Questions Anyone?

Now that we are home, the initial purpose of this blog has somewhat been fulfilled. We wanted a way to keep family and friends updated during my ablation and recovery. We will continue to post progress at various milestones along with anything new of interest.

It is also our hope and prayer that this blog would be helpful to others dealing with AF or contemplating an ablation. I will try to provide some more detail in this post regarding my ablation and answers we got from Dr. Natale. We would also welcome any questions anyone might have. Leave any questions as comments to this post and we will do our best to answer them as a follow-up comment.

Here is some additional info in no particular order:

EP Study: I had read some ablation procedures are preceded with an EP study where lasso catheters are inserted into the left and/or right atria to map out the electrical signals inside the heart, including any abnormal signals. The doctor can use this mapping info to decide what areas need to be ablated. Dr. Natale said he would not need to do an EP study in my case. My guess is that was because my ablation was relatively straightforward.

CT Scans: The brochure we had gotten from Dr. Natale's office mentioned a CT scan would be performed before the procedure and again at 3 months post-procedure. There had been a discussion on the forum I watch about the risks of all the radiation from the multiple CT scans along with the fluoroscopy used during the procedure itself.

• Pre-procedure CT Scan: Dr. Natale did not ask for a CT scan before the procedure. I didn't think to ask why specifically but my guess is it was not necessary since I was not having an EP study.
• Post-procedure CT Scan: I did ask Dr. Natale if he thought a follow-up CT scan was necessary when there are no symptoms indicating pulmonary vein stenosis (narrowing of the pulmonary veins due to scar tissue or swelling). He felt it was very important to rule out stenosis as a complication for any future issues like pneumonia. He said otherwise you could be walking around with stenosis while not knowing it but it could be causing problems that would not immediately be connected to possible stenosis.

Vagal vs. Adrenergic AF: Dr. Natale said he felt the causes for AF were similar regardless and that vagal or adrenergic types described more the timing of AF onsets and not necessarily the cause. I definitely had vagal AF and my episodes were always at night usually following a late or heavy meal. Dr. Natale felt that the digestive process would cause an adrenergic response as extra blood flow is required to the gut. I'm not sure if we discussed it but I'm sure my sleep apnea events would also trigger an adrenergic response.

Pacing vs. Drugs to Induce AF: One local EP I saw said if I wasn't in AF for an ablation, he would electrically pace my heart to put it into AF. Dr. Natale said he could pace even a normal heart into some sort of arrhythmia and he preferred to use adrenaline like drugs to get the heart to reveal possible AF trigger sites.

The Ablation Procedure: Dr. Natale performed a variation of a PVI called a PVAI (Pulmonary Vein Antrum Isolation). My understanding is the "Antrum" part means the burn lines are moved further out into the atrium from where the pulmonary veins join the left atrium. Early PVI ablations placed the burn lines inside the pulmonary veins. Stenosis was a common undesirable result plus not all stray electrical signals were blocked. Dr. Natale's method reduces the risk for stenosis and isolates more of the potential AF triggers in and around the pulmonary veins. After the PVAI, Dr. Natale used adrenaline like drugs to reveal any other potential triggers. He found one other site in the coronary sinus that he ablated as well. I believe this would be considered a focal ablation.

Sleep Apnea and CPAP: I brought up my sleep apnea during the consultation with Dr. Natale as a concern I had while being sedated. He was more concerned that my SA might cause me to take deep breaths that could make keeping the ablation catheter in position with proper pressure more difficult. The easiest solution was for me to bring my CPAP machine and mask with me for the procedure. The morning of the procedure they called someone from respirtory to fit an oxygen feed inline between the CPAP and mask.

Boxers or Briefs: I understood from the brochure from Dr. Natale's office that there would be a total of 3 incisions made to insert catheters - two in the groin and one in the right side of the neck. I had never had an ablation before so I was not sure where exactly the groin incisions would be. The best way I can describe it is by saying you would not want to wear briefs anytime soon after an ablation. The incisions end up pretty much right where the leg openings in a pair of briefs would be.

Overall Impression: It helped me to read what others had said that had been through an ablation. Almost every account I read said the procedure was no big deal. While I hope and pray I do not have to have any more ablations, I would not hesitate to have another if I thought it would provide relief from AF or something similar. I would again seek the most experienced EP I could find and Dr. Natale would certainly be top on my list.

That is all I can think of for now. Submit any questions you have for me or Melinda as comments and we will do our best to answer. Happy New Year everyone.

Dave

Home Sweet Home

We finally made it home but it was a day later than expected. We made it to Kalamazoo at 12:30 AM this morning. We spent the night at our daughter's apartment there. Our son came and picked us up this morning and we made the trip to Grand Rapids to pick up our luggage. The airlines won't reroute your luggage if you decide to change you destination. We still figured it would be worth it to get back to Michigan last night versus waiting until Saturday night or Sunday. No offense to anyone from Minneapolis but 9 hours hanging around the airport there is about 8 hours too many.

My ablation recovery continues to go well. I've been in normal sinus rhythm since the ablation. I noticed more "skipped beats" (PVC's or PAC's) yesterday and today but I was seriously sleep deprived so hopefully they will calm down. My right groin incision is the only one giving me any problems. My "California" bruise was joined by Oregon and Washington and the area remains a little tender but nothing to worry about.

I continue the daily monitoring with the HeartCard device. I will have to call in the recordings from work or somewhere else because the device is not compatible with cell phones and that is all we have anymore. I was put back on my heart meds (Flecainide and Cardizem) after the ablation but my understanding is I will be able to discontinue those once it is shown I have not been in AF for an extended period. This is one reason for the daily monitoring.

So now it is time to catch up on sleep, mail, bills... you know the routine.

Dave

Is There A Pilot On Board?

That's one thing you don't want to hear on your flight. And one thing you don't want to hear at your connecting airport is "Your flight has been cancelled and we have nothing else available until tomorrow or the next day". So at the moment we are stuck in the Minneapolis airport trying to find a way home. We might get a flight later tonight into Kalamazoo but there is a chance that flight will be cancelled as well. Who knows where will end up tonight but we're hoping and praying it will be Michigan and not Minnesota.

Hey - That One Looks Like Mickey Mouse

Did you ever look at clouds as a child (or maybe an adult) and decide one looks like a shape or figure? Well now I can do the same thing with bruises. I'm not sure if it was the walking yesterday or just part of the normal healing process but I now have a new bruise on my right leg. If I had to describe it, I would say it looks like the state of California (including mountains and rivers). I'm not sure if there is any kind of connection but it makes me wonder if I should have tried to have my ablation in Rhode Island or maybe the District of Columbia. The EP nurse did tell me some people bruise all the way down to their knee. Would that be considered a Continental bruise? In any case we'll see how many more states join the Union so to speak.

Today is our last full day in California. We plan to take the rental car for another spin and use up as much of the pre-paid gas as possible. I'm not sure if this is out of principle or because we want to see more snow-free landscape before returning to Michigan (where there is a winter storm watch in effect for the time we are supposed to be arriving tomorrow). Until next time...

Dave

On The Fifth Day Of Christmas...

I know Christmas is past but I'll continue the theme anyway. Today is my 5th day post-ablation and this is the day the doc said I could venture out more. Today we plan on sight-seeing in San Francisco. This may involve quite a bit of walking so we will play it by ear.

Recovery continues to go well. You can't even tell I had a neck incision but the groin incisions remain a little tender. I haven't had any problems with external bleeding but internal leaks and bruising are somewhat normal since the ablation procedure was performed while I was still on Coumadin (blood thinner). I am just noticing a bruise now around the IV site on my right hand so I'm guessing it may take days for some of the bruises to show up.

I hope to make a quick stop by the lab this morning for a ProTime test. Anyone who has been on Coumadin before knows that the constant monitoring is one of the inconveniences. Diet has a big impact on Coumadin dosing and my diet has not been as consistent here as it would be at home, especially with our Christmas dinner yesterday.

That's all for now. Have a good Wednesday everyone.

Dave

Third Day, It's All Right

Seems like it was my brother who went through a Beach Boys phase years ago. For some reason the chorus to the song "Little Honda" was playing in my head when I woke up this morning:

1st gear, it's all right
2nd gear, lean right
3rd gear, hang on tight
Faster, it's all right

Maybe it's the California air but the way I was singing it in my mind was "3rd day, it's all right". Today is my 3rd day post-ablation and it really is all right. I might not have had the energy I did yesterday but it has still been a good day. My wife and daughter spent some of the day shopping for last minute Christmas gifts and for as close to a traditional Christmas meal as we can have away from home. I spent the day resting at the hotel and catching up on a few things including sleep.

Tonight we'll venture out for a Christmas Eve Candlelight Service. It won't be the same as being at our home church with our wonderful church family but with what we have been through I know I have a strong desire to celebrate the birth of our Lord and Savior, Jesus Christ. I hope and pray you are able to do the same.

Merry Christmas Eve,

Dave

Snow isn't that bad

Hi everyone:

Most people would love to spend some time in the winter in sunny California. Especially in San Fransisco where the sun is brilliant, everyone is wearing a heavy coat with shorts on, and the mountains are so beautiful. Not us. We keep thinking about home where the winds are 50mph and the snow is whipping around and as my mom put it, "you can't take a breath outside without your lungs freezing up"!

Yes, we would still like to be home. It might have something to do with getting such a bad start on our trip. When we finally got out here last Sunday night I instantly got sick with some type of stomach bug which always happens when I travel. Something about going over the state line, I'm fine in Michigan, get into Indiana and boom, I'm sick. Weird.

I had pumped myself up before hand that I was coming out here to take care of my husband, I would be the strong one. I would ease his nervousness. He could talk to me, lean on me for strength. Ha! The first two days I was in bed and he was running back and forth to the store taking care of me while I was moaning and groaning. I tried to tell myself that at least it was taking his mind off of what was to come. I hope it worked.

The day of the procedure we got separated before we thought we would and really didn't have time to say all the things you do before someone goes into surgery. We just had time to give each other a look, but I could read his look and hopefully he could read mine.

Seemed like time went by pretty quick in the waiting area, I had my daughter and her fiance with me and they did a good job of talking and trying to lighten the mood, but to tell you the truth, by the morning of the surgery I was pretty much at peace with everything. You know how you have made a decision on something but at the last minute you start to question your decision? We did some of that which we knew we would, and we just talked about our options and the pros and cons and every time we came up with the same thing, go ahead with the procedure. I know in my case, I started to feel that God was giving me peace about everything. Too many doors had been opened that only God could have opened, so I felt we were doing His will.

Dr. Natale is one cool dude! He didn't make us feel like the 1000 questions we had for him was taking him off schedule. His staff was also very patient with us while we kept them for quite a long time asking everything under the sun. Dr. Natale even posed with Dave for a picture. The Dr.'s here in general seem more easygoing. They all wear jeans.

Today (Sunday) we got up, the sun is shining, the birds which are huge just like in the movies "The Birds" are singing and everything is fine again. Except for one thing, we aren't home.

The Doctor Is Out

I woke up Saturday morning feeling pretty upbeat. The ablation procedure had gone very well and I was going to be discharged from the hospital. I had a brief episode just before 7 AM of nausea with a cold and clammy sweat that had me a little worried. This was the second episode (the first was Friday afternoon) and I didn't know if they would still let me go home or not. They had a drug they put in my IV that helped the nausea almost instantly. My blood pressure was low during this time but they weren't sure if that was the cause or just a coincidence. The symptoms went away and my BP slowly returned to a more normal range. After breakfast they checked my BP while laying flat, sitting up, and then standing up and I passed with flying colors. They wanted me to walk some so I made a couple of laps around the cardiac care unit.

Not too long after returning to my room, Dr. Natale stopped by to discharge me. He thought the couple of episodes I had might have been caused by the sedation drugs and wound not continue. Short runs of AF are common in the first month or two post-ablation so he put be back on a lower dose of Flecainide and Cardizem for two months. We are supposed to schedule a follow-up appointment with Dr. Natale for 3-months. In the meantime they gave us a HeartCard device that lets me record my heart rhythm once a day and phone in the recordings for their documentation.

We did ask to take a picture before he left. Here is Dr. Natale with his still yet to be released patient:

Procedure Day

Sorry we didn't get to post anything yesterday after the procedure. It was a long day for all of us and Melinda was too tired by the time they got back to the motel to even turn on the computer. The lack of sleep the night before the procedure had a little to do with that. Friday morning started early since we had to be at the hospital at 7 AM. To be honest I was ready to get it over with.

We started with a stop by the lab for a last minute ProTime before heading up to the EP department. We got there before the staff did so we had to be let into the waiting room by someone else. After a 30 minute or so wait a nurse came to get me (I tried to hide but it didn't work). They took us to a prep area and the fun began. They had me undress and put on a hospital gown about the size of a washcloth. They shaved a little here and a little there (we'll just leave it at that). Then they started an IV and without warning said lets walk over to the EP lab. Melinda and I didn't realize we were separating until about mid-hallway. We had about enough time for a quick uncertain glance and a brief kiss and they led me away.

The EP lab was like something from a sci-fi movie. The room was already full of people going about different tasks and they had some music playing. In the middle of the room was a table they told me to lay on. I didn't get a chance or have the desire to check out much else, I just kept reciting 2 Timothy 1:7 to myself. There were 6 large flat computer displays above the table and several more computers setup in various areas of the room. Once I laid down I was immediately surrounded by 3 or 4 people doing one thing or another. I expected the EP lab to be cool from what I had read from others who had an ablation but I didn't expect it to be like a freezer. I began to shiver uncontrollably and mentioned it to the staff once or twice. They said they were about to cover me with a heavy sterile sheet but before they could one nurse told me she was going to give me some medication to help me relax and that is about the last thing I remember. I'm not sure but I think I might remember Dr. Natale coming in.

I do remember waking up slightly a couple of times during the procedure. They use conscious sedation, not general anesthesia, so it is more a matter of what you remember and what you don't. They had a mouth guard in my mouth probably to allow insertion of a temperature probe into my esophagus. About all I remember is that my throat was dry and because of the mouth guard I could not swallow. I kept trying to verbalize my concern but it came out more like grunts. The response I got was "We can hear you Dave, we are almost done. Try not to talk right now". I'm guessing this was followed up fairly quickly with another dose of meds to put me back into la-la land.

The next thing I remember was waking up I think still in the EP lab with several people removing all the various electrodes and patches that had been stuck on me. Then they rolled me back into the prep room where I was reunited with my family. They had to remove the sheaths from the catheter insertion sites. The one in the neck was pretty uncomfortable but fortunately I was still under some sedation. Then I was rolled from the prep room to a room in the cardiac care unit with family in tow. Along the way we ran into Dr. Natale. He stopped for a moment to talk to Melinda and explained the procedure went well and that besides isolating the pulmonary veins he found and ablated one other site that was a possible trigger source for AF.

The rest of the day was spent in a hospital room under constant monitoring. I was very much out of it for that afternoon. Dr. Natale stopped by later in the evening and explained that the additional site was in the coronary sinus and that it was a source for PACs (Premature Atrial Contractions) which are common triggers for AF. Other than that he said the procedure was very straightforward. This had to be close to a 12-hour day for Dr. Natale.

The night was as sleepless as I remembered from my earlier hospital stay in Michigan. It didn't help that I was right across from the nurses station - I think I can recite the order for Chinese food that was called in about 11:30 PM. But let me say that everyone that was involved with my care at Marin General was top notch.

Well that is enough for now. Next post I'll cover the discharge day.

Dave

And Now A Message From Our Sponsor

Of all the posts you will find on my blog, this one is the most important so please read on.

I work with someone who drove a diesel Mercedes for years. He was fond of that car because it was well engineered and would just keep running. I believe it was rust and not mechanical problems that caused him to stop driving it (Michigan roads + winter = road salt + rusty cars). I like a well engineered car as much as the next person so let me use that model for the sake of discussion. Let's say I wake up one morning and find a brand new diesel Mercedes in my driveway. First let me explain how it might have gotten there: Bill Gates develops AF, finds my blog using Microsoft Live Search (you think he would use Google?), considers the information here useful, and out of gratitude sends me a new Mercedes (thanks Bill - by the way, your wife has a good strong first name).

Back to the Mercedes - I could examine any part of this finely crafted automobile and come to the realization that it was the product of some very talented designers and engineers. I wouldn't have to go shake the hands of Hans and Frans to know they exist - the car itself is proof of that. Just like a building is proof that there was a builder and a painting is proof that there was a painter. This is the only logical and rational conclusion any thinking person could come to.

Now let me switch gears, so to speak. Before June 2006, I knew nothing of atrial fibrillation or the electrical system of the human heart. With all the reading I've done over the past 1-1/2 years, I still only understand a fraction of what makes a heart beat. There are articles out there that go way over my head dealing with the flow of potassium, sodium, and calcium ions in and out of individual heart cells. The human heart is truly an amazing organ.

Maybe you read my earlier post where I explained how AF is not life threatening - how a person can still survive with the top half of their heart essentially not working. Why would the AV node have a built-in safety mechanism that limits the ventricular response to atria that are quivering away at 300-400 beats per minute? A mechanism like this serves no purpose in a heart that is functioning normally. The existence of this mechanism does not fit an evolutionary survival-of-the-fittest model especially when you take into account that AF and other similar arrhythmias are much more common well beyond child bearing years (60-70's). You can argue that the reason is the refractory period is longer for the cells in the AV node but the basic question still remains - Why?

Consider this is just one of the systems that makes human life possible. Now study any of the other numerous complex systems of the human body, examine the intricate balances and interactions at the cellular level, puzzle about the order of development (which came first: the immune system or viruses?), and on and on. Apply the same rationale as you would if you stumbled upon a new Mercedes in your driveway, and there is only one logical conclusion you should come to.

Some wonder why there are diseases like cancer or conditions like atrial fibrillation if we were so perfectly engineered and created. Some theologians answer "because we live in a fallen world". I understand where they are coming from but lets go back to the Mercedes analogy for a minute. A brand new car may be perfect when it leaves the factory but it will develop problems earlier than normal if the owner does not change the oil at the recommended intervals or with the proper type. For a car this impact is limited to the single car. From what we understand about genetics, for humans this impact can span generations.

Please understand this is not about religion. This is about first realizing you and I are more than simply an accident, and second about seeking the One who created us and finding His purpose for our lives. But this does not stop with head knowledge. I have heard it said that the distance between Heaven and Hell is 12 inches - the distance between the brain and the heart. I hope and pray you will continue to search and come to this logical conclusion.

Next step: Save Yourself Some Pain

Spon·sor: a person who vouches or is responsible for a person or thing.

My sponsor is not Mercedes or Microsoft, He is Jesus Christ. I pray He is your sponsor too.

Dave

The Doctor Is In

I actually found my way to the correct room in the hospital today and after an hour or so wait we were called to meet with Dr. Natale. The wait was because he does his consultations when he is either finished or in between ablation procedures. This meeting was long awaited as I had read so much about Dr. Natale. I had decided if I ever had an ablation he would be the one I would want to do it. My reasoning was he was one of the most experienced in the area of AF ablations and I was not disappointed.

He was patient and willing to field every question we had. His responses included supporting facts and reasoning. It was reassuring to know he was drawing on the experience from thousands of procedures. All in all the meeting went well and helped settle our nerves.

After meeting with Dr. Natale, we spent some additional time talking with the EP nurse to discuss specifics of the procedure. I tend to ask too many questions sometimes and this might have been one of those instances. In any case I got the feel that the staff knows what they are doing as well.

So tomorrow is the big day. We have to be at the hospital at 7:00 AM and the procedure is set for 8:30 AM (Pacific time zone). I have prayed for and received peace. I appreciate any and all prayers for myself, my family, Dr. Natale, and the supporting staff. We will do our best to update this blog as soon as possible after the procedure. Thanks for reading (and praying).

Dave

The Calm Before The Storm

Wednesday was a relaxing day. We spent the day driving up the coast on highway one. It was kind of a nice distraction. We ended up in Bodega Bay, the setting for Alfred Hitchcock's 1963 movie, "The Birds". We did the normal tourist thing and visited some of the places featured in the movie including eating at the The Tides restaurant. I don't think anyone could tell we were tourist (not like taking pictures of everything was a tip off or anything).

This morning we are set to meet with Dr. Natale. As of now I have only had the one short episode of AF on Monday morning. This is still a surprise to me since I have been off all my heart meds since Monday. We will see what Dr. Natale has to say and post back later what we find out. Have a good Thursday everyone.

Dave

Guilt

When my husband was diagnosed with a-fib, we started to figure out a few things that might be a trigger to his episodes and food was one of them.

As I am the one that is usually responsible for meal planning and making the food choices, I really started to feel responsible for his atrial fibrillation which brought on a lot of guilt on my end. Every time he would have an episode I would think back on what I had laid down in front of him for his dinner the night before, if I had done something wrong and made him go back into a-fib, blah blah blah. I'm sure you know what I mean. I think about all of those dishes over the past years that he loves and (due to my love for him, right?) I would prepare. Like those 3 cheese meatballs, all of the pizza dip and his favorite dessert, cherries in the snow.

Well once I started to feel the responsibility that I might have brought all of this on him, because he can't say no to anything that I sit before him because that would hurt my feelings, there was a sudden change around our house. I wasn't going to cause my husband to die!

I started to research healthy food choices, how many calories, carbs, sugars and so on that he should have on a daily intake. It was quite the scene around our home. I printed up a daily schedule for foods and wrote everything down that he ate. And every night I would add up all the calories, fat, carbs and everything else. I wouldn't let him go over 2000 calories per day. It took me double time at the grocery store, checking all those labels and trying to select the healthy choices. I'm convinced that other shoppers thought I was nuts because I would be in the cereal aisle for a half hour checking every one for the lowest sugar etc.

I think I was trying to take back and make right for feeling that I was the culprit here.

When we would go to restaurants I would say no to him. When we went to family gatherings I would say no, you can't have that and everyone would look at me like I was such a mean wife. But I started to not care, and if it took me saying no to him to keep him out of a-fib then I would just take the punches.

Well you know, that is a very big responsibility to live up to. And I got tired of being the mean person all the time. I decided that I couldn't keep living with the guilt and the fear that I might do something wrong. Plus, I felt like such a hypocrite because I don't even eat right and take care of myself. I don't like meat, milk, fruits or vegetables. I like chips, cookies, candy and Starbucks. Something has to change here.

I started to put more responsibility on my husband to take charge of his food choices. I still do the shopping and cook the meals, but if he makes wrong choices, I don't feel as guilty anymore. I feel like that is his decision to make. It's made me feel better, and him also.

After all, I'm not his mother, I'm his wife, friend and partner. And I want to live many years with him and look forward to all the grandchildren we will have, hopefully someday. I want to look forward to traveling with him and I want both of us to live a healthy life. Without the guilt!

How A Ping Pong Ball Feels

Today I was supposed to go to the hospital lab for a ProTime (a test to check how long it takes for your blood to clot measuring the effectiveness of the blood thinner). Let me start out by saying that what happened was my fault for not checking to see where I was supposed to go first.

First we went to the hospital lab. They didn't have any lab orders for me so they sent me down to admitting. We stopped by a check-in desk where they looked for any paperwork for me and came up with a lab order and sent me back to the lab with the paperwork in hand. The lab then realized I had not been registered in the hospital computer yet so first they had me fill out a lengthy registration form. After I finished that they told me I would have to go down to registration anyhow. This is where I should have started. They couldn't use the registration form I filled out at the lab so I had to go through all of that over again.

I must have caused enough confusion and concern that the guy from the EP department came down I think to see if I was going to need some "special assistance". At that point most everything was straightened out so I pretended to know what I was doing - he didn't seem to buy it.

Now back to the lab with all the proper paperwork in hand and properly registered. I could see the light at the end of the tunnel - then it went out... "Hello, my name is (I can't remember). I am an Intern here. Is it okay if I draw your blood today?". I think I mentioned in my initial post that I am not a needle guy so what would you say if asked this question? Should I tell the truth? The best answer I could muster was "I hope so". She took this as a yes and several nervous minutes later successfully poked a vein in my right arm (Praise the Lord!). I hope she gets a good grade for dealing with needle-phobes like me.

We then went up to the EP department to deliver some paperwork from registration. We got to meet some of the people who will be taking care of me and that I have been in contact with by e-mail. They ran through where and what I needed to do on Thursday (consultation with Dr. Natale) and on Friday for the ablation procedure. For some reason they covered this 3 or 4 times like they thought I might show up at the wrong place or something. Now why would they think that?

All in all I think we were bouncing around at the hospital for a couple of hours. The good news is the nurse called me an hour or so later and told me the ProTime test came out in range so everything is still good for the ablation.

Dave

A Stowaway?

Guess who made the trip from Michigan with us? That dreaded atrial fibrillation monster. This was not completely unexpected as I am tapering off of my heart meds in preparation for the ablation procedure on Friday. It was, as always, an unwelcome guest in the early hours this morning. To my surprise my heart converted back to normal within an hour or so without the extra meds. I had been AF free since a cardioversion in mid November which was a great stretch compared to weekly and/or long lasting episodes before.

We spent most of the day hanging around the hotel. Melinda picked up some kind of nasty stomach flu and we are praying it is the 24-hour variety. I went to a nearby Safeway store for groceries and 7-up for her. I had to park in the area marked "compact only" because it was so busy. My Chevy Malibu rental car barely fit in between a BMW and a Range Rover!

If you think of it, please pray for a speedy recovery for Melinda. Tomorrow starts to get a little busier with a visit to the hospital lab for a blood test and I sure could use her support.

Side note: I started this blog in the Eastern time zone so I will continue to use that time zone for the posts even while in California.

Take care everyone.

Dave

We Made It

It was a long day but we finally made it to our hotel in California. We sat on the first plane for over an hour and by the time the runway was open again one of the engines would not start. So we had to start all over. They got us booked on a 3:30 PM flight but 15 minutes after I walked away from the ticket agent, I got a phone call saying that flight was cancelled and that they had us set to fly out on Monday morning. I went back down to the ticket desk and found out they had fixed the plane for the original flight and it was about to leave less than half full. We had to do the running through the airport thing to get to the plane in time.

The connecting flight from Minneapolis to San Francisco was completely full and Melinda and I had to sit apart in two middle seats. That was a fun 4 hour flight! We finally got here and got our bags and the rental car. We got a little lost so the drive through town and across the Golden Gate bridge was nerve racking but the view at night was beautiful. Tomorrow we'll check out where the hospital is a get a feel for the area.

Dave

Let It Snow?

Well so far we are sitting on the plane still at our departure airport. We had pushed back from the gate and were waiting to get de-iced when they closed the runways. We are waiting for the plows to clear and de-ice the runway before we'll be allowed to go. We'll see what happens with our connecting flight. Hopefully the next post will be from San Francisco. Have a great Sunday.

Dave

"Melinda-My Story"

Hi, My name is Melinda, and my husband has atrial fibrillation.

First of all, let me say that I come from a long line of passionate over-reactors. Everything is pretty much black and white to me, no middle ground. You have probably known many people like that, maybe even be married to one. It can be a topsy turvy life for your spouse. But in the last year and a half, I have started to change, and I've learned a lot about life, faith and that I can't control everything in life. Some things have to be handed over to the One who controls everything, and if I didn't know what faith was then, I know now.

When my husband Dave went to the emergency room that first time and was diagnosed with a-fib I thought, "well, that's it". Being the dramatic person that I am I started looking ahead to my future. What will I do without my husband, I don't want to live without him, he's too young to die. All of the crazy stuff you start to imagine when something that you aren't used to dealing with all of a sudden invades your world and all of a sudden, it's not your world anymore. You can be going along in life happily day to day and "bam" your perfect little world is being taken away from you. I still remember that first night that Dave was admitted into the hospital and I had to drive home alone. I cried all the way and all sorts of bad thoughts were rushing through my head, I had my poor husband dead and buried already. Now you know what I mean when I say that I am an over reactor. The next morning I got up around 6:00am and drove to the hospital where I was sure that he hadn't lived through the night. But of course he did.

Knowledge is the best tool to have in these situations, and as Dave and I learned more each day about his condition, I started to calm down. Especially after an a-fib episode was over. For the first year, I still panicked every time he would go into a-fib, I would just sit and couldn't do anything until the episode was over. I was so immobilized with fear.

As time has gone by, and I realized that he wasn't going to keel over on the spot, I started to get a "chin-up" attitude. I think that a lot of it was the fact that I stayed very busy with shopping for the right foods, researching and making sure he had the right proportions and picking up his ever changing medications at the pharmacy. I go there so often that I don't even have to give them my name anymore, they see me coming and get out the little white bag with whatever meds we need that week.

As we prepare to make the trip out west for the ablation, I've decided that I'm going to be the strong and positive one (hopefully) and try to contribute in a positive way.

It's odd that after a year and a half of being a total zombie at times because of fear, all of a sudden I have a peace of heart and mind with the ablation that will be done a week from today. I have no fears, no fears about the flight and a very unusual calmness about the whole situation. I attribute it to a gift of peace from Christ, who will never let us go through more than we can handle.

I'll see you in California!

Behind Every Good Man...

You know how the saying goes. I'm not trying to call myself good but I did want give credit to my wife, Melinda, for her support during all this.

My first stay in the hospital last year was a new experience for me and she did everything she could to comfort me. I remember not wanting her to leave at night because the nights were the worst. I mentioned before that sleeping at the hospital was impossible so I had way too much time to think. This was especially true the night before the cardioversion. I maybe got 3 hours of sleep. I had asked Melinda to come as soon as she could that next morning and I think she showed up about the same time as the tech for my 5:00 AM lab draw. She couldn't have gotten much more sleep than I did and I worried about that but I sure was glad to see her.

Since then she has always been there when I was waiting out an AF episode, dealing with some new fear, or just to listen. She has cried with me and prayed for me. She helps me keep track of my meds (have I always been this forgetful?) and makes sure my diet stays consistent (a requirement for the blood thinner Coumadin). The list goes on and on. I thank God for her every day.

I visit a forum for people with AF. Occasionally there will be a posting from a spouse of someone dealing with AF and that perspective is always interesting. I am hoping Melinda will share what it has been like from her point of view.

Dave

California Here We Come

If the weekly AF attacks were a monkey on my back, that last 3-1/2 week AF episode felt like a gorilla. Needless to say it got Melinda and I talking about what to do next. The groovy cartoonish AF brochure they gave me in the hospital described an "ablation" procedure that might offer some relief. This procedure involved inserting catheters through leg veins into the heart and then using RF or other energy to burn the offending areas inside the heart. The grand cure-all procedure described in the brochure was an AV node ablation along with implanting a pacemaker. Remember the AV node is kind of a key part of the heart's own electrical system so burning it into oblivion would explain the need for a pacemaker. I'm sorry but all the happy silly cartoon characters in the world are not going to make me ready for this extreme.

That initial (and incorrect) impression of AF ablation procedures has stuck with me. It wasn't until it seemed like all else had failed that we started researching more seriously. Thankfully their was far more accurate and hopeful information available. The now current standard for AF ablation focuses on isolating the pulmonary veins. It was discovered in 1998 that the majority of the stray electrical signals that trigger an AF episode originate in the pulmonary veins. This approach leaves the normal electrical system of the heart intact which, to me, is very desirable.

A Pulmonary Vein Isolation (PVI) is a more complicated procedure compared to other ablation procedures for simpler and more defined arrhythmias. Part of this is because the pulmonary veins are located in the left atrium. Feeding catheters up from the leg veins leads to the right atrium so a needle is used to make a small hole between the right and left atria in the wall (septum) separating the two chambers (called a trans-septal puncture). The goal is to ablate (burn) lines around each of the pulmonary veins (typically 4 of them) one dot at a time. There is not much room to work - the left atrium is about 2" in diameter and the pulmonary veins are about a half inch diameter. PVI procedures can last 3 to 4 hours or longer.

A lot of what I read mentioned that the outcome of a PVI is highly operator (doctor) dependent. I guess this is understandable based on the complexity involved. There seemed to be a handful of doctors that were at the forefront for successful ablations. One name, Dr. Andrea Natale, was at the top of the list for doctors in the U.S. He had been practicing at the Cleveland Clinic but, because of his success rate, the backlog to see him was 18+ months. I had already decided if I was ever ready for an ablation he would be the doctor I would want to do it but a year and a half is a long time to wait. To our surprise, the very day we decided to pursue an ablation, Dr. Natale announced that after leaving the Cleveland Clinic, he was now practicing in the San Francisco area. What an amazing coincidence.

Dr. Natale actually makes himself available via e-mail so I began e-mailing him about my case. He felt my chances for a cure from AF where quite high given my age and that my AF had not yet progressed to chronic or permanent AF. Because of his recent move to California, his backlog was now only 6 weeks! Melinda and I discussed this over the course of a weekend and decided this was my best chance to find relief from AF and hopefully be able to get rid of all the heart meds with all the wonderful side effects. I expect I will still need something for blood pressure but some people have also seen their BP drop after an ablation.

Dr. Natale is currently seeing a 80% success rate for a single ablation procedure, and approaching 95% with a second procedure. The two local EP doctors I have seen since our decision didn't seem to like Dr. Natale (one doc even brought up his name before I said anything). When I asked them why the only thing they could offer was that the success rates that Dr. Natale quotes are too high - they seemed to think 60-70% was more realistic. I guess this is as good a reason as any to dislike someone. Inflated success rates or not, I wanted to go to Dr. Natale because he has done thousands of ablations compared to less than 100 for the local doc. A newsletter I subscribe to just published results of a survey of ablation outcomes. Dr. Natale, or the procedure he has developed (a variation of a standard PVI called a PVAI), had the highest success rates. All of this has confirmed our decision.

It took some work to get things in motion but everything is set now for an ablation with Dr. Natale on December 21. We will be at the hospital a good part of the day on the 20th with pre-admission testing and a consultation. The procedure is considered outpatient but I will still have to stay overnight. We fly into San Francisco on the 16th and hope to spend the few extra days sight-seeing. Our daughter and her fiance will be about an hour away visiting his family. She plans on coming down before the procedure and staying with us until I am feeling better back at our hotel. I am thankful Melinda will have someone to stay with her the night I'm in the hospital.

It seems all of this came together very fast and I'm not sure it has sunk in yet. So far I have tried not to focus too much on the procedure and instead I'm looking forward to some relief. In the meantime I just keep typing away on this silly blog.

Dave

The Unwelcome Guest

Ever have a house guest show up unannounced? And then once they were there they wouldn't tell you exactly how long they were going to stay? I found out atrial fibrillation is kind of like that.

I wasn't sure what to expect after being discharged from the hospital after my first AF episode. I was given several new medications that were supposed to help one way or another. These included Flecainide (anti-arrhythmic), Cardizem (heart rate), Lisinopril (blood pressure), and Coumadin (blood thinner). The diabetes I was diagnosed with resolved itself after switching to a low-carb diet and weight loss. My stroke risk was considered much lower without the diabetes so after several months I was able to discontinue the Coumadin and switch to a daily adult aspirin.

Both Melinda and I were on edge during those first several weeks. The doctors acted like the AF might not ever come back but everything I had read told me it would. About a month and a half after my first episode, I woke up with AF. We both freaked. The uncomfortable memories of the hospital stay were still fresh in my mind and I wanted desperately to avoid a repeat. We sat looking at each other - me checking my pulse every minute or so and Melinda asking me each time if "it" was gone. I would say no and we both would sigh and our eyes would fall to the floor. This went one for about 90 minutes. Finally I felt a regular pulse. This time when Melinda asked me if "it" was gone I said "I think it might be". I had to check my pulse for several more minutes before I let myself believe the that AF had converted to normal. I think waiting out that first repeat episode was more stressful than the 4-day hospital stay.

Consistent with what I had read this pattern of repeat or breakthrough AF episodes continued. First about 40 days apart, then 30, then 20, then 10, then down to weekly episodes. At first I reported every one of my episodes to my cardiologist. He and I eventually accepted my progression as fairly normal for AF and I stopped reporting or even keeping track. Normally if I woke up with AF I would get up, take an higher dose of Flecainide, and rest or go back to bed to wait it out.

A couple of times I woke up with AF and decided I wasn't going to let it get the best of me and went on with my plans for the day. This was a mistake. Even with the meds my heart rate would shoot up and my heart would pound so hard I felt like my head would jerk with each beat. These episodes proved the hardest to convert. I had one in August 2007 that I was able to convert with another extra dose of Flecainide and Cardizem. The last one was in October. I woke up on a Saturday morning in AF. I tried the normal high dose of Flecainide and waited. Two hours later I was still in AF but needed to go into work. By the time I got home my heart rate was in the 120s. I took another dose of meds and went to bed. The unwelcome guest was still there Sunday morning.

I figured the next step would be my second electric cardioversion. I called my cardiologist who advised against a cardioversion but increased my meds instead. He also referred me to another doctor who specializes in the electrical system of the heart, an electrophysiologist (EP). I saw the EP 2 days later and he was in favor of a cardioversion but by this time it had been more than 48 hours so now it was more complicated. I went back on the Coumadin and had to wait for it to build up to the proper level. The EP also increased my meds over and above what my cardiologist had already done. Altogether I was in AF for 3-1/2 weeks this last episode. I was finally able to have the cardioversion and this time it was not nearly as scary since I knew what to expect. The worst part of it was getting the IV started. Just like before, one jolt and my heart was back to normal.

During this period I developed some unpleasant symptoms. Most of my evenings were spent sitting in a chair with a horrible headache and feeling light headed. None of my doctors could offer an explaination so I just lived with it. At first I figured it was the AF but the symptoms continued after the cardioversion. Melinda and I went out to eat one Friday night after work and it got so bad I asked her to take me to the ER (did I mention already that I don't like going to the ER). They did the required workup including a head CT scan to check for bleeding (one of the risks associated with Coumadin). Nothing showed up in the head scan (get over it, that joke has been done already) or in the other test so the diagnosis was probable medication side effects. I have since found some small relief by decreasing my morning dose of Flecainide. My doc considers this unconventional but he is not the one suffering. I had to try something and I'm not as worried about my morning dose since all my AF episodes have been at night.

Quiz time! Don't worry, it is multiple choice - just like my favorite tests in school:

1. Accept the AF and live a limited and probably shorter life.
2. Increase the meds to a more effective level and live with the side effects.
3. Find out what option C is.

Not sure about you but I am leaning towards option C.

Dave

Atrial What?

That was my first reaction when the doctor told me I had atrial fibrillation... atrial what? They gave me a brochure to read in the hospital. It described AF in very clinical terms but the seventies looking cartoon figures and diagrams made me wonder how dated the information was. It wasn't until I got out of the hospital and spent time reading what I could find on the Internet that I got a more current and accurate understanding of AF. I am very thankful for all the doctors who have cared for me but more than once they have disagreed with each other. Having a better understanding and knowing the experience of others has helped me filter the information I was given.

So what is atrial fibrillation? For starters it is the most common form of arrhythmia affecting an estimated 2-5 million people in the U.S. alone. It is common to develop AF after heart surgery or in conjunction with heart valve disorders. There can be other contributing factors but AF can also develop in otherwise healthy hearts with no discernible disease. This is called Lone Atrial Fibrillation (LAF). In my case I would guess that mild hypertension (high blood pressure) and sleep apnea were underlying causes.

To understand AF, you have to understand the normal electrical system of the heart. The top two chambers of the heart are the left and right atria and the bottom two chambers are the right and left ventricles. Each heartbeat originates with an electrical signal from the SA node, located at the top of the right atrium. The SA node is the internal pacemaker of the heart. This signal causes the atria to contract. This is the "lub" of the "lub-dub" heart beat sound. As the electrical signal travels down the atria, it is picked up by the AV node. Think of the AV node as being like a radio receiver that is listening for the signal from the SA node. The AV node delays the signal for a small amount of time before passing it on to the ventricles, causing them to contract. This is the "dub" sound. This sequence is what is considered Normal Sinus Rhythm (NSR).

During AF, the electrical signals in the atria start to recirculate and follow multiple circular paths instead of the normal top to bottom path from the SA node to the AV node. The multiple colliding signals in the atria act more like static that cause the atria to quiver between 300 and 600 times a minute. At this point the atria can no longer pump blood effectively. This is the cause for the most immediate concern for someone with AF, blot clots. Blood can become stagnant in areas of the atria and form blood clots. If a clot breaks loose it can cause problems depending on where it travels in the body. This can include stroke, pulmonary embolism (blood clot in the lungs), or heart attack. Blood clots are generally not a concern unless an AF episode lasts for more than 48 hours. Anti-coagulants drugs (blood thinners) can help minimize the risk.

Now on to the AV node. Remember the AV node is like a radio receiver that is listening for the signal from the SA node. During AF, the AV node ends up receiving a lot of static instead of the steady signal from the SA node. Thankfully the AV node has a safety mechanism built-in that limits how often it will pass on a received signal, kind of like a rev limiter for an engine. For most people this limit is somewhere between 150-180 beats per minute (bpm). It is because of this safety mechanism that AF is not considered life-threatening. The ventricles can still pump blood at rates this high but not efficiently. The resulting ventricular beats also tend to be irregular due to the unorganized character of the signals picked up by the AV node. The high ventricular rates can have some negative long term effects on the heart so drugs to slow down the heart are next on the list.

There seem to be two distinct forms of AF. One is called adrenergic (think adrenaline) where AF episodes are brought on by high stress or physical exertion. The other form is vagal (named after the vagus nerve) where AF starts during rest or sleep, or after a large meal. People who suffer from both forms are considered mixed or dual form. My doctors have yet to recognize these forms but every AF episode I have ever had fits the vagal form mold perfectly. On the flip side, I work with someone who so far has had two AF episodes both occurring during periods of high stress or too much caffeine. My doctors may not be convinced but I am.

Sorry again for the lengthy post. Melinda says I give way too much detail - I guess I just proved it. Next post I'll cover my treatment and experiences since my initial episode.

Dave

My Story So Far

Sorry for the long initial post but I've got 16 months to cover.

My medical history was pretty unremarkable for most of my life. No surgeries. No broken bones. That all changed in June 2006. One night while laying in bed, I could feel my heart doing something strange. It was nothing I could pinpoint, just kind of an awareness of each and every heartbeat. I asked my wife, Melinda, to listen to my heart. She held her ear to my chest and said that it didn't sound normal, it sounded like the sound from a seashell. She asked if we should go to the hospital but I said lets wait and see what happens. This episode lasted several minutes and then went away. In the back of my mind I wondered if this was the start of some impending serious heart trouble. I had always thought to myself I was a heart attack waiting to happen if I did not improve my health before I hit my forties. By the next day this was all pretty much forgotten.

Two weeks later it was back. I had spent a long Saturday working outside to the point of exhaustion. Instead of water I opted for can after can of sugar-laden pop. Once I got home I was starved from working all day so I downed a whole pizza late in the evening. Little did I know but this was all the perfect storm for triggering a certain type of AF (there is more than one type). Just like 2 weeks before, my heart started acting up once I was laying in bed except this time it didn't go away. I decided not to say anything to Melinda and went to sleep albeit slightly worried. Somehow I slept through the night. When I woke up I could tell my heart was still not right. I still didn't say anything to Melinda and decided I would go ahead and get ready for church and hope it would go away. After getting ready I thought I would try to take my blood pressure. I had been monitoring my BP with a new machine for about a month because my doctor had been concerned about high blood pressure.

Try after try the BP machine refused to give me a reading and displayed an error instead. Now I'm starting to get concerned. I could feel my pulse in my arm during the BP testing and I could tell it was very irregular. I checked my pulse and besides being irregular, I counted 30 beats in 15 seconds. Now confronted with a resting heart rate of 120 BPM my concern was quickly changing to a panic. About that time Melinda noticed my expression and asked what was wrong. I told her I thought we should go to the hospital. Those aren't the words a spouse ever wants to hear. I want Melinda to share her experience here as well so look for her perspective in future posts.

My panic didn't get any better on the way to hospital. This was one of those rare times I told Melinda to drive faster. Quick poll here: does anyone like going to the emergency room? I don't. The only good thing about presenting at the emergency room with chest pain or pressure is they get you in really fast. They had me hooked up to all kinds of stuff in no time at all. I think we saw my heart rate hit 145 once or twice. I'm not a needle guy so getting the IV was great fun (actually it wasn't that bad). Bless the ER doctor who had to deal with two pretty scared people but, how do I say this, his persona did not exude confidence. He would come in our room every now and then, look at the heart monitor, contort his face one way or the other and say "Hmmm...". Okay, Hmmm what? They did give me a drug (Cardizem) via the IV to slow my heart down. My heart rate would slow to 100 BPM for 10 minutes per dose and then climb back up again.

After a couple of hours of this they told me they were going to admit me to the hospital for monitoring. This ranks well below going to the emergency room in my book. They checked me into a lovely 4-bed ward and I exchanged my church clothes for some hospital pants and this really cool hospital gown (the cool part comes from all the ventilation you get from that wonderful opening in the back). I think they threw in some color-matched footies but in this getup I was hardly making a fashion statement.

A half hour or so later a new doctor comes in and introduces himself. I asked him if he knew what was wrong with me. He said "you've got atrial fibrillation, hypertension, and diabetes". The picture that comes to mind here is the old Batman fight scenes where the TV screen flashes POW!!!, BANG!!!, KABOOM!!! I guess it was my fault for asking. Just 24 hours earlier I was a normal healthy adult - well that just came to a screeching halt. Lets start with number one, "atrial what?" I asked. "Atrial Fibrillation. The good news is it is not life threatening." Those words were the first relief we got from all the anxiety we had been feeling. The plan was to keep me there overnight to see how I did.

I had the 4-bed (one TV) ward to myself until about 12:30 AM. I was having a hard enough time trying to sleep in the strange surroundings and then on come the lights. They rolled 2 guys in who have been in some kind of accident. They must have been 3rd shifters on their way to work because the guy next to me wanted to watch TV. My first night in the hospital with heart problems and my stress level is not doing so good. I eventually asked if they could move me to a different room so I could get some rest. They did move me but I found out resting in the hospital is pretty much impossible anyhow. They send people in all night long to check vitals and the lab folks show up bright and early every morning to see if you have any blood left.

The next day was filled with lots of fun activities, just like being on a cruise ship. There was an echocardiogram (ultrasound of the heart), we got to meet with a diabetic educator, and then there was the chemical stress test. They wouldn't let me do the standard exercise stress test because my resting heart rate was still in the 130s. I was more than a little nervous about having something injected into me that was going to do who knows what to my heart. The doctor told me not to worry and that if anything happened he would be right there. Well I feel much better now, don't you? The drug (Persantine) they give you for this causes a whopper of a headache as it wears off. They said caffeine would help the headache diminish quicker. My caffeine drink of choice would have been Mountain Dew but all they had was coffee that tasted like turpentine. I kept expecting it to eat a hole through the bottom of the coffee cup. Melinda wouldn't touch the stuff (she's the coffee drinker of the two of us) but I drank most of it out of desperation for any kind of relief.

Note for customer service: I'm sure this is not normal but the nurses I had seemed to enjoy telling me lies. They kept saying "you'll get to go home tomorrow". Well I heard this 3 days in a row. I considered telling them a lie of my own like "I'm related to George Bush" but I figured there was a 50-50 chance they would treat me worse then.

Tuesday afternoon my cardiologist told me the plan was to do an electric cardioversion the next morning. Right about then is when a healthy amount of fear set in. I grew up watching "Emergency!" so I felt I had a pretty good idea how this was gonna go. Roy and John get the orders from Rampart, open the little red suitcase, squirt some gel on the paddles and yell "CLEAR!!". Well, at least that is how I remember it. The guy that came in Wednesday morning to do my EKG said "I see you're scheduled for a cardiovert today". I said "yeah, I'm a little nervous about it". He said "don't worry, they give you some drugs so you won't even remember it. Even with the drugs though I hear some people scream real loud". Thanks to him, I now know one thing I would never say to someone in my situation.

In reality the cardioversion was nothing. The last thing I remember is the doctor asking my where I worked. The next thing I remember was waking up and asking the nurse if it worked. She said "yup" and I said "Praise the Lord!"

It wasn't much later that they let me put my church clothes back on and wheeled me out for Melinda to take me home. I felt like I had been released from prison - or from one prison anyhow. We decided to leave the blue footies behind but I did take a few extra things home with me from the hospital:

1. Three new medical ailments to bring up when everyone else starts talking about their medical problems.
2. At least 5 new medications including 6 days of one called Lovenox that burns when you inject it into your stomach (did I mention I'm not a needle guy?)
3. A sense of uncertainty about my life going forward.

You deserve a medal if you read this far. Please check back for more of my story.

Dave