Trans Oesophageal Echocardiogram

I was again poorly motivated during the morning wait for the TOE.  However, most people at work and those likely to contact me were off prior to the Bank Holiday, so not too many issues to respond to.

I found myself drawn to bike radar, where a member had been taken into hospital with fast AF.  It is surprisingly popular these days.

As expected, the TOE was quite unpleasant, although forgoing the sedative meant that I was not stuck in the hospital for an extended period of time the day before a bank holiday.  I was given a new anaesthetic, only introduced to the hospital that week.  It tasted pleasantly of toothpaste rather than the horrific fake banana flavoured one used previously; I also think it was more effective.

They were down there for about 15 minutes; I kept hearing good words like sinus, but really couldn’t concentrate on exactly what was being said.  Afterwards I asked whether they had measured the left atrium (previously 37ml/m2 instead of a healthy maximum of 28).  He said they hadn’t calculated, but it was “prominent”.  They decided it was worth doing an ECG while I was there, “for completeness”.

There was no queue; I think they were winding down for the Bank Holiday.  At the end of the ECG I asked if it was normal, he hummed (positively?).  I said I expected sinus rhythm with perhaps a couple of ectopics.  He hummed again and said that really, he was not allowed to say anything.  I was a little concerned because my ECG had recently been a little wobbly after the T wave.

HR 29-03-18

The worst of it looks like this; this is not quite how it would look with flutter, but definitely not textbook flat. I wasn’t particularly worried before; I thought it may be interference, but now I am starting to get a little paranoid.

HR 29-03-18 wobbly ST

I still don’t have a date for the meeting with cardiologist, but earlier this year he said probably one of the first three Wednesdays in April.

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Blood tests

My GGT is now down to 96, which is the lowest since I first started being tested in April 2016.  Perhaps this could have been lower, but is a little elevated after the several drinks I had four days previously at a school reunion (we left school 39 years ago!).

There was talk at the reunion of the Scarlet Fever epidemic in our school and the local area.  In the fifties, before I was born, this disease had resulted in the hospitalisation of a large percentage of our village.  When I caught it in 1970, antibiotic treatment had improved significantly and it was no longer life threatening, although the outbreak caused considerable concern in the older population.   Here is a picture of me on my preferred mode of transport at the time.

001

I did a little research and Scarlet Fever does have an effect on the liver, massively raising enzyme levels.  However, they return to normal after treatment.

I am still puzzled as to the cause of the high GGT; the spike in January 2017 suggests alcohol.  However, my test result of 98 in October 2017 came after 250 days without alcohol, so possibly another cause could also be the remains of the amiodarone in my system.  This may not be borne out by the evidence as the 6th July reading of 99 was taken when the maximum amount of it was in my system.

alcohol and GGT 27-03-18

Perhaps it is the alcohol I consumed several years ago which caused the damage and has only just returned to something approaching normal.  The Doctors don’t seem particularly concerned about it and I have severely moderated my earlier habits in order to avoid the return of AF.   A watching brief remains; I have another test scheduled for September.

 

Useful blog

Afib runner

https://afibrunner.com/

I mentioned this a month ago.  I have just received a fair bit of traffic from this site, so to say thank you, I have reposted the details.

This blog is well worth a read, the author is in persistent AF and is “more or less” asymptomatic.  In addition to his personal reflections there are lots of  reports on various bits of research and other news.

Return to cardiology looming

I am not sure of when my appointment with my cardiologist will be, but it should be at some point in the first three weeks of April.  I will have a TOE (Trans-oesophageal echocardiogram) to check that the LAA closure has properly healed along with the usual ECG etc.  I suspect that this may involve two visits.

As I am now feeling much improved and have not had any AF-like symptoms since New Year’s Day, I have decided that it would be appropriate to notch up the exercise level slightly.   If it gives me a problem, it would be better to happen before my scheduled appointment rather than after.

The singlespeed is now going to be mothballed in favour of my Bianchi (winter bike fitted with mudguards) which means no more canal banks, instead, I will be back on the road.

I managed 28 miles on Saturday and 34 miles on Sunday.  I headed out east to avoid the steep hills of the Peak District and was taking it steady, with no sprinting and I was sticking to the small ring for most of the ride.  In fact, I was in the bail-out gear on some of the relatively gentle slopes, but still managed total climbs of 1800 and 2150 feet respectively.  I generally felt quite good, and progress on the flat was brilliant, but I think the hills were a struggle due to a general lack of fitness rather than heart issues.

Interestingly, I last did the Sunday route in July 2017, when I felt recovered from my first ablation.  Even though this was in nice weather with my best bike and summer clothing, I was still ½ a mile faster on average yesterday.  I think this bodes well for my future recovery.

No longer snowbound

The heavy snowfall between 27/02 and 02/03 had kept us relatively housebound, so no exercise except for a snowy walk around the woods on Saturday.  I am certainly missing the bike.

The last of the snow melted yesterday and temperatures are now a balmy seven degrees in the sunshine.  As I am now five months post-ablation and feeling pretty good, although unfit, I think I can nudge the cycling up a notch.  Nothing too ambitious, but I will get the Bianchi out for a few trips on the road; this should also keep me cleaner than the canal paths.

Slightly recovered

In the morning, I felt slightly better, but cancelled my meeting in Barnsley later in the day and in London the following day.  I managed to work from home in my small office, but downstairs was too cold for me.  It seems that the indigestion followed by flu like symptoms were fairly common locally.  I feel quite pleased, It’s not related to my AF after all.

More indigestion

It is now Sunday, eight days after the indigestion started.  If anything it is now worse than before. However I decide to attend the BC training day.  On the way back from Nottingham I called in to see my mother who is surprisingly cheerful.  Half an hour after returning home, I felt terrible; freezing and sweating at the same time, just like flu.  I went to bed very early after not eating.

Indigestion

I have been experiencing indigestion/reflux for the last week.  This should be potentially worrying to heart patients due to the symptoms: pain in the chest, particularly when breathing in, which mimic the symptoms of heart attack.  However, I recognise the feeling from a bout I had several years ago, related I think to a gall bladder infection. The feeling was similar to this and not as bad as the opiate induced reflux from last year.  A quick check on the Kardia confirmed a normal heart rate albeit with a few ectopics.

I decided this was nothing to worry about and perhaps needing to rethink my diet (too much fast food recently) if it is not gone by the end of the weekend, then I may call the arrhythmia nurse.

 

Looking back, and forward

Over the last year of treatment there have been a number of false dawns; on several occasions I received a form of treatment and declared myself so much better, sometimes almost claiming to be back to normality.  This happened after the successful cardioversion, a few weeks after the first ablation and immediately after the second.  Each time it took a short while to realise that these were just an overreaction to a slight improvement or perhaps even self-delusion.  Confusingly, the first treatment step that did not leave me feeling instantly improved was the removal of Beta Blockers which was the one thing I expected to give a magical change.

The run-up to Xmas was tiring, in spite of me using saved holidays to reduce my last month at work to a number of two- and three-day weeks.  The two and a half weeks of rest over Xmas certainly helped.  I have been feeling greatly improved since January started (with the exception of New Year’s Day) and have not regressed.

This week was my first real test.  I had a busy day in the office followed by a trip to London, which involved parking at Luton and getting the train in, arriving at the hotel in the Barbican at 8:30 p.m.   After an 8:00 a.m. start in the morning, a long intense meeting finished at 4:00 p.m., after which I returned to Luton.  I then drove to Norfolk, stopping for food on the way and arriving at 8:00 p.m.  This was followed by another 8:00 a.m. start delivering a pilot environmental course to our teaching and support staff.  I had planned a 4:00 p.m. finish, but I was not sure exactly how long the exercises and discussion would take.  It finally finished at 5:10 p.m., leaving me to tidy up and drive the 120 mile back home.  None of this was any problem, but would have nearly killed me physically and mentally two months previously.

On the bike recently, I had noticed that the small inclines on the canal were not impacting on my HR as before and my rested pulse is also starting to trend downward.  Bad weather and too much work away from home has kept me from putting my health to the test with further exercise over the last two weeks, but this time, I think that I can finally say that I am on the road to a proper recovery.  The weather is still atrocious, but I will attempt to get out for a few walks and rides, not pushing yet, but working steadily towards improvement for the summer.