X-1

It’s all getting a bit too complicated.  I know this because the heart-nurse says, “you’re a bit of a complication”.  Annie thinks I’m Friday afternoon model.

I’m at the hospital for the pre-voice op assessment.  After my previous visit to the Cardio department this should be a piece of cake.  But it’s not – my heart rate is 140bpm.  Now they have to go into a team huddle and confer; the decision to go ahead will be decided by the anaesthetist not Mr ENT.

It started beating fast again just over a week ago.  About 6 hours in fact after this photograph was taken:

man and bike and sea

We’re in North Wales with Annie’s sister and her husband.  We’ve just completed a 10-mile bike ride – hard work but I feel fine (despite the missing leg).  But during a meal in the evening I start coughing on a piece of bread.  The heart goes into overdrive.  As it doesn’t stop after a few days I see my GP again.  He uses a ‘finger pulse oxiometer and heart rate monitor’ to check my stats.  It’s about the size of a clothes peg and slips onto my finger.

He gives me the results of another recent test while waiting for the monitor to stabilise. I’ve been passing blood and he decides on a PSA test “just in case”.  The results suggest it’s more likely to be the remnants of internal bleeding caused by the Warfarin rather than something sinister in my prostrate.  As we talk my heart rate drops from 135 to 80bpm.

Is it anxiety? – witness the numbers dropping in response to my immediate relief.  Then it shoots back up again.  Perhaps my subconscious is already thinking about ‘false-negatives’ – anticipating my return home when I Google ‘PSA results + interpretation’.   Too many ‘what-ifs’.  Chill out man.

He calls it “paroxysmal tachycardia” – sudden increase/decrease in heart rate, with no obvious cause.  Last night it was so bad I couldn’t breathe when lying down in bed.  I had to sit up all night.

To increase the dose or not to increase the dose – that’s the question.  My GP is not sure – he wants to wait to see what transpires at the pre-op assessment.  The issue, as he sees it, is that increasing the dose lowers the heart rate but also lowers blood pressure.  And if it the heart rate drops while I’m on a higher dose, my blood pressure could fall too low.  I decide to get one of these finger meters and keep a diary – to keep track and to see if I can discern any obvious trigger.

As I begin the pre-voice assessment I mention that my heart is a bit fast.  There are two nurses in the room – a regular assessment nurse and a heart nurse who sits in “on cases like yours”.  The heart nurse lets out an audible ‘hmm’ when she sees the numbers.

They are both very helpful and sympathetic.  They agree that the voice procedure is a priority – the failure of the vocal cords to close properly needs to be eliminated from the list of possible causes for the tachycardia.  They’ll see the anaesthetist and explain that apart from cancer treatment, heart problems and a dodgy voice I am a specimen of perfect health (i.e. – no adverse history, no obvious underlying causes and no contributory habits – so should be able to deal with the demands of a general anaesthetic even with a rapid heart rate).  As luck would have it the anaesthetist is the bike-riding one I met last time.  I suggest playing the bike card.

They arrange an extra ECG – with the additional printout my GP can decide whether or not to increase the beta-blocker dose – at least until the operation.  Then the heart nurse comes up with a masterstroke – she’ll suggest that while I’m unconscious I undergo another cardioversion at the same time – a sort of 2 for 1 offer.  This is how to increase efficiency in the NHS.  Two procedures for the price of one.  Every little bit helps.

I see my GP and he agrees to increase the dose.  But it’s to little avail.  There’s a message on the answer-phone from the hospital.  The anaesthetist clearly does not share the optimism of the assessment nurses; he has decided not to go ahead. Not only that – he’s written to the Cardio department stating that the heart must be fixed first, not the other way round.  Not wait until the problem settles down.  Wait until it no longer exists.  So the voice is on hold yet again.  And so, in effect, is the heart – because Heart Doctor No. 3 has already written to Oxford cancelling/postponing the Ablation.

I feel suddenly so helpless.  I have one team of heart doctors telling me I don’t need Ablation and another team telling me I do.  And no one telling me what will happen next. Other than “someone will be in touch with you”.  Who decides?  When do they decide? How do they decide?

It all seems a matter of luck.  A couple of weeks ago my heart was deemed perfect – and that coincided with the availability of a free slot on Mr ENT’s list.  I have to wait for these to coincide again – it’s a bit like the Ancients waiting on the conjunction of the Planets – it could be millennia before this happens again.  Which is all the more ironic because as I sit in the GP’s surgery waiting for a new prescription my heart rate is 87bpm.

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