Frustration Level 4 Gazillion
Another trip to the Dr. and I come home with increased frustration instead of a sense of direction in my treatment. For those of you who aren't aware of the situation I will start with a bit of recent history, then a bit of the long story, followed by current treatment plan; the root of my frustration.
The Recent History
Fri 3/2/12 @ 7 PM - Sitting at my laptop trying to do a vitrual Win 8 install on my laptop. Looking forward to some yard work during the coming weekend but nothing too strenuous. I am busy working on the machine configuration when a good bout of arrhythmia starts. It just flub-a-dooped in out of nowhere like it always does when it starts up. It decides to be a bit persistant and bothersome so I give up on working on the computer and head to the couch to lay down and watch a little TV, after all this is far from the first time I have been in arrythmia. I plan on riding it out and any distraction helps get through this.
Fri 3/2/12 @ 7:30ish - My wife gets home from work and sees me lying on the couch with the TV on. She is a bit worried because this is far from my normal position around the house, unless I am fighting off a cold or fever. She asks how I am feeling. I tell her I am having one of my tachyarrythmias again, and I should be better in a while. I am now curled up in what for all intents and purposes is a fetal position on the couch. I need to go urinate. I gather up the strength to head to the bathroom and release my water. I get a bit dizzy on the trip there and back. I am not too concerned because sudden changes in position and walking are known to do this to me while going through a tachyarrythmia.
Fri 3/2/12 @ 8:20 - I am still on the couch trying not too move and curled up as tight as I can get, but I am trying to fight off nervous twitches in my legs and arms because it feels like I am going to explode. I have to go to the bathroom again and I am going to need to move. I resolve myself to going to the restroom. and get up off the couch. I head to the bathroom which is only 20 feet away and before I get all the way there I am having some heavy dizziness and tingling. I manage to take care of business and head back to the couch under pretty steady dizziness. I get back down on the couch and a couple of minutes later cold sweats hit, my chest is pretty tight and it is hard to get a breath, or the ones I am getting in don't seem to be working. I decide to call 911, so I tell my wife we need to call 911. After all, my Dr told me if I have an attack of this magnitude I need to call 911 and quit trying to ride it out.
Fri 3/2/12 @ 8:30ish - Fire response arrives, and my wife is on the phone with the 911 dispatcher. These folks are supremely underappreciated so take the time to thank them when you see them (this ends my sermon on this subject). My wife followed the directions of the dispatcher to the letter and we were ready for the firefighters when they got here;followed soon by the Medic team. If you have ever had to chew four low dose asprins when you are thirsty you'll know what a tribulation that was. If not, let me try to compare it to swallowing a mouthful of desert. I asked if it was okay to have a drink of water too, as my tounge was shriveling at this point. I got a mouthful, it was the best mouthful of water I'd had in ages. The firefighters came in with an armload of cases and equipment. I was on a monitor in nothing flat. They looked at the screen and started asking a ton of medical history questions. I look over at the monitor and my BPM is fluxuating from the low to the high 200's. Okay, that is not too good I am thinking to myself. My wife is now able to hang up from the dispatcher as the first responders are here. In come the Medic unit, and I take the time to be impressed. They disconnect the first responders equipment and I go on a better monitor, IV is now prepped and hung, and I am on oxygen. I am still well over 200 on BPM, but I am feeling better just watching these guys go to work. They get instructions from the local Dr in charge via telephone to add some medication to the IV feed. I am going to get hit with 6 of something. The paramedic fellow tells me I may feel a bit of pressure from this. He hits me with the dose, I notice a little bit of tightness, but nothing much. Nothing happens... followed by more of the same. The person on the phone tells them to double the dose. So they tell me that they are going to hit me with 12 of something, and to be prepared for the tightness again. They hit me with the 12, again I feel some tightness but it abates fairly fast too. Nothing happens, and then a moment or two later the BPM drops to the 150 range. I am already starting to feel a bit better. Time for transport. I get on to the stretcher and get moved off for the next phase of the evening.
3/2/12 @ 9:30 - I am now in the ER at the local hospital, it's about a 10 minute ride from my house. The Dr is letting me know that my heart rate is fluxuating between 90-150 willy nilly. There is Atrial Fibrillation occuring; She needs to call my health care provider at this point. They have me on oxygen, a vital sign monitor and IV. My health care/insurance provider tells them I need to be transported to their facility which is a 45 minutes drive away. About this time my wife arrives to the local hospital and gets to sit with me while we wait to find out what is next. An ambulance arrives a bit later to pick me up, my wife is going to drive to the hospital in the car so we have a way home when this is over. This is where I am getting tired of bathroom troubles, because I had to get rid of water again twice in the last bit. The drive was uneventful, but the guy in the back with me was a firefighter/paramedic. So we had a nice conversation during the transport. He was fascinated by my monitor and the fibrillation he was watching. He also felt good enough about his knowledge to answer questions when I could come up with one, but I am kind of tired at the moment.
3/2/12 @11:30 - I arrive at the hospital I am actually going to be admitted to. The people here seem to be wonderful, except I have been admitted to the cardiac ward. This is now begining to get a bit surreal. The care I get on admission is great, they move my IV over to a better place. They hit me with some potassium, another injection of blood thinners to my stomach on the opposite side of my first injection ( a detail I left out of the previous stage). Those injections burn pretty good, but only for a moment. They do that for stroke prevention in arrythmias. I would like to note that now I am on a wireless cardiac monitor, I no longer have to be disconnected to go to the bathroom! Such freedom! I now get to eat, well okay maybe in an hour or so. I missed having dinner earlier, as I was engaged at the time.
3/3/12 @ 2:00 - My health coverage Dr arrives. She seems to be a nice lady and familiar with arrhythmia. She says that I am still definately in Atrial Fibrillation at this moment and wants to start an IV titration to get me to convert. I agree with this strategy as I do not really know if I was in a subgrade Afib previous to this point. We begin the titration, and I get a turkey sandwich to curb my hunger. IV titration is a gradual altering of dosage levels to achieve a desired effect. It is time weighted. I get told I will have an echocardiogram the following day. I try to get some sleep, my wife is up here with me and we are telling jokes and watching bad television until we snooze a bit. The nurse comes in and checks on me hourly...arrrgh! She needs to talk to me every time she checks on me. Maybe a stroke test, maybe she just needs to chart it. I answer her every time. I just hope my wife who is in the chair stays asleep.
3/3/12 @ 6:30 My wife and I both give up on more sleep today. The hospital is awakening and the noise levels begin to increase. I look at the menu, and show it to my wife. She decides to eat elsewhere. I don't blame her, and order my own breakfast anyway. I, at least was on an unrestricted diet, which means bacon is still available. I took pity on my co-residents and did not order it. I did have cofee as it is not a localized trigger for my problem. I converted at around 7:30ish, I didn't notice it. The nurse had to tell me. I was still feeling a bit odd, if you know what I mean. I had to wait for a while to see the attending before any decision could be made, and at this point I was still expecting an echo. My nurse had to tell me about the echo when I asked her; The Dr forgot to put STAT on the order, it is Saturday and there are not any imaging folks to do that order. You will have to reschedule with your provider...
3/3/12 @ 12:30 - I have been sitting in a hospital bed for the last 4 hours waiting to be released. There are no treatment plans or diagnostics that require me to be here. Thank the lord they charge by the day and not the hour. My Dr finally gets time to swing by. He pretty much says the following: " Hey! this Atrial Fib is hard to catch. There's alot of treatment options, but I can't make a recommendation here. You are free to go. There will be some follow up exams.
3/12/12 @8:00 - Echocardiogram - Doppler Echo. 40 minutes on the machine. Good images.
The Brief History
I have been chasing this down for 43 years now. Does that seem like a long time to you? I does to me. I had thyroid problems as a very young person. I was in 3rd grade at school. I was exteremely hyper, this is a known cause for arrhythmia. We treated it for many years. We eventually ablated the thyroid gland. I am on supplements and my thyroid levels are well controlled. I was also observed in arrhythmia by my mother at a young age. If I didn't have a shirt on, you could see my arrythmia occuring from across the room. My eondocrinologist guessed it was PAT ( paroxysmal atrial tachycardia). No EKG evidence. Later on in life I was involuntarily removed from Naval service due to an event? on a Holter monitor. I have been on Inderal, Quinidine Gluconate, Digoxin, Atenolol and probably a few very short term meds. My diagnosis progressed to the indefinate SVT later on. Holters and Event monitors are not very good at paroxysmal things. After my first ride to the ER with EKG traces and whatnot I thought I would be in the clear. After all for two weeks, up until today I thought the diagnosis was Atrial Fibrillation.
The Follow up
Today I walk in to the follow up appointment from the echocardiogram. I have never seen this Dr before. We go over the event that put me in ER. We discuss previous events of this magnitude. We also discuss history of little events. My Echo looks good. Overall mechanical heart is healthy. That is good news. We discuss treatment options and he is leaning towards an EP consult. I am pretty much in line with his opinion. He needs to go make a call before final recommendations. We have talked about A-Fib, Pill in Box, Anti-Arrythmics and prognosis. This has been a 30 minute talk so far. He leaves the exam room and then comes back in. Things have changed a little bit since he left. Now, apparantly there is not enough data for a firm diagnosis. I am a bit miffed here. They have hours of me in afib from 150-90 and back. They had me on an IV drip during this to check reaction. They know I converted. They are now not sure if it is Afib due to the high BPM of the initail phase of the episode. The numbers don't fit. But they don't have an alternative diagnosis except for the General Disrrythmia diagnosis. The EP consult is not in the future unless they can come up with more data? My treatment has been altered to add 50 mg Atenolol in the moring along with 100 at night. Stay on apsirin. Oh yeah, call 911 again next time it happens. Ummm?...really? Is this where I need to be? Any ideas?
The Recent History
Fri 3/2/12 @ 7 PM - Sitting at my laptop trying to do a vitrual Win 8 install on my laptop. Looking forward to some yard work during the coming weekend but nothing too strenuous. I am busy working on the machine configuration when a good bout of arrhythmia starts. It just flub-a-dooped in out of nowhere like it always does when it starts up. It decides to be a bit persistant and bothersome so I give up on working on the computer and head to the couch to lay down and watch a little TV, after all this is far from the first time I have been in arrythmia. I plan on riding it out and any distraction helps get through this.
Fri 3/2/12 @ 7:30ish - My wife gets home from work and sees me lying on the couch with the TV on. She is a bit worried because this is far from my normal position around the house, unless I am fighting off a cold or fever. She asks how I am feeling. I tell her I am having one of my tachyarrythmias again, and I should be better in a while. I am now curled up in what for all intents and purposes is a fetal position on the couch. I need to go urinate. I gather up the strength to head to the bathroom and release my water. I get a bit dizzy on the trip there and back. I am not too concerned because sudden changes in position and walking are known to do this to me while going through a tachyarrythmia.
Fri 3/2/12 @ 8:20 - I am still on the couch trying not too move and curled up as tight as I can get, but I am trying to fight off nervous twitches in my legs and arms because it feels like I am going to explode. I have to go to the bathroom again and I am going to need to move. I resolve myself to going to the restroom. and get up off the couch. I head to the bathroom which is only 20 feet away and before I get all the way there I am having some heavy dizziness and tingling. I manage to take care of business and head back to the couch under pretty steady dizziness. I get back down on the couch and a couple of minutes later cold sweats hit, my chest is pretty tight and it is hard to get a breath, or the ones I am getting in don't seem to be working. I decide to call 911, so I tell my wife we need to call 911. After all, my Dr told me if I have an attack of this magnitude I need to call 911 and quit trying to ride it out.
Fri 3/2/12 @ 8:30ish - Fire response arrives, and my wife is on the phone with the 911 dispatcher. These folks are supremely underappreciated so take the time to thank them when you see them (this ends my sermon on this subject). My wife followed the directions of the dispatcher to the letter and we were ready for the firefighters when they got here;followed soon by the Medic team. If you have ever had to chew four low dose asprins when you are thirsty you'll know what a tribulation that was. If not, let me try to compare it to swallowing a mouthful of desert. I asked if it was okay to have a drink of water too, as my tounge was shriveling at this point. I got a mouthful, it was the best mouthful of water I'd had in ages. The firefighters came in with an armload of cases and equipment. I was on a monitor in nothing flat. They looked at the screen and started asking a ton of medical history questions. I look over at the monitor and my BPM is fluxuating from the low to the high 200's. Okay, that is not too good I am thinking to myself. My wife is now able to hang up from the dispatcher as the first responders are here. In come the Medic unit, and I take the time to be impressed. They disconnect the first responders equipment and I go on a better monitor, IV is now prepped and hung, and I am on oxygen. I am still well over 200 on BPM, but I am feeling better just watching these guys go to work. They get instructions from the local Dr in charge via telephone to add some medication to the IV feed. I am going to get hit with 6 of something. The paramedic fellow tells me I may feel a bit of pressure from this. He hits me with the dose, I notice a little bit of tightness, but nothing much. Nothing happens... followed by more of the same. The person on the phone tells them to double the dose. So they tell me that they are going to hit me with 12 of something, and to be prepared for the tightness again. They hit me with the 12, again I feel some tightness but it abates fairly fast too. Nothing happens, and then a moment or two later the BPM drops to the 150 range. I am already starting to feel a bit better. Time for transport. I get on to the stretcher and get moved off for the next phase of the evening.
3/2/12 @ 9:30 - I am now in the ER at the local hospital, it's about a 10 minute ride from my house. The Dr is letting me know that my heart rate is fluxuating between 90-150 willy nilly. There is Atrial Fibrillation occuring; She needs to call my health care provider at this point. They have me on oxygen, a vital sign monitor and IV. My health care/insurance provider tells them I need to be transported to their facility which is a 45 minutes drive away. About this time my wife arrives to the local hospital and gets to sit with me while we wait to find out what is next. An ambulance arrives a bit later to pick me up, my wife is going to drive to the hospital in the car so we have a way home when this is over. This is where I am getting tired of bathroom troubles, because I had to get rid of water again twice in the last bit. The drive was uneventful, but the guy in the back with me was a firefighter/paramedic. So we had a nice conversation during the transport. He was fascinated by my monitor and the fibrillation he was watching. He also felt good enough about his knowledge to answer questions when I could come up with one, but I am kind of tired at the moment.
3/2/12 @11:30 - I arrive at the hospital I am actually going to be admitted to. The people here seem to be wonderful, except I have been admitted to the cardiac ward. This is now begining to get a bit surreal. The care I get on admission is great, they move my IV over to a better place. They hit me with some potassium, another injection of blood thinners to my stomach on the opposite side of my first injection ( a detail I left out of the previous stage). Those injections burn pretty good, but only for a moment. They do that for stroke prevention in arrythmias. I would like to note that now I am on a wireless cardiac monitor, I no longer have to be disconnected to go to the bathroom! Such freedom! I now get to eat, well okay maybe in an hour or so. I missed having dinner earlier, as I was engaged at the time.
3/3/12 @ 2:00 - My health coverage Dr arrives. She seems to be a nice lady and familiar with arrhythmia. She says that I am still definately in Atrial Fibrillation at this moment and wants to start an IV titration to get me to convert. I agree with this strategy as I do not really know if I was in a subgrade Afib previous to this point. We begin the titration, and I get a turkey sandwich to curb my hunger. IV titration is a gradual altering of dosage levels to achieve a desired effect. It is time weighted. I get told I will have an echocardiogram the following day. I try to get some sleep, my wife is up here with me and we are telling jokes and watching bad television until we snooze a bit. The nurse comes in and checks on me hourly...arrrgh! She needs to talk to me every time she checks on me. Maybe a stroke test, maybe she just needs to chart it. I answer her every time. I just hope my wife who is in the chair stays asleep.
3/3/12 @ 6:30 My wife and I both give up on more sleep today. The hospital is awakening and the noise levels begin to increase. I look at the menu, and show it to my wife. She decides to eat elsewhere. I don't blame her, and order my own breakfast anyway. I, at least was on an unrestricted diet, which means bacon is still available. I took pity on my co-residents and did not order it. I did have cofee as it is not a localized trigger for my problem. I converted at around 7:30ish, I didn't notice it. The nurse had to tell me. I was still feeling a bit odd, if you know what I mean. I had to wait for a while to see the attending before any decision could be made, and at this point I was still expecting an echo. My nurse had to tell me about the echo when I asked her; The Dr forgot to put STAT on the order, it is Saturday and there are not any imaging folks to do that order. You will have to reschedule with your provider...
3/3/12 @ 12:30 - I have been sitting in a hospital bed for the last 4 hours waiting to be released. There are no treatment plans or diagnostics that require me to be here. Thank the lord they charge by the day and not the hour. My Dr finally gets time to swing by. He pretty much says the following: " Hey! this Atrial Fib is hard to catch. There's alot of treatment options, but I can't make a recommendation here. You are free to go. There will be some follow up exams.
3/12/12 @8:00 - Echocardiogram - Doppler Echo. 40 minutes on the machine. Good images.
The Brief History
I have been chasing this down for 43 years now. Does that seem like a long time to you? I does to me. I had thyroid problems as a very young person. I was in 3rd grade at school. I was exteremely hyper, this is a known cause for arrhythmia. We treated it for many years. We eventually ablated the thyroid gland. I am on supplements and my thyroid levels are well controlled. I was also observed in arrhythmia by my mother at a young age. If I didn't have a shirt on, you could see my arrythmia occuring from across the room. My eondocrinologist guessed it was PAT ( paroxysmal atrial tachycardia). No EKG evidence. Later on in life I was involuntarily removed from Naval service due to an event? on a Holter monitor. I have been on Inderal, Quinidine Gluconate, Digoxin, Atenolol and probably a few very short term meds. My diagnosis progressed to the indefinate SVT later on. Holters and Event monitors are not very good at paroxysmal things. After my first ride to the ER with EKG traces and whatnot I thought I would be in the clear. After all for two weeks, up until today I thought the diagnosis was Atrial Fibrillation.
The Follow up
Today I walk in to the follow up appointment from the echocardiogram. I have never seen this Dr before. We go over the event that put me in ER. We discuss previous events of this magnitude. We also discuss history of little events. My Echo looks good. Overall mechanical heart is healthy. That is good news. We discuss treatment options and he is leaning towards an EP consult. I am pretty much in line with his opinion. He needs to go make a call before final recommendations. We have talked about A-Fib, Pill in Box, Anti-Arrythmics and prognosis. This has been a 30 minute talk so far. He leaves the exam room and then comes back in. Things have changed a little bit since he left. Now, apparantly there is not enough data for a firm diagnosis. I am a bit miffed here. They have hours of me in afib from 150-90 and back. They had me on an IV drip during this to check reaction. They know I converted. They are now not sure if it is Afib due to the high BPM of the initail phase of the episode. The numbers don't fit. But they don't have an alternative diagnosis except for the General Disrrythmia diagnosis. The EP consult is not in the future unless they can come up with more data? My treatment has been altered to add 50 mg Atenolol in the moring along with 100 at night. Stay on apsirin. Oh yeah, call 911 again next time it happens. Ummm?...really? Is this where I need to be? Any ideas?
Replies
wow, You have been through a lot!!!!