Back with the Cardiologist

This was my regular six-monthly review as required for the clinical trial.  Today there were worse than usual traffic and parking problems getting to the NGH so I arrived a couple of minutes late for my X-ray.  No problem and ECG and BP were all taken before my actual appointment at 9:30 a.m.  I had a nice chat with the Arrhythmia nurse about how my recent work stresses were affecting me.   I was finally invited in to see him at 10:20 a.m.

He seemed quite happy with the ECG and X-ray.  I showed him a few Kardia readings since the last visit; he was pleased I was keeping records and said that he had just ordered twenty for the use of patients in monitoring their AF.  He said that every reading I had taken was relatively normal, except for one.

18-08-12 HR

This was taken in Florida, on a day when I had drunk a lot of coffee.  He suggested that if this happens again, I should get someone to punch me very hard in the chest and phone an ambulance.  He had previously said that coffee is not a problem, but his opinion now is that I should avoid it.

Apart from that, everything is fine and I should come back to see him in twelve months.

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220 – age

Reported on Health Unlocked

18-11-08 HU

 

https://healthunlocked.com/afassociation/posts/139119844/exercise-and-af-from-patients-day-2018

A forum member reported  that a doctor  had suggested at a conference that exercise is a good idea, but if the HR goes above 220 – your age, you should stop.

This adds to my thoughts that the medical profession has no idea how to treat athletes with AF.  Firstly, I have to assume that the doctor was considering 220-age to be Max HR, which is nonsense.  If this is the case, their advice is that a high intensity level of exercise is not a bad thing unless (until) you have an AF attack, so I should be allowed a HR up to my previously tested max HR was 187 (20 beats above the 220-age calculation).

My cardiologist suggested that I am OK to exercise hard, but had forbidden me from taking part in racing or interval training.  I have translated this to mean that I should keep my HR below 165, my previously defined aerobic limit.

165 is actually 220 minus my age, but this is entirely a coincidence.  On the plus side, either way, I am not pushing myself too hard.

Rollers

I experienced a 16 second spike in HR up to 173 during a rollers session last night.  I am not sure whether this is significant, as the HR also dropped out a couple of times.  This is potentially an issue with the sensor rather than my heartbeat, but given the other spike on the velodrome recently, I will keep it under observation.

2018-10-25 Garmin

One year post treatment

This was a post written specifically for the HealthUnlocked AF forum, https://healthunlocked.com/afassociation

I have noticed that most “cured” sufferers disappear from the forum when they no longer need the support.

18-10-02 HU

In early 2015, I was a 53-year-old club cyclist, quite fit and athletic but my performance levels had reduced from the previous couple of years.  At first, I thought I was starting to feel my age.  This gradually got worse throughout the year, until I became convinced there was something medically wrong with me.

I was diagnosed with probable AF in February 2016, which was confirmed shortly afterwards when it became persistent.  I continued in decline through the year, worsened by my bisoprolol prescription.  A cardioversion in October helped and I had an amazing recovery, but only for two to three weeks before going back into AF.

In 2017 I had a hybrid ablation; a mini-maze in April and an RF catheter ablation in October.  The first stage isolated the pulmonary veins, the ligament of Marshall, (apparently it is on the outside of the heart, no-one knows what it does but it can be a focus for AF) and blocked off the Left Atrial Appendage.  The second stage did a CTI line for flutter, completed the box lesion set on the rear atrial wall and repaired a connection breakthrough on two pulmonary veins.  Within three days I was feeling much better, after six weeks I was completely off medications.

I have been largely AF-free since a few weeks after the first ablation; with one work stress related episode in May 2017 and one alcohol related blip on New Year’s Day.  My Kardia showed many ectopics throughout the year; on average there was one or two per thirty second trace.  Until my AF became persistent, I don’t believe I had ever had an ectopic beat, and I took my pulse very regularly.

in April 2018, my Kardia decided I was having a few episodes of “Possible AF” episodes and it decided I was having another couple in early May 2018, but the traces looked fairly normal to me.  In late May, I took printouts of my dodgy readings to my 6-monthly review; my cardiologist confirmed they were not AF and nothing to worry about.

Through the summer of 2018, I had a few noisy or chaotic Kardia readings, but never for long and not accompanied by any symptoms.  The ectopics have continued but I have grown to be able to ignore them.

In August, I went to the USA on holiday, and drank excessively; 20 units in a week, (before AF, I would have considered this level to be quite restrained).  This did not appear to have any effect, but one day I had several coffees and was rewarded with a bout of some sort of arrhythmia, which was called “unclassified” by the Kardia. Abstinence brought things back to normal very quickly.

I know AF is all about management of “quality of life” and there is no cure, but I think I am now as close as I could be.  I managed to hold back from excessive exercise for months after the two procedures; I am not sure if this was really required but it did not seem worth the risk at the time. I walked and cycled throughout my recovery and have now started to cycle out in the hills with the club again.  I am still being cautious; I am taking it steady with the social group rather than my previous racing buddies, but I am enjoying it.  I still weigh two or three Kg more than I should (at 79.5Kg. my BMI is 25.1), but I was 84Kg around this time last year.

I know everyone is different, but I would say that you should not be apprehensive about ablation.  If one is offered, I would go for it, sooner rather than later; AF is a progressive condition, and I am convinced early ablation helps.

GGT approaching normal

My latest liver function test results have just come back. My GGT is the lowest since the issue was first discovered. It was 217 (against a recommended 8-61) in April 2016; this was after a period of significant alcohol use.  It dropped slowly under reduced consumption, held steady during a period of abstinence while taking amiodarone and has further reduced now I am medication-free and sticking to guidance levels of 14 units per week. At 71, it is only just outside guidance limits.

18-09-26 GGT

Sunday Club run to the hills

18-09-23 GH1

After the previous week, I was unsure whether to head out on the hilly ride with the steady green or slightly more ambitious blue.  When I arrived at the start point, there were very few riders, due to the Majorca trip, so the faster riders amalgamated into a blue ride.  I decide to stick with green, in case the pace got a little carried away.

It was a pleasant ride with two new members (actually members of Mansfield Road Club) marred only by one of them doing the slow motion clipped fall twice.  She later went to the hospital, and has to return on Wednesday for a scan. Overall quite slow, but I rode in and out and so made it a nice 45 miler.

18-09-23 green H1

Weekend rides

Saturday’s ride was intended to be a short trip out to the avenue coking plant site to try the new wetlands path.  This did not take too long so I decided to try out the Five Pits trail, which is close by.  This was good for a few miles, but then I had multiple punctures from thorns left on the trail after hedge maintenance.   While mending the second puncture, I managed to break the Presta valve off the tube with the CO2 pump.  Unfortunately this was at the furthest point from possible rescue.  I had to walk three miles back to Grassmoor.  A costly episode; I was out of pocket for an inner tube, a COpump and three cartridges and a pair of Look cleats.

18-09-15 5pt

When I returned, Strava informed me that I had a 6th and 7th overall on a couple of trail segments, which did not really make up for the experience.

Sunday’s social ride was a very gentle trip out east, so I decided to ride in again.  Unfortunately, I was the only rider expecting a green ride, so my choice was to continue solo or to join the blue ride.

Blue F2 Sep

It was a very windy day, and the first half was mainly a tailwind.  I didn’t lead the group much; I was wary that I had a long ride planned.  Finally, I arrived home after 4 hours. Fifty-nine miles with rest periods at Bolsover waiting for the start, Edwinstowe at the cafe and two unplanned stops at Whaley, first for a dropped chain and then for a puncture (not mine this time)

This was a good ride: I ached a bit, but not too much and bagged the longest ride of the year.  Checking my records later, this was the longest ride since October 2014.  My symptoms started in early 2015 (when I thought I was just getting older and lazier), and diagnosis was a year afterwards in Feb 2016.

Sunday club ride

hardwick sep 18

I have been riding quite a lot recently.  Since my return from Florida I have ridden 17 days out of 25.  I have been feeling good, my heart is behaving and I feel more like a proper cyclist again.  The above is a picture of me from the club social hilly ride.  The route was over rolling hills to the SE of Chesterfield, which I normally use for my flat road rides, with 75 ft of climbing per mile.  The route was quite short, which allowed me to ride in to the start and then back home, and still only do 43 miles.

green h2

It was quite easy, although I bailed before three out of the remaining four riders decided to add one fierce hill in at the end.

 

NHS Heart age questionnaire

The members of the HealthUnlocked AF forum were getting upset about an NHS online questionnaire.

https://healthunlocked.com/afassociation/posts/138841186/more-on-the-%E2%80%9Cheart-age%E2%80%9D-questionnaire

Apparently the majority were given a Heart Age of 95 with an imminent stroke.

heart age.png

My figures seem better than most: heart age 60 (I am 55) with stroke or heart attack at 78. Not sure why I am different, but relatively low blood pressure/cholesterol and a BMI of 25.2 could be the reason.  The two bits of advice for me are to lower BP to below 120 (currently 123) and BMI to below 25.  If I could manage this I could reduce my heart age to 59, but would still be heading for a stroke or heart attack at 78.  I am now back to regular exercise and hope to drop a few Kg, but this questionnaire seems to suggest that it is not really worth the effort.

Ten years ago, I was invited into the GP’s surgery for a medical assessment; just blood pressure and a health questionnaire. I was given a heart age then of 50; I was very disappointed, given my level of fitness, I thought that my heart age should be the same as or even less than my real age. The nurse reassured me, saying that a heart age of 50 was the lowest she had seen in a 45 year old (in that surgery; I was living in a borderline social deprivation area). Her recommendation was to continue doing exactly what I was doing at the time. Ironic, as the exercise I was doing is what caused my AF.

Ten years on, my heart age is only ten years older. Strange given the AF diagnosis, two ablations, and a year of medication including bisoprolol, amiodarone and rivaroxaban. I would have expected that kind of rough treatment to age it considerably more.

I suspect the calculations from either of those questionnaires have little basis in reality on an individual basis.

 

 

Return to club riding

This was a long overdue return to riding in a group.  I didn’t want to impose on one of the faster groups by potentially slowing them down, so I selected the “Green” social ride.  Unfortunately, only two other Green riders were out that day: Dave, who was also returning from injury and Zoe, of a local bike accessories manufacturer.  We had a steady ride around the local flatlands, with a visit to a cafe for a heart friendly bacon sandwich, and managed to hit the max average ride speed of 14 mph exactly.

group ride strava

An enjoyable day all told.  I should be back again next week.

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