Saturday, July 26, 2008

Another ah hah moment!

As you may recall, I started drug therapy at the beginning of July for atrial flutter (flecainide and nadolol). The nadolol (beta blocker) was unbearable and I called the doc to see if I go on flecainide alone...YES! I did have some effects (mainly lightheadedness and low blood pressure) when I dropped the nadolol cold turkey (only 10 mg per day - the doc did not provide any instruction and I did not think to ask for any - this time). I have been off the nadolol for almost 2 weeks.

I was hoping my running would return to normal. The first week I did not have much time to exercise plus I was recovering from dropping off the nadolol. However, I have been running most of this week and really struggling (heavy legs). As I was doing an hour run this morning at Oak Mtn State Park, it finally dawned on me (as a slogged up another hill about 45 min into the run) that the flecainide was preventing me from reaching an upper heart rate beyond 144ish BPM. My running max is mid-170's. So no wonder I felt like crap late in the run because my heart was not pumping properly and my legs were starved for O2 and lactic acid was not being processed quickly enough. Duh!

Now I am trying to find answers to some questions. Can I reduce my dosage (with dr consent) that will help me elevate my HR and still be effective against the flutter? And/or, should I run in the morning PRIOR to taking my morning dose?

It was not pleasant running today because I normally hit mid-150's when I run up some of the hills at OMSP. That is when I had my ah hah moment. I kept looking at my watch hoping my HR would ease on up to the normal BPM and nothing happened. I am really thinking hard about the cardiac ablation or just quit running altogether and be happy....see me smiling :-(

Randy Pausch died yesterday. Visit his website and if you have not watched "The Last Lecture", you really need to spend an hour and watch it.

Wednesday, July 23, 2008

Just Another Wednesday

Man, what a scorcher of a week. I did not run Sunday because it was so stinkin' hot. I did run Monday afternoon (5:30ish) and it was still 95F. Oowwee. I did not run yesterday because I got home as the afternoon thunder bumpers started to light up the sky.

I did manage to get out at lunch today. While not quite as hot (86F), it was very humid and when the sun came out from behind the clouds the temp would spike up a few degrees.

The flutters still seem to be in remission. I have had a few instances over the past couple of days that it felt like I was going to have an episode and nothing happened. Maybe this dosage of Flecainide is doing the trick. I still feel a little groggy and lightheaded especially the few hours after I take the pill in the morning. So while I feel better and the running has improved since being off the beta blocker, I still have some side effects (either that or my general disposition has started to turn sour).

I also bought a running journal since my heart rate monitor software (Polar) won't work with the Mac (even using Windows). I cannot get my IR reader to read the watch. Apparently, there is an issue with the USB IR reader and the Mac's USB port. The port does see the reader; however, nothing happens. So I went to the written version which I think I will like better since I really have never used the HR watch and software to their full potential. Using the KISS principle.

Anyway, on to the next exciting events - reading and bed.

Saturday, July 19, 2008

Hey...I ran 5 miles today

Surprise, surprise, I ran 5 miles today. Of course, I did not do diddly the remainder of the day other than wash my little Me-otter. Note - I did not do any running while on vacation earlier this week.

I actually felt ok on the run. I did feel slightly lightheaded on my run, especially toward the end. The good thing is that my heart rate was normal during the entire run...normal being 130-150 BPM depending on the terrain. In addition, I have not had an episode of flutter even after coming off the beta blocker. It sure feels good to feel normal.

I will try another run again tomorrow as I ease back into the running thang. I will see how things go over the next week or so prior to my next cardio doc appointment.

Have a good weekend!

Wednesday, July 16, 2008

Whoa...what is up with that?

Well I did come off the beta blocker earlier this week. However, I had a really strange episode of lightheadedness while at the Biltmore estate on Tuesday. My wife and I had exercised for a little while in the fitness center that problem. We headed out to the Biltmore later in the morning. It was when I climbed the first set of stairs that it hit me. I felt bad. I thought, I am having a heart attack, stroke, bad day, etc. Well after struggling through the entire tour, I finally was able to find a chair and rest/recover. You could say that I was overwhelmed by the tour, but you would be wrong.

Let me digress for just a moment. Biltmore was built by a man that had never worked. He basically used someone else's money to bring a vision to fruition. Now granted, his vision was excellent, but many people have great visions with no resources to bring them to reality. The other thing is that George had his own bedroom and one for his wife. No wonder they only had one child. The Biltmore is a beautiful work of art and a lot of that effort is due to his grandsons. They had the vision to take a man's self-indulgent idea to a higher plane. What is brilliant is that they got the public to pay for it most of it. And yes, I contributed to the cause.

I can say that George's self-centered vision is not as bad as what I saw in Germany at the various castle's in the Bavarian region. King Ludwig II, the fairy-tale king, was a narcissistic SOB. His bedroom on one lesser castle was full of gold metal leaf and mirrors. He never married and seemed to have more for Wagner that he did for women...

Digression complete...after returning from the, I stopped at grocery store to take my blood pressure (102/58) which was way lower than my usual readings. [side note - they poor smuck ahead of me was 192/101 which is off scale high.] My heart rate was 62. After resting at the room, I went back to the store to buy a BP monitor and measure it again. My BP was closer to normal (128/70...HR 51). I have been measuring my BP ever since then and have not noted any low readings. In addition, I have not noticed any abnormal heart beats. Certainly no flutter.

Today we drove to Mt Mitchell, highest peak east of the Mississippi. Unfortunately, a section of the Blue Ridge Parkway west of the Mt Mitchell entrance is closed due to a rock slide (or something). So you have to take the long way around (40 east to 70 east to 80 north to Blue Ridge Parkway west). The 80 north route is a great route for driving the Mazda Me-otter. It is one o the twistiest, turniest roads I have ever driven. I am not sure my wife enjoyed the ride and much as I enjoyed the drive. I did keep the speed down because it was narrow and I was not familiar with the road.

We had fun hiking one of the trails at the park. The Mt Mitchell summit was not open due to renovation. We hiked to a couple of adjacent peaks and I took some pictures of Mt Mitchell. The hike took it out of me. I did have some lightheadedness initially and I had to stop and pee 4 or 5 times (not sure what that is all about). My wife thinks I may have diabetes (which runs in the family), but I have not experienced any other symptoms before now. All these issues are coincidental with the going on drugs and coming off beta blockers.

I hope to be feeling better soon (today would be great). We head to Cherokee tomorrow and then home on Friday (where my own bed awaits me).

Monday, July 14, 2008

Yea Baby!!!

I had to go to my regular doc today for a chapped ass (no kidding...and that is all I will say about that). Anyway, he has been going through some heart issues similar to mine and we chatted for a few minutes after my "exam." I told him what I was on and he suggested contacting my cardio doc and getting off the beta blocker. So I called the cardio doc (he is probably tired of hearing from me) and told him that I still have adverse reactions to the beta blocker - namely, dizziness, unclear thinking, low resting heart rate (low 30's), and general lethargy. So now I am off the Nadolol and on just the Flecainide.

So I am hoping to get out this drug-induced funk as the Nadolol wears off over the next couple of days. I am excited about being able to run with a normal heart rate.

My wife and I are in Asheville, NC while the kids are at a running camp. I am looking forward to spending some time with her and seeing this lovely place. We took the Miata. I hope we don't buy anything because we don't have any room. Hopefully it will be cheaper that way. We hope to see Biltmore ($47 stinking bucks per person...oooweee), Chimney Rock and Mt Mitchell. Then we will head over to Cherokee and watch this play Thursday evening. Then on the way home we will drive the Cherohala Skyway which I have ridden on my bicycle several times (Cherohala Challenge).

I hope to get some running and hiking in this week and I hope that things will return to normal as the Nadolol wears off.

Wednesday, July 09, 2008

Another Day, Another Dollar

I recently joined a forum, Cardiac Athlete (see links to the right). It seems to have a lot of folks that can relate to my experiences. It provides a breath of fresh air to read/discuss my issues with others in similar circumstances.

I did not exercise today...had a meeting all day downtown then headed to the house when a thunder bumper came up.

Yesterday, I did 30 minutes on the treadmill (15 walking, 15 at slow jog). Even though I am on 10 mg of Nadolol, I did not see any difference in my heart rate. However, it has only been a couple of days since I reduced the dosage. I did some very light weight lifting with the thought that maybe I will restart my toning routine (that I have not done in quite a while). I like to ease into the lifting so I don't get sore. So it takes a few weeks to develop a regular lifting routine.

Anyway, no other news on the cardio front.

Friday, July 04, 2008

The Flutter Story

To the left is the picture the doctor drew for me as he explained my "condition".

Essentially the heart functions by controlled electrical impulses that start from the sinus node and process through the AV node. The upper two chambers are the atria and the lower two chambers are the ventricles. Blood travels from the atria into the ventricles and the transport is controlled by the electrical impulses from the sinus and AV nodes (click the links for more in depth info). In the right atria, the pulmonary veins from each lung supply the blood from the lungs to the heart. Apparently, this is where my problem lies.

The doc said that my particular condition is caused by errant electrical pulses that are generated where the pulmonary veins enter the heart. The problem is initiated by atrial fibrillation which then results in atrial flutter. So the atria will beat rapidly and with a consistent rhythm (if it were inconsistent it would be atrial fibrillation).

According to the doc, middle age white males that are typically athletic and have cerebral jobs are more likely to develop this condition. Blacks and asians are much less likely. Also, your average middle aged ditch digger is less likely to develop this condition. He said that he just saw a doctor and lawyer with similar issues and asked what I did for a living. I guess being an engineering manager for a nuclear utility would fall in the cerebral category ;-).

He said there was a Norwegian (or Swedish) study done on cross country skiers using a sedentary group as a control. The skiers were four times more likely to develop this condition than the sedentary group. [So it proves that exercise is BAD for you.] He said that cold drinks, large meals, post-exercise, etc. were typical triggers (yep, I can relate to all three). So how do you fix it?

First he explained that he would like to try a drug therapy. Hence the Flecainide which he said is usually effective 60% of the time. He said that if it works, most other antiarrythmia drugs will work and if it doesn't the others won't either. The Nadolol is a beta blocker to help with rate control (which, if you read my earlier post, you will know it works for me). If the drugs don't work or the side effects are not acceptable, then an alternative is catheter ablation.

For my condition, the procedure will be to insert a catheter into a vein in my groin. The catheter is then snaked up into my heart where the doc would essentially ablate the tissue around each pulmonary vein where it enters the heart. Basically, the intent is to create ring of scar tissue around each opening to prevent the random electrical impulses from disturbing my normal heart rhythm. The procedure, for them, has been 85% effective with 1 in 4 needing a second procedure to close any gaps missed the first time around. So what are the drawbacks?

The doctor laid out 4 negatives. First, bruising is common occurence especially where the catheter is inserted into the vein. Second, there is a possibility of bleeding (or fluid buildup) in the sac around the heart which is removed by using a needle to suck it out (I quiver on that thought). He said that they have not had any bleeding issues for nearly 10 years (over 6000 procedures). Third, there is a possibility of narrowing the area where the pulmonary vein enters the heart. This caused by excessive scar tissue formation which constricts the entry area of the vein. Last, there is a possibility of a stroke caused by the formation of a clot in the right atria during the procedure that gets flushed out during a normal pulse of the chamber.

So that is the story with a pretty picture to go along with it. After the last couple of days on these drugs, the ablation is looking mo' and mo' better. Coincidentally, when I walked out of his office I ran into a guy that worked at one of our nuclear plants. He said that he had been on the drugs for over 10 years and was basically sick of it. So he told his cardiologist it was time to do something different. He was referred to Dr. Kay and had the ablation done earlier this year. He said it was the best thing he could have done and wished he had done it sooner!

So I will suffer through the drugs for the next few weeks. Try to run some and if there is no improvement in quality of life, I will ask for the ablation procedure. I just can't see being on a drug regimen for a long period of time and not being able to exercise.


Ran this fine 4th of July morn. I ran a very easy pace and my heart rate barely broke 100 bpm. I ran 3.6 miles and I am drained! It is a weird feeling to run so easy and be so fatigued. My resting heart rate this morning was 37 bpm. Waaay low. I am usually in the mid 40's. It seems like my heart rate profile is 30-40 bpm lower than normal on the high end. I am not happy with this condition because I cannot really even run or exercise.

When I was done and showered, I checked my heart rate and blood pressure. Heart rate was 37 bpm and blood pressure was 117/77. My legs are tired and I did not run far. With my heart rate being so low, I guess the transport of oxygen to the muscles is so low that my muscles cannot recover as quickly. So an easy 3-5 mile run feels like 10-15 because the of low recovery factor. Blahhhh.

My next post will cover what the doc told me on Monday.

Wednesday, July 02, 2008

The Monday Cardiologist Visit

I will write more details when I have time. The doctor was personable and took the time to help me understand my issue. In fact, he drew me a picture and explained the issue very clearly. I will pass on all I learned in a future post soon (before I forget everything he said).

I am on Flecainide (100 mg twice daily) and Nadolol (20 mg once daily). The first is a sodium channel blocker and the second is a beta blocker. He also took me off the Warfarin because he was concerned that the side affects (excessive bleeding and/or internal bleeding) were worse than the benefits. He did not think I was at a point that I needed to be on that particular regimen and suggested 80 mg of aspirin daily instead. I started the drugs on Tuesday morning. The side effects have thus far been minimal. Some drowsiness and dizziness, but nothing too bad. I did have a neat side effect this morning. As I sat down, I noticed as my arms moved up and down in my peripheral vision, that they left kind of blurring trail. The only thing that is similar is when you set up your mouse pointer to have a trail as you move it. That is what it looked like when I "flapped" my arms up and down. The effect did not last very long, but it was kind of cool.

I did run today to try out the heart rate. I was able to get up to 137 bpm when normally I should have been at nearly 160. My max heart rate while running all out is in the mid 170's. So now my max will probably be near 150 bpm. That really sucks. I am hoping that as my body adapts to the medication, my heart rate will go up some. Right now staying on this drug regimen will impede any goals I have for running.

I go back to the doctor at the end of the month to see how things go. This past month, I have had few episodes of flutter so it may be a while before I can readily determine whether or not the drugs are being effective. Once I type up the discussion the doc and I had, you will really understand this issue much better. It is quite interesting and beats anything I have found on the net to date.

It is late and I have been busy at work and traveling, so I am heading to bed. I will get the info up quickly for anyone that is interested in reading more about it. I hope to do some more running to see how this drug really affects my performance. I am not expecting miracles, but....