Wednesday, June 8, 2016

One Year Post-Op, So Was It All Worth It?

I know I'm actually 13 months post-op at this point, so I apologize for not posting this sooner, however, I have a good reason. Thursday, April 14th I had my one year follow-up with my Cardiologist, and let's just say things didn't exactly go as I anticipated at my appointment. I was actually waiting to post this until I had heard from my Cardiologist (I'll get into that later), which I finally did, last Tuesday.

So let's rewind back to March, about three weeks before Easter. I was at my Grandparents for the weekend with my family, and it seemed like all of a sudden, out of nowhere I was going in Bigeminy.  Bigeminy is when you have one normal heart beat and then an abnormal heart beat and the cycle repeats itself until it breaks, or you're able to break it with various maneuvers.

The runs of Bigeminy were consistent throughout the weekend. Though manageable, they didn't make me light headed or dizzy, so I wasn't overly concerned. The cycles of bigeminy eased up a bit, but my Cardiologist still wanted me to have an Event monitor. It's a long (irritating) story that I don't need to get into, but I was not able to get my Event monitor. Thankfully (or not, depending on how you look at it), my coworker had palpitations at one point during her pregnancy, and one of the Cardiologists we work with had bought her a Kardia (by Alive Cor) handheld EKG monitor.

(Alive Cor monitor and Kardia App)

The pocket EKG (as we'll call it), allows you to attach the finger plates to the back of your smartphone (I didn't since it's my friends). Once you download the free Kardia app onto your smartphone, you're able to record 30 second rhythm strips, and save them to your phone within the app. My coworker asked me if I'd like to borrow it, and I jumped on the opportunity. Since my runs of bigeminy had eased up, I really didn't have anything to record, but I set it up anyhow.

Let's just say, boy, was I thankful that I did! About a week before I was set to see my Cardiologist (Saturday, April 9th to be exact), the runs of Bigeminy came back with vengeance! That day I had given a lecture of interesting Echo cases at a sonographer symposium, and everything was fine. That evening I was relaxing with my friends at one of my favorite restaurants in State College when they started back up again. The runs would come and go throughout our entire dinner. I didn't eat much, and I just kept taking deep breaths to try and break myself from them. I  was tired, and wondered if that could be the cause. I also didn't have the Alive Cor with me, so I couldn't record any of the tracings. 

The next day after I returned home, I threw myself on my couch to try and relax, but the runs of bigeminy kept coming, so I grabbed the pocket EKG, and decided to give it a try. It worked! That evening/night and into the next day I recorded 33 rhythm strips to show my Cardiologist. Unfortunately, due to the arrhythmia, I didn't get much sleep (which was extremely frustrating considering how tired I was).

(Sample of my Bigeminy from the app)

Thursday rolled around and I headed to my doctors appointment. I had been looking forward to this appointment because my doctor anticipated that I would "graduate" to one year follow-ups after this visit. Once my cardiologist came in, he asked me how things were going, and we discussed my palpitations. I showed him the rhythm strips on my phone. As he scrolled through them, he commented that as a group, the physicians had discussed buying the Alive Cor monitors for the department. He was impressed with the quality of the rhythm strips on my phone and seeing how it worked. We discussed the possibility of putting me on a Beta Blocker to try and get me some relief from the palpitations, but first he wanted me to get an echo to see how things were going since I was there in October.

If you remember correctly, before I went to my 6 month follow-up, I found out my valve was already leaking. During the echo, Cathy and I chatted, and I watched as she did my study. The regurgitation didn't appear to be any worse, so that was reassuring. She finished my study, and then went to make sure she had all the images she needed. She came back in and took few extra pictures, but I didn't think anything of it. 

After the echo, we met my Cardiologist back in an office visit room to discuss the results of the echo. My Cardiologist asked me what I thought of my echo, and I mentioned I didn't think the regurgitation was any worse than it was in October. What he said next, I was not expecting. He said the valve leaflets were already thickened and narrowing which was something he didn't anticipate as the valve was, at this point, just under a year old. He also said the gradients across the valve had increased since the last echo (makes sense since it was narrowed). He said he wanted to take my echo to one of the surgical conferences just to discuss the case and see if any of the other physicians had seen this before.

That being said, we also discussed options should the valve continue to progress in this direction. At the time of my appointment he didn't feel it was necessary to act on anything just yet, and he said once he spoke to the other physicians and surgeons that he would call me to discuss further. Then we revisited the bigeminy that I was having. I told him I felt comfortable trying out a low dose Beta Blocker to see if it gave me relief of the symptoms. He agreed, and told me to start off with one pill a day, and if I didn't feel any relief of my symptoms within a few weeks, to increase my dose to two a day. Easy enough. Then he told me he wanted to see me back in 3 months, since the valve was progressing in the manner that it is, he wants to keep a close watch on it. So much for thinking I was going to "graduate" to one year follow-ups. I left my appointment feeling discouraged, but there was nothing I could do about it.

A few weeks went by and my Cardiologist called me to tell me he hadn't had the opportunity to present my echo yet, due to the high volume of cases that needed to be reviewed. He reassured me he hadn't forgotten and that he would call me as soon as he had the opportunity to discuss the case. He asked me how my runs of Bigeminy were going, and I told him they had improved, but not resolved entirely, and that I was considering upping the dosage to two a day. He agreed and thought that would take care of the few I was still having. He also told me that the Beta-Blocker and dosage he prescribed was so small and specific that it should not give me any adverse side effects.

Finally last Tuesday, my Cardiologist called me to discuss everything. He told me the other cardiologists and surgeons agreed that the valve was progressing at a faster rate than expected. He said a few others had seen this, however, it was rare. At this point he does not want to be aggressive, and he doesn't believe we need to be. He said that, if down the road, we need to take action, he said many people do well with an Angioplasty type procedure in the Cath lab, where a balloon pops open the leaflets and allows them more mobility without increasing the degree of regurgitation. At this point he still wants to follow me closely, just to see if things stay the same or continue to progress. With that said, he did want to get a closer look at things, so he said he was going to set me up for a Cardiac MRI, and told me his secretary would call within the next few days to set it up. He said I could do it at anytime, but wanted it before my appointment in July.

(Example Cardiac MRI)

He then asked me how my Bigeminy was, and I told him that increasing the dosage had improved them, and that I only feel them on a rare occasion, and he was happy to hear that. He asked me if I was having any other symptoms other than the bigeminy, and I said no, not that I had been aware of at least.

The next day the Children's Heart Center called me to set up my Cardiac MRI. The woman I spoke to then told me that she was looking at September. A little stunned, I told her my Cardiologist wanted it before my appointment in July. She then said, "well he told me to get you scheduled for our first available." She then explained to me that the MRIs are done by someone who comes from Syracuse, and he only comes to town one Thursday a month. So, I'll just have to wait and have him give me those results over the phone when the time comes. I've never had a Cardiac MRI before (that I'm aware of), so this should be interesting.

Overall, I'm feeling slightly discouraged, but in the end, I would have needed a valve eventually. My Cardiologist reassured me that I'm still doing well. He didn't place me on any restrictions, as long as I'm not having any symptoms, in which case, he'd want to see me back in his office sooner than July. We'll just have to wait and see if there are any changes on my echo then, as I patiently await my Cardiac MRI. On a more positive note: Someone is always having a worse day than me, and I'm reminded of that daily at work. At least I'm still on this side of the dirt. ; )

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