Is this bad timing to get an ablation?

I have mentioned in a few posts that my husband, Doug, has lung cancer, Stage 3, He just had his first Chemo treatment today, at Memorial Sloan Kettering hospital in NYC. They are wonderful there and I don't think he could be in better hands. However, I do know that is is likely in for a bumpy ride which may or may not end well.

Before finding this out, I had met with Dr. Natale and we all agreed, I would go for an ablation this summer, if it could be scheduled. As it turned out, there has been a delay, due to insurance issues. I believe Antonia, who handles these things for Dr. Natale, may have finally pieced together the necessary information, and an appointment for the ablation may be forthcoming this week. (A big thanks to Shannon for making a phone call also to help me with this too!)

So now I am wondering...is this bad timing for me to get an ablation? Why I don't think it is if all goes well, what if it doesn't?? God forbid I have some major complication or..worse - with my husband home battling cancer and my daughter living back home now (age 22), I am worried for their sakes. I remember hearing about another woman on this Board where everything went wrong and she is much worse off than she was before having the ablation. Has anyone ever heard of Dr. Natale having a bad outcome?

Shannon has been very reassuring, but...now that I'm in the thick of things with my husband, I'm scared.

Barb.

Hi Barb,

We can all certainly understand and sympathize with the difficulty of your decision in light of your husband's unexpected serious illness. We've discussed my view on the phone and I appreciate how it can seem overwhelming when the time comes to make a decision with your husbands treatment now getting started.

I've heard of very very few .. none really ... where the person, and especially with your kind of AFIB, having a really bad outcome with Dr. Natale. No one here can offer a guarantee of anything of course, but he is the best bet whose hands you can put your heart in of anyone out there, up front.

Take Tom from Hawaii for example who truly had a disastrous ablation with an under-skilled Hawaii EP in November 2011 and woke up after having his chest cracked open twice and a new mitral valve installed due to the EP yanking it out when not realizing his catheter had snagged the mitral valve!.Not unlike what happened to Pam at Johns Hopkins quite a few years ago when a similarly clueless trainee EP using a catheter he had never handled before did much the same thing to her. Nothing anywhere close to that is going to happen with Dr Natale, even under the worst scenario.

Tom recently had his aborted ablation finally completed by Dr N in Austin and wrote me expressing his gratitude at having gone to Dr N in spite of suffering the ordeal he had in Hawaii. His trust and faith in going to Austin was well rewarded and he told us all here last week that he feels the best he has in 15 years!

That is far more likely the kind of experience you would have with Dr N handling your case, especially with no where near the hurdles Tom has had to go through with this.

Think of it this way, about the worst that is likely in your case, especially with no other issues going on like Sleep Apnea, metabolic disorders like severe diabetes or very low blood pressure, etc that could predispose for a greater likelihood for possibly needing another touch up sooner rather than later after a first main ablation, is that you 'might' have some days or weeks of periodic AFIB or Flutter during the blanking period, which in your case the symptoms can be managed fairly well with meds since you don't have to worry about crashing your BP.

The much greater likelihood is that you will have taken a huge step toward greater freedom from AFIB and thus would more likely have greater strength and resilience to deal with your husbands illness as it unfolds over time. Both for yourself and for him.

The stress you have to go through is unavoidable, within a couple months post ablation your heart should settle down well even if there are periods of flippies in the first 8 to 10 weeks. Only in the more rare cases would that be enough to make you incapable of helping in your husbands care for more than a couple days at a time here and there for a number of weeks.

And with your 22 year old daughter staying with you now too, could she not step up if, and when, needed to help take the load off of you too as well as help out with Doug if any days arise in the first 6 to 8 weeks where you don't feel up to a day of driving around and dealing with hospitals?

Again, I cant promise anything, but we also talked about how the mind so often projects the worst and which so rarely happens as we might imagine. Even when there is more activity than we would prefer after an ablation, at the end of the day most will admit that the worrying and projections around all that were actually a lot worse than the reality of going through such a period on the way to the other side and a quieter heart , even when a touch up might be needed to button everything down for the long term.

We discussed too how easy it is to fall into the cycle of worry when we have been prone to worrying in advance a lot in life, I know how that can feel. You do have a lot on your plate Barb, there is no question about it, but AFIB is a big part of that load too and if the insurance can be worked out and since Dr N fully realizes you need an ablation and agrees, and I know he is fully up to speed on your husbands illness and your concerns now, I'd hate to see you have to pass up this opportunity to get this burden behind you while you also walk hand in hand with Doug through the unknowns of his illness.

It is extremely unlikely with Dr. Natale, no matter how your initial recovery period plays out, that you would be out of commission for much of those first couple of months. Every EP, including Natale, will have a certain percentage of patients with more blanking period breakthroughs than is the case with the majority of his patients, but the larger majority for Dr N has typically has a pretty easy go of it as it is.

I am one who after a colossal first ablation at his hands five years ago for persistent AFIB with two hours of actual burning ... and a number of improvements have happened since in catheter and imaging gear not to mention growth in his own skills and overall knowledge about ablations in general ... I had two 40 minute tachycardias in the first 24 hours post ablation and then not a blip for 11 months. After my LAA isolation last August, its now two weeks shy of a year 'with not one heart beat in arrhythmia.

That photo I sent you of myself and my wife taken two days after the last ablation when we were already out and about with friends in San Francisco Bay area is how it has been for me ever since and there were no restriction at all on my activity other than be smart about pushing it too soon with heavy exercise. Even after my huge ablation five years ago, with 4 days in the hospital and another 4 days taking it fairly easy at a family reunion outside Houston, I was back in California boarding a flight back to Hawaii for a month of pretty much non-stop activity and then back to Amsterdam 5 weeks later without missing a beat!

The odds are on your side that an ablation in August wont become any where near the big burden in your life over the coming months as your speculation right now might paint it.

Most of all Barb, know too that no one here will second guess your decision at all no matter which way you chose. We can all imagine and appreciate the dilemma you must feel, but only you can make the best choice for you. Just make what you think is the best choice for yourself first and foremost and for your family and Doug as well.

I have a real hunch that what's best for your overall well being is likely going to be what's best for Doug and the rest of your family as well in the long run.

Best wishes Barb,
Shannon



Edited 3 time(s). Last edit at 07/18/2013 09:37AM by Shannon.

Barb,

Best wishes for whatever you decide to do.

Shannon,

Again, you've provided excellent advice that is very well put, my friend.

George

Shannon - what a wonderful and reassuring message you just wrote. THANK YOU for being there to boost me/us back up when we waver, teeter, or just plain need to hear from someone who truly understands.

I am a bit (ha!) of a worrier and over-analyzer, so my tendency is to think "what IF?". You just helped me to see that what the likely worst case scenario might be (flutter and Afib for 8-10 weeks, etc.), which is something I could deal with if it happens. And yes, my daughter could help and both of my sisters have offered to go into the hospital with me, and one of the husband's has offered to stay here with Doug if he needs that during that time as well. So at least I know I have people on "stand by"...Thank God for family!

I didn't realize those cases regarding Pam and Tom were the result of inexperienced EP's. I am thankful that Dr. Natale is now available in my "neck of the woods" too, and you're right, I dont' want to miss the opportunity to have him do the ablation. It's one of the reasons I have held off for so long - wanting to go see him but not sure how to handle the long distance logisitcs. And of course, the ups and downs of Afib - when having a good day or time period, it's too easy to say "I can wait..it's tolerable". Trouble is, I've been saying that for 10 years. Had I acted sooner, I wouldn't be facing my current dilemma.

I just got off of the phone with Antonia again, and she promises that they will get back to me with a date soon. Just hoping they do that quite soon as I am supposed to be on Xarelto for 4 weeks before hand, and Dr. Natale will be in NY from Aug. 12-16...we're already a bit past that date. How important is it to be on this for that length of time? I think McHale had a very short window between the time he had his consult and his ablation, no?

Thank you again for your kind and encourgaing words ~ Barb

Thanks for talking me off the ledge My decision IS to move forward - now to get a definite date.

And Shannon - when are you going in for your Lariat procedure? Is it Aug. 5th?

Barb,

I am truly sorry to hear about Doug's lung cancer, but I am sure he is getting the best of care at Sloan Kettering. I am very pleased to hear that you decided to go ahead with the ablation with Dr. Natale. As Shannon so aptly put it:

The much greater likelihood is that you will have taken a huge step toward greater freedom from AFIB and thus would more likely have greater strength and resilience to deal with your husbands illness as it unfolds over time. Both for yourself and for him.

As far as complications are concerned it is very, very unlikely you'll have any with Dr. Natale at the helm.

Shannon,

I wanted to thank you for your thoughtful, caring, and helpful reply to Barb. I truly embodies the spirit of this Bulletin Board. Your presence on the Board is much appreciated by me and your fellow afibbers - well, hopefully your afib days are now well and truly behind you.

Hans

Barb,

I started on Xarelto two and a half weeks before the procedure and it wasn't an issue at all. I too over analyzed having the ablation for 10 years, and I am so glad that I had it done. When your ablation is done you too will wonder why you waited so long.

Good luck, you will do great !!!

Ken

You are more than welcome Barb,

Really glad to hear they are working out a date for you. I have every confidence you will be very glad you did when this is all behind you.

And yes, my Lariat is set for August 5th in Austin. Magdalena and I are leaving Sedona a week from this Sunday for Texas stopping in Houston for a few days to visit my sister and niece who is the trauma doc at Hermann Med Center there and her family before driving a rental car up to Austin two weeks from today on August 1st. Have a meeting at Dr N's office on Friday August 2 and then early Monday Aug 5 we start with a TEE followed around 10:30am to 11:00am with the two hour Lariat procedure itself with Dr N and Dr Burkhardt.

I may or may not be in a position to communicate much that first day as they put you in cardiac ICU the first night while the pericardial drain tube is still in the chest and I'm not sure what their policy is on cell phones or Ipads in ICU, I suspect that they likely frown on it in there? Anyway, we'll figure out some way to let Hans or Jackie know how it all went and they can pass along an update. I'll give Magda or my brother who will also be there the numbers to call.

To Hans and GeorgeN:

Many thanks for your kind words, we can all sympathize with Barb's situation and how hard it can be to see the forest for the trees when there is too much on the plate on one time. The way you have structured the forum and this website Hans has facilitated this evolving into an excellent support system for AFIB on the web. Its my pleasure to contribute whatever I can.

Take care, Shannon

All I can say is "wow". You are all a true blessing to those of us who struggle so with our Afib. I wish everyone had this kind of support! I am very thankful that I do. This Board has been a God send, Hans. THANK YOU.

Shannon - it's your turn next. I'm not sure how best to support someone who already knows so much about this and is already so positive. But I;m sure I"m not alone in hoping that you will keep us all updated every chance you get, and that I will be praying for a quick and speedy recovery. More on that in the coming weeks....

Ken - how are YOU doing? Your message sounded pretty upbeat, so hoping that is a sign that all is good.

Time for bed....good night my friends ~ Barb

Barb

Go ahead with the ablation. I had cancer before the afib and I know how hard it is for you to be a caregiver for your husband and to deal with cancer and the side effects of treatments. But it sounds like you have family there for yourself and your husband which is great! Take advantage of that!

When you have your ablation the only thing I could think of that would be a problem for you is that you need to stay off your feet for a few days because they go into your groins with the catheters and you need to heal before you are on your feet or walk a dog. You have family to help you, which I did not have, so that is a plus for you. I also had to have a second ablation last year for flutter but it was only a 90 minute procedure and I am now afib and flutter free. Just do it and get on with your life and be there for your husband. Good luck to you.

christy

Barb,

I am doing good, it has been two and a half weeks since the ablation and I have been in NSR the entire time, I can't tell you the last time I have gone that long in NSR. I started back to work this week and put in a full week so my energy level seems to be back to normal.

You will be in the hands of the best of the best so relax and look forward to your well deserved NSR.

Ken

Barb,
It is understandable to be scared with this. I think we all have been especially before the procedure. It is great that you have a good support system. Put them to work for you! Best Wishes!
Betty

Hi Barb, I started on xeralto the week I had the ablation. I,m one of those who have had a rocky recovery from my ablation on 6-14. I am happy To report that I am feeling well the last 6 days with no af/flutter. I still feel fortunate to have had such an experienced ablationist work one me. When I was not feeling so well I was comforted by the fact that it was my reaction to the procedure and it was not the result of operator error. Follow up care with dr Barrett has been excellent. He has been there for me every time I needed him. Shannon has also been a godsend for me. Passing up the trifecta available to you now with Natale to ablate you Barrett to be in charge of follow up care and Shannon to guide you may be a lost opportunity. Of course this is a serious decision that only you can make. I have no regrets. Good luck with your decision. Dennis.

I appreciate you all sharing your stories and giving encouragement - thank you. I am a big chicken when it comes to hospitals and getting procedures and things...had a gynecological procedure done about 3 years ago and I shook so badly while waiting for things to start that I think the Aesthesiologist knocked me out to put me out of my misery! lol..

Happy to hear that you are all on the road to recovery, even if there have been a few bumps in the road.

Yes Dennis I agree - the combination of Dr. Natale, Dr. Barrett and Shannon - as well as so many on this Board (Hans, Jackie, George, etc.) is unique and so very fortunate. Now if the hospital would just call me and get a date on the calendar!! Argh...hopefully next week?

Barb