AFib Cyclist

Mis/Adventures of an everyday Cyclist with Atrial Fibrillation

Fine. Not fine.

Cardiac ablation now a few days behind me. Recovery is underway. The hole in my groin – about the size of my little finger – has failed to saturate its dressing over the last 24 hours, and the rather unfortunately timed ‘tummy bug’ has subsided, allowing me to venture from a world outside the bounds of the toilet or duvet.

Suddenly the advantage of such a ‘keyhole’ operation is crystal clear – I feel – outwardly – normal.

Sure – there is the dull ache in my chest, and there is something wrong with my throat – but otherwise – we are good here – right?

Liberating huh? Sure. If this is a fix and freedom from medication, this is a great success.

So yeah, a week of taking it easy they said. Noted. But I feel fine.

Pressing on with breakfast prep, put on some washing, jump in the shower – oh – oh my – there we are – there is the limit. A pressure and a very dull heavy ache spread across my chest.

I appear to have found my limits. I am fine. Not fine.
A week clearly means a week.
I will be a good patient.

It is almost like they have done this before. Pffffft…. what do they know 😉

Hit by a bus

Coming out from the general anasthetic was a pretty dark time for me following the ablation.

A vague memory of the spiral vents of the excellent view of the cath lab ceiling came and went.

I need to cough, I REALLY need to cough.

I am awake, I can see – well as well as I can without glasses on. Nurses. Monitor. Good god I feel like shit.

Senses start to kick in, and I remember the anaesthetist saying that I would wake up in the same place but not remember, they would remove pipes from my throat, and I would be wheeled through to recovery.

Systems check.
– I can see.
– I can hear.
– No one seems all that alarmed about things.
– Nothing appears to super hurt.
So far so good.

Okay any red flags. REALLY need to cough. Sweet Jesus – AM I ON THE SUN RIGHT NOW? How can I be this hot doing nothing? I appear to have been put here by some helpful giant with no comprehension of articulation…. I could REALLY do with moving my shoulders, hips and legs.

One cough. Meaty, and productive, and an attempt to move my hips and all hell unleashes.

People are now pushing on what is clearly the immediately clear sharp and present wound in my upper leg / groin. This is a real bonus. “Please, do this more.”
Attempts to move to stop this are not greeted with encouragement. I think… I am going…. to puke.    ….ahh my old friend – the kidney dish….  in the ENTIRE history of mankind has anyone in danger of hurling ever flailed around an attempt to find a receptacle barely an inch deep made of reformed card? I SERIOUSLY doubt it.

STOP trying to look down. DONT cough. I can feel a fan now – sweet.

I can feel people picking at a dressing, more pushing, lots of mopping. Could really do with moving that leg now.

Words cannot articulate how low I feel right now…. but I am starting to feel more human. Groggy. Rambling. Hot*. Uncomfortable. Unable to move.

The clock says a half hour has passed – I simply cannot account for the time.

People come, people go, I get a drink.

I have glasses again. I can see things. That makes a hell of a difference. Calmer.

Feeling like shit.

An hour passes in the blink of an eye… felt like about five minutes.

Back to my room.

Three further hours of lay still, no moving.

For a small hole in my leg, some pipes down my throat, and what I assumed would be painless works inside my chest – I am really really not enjoying myself right now.

Note to self – advice to others – operation – a dream – coming around – sweet rotating bubble wrap trousers of Christ that was an ordeal.

 

 

*Hot makes me nuts. Seriously. I do no do hot.

 

“Fricking Lasers”

Sharks*, with Fricking Lasers!

The phrase used on paper was RF – but words used out loud were Laser. My reading around suggests RF, LASER or cryogenic means are possible. The outcome is the same…. burnification – resulting in scar tissue. Scar tissue insulates. Problems go away. Persistence in referring to the Oesophagus as “Food Pipe” (which had me “I am sorry what?” a few times…. in a ‘open up here comes the aeroplane spoon neeoooowww’ level of “did they just say that?”) had me suffering further flashbacks to other things I really need to let go like Mr Stevens** and Gravity being 10ms^2 in the second year. My mind really is all over the place.

They think I am shaking because I am afraid – well yes – I am Christ – I expected to be put out before seeing the venue as it where…. but no – this is actually it….. I am shaking because it is Baltic in here. The room I walked into, in my slippers and wonderous arseless-back-to-front-cape-of-submission is not some room of tech… it is super apparent now that this is the real deal. The whole gig has been leading up to this room, off of a corridor, with a tonne of wiring, screens, hardware, desks, computers, wow…. if I wasn’t shitting myself then this would be FACINATING.

A moment of clarity finds me going back to the ‘please sign this paperwork chat’ key points. Groin – although not entirely sure where….. that’s a pretty big and 3D space…. there was vein not artery (answering one my questions) – into top right chamber – through the septum wall (solving my other query) – and about half an hour of laser – taking super care not to burn your food pipe (*mutter*) which sits directly behind the back wall.

Brain skips again.

“Is light a radio frequency, or is radio slower wavelengths of light”. I wonder where one stops and one begins? There are lights that you cannot see, Ultra, Infra… so its not that…” My mind raced desperately trying to drown out the reality that I would be completely in these peoples hands within the next few minutes.

The background noise buzzed away as I went through the questions infront of me on a giant quizz-show-sized touch screen…. my game show host noteably in scrubs, and there did not appear to be prizes for the questions going on.

I snap back to the minor army of people now milling around me. Weaving cables to and from the various sensors I appear to have been festooned with since finding myself parked here.

A voice was directed to me again as opposed to the others running through something almost pre flight check list…. back to the clear and present.

“Lay back if you could.”

“Can you straighten your shoulders up over your hips – it makes the picture straighter for us? Thank you.”

“Sorry these stickers are cold – they have metal in them”

There are a lot, no, there REALLY are a lot, some are going to be for 3D mapping of the catheters, some are going to be ECG, and the reassurance of the ones now being jelled to my head is to check that I am properly asleep not just immobile and screaming. Drop that image – adopt something slightly more Wierd Science…. no hang on – its going all Borg now… distract – distract – look at those air conditioning vents… I wonder if they are filtered?

No one here is talking about TV last night, or the weather, everyone is very much on the case.   “… how many people are there here, there seem like a lot?”

“There are ten right now, but can be more, probably twelve.”

The lady to the left of my shoulder in glasses replies – she stands under a bank of what must be 8 screens arcing around above me ahead of clearly where the surgeon is going to dive in.

Okay – fine, wow they are all very busy. It is COLD in here, and I am laying on a blanket with all the charm of the ‘have I pooed myself’ heated seats…. good god… don’t let me poo myself… in fact – let’s keep farting to a minimum too… Jesus – do you far while you are under a general? Noooo. My mind is now racing.

“You are receiving some chemicals that will make you feel a little happy drunk”

… the more familiar face of the lead-clad anaesthetist looms into view to my right. He amuses. I am shaking a little less now. He has a comedy sized syringe in his hand full of what I assume is not Copydex. He seems amused, I am amused, I am shivering less… as I notice his colourful neckerchief – which I guess is an attempt at brightening up his thyroid shielding – elements of FallOut world flash through my mind.

“I am giving you some now to put you to sleep”

… nice, thanks, there are a lot of people here. Wow.

I can feel it going up my arm – not stinging as he suggested, but noticeably colder than the rest of me…. I wonder why they don’t warm it up. There is no ‘can you count back from ten’ for me to fight against and fail – simply the moment akin to the carpeted sinking into the floor of Trainspotting.

“Ahhh – there we are. Sleepy time.”

… I think I matter to spit out as he moves away from me into the shade. No relaxation, just a moment to notice the sensation and then the broadcast ends without struggle, option, or loss.

My work here is done – I am now very very firmly in the hands of these people.

Sleep. Thoughtless. Memoryless. Dreamless Sleep.

> wait

...time passes

 

 

*No Sharks were harmed in the fixing of my heart.

** Mr Stevens I randomly met on holiday in Norway of all places – no longer a physics teacher – now an accomplished photographer and videographer. The fact that on introducing myself he remembered me…. does not bode well some 33 years on.

SURPRISE!

The big day was upon me – D Day for the ablation – pulmonary vein isolation (PVI). A bit of light welding while up on the ramp. Jokes. Dark humour. Deflection. Self-deprecation. Lighthearted. Distraction…. a regular day-in-the-office for me 😉

Quiet acceptance that if anything was going to go wrong it was out of my control, and generally speaking this is what I needed, this is what I needed, and I was fully aware of the “greener grass” I had been waiting for had to be managed.

Everything is going super well. Calm. Time. Questions answered. Minimized stress and conscious punctures.

Any other time I have been put under I have gone into a room, been put asleep and not seen the place IT, whatever it was, was going to happen. Oh no, there I am stood there in my hospital gown, slippers, chatting away to a guy in front of a giant TV when I realise that no, no, see all this…  this CSI lab meets network lab meets workshop… it is for me. GOOD GOD.

If there was something I would change of this process is letting people know that.

“SURPRISE!”

Thirty Eight Minutes

There is an element of denial to the whole thing. Your heart is on the inside – there is nothing obvious, or apparent. When it is good, it is good, and it is very easy (for me) to assume that it all was a lot of fuss about nothing – and everything has just been blown out of proportion.

Picture the scenario. Trainer road. TT bike. Indoors. Sweating running down my face, and the inside of my glasses. Headphones, Biffy Clyro today – loudly. Five lots of eight-minute 80 to 90% FTP efforts. Trying to relax as much as I can – trying to hold on to any elements of form I can muster during this pitiful effort session.

THERE IT IS. The unmistakable sensation of slipping into AF – akin to a fish flapping around somewhere between your oesophagus and your ribs. Yanked rudely from my concentration, from my internal dialogue, from my little world of pain to focus on the screen in front of me to pick out a time.

“Thirty-Eight Minutes”

Well – I am over half way – I may as well wing it – putting my head down, closing my eyes, and trying to focus back on the fluidity, motion, and form.

Soon enough the session came to an end – sure enough – the AF then kicked in and out as it saw fit for the remains of the day.

The feeling of achievement outweighing any concerns over the trigger.

A quiet acceptance that it felt good to feel bad. It was real.

Denial and doubt are easy. Acceptance and dealing with is hard.

Here is to hard.

We are not always here for the easy.

Pffft – 38 minutes – is that all you got?

Anniversary

Glancing down at the pint in front of me – and the sudden shuddering realisation that one year ago – weather aside – people aside I appear to be replaying by three day August Bank Holiday Weekend.

– Caffeinated Coffee – check.

– Beer – check.

– Been riding – hard – check.

– Similar two days before – check.

– Lacking in sleep – check.

Throw in a swim, and a lack of heat and this seems to be a carbon copy of the year before… the exception being the lack of a life-changing night in A&E.

So – in the last year – I have:

– An overnight in the hospital;

– Cardiologist. Twice;

– All but stopped riding;

– Stopped drinking;

– Stopped drinking caffeine;

– Adjusted to medications;

..and watch the issues go away.

Six months pass, and the issues come back again. More often, less sustained. Back with examples, times, EKG’s.

– Different cardiologist;

– Referral to an electrophysiologist;

– Increase in dosages;

– Anti coagulants;

– Limited caffeine intake again;

– Drinking returns;

– Discover Cardiac Athletes;

– Ablation cancelled;

– Start structured riding plan;

– Start structured swimming plan;

– Ablation pending.

That has been quite the adventure.

Here I am. A year on – what a change.

From treading on eggshells to an understanding and respect.

Moreover – a great weekend – with the people I love, doing the things I love, and nothing more. What more could you ask for?

Guilt

There it is again. Stinging. Clear and present, amidst the false comfort of the lack of short-term-discomfort-in-the-name-of-long-term-gain I am currently immersing myself in.

Skipped riding last night after skipped beats during the day. Wondering whether I should be swimming this evening after skipped beats on a lunchtime walk.

The easy route – it may be the safe route – but it messes with your head. Should I have gone? Would it have been okay? What if it had not been okay?

There is no rhyme or reason – no “it would have been okay” – just that feeling that I am letting myself down.

This, is NOT a high point.

A day on a calendar

Today – a new date came through for me. Radio Frequency Ablation, or Isolation of the pulmonary veins – the golden bullet in terms of AF suffers. It seems east enough to say out loud, read about, or write down. However as the letters go onto the page you realise that this time it feels more than just a hoop through which to jump to get to a destination. This time it feels more like a battle, or a trial by fire. Someone nicely, and with decades of experience, burning the inside of your heart to order… and to cherry that icing – cutting into your groin to get there.

While it seems like an odd thing to be able to say – but – “I am GLAD that the last date was cancelled.”

Why? Well – I had previously viewed it as a trivial hoop through which to jump, a doorway, and on the other side, the world would be greener grass, singing birds, and sunshine twinkling through perfect blossom trees.

I had hung a number of events on “not today” but “once everything is better”. Which – while things will undoubtedly (eventually) be better – statistically speaking – there is zero to stop them happening now, and the motivation to make the changes is still required.  This is a good thing.

Indeed, it is nearly always greener where the cows are sh1tting – and just being in that green field is not enough to make a change, to ‘do-the-needfull’ – so thank you – and hint taken. An opportunity if you will.

So – with a readjustment of outlook, and having started a lot of the things I had promised myself for “when I am better” my attenion is far more drawn to the small matter of a general anasthetic, and an awefully nice chap burning me – intentionally in the name of a fix. I cannot get away from the concept in my head of a guy with a soldering iron trying to accurately mark a beating heart… inside… with a blindfold on. Accompanied by small hissing noises, and puffs of acrid white smoke.

So why on earth would this be something I was up for? Well, because for Atrial Fibrilation – this is the weapon of choice. Minimally invasive, quick recovery, with a statistically high likleyhood of success.

The procedure involves being asleep – I am good at this – so this does not worry me so much. Then, through an incision in my groin, a bunch of equipment is threaded up into your heart.

Imaging and a very VERY localised GPS system delivers mapping of the beating heart to the surgeon, on the outside, without a clear view. A map is then taken of electrical activity going on within the atrial chambers.
A boundary of non-conductive scar tissue is created as neatly as possible around the pulmonary veins entering the right chamber (on the users left) – while the target is moving.

The scar tissue either prevents the propogation of the extra beat signal from the muscle scheaths around these veins, or adsorbs them enough to reduce their effect on the two upper chambers. Taa-Daa – done.

Remove all the equipment. Stitch back up. Home for tea and medals!

…well after a likely overnight, and then three days of taking it really easy. But otherwise… simple right?

RIGHT.

The only great solace I take was from hearing the surgeon say how much harder it used to be with 7 hours of X-ray exposure for both of us. Now the procedure takes half the time and has far more accuracy. The experience of doing it the harder way will no doubt deliver when it matters.

…I hope.

So – lets get some things out and formalized:

1. I am a lot more hesitant about this date – what it has not changed – what it stands for has;

2. I am not waiting on completion to press on with being more me again;

3. Having the date moved again will not sit well with me;

4. It needs to be done;

5. I need pictures of the gig – or it didn’t happen!

Adventure awaits!

… or just plain old tying my shoelaces without getting puffed, or intervals without that sensation of misfiring making me ask myself “do you really NEED to do be doing this.”

Either way – into the diary it went…. and all the purely emmotive cruft that went with it.

Change the frame, the picture is fine.

After speaking with my sister this evening the following three sentences summed up a great deal of how I am learning to readjust – and at the same time grounded me in terms of what I already knew:

It is not a race.

However it is competitive.

You just have to realise you are only ever competing against yourself.

Oh yes.

Sure she was talking about being on holiday and balancing family time, adventure, learning, with missing out on exercise.

What our generally sedentary parents did to us (and my cousins) I am yet to figure out – but for not necessarily naturally slim people we try hard.

Change the frame – the picture is fine.

Work and Play

It was a concern to me, and I should imagine others – well – how does this affect what you can do? The answer is that it effects this a bunch… but it is all very much comparative. Shortness of breath, slow pulse, at times feeling a little faint, unable to push yourself for prolonged periods.  But it needs perspective – stick with me a moment and try and put my personal experiences into some kind of relatable frame.

Did I get puffed like an asthmatic ant while trying to walk up to the top of a 1800ft hilltop with family and friends this weekend? Sure I did. Did I push on, yup. Was I walking faster than my featherweight seven-year-old – also yes. Father points – check.

Did I also have a number of occasions where situations during my working day caused me to skip beats and hesitate? Sure. But hey – sometimes these are healthy reminders to stop, take a moment and ‘measure twice cut once’ – after all – it’s not like I have been doing this for almost 20 years now? Indeed. So what the hell is a flutter here and there? Meh. It’s not even touching the sides of indigestion let alone those afflicted with the dreaded man-flu!

Have I been relegated to B-Group rides whenever I head out cycling with others – yup. Does that sting like hell. Sure – dropped – alone – unable to keep up, others waiting for proper chunks of time. No one wants to be that person – no one wants that forced on them.

But in redressing that balance lets take a wider view on that. I have been swimming twice this week covering over two miles at a relaxed pace… this week arms – with a float wedged between my legs to keep them still.

After some serious reframing of the picture, I am enjoying the attitude of the B Group rides. Realising you are chemically ‘rev limited’ and don’t respond quickly to changes of gradient simply highlights the application of my personal preference for slow grinding watts on the flats and neuromuscular efforts sprinting for signs are still possible. Embrace being a diesel engine.

On the stationary bike – I have put in three and a half hours of TrainerRoad sessions over three days this week. The program is based on your calculated FTP – so the sessions are interval based, and periodized within that scale – achievable within your new limits. Capacity already growing and the reasuring familiarity of dull leg ache returns.

As for work – I believe its also safe to say that I have had one absent day in the last year due to it – after being up all night at the hospital. Pffft – people have longer off with a stomach bug! Weaklings!

Medication will set a bunch of limits on things. It will also protect you. It is a fine balance. So do not be so quick to write off your abilities or the abilities of others. What you can do WILL change, what you think you can do will go down in flames – but do not write yourself off. You simply need to assess your situation, get sound advice, find likeminded souls and press on. You can find your new limits – learn when it is okay to take a day out (and ACCEPT THAT IS A NECESSITY as part of the journey) – refocus on your goals and go ‘do all the things’.

How many of my colleagues have done any exercise this week? Cardio? Strength? Cross? Let alone structured programme, or goals? Right. That is probably going to be a no…. in my line of work. So take your judgements about yourself, or me, put them in a tiny box, and throw them in the sea where even Jaques Cousteau or the dude from Alien would have an issue finding them.

/me steps down off of soapbox.

Seriously. Perspective. Informed professional advice. Anecdotal sources such as this. Do not write yourself off. Do what you can, when you can. You are lapping everyone on the couch or sitting in front of a computer. Live.

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