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MEDICAL: Our Story So Far

You may recall that I had an unexpected visit and stay in the hospital back in February, and since then have only on the rare occasion vague-booked about that and follow-up medical news. Well, it’s time for me to rectify that and spin the whole tale for those who are interested to know it. (Okay, it won’t be the WHOLE tale. I mean it’s my private medical information, but I don’t mind sharing the top-level details with the world. Still, be warned—even the “top-level details” are long, meandering, and have the occasional bit of blood and medical ickiness in them.)

IT ALL STARTED ON VALENTINE’S DAY
Actually, it was February 12th, but close enough. I wound up with a cut that was not closing up as quickly as I’d have liked, so I had some friends take me to the emergency room. By the time the doctors saw me, the wound had stopped bleeding and wasn’t so bad that it required stitches or other treatment, so I thought I was just going to be discharged. That’s when the doctor inquired about my elevated heart rate. I figured it was just a combination of adrenalin from the excitement and nerves from being in the hospital, but after sitting calmly for a bit, it didn’t go down. Indeed, after administration of a heart-slowing medicine it STILL didn’t go down, so I got to stay overnight.

After many tests, various different drugs, and TWO nights in the hospital, it was determined that I had nothing worse (nor better) than atrial fibrillation (a-fib for short). They prescribed some meds and arranged an appointment with a cardiologist (in 4 weeks, telling me that any danger this posed to me was at least not immediate). They also told me that my bloodwork indicated that I was diabetic, so they prescribed some more meds and arranged an appointment with my primary care physician. And then they turned me loose.

FIRST: THE DIABETES
Look, I’m middle-aged and fat. Diabetes has been on the warning track for me for years, so this didn’t come as a complete shock. But looking at the numbers, it seems as though I just barely wandered into the diabetic camp because my A1C was 0.2 over the trigger level, and that trigger level was what we game designers call a “derived stat.” That is, it isn’t a single value for everyone, it’s determined by a combination of other factors—in this case, age, weight, and some lifestyle factors. But if I were ten years younger, or fifty pounds lighter, I wouldn’t have been diagnosed as diabetic.

Anyway, I met with the doctor, discussed my diet (which was already pretty close to what they recommended) and my eating habits (my big sin was only eating two meals a day rather than three), and got set up with a daily regimen to test my blood sugar and increase my exercise, even slightly.

From the start, my glucose was not only in the “below danger” range, it was in the “damn, that’s right where we want it to be” range. And after three months my A1C (which is a measure of average blood sugar for the past three months) was back well below the trigger level. So if my readings were like that in February, I’d never have been diagnosed as diabetic. But they were, and the funny thing about diabetes is that once you’ve been diagnosed, there’s no “undoing” it. You’re always going to be considered diabetic, you just may be managing it well.

So that’s where I am now. Managing it well. Of course, to be fair, I probably WOULDN’T have made the few crucial adjustments that were necessary to get me here without that initial diagnosis. And most of all, I definitely wouldn’t have lost the 20+ lbs. I’ve done if not for those few crucial adjustments. So overall I’d say that this diabetes diagnosis has actually been really GOOD for me.

Still, it feels weird to realize that if I was starting from scratch, I wouldn’t be in the “got it” box, but since I AM in the “got it” box I’ll never get out no matter what my blood readings are.

MEANWHILE, BACK AT THE HEART OF THE MATTER
After a follow-up EKG and other little in-office tests, the cardiologist told me that he’d HOPED that my heart would have gone back into normal sinus rhythm on its own. It seems that a-fib is super common, though for reasons no one has really pinned down. About 30% of people will have an encounter with it at some point in their lives, and most don’t need more than short term medication to set things right. I was not one of these people. My heart seemed to LIKE beating twice as fast as it should, and wasn’t going to give it up without a fight. Also, tests revealed that on top of the a-fib I also had an atrial flutter (an arrhythmia which, in fact might, might be the cause of the a-fib in the first place). It was explained to me that these were basically electrical problems within my heart—some nerves in there were sending false signals and causing the heart to beat in non-ideal ways.

The cardiologist put me on a couple of different beta-blockers and a blood thinner, because while the a-fib itself wasn’t likely to cause any immediate problems to my heart, it would cause blood to occasionally pool in my heart. This can have the unfortunate side effect of creating clots that my heart would eventually shoot out and straight into my brain, which is the classic description of a stroke. So I’ve been going to the anti-coagulation clinic once a week just to make sure that they’re keeping my blood in that Goldilocks-style just-right thickness where it won’t clot in my heart but it also won’t cause massive nosebleeds, bruising, and other hematological unpleasantness.

He also scheduled the first surgical procedure to try to fix this—a cardioversion.

SHOCK TO THE HEART AND YOU’RE TO BLAME!
(Yeah, I know I got the lyrics wrong, but it amuses me!)

Cardioversion is where they chemically slow down and technically stop your heart, then use defibrillators to start it again. Basically, it’s the “did you try turning it off and turning it on again?” procedure. The theory is that when you restart the heart it will automatically go to its “factory setting,” and the hope is that it will stay there for a while—perhaps for good. The procedure takes about five minutes to perform.

I had my cardioversion in early May, and it did indeed get my heart back beating in a normal, no flutter, sinus rhythm at the appropriate rate. However, that didn’t last, and overnight my heart went back to its a-fib and a-flutter.

HOW CAN YOU MEND A BROKEN HEART?
At a follow-up meeting with the cardiologist, we started talking seriously about the next procedure—cardiac-ablation. There are, it was explained to me, two main types of this—one to target the flutter, and one to target the a-fib. Both are essentially the same thing—sticking two catheters up a vein and into the heart, then using them to burn out the nerves that are misfiring. In a flutter ablation, this is generally one little patch (often in the right atrium). In an a-fib ablation (also called a pulmonary vein isolation), it is several larger patches where the pulmonary veins enter the left atrium. The flutter ablation is an out-patient procedure that takes about four hours to perform. The a-fib ablation takes a little longer and requires and overnight stay in the hospital for observation.

I FIX BROKEN HEARTS, I’M YOUR HANDYMAN
So that pretty much brings everything up to date. I have a flutter ablation scheduled for mid-June. The hope is that it will at least resolve the atrial flutter (which apparently is the more dangerous of the two conditions) and either ALSO correct the a-fib as a side effect, or make the a-fib easier to control with meds. In the meanwhile, I’m still going to the anti-coagulation clinic once a week (which is okay, because those folks are very nice).

Now that I’ve gone to the trouble to write all this down, I’ll be more likely to post updates, since those will be quick and easy with the big background story already written.

I’m feeling fine. One of the weird things (that seems to flummox many of the doctors I talk to) is that I have no secondary symptoms from the flutter or the a-fib. I feel 100% normal, and only notice that anything’s amiss when I take my pulse (which I now do several times a day). I’ve been as active as ever, even a little more so (particularly on the day when I got in the ring to try sumo for the second time in my life . . . but that’s another story), and haven’t had anything you could call chest pain or any shortness of breath that wasn’t appropriate to my situation (fighting a sumo wrestler is SUPPOSED to leave you a little winded). So I don’t need assistance or emergency prayers or anything like that. But I will take your good thoughts and well wishes, PARTICULARLY when the procedure itself comes around in a few weeks.

One Comment

  1. Louan Minzner wrote:

    Hey Steve, thank you for sharing. It’s tough coming to terms with our health and aging issues but your honesty and awareness will make it easier all around. Your heart may have a wonky electrical system but it’s definitely in the right place I like your musical theme but thanks no thanks for giving me an ear worm yesterday but couldn’t remember the actual words—I could have looked it up but it was more fun to guess—so I was singing different variations of Shot/shock/schlock/stabbed through/to/of/in the heart. How about Doctor doctor give me the news I’ve gotta bad case of… you fill it in. Anyway, keep us posted about the date for the ablation in mid June so I can send well wishes and all that good stuff. xoxo Louan

    Saturday, June 2, 2018 at 9:05 am | Permalink

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