Ablation date set for October 3rd w/Dr. Natale. I have many questions.

Hello everyone,
They just informed me that there's a cancellation and they can move my ablation date to October 3rd from December 8th with Dr. Natale in La Jolla, San Diego if I want.

Now that the ablation date can be closer, I'm getting nervous and have many questions.

My questions to all of you who went through ablation with or without Dr. Natale. Perhaps these questions and topics are addressed before in other posts, but I ask again here, so I can read them all in 1 place. Sorry and thank you.

1. I'm not on any meds, but they will put me on Xarelto for 4 weeks before ablation and perhaps a few more months after ablation. I'm currently taking magnesium, taurine, COQ10 and fish oil. Do I have to stop the supplements while on Xarelto? Any interactions between Xarelto and the supplements? Is it expensive to be on Xarelto if I have PPO BlueShield insurance?

2. Linda (the Nurse Practitioner) told me that I can be back to work in 3 to 4 days. Is this realistic?

3. How long after the ablation do you think I can deal with anxious situation? I'm in a band and often, before we hit the stage, I get anxious and filled with adrenaline. This often triggers the episodes while I'm on the stage and afterwards. I can't live without music. I mean, I would like to continue performing. How long after the ablation can I go back to screaming my lung out and jump up and down like Van Halen ?

4. How long after ablation can I go back to jogging? I used to jog everyday, but since I had the beast, I had to jog less because somehow jogging everyday triggers the beast. I would like to jog everyday.

5. After ablation, can I eat normal food? Any restrictions?

I'm sure I have more questions, but for now I don't remember them all. Anything else you all can advice or share with me?

I appreciate any comments. Thank you.

Duke

Duke, sadly, I don't have any answers for you, but as someone who is considering ablation, do you mind me asking how old you are, if your heart is "healthy" and what made you decide to have the procedure done? oh, and how often were your episodes?

Duke,
In regards to question number 2 about when to return to work, I don't think that returning to work in three to four days is realistic. It will depend on the activity level of the work you do, how extensive your ablation is, and how your body reacts to having your heart branded with a branding iron. Some of this won't become apparent until post ablation. I've heard some talk about returning to work immediately and good for them. I took off three weeks after my Natale ablation and then developed a "delayed inflammatory response" so needed more time. Hopefully you will have an understanding boss if your recovery isn't immediate.

In regards to eating you can return to a regular diet immediately.
Betty

Depends what your work is. If physical, forget about it. Same for the runs. This is after all, heart surgery of one kind or another.
You're going to have to take it easy for a while.

Erich,
I am 48 y.o. male. I'm healthy and fit, except for the out of whack electrical system. I'm not taking any meds right now and have Afib for 1.5 years. My episodes happen sometimes in 2-3 weeks or sometimes a few times per week. It's unpredictable. I decide to have the procedure because I hate the feeling of fearing the beast, not knowing when it shows up. And if the procedure doesn't work out, it's fine with me because at least I put my gloves on and fight the beast mano to mano (not sure if I say it correctly :-)

Am I nervous with the procedure? Yes.
Am I worried what is like after the procedure? Yes and that's why I have so many questions and ask some of the questions in this post

But in my mind, I always picture Afib is like a monster, beast, devil, etc. And the only way to kill it is to slaughter it. And if I don't kill it, it will kill me or suffer me. It's a fight I have to face and I don't like to negotiate with the monster, beast, devil or whatever you want to call it.
Anyway, that's just my personal thinking. Sorry for the unpleasant description..

Betty & Afound99: Thank you for your suggestions. I work for myself at home and at times, drive around to look at properties. No physical work.
Betty, what is "delayed inflammatory response" ?

Thanks again for all of your comments.
I wish you all well.

Duke

Duke, I was back to swimming laps 3 days after my ablation, but I just had a basic PVI. It depends on your job and how extensive your ablation is. If you have a desk job, you could possibly go back to work pretty quick. If you have a physical job, I would say not.

Jim

Hi Duke, I'm 50 , just had a PVI 3 weeks ago. I was previously very physically active, but quit racing (Bike, triathlons) about 4 years ago due to the afib. I went back to work in a week. I'm a physical therapist , but I don't need to be very physically active, just walking around and using the computer. I would love to start exercising again, but honestly, I don't feel like it yet. My resting HR is still in the 70's, it was in the 50's. I've been doing some walking/ hiking (not to strenuous) in the 3-4 mile range. I still have some SOB walking up hills, so I'm not going to push it. In fact, I'll probably not start anything more until I'm off the coumadin . (2-4 more weeks) I am feeling a little better every day, but I can tell things aren't quite right yet. If I feel good, I'm going to start some light lifting , core exercises, ( TRX) and maybe some stationary bike when I"m off the Coumadin. I may start using the rebounder a little sooner, but I bought a heart rate monitor, and I'll keep my HR low for a while, maybe even until 2015. I figure, what's the rush?
I'm glad I got it done, I probably waited too long, but I had periodic success with diet and supplements . If I were having weekly events , I would be knocking down the door to get it done.
Best Wishes,

John

Duke,
Getting your heart branded causes your heart and surrounding tissues to respond with inflammation. This usually occurs immediately after the procedure. In my case it wasn't a problem until I returned to work three weeks after the ablation. The first day back to work was fine. The second day I began having sharp chest pain, nausea, short of breath and it really hurt to breathe. I'm a nurse practitioner and need to give the impression at least that I'm in better shape than my patients. Kay, Dr. Natalie's NP told me it was a delayed inflammatory reaction and to take Motrin 600 mg three times a day for a couple days. It helped but the problem recurred and I had to repeat the Motrin along with Lasix and potassium. It was only a problem for about a week.

I've been in NSR since my ablation a year ago and very glad to get it behind me. Like many others, wish I had done it sooner. Best wishes as you go forward.
Betty

Hi Betty,
Thank you for more info.
How long did you experience the sharp chest pain, nausea and shortness of breath after the ablation?
Is it a week or longer?
How extensive was your ablation and were you paroxysmal or permanent afibber?

Duke

Hi Duke,

Betty's ablation was very little like yours will be, as she will no doubt share. Most of us were a lot older than you and had more advanced cases than do you when we had our initial procedures. The odds are at your age that you'll have very little SOB, perhaps a little but nothing to worry about or try to imagine or calculate exactly what it's going to be like for you.

Believe me Duke, most of us have been right where you are now with many of the same questions and concerns so we all understand the flood of thoughts and new queries once the dice is cast and we are in the final countdown. Many of us have found it easier on our own peace of mind to start the unwind and let go of too many blow by blow details once we have mostly heard it all before and just let the mind rest with the decision as much as possible in the weeks and days leading up to the ablation. As least as much as we can.

You have read a lot of accounts here in the many months you've been building up to the ablation that is now coming in October, and how nice is that to have this early spot come free! My sincere suggestion now for the remaining weeks is to start to relax and appreciate the great decision you have made and the great good fortune of getting a cancellation that allowed you to move up to an earlier date and get it all over with soon.

Really Duke, at this stage, and having heard and read pretty much the full gamut of what is both possible and likely in a case like yours and knowing too that you could not have possibly made a better choice, just be very happy with that knowledge and begin to let go of the anxiety and 'what if' kind of concerns etc. It's all fine and a natural part of the process to want to cross every T and dot every I along the way during the decision process, but at a certain point rehashing more of other folks experiences becomes a little redundant and can start to feel a little cluttered in the attic so to speak.

Now your job is truly well done so just start rowing your boat gently down the stream and embrace the fact that life really is but a dream. Nothing anyone of us can say now about our own experiences is going to change anything about your ablation and how you will sense and interpret it at this point. You are already far better prepared than you might think and all you have to do from here is follow a few simple instructions and show up in time and having taken your last dose of anti-coagulant drug at the right time that Linda tells you too. That's it pal!

Easy does it from here and try not to overly analyze every little detail yet again between now and then ablation and you will do just fine. Doing so again at this point when you are officially in the chute now and almost ready to go, typically only adds more anxiety and a can make for a more restless mind with out, in the end, really telling you much more than you already know.

A few practical questions are fine at this point Duke, but try not to imagine too hard how every little step is going to feel for you. No matter what any of us say now, it won't really correlate precisely with your own experience going through the process in any event.. Think more peace of mind and less clutter up there over the next weeks if you can.

Go to the movies the beach for some sunsets and some nice walks in the coming weeks and most of all, take it easy. You're in the best possible hands already and are very lucky as well so no worries.

Be well and you'll be answering these questions for newcomers before you know it!
Shannon



Edited 3 time(s). Last edit at 08/29/2014 04:40AM by Shannon.

That was nicely put Shannon!

Thank you John21,
I'm glad you found it useful. We can all relate to how the mind tends to work overtime with all the 'what If's' once our ablation draws near, it's often good to step back and get a more handy perspective to save ourselves from a lot of unproductive worry and gnashing of teeth over concerns that will almost never really occur. Especially when you've made as good a choice as Duke has.

Be well,
Shannon

Right, with Natale you have the Gold Standard..

Hello everyone,
I want to thank you for all your comments.
Since I've joined this forum, I did learn that Dr. Natale is one of the best ablationist. I don't doubt that he will do the best job.
However, it's not Dr. Natale that I'm concerned. It is me that I'm worried about. In other words, I don't know how my system will react to all the burns and how my body will heal as time goes on. May be you have seen a movie scene where a best surgeon or doctor in a most advanced hospital in the world walk out of the operation room shaking his head and said to the patient's family, "I'm sorry for your loss, but we did the best we could" :-)

It's not the doctor or the equipment. It's how am I going to recover, that is the question. Like some of you mentioned, everyone is different or should I say everyone's luck and destiny is different. How each one of us heal and recover differently. Only time and destiny will tell.

Destiny. What a word :-)

Yes, I do understand that we want the odds to be in our favor if we choose Dr. Natale. That's why he's the chosen one, for me and for lots of you.

Thanks again folks. Especially Shannon, for always taking the time to write a long reply that is filled with details. I love it :-)

I wish you all well.

Duke

Duke my suggestion is to take it really, really easy after your ablation. Don't go jumping around on the stage for goodness sake. Afib is tough on the body and with the lack of sleep, concern, and less than optimal circulation that goes along with it, your body has been through the grinder, and you need to give it time to heal. This goes beyond the simple healing of the wound, but in that regard think of a burn on your knuckle. It would take at least a week for it to scab over properly and another week for the skin to form a new layer and it would be red and inflamed for some time after that. So for that first few weeks or even a month just get up and move around and go for walks. I can tell you from personal experience that it is not at all worth it to get too active too soon. Some have and have gotten away with it, but you risk relapsing (I did). From what I can glean it takes a lot of us between 6 and 12 months to start feeling really good again. Any cardio workouts of longer duration could probably have been a contributing factor to your afib, and are not good exercises, maybe ever again. You can get back in perfect condition later on in your healing by using short high intensity training, strength training and even vibrating plates, without doing the kinds of exercise that cause sustained depletion of your electrolytes. There are lots of good suggestions on Dr Mercolas site for this. It has taken me fourteen months since my ablation to bring me back into good condition again. But I am still very protective of my heart and do not put myself in a situation where I have to "go hard", just in case things are feeling off.

All the best to you.
Ron

You are welcome Duke,

And regarding your fears that you are going to be some extreme odd ball that kicks the bucket with Dr Natale or has some diasterous outcome because of some unique physiology or body type not reacting as expect ... that kind of thinking belongs in Texas, where I grew up, to an unhandy and counterproductive practice we euphemistically call 'mind - ****ing' (excuse my French). It belongs to a purely optional irrationality of fear-based projection and is particularly unwarranted for a guy like you who is young, quite healthy otherwise and in reasonably good shape. Just recognize it for what it is and have a good laugh about it Duke whenever you see such silly thinking trying to run away with your peace of mind and come back home to center.

You are going to be just fine Duke, a few relatively minor to moderate twinges and a sore spot here and there for a bit and perhaps a bit of transient fatique for a while and that typically covers it along with the usual other passing symptoms commonly reported.

Compared to your worst fears, you are going to be very surprised at how comparativrly easy it is. Plus RonB's experience of taking so long up to a year to regain his more of less normal energy and feeling from before, is very unusual. Most people are pretty much fully back in the saddle by three to four months tops and that is only to get to the point where you hardly even notice or think of the ablation anymore day to day.

RonB had a bit of a rough go of it initially having traveled all the way to France and then experiencing nearly immediate reconnections around a PV that put him right back in flutter or AFIB and required a touch up right then and there before they returned to Canada. They do that on occasion in Bordeaux for those who travel such a long way and its a trade off with having to redo the while long trip a couple months later.

Dr Natale told me not long ago that he gave up making such exceptions and doing very early repeat touch ups unless in some extreme circumstance. and he generally now avoids doing so quick a touch up when there is post ablation AFIB, even in those fewer cases where it looks like it will have to be done at some point and is not just blanking period activity. He had found over time that the inflammation from a very recent ablation is generally still too much to allow laying down new solid transmural lesions that last for the long term. It's best if you can get an ECV or use AAR or rate control drugs to keep the activity reasonably under control or tolerable enough at least to give it at least two months of healing, if possible, before a touch up.

I fully agree with Ron's advice not to rush back into a hectic life style right away, take it easy those first three weeks to a month even though going back to work in most cases is okay within a week or so. And also his recommendations on not going crazy with too intense stuff too soon and to stay with the electrolyte repletion program as part of your ongoing life style and health maintenance from here on out.

The typical experience is a gradually improving scenario day by day until you are well out and about and doing all sorts of errands by end of the first week , if not a few days earlier, and most residual period of tiredness or fatique tend to skip away within the first four weeks to two months after which things typicly hVe returned pretty close to normal life. Don't be too afraid to test your heart with normal range of activity by end of the second month at the outside. You don't want to run a marathon or go nuts with it all that soon but most folks are fully able to resume a pretty typical exercise program within two months .. Three at the outside.

The issue about no longer recommending doing very early touch ups in the first days to few weeks after an ablation, I have learned this just over the last year from Dr N's remarks.

When it takes much longer than that the typical 3 to 4 months maybe 6 months for the faintest remnant side effects from the abaltion to dissipate, then typically most often its because the first ablation was not yet complete enough and a touch up is in order to really settle everything down and make it all solid and trustworthy for the long term.

I had a very extensive 'soup to nuts' index persistent AFIB ablation with a lot of lesions, far more than you will have Duke, and almost two full hours of burn time which is also more than twice as much burning as you will experience in a PVAI for paroxysmal AFIB, and yet I was flying back to Hawaii where my long time home was in a weeks time from Austin via San Fran to Honolulu, and then returned to Amsterdam which is literally half way around the world from Hawaii, about 5 weeks after my ablation, as I was living there at the time, and resumed riding my bike all over Amsterdam every day.

And I was climbing a few times each day an incredibly steep, narrow and twisting four story stair case to get to my flat at the top floor of a charming 17th century canal house built in 1640 right on the lovely Keizersgracht canal in the heart of old Amsterdam and with no real issues to speak of. I wasn't racing up those crazy Dutch stairs, mind you, but could make it okay with one continuous jaunt up to the top. This canal house was built at a time when there were no strict building codes for such things I can tell you. But I made it up and down without having to pause mid way up as well by then in the weeks and first months after the big ablation.

And it was a far cry better than trying to navigate those stairs while in high speed persistent AF as in the months before the ablation, that's for sure!

You are going to do just fine and that's the last I'll say on the matter prior to you going in Duke. You've got everything stacked in your favor so don't make it any harder on yourself than is necessary and certainly not with projections of some diaster that is not going to even remotely happen to you with this physician.

Take it easy,
Shannon



Edited 4 time(s). Last edit at 09/01/2014 10:21AM by Shannon.

Duke Wrote:
-------------------------------------------------------
> Hi Betty,
> Thank you for more info.
> How long did you experience the sharp chest pain,
> nausea and shortness of breath after the
> ablation?
> Is it a week or longer?
> How extensive was your ablation and were you
> paroxysmal or permanent afibber?
>
> Duke

Duke,
The delayed inflammatory response initially lasted a couple days between weeks three and four. It returned later the same week for only one day.
My ablation was extensive according to Dr. Natale. I was a paroxysmal vagal afibber for many years before the ablation.

Duke, there are risks with everything we do. We have to weigh the risks and make the best choices we can. For me the cardiac regulating drugs, like Flec, were making me so foggy headed that I was driving through red lights and stop signs. An ablation with Dr. Natale was a better choice.

You have already considered your choices and made a decision. It sounds like a good one. Enjoy some peace this month knowing the beast will soon be behind you. And don't watch scarey movies.
Betty

Hello Duke

Go back to page 3 of this forum and read my account of the procedure in Austin at St. David's. It's titled "History and one month Natale ablation report". It will be a piece of cake for a guy like you. I rode my bike 7 miles today in the Florida sun and no Afib since June 30! Dr. Natale is the juice.

I had a Natale ablation in Austin on a Thursday, came home on Friday and was back to work (non-physical) on Monday. Other than a sore throat from the "trachtube" I had no problems from the procedure. Per Natale I waited three weeks before I resumed my exercise prrogram. I will confess that I was apprehensive when I started to exercise again as I had started to experience arrhythmia with physical exercise. It has been 3 1/2 years and have not experienced any issues. Other than warfarin for the first 90 days post-procedure and an aspirin a day require no medication.


Steve

I want to thank you all for your continued comments

Gary ,congrats on your continued NSR and thanks for sharing your story.

Steve (Jayhawk), how long did you have the sore throat after the procedure?

RonB, your advice is well taken. Thanks.

And of course Shannon, I appreciate your phone call to check on my mental status :-)
I always enjoy our conversation. I love you man. Can I say that? :-)

I wish you all well and NSR forever.

Duke

Duke

It was probably a couple of days......the sore throat was from the "tracttube" not the actual ablation.
I have had numerous orthopedic surgeries and always get a sore throat from the tube.

s

Thanks for answering my question duke!

We are close to the same age (I'm 36), and have similar profiles (11 months of afib, monthly -> weekly episodes), also taking no meds.

I feel we may be heading towards similar outcomes as well, I might experiment with drugs/oac's but I think I may need teh ablation sooner rather then later. Anyway, I'll look forward to hearing about how you progress post-ablation! Good luck!!!