Atrial Fibrillation surprise

Heart disease and disorders come in many different forms but this is what happened to me. The funny thing about atrial fibrillation / cardiac arrhythmia is it can have no symptoms. My new cardiologists says there are three groups: (1) those without symptom, (2) those with mild, and (3) those who have severe symptoms. I was in the middle group, mild, with nothing that really told me there was a problem. She also said it comes with age more than anything else. So this is how it became known.

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Friday I noticed frequent urination, low flow, dark color but nothing out of the ordinary. Since my doctor suggested pre-diabetes (I am too fat), I bought a glucose meter and started testing. Sure enough I’m in the between range, more than normal but less than full. So I had a big meal, part of establishing a baseline, and headed home to start fasting (i.e., water, coffee, tea, broths, one small lemon per day.)

Saturday, I still had short urinations but ending with pain. I noticed a little red seepage and by Saturday afternoon, called my physcian’s office. The on-call doctor diagnosed a bladder infection and ordered Cirpio, 500 mg, twice a data, a strong antibiotic. I started it Saturday at 6 PM.

Well that night was pretty rough but by morning, the pain seemed less. Then 2:00 PM Sunday afternoon, I passed a small pea-sized kidney stone. Full urine flow returned, still streaks of pink and a little pain but I was on the mend. I was glad to have the antibiotic since you don’t want any secondary problems.

When you take an antibiotic, you should complete all days of the full protocol, even after the symptoms abate. Otherwise, slightly resistant bugs might survive and become a problem. So I continued the twice a day, 6 and 6 and was at work on Monday. Urine flow was normal and no pain. But late Monday afternoon, I noticed the right side of my tongue felt ‘funny.’

I go home, fix dinner, and take a nap. When I got up around 10:30 PM, the left side of my tongue was swollen. So we watched TV and around 2:00 AM I went to bed only to discover I could not swallow without risking it going down the windpipe. . . . Not Good.

I told Holly what was going on; printed off a copy of my fasting log that included my prescription usage, and; drove to the Huntsville Hospital ER expecting a standard drug reaction protocol. The waiting room was empty and when they heard me talk and stick out my tongue, well they pretty well marched me into a treatment room. They hooked up the heart monitor, blood pressure, oxygen sensors and blood pressure machine (the machine that goes 'ping'.) Another nurse put an IV in my dominant, right hand, because I wasn't quick enough to get her to put it in my left hand (need a tattoo there.) The doc came in, confirmed the drug reaction diagnosis and scheduled a steroid shot in the butt, and via the IV, pepcid and benadryl. In a semi-upright position, I was watching the nurse admin the last of the benadryl when my eye sight became a TV screen full of static.

When I came to, I was flat on my back and five faces were looking at me and someone was calling my name. They said my heart stopped for six seconds, beat once, and stopped again for six seconds before it resumed beating. I had atrial fibrillation and this time the ordinary drugs treating the allergic reaction and stress briefly stopped my heart.

Atrial fibrillation basically is the heart not beating with coordinated pulses but a lot of small disconnect pulses. Many folks are asymptomatic and my only symptom was getting tired and taking a nap when I first got home. Depending upon severity, people can go years without symptoms and I had history including a successful heart stress test three years ago and annual physicals. So the original problem was successfully treated, my tongue got back to normal but I was sent up to the heart wing of Huntsville hospital after 6:00 AM.

They peeked and prodded and tested and I had a bag of saline (probably to keep me from sneaking out.) So Tuesday afternoon, they tried to put an IV in my forearm, better to handle motion as I moved about. The senior expert came in with a trainee and I agreed to be 'the pin cushion' and told them about my needle phobia. Well the little girl tried but the more she worked, the more my needle phobia came on. But I forgot about the heart monitor I was wearing as I was going into shock. Suddenly instead of three of us in the room, there were six and more coming! Going into 'shock' on a heart ward attracted a lot of attention.

That afternoon, I asked and got a copy of my current EKG and borrowed a stethoscope to hear my heart. I wanted to know what the syndrome sounded like. I'm not trained but I could hear the upper chambers working hard and the quieter thruttering of the other chambers. Taking a breath really brought out the difference.

Treatment was the next day. I had a ‘chemical’ stress test with an isotope to check for heart blood flow . . . everything is good with no blockages. Then they put me under to check for blood clots and finding none, used a defibrillator to shock my heart back into coordinated beating. It took three zaps but it worked (probably all that Prius EMI.)

The doctor discussed my follow-up meds and was going to release me at 7:00 PM. I asked if it could be 5:00 PM so a co-worker could pick me up after work and he agreed. The saline bag was disconnected (yes!) but I was still hooked up the wireless, heart telemetry unit.

I checked in the desk and did 30 minutes of power walk . . . instrumented. A heart ward often looks like a geriatric center and it was unusual for them to see a patient power walking the hall. Still, I was able to get both a resting and active EKG sheets. Borrowing a stethoscope, the heart sounded consistent with and without taking a breath.

As for the other health issues, my former blood pressure drug and Ciprio are on my list of allergies. They continued the steroid treatment even though the initial symptom, swollen tongue was gone. I've got a new blood pressure med and it was way more effective than the old one . . . another symptom of a pending drug allergy.

As for pre-diabetic, the blood test, HbA1c provides an average glucose index and at 6.1, just over the threshold 6.0. So I'm close enough to be an exercise and diet controlled diabetic. In contrast, the hospital glucose meter kept showing some moderately high values and they offered insulin shots which I declined.

I had continued my fasting started on Friday evening and did not trust these high levels because I had continued my fasting diet. Then I learned from a nurse and confirmed by the physician that steroids can cause a temporary, high glucose reading. BTW, the 'clear liquid' hospital diet tastes a lot better than their standard fare . . . ask for it.

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So it took two days of an unexpected hospital stay. Lesson's learned:

• If you are headed to the ER and have time - take a goodie bag with clean underwear, personal razor, and independent Internet access (don't trust the hospital 'public' WiFi.)
• Take the minimum wallet contents and leave the rest at home - my checkout was delayed an hour because security was holding my wallet. We walked to their office and picked it up.
• Negotiate your treatment - I knew I was fasting and pre-hospitalization testing showed I was getting back to normal glucose readings. Over treatment can be as bad.
• Use it as a personal training session - I borrowed a stethoscope and heard my heart when it was bad and later when it was good. Ask and often the staff will share insights we can use to improve our own, health monitoring.
• Tell jokes and treat everyone with respect - even if they seem a little off, everyone loves a laugh, and though you might be hurtin', a little humor can take off the edge. Send them a thank you note . . . you may see them again.

Bob Wilson

ps. I'll post more technical details later.

 

This is what I noticed. When the local glucose meter said I needed insulin, they were quite willing to shoot me up. But I had been fasting over four days and been tracking my levels before going in. It made no sense until the nurse remembers steroids can shift the readings.

Now I just checked and it appears steroid use can trigger a diabetes incident:

So the high levels were accurate but only because the steroid was triggering glucose production, a temporary condition.

Bob Wilson

 

Hind-sight is 20/20 but in real-time, we have a too brief period of time to observe before making a judgement call. Under time pressure, I don't fault mistakes as much as happy how well everyone recovered. So let's keep things in perspective:

• kidney stone vs bladder infection - I knew the kidney stone symptoms and accurately told the on-call physician my symptoms. Other than possibly an analgesic, there wasn't much she could do and the antibiotic could provide some protection . . . and she might have been right.
• drug reaction - once the allergy reaction occurs, I might have 'home treated' by taking some OTC benadryl but what if it had triggered the heat stoppages while I was in bed instead of the ER?
• atrial fibrillation - in theory, someone might have seen it on the ER heart monitor but they were distracted by the visibly swollen tongue. I had no heart symptoms. But what would have been the alternative? Not treat the allergy reaction because it might trigger a heart stoppage?
• insulin and steroid diabetes - I had the presence of mind to turn down an insulin shot knowing I had not broken my fasting. Had I eaten anything, I might of agreed.

I'm glad a potentially hazardous syndrome has been identified and corrected (for now.) But as much as we respect skilled professionals, we also need to use our own understanding to negotiate a better plan when based upon relevant observations and shared.

Bob Wilson