Hi,

I just had my ablation with Dr. Natale on May 2nd. Everything seems to have gone well. The only thing I'm struggling with at the moment is a LOT of gas/bloating in my abdomen. Thankfully, I do not have heartburn, but I am not able to burp or pass gas as 'efficiently' or as 'completely' as I'm used to doing. I am able to burp/pass gas, but just not as well. I'm having ups and downs with it, and am pretty sure this is causing the problem. I am hoping this is just temporary; I know my body has gone through a lot and that I may just need to be patient.

But, I wanted to see if anyone else had this issue and what they did to help relieve symptoms, expedite the healing process and prevent further aggravation.

Two things that are helping are:
1) Stopped drinking with a straw--that caused me to swallow air every time I drank
2) Once my insertion sites stopped bleeding, I laid on my stomach and that was pushing air out through my throat, helping me burp better
3) Taking Advil as a pain reliever so I could sleep, then laying on my back for a while, I'm sleeping for an hour or two, then waking up and being able to almost immediately clear some gas

Also, my Foley catheter caused me extremely excruciating pain and it felt like I was peeing knives and needles for the first 32 hours. If my wife hadn't given birth to our first son 4 months earlier, I would say this is the worst pain that could be experienced. Ha! So, that helped keep things in perspective But, the catheter was still really painful--it started hurting even before they removed it (when I started to move around a little bit in my hospital bed). I ended up finding a drug on my smartphone called pyridium which is a urinary tract analgesic and asked for that. Instead, my nurse kept trying to give me a narcotic, but I said "I don't need morphine, I just need something to help me pee." Eventually, the Charge Nurse got it for me. I think it helped, but it didn't kick in until after I'd cleared about 1000mL of fluid.... :/ I really wish I would have taken it immediately after regaining consciousness. I am saying this for the benefit of any males preparing for an ablation.

Thank you.

Hi Stephen, I had an issue with the Foley catheter too, not as bad as you by the sound of it. Once they pulled it out, I had trouble urinating and had some small drops of blood mixed in. But after an hour of the type of pain you're talking about I got a stream going and the blood disappeared. They used pyridium as well. The nursing staff said it could have easily have been some damage as the catheter was squeezed past the prostate. Of course, the urology department had to check it out before I was released and they wanted me to get a cytoscopy "just in case" which I haven't done yet.

Hello Stephen..... Foley catheters are never fun. I hope by now you are enjoying a little relief from the woes you've described.

Overall, in spite of those problems, how's your heart?

Jackie

I have had a Foley twice in my lifetime and it was NO FUN. I was in tears when they took the Foley out the last time. Next time I am going to take some heavy duty narcotics, some tranq's and a shot of single malt scotch before they remove it. Going in, they used freezing in gel form and it was painless. It would not have mattered anyway as I was in so much pain BEFORE insertion that I hardly noticed it until they told me it was in. I was literally wailing in pain.

I think, now, that the anticipation of the removal contributes to the level of pain experienced, hence the single malt. And the tranq's. I want to be in lala land like when having root canal surgery at the oral surgeon last week. I was the happiest guy in the world as he hacked through my teeth into my root canal to find a root that had been left behind during a root canal TWENTY+ years ago. Sic. No pain. Just noted during a regular cleaning by my oral hygienist... a "pimple bump" on the side of my gums. It turned out to be a horrendous infection caught very early. Two more weeks and I would likely have lost several healthy teeth. Get your teeth cleaned! And do your best to keep your mouth in good health. I have no doubt that oral health is directly related to heart health and arrhythmias. What I had thought was a return of aFib and palpatations was very likely caused by the infection in my mouth.

To return to the topic regarding gas and bloating..... I have recently changed my diet from a paleo like diet to an almost strictly vegetarian diet. No meat. Little fish and a few eggs a week. LOTS of legumes and fruits and veggies though and the extra fibre is tough for the body to break down. It has taken my system 8 weeks thus far to adapt to the new regimen and I think it will take another 8 to completely adapt. I have experienced tremendous gas and bloating in the past 8 weeks since starting the new diet but it has been well worth it. I might look to any changes in your eating habits post-ablation for the cause of gas and bloating. I know after I was in hospital I suffered the same as my eating habits had changed slightly. For instance, I was eating lots of soups with barley and legumes in it. Methane? Enough to power a small city. Interestingly, on a very personal note, I am finding that what escapes and is eliminated no longer stinks to high heavens. My innards are cleaner than they have ever been due to the extreme fibre I am taking in. And MOST interesting of all, my hypertension is just about disappeared (3/4 of med now gone); my diabetes which was wanting insulin to handle is almost gone (1-2 Metformin a day and expect that to be gone in another 8 - 12 weeks as my weight drops like a rock). My heart is generally calm if I maintain Potassium level and I feel pretty good.

HOWEVER, bloating and gas in MY case, anyway, are directly related to diet change. Have you changed your diet in ANY way? Even the time that you eat is suspect. I cannot eat after 7 p.m. any longer or I will have a lousy night of gut rumblings and gas and bloating guaranteed due to the gut trying to break down that fibre and process it.

Just a thought. I can't wait for my next visit to my endocrinologist and his nutritionist. Neither know squat about nutrition. Only about medication. I can't wait to see them faint dead away when I tell them I am eating 3-4 large navel oranges every day and my blood sugar is NEVER above 9.5 and generally hovers around 6 or so. Part of the program is that I do not eat ANYTHING that is processed. No flour. No sugar. No salt. No processed foods of any kind.

Murray L

--------------------------------------------------------------------------
Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Hey Steve, good to hear its all over but the healing!

Welcome to the Foley club .. where its no fun all the time :-)! I've had that unique displeasure to have had a Foley four times in my life and the first two were a bit of an adventure, while the last two during my first persistent AFIB ablation with Dr N there in Austin at St Davids in 2008 and again with my LAA isolation ablation with Dr N last August in San Fran were both pretty easy-going ... except for the yanking part which, at best, conveys that 'weak in the knees' feeling of have a 15" long 1/4" diameter rotor rooter drain yanked out of one's wanger! It feels kind of like your urethra is being inverted for a moment as the Foley is yanked out.

Removal of said Foley catheter can be a levitation-inducing experience too, as I discovered in the very same CPMC hospital in San Francisco where I had my last Natale ablation last summer. But this was in 1988 and CPMC was then called Pacific Presbyterian Medical Center, but is nevertheless the very same place. This was for my second anterior cervical fusion in two years with a neurosurgeon and orthopod there who I was sent to from Hawaii by my Hawaii orthopod, when a C4-5 disc rupture that was directly above the C5-6 fusion area from my first fusion 10 months earlier, had started to press in on my spinal cord which is not a good thing.

In any event, I had had polio when I was 10 years old and it is now common knowledge, but wasn't so well known then in the mid 80s, that one should never use Succinylcholine drug as part of anesthesia during surgery on people with polio, particularly if they had post-polio muscular atrophy or post-polio syndrome which I did at the time, although that diagnosis was still one year in the future at that point in 1988.

The problem is, Succinylcholine is used to temporarily paralyze your muscles during delicate surgery like a spinal fusion so no inadvertant muscle twitches might happen at the wrong time with possible disastrous consequences.

Not knowing this, and not realizing yet that this whole cascade of three cervical disc ruptures and subsequent single segment fusions had, at its core, the on-going new muscle weakness from the late effects of my original 1962 bout with polio that was now taking hold and manifesting as a whole host of secondary orthopedic and neurological problems starting in the early 1980s, it was easy for the anesthesiologist to miss back at the time frame the issue with succinylcholine on a person with new neuromuscular weakness stemming from the late effects of a old paralytic disease like polio.

What can happen is, that succinylcholine used on a person with active post-polio can make it very hard to regain muscle function for some time after use of succinylcholine and that is what happened after that fusion surgery.

They had not installed a Foley catheter during the surgery and yet afterward my urethra muscles were totally locked down and 'asleep' so I couldn't pee for a million bucks! After some hours of this, things got urgent as they had dumped a lot of fluid into me during the surgery and were doing so still with an IV bag of saline. They were considering taking me back into surgery since my urethra or muscles that control the bladder were not cooperating and were totally contracted shut and they needed to open up that function so I could evacuate the urine ASAP.

First they sent in a male nurse/tech for one try with a Foley kit.. I had only a PCA machine ( patient controlled analgesia) with the trusty Morphine at the ready with the push of a button. The nurse advised me to start pushing that button like mad as he was going to install the foley now!

There is a plastic bullet shaped tip at the leading end of the long foley tube and he slid that up toward the locked sphincter-like muscle that controlled bladder ingress and outflow ( this is when I discovered the wisdom of doing this during anesthesia!) And then, when he could not penetrate that locked down muscle he said "Okay push the button and keep pushing it and hold on to the bed railing while he repeatedly tried to ram it through!! Here I was, in a temporary Halo brace to stabilize my then unstable neck from the hour old fusion on top of the prior fusion, and it literally felt like this guy was trying to stab me to death 'down there' with this Foley catheter!

Finally, he broke through, but not until I had drained a good deal of that morphine syringe in the PCA and I needed every bit of it and more..

Three days later after we had gotten rid of all the excess fluid, another nurse, this time a female, crept into my room while I was sleeping and decided to yank the Foley with I was laying there in peaceful slumber. I guess she had not observed that the Foley had become more or less 'glued' to the 'tip' via the crusty dried blood, as you can imagine, from all the violent action of a few days before. I will never forget that feeling of sudden total shock and literally levitating a few inches off my bed, with a Halo on, when she yanked that Foley out of me!! Needless to say, I wasn't a particularly happy camper that morning... I realize she was trying to spare me the extra anxiety of knowing it was coming, but that wasn't worth that kind of unexpected shock. The rest of my stay there I'm sure I sleep with one eye open toward the door, like a cat .

Anyway, I tell you all this Steve, just so you can know you have many comrades in your Foley gedoe, and to also realize that its not as bad as it could have been, Ha!

Nevertheless, I'm sure you'll be feeling much better down there soon and hope you make a speedy recovery with decades of NSR ahead of you...

Take it easy,
Shannon

OMG!

Marvelous this like the worst part of the ablation. Do they insert the Foley caths after they know you out for heavens sake?

Yes they typically do.

afhound99,
Was that Foley insertion after anesthesia?

Wow. I got tears in my eyes just thinking about that. My question is why do some even get a foley. I have had 3 ablations, 2 in Edmonton and one in Bordeaux. no foleys thank God.

Adrian

Really the story of my one rough experience with the Foley wasn't nearly so much to do with the Foley it self but the circumstances and how it was used in that one case 25 years ago.

Its not that bad 98% of the time and, in fact, for the vast majority its only the momentary removal process that can feel a little queasy.

The Foley is commonly used for 12 hours or so now with the high tech Thermo-cool and other irrigated catheters to help get rid of the excess fluid used to keep the heart tissue cooler while doing the ablation.

In any event, I shared my one 'memorable' experience with the Foley with Steve with a little gallows humor in mind and to let him know he has plenty of company in this common procedure, but the vast majority have no where near the rougher experiences like Steve and I have had .. really its a pretty routine thing and nothing to be too worried over.

Seriously, my last two Foley's at St Davids in Austin and CPMC in San Fran for the two Natale ablations went smoothly without a hitch.

Shannon

And PS McHale, yes you will never know a thing when they insert it only under anesthesia and removal isn't really that bad at all the vast majority of the time. Its more of a 'funny' strange sensation that you may well remember but not as a real 'pain' more a feeling like having the 'Willy's' momentarily and then its all over and you'll be fine.



Edited 1 time(s). Last edit at 05/06/2013 06:57AM by Shannon.

Right, McHale, after anesthesia (along with the shaving) - at least that was the procedure at MGH. And really taking it out was nothing - just a sudden loss of pressure it felt like, no pain at all. It was just a problem for a while because of the slight damage they did getting it in. You will probably be luckier.

Okay as long as I'm in the twilight zone I don't care what they do down there..........well almost!

Are you going to be twilighting or was that just vernacular? I was on full general anesthetic.

I'm assuming general anesthesia .......Shannon?
I guess conscious sedation would be The Twilight Zone.

McHale Wrote:
-------------------------------------------------------
> I'm assuming general anesthesia .......Shannon?
> I guess conscious sedation would be The Twilight
> Zone.


Yes McHale, your anesthesiologist will likely induce anesthesia with Propofol (also known as Milk of Amnesia) ... as well as some versed and fentanyl in all likelihood then he or she will likely either continue with a propofol drip to keep you under during the ablation or use another anesthetic for that purpose. In any event, you wont know a thing until it is all over and there isn't much pain afterward.

Natale doesn't use conscious sedation as they have found it easier to make consistent transmural burns when the anestheisologist can control respiration though a ventilation tube under general (which will also be installed after you are out, just as the catheter placements will be done without you knowing anything at all) ... such that Dr N will start a burn when you are at the bottom of a controlled breath. General anesthesia also prevents and inadvertant deep breaths or physical movement from making a mistake with an ablation burn. Its enough having to deal with a beating heart not to have to also deal with a sudden unexpected sigh or moan from only a consciously sedated and not intubated patient.

Plus, under general anesthesia your whole body is relaxed which helps minimize the back pain that some people under conscious sedation get when subconsciously they still tense up on that hard flat table where they are strapped down for up to 4+ hours at times.

Its the best way to go.

Cheers!
Shannon



Edited 1 time(s). Last edit at 05/06/2013 07:46PM by Shannon.

Dear Shannon,

Wow! Thank you for sharing your experience--I really needed to hear that! Thankfully, the pain subsided down there now to about 1% of what it was, and I must say I got some really good hard belly laughs (actual LOL) while reading it--which I also really needed! So, thank you for at once empathizing with me, while also cheering me up and letting me known I'm not alone (and that it could have been worse). Brilliant!

As for the gas pressure, that has now subsided. But now things are very free flowing on the other end if you know what I mean. The nurse thinks I probably caught a bug and that it's unrelated to the ablation. That is sounding more likely as things are getting better.

As for the ablation, I have been in NSR since I regained consciousness after the procedure!!! I've had about 1 pre-beat a day (it's unbelievable) since the procedure, which is a huge improvement from being in Afib for 4-17 hours a day every other day (or daily). The chest pressure is almost gone and it just feels too good to be true. I'm almost afraid to type out how good my heart feels after 11 long years of Afib for fear of jinxing myself! Natale told me that I had 3 PVs, some posterior wall tissue and some spots on my superior vena cava that were active trigger spots. He had 35 minutes of burn time, and the ablation surgery took 2 hours total. He said that my left pulmonary vein was the most active with triggers, and that my right upper and left lower pulmonary veins also had trigger spots. Nothing from the right lower pulmonary vein. He did isolate all 4, though, of course.

He said that 12-15% of people in my case (paroxsymal, straightforward, no structural heart issues) might have to come back for additional ablations on new trigger spots in future years, but that even then, those cases seem to be more for females and those with larger atriums. Hopefully, by sticking to the Strategy and eating a mainly Paleo diet, I won't have to return. BTW, I did get a toxicology test done last month (urine test from Doctor's Data, no chelating agent), which showed me in the 95-99% range of mercury toxicity! I think that may be my root cause since I was 22 years old when my afib started, and had zero risk factors (normal BMI, no structural heart issues, no chronic diseases, etc.). Needless to say, I will be reading more thoroughly through all of the amalgam research and will continue to be a part of this forum for a long time to come (I did get my amalgams removed last year--the safe way--but the damage was already done it seems)! Like Jackie says, "Afib is our canary in the coal mine."

THANK YOU to Hans, Jackie, Shannon and all who have been a tremendous help and blessing to me along my Afib journey. You are all very special to me and I hope I can help others as well. This is not the end, but hopefully the end of Afib for me

I cannot say enough good things about Dr. Natale and I am so glad that I had the opportunity to go to him.

Steve

Shannon,
Thanks again for the informative and priceless post.
The former executive director of St Luke's who will remain nameless I consulted with a few months back told me he does conscious sedation which scared the daylights out of me as I've heard other posters say they felt almost every burn. That is an amazing explanation of using general anesthesia to control breathing and movement. I'm assuming this is using High Frequency Low Volume Jet Ventilation to limit respiration movement. A low volume high pressure "jet" of oxygen flows into the airway for a
brief time but at a high frequency. The patient receives enough oxygen, but with very little respiration movement. Because the catheter is stable and not affected by respiration movement, more effective lesions can be made.
Yes that was a quick appointment I called the first day after your email and once I consult with him I'll be ready to go.

Hopefully as soon as he comes back from Texas and San Fran in June. There are already 5-6 patients waiting for ablations that saw him for consultations.

Stephen Thanks for your post. You were still considered paroxysmal getting AFIB almost everyday for up to 18 hours and how long were you that bad? Where your 11 years of AFIB frequent at the beginning? Where you taking any AAR's meds? What size was your atrium from all that AFIB? Wow Natale did it in 2 hours no less.



Edited 2 time(s). Last edit at 05/06/2013 08:39PM by McHale.

Hi McHale,

Yes, Natale said I was still considered paroxysmal. Here's my symptom history (BTW, I was VERY symptomatic--could feel every irregular heart beat. Even though I didn't have issues with arrhythmias until age 22, from a young age - as long as I can remember - I was always very aware of my heartbeat even at rest, even though my heart size and structure is normal. May have been a self-fulfilling prophecy because I was always concerned I might have a heart issue and then, BAM, at age 22 I actually developed one!):

As felt by me and confirmed by Holter Monitors and Event Monitors throughout the years:

2002 - 2006: ~30% Afib/70%Aflutter in/out throughout the day and night with episodes lasting for a few minutes to about 1.5 hours in duration. A nuisance throughout the day most days and nights. I was only placed on Atenolol which didn't help my arrhythmias.

2006 - 2009: was put on Flecainide, which reduced my frequency of arrhythmia episodes so that I could actually go a few days at a time with no arrhythmias/skipped beats.

2009 - November 2012: taken off Flecainide because I registered what looked to be some VT on a random Holter (although when I later showed Natale in 2010, he said he thought it was rapidly conducting AFlutter). During this time, my "long" arrhythmia episodes increased from 1.5 hours every few weeks to 4-6 hours in length every 1-2 or 3 days. Also, had a few episodes lasting 6-12 hours in length, about once a month or two. I tried Rythmol (stopped arrhythmias during the day, but then as soon as got sleepy, BAM--launched into a long arrhythmia for the night) and Dronedarone (TERRIBLE), neither of which worked, so I stopped AAR altogether.

December 2012: had a "long" arrhythmia every day of the month, lasting 6-9 hours in length.

January 2012: I think December put me over a tipping point, because I continued have 6-9 hour episodes every 2-3 days.

February 2013: had my first "long" arrhythmia which lasted 17 hours in length, then another one 23 hours in length and then another one 27 hours in length. In hindsight, these long episodes were precipitated by my:
- taking a mild detox product (Clean Start by Nature's Sunshine--I did my first back-to-back ~25 days total),
- drinking 1 tsp of Chlorella a day, and
- taking Standard Process Cholacol II every day. I wonder if these were starting to pull out Mercury at a higher rate and sent my heart into arrhythmia over drive???

Anyway, 24 hours in length was my limit, so I immediately booked a follow up appointment with Natale for March 5 (I'd seen him once in July 2010, but decided to wait and try other alternative medicines/therapies).

Started taking Quick Release Verapamil 120mg, which ACTUALLY worked about 70% of the time in knocking out my long arrhythmia episodes like a PIP--I'd put it under my tongue about 30 minutes into an episode (once I felt like it wasn't going to convert into NSR) and let it completely dissolve--tasted nasty, but was worth it. I'd get anywhere from 4 hours to 1-2 days relief from the next onslaught.

March 5, 2013 - May 2, 2013: went to Natale and booked an ablation for May 2nd. Continued with Verapamil as needed. Continued with "long" arrhythmias 4-9 hours length every 2-3 days, and a few 12-17 hours in length.

I think Natale considered me "paroxysmal" because I always converted on my own, even if just for 4-24 hours. I was never cardioverted, either. Natale said atrium size was "normal" but I didn't get a measurement from him. Also, he did not detect any atrium enlargement or remodeling, thanks be to the Lord.

Hi Stephen,
Good to hear no remodeling or enlargement. My atrium shrank from 4.4-4.6 to 3.0 cm after being on Flec for 13 months after my last stress test showed on 5/12 last year.
Hopefully it stayed the same even though I haven't been in rhythm about 30% of the time.

We're you on any blood thinners before or after? Anybody? I'm trying to find out if I can stay on Xarelto before and after the ablation without being switched to Coumadin.
Don't want to waste a month trying to get stable on it!

Thanks for the detailed post!



Edited 1 time(s). Last edit at 05/07/2013 06:22PM by McHale.

McHale, my EP at Barnes - St. Louis takes patients off Xarelto 48 hours before the ablation and has them back on it late that same day.

McHale Wrote:
-------------------------------------------------------
> Hi Stephen,
> Good to hear no remodeling or enlargement. My
> atrium shrank from 4.4-4.6 to 3.0 cm after being
> on Flec for 13 months after my last stress test
> showed on 5/12 last year.
> Hopefully it stayed the same even though I haven't
> been in rhythm about 30% of the time.
>
> We're you on any blood thinners before or after?
> Anybody? I'm trying to find out if I can stay on
> Xarelto before and after the ablation without
> being switched to Coumadin.
> Don't want to waste a month trying to get stable
> on it!
>
> Thanks for the detailed post!

McHale:
That is an incredibly small Left Atrium Size! I was at 60mm. Last check around 54mm. Hoping to break into the 40's in two weeks when I have an echo and/or MRI. They told me that 40ish was normal. Leads me to wonder what folks on the board have been told their LA size was/is and if it shrank in NSR either via ablation or meds.

I am advised that when in the 40's my chances of a successful ablation are significantly higher. It was suggested that the enlarged left atrium was causing my valve not to seat properly and to murmur, which would correct itself in all likelihood if and when my LA shrank back down.

Thanks for sharing. Everyone.

Murray L

--------------------------------------------------------------------------
Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

I was/am on Warfarin (Coumadin). I will be on Warfarin for the next 3-6 months, maybe 9 months.

If my INR didn't get into range, they were going to switch me to Xarelto, so I think they might let you stay on Xarelto.

The INR is a pain--I was 2.73 going into surgery (had been stable INR between 2.0 - 3.0 for 2 weeks). But when they checked me at 4AM after my surgery, I was at 3.22, probably because I only ate 1 meal that day. So they dropped me lower and then I ended up with an INR of 1.5 three days later. NOT FUN/Dangerous. So, they jacked up my Warfarin dose again the last few days and we'll see where I'm at tomorrow morning.

Hi Stephen,

If you were more or less consistently eating a consistent amount of Vitamin K containing foods prior to the ablation .. and then suddenly you not eating that day and having what is almost always a low K intake meal at the hospital and possibly the day after, that could easily have increased your INR, though usually such an increase from 2.7 to 3.2 would take a few days ( 3 to 5 generally) to really show up.

In any event, it's always a good idea to keep your Vitamin K intake as steady and consistent as possible via dietary and supplemental avenues, using low dose Vitamin K1 ( around 50 to 75mcg) and low dose K2-MK7 in the range of 45mcg to 90mcg daily dosage for K2-MK7. Just find a dose that works for you and titrate your Coumadin to get a good middle of the 2 to 3 range and stick with that Vitamin K1 and K2-MK7 low dose regime as much as possible. That can often help stabilize a very variable INR, particularly if you don't also have genetic Coumadin resistance and thus require much larger daily doses of Coumadin to stay relatively in range with is much harder to do when your dose is from 12mg to 15mg a day of Coumadin, as mine is ... seems like I get all the fun luck of the draws!!

Anyway, hang in there and a few more months will pass soon enough and consider yourself lucky that you wont need to deal with anti-coag issues for the long haul.

Take it easy,

Shannon



Edited 1 time(s). Last edit at 05/10/2013 09:09PM by Shannon.

Stephan,
Yes I can stay on Xarelto right up to the ablation which they already offered me on May 29th......!