Betting the Over
It has been three months since the ablation procedure. Since my last post, which was fairly optimistic, things got worse, and I got very discouraged. I fired off an email to my cardiologist, full of anger and desperation about how my heart was going dippy at the slightest provocation. He was sympathetic, and offered to start me on antiarrhythmic drugs. (You know what rhythmic means. Arrhythmic means the opposite, and anti-arrhythmic means the opposite of that. Why not just call them rhythmic drugs?) He knew I’d refuse, and I didn’t bother to respond to his offer. Then things seemed to get better, and lately, knock on wood, they’ve been pretty good again. I’m still avoiding anything high intensity, but I can do some light weightlifting, some light jogging, and some brisk walking, and my heart generally behaves itself. Sometimes I will have little episodes of an inexplicably high heart rate, but it doesn’t seem to be afib high, and it usually only lasts for seconds. I still get a flopping sensation in my chest now and then, but it is more like a goldfish and less like a 5 pound bass with a hook in its mouth. The best part about the three month landmark is that I should be able to go off of the blood thinners that I’ve been taking for most of 2018. The doctor is scheduled to call me any minute now, hopefully to give me the nod. That alone will make me feel less fragile. Less like a patient, more like a person.
For months I have cringed a little every time a conversation leans toward making plans for the future. Let’s throw a party. Shall we take a trip in the spring? Can we bring the kids home for Christmas? What do you want to do for your birthday? When I respond, a voice in my head inaudibly finishes every sentence with the subtext, “If I’m still around.” It reminds me of the game people play in Chinese restaurants, when everyone reads his fortune cookie and adds the phrase “In bed.” A chance meeting opens new doors to success and friendship. In bed. Ha ha. For months, my fortune has sounded something like, “Let’s go somewhere warm in January. If I’m still around.” Sure, we’re all going to die, but I’ve come to assume that in my case it is likely to happen any minute now. And it didn’t seem fair; I’ve worked hard to stay in shape, practicing healthy habits, eating healthy food, running marathons. I thought that should entitle me to a long life free of, at the very least, heart disease. I was dead wrong. We are not entitled to anything, and the universe doesn’t owe us shit. All of life is suffering, pain and misery, according to Buddha. He must have been a fun guy at a party.
I became a runner in the 60’s, tagging along with my father, who was an aberration in those days. Running, if you weren’t on a track team or you weren’t being chased by a bear, was plain crazy. Running as a recreational activity hadn’t really been invented yet. But something inspired my father to run, and he inspired me. We both kept running, sometimes together, right up until he was diagnosed with a rare, aggressive and untreatable cancer. I kept going without him. By then, the rest of the world was running along with me. Hell, bent-over old men and pregnant women pushing strollers were passing me by.
Right now, the medical profession is sifting through evidence that suggests running, if you do it long enough and hard enough, may cause you to have atrial fibrillation later in life. I didn’t see that one coming, for fuck’s sake. In the book Body By Science, the authors assert that running does not meet their definition of “exercise,” because it is an activity that undermines health, citing injury statistics, and progressive conditions such as degeneration of the knees, bone spurs, and chronic lower back pain. Running’s distinction as a “positive addiction” is perhaps becoming a dubious one.
The blood thinners that I’m taking give me a statistical advantage for avoiding a stroke. They are prescribed routinely after heart surgery, and before and after cryoablation. Three months post surgery seems to be the usual sentence. But some people with atrial fibrillation end up taking them for the rest of their lives. Doctors have a little paper and pencil test that they use with patients like me. It factors in things like heart disease, diabetes, age, history of stroke, etc. The lower the score, the better. A zero on the test is what you’re hoping for. I got one point, a point that was awarded to me after having an angiogram, where they discovered a slight narrowing of a very small coronary artery. The doctor had the option of doing a bypass at the same time he repaired my mitral valve, but it was so small that he decided to leave it alone. But even with one point, I am considered low-risk for having a stroke.
The mechanics of how atrial fibrillation and stroke are connected are less than crystal clear, at least to my naive and uneducated level of understanding. There is a suspicious structure in the heart called the Left Atrial Appendage. It is a small sack connected to one of the upper chambers of the heart, and it apparently collects (either accidentally or on purpose) blood clots. As the theory goes, when the heart goes into atrial fibrillation, these clots can shake loose from the appendage and enter your bloodstream. If they weave their way into your brain, you have a stroke. Sometimes surgeons will remove the atrial appendage, which gives the patient a statistical advantage for avoiding stroke.
I still have my atrial appendage. But having just received the call from my doctor, I am no longer taking blood thinners. As of today, what stands between me and a stroke is a low score on a test, and my doctor’s parting words: “I’ll keep my fingers crossed for you.” You can imagine how relieved I felt at hearing that.
I don’t know yet if my atrial fibrillation is cured, and I won’t know for sure for several months, when they’ll have me wear a heart monitor for 30 days, and will then decide if I’m good to go, or if I’ll need some other procedure. I’m not sure how much running I will do. My doctor advised me to “listen to your body.” My body seems to be dropping hints that it might be time to hang up my running shoes, at least for a while. I have been stubbornly ignoring it until now, but without the blood thinners, I have a greater incentive to avoid things that I know tend to trigger a wonky heart rhythm. In the meantime, perhaps I’ll plan a trip to someplace warm in January. I'm starting to think the odds are good that I’ll still be around.