the thread of ATRIAL FIBBING

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

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

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

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

EIGHT HOURS LATER

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

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

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

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

> little blob of cottonwool

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

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

> elrond

elrond hubbard

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

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

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

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

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

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

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

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

“Heart rate ain’t nothin but a number”

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

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

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

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

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

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

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

WHY DID THIS HAPPEN?

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

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

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

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

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

Good luck on the 23rd!

this is all very good.

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

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

it had some key elements:

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

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

* other patients - “notable exceptions” plz.

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

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

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

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

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

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

glad you’re doing ok!

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

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

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

so next time i will :)

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

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

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

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

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

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

Glad to know you’re out, Mark!

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

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

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

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

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

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

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

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

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

"really nice steak" was definitely not on the menu

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

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

with notable exceptions the other patients were also fine

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

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

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

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

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

post-consultant update:

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

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

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

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

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

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

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

mark supplies his own armband AND jackboots iirc

gold spiked helmet

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

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

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

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

(hence posting like an mf on ilx obv)

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

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

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

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

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

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

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

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

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

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

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

what is a

-checks text from mmac-

heart echo check

and why

-double checks text from mmac-

do "they" want me to get one?

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

Echocardiogram. Dunno. But it is painless!