Different strokes

There’s a revolution going on in the NHS which, unless you are directly involved, you may only discover by accident. Like we did today. We see a cardiologist; but not at a hospital. He’s not a consultant either, he’s a GP.

About 4 years ago I was diagnosed with Atrial Flutter; this is common during the first week after heart surgery. Or surgery anywhere near the heart for that matter, which is how I came into contact with the condition. The heart beats regularly but extremely rapidly - usually upwards of 250bpm.

Then I was diagnosed with Atrial Fibrillation. This is similar to Flutter except that the heart rhythm is irregular as well as fast.

If this carries on for any length of time, the blood within the chambers - known in the trade as ‘old blood’ - gradually begins to clot and settles into the nooks and crannies of the heart. This is not a good thing. If any clots escape into the bloodstream they can cause a stroke if they end up in the brain or an embolism if the end up in the lungs. It’s usually treated with drugs - anticoagulants like warfarin to reduce the risk of clots and beta blockers to slow down the heart rate. I now take these on a daily basis.

Every so often, my heart throws a wobbly; the beats are ectopic - they miss or skip and cannot keep time and are often violent — like a very bad drummer, trying to build a shed.

Episodes appear to be completely random and when they occur I take what’s known as a ‘pill-in-the-pocket’ - a drug which restores my heart to a regular rhythm.

My GP is concerned because the drugs are causing unpleasant side effects and so refers me to a specialist GP in Milton Keynes who deals with heart conditions; “he knows more about the heart than anyone else in MK”.

About a month ago, in anticipation of the appointment, I get a portable heart monitor for a couple of weeks to try and record any arrhythmias. Most people I speak to who’ve gone through this, never get the arrhythmia when they have the monitor; but I'm lucky. Today’s blip shows the report - 4 episodes in one week - that’s record.

And so today, Anniemay and I find ourselves at a swanky new surgery where the GP has his own equipment for producing echocardiograms; I lie on the bed while he conducts the test. Anniemay is invited to watch while he gives a commentary on what he sees.

This is absolutely revolutionary; contrast this with the procedure in a typical cardiology outpatients clinic in a hospital. The person conducting the test is not allowed to discuss the results. You may then have to wait to see someone to discuss the outcome. The whole process can take months.

I have what’s known as paroxysmal atrial fibrillation. The ‘paroxysmal’ bit simply means that no one has a clue as to what triggers an episode. And it's incredibly common.

We discuss the results. There are no signs of heart disease. My blood pressure is fine. My heart is, apart from some dodgy wiring, to all intents and purposes, hunky dory. The doctor is terrific - he listens, he explains, he reassures; “your heart is not going to kill you”.

His only concern, apart from the side effects of the drugs, is the risk of a stroke. Atrial Fibrillation is the major cause of strokes in the UK. And this may sound odd - I am more wary about the risk of a stroke than I am of my cancer returning. Because I know a bit about cancer now; I know how to get myself into the right frame of mind to deal with it. The scary thing about strokes is their unpredictability. They come in all shapes and sizes.

I was in hospital one time and man was brought in to the bed next to me. He was about 40, I guess and lived alone (this would turn out to be significant). On this particular morning, he got up as usual, showered, shaved, had his breakfast and then drove into work. As he walked into his office, the receptionist called out ‘good morning’. He tried to return her greeting but found he couldn’t; he was unable to speak. He’d had a stroke. And it wasn’t until he came into contact with other people that it became apparent. (If you’re wondering how I gleaned this level of detail, he wrote it down later for the doctors.) Now this is scary stuff.

Anniemay and I are relieved about today - AF is a nuisance and we’ll just have to put up with a life on drugs. We'll investigate alternatives if things become too unpleasant. There are plenty of other things to worry about; like what to blip tomorrow.