the thread of ATRIAL FIBBING

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.

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

I incl. this update in email (to mark and others) just now:

I recently had my first follow-up to the early Sept. catheter ablation, and still no afib, no "significant" irregularities at all. Also no aftereffects of the procedure, though there can be quite a few (before consenting to go through with it, I researched the research on these, found a pre-Trump gov study that reported a 1 % chance of any of them occurring, so went with that)(Mayo Clinic site said that first catheter ablation only has 50 % chance of success---second try:80%---but so far it's worked for me)