Blood Pressure Highs/ Catheter Ablation/The Transmitter

     The change from Ex-Forge to the new BP medicine worked out badly, and we had some real concerns about how high my blood pressure went. One evening we went to the Sibley Emergency Room after speaking with the duty doctor for my cardiology group. They found no basic problem at the hospital, but suggested checking with Dr. Vassallo about the medicine. After talking with him, I was switched back to the Ex-Forge, and I kept a careful record of my BP for a couple of weeks--and it was generally fine.
     During those two weeks we visited the doctor who specializes in catheter ablation. The upshot of that very pleasant session was the following advice: "Since you are asymptomatic--much as I love doing these operations--I cannot recommend it." This took a weight off my mind, as I had no wish to have wires threaded up from my groin and through my veins into my heart, so that they could poke around trying to find the right place to "ablate."
     St. Jude were supposed to be sending me a transmitter so that I could, from time to time, transmit to them how my pacemaker was functioning. First they sent it to the wrong address. Then, after a phone call from me, they sent it to the correct address. I had to plug it into the telephone jack--it has a splitter--and there was also a small power pack to be plugged into an electrical outlet. I stripped off my shirt, plugged in the power, held the recording device against my pacemaker, and followed the instructions as to which buttons to press. One icon lit up, showing me that the signal was going from my pacemaker to the transmitter. But the transmitting icon never lit. After a couple more tries, I phoned technical support.
The answer--they had sent me the wrong transmitter for my type of pacemaker. Which means--waiting for the replacement and then packing up the one they first sent me.

Next: Catheter Ablation?

     I saw my cardiologist on September 29, and he told me to stop the Multaq and to throw away the pills I had left. He decided to stop the ExForge--the blood pressure medicine--and to substitute Edarbi. He gave me a month's supply of the pills.
     He then explained to me a procedure called 'catheter ablation,' which he said might be particularly suited to my condition. Catheters are introduced in your groin and are pushed up the arteries (or it it veins?) into the heart. Some radio/electronic device is supposed to detect the area or spot where the fibrillation originates, and the spot can be 'ablated'--destroyed, zapped.
      I have researched this procedure and I have seen nothing that indicates under what circumstances it is called for--except when medications do not help the fibrillation, which seems to have been my case with the infamous Multaq. What eludes me is how serious is my fibrillation. In this session with my cardiologist he did get the technician who monitors pacemakers to check if I was 'in fibrillation'--and the answer was 'yes.' Which was a repeat of the result when I had the pacemaker tested at three months. On the other hand, when I check my pulse myself, it usually seems very regular.
What has concerned me since this consultation is that my blood pressure seems all over the place. Sometimes very high, and sometimes very low. I was told that the new medicine might take ten days or so to kick in, but the ten days are well past now, and the results are strange: highly variable. So much so that one evening, with readings upwards of 170 over 110, we checked with the doctor's office and the duty cardiologist suggested we go to the Emergency Room at Sibley Hospital, which confirmed a reading of 190 for the systolic. In the end, after blood and urine tests, they let me go with the message that readings above 220 over 120 were regarded as 'dangerously high,' and that I should contact my doctor about adjusting the blood pressure medicine. That was on Friday night--October 14--and since then all the readings have been on the low side. So heaven knows what is going on.
This coming Thursday, Joan and I will talk to the ablation doctor.

Multaq, Pradaxa, and Exforge...

These were the three drugs that I was prescribed before we went to England. Pradaxa is a blood thinner: Multaq is for the arrhythmia or fibrillation: Exforge for the blood pressure. Pradaxa and Multaq have to be taken twice a day, which is a nuisance because it is very easy to forget to take the evening doses.
    We went to England on June 1, and as time passed I did begin to forget that I had the pacemaker. In London we walked for miles and miles, but never very strenuously. In Wales, with Dan and Karen, we did some strenuous hikes along the coast. And in Devon we hiked the coastal path, which had a lot of steep uphills that had us both pausing for breath. I would check my heart rate, and usually it was in the range of 90 to 100 bpm.

    Here is Joan on a stretch of the South Devon coast, and you can see the up-and-down nature of the terrain. All this hiking was very encouraging, as it seemed that--heart problem or no heart problem--I was able to engage in vigourous physical activity. We returned to England on August 23--a significant date as Washington had an earth tremor, or earthquake, which lasted about 30 seconds and had everyone running out of buildings.
    Shortly after getting home I was trolling around on the Internet and did a search on Multaq. This is what came up:

    "FDA notified healthcare professionals that it is reviewing data from a clinical trial that evaluated the effects of the antiarrhythmic drug dronedarone (Multaq) in patients with permanent atrial fibrillation. The study was stopped early after the data monitoring committee found a two-fold increase in death, as well as two-fold increases in stroke and hospitalization for heart failure in patients receiving dronedarone compared to patients taking a placebo. FDA is evaluating whether and how the preliminary results of the PALLAS study apply to patients taking dronedarone for paroxysmal or persistent atrial fibrillation or atrial flutter. The PALLAS study results are considered preliminary at this time because the data have not undergone quality assurance procedures and have not been completely adjudicated. FDA will update the public when more information is available."

    I had an appointment with the pacemaker technician on Monday August 29, when he checked the operation of the pacemaker--which was working perfectly. I asked if I could see the cardiologist, and I showed him the FDA warning. I did not get the impression he had seen it before. He assured me that my fibrillation was paroxysmal and not permanent, and that the warning only applied to permanent fibrillation. The technician, who was monitoring my heart, cut in to say that I was, at that time, actually 'in fibrillation.'

    So I am left with a question mark--something like this: if X doubles the chances of death of someone whose fibrillation is 'permanent,' might there not also be a detrimental effect on patients with fibrillation that is less than permanent? And obviously the FDA think that could be the case, as they are going to evaluate what Multaq's effects are on patients with paroxysmal fibrillation.

    It was agreed I would remain on Multaq until my next appointment on September 29.

    I renewed my prescriptions: my share of the total cost was about $270. Aetna covers the rest. These drugs are expensive.

   

Change the Pills again...

     The next appointment left me feeling somewhat uneasy. Since the 'interrogation' and the change of pills, my blood pressure had been unusually high, giving rise to my earlier feeling that fixing one problem might be exacerbating another. Strangely, though, when the doctor took my blood pressure, it was very low. We did a brief EKG--amazing how quickly the nurse sticks these sensors on about ten places, switches the machine on for a minute or so, and then whips all the things off again--taking generous portions of chest hair with them. The EKG that I had on this occasion gave rise to the comment that I still have a minor amount of a-rhythmia--a finding that does not exactly cheer me up.
     The appointment led to yet another change in medicines. And that was that. "Call me from England if you have a problem. See you in three months' time."
      Tomorrow we go to England. I am keeping my fingers crossed that I will not have any further problem while we are there.

Pills, Pills, and more Pills.

     About a week ago I had two appointments--one with the cardiologist and one with a pleasant young lady--a technician from St. Jude Medical--who performed the much-heralded "interrogation." This was a non-event, totally unexciting, taking all of five minutes. I took my shirt off, and she draped a wire with some sort of sensor around the back of my neck so that it hung down over the bump of my pulse generator: sorry--I should say 'pacemaker' as you may not be one of the cognoscenti. The sensor was connected to a printer/reader device that spewed out a long roll of paper that would be reviewed by the cardiologist. "But don't expect to hear from him as I can see that everything is working perfectly," said the technician. End of interrogation, except for--"fix an appointment for a further check in three months time."
     The appointment with the cardiologist was less satisfactory as he decided to change my pill regime. In addition to the blood thinner (Pradaxa--the hugely expensive drug at $750 for three months' supply), he prescribed a beta blocker (Micardis), the function of which is not clear to me. He also changed my blood pressure medication to something called Multaq (sounds like a Taliban leader) and annoyingly it has to be taken twice a day. So now I have to take three pills first thing in the morning and two pills at night. The pill-taking is all getting to be a bit too much. Mornings are not so bad, but I do tend to forget in the evening, and sometimes before I fall asleep I suddenly remember I have not taken the required two pills. It's not so bad if we are home in the evening and I can take them with our meal; but if we go out to eat or travel it is only too easy to forget. And just the fact that I have this pill regime is a constant reminder to me that all is not well
     The cardiologist did emphasize that I should return to my usual exercise regime, and I have started to do so, getting back to my routine of treadmill, bicycle, and elliptical trainer for 40 minutes or so each morning. I cannot lift weights as my shoulder hurts if I attempt anything more than a five pound dumbbell.
     The good news is that I have begun to forget that I have the damn pacemaker, although from time to time, particularly if I raise my right arm higher than usual, I do get pain in the general area of my wound and shoulder just to remind me that it's there.
     I have also had the experience of being patted down twice at airports as I refused to go through the magnetometer. Next time, I think I'll risk it, as the patting down procedure is very elaborate. At Dulles Airport I had to wait while the expert patter down was found, by which time my jacket and shoes and the Macbook had all passed through the x-ray and were sitting there blocking the line of containers until Joan managed to scoop them up. The training for a patter downer is obviously very rigorous: put the blue rubber gloves on, explain the routine and the private parts that will be invaded, ask if you would prefer the patting down to take place in private, ask if there is any area that is sensitive, and then get to work--feeling with open hands, patting with the back of the hands, smoothing down this and that, and finally taking the gloves to a machine that presumably checks whether you have been in contact with explosives. Exactly the same routine--with exactly the same script--was followed at Santa Barbara on the return trip. I think I'll just speed through the magnetometer next week when we fly to England.
I suppose that I am coming to the end of this blog. I hope I am, although I am still somewhat anxious about my heart. First it was the fibrillation, from which, according to the cardiologists, I "got out of" naturally: my heart corrected the situation, leaving unanswered why it had fibrillated in the first place and  whether it would fibrillate again. Then it was the bradycardia--heart too slow and stopping from time to time--for which the pacemaker was installed. Now, it seems--that's it. Heart problem over and done with? Back to a well-tempered heart (?) that went up to 122 beats per minute on the bicycle and treadmill this morning. Or is there something else lurking there that has so far not been detected? One wonders.

Cutler Computer Art

An Address to the Heart...

       Over the last few weeks I have been recording, for The Library of Congress, the complete poems of W.B. Yeats, in which the heart--usually metaphorically--is often directly addressed. And, frankly, sometimes the results are quite banal, and one wonders why the winner of the Nobel prize for literature decided they were worth publishing.
Take the first verse of "A Song," for example.
    
        I thought no more was needed
       Youth to prolong
       Than  dumb-bell and foil
       To keep the body young.
       O who could have foretold
       That the heart grows old?

     The answer to the question is "well, pretty much everybody, unless they believed in eternal youth."
I quite like "dumb-bell and foil." But though W.B.Yeats might have lifted the occasional dumb-bell, I doubt that he did much fencing (the 'foil').
      You might also note that he is fairly liberal with his near rhymes ('prolong' with 'young') and doesn't worry too much about exact scansion.
       He is better in a direct address to his heart in "The Tower."
  
      What shall I do with this absurdity--
      O heart, O troubled heart--this caricature,
      Decrepit age that has been tied to me
      As to a dog's tail?

      I had a certain fellow feeling when I recorded those lines.

     Another tick he seemed to have was an addiction to long titles. Such as: "On hearing that the students of our New University have joined the Agitation against Immoral Literature." "I see Phantoms of Hatred and of the Heart's Fullness and of the Coming Emptiness.""The Poet pleads with the Elemental Powers."

    I thought: let's give it a try:

         The Poet addresses his Heart with the News that
               He has to have a Pacemaker Installed

          Old Ticker, why have you betrayed me,

          Fluttering, quivering, missing the odd beat,

          Shaking the stylus on the EKG?

          Is it revenge for my conceit,

          Feeling so fit for seventy-six?

          Did I push you too hard with the hiking and biking?

          Is that why you’re playing these cardiac tricks?

          Or was my diet not to your liking?

          Maybe it’s simply our DNA,

          Some maladjustment growing since conception,

          The genetic dice just rolled that way,

          Creating some electric misconnection.

          Possibly it’s just the wear and tear of years,

          The heartaches, strains, vicissitudes of life,

          Those disappointments and those fears and tears,

          Sorrow, regrets, omissions, anger, strife.

          But life has also been so rich

          With love and pleasure, beauty, music, art:

          These soothe the soul, but cannot stitch

          The tattered tissues of the aging heart.

          And now for shocking news, my dear Old Ticker.

          Down through our veins they’re threading wires

          To goose you into beating quicker

          To match the speed a longer life requires.

          Sorry to saddle you with this encumbrance,

          To make your pace beat faster than before.

          Consider it as life insurance,

          Covering the risk we both might suffer more.

         “Your heart will last a lifetime,” I’ve been told.

         “How true,” is all I can reply.

          You’ve been a bosom pal, a heart of gold:

          We’ll hang in there together, you and I.

          Forget the intimations of mortality,

          Just be very thankful we’re alive:

          Let’s rather focus on longevity—

          I think I’m going to shoot for ninety-five.

     It took some time to work this out, and I did reject two verses that maybe I should have kept:

                     Rejected Verses

          And now for shocking news, my dear Old Ticker.

          They’re going to make you work much faster,

          To goose you into beating quicker

          With an electronic blaster.

          Well, maybe ‘blast’ is just exaggeration.

          The voltage will be miniscule

          And only last a fleeting micro-sec’s duration,

          And with the power of just a milli-joule.

All for now. I have the interrogation appointment in a week's time. That should prompt another entry.

    

  

You'll Forget It's There...

     Two weeks into it (or IT in me), but I have not yet reached the stage of forgetting about it. Indeed, the thought that it is there is more or less constantly uppermost in my mind, or at most one layer down. And as I forget about the warnings against raising my arm and reach for a high shelf, or brush my hair, or try to dry my back after a shower, there is more than sufficient discomfort to remind me--that it's there, presumably sparking away at a rate of 60 bpm. And look at that little mound of flesh below my collar bone, which seems to move in a circular motion when I use my right arm to perform some repetitive action--cleaning my teeth, for example.
     But the reminders that IT is there go beyond that fact; they raise all sorts of worries that percolate through my mind about my heart. Is this going to fix the problem? We started with atrial fibrillation. That was to be fixed by shocking the heart back into regular rhythm. Then the diagnosis changed to heart block category two, and hence the pacemaker. But when I ask whether the atrial fibrillation problem is solved, the answer was, "probably, but we cannot be sure." Or was it--"most probably."? So there is a continuing level of anxiety, which I suppose will only go away with the passage of time and some assurance that nothing else is wrong--that the pacemaker has fixed the problems.
     Joan has suggested we need a name for the pacemaker. She draws an unlikely analogy between the pacemaker and our GPS, whose voice that guides us and bugs us ("recalculating ") we have named Agnes. I forget where that came from. We'll have to think about a name for the "device"--as the Manual insists on calling it--but perhaps we should wait until the technician interrogates it. He will probably know its name.