A Patient’s Journey Through the Convergent Procedure

Jonthy E. Williams, Austin, Texas
Jonthy E. Williams, Austin, Texas

This year has been a challenging one. After losing my mother in April 2012, I found myself in the emergency room at the Heart Hospital of Austin the day after her funeral. During the funeral, I had developed a bad sore throat and laryngitis, and couldn’t speak. So the next morning, I went to a walk-in clinic because I was afraid I might have strep throat. After the nurse took my vital signs, the doctor told me I didn’t have strep but that I was in atrial fibrillation and that my pulse was racing at 150 beats per minute. He asked me if I was short of breath or felt faint, and I replied that I didn’t think so. He told me I needed to get to the ER as soon as I left his office.

My brother drove me to the Heart Hospital; they performed an EKG test and confirmed the fast pulse. I was stunned. I had never had heart problems and had no family history of cardiovascular disease. I had always been an athlete and a runner, and had participated in 2 marathons, 4 half-marathons, and numerous 5Ks and 10Ks since I was about 20 years old.

Because of a second doctor’s scheduling, I spent a very uncomfortable night in the ER. I kept watch over my pulse rate and tried to mentally will it to slow down but, of course, had no control over it. 

I later found out that my initial visit to the ER was for atrial flutter, which my doctor told me can cause symptoms similar to atrial fibrillation. I did have the classic symptoms of atrial flutter, but because of all the recent stress in my life, I couldn’t tell my doctor when the symptoms had begun. My doctor then performed a transesophageal echocardiography test to make sure I hadn’t developed any blood clots in the chambers of my heart (fortunately I had not). The next step was a cardioversion to restore my heart’s normal rhythm. During the procedure, I was given medications to keep me free from pain and to help me sleep. Then my doctor delivered a brief electric shock to restore my heartbeat. When I woke up, my heart was beating at its usual 60 beats per minute (bpm). My doctor prescribed blood thinners and beta blockers in order to prevent a stroke and to keep my heart from beating too fast. He scheduled a catheter ablation for one month later. I walked out of the ER that afternoon feeling better but also wondering why this had happened to me. I hoped that with reduced stress, I would not have to endure a repeat of this kind of episode.

In May 2012, I had the catheter ablation done. The procedure was successful; it took about 2 hours because they were able to quickly induce my arrhythmia. 

At a follow-up visit, my doctor told me I had experienced atrial flutter and that I could also develop atrial fibrillation in the future. My heart rate was now around 48 bpm (much lower than I had ever had), so I was taken off the beta blockers. He also took me off the blood thinners and put me on an aspirin regimen. I felt great and was sure this would be the end of my health problems.

Then, in early February 2013, I returned to the hospital with shortness of breath and the feeling of pressure in my sternum. This time I knew I was having symptoms. It was like I had run a 5K but the race had never stopped — my heart rate was 123 bpm. I spent the night in the hospital and my doctor performed a cardioversion the next morning. 

He informed me that this episode was not atrial flutter but actually atrial fibrillation. I was disappointed that last May’s ablation had not cured my arrhythmia. My doctor once again put me on blood thinners; however, this time he could not prescribe beta blockers because after the cardioversion, my heart rate was low. I went home asking why this was happening again, and was skeptical that the results of the cardioversion would last.

Two weeks later, I was back in the hospital and was cardioverted once more. My brother stayed by my side until the procedure began. I was glad he was there to see me through another procedure. 

After this experience, my doctor recommended I have a convergent procedure. I had no idea what this was, but was willing to try anything that would stop the atrial fibrillation from returning. 

After another episode of atrial fibrillation in February 2013, I was ready to proceed with the convergent procedure. I was tired of being short of breath and worn out all the time. Since the convergent procedure is a relatively new surgery, I was told there were only two doctors in Austin who were performing it: my electrophysiologist and a cardiac surgeon at the hospital. My surgery was scheduled for April 18. Two months was a long time to wait, but I decided that I would stick it out and hope I didn’t have to undergo another cardioversion in the meantime. I was lucky I had a best friend who helped me to deal with my stress. I canceled my membership at the fitness center, stopped drinking caffeine, and tried not to worry over day-to-day problems.

The week before the surgery I met the cardiac surgeon who was going to be doing the epicardial ablation portion of the procedure. Since I’m 57 years old, both of my doctors looked very young to me! However, I learned that they were both top-notch professionals. The doctor told me there would be significant pain associated with the surgery, which I shrugged off by saying “Oh, I’ve had a hysterectomy, just give me some pain medicine and I’ll be fine.” He explained that pain from the waist down is much easier to control with pain medications, but that the pain I would experience this time would be ongoing pain, possibly for weeks after the surgery. I really had no idea what I was getting ready to experience, but his words sounded foreboding.

The day before surgery, I pre-registered, had blood work done, and met the anesthesiologist for the surgery. I really liked him because he was very personable and easy to talk to. Once again the subject of pain came up and he confirmed what the cardiologist had told me about long-term pain and recovery. By this time I was pretty defensive and cracking jokes to deal with my denial. Now that I have been through it, I know the pain they were referring to was beyond my wildest imagination.

That evening, I took a shower and was given antiseptic wipes to clean my whole body. I went to bed around midnight, but didn’t get much rest that night. My surgery time was scheduled for 7:00 a.m., and I had to be at the heart hospital at 5:00 a.m.

As I was being prepped for surgery, one of the nurses introduced himself to me. His name was Nico, and he was very sweet and personable. He told me he would be one of a team of about 10 other nurses and assistants, and that they all viewed their patients as family. My boyfriend and the assistant pastor of my church were also there to help calm me, and we held hands and said a prayer. 

Within a few minutes I was wheeled to the operating room and was able to greet all the masked nurses and doctors before I was given sedation. My procedure was 6 hours long. 

The first thing I remember when I woke up in recovery was feeling immense pain. It was a pain that I couldn’t even imagine, and I could hear myself asking for more pain medication. Later I was in the Critical Care Unit (CCU) for close observation for the first 24 hours.

The 6 weeks following my surgery were tough. I stopped taking pain medications after the first week, but still had pain in my sternum if I bent over to tie my shoes or pick up something off the floor. My instructions were not to drive for 2 weeks and not to lift anything over 20 lbs. for a while. I didn’t drive until about day 10, and probably shouldn’t have because I was still shaky from the anesthesia.

The pain I was experiencing most often was a feeling of a giant scab surrounding parts of my heart. When I expressed this to my doctor, he seemed to confirm that this would be the case for a while. I told him about the pain when I bent over, and he said that was normal as my heart was healing. My EKG showed that I was not in atrial fibrillation, which was good news. When I first got home from surgery, I had read some hospital literature that informed me that while my scar tissue was healing I might have an episode of atrial fibrillation and that it might take up to 6 months for the scar tissue to completely heal.

After a visit with my doctor, I decided to go on a 4-day trip to Taos, New Mexico with my boyfriend. We would be flying to Albuquerque and then renting a car to drive the 2 and a half hours to Taos. 

I did pretty well on the trip, but around 3 p.m. each day, my chest or sternum area felt tight and I walked with some difficulty. My boyfriend and I took it easy every afternoon and slowed down our tourist activities. On one day we took an 80-mile scenic drive from Taos to Red River, then to Eagle’s Nest and Angel Fire. Across the highway from Angel Fire we visited the Vietnam memorial and were moved by the exhibits. After going through the museum, I walked down to the chapel and was blown away by the beauty of the architecture and also the setting in the mountains. 

The trip was relaxed but tiring. Our flight through Dallas on our way to Austin was delayed by about 45 minutes, so we didn’t get home until around midnight. I was wiped out the next day but wasn’t aware of how tired I was until that evening, when my heart rate felt like it was racing a bit. My pulse was around 85 bpm, but I just figured it was from the trip. By day 2 my heart was beating at 90 bpm, and my body was aching. The next day it was up to 95 and I was running a low-grade fever.

I decided to go to the ER at the Heart Hospital of Austin at 3:30 in the morning. I wasn’t sure if I was in atrial fibrillation, but I didn’t feel well. After an EKG and blood work, the ER doctor told me I was just dehydrated and gave me IV fluids. I was home by 6:30 a.m. and fell into bed to sleep.

In early June, I found myself tired and depressed about the lack of progress I had made in the last 6 and a half weeks. I did my normal chores around the house but still had pain in my sternum. My pulse had risen to the high 80s, which was not erratic but high for me. 

The biggest problem I have had dealing with the healing process is that I am not a patient person. I like to get things done and then move on to the next thing. I was past the stage of second-guessing the procedure, but also not yet feeling the full effects of a now healthy, beating heart.

The following day, I went on a local hike and bike trail. I promised myself I would try to hike the 3-mile loop that I’ve done so many times in the past. I took a big bottle of water to avoid dehydration, and took small sips at regular intervals. I hiked at a much slower speed than in the past, and finished it in 1 hour and 20 minutes. This amount of time would have been laughable to me a couple of months ago, but I felt proud that I had persevered. 

Two months after my convergent procedure, I was feeling better each day. My friends told me how good I looked, the pain had subsided, and the only thing I was feeling at that point was the tightness of the scar tissue. I was also experiencing a lack of appetite: food did not taste good to me and certain foods that I ate with pleasure didn’t appeal to me anymore. I didn’t understand this, but figured it was probably a blessing since I was able to lose some weight. 

It has now been a little over three and a half months since my convergent procedure, and I’ve been keeping busy. I have started a small exercise program and have lost almost 20 pounds since the procedure in mid-April. I now walk about 1 hour (approximately 3 miles) two times a week, and am starting to swim regularly at a local pool. 

My appetite is still not the same. Certain foods don’t appeal to me right now and I am still bothered by what feels like scar tissue healing in my heart. I am also bothered by sensations outside the area of the heart — from the incision site all the way under both breasts. I believe that certain nerves may have been affected by the ablation procedure. I didn’t notice this with the first ablation, but since the inside and the outside of the heart were ablated, it’s been a whole different and challenging experience. 

I am also still on blood thinners twice a day; however, it is expensive. Last month I spent $175 for a 30-day supply. 

However, I don’t take anything for granted anymore. I try to relax and make the most of every day. The convergent surgery was hard on me, but so far, I have not experienced any more atrial fibrillation. While not many people have heard of the convergent procedure, I think it will become a standard in medicine in the future.

 

For more information about Jonthy, please visit: http://jonthywilliams.blogspot.com/