I Can Feel Your Heart Beat

I’m coming up on the three month anniversary of my heart surgery.  I’m excited about this, because it means that I get to stop taking blood thinning medicine.  On the other hand, today I was fitted with a heart monitor, which I have to wear around the clock for thirty days.  It isn’t the end of the world, but it is annoying and inconvenient, and compels me to wear a fanny pack, something I’ve managed to avoid since the early 90’s.

The blood thinners are routine protocol after heart surgery.  By thinning the blood, they reduce the chances of a blood clot finding its way to a useful organ, for example the brain, which would be bad, as well as annoying and inconvenient.  The medicine comes with problems of its own. You have to regulate your diet fairly carefully, and eliminate certain foods like leafy vegetables, sardines, liver, green tea and natto.  Yes, I get it--some people might not have a problem living without most of these things. But wait, there’s more. Your skin becomes fragile, and a casual brush up against a rough surface can cause a wound that bleeds for days.  A fall can cause a nasty bruise at best, and internal bleeding is a possibility. For me, on most days, I see traces of blood when I blow my nose. I can’t shave with a razor blade. Flossing my teeth is risky.

Now I’ll  be able to participate in activities like pruning roses, playing with cats and whittling.  Not that I ever do any of those things, but now I’ll have the choice. I’ll be able to eat big salads again, maybe enjoy a deep tissue massage without fear of bruising, and have the occasional bowl of hot rice with natto. Should I stumble and fall on a hiking trail, which I have a tendency to do on occasion, I’ll no longer assume that I’m going to die from internal bleeding.

Just after my surgery, my heart had problems keeping a beat. It had a tendency to “flutter,” which sounds cute, but it isn’t.  My heart rate went way up, my blood pressure went way down. They gave me medicine for this while I was still in the hospital. It worked--my heart took up the beat like Buddy Rich--and they weaned me off the meds. Then my heart fluttered again, for a whole weekend, and they put me back on the meds. None of this is particularly surprising, apparently, after having one’s heart cut open. Now I’m off again, for about a month, and my body has had time to flush out any residual effect of the drug.  Mostly. The drug in question has a remarkable average half-life (the time it takes for the body to metabolize and eliminate half of the drug) of about 58 days. For comparison, heroin has a half life of about 8 minutes.  Anyway, now that much of the heart medicine is out of my body, here’s the million dollar question: Is my heart going to start fluttering again?  This is important to know, since it is during these periods of arrhythmia that the heart is most likely to spew blood clots. To help answer the question, I’ve been fitted with a cardiac “event monitor,” which I must wear 24/7 for thirty days.  

It isn’t that big a deal.  I wear three stickers on my chest, to which three wires are attached. The wires snap on, just like the snaps on baby clothes. The wires converge in a little plastic box not much bigger than an old fashioned matchbox.  I also carry an ancient Blackberry phone, that connects wirelessly to the matchbox unit, and transmits the data from my beating heart to...somebody, somewhere, I’m not sure. I hope they’re paying attention.

I got the monitor yesterday.  Tomorrow I’ll be taking my last dose of blood thinners.  You might be wondering why they are taking me off of blood thinners before they have answered the million dollar question.  What if my erratic heart starts blowing blood clots into my newly viscous circulatory system, causing a stroke? In fact, the usual protocol, as explained by my cardiologist, is to continue with the blood thinners until I return the heart monitor, after thirty days.  This meant that I would have had to continue taking the blood thinners for another month. When that reality sunk in, I whined about it. “That isn’t what I hoping to hear,” I complained to the cardiologist. He immediately, remarkably, changed his mind.

“No problem, I’ll take you off the blood thinners now,” he said.  He explained that my medical history puts me at a low risk for blood clots and strokes, and he didn’t see any compelling reason to keep me on the drugs.  Still, I wonder why he didn’t just say that in the first place.
What happens if my heart continues to flutter?  Will I go back on the drugs again, the common side effects of which include vomiting, heart failure, pulmonary fibrosis, tremors, loss of coordination and uncontrolled movements?  My doctor mentioned one possible drugless intervention, called “ablation.” It sounds like magic, but they thread a small tube through a vein in your groin, use it to somehow determine the exact location of the cells that are causing the faulty rhythm, and they kill the nefarious cells using heat, cold or more magic.  It is usually an outpatient procedure, it is relatively non-invasive, and it often works, although not always the first time. Bruce Bochy, the manager of the Giants, had it done twice last year. That was the year that the Giants lost 98 games. Not that I’m suggesting there was a connection, but it makes you wonder.

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