Fixing the Pump… 2eme Etape: Focusing, Fidgeting, and Fiats

Last we left off, the process of a simple cardio ablation was covered and although it’s an amazing procedure pioneered in the last 20 years or so, it really is a simple procedure for the patient. If you’re reading this blog and fretting about your first ablation, don’t be. You’ll be up and at ’em in no time. This post will focus on what happens after the surgery and you get up and at ’em, but you heart is still “broken”.

I had heard it was possible to experience arrhythmia shortly after and ablation. After all, it’s not used to being burned from the inside. I took it very easy after the ablation, but did a short hike with the Mrs. & the puppy about 5 days later (I got dropped). About 10 days after the surgery I tried riding the bike indoors with my Tacx Genius. After 1 minute 50 seconds I went into full V-Tach with my heart rate skyrocketing over 210bpm. A few days later I tried again, this time lasting about 4 minutes into the San Sebastian ride before I went from 120bpm to 210bpm. I stopped immediately , put away the trainer, took a shower, got dressed, and did some work on the computer but I was still in V-Tach around 220bpm for 90 minutes.
Tacx Session
After this episode, I decided to try the beta-blocker my doctor prescribed as a preventive. I tried the trainer again and actually got a full 2hr+ ride in. However, no matter how hard I pushed, my heart rate was usually around 100bpm and if I really suffered I could get it up to around 120bmp. I ended the trainer session not from fatigue or demotivation but from bordom. Even though my wattage was fine, the subdued heart rate also subdued all those great hormones that make you feel good about exercising. Turning the pedals never felt like such pointless work.

Still thankful that I can remain active I tried riding the Tacx trainer again on beta-blockers. The result was the same but I was prepared for the sensation. I struggled to hit 100bpm. Then suddenly I went into V-Tach at 210bpm… while on beta-blockers! It’s my opinion that all good things in life happen between 100 and 200bpm so skipping over the good stuff is… well… again pointless. So I stopped taking beta blockers. They didn’t stop the V-Tach, and without them I could at least ride for a small amount time in a normal HR range.

The second ablation was approaching in late February, about 14 weeks after the first ablation. The cardiologist cited that the combination of being conservative and discovering that my “athlete heart” was a little larger than he assumed meant that he would be a bit more aggressive and informed this time around. I learned a few tricks after the first ablation as well. I had no problems with the incision on my right leg and felt fine throughout… except for one thing. The worst part for me was the urinary catheter. As soon as I woke up I was wide-eye and beging for it’s removal. I learned that lesson and tried to be a dehydrated as possible going into the procedure this time. Wise? Healthy? Probably not. But they do tell you not to eat or drink after 7pm the night before anyway, so whats a few more hours of fluid abstinence? The other improvement on the second procedure was that my cardiologist learned the nuances of my arteries. Apparently, he struggled during the first procedure to enter the artery in my right leg because it was so small (sounds bad right?, but I guess it’s typical with younger folks and active people and probably isn’t bad) and the second challenge was that the artery and surrounding area was constricted by the large amount of muscle mass in the upper thigh (Sartorius and most likely the Abductor Logus) The incision point was quite swollen and bruised after the first surgery as a result.leg-presses

For the second surgery, I arrived promptly at 5:30am and by 7:30am I was checked in, changed up, vitals checked, and transported to the cardiology waiting room. This is an interesting room at 7:30am because it’s a line-up of “Who’s Who” for heart operations during that day. In this hospital, there were about 7 bays occupied out of 8 total and the room was buzzing with interns, nurses, and other staff in the medical hierarchy that I’m not familiar. “Buzzing” is the right word because at 7:30am, they just got in no less than 30 minutes ago and have plenty of caffeine in their systems. I think I counted 30 blue-robed staff people for the 7 of us with busted hearts waiting for our mechanics. Who doesn’t have caffeine in their system? Me for one. Nor anything else. I was getting sleepy on the gurney in the cold room. I was the first arrival and got plenty of attention but once a nurse who was doing either paperwork or vitals said “You might want to take a nap, I’ve never seen a cardiologist get in here before 8:30am”. I had only slept a few hours the night before so the proposition was intriguing, but not congruent with my “let’s do it!” inner voice. I counted ceiling tiles.

My cardiologist is a really great guy and a fantastic doctor who had a few tricks up his sleeve for the second time around. He upgraded our OR to a different lab with different equipment and different computers. It was apparent when two new nurses (one with some experience teaching the other) how to administer the stickers on my chest. The stickers are for the mapping process and software to capture a real-time 3D view of the heart. During the first procedure I had 4 or 5 stickers, each about the size of a hand on my chest. This time… mega-stickers! There wasn’t a centimeter on my chest that didn’t say “3M”. #Sponsored. The larger stickers were used on the new upgraded OR mapping system. Things were different this time around.

I was then introduced to the young anesthesiologist with a southern twang and her side-kick as well as a half a dozen other nurses and technicians. I was losing track of names and even the count of the number of people that I was introduced to. At around 7:45am, my cardiologists arrives and extends a handshake. He’s outdoing himself by 45 minutes according to the pessimistic nurse but I expected him about now. We chatted for a while and then it was game time. I was wheeled out of the bullpen and on the way to the big show… and that’s all I know.

I awoke at around 3:30pm. My first thought… urinary catheter… none! Success!! Well, I did my little part anyway. Even after being awake for 30 seconds, I feel completely fine and together. Then I notice a projectile coming my way! My mom is sitting next to me and immediately thrusts a phone in my face after dialing a number. I put my ear to it. It’s ringing. My wife answers. In the conversation I say it’s done, I’m fine, feel ok and I’ll Skype her later when I get into my room. At least that’s what I think the phone call was about because 1 hour later I don’t remember talking to my wife. #Anesthesia

The incision on my upper thigh which they used to gain access into the heart was much better than before. It was clear that the cardiologist had adapted to my “weird” legs and arteries. To this date, he’s the only one who’s ever used the words “large amount of muscular mass” when referring to my legs.

I’m roomed in the cardio ward with another gentleman, about 82 years old. I have trouble sleeping just like the first stay but this time I brought earplugs and asked for some weak over-the-counter sleep aid (such as Tylenol PM). Still restless, I struggle with the IV in both my elbows, impeding on my slumber-style. Just when I start to doze off, a crash-cart rumbles into the room to take vitals on my roommate. Every 45 minutes. Finally, around 4am, I fall into the ..best …sleep ….ever.

1 minute later, I awake immediately with a jolt! My whole body is shaking… because the nurse is shaking me!
Nurse: “Are you OK?”
Me with bleary-eyes: “Yes… ahh, … yeah.. sleeping. That’s all.”
Nurse sounding very alert: “Well we noticed your heart rate was very low!” She starts to take vitals from the familiar crash cart.
Me: “Oh?”
Nurse: “Yes, 41”
Me: [raised eyebrow]
Nurse: “And.. it just went even lower to 37!”
Me: “Yup. 41 is normal, I’ve never taken my pulse sleeping but 37 doesn’t seem far off”
Nurse: “Oh…. Ok, we’ll keep watching it then.”

I never did get back to sleep fully.
Breakfast came around 7am and I felt fantastic. It was like I had been driving around a beat-up old Fiat and someone decided to upgrade the engine to a Lamborghini overnight. Everything was smooth! I didn’t realize how run-down I felt the past 2 years until that morning. My cardiologist arrived and said the procedure was long (about 7hrs) but at the very end they tried to stress my heart into V-Tach by pumping me with adrenaline for 45 minutes (that’s much longer than they usually do) and it worked perfectly.
However, as we know from before, the truth with cardiac ablations is not fully known until the weeks after.

We shook hands and I went home. Zoom, Zoom!

The next day, I was a Fiat.

Up next, 3eme Etape…

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