Angie & Jim

Cautiously Optimisticby Jim

Well, I have some good news. The cardioversion was successful and she’s back in regular rhythm (and in only one shock). They pumped 360 joules through her (yes, the geeky engineer in me just had to ask) and it was enough to fix things. They only wanted to zap her once, so they didn’t ramp up with little shocks like they usually do. She just got the big one first. She was sedated, so she didn’t feel a thing. She’ll be in recovery soon and I’ll be able to go see her. Now, we’ll see if the amiodarone will be enough to keep her out. I don’t know how long they’ll want to observe her, but when the doctors come and talk to us after Angie wakes up, I’m sure they’ll tell us.

Cardioversionby Jim

They just took her back to the OR where they’ll be doing the procedure. They will do a transesophageal echocardiogram to check for blood clots before doing the cardioversion (that’s standard procedure before shocking you out of arrhythmia). If they don’t find anything, they’ll move forward and see if they can stop the arrhythmias. The whole process shouldn’t take very long, so I should be able to post again soon with any update.

We’re hoping and praying that this cardioversion will be enough to get her out and that the amiodarone will be enough to keep her out of arrhythmias. If that’s the case, we should be able to go home tonight. If they can’t get her out, they plan to transition her back to her previous anti-arrhythmia drug. That transition has to be done under observation over 48-72 hours. I don’t know if they can start that immediately, or if they have to wait for the amiodarone to get out of her system.

A Trip in the Emergency Roomby Jim

Well, using her pacemaker to get her out of arrhythmia didn’t work, so they’re going to do the cardioversion tomorrow. We saw both Dr. Dubin and Dr. Lui and they are concerned about the recent developments. Angie’s heart function has decreased even more since her visit last week, which worries them. They didn’t have a bed available on the cardiovascular floor, but they wanted to observe her for the night, so they asked that we head to the emergency room and “check-in” that way. They have a brand new emergency room in the new building and I guess we came at just the right time because there was practically no wait. Fastest emergency room admission ever.

The plan now is that they will observe her tonight and do the cardioversion tomorrow. There is concern that the amiodarone (her new supposedly more powerful anti-arrhythmia drug) isn’t enough to keep her out of arrhythmia after they cardiovert her. The problem is they have no way to know. She’s gotten stuck in bad rhythms like this before on other medications and had to cardiovert out, so the amiodarone may still be good enough, but the initial signs don’t look promising. If she goes back into arrhythmia after the cardioversion, they’ll need to transition her back to her previous medicine (dofetilide), which means she’ll have to wait for a few days for the amiodarone to clear out of her system before putting her back on dofetilide. Once the dofetilide is in her system (it takes a few days: it has a longer half-life than amiodarone), they’ll do another cardioversion to get her out of arrhythmia and keep her out. So that’s our plan for the week.

Awaiting a Cardioversionby Jim

We’re here at Stanford waiting to see the cardiologist and electrophysiologist. We had to schedule these appointments only a week ago, so they had to squeeze us in and so we’ve got to do a lot of waiting. So far this morning they’ve done an EKG and a device check. Angie is still in arrhythmia, which means the plan is to do a cardioversion, but the latest word is that they’ll do it tomorrow morning. Expected recovery is pretty quick, so we shouldn’t need to stay long. Dr. Lui did say, “bring a bag,” when we were talking about it last week, so I expect we’ll be spending at least one night after the procedure for them to observe her. I’ll post again in a few hours after we have heard from the doctors.

The Ol’ College Tryby Jim

Well, we had our post-op follow-up appointment today to do a device check and speak with Angie’s cardiologist, and I’m afraid there isn’t good news. The device check revealed that Angie has been in arrhythmia since January 9, the day of the ablation. Getting into the arrhythmia isn’t surprising, because they had her stop her anti-arrhythmia medications before the procedure to induce arrhythmia so that they could find the rogue circuits while they were mapping out her heart. The unfortunate thing is that the new medication they put her on hasn’t been enough to get her out of arrhythmia since the 9th. That wasn’t really what we wanted to hear.

So, currently the plan is to increase the dosage for another week to make sure we give the new drug “the ol’ college try” before giving up on it. Dr. Lui asked that we come back in a week and if she’s still not in sinus rhythm (or regular heat rhythm), they’ll need to intervene. They’ll try first with her pacemaker and if that doesn’t work, they’ll have to cardiovert (shock) her. We’ve done a couple cardioversions before, but they aren’t fun. Dr. Lui mentioned the possibility of going back to a former anti-arrhythmia medication if this one just can’t cut it. We’re definitely hoping that the increased dosage is all it takes and we don’t have to be admitted to the hospital next week.

We’re Going Home!by Jim

Our nurse just gave us our discharge instructions, so we’re almost done. Angie has an IV in each arm that needs to be removed, which should only take a couple minutes. We’re happy to be headed home. Thanks again for all of your love and support!

Impending Dischargeby Jim

When a doctors says the words, “discharge papers,” you know you’re probably going to leave today. Things go slowly at the hospital, but it was early this morning when Dr. Motonaga said something about getting Angie’s discharge papers started. I anticipate we’ll be on the freeway home by early afternoon today. Hooray!

The doctors gave Angie her 1-2 week at-home care instructions during their regular morning rounds this morning, which was another good indication that we’ll be out of here soon. She’ll finish loading the new arrhythmia drug at home and continue to adjust her other meds to compensate while she gets to her regular dosage. From here on out, we’ll be trying to manage the arrhythmias with a combination of medicine and hardware (her pacemaker). They’ll check her pacemaker in a couple weeks to see how the medicine is doing. This should allow her body to acclimatize to the new drug and hopefully we’ll see a decreased (or ideally eliminated) occurrence of the arrhythmias.

I’ll do a quick post when we’ve been discharged and before we go so you will know when we’re on our way home. (We’ve had to stay an extra day after being told we were being discharged, so it isn’t official until you’re walking out of the hospital.) Thank you all again for keeping up to date and following along with our medical adventures this time. It means a lot to us that you’re aware of what we’re going through.