the thread of ATRIAL FIBBING

a month or so back i went for my six monthly asthma check-up: all fine -- a bit breathless, a bit overweight, but nothing to be alarmed about… except my blood pressure was unusually (tho not wildly) high… the nurse suggested i talk to the GP

a week later i saw the GP: blood pressure now more or less normal (the first reading seems to have been an anomaly)… but did i know i had an irregular heartbeat: i did not. he sends me for an ecg there and then and calls in another, more experienced colleague -- yes, atrial fibrillation, or AF, as everyone calls it. one of the chambers of the heart -- atrial is from atrium, latin for a large open space within a building -- is not pumping properly with the rest, but kind of fluttering quite fast… doing the work, but in the wrong way

quite common, in itself quite treatable -- higher risk of strokes, underlying causes can be sinister, need to look out for heart attacks

i had been feeling a little odd recently: in particular when waking up, a bit lightheaded, a but buzzy and fluttrry, as if the blood were thrilling in my fingertips (not quite tingling, i can never quite find a better word than thrilling, tho doctors look blank when i use it) -- was this related? maybe

referred off for blood tests (next day) and echo cardiogram (appointment a month away): warned to looking out for breathlessness (asthmatic, hard to spot), chest pains travelling to arms and throat -- if these occurred, call GP or at weekends go to A&E -- and keep the warning threshold low, better safe than sorry

OK: once you're advised to look out for chest pains -- for fear of a heart attack -- you notice a LOT OF SENSATIONS IN YOUR CHEST… plus i was intermittently feeling fluttery and odd, not bad exactly but not myself

the saturday following this GP visit, i felt distintictly weird with -- i don't know to call them -- not pains, certainly not shooting pains, but mild sensations of griping in my chest, mainly to the left of my heart… talking to NHS helpline (111); they asked a lot of questions abt symptoms (mostly negative) and go to A&E -- better safe than sorry

triaged at A&E (another ECG) and then a very long wait -- clinic is largely full of young people with amateur sporting injuries… i am not seen for some hours, probably because not instantly urgent. when seen, instantly given a disprin and CLOPIDOGREL to thin blood: diifferent kinds of decoagulant

describing symptoms to a doctor whose english isn't great: making her laugh when she ask "do you feel pain anywhere?" and i say "i'm 56, i feel pain everywhere"

hooked up to a heart monitor and left: monitor beeps trills with alarm whenever irregularity of beat gets too extreme; a nurse comes to turn the alarm off. One asks me if I’m breathing — I say, “What?” as I couldn’t quite believe the question and she says, “Computer says you’re not breathing but you must be, you’re talking to me,” and went off chuckling to herself.

Doctor comes back to take blood — as clumsily and painfully as I’ve ever had blood taken. Also unsuccessfully: she had to get a nurse to do it all over again (nurse rolling eyes and muttering “doctors,” at herself and a little at me). .More waiting: the curtain is drawn back so I can watch activity on the ward and occasionally hear my name mentioned. Lots of people in a desperate state: I’m feeling a bit of a fraud or a nuisance, though no one says so. Unsure if being let home that evening (main worry: I'm cat-sitting -- who do i call to dep for me and how to sort this out logistically, the key to my neighbour's flat is in my pocket). Also phone running low.

Sent for x-ray: wheeled there on my bad by a very chill and amusing porter who asks if i like going fast and pushes the bed down an empty corridor VERY fast, x-rayed by a very camp and anxious x-ray operator w/a big red hipster beard.

Shift changes: new nurse chatty comes on and explains stuff (inc.the wait). Doctor returns: all tests are negative, but my AF is fast (I was right to come in) and she prescribes DIGOXIN. Home again -- sleep better, thx to digoxin.

GP again: he affirms that all tests are negative (meaning no sign of impending or previous heart-attack, and some underlying causes ruled out). Chest x-ray also shows nothing sinister: apparently I have a blunted right angle -- but he seemed unworried by it. takes me off DIGOXIN and onto BISOPROLOL (a beta blocker, small dose at first in case it interferes w.asthma: in the event it does not) and refers me to a cardiologist. cardiologist visit is a bit of a frustrating dud imo: he talks mostly to himself, can't open his computer to see my relevant records (he's a locum), talks abt CARDIOVERSION (which the GP had been cautious about), which will need me going onto decoagulants and seems to think I shd have a much higher does of bisoprolol… mainly he's cross with me that the echo cardiogram hasn't happened yet.

(cardioversion is an electric shock to jumpstart the delinquent atrial chamber into synching with the rest of the heart: decoags bcz blood can pool in a fibbing atrial chamber and form clots, and the jumpstart can release it = risk of stroke)

so that is where i am: the beat-blockers are working well (i was a bit insomniac for a while but it's not a routine side-effect and may well have been pre-trump anxieties); echo cardiogram is next month -- then back to a cardiologist (i hope a different one) to discuss cardioversion or other treatment. i feel myself again, am sleeping properly, off all caffeine (and past the caffeine hangovers), dieting reasonably rigorously and planning to exercise more any day now (high-intensity work-outs are contraindicated lol), drinking only red wine now and then…

plus feeling a bit sorry for myself. and bcz i can't help feeling this was a bit self-inflicted (causes are various -- sometimes never determined -- but two likely ones are caffeine and being overweight and out of condition) (plus a month's stressing over that kickstater may not have helped), a bit guilty also :(

I wouldn't beat yourself up about the caffeine. The latest guidelines say it is unlikely to cause AF:

"Habitual caffeine ingestion has been investigated in several prospective cohort studies (Table 9), but these failed to show any significant relationship to incident AF.168 Also, heavy coffee drinking167 failed to demonstrate a significant relationship between caffeine and AF or flutter even in very high consumers (10 cups, 1000 mg/day). Overall, caffeine consumption on a habitual and regular basis does not seem to increase the incidence of AF."

By the way I interviewed a cardiologist who is an expert in AF the other day (I'm a medical journalist), and because both my parents have AF I asked him what I should do to maximise my odds of avoiding it. He said: control your blood pressure, control your weight, and if you have sleep apnoea get it treated.

Might talk to my GP about sleep apnoea -- not aware that it's a problem, tho i do get sleep paralysis now and then.

and thanks ZZ, i started t thread to find stuff out, not (just) to talk abt myself

good thoughts to you mark - let's hang out soon?

yes! (thank you)

good thoughts.

my father also has recently had some of those issues (faints, trips to the hospital, checks about two years ago) (there was a risk of irregular heart beat at some point too, but it was a kind of precautionary talk).

Anyway he has been lightly exercising regularly and is feeling much better, and has had to be very very disciplined about his diet (he has cut off ALL drinking)

POINT TAKEN

Atrial fibrilation is an area where "excessive" aerobic exercise appears to have harms. A number of cardiologists (most publically James O’Keefe) favor some moderation (1-20 mi/wk running equivalent, but not more) because of AF, hypertrophic fibrosis, and increased atherosclerosis in high intensity runners.

5 times more AF in athletes than non-athletes
19% more AF in those exercising more than 5 hr/wk

first reaction: i don't take tips from james o'keefe!
second: no danger here of excessive aerobic exercise tbh -- once my weight is down a bit and my asthma under better control i will explore stuff that's *gently* aerobic
(maddeningly the london fields lido is closed for refurbishment for the next few months: swimming is my usual outlet, with a nice brisk walk back and forth)

thx for links :)

I believe AF is often congenital, and many people have it all their lives and don't know it until it's diagnosed ... wondering if/whether you caused it or could have prevented it seems like a natural reaction but also a source of needless stress.

My father has been treated for AF for a long time and it seems not to have affected his quality of life very much (at 82 it's not at the top of his long list of medical problems). The blood-thinning drugs now in use seem to be much better and safer than what he was prescribed 25 years ago.

One nice aspect is that this is the one area of my life in which people routinely describe me as "young"! Admitttedly my GP -- who is literally 12 -- grinned a bit as he did so the first time, but it was still pleasing to hear, if unconvincing.

woke up at 6-ish with fingers tingling* again, first time at this degree since i went onto beta blockers -- v mild symptom in itself, but it's the one everyone i've seen seems to skip over, as in "oh, i don't know if that's linked" -- ok but something must be causing it, it only started a few weeks ago

*except this isn't the right word

consequence: tired all day, not got much work done, can't focus (this is lack of sleep but the fingers thing seems to cause that)

could maybe up my BB dose but shd probably check with a doctor first

ok so i just came back from my ECHO CARDIOGRAM

the nurse taking the reading sad: "apart from the arrhythmia nothing to worry about here, everything heathy and being kept under control, nothing running away with itself" -- i choose to read this as GOOD NEWS! the info will go back to the cardiologist i didn't take to and he will write to my GP and it will decided if/when i go onto to CARDIOVERSION

in terms of my self-care, basically the daily dose of beta blocker are effectively keeping everything chill, maybe twice a week i feel my fingers are fizzing and thriilling a bit and up the dose a bit

i am fully off coffee for three months more or less -- that one cup i had three weeks ago really made itself felt, and as it seems a bit daft to be necking beta blockers just to undo the effect of a strong cappuccino i will no repeat the experiment

alcohol: red wine seems fine (as per medico-urban-mythological factoid re heart health); beer's effect i notice a bit more so i will probably stick to red wine; anything wildly salty (like a large packet of crisps) seems to get my heart pit-pattering (though a good long slug of water seems to calm it down)

i am sleeping excellently (absence of coffee, who knew! beta blockers may also be contrbuting): literally for the first time in my life routine fast asleeply as head hits pillow -- i am more aware than i ever was of the degree to which yr heart responds to and contributes to matters emotional (which is obviously like DUH! given every document slurched out by the romantical-industrial complex but is still a surprise to notice when you have a condition novel enough to notice variation as it happens) -- life is just a never-ending forest of feels and yr organs are right in there working at that

so yes: next task, try and lose a bit of weight over xmas so the cardiologist doesn't make more unkind comments i guess

oh, also: i am definitely more physically tired at the end of the day than i'm used to being -- presumably bcz my pore wee heart is not currently able to oxygenate my blood so effieicently, one chamber is pumping much more to less effect

^^^possibly also the absence of the energy-shifting effect of coffee is contributing to this feeling -- viz i am no longer waking up tired and sluggish, which was pretty routine when i was highly caffienatated

ps you get to hear the magnified sound of yr own heart with an echo cardiogram, and in my case a more unconvincing and indolent arrhythmic squelch it is hard to imagine :\

belated update: two saturdays ago i fainted in the bathroom, banging my head quite sharply on the edge of the bath as i fell -- i spent the afternoon in A&E being checked out

conclusion: no concussion, and incident semi-unrelated to AF -- i have also suffered from VASOVAGAL SYNCOPE all my life (proneness to to faint: going through puberty i was toppling over like an automated ninepin) and apparently it has a tendency to return in middle age. it occurs bcz the body is not able to regulate blood pressure with the swift exactness it's supposed to (so e.g. it ends up in yr legs not yr head when you stand up too quick?)

probably -- this was my sister's suggestion (she also suffers from VS, plus her partner has AF) -- the beta blockers slightly exacerbate the tendency to sluggish regulation, so i shd take it seriously when i feel dizzy and not just sit down but LIE down, with legs elevated if possible…

ffs! :/

Hope you're keeping well since then, dude - a friend of mine has a proneness to proneness brought on by having a wee - this is only amusing for everyone else.

yes i've been fine since, no recurrance, and the doctor i saw talked me through the various triggers, so forewarned is forearmed (that particular one i don't seem to be cursed with)

i was actually a lot less bothered by fainting itself -- i am kind of used to it, tho it had been several years since the last time it happened -- than the fact of the bang on the head (a dimension i somehow always till then avoided)

the worst injury i sustained as a teen was fainting on the way to a music lesson with a schoolfriend after i turned my ankle stepping carelessly off a kerb (sharp pain was my primary trigger as a kid). i came to with my face pressed onto gravel and my pal kicking in the chest to "wake me up" -- he assumed i was kidding around, i think

i brushed myself off and limped into the lesson

CARDIOVERSION scheduled for 20 april: an electric shock to restore proper hearth rhythm

(i need to lose a bit of weight by then, i feel)

rescheduled for 18 may (and above post shd read "heart rhythm", my hearth is in good working order beats-wise)

mild irritation re poor communication between hospital/consultant's office and GP: when i first get an apoointment for this procedure, former tells me i need to be on anti-coagulants for a minimum of 6-8 weeks in preparation -- i get a letter (which i know also goes to my health centre bcz i copy and post it; i imagine it also arrives at my heath centre via the shared computer link but probably doesn't actually ping onto anyone particular's desk alerting them to this request re anti-coag)

after a week or so not hearing anything i call and leave my GP -- actually the trainee GP who originally saw me -- a message to call me, which he does the following day (he's not in every day). i ask him about prescribing the anti-coagulants: he says it's probably less complicated if i talk to the cardiology department about it, which i do

they say they'll send the request through to the health centre

i hear nothing for a few more days and ring up my GP again: he says "oh that.s naughty of them, what they should do is book you into the anti-coag clinic [or similar, i forget the actual term he used], where this is dealt with" he looks for and finds the request -- says "ok, maybe i should prescribe this directly from here, i'll just check with my colleagues if that's ok" -- which he does, fairly swiftly, so that's ok, i can pick the meds up the next day

we also both now spot that the 6-8 weeks has -- in all this fiff-faff -- been fairly sharply cut into (20 april is exactly six weeks from today) so if i do need to be on them the full whack, it's already too late. he says "maybe ring up the cardiologist and re-book"

which i do, and it's fine -- but basically the only reason any of this was sorted was me being the go-between between the two offices, which i feel is not how it's meant to work (viz if my english was poor or if i didn't have my mum's scepticism abt the ability of professionals to do the common-sense bits of their jobs better than me)

(tbf my gp is lovely -- if young -- and i enjoy talking to him; and ditto the person on the phone in cardiology -- the consultant was a bit of a twerp but with luck i will be under anaesthetic during my next dealings with him)

my mum's scepticism was abt the ability of professionals being to do the common-sense bits of their jobs better than HER: she generally thought i was also p bad at this kind of stuff)

update: after a suggestion from my sister's b/f -- who has the same condition and is on the same meds -- i switched the time of day i take my beta blockers from morning to evening

as a result i am MUCH LESS TIRED during the day (in fact back to normal), bcz my tired period as a consequence of the beta blockers coincides with actually being asleep (and in fact i sleep really well)

(i was told to take them in the morning initially bcz they sometimes affect ppl w/asthma, and also some ppl feel nauseous -- my GP felt i shd be fielding these reactions during the day when i could go into the health centre and not in the middle of the night when i'd have to go into A&E -- but as i am not having either reaction it seems an unnecessary precaution) (plus also switching them to evenings is clearly working better)

Glad you're feeling better; I'd missed this thread til now. I can back up the evidence that mid-50s are not for the cowardly!

switching your beta blocker to nighttime is fine -- your tiredness may be simply related to decreased exercise tolerance, a common side effect of beta-blockers (even B1 selective drugs like bisoprolol), especially in people like you with underlying pulmonary disease (asthma). as an added bonus, there is even a little bit of literature indicating a mortality benefit from nighttime vs daytime use of antihypertensives (which include beta-blockers), though the evidence is not terribly strong last i checked

the "thrill" you feel in your fingers is actually very likely due to the AF -- when the heart is in AF, the cardiac output (a measure of how well the heart pumps blood around the body, especially the sites furthest from the heart such as the fingers) is lower due to the dyssynchronous beating. do your fingers often feel cold? this also explains your recent passing out episode (blood wasn't being pumped effectively to your brain). lightheadedness is a very common symptom of AF, and it's interesting that you mention that you've had fainting spells in the past, as you've likely had paroxysmal AF for quite some time. be sure to take your bisoprolol regularly!

being put on digoxin initially is peculiar - this drug is rarely used for AF these days

honestly if half of the people in the world were as up to speed with their medical conditions as you are, we'd spend a lot less on health care. if you're looking for a good reference, UpToDate's beyond the basics series is a really good resource for patients who care to know more about their disease and have a reasonable degree of health literacy. you can check it out here: https://www.uptodate.com/contents/atrial-fibrillation-beyond-the-basics?source=see_link

cheers k3vin, that's all extremely useful :)

if anything the finger "thrill" is more like they're warmer than they ordinarily would be: it's not a numbness -- it's a bit like the way yr face sometimes feels when you're quite drunk, that you can feel it more than you should be able to (which is overdilation of capillaries maybe?)

i did used to suffer from cold fingers as a kid (not helped by living in a v cold house and having to do lots of musical instrument practice in unheated rooms) but i wouldn't especially say i do now

i also suffer from easily putting my leg to sleep by sitting on it like a kid, slightly awkward in an office when yr hobbling around trying to get the blood back into it, and everyone else in the office is younger than you

(which is overdilation of capillaries maybe?)

i mean the face is when yr drunk, i don't see how the fingers would be

after a week or so of much better response to the BBs (as taken in eve not morn) inc actually reducing my req dose to minimum suggested, a couple of days of increased fizziness and sleeplessness (necessitating, as i am on self-imposed deadline re introductory essay to my anthology, a COFFEE today, the first in maybe ten days) (i really have been good abt coffee considering the volume i've drunk in the last five decades)

cardioversion is on 18 may: everyone is saying supersafe procedure, back at work the next day etc -- even so i am trying to get the book in proper order before i go in

Best wishes for the procedure.

be supersafe, mark.

cheers guys :)

All best Mark.

Timothy Gowers, famous mathematician, blogged his mathematical reasoning as to whether or not to have catheter ablation surgery for his (much later stage) AF: https://gowers.wordpress.com/2012/11/05/mathematics-meets-real-life/

cheers mick, that's interesting and useful

(mr gower is i am pleased to see still blogging five years later, which is also reassuring)

My stepdad had that procedure in 2004 after an irregular heartbeat was diagnosed after he nearly died from pneumonia. He was a very heavy boozer and has cut it down since then, but still spends a lot of time in what he calls the fun-house (it's a casino!) playing blackjack, moderately boozing and having the odd cigar. He walks a few miles to the Town library to read the papers every morning. He is definitely in better shape now than he was 13 years ago, so it must have done him some good.

"that procedure" = cardioversion or catheter ablation? (which is next on my suggested list, if the cardioversion doesn't take after a couple of tries)

there's also an ablation where they insert a balloon into yr arteries and blow it up which is apparently 👌🏽 😜 👌🏽

meanwhile the oblique strategy i just turned up = "go to an extreme, move back to a more comfortable place" which seems on-point

He had the cardioversion, which I think caused him a lot of angst at the time. He said it was no biggie afterwards.

Good luck mark, hope yr up and at 'em again in no time

Good luck with the oblation/ablation, me and the kitten golems will be think good thoughts for you tomorrow!

thank you! i should be out again by the afternoon and able to be back at work again the following day acc.the medical profession

(tho lol to that, i am going to stay with my sister and be pampered over the weekend instead)

Good luck dude, thinking good thoughts.

Yeah good luck man

PAMPER ON MY FIBBING FRIEND

Take care! I mean, you are doing, so just keep on with that!

ok so the excellent news is that i am up from under anaesthetic, out of hospital and down in hastings being pampered by my sister and her family -- i have to do nothing strenuous for two days which is FINE BY ME :D

the more boring news >:( is that the cardioversion did not work -- they stopped and started my heart three times but like the apostle paul it three times denied me so in c.6 weeks time i have to talk to a new consultant abt the next step ("he's electrical" acc.today's cardiologist, who also told me my "heart is stubborn") (which i am not entirely astonished to discover tbf)

anyway glad to be back in one piece (i feel fine except for a routine weather headache i've had all day, not shifted by being knocked out for 60 mins or electro-jolted apparently)

congrats on remaining alive, commiserations on having to do it all again

glad yr feeling good! what's the next step likely to be mark?

he now has moved on from filing me as a music teacher to believing i am a professional songwriter who loves the beatles

LOL

i raised the sleep paralysis thing (viz is there any knwon connection) but as the last question in a longish consult over the phone it didn't get much discursive attention, i will ask again when i next see him face to face

apparently there is a link with sleep apnea but im p sure i don't suffer from that

a thing happening a fair amount is that i'm being woken from very-mild-peril dreams by the racing of my heart

i know this can happen to anyone -- ie is not necessarily a symptom of the condition -- but does indicate to me how much stress i'm probably processing unconsciously, and how much (if it hadn't been for the flutter as a fact) i would be saying serenely to myself that i'm neither stressed nor anxious

ie i am very good at hiding my anxiety from my conscious mind, setting it in the background somewhere -- but it is churning away still

new cardioversion on 22 june, maybe this one will take and also keep

my dad has some afib experience following heart attack at 60. ablation, cardioversion, etc. he's read extensively about it and has also had some occasional sleep paralysis - but doesn't connect the two (I asked him) and hasn't heard of a link. doesn't mean it isn't connected in your case of course! he reckons his afib recurs mainly due to posture and the vagus nerve, an idea that medical people apparently refuse to discuss.

crossing my fingers for 22 June btw!

I have palpitations sometimes and also get sleep paralysis when I nap - never wondered about a connection but this is interesting.

best of luck to you mark, hope it all goes well.

Yup, best of luck!!

update: in and out in hours, cardioversion successfully returned heart to proper sinus rhythm for the time being, everything very routine and straightforward, sorry not to report sooner but i was still quite tired yesterday and basically just looked out of the window all day lol

my p-waves are back baby (for the time being)

glad you're back in rhythm and hope you're less tired today?

https://www.youtube.com/watch?v=8WG118J4XlU

(note trumpet playing cowboys)

so i had a phone appointment with my consultant but as they had failed to organise an ECG beforehand there was literally nothing to talk about (i also attempted to organise the ECG -- as i managed to get one last time by battling for it myself -- but this time no dice)

i expressed my irritation abt this in the appointment and got a long lecture abt we're in a pandemic and nothing is working properly but also an acknowledgment that i was basically right to be frustrated: he suggested we switch the appointment to the royal free (where he also gives clinics) since they are now opening up to face-to-face, and since i am gong to be in the building i will be able to get a walk-in ECG beforehand (the same way it used to work before COVID)

i just got my appointment date from the royal free: it's in december (fine, i'm not really in a hurry i guess) and… it's a phone appintment

royal free's contact structure includes me being able to send emails to change appointments -- which barts does not -- so i have done this

so to catch: they caught my request abt the december appointment needing to be face-to-face and changed it -- but then at the last moment the pandemic clamp came back down and it was postponed

four months later it has not been rescheduled -- tho i am copied into to a request earlier this week from one dept to another to action this (i will chase it up next week)

i also went into my health centre last week for my various routine yearly tests: blood pressure was high and everyone went scrambling, the nurse said i had to talk to a GP. well i did -- but it was a GP who i've had before and liked (very thorough and matronly) but this time she seemed scattered and flustered, a mixture of bossy and distracted, asked me questions but only half-listened, did some hurried tests which were all fine, and eventally agreed that the best thing was to up my BISOPROLOL to see if that had any effect and to check in with my actual real GP (who i never see) if it stays high.

she also quizzed me about coffee. well the consultant has always said coffee is nothing to worry about (re the atrial flutter) but maybe BP is a different matter? so i said actually it's time i took a break from caffeine and/plus also i shd maybe shd some of my extra lock-in pounds vcz they probably aren't helping.

i don;t even drink much coffee now but this has been the toughest caffeine withdrawal i've ever been through, i'm still achey (head and muscles) eight days later and have the mildly feverish hot-eyes thing -- tho i am sleeping better. (i did a lateral flow case just in case but at least it's not THAAAAAAT… )

plus it took me ages to find my BP meter, i'd put it in a dumb place and i then kind of wanted not to test it until the caffeine was out of my system, so i waited until yesterday. BP still higher than it should be -- which of course immiedately started making me anxious, like every twinge is thet start of a heart attack. a couple of years back a nurse identified that i have "white coat syndrome" with regard to this procedure -- as if the electronic hum of the BP monitor secretly stresses me and drives up my reading. she always did it with an old-school hand-pump monitor and got "better" (lower) readings. but i don;t have a hand-pump monitor plus i always find it a bit of a scuffle getting the stupid in the correct position on my arm, which is ANNOYING and probably also raises my BP lol.

anyway today my pulse was a little lower -- below 100 -- but too high still for calm and normal. the thing is, this is the first time it's been checked for at least six months and it may have been high for AGES (i'd stopped checking bcz of the white-coat thing and just assuming i had an upcoming appointment and so on). when i was talking to the GP last week i was basically feeling absolutely fine. i'm feeling a bit rough now but i think it's 2/3 caffeine withdrawal to 1/3 ramped-up anxiety.

it's a bank holiday tomorrow, i will take it easy and then call my *actual* GP (who is good but i never actually see) on tuesday. maybe she will send me into A&E like happened in sept 2019 -- i thiiiiink i am fine (“heart rate ain’t nothin but a number” per the cardiologist in the hospital i wd be in, see upthread) and i am not keen to be on a ward at all (i am double-vaxed and boosted but the boost was five months ago)

cant have symptom w/o typos

mm typos

i was off caffeine for a lot of last year after my last procedure (which was successful for a while then reverted)

but over xmas i had two big editing projects and i just always cave and start the day with coffee when i'm editing: the upside we all know and love, the downside is ambient headaches and sluggishness first thing, combined with mild fatigue from the beta blockers (tho i was only only a low dose of beta blockers most of last year)

a second downside -- it belatedly occurs to me -- is that i tend to dose my headaches with paracetamol (acetaminophen), not in vast doses per day but pretty regularly, and i believe long-use paracetamol is sometimes asssociated with high BP? if cutting out caffeine also means cutting out paracetamol (as it generally seems to) then that's probably a good move, tough as it always is

(actually tbh i've stopped finding the fatigue from the beta blockers such a problem, so that's something i guess)

Did any med tell you to cut caffeine? I've never had one do that, never found any studies to support the idea, more like this just now (usually minus the weasel disclaimer at end):

Research suggests that caffeine isn't a cause of abnormal heart rhythms or atrial fibrillation, and drinking four to five cups of tea or coffee a day shouldn't increase your risk of developing coronary heart disease either. However, the effect of caffeine will vary between people.

Drinking caffeine with atrial fibrillation - British Heart Foundationhttps://www.bhf.org.uk › ask-the-expert › af-and-caffeine

And sodium of course, which is one sneaky ingredient.

no the caffeine decision was purely mine, not a med suggestion: and my reasoning is the headaches and the sluggishness -- plus possibly the side effects of the paracetamol i take to tamp down the headaches

i know from previous experience that once i properly kick it i can cut out painkillers altogether (i also know from previous experience that i can only kick it for a few months at a time but)

sorry you've had a rough few days, mark, how are you feeling now?

my mom has AFIB (and I'm pretty sure I'm not many years before getting it myself), her doctors have told her to limit caffeine, she says she can tell the difference if she only has one cup of coffee (sometimes half a cup of regular mixed with half of decaff), rather than a few. So hopefully cutting back will help you, although if your withdrawal hasn't stopped you could taper rather than cold turkey? My worst ever headaches were when I was in uni and taught at a summer camp; I had a strong cherry Coke habit and went suddenly to no pop at all, couldn't figure out why these stupid kids were giving me a headache everyday and finally realised it was cold turkey from caffeine.

generally fine yesterday, mildly headachy this morning (day 11) -- monday was very bad but i think that was a weather migraine sneaking in there lol (difft bit of my head)

it's not like i was even drinking very much coffee any more, there's nowhere really to taper to! tiny little cups? plus i know myself well enough to know that tapering won't work where cold turkey actually might, at least for a while

Another alt to cold turkey/tapering: Sometimes when I've needed to temporarily abstain, I've found that my body can be fooled or satisfied by the taste etc. of decaf--dunno if this would work long-term, though.--

think i'm over the hump cold turkey-wise -- it definitely took longer than usual

i went in for a blood test yesterday and the nurse told me to contact her if my blood pressure remains high; i'm meant to be seeing my own GP about all of it but (bad timing) she is on holiday till first week of may. i think i probably need the dosage my BP meds (RAMIPRIL) to be raised. also i need to talk to my cardiology specialist abt my raised pulse rate (ideally without being sent to A&E in the interim, which i want to sidestep for COVID reasons if possible) (this happened pre-COVID, basically a needless stay in hospital i feel) (see upthread for the tale… )

(i don't really want to be seen by the doctor i saw a couple of weeks ago, i find her very confusing to talk to)

just aced my blood pressure check lol yay

health centre pharmacist then describes symptoms of high blood pressure (= headaches) and of low blood pressure (= fainting when you stand up): naturally i suffer from BOTH of these most of the time

also she said “you’re still very young” — ok then, yes that's correct i am

anyway i have booked a big "where we are now" face-to-face with my GP next week to talk abt all my many ailments and how they interact and what i shd do abt them (this is partly bcz if i am moving out of london and away from this i think unsuually good health centre i am going to be gambling with the kinds of NHS uselessness that e.g. colonel poo rightfully decries -- better get the good stuff while i still have good access)

nice to hear this mark.

have you done any looking yet at what's going to be available near you?

not yet no :|

might not be a long piece of research lol

nice possibly final visit (since i’m moving out of london) with my primary GP of nearly 40 years, just to have a face-to-face to jigsaw together the implications of all my ailments: for which the answer is mainly (a) re the topic of this thrread viz my high pulse-rate get my cardiology consultant to move his ass and give me a rescheduled appointment (she thinks more ablations are pointless but says he's the one whose knowledge counts and i will likely have to change meds somewhat as BISOPROLOL is evidently not doing what it needs to

as for my asthma more exercise and lose a little weight lol. the headaches are “stress” headaches (ie who knows what causes them, maybe just the state of the world) and (she is old-school) paracetamol is fine in moderation and not implicated in blood pressure (which is now back to normal). i’m booked for a hearing check re my tinnitus and try epley exercises for my labyrinthitis. anyway she is a good wise person (actually my favourite GP at the centre even if i nearly never see her) and i will miss her

i mentioned the *other* GP i saw a few weeks ago to my sister (who was also a patient at this centre for many years) and she laughed and said "she always made me feel i was being told off" -- which, well, true, me too, but i guess i kind of feel i deserve to be told off so it doesn't really register

maybe stress headaches in part from getting more writing-editing gigs, also re health and considerations of moving from London---maybe try this very basic form of meditation I read about, which is sitting for 20 minutes not thinking about much: I tried sitting on bench by front door of library after hours on a short day, mostly sheltered from the evening sun, but with a glow around the frame, just the occasional passing car, although I did sneak peeks at my travel clock, will try to do better about that ("trying" all this keeps some tension in there but I've only started these breaks).
My tinnitus long ago became part of the environment, and occasionally I think I hear crickets. Having doctor remove ear wax helped (don't try it yourself, though there are kits). Easy on the headphones for a while after that.

in the end i wrote a letter to my cardiologist, one copy to barts and one to the royal free (he does consultation at both) to point out that i was due a rescheduled appointment after the pandemic cancellation in december and it was now something like eight months?

anyway i got a reply and now have an appointment in november -- that's quite a gap but tbf i haven't been suffering or i'have made more fuss

meanwhile in jab news: i got flu *and* my covid booster this afternoon 💉💉

i: an old lad in the packed waiting room was quietly looking at facebook or youtube or whatever on his phone and got ambushed by a VERY LOUD advert screaming at him for not satisfying HIS WOMAN and he needed [such and such a pill, didn't catch its name despite volume] which is SIX TIMES MORE POTENT THAN VIAGRA etc, anyway he found the off button eventually
ii: the pharmacist pronounced it "omnicron" (am i a dick for find this funny? yes i am) (same question-answer to part i)
iii: afterwards he said "i strongly advise you to eat a banana! this will deplete your energy!" i asked did he mean in the next ten minutes or later today (i was already on my way to MS afterwards) and he said "over the next two weeks!" -- which again made me laugh (no one strongly advises you to eat a banana in the next two weeks). luckily i had my mask on so no one spotted i am finding them funny: apparently my being-a-dick levels are off the chart today

my original anti-COVID jab and the two boosters were both pfizer and i had no symptoms at all (ditto the time i tested positive with the thing itself); this was my first dose of moderna so it wd absolutely serve me right if i get the works, we shall see

I thot it was omnicron! Let's all go to see allll thee timelines at the Omnicron.

turns out that eating bananas is good, when did i forget this

they gots potassium, also they taste good (to me)

ketchup inc.minor downstream implications

so after asll the faff i scored an appointment w/my nice consultant in mid-november, at which it was decided to put a pause on further procedures for the time being: my fib has calmed down into flutter (viz the aberrations form regular rather than wild-party patterns) and my resting pulse rate is only *exactly twice* a normal pulse rate (c.126 instead of 60ish). but as i have no other symptoms we decided let's just observe for the next six months and decide the way forward then

so far so good, except today i was in for a bunch of tests and a chat with the consultant anaesthetist abt an entirely unrelated procedure: not urgent -- the condition is a minor inconvenience tho i cd do without it -- but also something the meds think is worth tackling. tests all fine and i have a letter from my cardiologist to say "yes i know his pulse rate is twice what it should be, here's why that's no emergency", which helps orientate the student that does the ECG.

anaesthetist also talks through all of this and explains the best kind of anaesthetic for the surgery (spinal not general) and what that entails (off blood thinners for three days, longer if there's bleeding afterwards, as there might be). strongly advises i do sleep studies to see if i have sleep apnea (i don't think i do but he's the specialist). and then says he thinks given my heart condition that i'm probably high risk in the context of the surgery being explored, and he's going to postpone it until he's talked to my cardiologist. since there's a chance of clots and embolisms and also just general heart chaos courtesy the anaesthetic. "and we wouldn't want that" -- well no we wouldn't

i was planning to postpone it anyway as i'm in the middle of moving house and it feels like too many things at once! so this isn't a catastrophe. but it is the first real-world consqeuence of the condition since they admitted me (in 2019? see above) for a week, for racing pulse…

I think you can do sleep studies now in the comfort of your own home so that's a plus

i asked abt this and they said no it's in the hospital

If you do have surgery, the anesthesia may make you lose some words for a while: they'll say Oh Noes, what could it be, better run some neurologicals---but (judging by the experience of several friends & relations in recent years), it may well turn out to be anesthesia---if they can't find any other cause and the condition is temporary, that is. Can last up to 3-4 weeks, at least it did for a couple of the people I know who were affected.

better safe than sorry obv but i've actually been under full general anaesthetic since the fibbing began -- albeit for fibbing related procedures so i guess they have the heart under close observation throughout

and they didn't involve sharp cutting knives which this one in a small way would

hope this goes well for you

waiting for a phonecall from my health centre following up on the letter the anaesthetist sent to my GP, which fingers x-ed is just admin

meanwhile ATRIAL FIBRILLATION was trending on twitter this morning -- partly bcz it's apparently stroke prevention day (tbc i am in favour of stroke prevention) and partly bcz thousands of anti-vaxx numpties are busy screeching that AF is caused by the jab (clue: it is not)

oh the letter arrived at my house also, he thinks i am at risk of sleep apnea and wants me to take a sleep studies test -- which fine, sure, w/evs

Believe me, taking one and getting CPAP was a game-changer for me!

yeah it made a big difference for mr veg also

Same for me - especially helping with racing heart in the middle of the night stuff.

turns out -- six months later -- that i have no significant sleep-disordered breathing tho i do have "severe snoring" lol, sorry neighbours i can't hear it and it doesn't affect me

quick atrial update: despite ongoing adventures with vertigo lol, my annual check-up went v well -- the consultant (the same cheery guy who i have now seen in three sepeatre hospitals, barts in smithfield, the royal free in gospel oak and this time in fkn ENFIELD) (nice shiny modern building tho) was v positive: my heartrate may be a bit faster than all you sad normies but i am otherwise reassuringly asymptomatic (viz this higher rate causes me zero distress) and he thinks no further procedures are necessary at this stage 👍🏽👍🏽👍🏽👍🏽

(not even sure what these procedures wd acually be: more cardioversions and ablations? on towards a pacemaker? anyway, we not going in that direction yet)

(i have a friend whose grandad had 18 !! ablations and lived into his mid-80s so i am chill either way, tbh i just want a quiet life and life in plymouth is exactly this, between the world-historical storms anyway)

Hooray! (but sped up so it doesn't sound like whalesong to you)