End of the line?

I am addicted to exercise and adventure. I just can't get enough of either, and prior to my PM and a subsequent thrombosis issue, the only thing that kept me from the life of a thru-hiker or RAM (race across America) participant was money and family.

A few days ago I got a call from my cardiologist that I must see him ASAP. He got my latest phone interrrogation and was not pleased with the findings. For the first six weeks after I was stented for a LAD blockage, I obligingly participated in "walking only" as my form of exercise. It was horrible - slow, boring, and unchallenging (despite exploring new venues whenever possible). I was then allowed to proceed slowly (had to wear a heart-rate monitor and stay under 150 bpm) with getting back to my active lifestyle (running, swimming, biking, lifting, etc,).

By the third week I was starting to step up all activity levels. The interrogation however revealed that I was in afib three times each of those first two weeks, and eleven times (sometimes hours at a time - all without my knowledge) by the third.

I was given three choices. Ablation, rhythm meds (coumadin, etc,), or acting my age/condition and try and blend in with the mall walking seniors. My doctor outlined all the negatives of the first two and is giving me three weeks to try and modify my obsessive approach to endorphine-seeking to suppress the bouts of afib.

Hopefully someone out there has some advice to help me choose the correct path. Thanks for your time,

Gary

9 Comments

thanks for the responses

by gevans - 2008-02-06 02:02:23

I appreciate the comments and will add a few answers too. In regards to the question about feeling the atrial fibrillation - no I've never felt a thing. I even had my heart-rate monitor go off one time when my HR jumped from the 120's to 164. I immediately stopped and within seconds it dropped precipitously. I then started running again and within a quarter mile the alarm went off again - this time the device showed 171 (I'm supposed to stay lower than 150 which is usually not a problem as slow as I go nowadays). I called it a day and walked back to the car, but I never really felt anything abnormal.

I also assumed that those monitors only record Vtach rather than afib (since the former is when we feel our pulse), but when I compare my workout logs with the episode days that my cardiologist downloaded from my device there is a direct correlation. It must occur during my runs, or maybe during the recovery...or could it be overnight? He's changed my settings so that he can pinpoint specific times rather than total episodes (but this means much more battery usage, so its just for three weeks or so).

I also liked the eating hypothesis, as the time my monitor alarm went off was shortly after eating (ordinarily I wait an hour or so, but an impending storm was approaching and I wanted an outdoor run).

Anyway, just wanted to thank you all for your advice,

Gary

Medication

by Nutbeem - 2008-02-06 04:02:10

Gary - I would try the medications first, before you give up your addiction.

It seems that you love of exercise and the outdoors adds greatly to your life, and rather than give that up, I would try everything else.

You can try the meds for a couple of months and see where they go - you may strike gold, and off you go across America!


Oblation Risk/benefit

by ElectricFrank - 2008-02-06 06:02:05

Gary,
It sounds like you need to come to terms with your body changing as you age. I don't mean you are old, but we can't keep climbing Mt Everest forever.
That said keep in mind that an oblation is a serious procedure where they deliberately destroy heart tissue in the hope of stopping the afib. If they don't hit the right spot the best that can happen is the afib is still there. The worst is that it can irritate good nerve conduction tissue and cause a whole bunch of new problems. If you go down that route it is very likely that you will wind up totally pacemaker dependent and more limited than you are now.
Personally, if I was addicted to working out at an intensive level and didn't have symptoms, I would forget the drugs and oblations, and go for it. You might do just fine. I can't imagine afib not causing problems for you at the exercise levels you are working at. On the other hand you may drop dead in the middle of a workout. At least you would die with a fit body!!
I hope you take this in the way I mean it. I am 77 and continue to hike alone in the Sierra's knowing I could have something serious happen, but it beats watching TV until something happens.
best,
frank

ablations and success

by VIOLIN - 2008-02-06 08:02:34

Gary, i want you to know that a fib ablations are long and difficult. i ended up with a pacemaker after seven ablations--the last one being with the pacemaker and ablating my av node. this hassle with a fib and a flutter has gone on over about five years. fine for a few months, then out of the blue knocked off my game suddenly when the spells would hit, and they seemed to get just as frequent with the additional ablations. many have had success up to 70 % but those of us who have patiently tried again and again for the next one to work need to be heard. at least with the pacer i know i have a back up and my life has returned to normal...not so after the failed ablations.In fact i just broke my leg kayaking!! my doctor is one of the best in south florida and i know he worked hard to eliminate my a fib.

weight and see!?

by petemanning - 2008-02-06 08:02:56

Hi Gary,
Sorry to hear your news.
Maybe if your are trying to assess the effects of endurance /aneroebic exersize and must have a break from this sort of training,you could get into some power type lifting that does not give your heart rate a chance to rise.
Recently I heard that heart attack patients were encouraged to undertake resistance training as part of their recovery;previously this was NOT advised and the mall stroll approach was far more prominent,but as I say the research has shown resistance training to be beneficial.

I appologise if the next bit insults your athletic intelligence.
workout could be :
cardio warm up:nice and easy say 100-110
Warm up: 10 reps of specific exersize
2-3 sets of 3-6 reps

I personally think exersize causes or heart to adapt specifically to that type of exersize(i.e "athletes heart" for endurance athletes.
I maybe totally of track ,but I sometimes wish I had tried modifying or cutting back my endurance training before I resorted to a pacemaker,becuase during the pacemaker recovery time,my heart palpitations all but dissapeared.

To make a long story a bit longer;I'm saying I think that it sounds like a good time to try a few things like diet analysis,exersize type change, and supplements .

Also what do you know about magnesium?effects,your levels etc.
Hope this helps.
train smart
Pete

afib etc

by axg9504 - 2008-02-06 09:02:30

It doesn't seem from anything that you wrote that this is an exercise-ending situation. Would exercise lead to afib? I was once diagnosed with paroxysmal afib based on 3 strip charts on an event monitor taken on a treadmill. 2 other EP's disagreed when I showed these same charts to them and I have always wondered why the divergence of opinion. I was prescribed coumadin too, especially because I had a TIA 14 years ago (when I was fit) and have a PFO (incomplete closure of the atrial septum). My evaluation of my situation is that if I was in afib for a few minutes while I exercised, that was not enough to warrant a blood thinner of that magnitude based on the chance that a clot might develop. I also found from reading the literature that aspirin, in my situation at least was a good alternative. I believe there is a scoring model for deciding on coumadin therapy in which my TIA adds a lot of points.

In the Cleveland heart forum several people I have seen posts from Coumadin taking runners who seem to tolerate it well.

I am curious though as to whether you feel anything at all in afib? Isn't your rate different? I know it's possible but I always thought you would feel some symptoms.

Why not try some of the beta blockers first?

afib too

by hotform - 2008-02-06 10:02:18

Gary, I can understand your frustration.
I went through not being able to exercise and I didn't like it all. My doctor only brought up ablation to me as a last resort and we decided to try meds first. I had been on several meds through the years and none of them were really holding the afib in check. My doctor finally put me on Rythmol 225 SR capsules. I didn't have a bout of afib for over two years after going on this.
I always wondered why I could be perfectly normal one minute and have afib the next. When I had my pacer put in I actually had trouble with my diaphragm being paced from the high output of the pacer. Several adjustments and it was OK and stopped. But why was it being paced? Because it is right up against my heart and the electric was just traveling across. So I have noticed that when I have an afib episode it is always after eating. My theory is unproven, but it is this. After eating with my stomach filled it pushes against my diaphragm which in turn comes in contact with my heart which disrupts the electrical signal in my heart which causes the afib episode. When I have afib my stomach actually feels like it is jumping which I think is caused by the disrupted heart beat. I have noticed this only happens after a high sodium meal such as Thanksgiving dinner with high sodium gravy and stuffing, or a local favorite the fish fry. Every time I have had a blood panel done while being in afib I have also had a low potassium level. Since potassium is needed to process sodium and too much sodium could be dropping my potassium level which my heart also needs to maintain a normal rhythm.
So my theory is that the sodium robs my body of the needed potassium and that in combination with everything pushing up against my heart causes the afib.
I suspect my case is not unique. I also think that while this is what is happening to me, for a lot of other people it could be something else altogether that is causing the afib. It took me years to piece something together that has really helped me by just simply really watching what I eat.
I didn't tell you any of this to discourage you but I would try the meds first and start trying to pay attention to what is going on when you have afib and hopefully you will find something like I did that helps.
Oh, and like me you probably wonder what brought on all of your heart and afib problems to start with. For me it was getting married. No, not my wife, but the doctor who gave me the blood test for my marriage license. This was 22 years ago and I went to an old small town doctor at the time. I thought he would send me to the local hospital for my blood work. I was wrong. He got out one of those old syringes that they used to screw the needle onto the end of. One of those big suckers that looks like they could suck a pint out of you. Turns out I got hepatitis A from my doctor who also had it and was using a dirty needle that he thought was sterile. The hepatitis was the beginning of changes in my body and the beginning of afib and heart problems. Rick

scheduled second opinion...finally

by gevans - 2008-03-02 05:03:48

I appreciate all the helpful comments. I'll use them all in two weeks when I first talk to an EP. In the meantime I'm just walking, swimming and using a stationary bike (none of those get my HR much above 100 bpm, so that meets my interpretation of the cardiologists "walking only" regimen) and keeps me sane...at least until I get bored.
Gary

running again

by gevans - 2008-03-27 03:03:26

I've officially dumped the Cardiologist for an EP (he's allowing me to run again) and my lifestyle is back to (nearly) normal. I'm now on Flecainide (as well as beta blockers, plavix, aspirin and vytorin) but eventually I may have to have an ablation. We're still evaluating the data...but I'm having fun in the meantime.

Gary

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