the thread of ATRIAL FIBBING

Mediterranean diet.

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

Italian research shocker

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

(thank you for posting)

They could have used more editorial assistance on that abstract.

sanpaku are u no longer vegan???

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

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

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

DOUBLE HURRAH!!!!

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

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

Hurrah!

Brill!

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

Yay, mark!

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

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

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

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

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

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

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

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

Bah, sorry to hear that, man

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

good news! i wish my heart behaved properly #emo

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

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

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

:)

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

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

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

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

also i got this again on sunday:

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

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

GAH mark!

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

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

Also good news!

time for u to embrace yr destiny, mark

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

👍

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

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

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

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

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

alright elrond

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

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

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

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

EIGHT HOURS LATER

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

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

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

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

> little blob of cottonwool

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

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

> elrond

elrond hubbard

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

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

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

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

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

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

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

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

“Heart rate ain’t nothin but a number”

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

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

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

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

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

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

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

WHY DID THIS HAPPEN?

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

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

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

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