the thread of ATRIAL FIBBING

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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 :(

mark s, Saturday, 12 November 2016 10:49 (two years ago) link

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."

Zelda Zonk, Saturday, 12 November 2016 12:00 (two years ago) link

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.

Zelda Zonk, Saturday, 12 November 2016 12:14 (two years ago) link

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

mark s, Saturday, 12 November 2016 12:28 (two years ago) link

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

mark s, Saturday, 12 November 2016 12:39 (two years ago) link

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

Bein' Sean Bean (LocalGarda), Saturday, 12 November 2016 13:00 (two years ago) link

yes! (thank you)

mark s, Saturday, 12 November 2016 13:07 (two years ago) link

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)

xyzzzz__, Saturday, 12 November 2016 13:48 (two years ago) link


mark s, Saturday, 12 November 2016 14:24 (two years ago) link

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

Distribution of all possible outcomes (Sanpaku), Saturday, 12 November 2016 14:41 (two years ago) link

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 :)

mark s, Saturday, 12 November 2016 14:47 (two years ago) link

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.

Brad C., Saturday, 12 November 2016 15:14 (two years ago) link

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.

mark s, Saturday, 12 November 2016 15:21 (two years ago) link

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

mark s, Thursday, 17 November 2016 10:05 (two years ago) link

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

mark s, Thursday, 17 November 2016 15:17 (two years ago) link

two weeks pass...

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

mark s, Wednesday, 7 December 2016 16:12 (two years ago) link

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

mark s, Wednesday, 7 December 2016 16:15 (two years ago) link

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 :\

mark s, Thursday, 8 December 2016 10:23 (two years ago) link

one month passes...

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…

mark s, Friday, 27 January 2017 11:47 (two years ago) link

ffs! :/

illegal economic migration (Tracer Hand), Friday, 27 January 2017 11:51 (two years ago) link

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.

Andrew Farrell, Friday, 27 January 2017 11:55 (two years ago) link

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

mark s, Friday, 27 January 2017 12:04 (two years ago) link

one month passes...

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)

mark s, Wednesday, 1 March 2017 14:35 (two years ago) link

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)

mark s, Thursday, 9 March 2017 17:40 (two years ago) link

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)

mark s, Thursday, 9 March 2017 18:22 (two years ago) link

one month passes...

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)

mark s, Tuesday, 25 April 2017 19:47 (two years ago) link

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!

Supercreditor (Dr Morbius), Tuesday, 25 April 2017 20:09 (two years ago) link

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:

k3vin k., Tuesday, 25 April 2017 20:17 (two years ago) 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

mark s, Tuesday, 25 April 2017 20:29 (two years ago) link

(which is overdilation of capillaries maybe?)

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

mark s, Tuesday, 25 April 2017 20:30 (two years ago) link

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

mark s, Friday, 5 May 2017 10:32 (two years ago) link

Best wishes for the procedure.

xyzzzz__, Friday, 5 May 2017 14:36 (two years ago) link

be supersafe, mark.

Supercreditor (Dr Morbius), Friday, 5 May 2017 14:40 (two years ago) link

cheers guys :)

mark s, Friday, 5 May 2017 14:41 (two years ago) link

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:

mick signals, Saturday, 13 May 2017 00:31 (two years ago) link

cheers mick, that's interesting and useful

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

mark s, Saturday, 13 May 2017 10:15 (two years ago) link

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.

calzino, Saturday, 13 May 2017 11:20 (two years ago) link

"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 👌🏽 😜 👌🏽

mark s, Saturday, 13 May 2017 12:39 (two years ago) link

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, 13 May 2017 12:40 (two years ago) link

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

calzino, Saturday, 13 May 2017 12:55 (two years ago) link

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

del esdichado (NickB), Saturday, 13 May 2017 16:06 (two years ago) link

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

tokyo rosemary, Wednesday, 17 May 2017 15:30 (two years ago) link

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)

mark s, Wednesday, 17 May 2017 15:52 (two years ago) link

Good luck dude, thinking good thoughts.

Matt DC, Wednesday, 17 May 2017 15:55 (two years ago) link

Yeah good luck man

Le Bateau Ivre, Wednesday, 17 May 2017 16:12 (two years ago) link


illegal economic migration (Tracer Hand), Wednesday, 17 May 2017 16:26 (two years ago) link

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

Andrew Farrell, Wednesday, 17 May 2017 16:31 (two years ago) link

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"'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)

mark s, Thursday, 18 May 2017 15:59 (two years ago) link

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?

del esdichado (NickB), Thursday, 18 May 2017 16:19 (two years ago) link

GAH mark!

Li'l Brexit (Tracer Hand), Friday, 16 August 2019 10:39 (two months ago) link

"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 ...."

Andrew Farrell, Friday, 16 August 2019 10:42 (two months ago) link

Also good news!

Andrew Farrell, Friday, 16 August 2019 10:42 (two months ago) link

time for u to embrace yr destiny, mark

(Appears only as a corpse) (bizarro gazzara), Friday, 16 August 2019 10:44 (two months ago) link


xyzzzz__, Friday, 16 August 2019 10:46 (two months ago) link

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

mark s, Tuesday, 20 August 2019 10:40 (two months ago) link

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"

mark s, Tuesday, 20 August 2019 11:02 (two months ago) link

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

xyzzzz__, Tuesday, 20 August 2019 11:03 (two months ago) link

alright elrond

mark s, Tuesday, 20 August 2019 11:04 (two months ago) link

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

xyzzzz__, Tuesday, 20 August 2019 11:37 (two months ago) link

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"


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 ( 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!!)

mark s, Thursday, 22 August 2019 11:16 (one month ago) link

> 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

koogs, Thursday, 22 August 2019 11:38 (one month ago) link

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.

American Fear of Pranksterism (Ed), Thursday, 22 August 2019 11:38 (one month ago) link

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, 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)

mark s, Thursday, 22 August 2019 12:26 (one month ago) link

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

mark s, Thursday, 22 August 2019 12:27 (one month ago) link

four weeks pass...

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)

mark s, Thursday, 19 September 2019 17:14 (one month ago) link

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

k3vin k., Thursday, 19 September 2019 20:46 (one month ago) link

“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 :)


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.

mark s, Saturday, 21 September 2019 14:51 (four weeks ago) link

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.

mark s, Saturday, 21 September 2019 15:11 (four weeks ago) link

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

mark s, Saturday, 21 September 2019 15:13 (four weeks ago) link

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!

xyzzzz__, Saturday, 21 September 2019 15:42 (four weeks ago) link

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.

Fizzles, Saturday, 21 September 2019 15:43 (four weeks ago) link

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

mick signals, Saturday, 21 September 2019 17:12 (four weeks ago) link

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!

k3vin k., Saturday, 21 September 2019 19:20 (four weeks ago) link

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 :)

mark s, Saturday, 21 September 2019 19:51 (four weeks ago) link

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

mark s, Saturday, 21 September 2019 19:56 (four weeks ago) link

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 :)

gyac, Saturday, 21 September 2019 20:30 (four weeks ago) link

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!

coup de twat (suzy), Saturday, 21 September 2019 20:55 (four weeks ago) link

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.

dow, Saturday, 21 September 2019 23:13 (four weeks ago) link

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

dow, Sunday, 22 September 2019 00:52 (four weeks ago) link

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

Fox Pithole Britain (Noodle Vague), Sunday, 22 September 2019 08:05 (four weeks ago) link

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.

Andrew Farrell, Sunday, 22 September 2019 08:17 (four weeks ago) link

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 :(

The Pingularity (ledge), Sunday, 22 September 2019 10:55 (four weeks ago) link

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

Fox Pithole Britain (Noodle Vague), Sunday, 22 September 2019 11:00 (four weeks ago) link

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

The Pingularity (ledge), Sunday, 22 September 2019 11:02 (four weeks ago) link

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.

coup de twat (suzy), Sunday, 22 September 2019 11:10 (four weeks ago) link

"really nice steak" was definitely not on the menu

mark s, Sunday, 22 September 2019 11:12 (four weeks ago) link

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

xyzzzz__, Sunday, 22 September 2019 11:36 (four weeks ago) link

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

Luna Schlosser, Sunday, 22 September 2019 11:42 (four weeks ago) link

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

mark s, Sunday, 22 September 2019 11:51 (four weeks ago) link

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.

coup de twat (suzy), Sunday, 22 September 2019 11:57 (four weeks ago) link

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

Fox Pithole Britain (Noodle Vague), Sunday, 22 September 2019 11:58 (four weeks ago) link

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)

mark s, Sunday, 22 September 2019 12:10 (four weeks ago) link

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

mark s, Monday, 23 September 2019 10:42 (three weeks ago) link

two weeks pass...

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 :(

mark s, Wednesday, 9 October 2019 16:18 (one week ago) link

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

imago, Wednesday, 9 October 2019 16:31 (one week ago) link

mark supplies his own armband AND jackboots iirc

to regain his mental focus, he played video-game golf (bizarro gazzara), Wednesday, 9 October 2019 16:36 (one week ago) link

gold spiked helmet

imago, Wednesday, 9 October 2019 16:37 (one week ago) link

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.

There's more Italy than necessary. (in orbit), Wednesday, 9 October 2019 16:42 (one week ago) link

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

Hideous Lump, Thursday, 10 October 2019 06:11 (one week ago) link

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