my own kitchen since the ablation, as i'm on major deadline today and need to be fully focused

(hence posting like an mf on ilx obv)

(will update my condition when this draft is sent, i hope today)

retroactive update: so on 30 dec i had a big post-ablation consultation -- hoping to hear that (a) the ablation had broadly worked after a hiccup that sent me back to hospital during the so-called BLANKING PERIOD and (b) i could change and reduce my medication, esp. my beta blockers (BISOPROLOL) which absolutely leave me tireder than i feel i ought to be feeling, also the RAMIPRIL (for blood pressure) leaves me headachey and the only thing that honestly counters the headache is the caffeine in ANADIN EXTRA (but caffeine brings its own problems)

(a) consultant notes that the ablation did NOT really work, that i've ended up post-procedure with ATRIAL FLUTTER which is contained and controlled by my meds as is
(b) meds not to change for now
(c) in a few weeks another CARDIOVERSION) (stop heart and restart via electric shock) to see if it can be jumpstarted into its proper rhythm -- so far cardioversions haven't been effective at all, my heart has been described as "healthy but stubborn" (which is good i guess)
(d) after that we can revisit my level of meds
(e) consultant muttered more or less to self "i'd like to bring you at least a couple of years of normal heart function" -- dude don't say the dispiriting stuff out loud plz
(f) but realistically i am caught between two consultants of very different opinion -- one (who did the last ablation) who thinks the procedures are basically a waste of time and i shd be controlling all this with meds and my life can be long and productive that way, and mine, who is gung-ho abt procudures but also now i feel disappointed (probably in me, for not being a success for his appproach) (he is nice in person, has a good and funny consultant manner)

the tiredness i guess i can learn to live with: after all i'm going to be 60 this year and i believe that's a thing! the headaches are a bore but i probably need to lose weight to tackle blood pressure and to reduce intake of RAMIPRIL, and exercise is a bit counter-indicated by tiredness, which is physical as much as mental.

(during the return to coffee noted above i was pleased to note i was not getting palps or other amplified symptoms -- to start i felt p good in fact, focused and un-achey etc. toward the end i was getting the usual morning sliuggishness and coming off caffeine i got the usual headaches, which have only just now dissipated tbrr, a week after requitting. basically my coffee counters the beta-blocker tiredness at point of consumption but then leaves me even more tired later plus less likely to sleep soundly. off coffee i sleep well and increasingly sleeping well is a deep pleasure for an ageing fellow)

Sorry to hear this Mark, and I especially sympathise with the last clause.

when it's available and possible, sleeping well is basically one of life's great gifts.

after next cardioversion - if it fails - will funny yet dispiriting procedure-happy consultant perhaps start to take view of the other one?

i think the alternatives are further ablations or controlling it with meds

further ablations *ma*y finally jab all the misfiring buttons in the right way to shut off the misfiring, but risk further misbehaviour during the blanking period (which is basically when the scar tissue isn;lt yet grown in to muffle the misfiring)

meds: when i mentioned the tiredness to the other consultant (as my main reason to want to go ahead with the ablation) he said that different beta blockers might not have the tiredness effect? so i guess that's what i need to look into

what is a

-checks text from mmac-

heart echo check

and why

-double checks text from mmac-

do "they" want me to get one?

mmm possibly "they" are reading my posts all week, tbf

Echocardiogram. Dunno. But it is painless!

the suggestion i need one isnt!

this is a hard q to answer w/o knowing more abt yr earlier communications and interactions with them -- or did they just slide into yr DMs on twitter?

ecgs are useful for many many observsations in and around the heart obviously -- sometimes just to rule out something where you have a symptom that's very likely benign but might be an indicator of something it wd be smart to pre-empt? (i have gone from being a total snowlake abt this organ -- WHAT IF IT JUST STOPS! -- to very admiring of its rugged meaty pertinacity -- OMG IT JUST KEEPS ON GOING! -- but mine has been routinely determined, after many of same, to be v-healthy-if-somewhat-wayward…

on foot of an uncle, completely bolloxed after a life of hectic drinking, showing up something in a scan recently

issue could be related to his chosen career but could also have a genetic element so the icy finger of probability has poked out a text as detailed above and hit send, the dick

my mum was convinced i'd be male-pattern bald by 35 based on genetics, she looked at my tousled head aged 45 (me) and said "that's the one thing i've ever been wrong about"

it's a lottery is what it is and peeking inside the works can do little harm unless yr a worrier

coincidentally last week my doctor strongly recommended that I get one soon based on a health issue last january, which could either be anemia (probably likely, my iron is historically bad but I thought it was under control) or some other unrelated heart issue

I've had intermittent atrial fibrillation (lone atrial fib) for 12 years now. It was originally treated with a right heart ablation. That is not now considered the definitive treatment, but that in combination with flecainide it has kept me mostly free of it

The weird thing is that my older brother has had almost exactly the same experience

does anyone else run around bumping into people for an hour three times a week

i somewhat dread being informed that is a thing not to do anymore

5-a-side? Dodgems?

the polycule regrets

xp think of a hybrid version basically yeah

so it's being said ppl with heart issues are at risk covid-style but i don't know if this includes fibbing? i keep being told my heart is basically v healthy, it's just like keeping time badly

Sigh. I don't know either but my bf had an extremely scary day of recurring episodes two weeks ago, potentially connected to working out at the gym? With no chance of insurance anytime soon he was considering flying to another country and paying for private care just to find out wtf is wrong with him but that's off for now, so...very worried, yes. My sense is no one really knows much re covid so far?

i was on a AF mailing list until december which gathered all kinds of info -- no idea how reliable -- but (a) it all just went into a mailbox i never looked at and (b) i seemed to have been signed off it since jan so i'm none the wiser

so anyway i am lined up for a cardioversion in a few weeks (no date yet) which in routine times is an unproblematic and unrisky heart procedure, in-out in an afternoon, at worst overnight if they schedule you for an evening op, just an electric bump to see if they can nudge it back into proper rhythm for a while

i'm guessing it will simply be postponed bcz urgent stuff will be overwhelming the system in all other directions (tho barts doesn't have an A&E so maybe not) (except my last one was at homerton, which very much does).

anyway i guess wait and see what i'm told -- maybe this is how i will find out how at risk i am

In an example of terrible timing my dad's just been told he'll need a pacemaker fitted within the month. Doctor asked him if there'd been any sudden deaths in the family...

yikes, best of luck koogs

He had a tiny stroke before Christmas which affected his peripheral vision and he had to surrender his driving licence for a year (at least) so now he spends even more time watching the sport on TV. Or would if it hadn't all been cancelled. He needs a hobby.

Good luck to all.

Yup.

barts just called to say that my prep appointment next week for the upcoming repeat cardioversion is indeed postponed, until when they don't know

not startled to learn this, and in fact somewhat relieved

Hope fibbers get a bit of clarity soon (and remain healthy!)

Mark today fb reminded me that it is a year since ur book and attendant goodies arrived at my door 🙌

http://1.bp.blogspot.com/-jSUtkUyuiK8/Tc13_bGMJsI/AAAAAAAALnY/UHcdt2yaU5Q/s400/Fibber%2BMcGee%2BAnd%2BMolly.jpg

just saw this, thx wins :)

yes, its actual real public birthday has been making me combination happy and sad tbh

so it's being said ppl with heart issues are at risk covid-style but i don't know if this includes fibbing? i keep being told my heart is basically v healthy, it's just like keeping time badly

― mark s, Saturday, March 14, 2020

I think this is right

(dad had his pacemaker operation on Thursday, but even as an out patient op I find it odd that they went ahead with it. Was complaining on Saturday of bruising and that the external monitor wasn't finding a signal, but otherwise fine)

all the best koogs

in AF and me news: patient (me) reports no change, all seems fine

a couple of nights now i've woken with the flutter at some intensity -- where generally sleeping damps it down.

the first i couldn't get back to sleep properly and when i did get up (earlier than intended) i discovered i'd forgotten to take my beta blockers the evening before and evening plus morning dose sorted it well enough.

the second it sorted itself out by itself and i went back to sleep and slept well and late. in each case during the wakefulness i lay worrying that i would have to go back into hospital to get it regularised (which there are now other reasons to not want happen). anyway fingers x-ed it's mostly a mix of anxiety and intense dreams.

like i feel absolutely fine and normal right now but during the wakefulness i could somehow sense the beginnings of every CV19 symptom lurking but i know this is a very normal state of mind for everyone awake at 4 in the moming

lol yes :/

since this began ive hugely favoured lying on my right over my left side when trying to get to sleep: on my left (heart side down) my flutter was more evident and this made me anxious and less likely to sleep, but also i'd get a thing where as i did drop off i'd often seem to get a heart skip and this -- real or imagined -- woke me up again in a panic.

now i find i'm *entirely* favouring sleeping on my right (heart side up) bcz the other way seems actively to exacerbate the flutter? i mean i know yr ribs protect yr heart from being actually squished but

anyway this is all so borderline between symptoms real and dremt that i never get good answers when i ask the specialists or (don't do this) try and google it

every now and then i wake early bcz the flutter seems high, like i just necked an espresso in my sleep to jolt myself awake -- and cant get back to sleep

(this time after a stressful dream abt conflict at work) (knowingly caused by me i might add lol)

a weird thing is that caffeine seems not to heighten the flutter, quite the opposite in fact

lol i just got called to be told the revised date for my repeat fibrillation is exactly a fortnight from now, which GOOD i guess but also uh oh (in hospital but not overnight unless something goes awry)

Hope this goes smoothly!

ok so i went into barts cardiology on monday at 10am and smoothly is how it went and i am now out and in day two of recovery post-cardioversion (which i called a "repeat fibrillation above lol: not its name no, fibrillation is the name of the monster) -- in fact despite lots of boring waits* i was out by 6.30pm same day

i: barts was eerily calm and unpeopled compared to any other time i've been there -- never more than two other ppl on the ward, waiting either for cardioversions themselves (very quick procedure) or pacemaker box changes (longer op tho perfectly routine)
ii: nurses etc all cheerful and professional, not at all a stressed environment -- i was due to be sorted super-quick but apparently then bumped by an emergency post heart-op arrival who'd fainted at newham and been transferred… most of my entertainment all day was listening to phone discussion which of newham and barts needed to hold a post-op bad for this person
iii: also eavesdropped: that barts had not had an actual official COVID patient since the bulge in march, tho of course they were testing everyone on entry
iv: thx to newham fainter i wasn't seen till 3ish having arrived at 10 but as noted the procedure is p quick: wheel me to a lab, sedate me, zap me -- sedation wasn;t full anaesthetic, so i was conscious but very far removed from anything going on. my memory of the actual electric shock is a comically cartoonish silent bump in which every item in the room flew up the air and settled again. i suspect this is not what happened.
v: one zap and my heart was normal sinus waves again, first time in 18 months i think. they told me before that they'd try three times before giving up: but it was just one and worked, so hurrah! the first cardioversion i had -- possibly discussed upthread -- i was fully asleep, they tried it three times and it didn't work ("you have a stubborn heart mr s") and i also got a mild red iron-shaped scorch mark on my back from a shock-paddle lol, tho a bit of savlon sorted this out quickly. this time i dodged all of this and was back on the ward and fully awake (no driving or heavy machinery** for 24 hrs!) by 4pm.
vi: so now we just wait and see how long before it reverts to weird shit, 3 days 3 months 3 years? it may not revert! but i suspect it probably will -- something in my structures pushes towards it. but fingers x-ed…
vii: anyway i am back and beefing calmly as i normally do, hullo ilx

*yes i took in a cpy of the LRB to while away the time, no it never left my bag
**what does heavy machinery actually mean in this context? (i will never google "heavy machinery")

nice to have you back, sir :)

that heavy machinery in full

https://d2rd7etdn93tqb.cloudfront.net/wp-content/uploads/2017/05/ripley-power-loader-aliens-051617.jpg

👍

I read this thread a couple days ago and was hoping they weren’t re-fibrillation you!

genuinely feeling better since the cardioversion: less tired and sluggish, much less sense that my heart is like skittering and bumping. i'm off caffeine again (my choice, the consultant says it's not relevant but for all its benefits it makes me jittery and anxious)

the arrhythmia may come back (it may already be back, i often wasn't aware of it) but the flutter seems to have been banished for now

i'm on one less med (no DIGOXIN) and wd like to be on lower BISOPROLOL tho this probably won't happen till after my next review (by phone app! tho i think i'll imagine i'll need an ECG leafing up to it, which will be hard to do over the phone)

the one downside is that i've had a near-constant headache for a week now -- really bad on monday till i dosed up with anadin extra (paracetamol aka acetaminophen, aspirin, plus caffeine). so the headache might just be caffeine withdrawal (plus weather pressure effects), or a med side effect (RAMIPRIL is mildly head-ache inducing) or maybe my increased heart power is pumping too much blood into my head lol

aside from monday it's tolerable though -- meaning i can work through

(meaning i am staring at a screen all day: also famously headache-inducing)

i'm sorry about the headache, mark, i really sympathise with you there. on the other hand... BISOPROLOLOLOLOL

seems to be fine today tbh, i think it's weather exacerbated by caffeine withdrawal

so it turns out that six months on my heart is still in good sinus rhythm (per an ECG last week) so my arrhythmia nurses are happy for me to reduce my beta blockers -- which with luck will mean feeling less tired day-on-day.

this is excellent news! i was somewhat resigned to the arrhythmia returning -- it always has done before -- NOT THIS TIME, SO FAR

(rewarding myself with a cup of coffee, living dangerously with that caffeine bump which the experts says is unrelated to all this)

(ok it's more like four months than six i guess)

I have Wolff-Parkinson-White syndrome and may have to have this fibbing thingy done at some point, it may go away though, and I don't feel like I've experienced any real symptoms for more than a year, and the tachycardia used to be pretty bad, so idk, maybe it went away by itself, have heard that happens. I do have one coffee first thing every morning which seems to be ok, but any caffeine at all after midday and I will not be able to sleep until maybe 4am.

best wishes CaAL :)

this last week i have been a bit puzzled that i seem not to be dropping off to sleep easily -- eg much late-night scrolling of random wikipedia pages to no evident purpose (the somewhat arbitrary list of unsolved murders since the bog ppl to someone earlier this year, the tale of the michelin man, did you know he once sued ilxor user MOMUS)

well as i finally drop my beta blockers to one quarter what they were three weeks ago as suggested by my my arrhythmia nurses above i just realised this is the reason: i am currently on half and will soon be on one quarter my beta blockers! i assumed i would be less physically tired but wobs is a bad week to judge that perhaps. needs less sleep feels a less handy improvement at least initially and it will probably wear off before i find a way to harness it (im not actually getting younger) but it is mildly exhilarating, like that first time when i went onto the atkins diet and more or less skipped sleep for a week without blowback! (a thrill never recaptured)

in conclusion the human body is weird, don't have one if you can avoid it

(adding: the sleeplessness predates the two whole bottles of red wine i consumed one on eve one on day so it's not that despite the rosso being a stimulant for me at least when i haven't had much in a while)

very palpy last night, and tachy today -- resting pulse 140-ish just now? beta-blockers prob too low too soon, upping them a bit again >:(

(this after six months of being nicely steady, which is annoying)

ffs! best of luck with the beta blockers, mark

my doctor in china put me on beta blockers then my doctor in the UK insisted I come off them. alcohol seems to lead to more palpitations than caffeine for me for some reason, I will admit the more I find out about this stuff the more I realise I know nothing, suppose most things are like that.

i've gone back to half-dose from quarter-dose of my betas (half that is of what i was on for a year+) and wll stick at half-dose for a while i think

my pulse-rate still seems a bit up (116) but tbh i never know when a sensible time to take it is (eating always bumps it up for a while for example)

anyway i feel much better and more energetic again

tapering seems like a good plan

flutter is definitely back lads >:(

i had an ECG -- a tale in itself lol -- in advance of my heart review this coming monday and they were briefly p keen to keep me in (as happened before upthread) (heartrate fast tho not as fast as it was upthread): anyway luckily they relented when (a) as always i have no other symptoms (no chestpains, no difficulty breathing) and (b) they knew i'd be talking my specialist v soon

i p much knew it was back -- i could feel it skipping around at night and i've woken up a few times w/it racing (tho everyone gets that and i've always had sleep paralysis issues) -- but i crossed my fingers and hoped self-diagnosis was inaccurate (which tbf it is). i put my beta blocker dosage up again -- not to full wack -- so i'm mildly feeling fatigue effects (a mix of beta blockers, heart flailing away needlessly, being 61 in a month's time lol)

upside: flutter is considered less severe than the fibbing of the thread's original title, so we have in a sense progessed -- during the ablation of two years back they couldn't tap out all all the misfiring spots and i suspect the ones left untreated are combining to cause the flutter. flutters are more likely spontaneously to self-correct and the cardioversion zapped it back into behaving well for at least six and i think more like nine months

my specialist insists that caffeine is not an issue (i'm back off it but every time i have a demanding editing job i will be back off the wagon)

anyway i'm a bit fed up obviously but symptomatically it is fine tbh (some tiredness, but def not as bad as two years back) and on monday i guess we will know what ways forward there are (upside: i just got my second vax yesterday so i wd be reasonably safe for further procedures if this is what they suggest, and more to the point unanxious abt them)

(the ECG tale is that basically i had to organise it myself and i am not my own GP so this involved a *lot* of boundary-busting pestering and checking) (including being given someone's direct email -- i think by by mistake -- which i immediately exploited with vigour)

(in the end this all worked and i was lucky in the admin ppl i reached out to)

(including being given someone's direct email -- i think by by mistake -- which i immediately exploited with vigour)

First Boris' phone number, now his email, what are they playing at at No. 10? All the best, mark!

Yeah, best of luck, man.

hope they can come up with a good treatment plan on Monday, and that you don't feel too rough after your second jab!

Best of luck, d00d!

had my six-month review with my heart specialist (45 mins before the appointed time, #ffs dude)

his definition of fibrillation (vs flutter) is "there's a riot going on in yr hart" -- well i don't have that any more, which is a guess one step foreard, the issue now (flutter) is much more organised (=basically it sometimes just beats much too fast). his proposal going forward is One More Cardioversion this summer, to thump everything back into shape for Good This Time, plus of course toning my well-being by losing weight, regular but not too strenuous exercise and maybe fully giving up coffee :( :( :(

i mean some of those are things i shd probably do (exercise can once more become a thing now i've had the double jab)also give up personal and globally induced stress and anxiety but that was my gloomy and resigned suggestion -- he agreed that they weren't helping and also that there was nothing anyone could do about them.

he now has moved on from filing me as a music teacher to believing i am a professional songwriter who loves the beatles -- i guess this is how he remembers which one i am. but i will always be grateful for the phrase "difficult heart architecture" so this is merely a tiny and weird price to pay

also he was effusively grateful that i organised my own ECG and got it sent to him. tbh i could do with a strong coffee right now but

he now has moved on from filing me as a music teacher to believing i am a professional songwriter who loves the beatles

LOL

i raised the sleep paralysis thing (viz is there any knwon connection) but as the last question in a longish consult over the phone it didn't get much discursive attention, i will ask again when i next see him face to face

apparently there is a link with sleep apnea but im p sure i don't suffer from that

a thing happening a fair amount is that i'm being woken from very-mild-peril dreams by the racing of my heart

i know this can happen to anyone -- ie is not necessarily a symptom of the condition -- but does indicate to me how much stress i'm probably processing unconsciously, and how much (if it hadn't been for the flutter as a fact) i would be saying serenely to myself that i'm neither stressed nor anxious

ie i am very good at hiding my anxiety from my conscious mind, setting it in the background somewhere -- but it is churning away still

new cardioversion on 22 june, maybe this one will take and also keep

my dad has some afib experience following heart attack at 60. ablation, cardioversion, etc. he's read extensively about it and has also had some occasional sleep paralysis - but doesn't connect the two (I asked him) and hasn't heard of a link. doesn't mean it isn't connected in your case of course! he reckons his afib recurs mainly due to posture and the vagus nerve, an idea that medical people apparently refuse to discuss.

crossing my fingers for 22 June btw!

I have palpitations sometimes and also get sleep paralysis when I nap - never wondered about a connection but this is interesting.

best of luck to you mark, hope it all goes well.

Yup, best of luck!!

update: in and out in hours, cardioversion successfully returned heart to proper sinus rhythm for the time being, everything very routine and straightforward, sorry not to report sooner but i was still quite tired yesterday and basically just looked out of the window all day lol

my p-waves are back baby (for the time being)

glad you're back in rhythm and hope you're less tired today?

https://www.youtube.com/watch?v=8WG118J4XlU

(note trumpet playing cowboys)

so i had a phone appointment with my consultant but as they had failed to organise an ECG beforehand there was literally nothing to talk about (i also attempted to organise the ECG -- as i managed to get one last time by battling for it myself -- but this time no dice)

i expressed my irritation abt this in the appointment and got a long lecture abt we're in a pandemic and nothing is working properly but also an acknowledgment that i was basically right to be frustrated: he suggested we switch the appointment to the royal free (where he also gives clinics) since they are now opening up to face-to-face, and since i am gong to be in the building i will be able to get a walk-in ECG beforehand (the same way it used to work before COVID)

i just got my appointment date from the royal free: it's in december (fine, i'm not really in a hurry i guess) and… it's a phone appintment

royal free's contact structure includes me being able to send emails to change appointments -- which barts does not -- so i have done this

so to catch: they caught my request abt the december appointment needing to be face-to-face and changed it -- but then at the last moment the pandemic clamp came back down and it was postponed

four months later it has not been rescheduled -- tho i am copied into to a request earlier this week from one dept to another to action this (i will chase it up next week)

i also went into my health centre last week for my various routine yearly tests: blood pressure was high and everyone went scrambling, the nurse said i had to talk to a GP. well i did -- but it was a GP who i've had before and liked (very thorough and matronly) but this time she seemed scattered and flustered, a mixture of bossy and distracted, asked me questions but only half-listened, did some hurried tests which were all fine, and eventally agreed that the best thing was to up my BISOPROLOL to see if that had any effect and to check in with my actual real GP (who i never see) if it stays high.

she also quizzed me about coffee. well the consultant has always said coffee is nothing to worry about (re the atrial flutter) but maybe BP is a different matter? so i said actually it's time i took a break from caffeine and/plus also i shd maybe shd some of my extra lock-in pounds vcz they probably aren't helping.

i don;t even drink much coffee now but this has been the toughest caffeine withdrawal i've ever been through, i'm still achey (head and muscles) eight days later and have the mildly feverish hot-eyes thing -- tho i am sleeping better. (i did a lateral flow case just in case but at least it's not THAAAAAAT… )

plus it took me ages to find my BP meter, i'd put it in a dumb place and i then kind of wanted not to test it until the caffeine was out of my system, so i waited until yesterday. BP still higher than it should be -- which of course immiedately started making me anxious, like every twinge is thet start of a heart attack. a couple of years back a nurse identified that i have "white coat syndrome" with regard to this procedure -- as if the electronic hum of the BP monitor secretly stresses me and drives up my reading. she always did it with an old-school hand-pump monitor and got "better" (lower) readings. but i don;t have a hand-pump monitor plus i always find it a bit of a scuffle getting the stupid in the correct position on my arm, which is ANNOYING and probably also raises my BP lol.

anyway today my pulse was a little lower -- below 100 -- but too high still for calm and normal. the thing is, this is the first time it's been checked for at least six months and it may have been high for AGES (i'd stopped checking bcz of the white-coat thing and just assuming i had an upcoming appointment and so on). when i was talking to the GP last week i was basically feeling absolutely fine. i'm feeling a bit rough now but i think it's 2/3 caffeine withdrawal to 1/3 ramped-up anxiety.

it's a bank holiday tomorrow, i will take it easy and then call my *actual* GP (who is good but i never actually see) on tuesday. maybe she will send me into A&E like happened in sept 2019 -- i thiiiiink i am fine (“heart rate ain’t nothin but a number” per the cardiologist in the hospital i wd be in, see upthread) and i am not keen to be on a ward at all (i am double-vaxed and boosted but the boost was five months ago)

cant have symptom w/o typos

mm typos

i was off caffeine for a lot of last year after my last procedure (which was successful for a while then reverted)

but over xmas i had two big editing projects and i just always cave and start the day with coffee when i'm editing: the upside we all know and love, the downside is ambient headaches and sluggishness first thing, combined with mild fatigue from the beta blockers (tho i was only only a low dose of beta blockers most of last year)

a second downside -- it belatedly occurs to me -- is that i tend to dose my headaches with paracetamol (acetaminophen), not in vast doses per day but pretty regularly, and i believe long-use paracetamol is sometimes asssociated with high BP? if cutting out caffeine also means cutting out paracetamol (as it generally seems to) then that's probably a good move, tough as it always is

(actually tbh i've stopped finding the fatigue from the beta blockers such a problem, so that's something i guess)

Did any med tell you to cut caffeine? I've never had one do that, never found any studies to support the idea, more like this just now (usually minus the weasel disclaimer at end):

Research suggests that caffeine isn't a cause of abnormal heart rhythms or atrial fibrillation, and drinking four to five cups of tea or coffee a day shouldn't increase your risk of developing coronary heart disease either. However, the effect of caffeine will vary between people.

Drinking caffeine with atrial fibrillation - British Heart Foundationhttps://www.bhf.org.uk › ask-the-expert › af-and-caffeine

And sodium of course, which is one sneaky ingredient.

no the caffeine decision was purely mine, not a med suggestion: and my reasoning is the headaches and the sluggishness -- plus possibly the side effects of the paracetamol i take to tamp down the headaches

i know from previous experience that once i properly kick it i can cut out painkillers altogether (i also know from previous experience that i can only kick it for a few months at a time but)

sorry you've had a rough few days, mark, how are you feeling now?

my mom has AFIB (and I'm pretty sure I'm not many years before getting it myself), her doctors have told her to limit caffeine, she says she can tell the difference if she only has one cup of coffee (sometimes half a cup of regular mixed with half of decaff), rather than a few. So hopefully cutting back will help you, although if your withdrawal hasn't stopped you could taper rather than cold turkey? My worst ever headaches were when I was in uni and taught at a summer camp; I had a strong cherry Coke habit and went suddenly to no pop at all, couldn't figure out why these stupid kids were giving me a headache everyday and finally realised it was cold turkey from caffeine.

generally fine yesterday, mildly headachy this morning (day 11) -- monday was very bad but i think that was a weather migraine sneaking in there lol (difft bit of my head)

it's not like i was even drinking very much coffee any more, there's nowhere really to taper to! tiny little cups? plus i know myself well enough to know that tapering won't work where cold turkey actually might, at least for a while

Another alt to cold turkey/tapering: Sometimes when I've needed to temporarily abstain, I've found that my body can be fooled or satisfied by the taste etc. of decaf--dunno if this would work long-term, though.--

think i'm over the hump cold turkey-wise -- it definitely took longer than usual

i went in for a blood test yesterday and the nurse told me to contact her if my blood pressure remains high; i'm meant to be seeing my own GP about all of it but (bad timing) she is on holiday till first week of may. i think i probably need the dosage my BP meds (RAMIPRIL) to be raised. also i need to talk to my cardiology specialist abt my raised pulse rate (ideally without being sent to A&E in the interim, which i want to sidestep for COVID reasons if possible) (this happened pre-COVID, basically a needless stay in hospital i feel) (see upthread for the tale… )

(i don't really want to be seen by the doctor i saw a couple of weeks ago, i find her very confusing to talk to)

just aced my blood pressure check lol yay

health centre pharmacist then describes symptoms of high blood pressure (= headaches) and of low blood pressure (= fainting when you stand up): naturally i suffer from BOTH of these most of the time

also she said “you’re still very young” — ok then, yes that's correct i am

anyway i have booked a big "where we are now" face-to-face with my GP next week to talk abt all my many ailments and how they interact and what i shd do abt them (this is partly bcz if i am moving out of london and away from this i think unsuually good health centre i am going to be gambling with the kinds of NHS uselessness that e.g. colonel poo rightfully decries -- better get the good stuff while i still have good access)

nice to hear this mark.

have you done any looking yet at what's going to be available near you?

not yet no :|

might not be a long piece of research lol

nice possibly final visit (since i’m moving out of london) with my primary GP of nearly 40 years, just to have a face-to-face to jigsaw together the implications of all my ailments: for which the answer is mainly (a) re the topic of this thrread viz my high pulse-rate get my cardiology consultant to move his ass and give me a rescheduled appointment (she thinks more ablations are pointless but says he's the one whose knowledge counts and i will likely have to change meds somewhat as BISOPROLOL is evidently not doing what it needs to

as for my asthma more exercise and lose a little weight lol. the headaches are “stress” headaches (ie who knows what causes them, maybe just the state of the world) and (she is old-school) paracetamol is fine in moderation and not implicated in blood pressure (which is now back to normal). i’m booked for a hearing check re my tinnitus and try epley exercises for my labyrinthitis. anyway she is a good wise person (actually my favourite GP at the centre even if i nearly never see her) and i will miss her

i mentioned the *other* GP i saw a few weeks ago to my sister (who was also a patient at this centre for many years) and she laughed and said "she always made me feel i was being told off" -- which, well, true, me too, but i guess i kind of feel i deserve to be told off so it doesn't really register

maybe stress headaches in part from getting more writing-editing gigs, also re health and considerations of moving from London---maybe try this very basic form of meditation I read about, which is sitting for 20 minutes not thinking about much: I tried sitting on bench by front door of library after hours on a short day, mostly sheltered from the evening sun, but with a glow around the frame, just the occasional passing car, although I did sneak peeks at my travel clock, will try to do better about that ("trying" all this keeps some tension in there but I've only started these breaks).
My tinnitus long ago became part of the environment, and occasionally I think I hear crickets. Having doctor remove ear wax helped (don't try it yourself, though there are kits). Easy on the headphones for a while after that.

in the end i wrote a letter to my cardiologist, one copy to barts and one to the royal free (he does consultation at both) to point out that i was due a rescheduled appointment after the pandemic cancellation in december and it was now something like eight months?

anyway i got a reply and now have an appointment in november -- that's quite a gap but tbf i haven't been suffering or i'have made more fuss

meanwhile in jab news: i got flu *and* my covid booster this afternoon 💉💉

i: an old lad in the packed waiting room was quietly looking at facebook or youtube or whatever on his phone and got ambushed by a VERY LOUD advert screaming at him for not satisfying HIS WOMAN and he needed [such and such a pill, didn't catch its name despite volume] which is SIX TIMES MORE POTENT THAN VIAGRA etc, anyway he found the off button eventually
ii: the pharmacist pronounced it "omnicron" (am i a dick for find this funny? yes i am) (same question-answer to part i)
iii: afterwards he said "i strongly advise you to eat a banana! this will deplete your energy!" i asked did he mean in the next ten minutes or later today (i was already on my way to MS afterwards) and he said "over the next two weeks!" -- which again made me laugh (no one strongly advises you to eat a banana in the next two weeks). luckily i had my mask on so no one spotted i am finding them funny: apparently my being-a-dick levels are off the chart today

my original anti-COVID jab and the two boosters were both pfizer and i had no symptoms at all (ditto the time i tested positive with the thing itself); this was my first dose of moderna so it wd absolutely serve me right if i get the works, we shall see

I thot it was omnicron! Let's all go to see allll thee timelines at the Omnicron.

turns out that eating bananas is good, when did i forget this

they gots potassium, also they taste good (to me)

ketchup inc.minor downstream implications

so after asll the faff i scored an appointment w/my nice consultant in mid-november, at which it was decided to put a pause on further procedures for the time being: my fib has calmed down into flutter (viz the aberrations form regular rather than wild-party patterns) and my resting pulse rate is only *exactly twice* a normal pulse rate (c.126 instead of 60ish). but as i have no other symptoms we decided let's just observe for the next six months and decide the way forward then

so far so good, except today i was in for a bunch of tests and a chat with the consultant anaesthetist abt an entirely unrelated procedure: not urgent -- the condition is a minor inconvenience tho i cd do without it -- but also something the meds think is worth tackling. tests all fine and i have a letter from my cardiologist to say "yes i know his pulse rate is twice what it should be, here's why that's no emergency", which helps orientate the student that does the ECG.

anaesthetist also talks through all of this and explains the best kind of anaesthetic for the surgery (spinal not general) and what that entails (off blood thinners for three days, longer if there's bleeding afterwards, as there might be). strongly advises i do sleep studies to see if i have sleep apnea (i don't think i do but he's the specialist). and then says he thinks given my heart condition that i'm probably high risk in the context of the surgery being explored, and he's going to postpone it until he's talked to my cardiologist. since there's a chance of clots and embolisms and also just general heart chaos courtesy the anaesthetic. "and we wouldn't want that" -- well no we wouldn't

i was planning to postpone it anyway as i'm in the middle of moving house and it feels like too many things at once! so this isn't a catastrophe. but it is the first real-world consqeuence of the condition since they admitted me (in 2019? see above) for a week, for racing pulse…

I think you can do sleep studies now in the comfort of your own home so that's a plus

i asked abt this and they said no it's in the hospital

If you do have surgery, the anesthesia may make you lose some words for a while: they'll say Oh Noes, what could it be, better run some neurologicals---but (judging by the experience of several friends & relations in recent years), it may well turn out to be anesthesia---if they can't find any other cause and the condition is temporary, that is. Can last up to 3-4 weeks, at least it did for a couple of the people I know who were affected.

better safe than sorry obv but i've actually been under full general anaesthetic since the fibbing began -- albeit for fibbing related procedures so i guess they have the heart under close observation throughout

and they didn't involve sharp cutting knives which this one in a small way would

hope this goes well for you

waiting for a phonecall from my health centre following up on the letter the anaesthetist sent to my GP, which fingers x-ed is just admin

meanwhile ATRIAL FIBRILLATION was trending on twitter this morning -- partly bcz it's apparently stroke prevention day (tbc i am in favour of stroke prevention) and partly bcz thousands of anti-vaxx numpties are busy screeching that AF is caused by the jab (clue: it is not)

oh the letter arrived at my house also, he thinks i am at risk of sleep apnea and wants me to take a sleep studies test -- which fine, sure, w/evs

Believe me, taking one and getting CPAP was a game-changer for me!

yeah it made a big difference for mr veg also

Same for me - especially helping with racing heart in the middle of the night stuff.

turns out -- six months later -- that i have no significant sleep-disordered breathing tho i do have "severe snoring" lol, sorry neighbours i can't hear it and it doesn't affect me

quick atrial update: despite ongoing adventures with vertigo lol, my annual check-up went v well -- the consultant (the same cheery guy who i have now seen in three sepeatre hospitals, barts in smithfield, the royal free in gospel oak and this time in fkn ENFIELD) (nice shiny modern building tho) was v positive: my heartrate may be a bit faster than all you sad normies but i am otherwise reassuringly asymptomatic (viz this higher rate causes me zero distress) and he thinks no further procedures are necessary at this stage 👍🏽👍🏽👍🏽👍🏽

(not even sure what these procedures wd acually be: more cardioversions and ablations? on towards a pacemaker? anyway, we not going in that direction yet)

(i have a friend whose grandad had 18 !! ablations and lived into his mid-80s so i am chill either way, tbh i just want a quiet life and life in plymouth is exactly this, between the world-historical storms anyway)

Hooray! (but sped up so it doesn't sound like whalesong to you)

interim update (non-fib related): just got the all-clear from exeter clinical genetics dept re the mutated and cancer-causing SDHA gene detected in another wing of my family: i did NOT inherit it so in that small sense i seem to be in the clear

(writing it down publicly here as i am quietly relieved: the testing of this was bludged up by me moving out of london and i had to restart the whole process 18 months after first begun -- however it is now complete and the outcome is good)

annual check-up for ASFib in a month's time: all interim pulse tests suggest while my heart is a bit high it is not wildly high; BP is also a bit high but just abt kept in the good zone by RAMIPRIL -- in general old-man news i am a mass of unwanted aches everywhere but none of them are a danger sign

Excellent news.

man the second i turned 50 the unasked-for aches became a v real part of my life. anyway great to hear mark!

glad to hear it!

Yeah, good news!

Cheers!

Good to hear!

Just saw this---did yall know about it? Hey Doc!

Arm position during blood pressure check may lead to wrong reading, study finds
Common arm positions during screening can cause a significant increase in the systolic pressure number.

i literally had this discussion with the nurse the last time i was in, for some pointers when i was taking my own BP

i already knew it has to rest on a surface tho