Wednesday, April 6, 2016

Not how we planned to spend April Fools'

“Blessed are the hearts that can bend; they shall never be broken.” — Albert Camus

PAUL HAS had a wonky heart beat since he was a child. It would beat a few beats normally, skip a beat, beat a few beats and skip a beat. It was disconcerting, but since his mom had the same thing all her life, Paul mostly ignored it.

About three years ago, the uneven beating got more pronounced, so he went to a cardiologist who had him wear a heart monitor for a week and told him that he had atrial fibrillation. The doc said it wasn't bad enough to require treatment, but if and when it got worse, Paul should be reexamined.

Over the course of last year, it did get worse. He was having longer and much more frequent a-fib episodes and couldn't go up stairs without getting winded. He was scaring the bejesus out of me.

Paul and I went to work as usual Tuesday, April 29, and later he drove home to practice. I was pleased thinking about what a nice afternoon he would have at home immersed in music with the kitty cats to keep him company. That's not how it went.

Paul started having an a-fib episode that was worse by far than anything he'd ever experienced. It felt like his heart was going to explode. He got in the car to drive to the urgent care clinic, but he could hardly drive the twelve-block distance and had to pull over to the shoulder of the road. When he managed to finish the trip, he could barely walk from the parking lot to the clinic. He was sweating profusely and looked awful. They immediately called an ambulance that took him to Mercy Hospital ER in Des Moines.

I was at the office without a car because Paul's intention had been to come back to work toward the end of the day. Frantically I borrowed a car and met Paul at the ER where we remained for eight hours as they diagnosed and tried to get his heart to calm down.

As luck would have it, the cardiac doctor on call, Robert Hoyt, is an electro-cardiologist, exactly the cardiac specialty Paul needed — and as it turned out, not just any EC.

Here's a little from his curriculum vitae:

"Dr. Hoyt is board certified in internal medicine, cardiology, and clinical cardiac electrophysiology and is also certified by the International Board of Heart Rhythm Examiners. He is a Fellow of the American College of Cardiology and the Heart Rhythm Society,
 has written or co-written more than 100 scientific articles related to cardiac arrhythmias and has presented lectures and papers in North America, Europe and Asia. He has been invited to perform atrial fibrillation ablation procedures in Bejing, China and Madrid, Spain and has served as reviewer for the journals Circulation and Heart Rhythm."

Did I mention we were lucky?

What we learned is that Paul has two heart malfunctions: atrial flutter and atrial fibrillation that occur in two different parts of the atrium. He was given a medication while we were at Mercy ER to restore normal heart rhythm, but it didn't work, so the doctor and staff had to shock his heart back into rhythm. We were both scared out of our minds.

Turns out the Iowa Heart Center cardiac triage nurse working at Mercy ER
the night Paul had to have his heart shocked into rhythm is Chris Foster who is
good friends and neighbors with Jason Danielson, our extra-special jazz pianist friend.

Dr. Hoyt's recommendation was that Paul have a procedure called a catheter ablation to cauterize the malfunctioning areas of the atrium causing the flutter — apparently Paul has a "textbook" case of flutter; there were several enthusiastic comments made about how they don't often see such a "perfect example" of flutter (which wasn't nearly as exhilarating to us) — and then wait to see what treatment would be most effective for the a-fib.

Again, we were lucky. The soonest availability for the procedure with Dr. Hoyt was more than a month away; the soonest appointment with his partner, Dr. Campbell, was almost two weeks away, but a day and a half later, the Iowa Heart Center called with a last-minute cancellation for the following day, and April 1 Paul had the flutter ablation performed.

We lucked out again. There was a brand new instrument at IHC, and on the day Paul's procedure was performed, the manufacturer's representative from the company that makes it was on hand while Paul was being ablated.

Here's how the procedure goes: an incision is made at the groin and the micro-instrument is inserted and threaded up through the femoral artery to the heart and is used to make tiny cauterizations wherever the electrical current is freaking out. They cauterize and check, cauterize and check, cauterize and check and so on. Doctor Campbell made 86 cauterizations in his heart. 

It took a bit longer than it otherwise might have because in additional to having unusually long lungs — which every doctor who ever looks at his chest x-rays remarks upon (possibly an advantage to a brass player) — the isthmus of his heart, the area that was being treated, is also long.

Paul spent the night in the hospital, as did I, and he's been recuperating at home since, each day getting a little stronger. 

Although the ablation went well, the doctors won't know for sure if it was entirely successful for at least six weeks because his heart has to mend. It was initially unnerving for Paul afterward because he kept feeling weird things happening in his heart and assuming that the procedure had failed, but we now know that it will take a while for the scar tissue to form and his heart to settle down. The femoral artery is roughed up and inflamed, so is the heart valve, and the whole area of the heart that was cauterized is trying to heal.

This procedure only treated the flutter. He's on a medication for a-fib which he'll stay on for at least three months. Then we'd like to see what his heart does on it's own. If it turns out that he needs the medication, he'll continue taking it, and if we're lucky, he won't require another, more complicated procedure for a-fib.

The kinda funny/exasperating thing was that when IHC called to tell Paul there was a last-minute cancellation making it possible for him to get the flutter ablation done immediately (which Dr. Hoyt recommended because Paul was "pretty symptomatic"), Paul asked if he could call them back after he consulted with me. 

Why would he hesitate, one might rightfully ask! 
Because Paul had his busiest-ever trombone-playing week scheduled — eight performances, clinics or formal rehearsals in seven days. 

"Gee," he said, "I don't know if I can get subs." 

Guess what I said.

BTW: I swear if he were in a coma, all I'd have to do is bring someone in with a trombone to play a few choruses of something. He'd sit up and tell them that their G-flat 9 (or some such thing) was wrong. 

When he was in the twilight zone in the ER, induced by the so-called Michael Jackson drug, apparently Paul was chattering on and on to the staff about major and minor pentatonic scales. He told them that Dizzy Gillespie had just stopped by for a visit to demonstrate how using the bebop scale puts the chord tones on the strong beats. Yup, now we know for sure what's in Paul's subconscious.


  1. Oh my gosh! That's some scary stuff! Thank goodness it all seems to be working out. Let's hope the procedure worked and that he heals without incident. So far, luck has been on your side - may it continue to do so. Big hugs to you both.

    1. Yup, we were lucky, lucky, lucky to get Dr. Hoyt right off the bat. Thanks for the moral support.

  2. You both must have been terrified. I hope you fussed at him for driving himself to a care center. I worked with a lady who started feeling bad and decided to drive herself to the hospital and she ended up wrecking her car and dying from a heart attack.I'm glad your husband had a great doctor because a lot of what happens to you depends on what doctor happens to be on duty when you go to the ER.

    1. I'm thinking he may have learned that it's not a good idea to try to drive himself. Naturally I felt awful that he was alone!

  3. familiar. Hope he is doing better. I had both and both ablations. After the A fib mess up I went into A Flutter which is symptomatic and so is A fib at different times. The A fib catheter ablation I had first is where doctor ruptured my septum-hello! Ended up with cardiac shock, tamponade, and rising towards the light. Also, pacemaker, kidney damage, thyroid kill and mid brain stroke which took half my vision in both eyes. My feeling is A fib is like a river flooding...if one part is blocked it will sooner or later find another way back. Ask your doctor about longevity of procedure. Lots of diet changes can be made to alter A fib as well as anxiety and stress.

    1. Yikes, Lynn, YIKES!!!!!! If you see this reply, message me your phone number on FB. Paul might like to visit with you. We had already put ourselves on a diet about two months before this happened. Paul has lost 18 pounds; I've lost 14. He's 14 more to go, and I've got five.

  4. good to know I am not the only one who rattles on while under twilight sedation...I do an epic Ethel Merman, apparently. Hope Pablo is healing peaceably. I hope you are peaceable as well with Paul's recuperation.

    1. Ethel Merman, eh? I really wouldn't want to find out what I'd have to say under twilight sedation!

      I'm learning that there's a need for emotional recuperation as well as physical. Paul has been up and down, as have I. I feel a bit like an appliance who internal wires have been stripped of all insulation, and now they're arcing and shorting out and causing small fires. I'm emotionally depleted.

  5. As someone who was told several years ago that his heart is somehow abnormal, I can totally relate with this situation. It is nice to know, however, that those of us who actually trust our physicians today are actually often rewarded for our trust as you were. As to the music references, hey, your story would be less entertaining and light without it, right?

    Leonardo @ U.S. HealthWorks Medical Group

  6. I understand what's it like to have heart problems in the family. My father had heart problems for as long as I can remember, it can be so scary! I wish you and your husband all the very best and I am glad he's gotten fixed up and is feeling better. Best of luck on the road to recovery and a long happy life!

    Roman Dean @ Mac MGI