Post Ablation Day 1

I finally got to see Sam around 11:30pm with his mom. He was still very groggy and in a lot of pain. He said this ablation was more painful than the one in May. He had a great night nurse - Ramone who was in his room constantly to check his blood levels at this groin site. Once it dropped below 200 he was going to remove the tubes and apply a 10lb sandbag to clot the site.  I left the hospital in the early morning hours and came home to get some rest and his mom stayed with him. At around 6am he was able to get up and walk around and try and put some pressure on his groin. However, soon after walking around in his room he started to bleed and was sent back to bed for another 4+ hours.

[The sandbag that had to lay on Sam's groin to clot the blood at the site]

Dr. Wong came in to see Sam around 1:30p today and wanted to explain to him everything that he was able to do during yesterday's procedure. He drew on Sam's patient board and explained how he went in and worked on his heart. Looking at the photo below - the atrium with the arrows is the right side of his heart. This is the side that they fixed back in May and is still blocked and after testing isn't showing any signs of active signals. The side with the dots is his left side and that is the one where Dr. Wong spent 6 hours ablating. The total number of ablations done in Sam's heart was between 300-400!

[Dr. Wong's drawing to Sam as he explained to him what he did inside of his heart]

Dr. Wong was able to use a new devise that is able to chart while he is catheterizing. It shows him how effective the ablation is and measures the tissue to see if it was destroyed enough to build a block in his heart. This is something that wasn't available back in May for his procedure. The Dr was confident he ablated all of the triggers on the left side of his heart. On the right side everything was gone for good BUT he did see some Atrial Flutter after inducing his heart back into an arrhythmia and it came from the right side. However, it was mysterious and he couldn't find the source... with the left side being fully ablated there are no triggers to feed off of the flutter should it come back. 

Next Steps:

We have a follow-up appointment with Dr. Wong in January. At that time he will be taken off of all of his arrhythmia medications and placed on a 30 day heart monitor. If there are no issues seen on the heart monitor he will discontinue the medications for good. If for some reason there are still issues within his heart we will re-evaluate at that time. 

We agreed with the Dr today that the next time we are leaving Royal Oak Beaumont it will be with our baby in March/April 2013. 

For now Sam is shuffling around for the next week... 

 

Post Ablation Update

We arrived at Beaumont Royal Oak at 10am this morning. After checking in at the registration counter we headed up to the 8th floor central tower to the same waiting room as his other procedures - Schlafer Cardiology Center. They took Sam back right away to start his prep and came for his mom, dad and I to go see him after he was ready. They had taken blood work in the prep area and his potassium was elevated to 5.9 (a normal range is 3.2-5). Dr. Wong was concerned and ordered a redraw of his blood work. If Sam were to be under anesthesia and they were ablating with the elevated potassium level it could cause a lethal level of arrhythmia issues (his words not mine). After 7 pokes and 3 nurses the anesthesiologist was able to get his 2nd blood draw for his potassium level. It came back normal and at Noon they whisked him away to start. 

Around 3pm one of the nurses Kathy came out to update us - They had incubated him at 12:15pm and made it to the left side of his heart (again this wasn't an easy task and took about 30-40 minutes) and started to map out the left side. Dr. Wong was going to start ablating the heart using his 3D mapping while she was out talking to us.

[Image is of a heart being mapped... I couldn't obtain Sam's specifically but this google one gives a good idea]

At 7pm a familiar face came in to update Sam's mom, his cousin Jeff (in from Florida) and myself. It was Ann, the same nurse that we dealt with in May and it felt like deja vu. As like May, we were the last family in this waiting room and she was coming to give us an update and let us know it would still be a few hours... Dr. Wong had triggered Sam's heart into Atrial fibrillation/flutter and was trying to get it under control by continuing to ablate the left side of his heart where the hot spots were active. The spots that he ablated on the left in May were now active - hence causing this disruption in his heart. Again this is very common to have to undergo two ablations to get the actual arrhythmia issues corrected. Ann also mentioned that they are being very careful around his esophagus - as when they are ablating it can get too hot and they do not want a hole to form in his esophagus. 

At 8pm Ann came back out and said they have ablated the left side of Sam's heart and have now gone back over to the right side to map it to ensure that the flutter/fibrillation that should be corrected on the left goes to the right to become active. They did notice while mapping that the original ablation areas on the left are still doing great but they did find some activity in the top part of his right side that Dr. Wong was addressing. 

At 10:30pm Dr. Wong finally came in to see Sam's mom and I and talk about the procedure. After 10 hours Sam is in the recovery room and we are waiting to see him.. Dr. Wong said they spent most of their time on the left side of his heart  but he feels confident he got all of the signals. Dr. Wong even tested Sam's heart after completing the left side to ensure arrhythmia issues wouldn't occur after all the work he had just completed. However, while working on the heart he found something mysterious (he is really using some crazy words today)... all of a sudden his right atrium went into atrial flutter. It was very difficult to detect as it didn't appear in the same circut that they corrected in May (and it should have). However, After corrected and triple checking both sides he couldn't get it to replicate again - hopefully its left his heart for good!

I have filled my day with day time TV in the waiting room, stalking facebook, pinterest, work emails, texting/talking on the phone with friends/family, coloring and visitors... what a long day! Just counting down until I can see Sam and talk to him... more to come tomorrow!

Ablation #2 Scheduled for Tuesday.....

We met with Dr. Wong on Monday, August 27th for Sam's 3 month post-ablation update. Despite the fact he was running late and by late we mean almost 2 hours behind... the original plan for this appointment was for Dr. Wong to take Sam off all of his arrhythmia medications and put him on a 30 day heart monitor to see how his heart was doing after healing for 3 months. However, after we finally got to see Dr. Wong he decided against his original plan. Since Sam hasn't had too many episodes lately he didn't want to mess with his medications and cause something to go hay wire. Which we both appreciated.

Sam is having a 2nd ablation on Tuesday, October 9th at Beaumont. Dr. Wong is confident this should correct all of his arrhythmia issues once and for all. His plan of attack for this procedure is to successfully ablate the left side of Sam's heart. We are very hopeful he is right as this procedure comes about a month before his 1 year post-op mark. Dr. Wong mentioned the night before he plans to get 12 hours of sleep, eat a couple bowls of Wheaties for breakfast and be ready for another long day. I am looking forward to another hospital slumber party, hoping this one goes a little faster and we can finally put Sam's heart arrhythmia's behind us.

Stay tuned...

Cardioversion

Rewind....Last week Sam started to get atrial flutter again and this time it wouldn't go away. His heart rate was over 130 beats a minute and we went into the doctors office last Wednesday, July 18th. Usually an extra dose of medication would bring his heart rate back down but that hasn't been working. Sam had an EKG done and met with Dr. Wong's nurse - Carla (Dr. Wong was out of the office when we went in). She looked over everything, examined Sam and texted Dr. Wong with the details of what was going on with Sam. Dr. Wong believes the atrial flutter is coming from his left side of his heart since he had fixed the right side of the heart in May. Sam was advised to increase his motoporal - taking an extra does if needed and to come back for a cardioversion next week.

[Sam's rhythm and heart rate prior to cardioversion]

A cardioversion is when an abnormal heart rate is converted via electricity (being shocked). Doesn't sound very appealing and I did ask how many shocks one's heart could take in a day.... 12! Unreal right!? One pad is placed in the center of the chest and the other is placed in the center of your back. These are connected by cables to a machine which functions as a electrical defibrillator. A synchronizing function allows the cardioverter to deliver a reversion shock, by way of the pads, of a selected amount of electric current over a predefined number of milliseconds at the optimal moment in the cardiac cycle which corresponds to the R wave converting the heart back into a normal sinus rhythm.

Fast Forward to today... we arrived at Beaumont at 6:30am and checked in for Sam's cardioversion. I started to get flash backs when we entered the waiting room as it was the same waiting room I waited 11 hours in for his ablation back in May. They took him back for prep and I was finally called back at 7:45am to see him. Dr. Wong was running late so I sat their cracking jokes and filling him in on all the other people their and my people watching information from the waiting room. Dr. Wong came in around 8:15am to talk to us and explain what his goal was today and for the future.

They took Sam into the lab and did a TEE first to ensure there were no blood clots around his heart and then performed the cardrioversion (only once) and then he was back in recovery. I made Dr. Wong promise me it would in fact be this short of a procedure given his track record. I went back to the waiting room and after 15 minutes Dr. Wong was already back to see me.. I was shocked! He said he was back in a normal sinus rhythm and in recovery. Music to my ears. Now this is not to say this all happens again but I am remaining positive and calling in a favor to the big guy up stairs to give us a reprieve. We were discharged at 11am and headed home for Sam to nap all afternoon from the anesthesia.

We see Dr. Wong for a follow-up appointment on August 27th and are sticking to the 'original' plan of taking Sam off all of the arrthmya medications and monitoring his heart for a month on a heart monitor. However, Dr. Wong is being proactive and is already requested his 2nd ablation be done in October so that he can ensure the heart doesn't have any other arrthmyia triggers. He is confident

Stay tuned....the beat goes on.

Ablation Updates

Its been almost a month and half post ablation and I am sorry for the delayed update! This thing called life gets kinda crazy at times. Sam's first week home was spent taking it easy as he was very sore from the long procedure and was starting to feel the burning sensation in his chest from all of the ablations. What hurt him the most was his arms/shoulders - since in the operating room they have you flat on the table with your arms out straight the entire time. Dr. Wong had decreased Sam's arrhythmia medications prior to us leaving the hospital.

For a few weeks post ablation Sam didn't feel any arrhythmia issues like the atrial flutter or atrial fibrillation he felt before the procedure. Things didn't feel "normal" but that was due to the trauma his heart had been through and part of the healing process. However, a couple weeks ago Sam started to get atrial fibrillation again. Needless to say it was disappointing for him despite the fact we were told it may take several ablations to fully correct the issue. It was a speed bump in the healing process but luckily Sam was able to take an extra does of his medication and it stopped. Which is a VERY GOOD thing since before the procedure the medication wasn't working anymore and he was on the highest dose he could take.

The goal is for Sam to be on the decreased dose of the arrhythmia medications for 3 months and come in for a check-up at the end of August with Dr. Wong. At that time he will have an evaluation and some standard heart tests run. From there they are going to put him on a 30 day heart monitor (always enjoyable for Sam). They want to see how the heart is doing post-ablation but AFTER its had time to rest. If the monitor shows everything to be in good working order he will be able to stop taking all of the arrhythmia medications and the blood thinner. [Fingers crossed]

 

Sam's birthday is this Saturday so he is currently deeming it his 'Birthday Week'....we are going to enjoy our summer and we will keep you posted during the recovery process.

Day 1 - Post Ablation

Late last night and into this morning Sam and I were rehashing what Dr. Wong told us and going through all of Sam's aches and pains from being on the table for so long. The first thing to really bug him was his arms. His arms were extended and tied down during the procedure making them incredibly sore for him. I would periodically get up and try and massage them to keep them from cramping up. Sam had to lay flat all night in order for his groin to start to heal up before he was able to sit up or walk. 

Sam's nurse would come in every hour and check his catheter site for swelling, make sure a hematoma didn't start to form and checked his blood to see if his level had dropped below 190 in order for the tubes to be removed. He was able to get them removed at 3:45am. A few nurses came in to do this and after the tubes came out the charge nurse had to apply pressure on his groin for 30 minutes to ensure the 3 small holes would clot. However, since Sam was placed back on his blood thinner medication right after he woke up it wasn't that easy for the sites to clot. At 4:30am the nurse was able to alleviate her pressure (her fingers were numb) and place a sandbag on Sam's groin (sounds so great right?). The sand bag had to stay on for at least an hour and then he wasn't able to get up or move his bed until 8:30am.  Needless to say there wasn't much sleeping during all of this as they had to do constant vital checks and incision area checks. I finally fell asleep in my upright hospital chair in the most ridiculous position at about 6am - I think I was annoyed there was nothing going on with Facebook and had run out of things to do. Sam & I both got about an hour of sleep (it felt pretty amazing). 

Just before Sam was able to get out of bed I ran downstairs for some much needed Starbucks and got him some fruit and breakfast items from Papa Joe's. At 8:30am his nurse came in and he was FINALLY able to get out of bed and stretch - he was mad at the midnight nurse for not even letting him move just a pinch. Once he got to finally walk a bit he felt a lot of pressure off of his chest and started to feel a little better. BUT since he was flat on his back from 11:30am 5/31 to 8:30am 6/1 his right butt check was blessed with a sore from not being able to move. This currently hurts Sam more than his groin and made making him comfortable a real challenge.

We got home around 4pm and spent about an hour trying to find the right pillows and positions on the couch for Sam to be comfortable. He finally fell asleep after all of the adjusting and I was able to sneak in a few winks as well. We were told by the discharge nurse that tomorrow will be the peak of his pain - he will start to feel a burning sensation in his chest from the ablations and overall feel like he played in traffic. He isn't allowed to drive until Sunday and isn't allowed to lift anything over 10lbs for a few days. I on the other hand have been building muscle by assisting him up and down.

We have switched sides of the bed to make it easier for Sam to get in/out. His incision sites are occasionally leaking so I have been changing his bandages frequently. Its really difficult when he is on blood thinners and they want these small holes to clot but he has to keep moving... sigh. 

I am currently listening to him snoring so I am going to try and get some sleep before he needs help with something in the middle of the night. Good Night!!

Post Ablation Update

I am not even sure where to begin... I can start with neither of us anticipated what today turned out to be. We arrived at the hospital just after 9:30am and Sam went back for his surgery around 11:30am. It was supposed to be 4-6 hours but turned into 9+ hours of surgery. The staff was fabulous and came out and gave us updates every 1-1.5 hours. Dr. Wong himself even came out around 3pm after he had finished the right side of Sam's heart. Needless to say today has been longer than his open heart surgery was in November. It was just as stressful and I felt less prepared.

They went into the right side of his heart first to correct the atrial flutter that he was currently in. The Dr was successful in ablating part of the circuitry on the right side of his heart. He then continued the ablation until he formed an electrical block around the right side. They look for spaces within his heart (kinda like a where's waldo) and once they find them all they ablate, recheck and repeat.

Then things got tricky... what should have taken 30 seconds for the catheter to get from the right side of the heart over to the left side took 40 minutes!! Sam's heart is still very enlarged which made it difficult for them to go around his atrium along with his veins being very small. (common due to his surgery still being fresh and from the arrhythmia issues he has been having). Dr. Wong tried to use x-rays and other devices to see inside to assist in guiding his instruments however, they didn't give him the clear images he was hoping for. They did however see that his heart is contorted - this could be from being so enlarged or from the trauma of his open heart surgery in November. As Dr. Wong described it to us "I was lost with no map and had a foggy window".... scary to think about when you are talking to someone that was dealing with your husbands heart! Basically when guiding the catheter from the right to the left side he was completely blind and hoping for the best. If he went too far one way he would have made a hole in his heart, if he went too far the other way he would have gone into his aorta and thankfully he went just the right way and got through to the left side. 

Now that they finally made it to the left side....They checked his veins to see if they were the "triggers" for his atrial fibrillation and they all checked out normal. They did however find multiple "hot spots" on the back of his left atrium. Whenever they went over these areas his heart went "CRAZY". Dr. Wong was able to ablate all of the hot spots and also build fences around his veins in hopes he created blockages around them for the future. 

Both atrial flutter and atrial fibrillation can cause your heart to enlarge or stay enlarged until those rhythm issues are fixed. Dr. Wong said 1/3 of heart valve surgery patients have to undergo ablation surgeries. We are hoping in Sam's case over the next three months his heart will finally start to shrink in size and fix its contortion.

After we finally got to speak to Dr. Wong - Bonnie, David (a close family friend) and I headed down for some much needed food making phone calls/texts along the way. We were told Sam wouldn't be awake for at least an hour or so however, my cell phone rang in the elevator on the way up to his room and his little groggy voice was calling me from his room to see if we left him - I don't know if he will remember this later. 

Sam is in pain and still laying flat - we are hoping his catheter tubes can come out of his groin in the next few hours. I am hunkering down for a long night at the hospital in another uncomfortable hospital chair. 

Happiness is hanging out together ... even if its in the hospital on our anniversary :)

(I got the below figurine for Sam and gave it to him in his room after his surgery)

We appreciate everyone's thoughts and prayers - they mean so much to us. I will keep you all updated tomorrow!