Wednesday, May 12, 2010

The Countdown Has Begun

Yesterday Grandad saw the Interventional Cardiologists in Houston.

We arrived at the appointment about 45 minutes early and actually got in early.  Over the next three hours, Grandad was examined by three different doctors; his vitals were taken; he had an EKG and blood drawn.  In addition he was generally poked and prodded by all three doctors.  Their conclusion was what we already knew, Grandad's heart is in atrial fibrillation.  In addition, his heart is in "full flutter."  Both of these are caused by a small area of electrical abnormalities in the upper chambers of the heart. 

They consulted with each other and then presented several options for treatment. 

The first choice is to try a different medication.  They explained that the medication he's been taking, Amiodorone, is considered the "big dog" of medications that regulate heartbeat.  If Amiodorone doesn't work, none of the others is likely to work, but they are willing to try something else if that's his preference.

The second choice is to shock the heart with paddles to restart his heartbeat.  After this procedure he would be required to continue taking the same medication to control his heartbeat.  This procedure works for some people, but is considered a short-term solution.  They do not believe this is a good option for Grandad.

The third choice, and the one they recommend, is cardiac ablation.  Cardiac ablation involves ablating specific areas within the left atrium near the openings of the 4 pulmonary veins which are the blood vessels that deliver oxygenated blood from the lungs to the heart.  The ablation is performed using a heart catheter through the arteries in both legs.  It can take as long as 4-5 hours and may have to be repeated 2-3 times for full success.   There is a slight (1-2%) chance of stroke.  The success rate for cardiac ablation is around 80%.

They did not discuss a heart pacemaker with us, although through research we know that it is the treatment of last resort.

We chose the cardiac ablation treatment and asked to be scheduled as soon as possible.  The first available date is Wednesday, June 8 at the Texas Heart Institute at St. Luke's Hospital in Houston.  He will have to be in Houston on the 6th or the 7th for preoperative testing which includes trans-esophageal echo-cardiogram (TEE) to assess the heart function and, specifically, to look for blood clots.  Any evidence of blood clots around the heart will result in cancellation of the procedure. The doctors must also make a complete map of his heart before surgery.  Once the procedure is complete he will stay in the hospital overnight and, if all goes well, will be released the next day but expected to stay in Houston for a few days. 

We are relieved to finally have a diagnosis and a plan for treatment.  But we were both disappointed that an earlier date is not available.  We have asked to be notified in case any time opens in the schedule.  They indicated that they do occasionally have cancellations and put him on the list to fill any slot that may open up. 

I appreciate the fact that a "panel" of doctors looked at the evidence and presented the options.  I'm a firm believer in the old adage that two heads are better than one.  I also appreciate them giving us the final say in the choice of treatment.

We are home tonight and tired but hopeful.  It feels good to finally have a plan.  Now we start the countdown.  As always, we appreciate your prayers.

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