Let them eat cake

In 1960 a song by Peter Sellars and Sophia Loren became a surprise chart hit.  Apart from the refrain it has, thankfully, all but disappeared from my memory.  It’s from a film in which Sellars plays an Indian doctor and Loren, a millionairess.  In the song Loren describes how her heart behaves when she’s with Sellars.  If you’re of a certain age please feel free to join in; “it goes, boom boody-boom boody-boom boody-boom boody-boom boody-boom boody-boom-boom-boom” (repeat).  Really.  I find it hard to believe that this song was produced by the very same man who went on to produce Eleanor Rigby.  I guess everyone has to start somewhere.

At around 6.00pm on Monday 13th June, my heart starts beating out a not too dissimilar rhythm (though not, I might add, stimulated by thoughts of Peter Sellars).

For about a week after Ablation my heart behaves in an impeccable fashion; steady, not too fast, delivering just the right amount of oxygen to the parts of my body that need it.  Life is good.  Positive thoughts knock at my door – “come on in” I beckon.  Prior to the Ablation I would have dismissed them with the response I usually reserve for Energy Supply salesmen who call offering to “lower my tariff”.  On Sunday, Annie’s eldest, Chris, brings his bike round for some TLC (he’s taking part in the London-Brighton charity ride).  As I get out my fettling tools I become quite envious of his new Lycra shorts and swear on my torque wrench to ride my bike the very next weekend.

Having spent much of last week being pampered by Annie, I go back to work on Monday morning full of the joys of Spring, looking forward to getting back into the swing of things.  Since June 2010, when my heart and vocal cord went the way of my lung, I have spent more time on sick leave and annual leave than I have actually working.  I’m beginning to feel like the new boy again.

I arrive home before Annie so have a wee nap on the sofa before preparing supper.  A small slice of carrot cake, left over from the goody bag she brought into the JR, staves off the pangs of hunger.  This seemingly innocuous confection may turn out to be significant in what follows.

When I awake my heart is beating fast.  It throws in extra beats and then misses a few.  Not unlike a drummer I once knew.  Climbing the stairs to retrieve my Oxiometer leaves me gasping for breath.  I read the discharge notes very carefully; irregular and/or fast beats are common for a few weeks after Ablation ‘and will settle down’.  If it’s a full-blown tachycardia though, it’s off to A&E.  My heart rate is around 105bpm so I decide to wait and see what happens.  I should have read the small print.  I missed the caveat on the 90% success rate; ‘… but it may involve more than one session of treatment’. 

My initial response is more despair than panic.  It’s not life threatening.  It is however uncomfortable and debilitating.  And it changes everything.

So what’s the cause, the trigger?  The carrot cake is a possibility (although I’m clutching at straws here).  I was all right before I ate it – not all right afterwards.  Simples.

There is a link between eating and the heart – the Vagus nerve is part of the nervous system managing, among other things, digestion as well as regulating heart rate (see A Change of Heart, March 2011).   When we eat, blood is diverted to the stomach and so the Vagus nerve has to ensure that the heart is still able to satisfy all the other demands made upon it.  Damage or compromise this nerve in some way and things can go wrong.  And it seems highly likely mine was damaged during lung surgery – putting my finger in my left ear still induces a cough.  (Note to new readers; trust me on this one – it’s a long story).  Of course you can also mess up your heart simply by eating too much.

Perhaps Marie-Antoinette knew a thing or two about the Vagus nerve – it might well be that her response to starving peasants –“let them eat cake” was a cunning ruse to dispatch large numbers of the populace in one go, in an attempt to prevent the French Revolution.

I read the small print again.  Atrial Fibrillation is common after Ablation.  I recall the cardiologist who referred me for Ablation therapy in the first place, saying that mine was not a straightforward case; Flutter usually arises in the right atrial chamber while Fibrillation usually arises in the left.  My Flutter appears to jump across from right to left.  Huh. Typical.

By Tuesday my resting heart rate is down to 90bpm but it’s still jumping around.   Work is a very different experience – I’m sluggish all day and struggle to concentrate.  I’m close to dozing off while reading a document on my computer.  Although that could say as much about the subject as it does about me.

Annie listens to my heart – she’s getting good at this; “it’s definitely not in sinus rhythm.”  She’ll be wanting a stethoscope next.  Although she can’t tell if it’s reverted back to flutter mode – we’d need an ECG for that – she has confirmed that it’s not in its normal steady mode.

We both share a new concern – if the Ablation has not worked this time, how do I get it fixed?  It will be 3-4 months before I have a follow up appointment and if I have to go through the normal waiting list it could be next year before I get a second chance.  I park the voice issue to one side; no point in getting wound up about it now.

The discharge notes suggest phoning the cardio-ward at the JR in case of any queries.  My voice has all but gone so Annie phones on my behalf.  The nurse on duty explains that ‘normal’ fluctuations are short-lived – although the episodes may occur for up to 2 weeks after treatment, they shouldn’t last more than a few hours; “if it lasts more than 24 hours, we’d be concerned”.  It has.  They are.

The nurse talks to the on-call doctor and comes up with a plan – I’m to arrange an ECG at my GP surgery and get the results to the JR.   And they’ll take it from there.  Nurse; “tell him to take it easy”.  Annie; “he’s been to work today”.  Nurse; “(sigh) what can you do with them?”

It all works like clockwork.  I have the ECG late Wednesday morning and in the afternoon a call from the JR confirms that everything is hunky dory – my heart is back in sinus rhythm.  They confirm that additional (ectopic) beats and palpitations are common after Ablation.  If it happens again – and lasts for 24 hours – then I’ll need to go through the same process again.   This is fine because we’ve established a mechanism for communicating quickly that seems to work.  Thank you GP surgery and Oxford Heart Centre.  In the meantime I stop eating cake.

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