Ultrarunner fighting Atrial Fibrilation (AF)

This blog has pretty much always been about running ultras, mostly Hardrock. It still is but now it is also about running after AFib. I was forced to miss Hardrock in 2011 due to the onset of AF but my long term goal was to get back to running milers. And hopefully help any other runners with AF who stumble upon this site. I never made it into Hardrock in 2012, or 2013, or 2014. I didn't have a qualifier for 2015. I ran Fatdog in Canada instead. That was tough. I finished my 4th Hardrock in 2016 and now I'm back to try for the magical number 5.

If you want the history of my AF the heart problems all started back on May 25 2011: http://howmanysleeps.blogspot.com/2011/05/out-of-hardrock.html

Tuesday, September 27, 2011

3 weeks post surgery

While they warned me I could have episodes and it would take a few weeks for my heart to settle, I was unprepared for just how crap I felt in the first 2 weeks after the ablation. I had several bouts of arrhythmia culminating in the one episode of full AF. I suffered major visual disturbances that created a shimmering blurriness around the periphery of my vision. Sometimes this spread across my line of sight and I could not read until it passed. This was transitory but very annoying. I had a growing headache through the first week which progressed to a full blown migraine one night, leaving me paralysed on the couch in the fetal position for hours. Apparently this is a known side effect of the surgery. It felt like that Mac truck kept backing up over me for good measure.

3 weeks out and I still have residual groin bruising and some tenderness in the area of the wound. My arm swelling and bruising have gone down but I still have altered sensation and get the occasional 'carpal tunnel' type pain/sensation through my wrist. And I still have dyspepsia and general heart burn type symptoms. I am blaming the medication (warfarin) for that rightly or wrongly. That is settling also, though. But importantly, week three brought a dramatic improvement in my wellbeing. I actually started to feel better despite the medication. Hy heart settled and there was no flip-flopping feeling. I could lie on my left side without inducing arrhythmia. I was back running easily a few times a week. I had more energy and a somewhat clearer head. I was getting excited that I had passed the worst and just perhaps I might have beaten this thing. Well the ablation might have beaten this thing. The Professor had told me that by week 3 I could ramp up my training back to what I was previously at. I even spent a very easy 5 hours walk/jogging on the Great Ocean Walk to remeasure some track changes. And boy did that feel good.

But a couple of days later my heart rate started misbehaving on my regular easy evening runs. It would rapidly accelerate for no reason and fall as quickly. Despite going very slow and walking to warm-up. Yesterday I had my first day back at work. I was almost supernumerary so not particularly stretched. I felt a bit fatigued but decided an easy 8km would clear my head. There was nothing easy about it. And when I got home I felt horribly nauseous. Something I hadn't experienced for a while now. I had a glass of cold soda water to help settle my stomach and I went straight into AF.

It only lasted a couple of hours but was enough to wring me right out and leave me more than a little disappointed. I guess I haven't beaten it yet.

Put HR monitor on and this is me sitting on the couch, not hard to guess when I came out of AF?

Wednesday, September 14, 2011

Pulmonary Vein Isolation Ablation

The anaesthetist said to me while I lay flat on my back: 'there are a lot of things that could go wrong, but you could also get hit by a Mac truck. We don't have any Mac trucks around here so you should be OK'. I woke up after 5 hours of surgery and was looking for the Mac truck that had hit me. Remembering that one of my primary motivators in chronicling this illness and subsequent treatment options is to benefit others who might suffer the same affliction, I will not sugar coat my experience. I wrote this soon after getting home and have had time to since reflect on it all.

Simply put it was pretty horrible. Of course I know nothing of what went on while I was under. And all the staff who attended me, from the meals lady to my cleaner to the many nurses and all the way through to my surgeon and his assistant I could not fault my treatment or care. But the pain and discomfort was not fun. In retrospect I should have asked for pain relief on the first night. And some anaesthesia for the lady sharing my room who ensured that any chance I had of sleeping was totally gone. Her hourly trips to the toilet shuffling noisily past my bed, slamming the door into my curtain rail, endlessly dropping her bed remote-control and swearing at the top of her voice, the unbelievable flatulence (both in episodes and loudness), the spontaneous loud groaning and cursing that scared the life out of me in the dead of night, flicking lights and the TV on and off and the list goes on and didn't stop until 5am. I forgave her the constant raking, chest-rattling cough as she was denied access to cigarettes and that clearly irritated her airways. Mind you every time she startled me with an outburst or loud noise either organic or mechanical I would flinch. This flinching would set off pain receptors in multiple sites which to do justice I need to cite: my chest (incredibly sore from the actual ablation kind of like a horse had kicked me), my throat (incredibly sore from the probe/scope and airway that had been down there), my abdominal muscles (painful from the clexane injection directly into my tummy), my elbow (where the cannula remained in case needed and was digging into me mercilessly), my groin (very sore from the puncture site and subsequent pushing and pulling through the small hole and now with a full body clamp squeezing into it to stop the persistent leaking), my back, buttocks and my heels (I had been lying flat on my back in the same position for many, many hours to stop the bleeding and I had pressure pain like never before), the end of my penis (majorly inflamed from the catheter that had been pushed up there to drain my bladder during the procedure) and a headache. I maybe could have managed all of this if I was able to just relax and go to sleep. No chance with my neighbours antics going on. Of course I was also on hourly observations so if my room-mate didn't jerk me out of any hint of sleep the obs would. Mind you the obs were a welcome interval punctuating the long night and reminding me that another hour had passed and I was closer to daylight.

I couldn't help trying to imagine what the poor bugger who had gone in the same time as me for open heart surgery was feeling. I got off lightly by comparison. Like I always say: there is always someone worse off.

Needless to say I slept most the next day. But so did my room mate. I encouraged any medical or meal staff to wake her up. I wanted her tired so she would sleep the next night.

The saving grace was my surgeon came to see me mid morning after the surgery. He said they had some difficulty because the tissue was very thick and fibrous around the root of each vein. So they isolated each one by burning around them. Then they stimulated my heart into AF type behaviour and unfortunately the pulses jumped over the burnt tissue. So they repeated the burn and on the second testing there were no transmitted pulses. He said he expects me to see significant improvement. I was very happy with that prediction. Of course we really won't know until it has all healed up in a few months time but it is definitely promising.

The next step was to get me in some sort of condition to send home. Unfortunately the post-procedure pill-cam had demonstrated 2 haematomas in my oesophagus (explaining one of my pains and why eating hurt like hell) that could potentially bleed given the blood thinning medication I was now on. So I was kept in for a third night. They stopped the clexane injections into my tummy in case it caused my throat to haemorrhage. But the warfarin was continued as that takes a couple of days to take affect and I needed protection from having a stroke.

I went home early on the fourth day. I had to report for a blood test early every morning for the next week and ring for the results that afternoon to determine my daily dose of warfarin. My left arm is covered by a massive bruise from my elbow to my wrist (there was a catheter in my wrist during the surgery to test the blood gases continually to make sure that I was getting enough oxygen despite the breath suspension technique used to stop things moving). It is also swollen because of this and still keeps erupting into an itchy rash. So I have been getting all the blood tests on my right arm and it is starting to look a little worse for wear. My groin developed a massive purple bruise with a hard lump at the entry site. But no pain there after a few days.

Over a week later and I have had several bad episodes of AF. Still. They warned me that could happen but after a week I hoped I would be seeing less of it. It is hard not to be disappointed when it happens. I am still on the flecainide to suppress my heart and that is making me feel like crap. Mind you I felt really crap and was really tired for a week after the surgery. We won't know for a month or so until I ween off the medication how effective it has really been. I am prepared psychologically to go through it all again if need be. I was warned that was very likely. I would rather not, especially now that I know what I am in for. But if it means improvement I will go through it. No question. I just hope to avoid that Mac truck next time.