Recovery update 4 - Natale ablation for persistent afib

I spoke with Dr. Natale’s assistant this weekend and arranged for a Monday (today) appointment to review the information, treatment program and prognosis developed by my local cardio and internist. The assistant apparently read my posts on on afibbers.net, figured out who I was, and contacted me to come see Dr. Natale. This was fortuitous as I had planned to call Dr. Natale’s office on Monday, information in hand, and arrange to get the good Doctor’s input. It was not possible to get all the data transferred in time for the appointment, but Dr. Natale was able to read my Cardio’s report.

The addition of Colchicine to the Celebrex I have been taking for 2 weeks has helped significantly. I started taking it on Friday immediately after I left my local doc’s office, and began feeling better by Sunday. Today the improvement has continued, the 4th day of taking 1 - .6 mg tablet of Colchicine, twice daily.

Dr. Natale had insight on all of my symptoms. The bloating, belching, digestive, fluid retention, constipation and appetite problems apparently are not uncommon after extensive ablations such as I had, and are related to vagus nerve impairment as it connects to the digestive system. It typically will self resolve after 2-4 weeks, occasionally as much as 8 weeks. In my case, the appetite, bloating/fluid retention issues are mostly cleared up. Belching and constipation are improving.

Dr. Natale was not able to review my chest X-ray, but in listening to my lungs during deep breathing, felt that perhaps my lower left lung, where an effusion was evident on the Xray, had begun to clear up or improve.

Dr. Natale arranged for an echocardiogram which did show pericardial effusion, but in his opinion the amount of fluid poses no immediate risk and may have already begun to respond to the Colchicine. My pulse was strong and my EKG showed normal rhythm.

My prescriptions have been altered to discontinue Celebrex after 1 week, and cut the Colchicine dosage by half in one week, then continue taking for a full month. Dr. Natale’s prognosis is that my symptoms will continue to resolve without further intervention, and that I should begin to exercise again.

I am greatly encouraged by the Doctors prognosis. As symptoms resolve and I recover from weakness and exhaustion, I am really looking forward to exercise, and getting off my butt!!

Thanks to all the board members for their kind words and interest. I hope my experience will help others avoid some of the issues I’ve been dealing with.

Great news to hear John,

And thanks for the fast update! As we discussed this weekend I felt confident things would turn out fine once you saw Dr Natale again and am so glad you got in to see him today while he was still in the Bay Area attending the last couple days of the annual American Heart Rhythm Congress held this year in San Fran, as he returns to Austin tomorrow evening, so it was fortuitous timing all around indeed.

Sounds like you are well on the road to recovery which I trust will happen in fairly short order from here on and am just very happy to see things take such a good turn for the better now for you and your wife and look forward to hearing of your steady progress going forward.

Will touch base soon to catch up.

Cheers!
Shannon



Edited 1 time(s). Last edit at 11/03/2015 08:01AM by Shannon.

Great news John!

Kudos to Dr Natale and his staff for reaching out to you once the right people became aware of your problems!

John,

I have read all the posts in your tread. I am so happy and relieved that you are finally feeling better.

Cheers!
John

I had some suspected vagal nerve damage after my ablation from persistent a-fib by Dr. Natale. Mine took almost 6 months to fully resolve but i am completely fine now and fully a-fib free. I think when he ablates extensively the vagal nerve is easily impacted.

Hi Lorenzo,

It varies of course and depending on how challenging a case is there can be some degree of vagal stunning but the rates reported are not too high in the 10% to 15% range of those of us with more difficult and more extensive procedures required. And a lot lower numbers when considering the full pool of patients. Though most of those higher per tage cases occur with more challenging cases of AFIB to address, and all resolved usually within 2 months or less and occasionally up to 6 to 9 months for full resolution though typically the last few months of these more drawn out cases tend not to be very noticeable as the effect gradually fades and recovers. Some degree of very mild vagal stunning is likely quite common in ablation but this more common degree typically only last days to a week and is not much of a nuisance with perhaps some increased burping and bloating for a few days to a week or two in such cases.

Entrenched AFIB is a very tough challenge to address effectively and having to possibly having put up with temporary issues like mild to moderate vagal stunning to me is very much worth the much higher odds of being free of the beast with the least amount of total work needed in the long run and least number of total procedures by going to a maestro level operator who knows how to address whatever a given case demands in the most effective way.

It's somewhat analogous too, to having many other kinds of surgeries ... like with my wife's partial nephrectomy last January to remove what we feared at the time was a renal cell carcinoma tumor. She had partial regional numbness and other local effects around the large incision site for quite a while that gradually faded as everything slowly reconnected. Though in a case like hers with that kind of major incision, the rate of occurance of nerve stunning or incision is likely 100% and typically takes a good deal longer than most vagal impact of ablation.

The good news too is any vagal effects only rarely occur during any touch up ablations with a top tier operator who did a thorough job the first time around, as typically such touch ups are truly just that with a minimum amount of work and less often require new lesions in closer proximity to the vagus pathway ... assuming your EP is highly skilled and has minimal to few reconnections of prior work in any touch up that may be required.

Glad to hear things are going well for you these days Lorenzo and continue enjoying the NSR!

Shannon