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Medical Saga continues (some cycling related content)
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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

7/7/18 11:43 AM

Medical Saga continues (some cycling related content)

Last I reported a cortisone shot had restored function to a knee (at least temporarily). But then my repaired shoulder starts acting funky, and it turns out one screw had backed out and another had slightly penetrated through the back of the bone (the backed out screw is much more problematic).

So yesterday I go to the hospital for day surgery to remove the screws. I'm wheeled down to the OR, strapped in, and then an anaesthetist says someting like "how long have you been having A- Fib?" I'm like WTF......So they do an EKG and yes, I'm in A-Fib - never had it before to my knowledge, did not know I was in it then. They won't put me under because of the A-Fib, but at least the surgeon takes out the backed out screw with a local.

Then I spend last night in the hospital with continuous monitoring, an echocardiogram and another EKG. They are talking about keeping me there until Monday and doing a cardioversion (sort of a low-grade defibrillator). But last night my ticker "self-converts" or returns to its normal rhythm, so I am discharged today. Got an increased dose of metoprolol (which I take for the aneurysm) and starting on a blood thinner, Xarelto. Follow up with the cardio. I am apparently a somewhat rare patient in that I don't feel symptoms and don't know I'm in it, which requires extra precaution.

When talking to the cardio I mentioned an incidence in cyclists and he said "me." Says it's not unusual in "lifetime athletes." So I think he should be a good guy to work with. He thinks it's manageable and not limiting as to effort level (the medication may have a limiting effect of course).

He showed me a cool little device called Kardia where you can grasp two sensors, and with a smart phone app it tells you if you are in A-Fib and creates a data file you can send to the doc. I will ordering one, Amazon.

So The Beat Goes On ha ha.

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Sparky
Joined: 08 Dec 2003
Posts: 16693
Location: Portland, OR

7/7/18 1:37 PM

No surprise on the arrhythmia really. I am heading to the doc myself. Too many thousands of hours in zone 4 my friend.

Me, I get lower chamber fires early at the same time as the upper. So the next fire has a lot of blood to pump and I get the thump of that. Like you are skipping a beat, but premature firing in simultaneous fashion as the other chamber feels just like that.

As I get older it gets 'more worser-er' as my fitness for the season lowers my resting HR. And only at low hear rates I notice it. Although I do get the occasional 220 on the HRM which I used to think was a hardware issue in the HRM. Turns out the hardware issue is elsewhere.


Last edited by Sparky on 7/8/18 2:05 PM; edited 1 time in total

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daddy-o
Joined: 12 Apr 2004
Posts: 3201
Location: Springfield

7/7/18 2:08 PM

Three cheers for twentyfirst century medicine! Glad to see you were released ahead of schedule. Send the anesthesiologist a get out of jail free card or something.

BTW, how is the knee?

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dfcas
Joined: 11 Jan 2004
Posts: 2500
Location: hillbilly heaven

7/7/18 3:02 PM

Sorry to hear this dan. Surely this crap can't continue.

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lrzipris
Joined: 04 Mar 2004
Posts: 407
Location: Doylestown, PA

7/7/18 4:01 PM

Jeez, Dan, enough already! This getting old stuff is not fun at all. Good luck.

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Marc N.
Joined: 12 Jan 2004
Posts: 444
Location: Israel

7/7/18 10:29 PM

Jeez Dan

You didn`t have to go to all this trouble to prove to April that you introduce threads that are new and different. How about you deal with this and then let us return to the boring cycling/political content we are used to. Good luck!

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greglepore
Joined: 10 Jan 2004
Posts: 1632
Location: SE Pa, USA

7/8/18 6:28 AM

Yeow. I'm betting on Afib in my future as well. Good deal on the screws though, mine are annoying as heck, but there's like 15-20 in my radius, and they've been there for 8 years, so, nah.

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

7/8/18 7:40 AM

Thanks all

Marc, yes, I take my responsibilities as a content generator quite seriously.

Daddy, the post-cortisone knee is great - I don't even think about it, though I will keep with the PT.

While I have had quite a run of issues, I've also been very fortunate through this process. Latest example, if you're going to have a first episode of A-Fib, what better place than in a hospital (especially since I can't even tell if I am in A-Fib without checking my pulse). Also fortunate to have docs who don't mess around. I wanted to have the surgery (though not when I realized the risk), and I REALLY didn't want to be admitted, but they were having none of it, and they were right.

I wonder if cycling is a factor in not realizing the A-Fib. My hr was around 80-120 (up to a high of around 150) and it didn't feel any different to me than my normal 50s or 60s. However in cycling it's up in that range all the time, so maybe that's why I don't notice it.

One thing I've learned is that docs, particularly ortho and cardio, really like patients who are active and keep in shape. That is a big factor to them, an important part of your history, and they factor it into treatment.

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April
Joined: 13 Dec 2003
Posts: 6420
Location: Westchester/NYC

7/8/18 9:15 AM

“One thing I've learned is that docs, particularly ortho and cardio, really like patients who are active and keep in shape.”

Not ALL orthos. Plenty spent most of their time doing joint replacement on old couch patatos and considered being able to walk and lift a coffee cup as “success”.

“Good deal on the screws though, mine are annoying as heck, but there's like 15-20 in my radius, and they've been there for 8 years, so, nah.”

My first ortho doctor refused to even talk about removing the screws (and plates). He pride himself on “never had to remove the plate & screws for ANY of my patients”! Right! Since he categorically refuses to discuss it!

I had to go to the another who agree to have it removed. Even the second one asked me repeatedly “can you live with it?” “It” being reduced range of motion and constant irritation at activities!

Having it removed made such a big difference I don’t regret the second surgery. Also taught me not to accept “good enough for couch patato” result from some ortho doctors (ok, big city, non-active population)


Last edited by April on 7/8/18 11:03 AM; edited 1 time in total

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Sparky
Joined: 08 Dec 2003
Posts: 16693
Location: Portland, OR

7/8/18 10:17 AM

Just remember, the guy that barely graduated at the bottom of the class is still called 'Doctor'. ;)

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KerryIrons
Joined: 12 Jan 2004
Posts: 2927
Location: Midland, MI

7/8/18 11:01 AM

Xarelto

I took Xarelto for a month after the surgery to screw my broken femur back together. It had a noticeable effect - easier bruising, frequent nosebleeds.

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April
Joined: 13 Dec 2003
Posts: 6420
Location: Westchester/NYC

7/8/18 12:55 PM

"if you're going to have a first episode of A-Fib, what better place than in a hospital "

Not sure I quite understand it as such. It could be you were a-fib for a while but only discovered it when you got checked during the pre-op check? Or that you only had one short episode and it happened while you were in a hospital? If it's the latter, it's indeed the luckiest thing to happen. But it may not be the first episode...

I had a bout of abnormally high heart rate when I had an "attack" of hyperthyroidism. I had no "symptom" as far as activity limitations. In fact, I was riding better than I ever did! But it was when I was doing a heart rate check after riding that I discovered my heart rate was considerably higher than my usual and it didn't come down days after riding. And continued checking alarmed me to the fact the significantly high heart rate was NOT related to physical activity. That's when I ran to the doc and got the proper diagnose. Thank god. (I'm now in remission, hopefully for good)


Last edited by April on 7/8/18 6:31 PM; edited 1 time in total

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Brian Nystrom
Joined: 26 Jan 2004
Posts: 4163
Location: Nashua, NH

7/8/18 1:48 PM

Dan, do you wear an HRM when you ride?

If so, have you ever noticed any odd readings that might be a-fib related?

If not, perhaps you should consider it.

FWIW, my Ortho had no qualms about removing my hips screws. He knew I was active and that the heads would begin to protrude as the bone healed, causing sensitivity and irritation. He told me that a bursa would eventually form there, but I wasn't interested in waiting for that. His only caution was to be careful for a few weeks while the holes filled in. As I'm sure you experienced, the "screwectomy" was nothing compare to the original surgery!

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Sparky
Joined: 08 Dec 2003
Posts: 16693
Location: Portland, OR

7/8/18 2:07 PM

""if you're going to have a first episode of A-Fib, what better place than in a hospital "

I doubt that was the first episode, frankly.

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Tom Price
Joined: 11 Jan 2004
Posts: 428
Location: Rochester, NY

7/10/18 10:44 AM

My AFib is similar to yours, I do not notice any difference when in. I only would notice when I put on a heart rate monitor. I used to go in and out of AFib and had many cardioversions. They would last from a few days to a few months. There was one time when I was in for a cardioversion and the nurse had spent about 15 minutes prepping me for the procedure and then finally hooked me up for an EKG which showed a normal rhythm. She was not happy that she had not done that first, so home I went. I am now in permanent AFib and since I have few symptoms I have not considered an ablation. My resting HR is 68 up from 60 when things are normal. I take coumadin for my blood thinner and have very few issues with it.

There is a wide variety of AFIb so your situation may be different. I had a co-worker that had an extremely high heart rate when in AFib and he went in for an ablation because it was extremely uncomfortable. My doctor said that I loose about 10% of my heart volume when in AFib and that combined with the beta blocking heart med that limits my upper heart rate makes me about 20% slower when I ride (which is not much any more, mostly to keep my wife happy).

I recommend that you pickup a copy of the book that Leonard Zinn co- wrote "Haywire Heart".

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

7/10/18 1:24 PM

Thanks again

Well I can't say for sure it is the first episode, but I can say I take blood pressure frequently, which gives a pulse, and I haven't seen anything like 120 at rest, let alone for 7 hours. At the hospital they referred to it as "new onset A-Fib." I believe my pulse earlier that morning was normal. There may have been episodes before that were milder, who knows. I can remember a somewhat elevated pulse some time ago that lasted only a very short time. When the A-Fib was discovered, I'm glad it could be worked up quickly.

As to Xarelto, we'll see about side effects. The sheet I got said call the doc if you get easy bruising and nosebleeds. I haven't noticed anything yet.

Brian, I do have an hrm and usually don't use it, but I guess I will start.

Tom, I have a friend who is in chronic A-Fib, and another who was diagnosed in surgery like I was, and otherwise has never had a significant event. I'm impressed that there is a big range of severity. Just how to see how mine develops. I'd be happy if I can ride to my own max effort, whatever that might be. Glad yours is manageable and not causing significant symptoms.

My pocket EKG machine has been delivered.

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

7/13/18 5:56 AM

so far so good

Rode my bike into work today. Haven't had any issues.

The cool thing is I got my Kardia pocket EKG machine, which you can put in a jersey pocket and not even know it's there. With your phone, gives a medical quality EKG in 30 seconds. My first one showed normal rhythm, and the dread sinus bradycardia (low hr). Doh. Emailed it to my cardiologist. This thing is great.

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Sparky
Joined: 08 Dec 2003
Posts: 16693
Location: Portland, OR

7/13/18 9:58 AM

Pocket? do you have to take it out and use you fingers like the pics I am seeing? Or does it pickup HR otherwise?

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

7/13/18 10:31 AM

Pocket

I just meant it is pocket-sized. You open the app in your phone and put your fingers on the sensors, and it records and analyzes the EKG on the phone. So on your bike, you would have to stop for a minute or 2.

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Sparky
Joined: 08 Dec 2003
Posts: 16693
Location: Portland, OR

7/13/18 12:16 PM

Did you do, or consider the premium membership for the unlimited history et al?

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

7/13/18 12:30 PM

Premium

No, but I'll look into whether I think it's worth it.

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

7/27/18 8:23 AM

update

Followed up with the cardio PA for the A-Fib. I haven't had any recurrences. She says no restrictions, ride as hard and long as I want, travel where I want. For an isolated trip like Antarctica I would take along some extra meds, that's about it. I also have my pocket EKG machine, which works great. It's sort of a see what happens scenario, but expected to be manageable.

She said in a way I'm "between a rock and a hard place" because in the A-Fib episode my hr was high, but it's normally low so they don't want to give me too much of the beta blocker (which controls the rapid pulse). But overall it's better to be in shape. This situation my be common for cyclists.

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Sparky
Joined: 08 Dec 2003
Posts: 16693
Location: Portland, OR

7/27/18 8:33 AM

"This situation my be common for cyclists."

See my first sentence in my first post in this thread.

Good news none the less.

Any one on beta blockers here? I was reading in anticipation, riderbehom are take meds after ride. Performance stifled for some riding on recent dose prior to effort on bike/ride etc. Anyone here concur with this?

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Sparky
Joined: 08 Dec 2003
Posts: 16693
Location: Portland, OR

8/15/18 3:25 PM

I'll put this here.

My turn I guess . Sitting waiting to go in for an EKG and to be fitted with cardio monitor to wear for 48 hour sample. My heart had been kinda misfiring a lot of late. Except when i am riding, anything close to resting HRs a bit hay wire, way more the the occasional previously.

wired for sound now. ;) 7 leads

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dan emery
Joined: 11 Jan 2004
Posts: 6019
Location: Maine

8/15/18 6:42 PM

Good Luck

If you got it, better to know about it. Most of this stuff can be treated. Let us know how it goes.

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