The three most important letters in the Alphabet!

NSR

For a heart patient, especially for this AfibAsian, NSR (Normal Sinus Rhythm) are the best letters in the alphabet.  On Thursday, July 18th I finally met with my electrophysiologist and received the "all clear" to proceed and exercise with higher intensity. Of course during this time to maintain a more sensical approach so I will stay the course. Thanks to "Michelle" I'm a bit bound by taking it easy and will be forced to return to active running when I'm given the all clear, but it was the best news I've had since the ankle sprain.

So next step is to just make sure I follow the doctor's orders.

As for my EP he's ok with me doing things, but when I asked about training his reply was for running to stay fit, but if I had a goal and desire to do something is train within my limits. 

For now my updates will be more about "Michelle" the diva cankle and hopefully I'll be ready for some fall running.

If most of you know me then this is a huge milestone for me.

Moving forward! Lub-dub lub-dub

Normal Sinus Rhythm

Michelle Update - Fri. July 19th

Bruising from Acupuncture and a bit of Michelle

Volunteering

Since my summer running is on Hiatus...Thanks "Michelle" I've shifted to helping Miss L to get her volunteer hours volunteering at the last couple of events.

The Cyclelogik/Hintonburg 5K and the Farm 5/15 Run.

Always fun to give back and still get to see my running friends. Best run community!

Traffic cones err volunteers

Water Station with my girls

Courtesy of Ian Hunter

Courtesy of Ian Hunter

Courtesy of Ian Hunter

Courtesy of the cankle's namesake Michelle

Four Month Post Ablation

Four Months

I'm not too sure where to start as it has been quite the whirlwind week with Jury Duty selection and Dental check ups and then the 3rd item which I didn't reveal last week was my Holter results.

In general I feel totally fine for the past several weeks. I've done an outdoor run here and there and trying to get back to my new normal. In fact I'll be honest it is a HUGE struggle to hold back, but I know that it is best for me to allow my heart to heal.

I'm not going to dwell to much on the report, but there is good news and uncertain news. I don't want to say bad as I have not met with my cardiolgist so this is just my interpretation and no one else's.

Good News

During the two week monitoring I was in normal sinus rhythm and no Atrial Fibrillation! Greatest news ever. The ablation did exactly what it was supposed to do.

Uncertain News

As a result of this monitoring I had this one during one snowboard adventure, about five OTF workouts and a run. Of course the report doesn't say when it was and the day so I can only say there were three episodes of Ventricular Tachycardia. So Dr. Google says that's not good.

Soooo what do I do now? I either stop and do absolutely nothing or I wait for the call. Of course I got access to this report April 2nd so IF there was something to be concerned about then the cardiologist would have called me. That was advice from one of my classmates in my Stress management workshop. It is what it is. You now need to hear and wait for the doctor and no matter what "experts" are out there, they are not your doctor. They don't know you as well as your cardiologist.

So I'm taking that advice seriously and proceeding with caution and staying active as best as I can and within my limits.

Back to where It Started

I took the advice of my friend Heather when I met with her to see her sister play ultimate in a tournament in Gatineau. She had taken the week off and the above news I wasn't ready to share publicly until I found out more and her suggestion was to talk to my GP. At least talk to someone who sent me to the Heart Institute in the first place. He's always had a gut feeling or a hunch when it came to my medical problems. So her advice was perfect timing to set my anxiety levels back at ease. However, he was off for a week and I only saw him just before Good Friday. 

I brought in the paperwork from my Ottawa heart dashboard. The reports, ecg's and the one piece that I wanted interpretation is the Holter results. We talked about the V-tach and he basically gave a list of potential causes and basically the end result was that it's only been 4 months and it is possible I am still healing and I need to follow the original plan of moderate pacing and to stay the course. He said that for V-tach it is different for everyone and one factor he mentioned was stress and it could be a link to the V-tach, but it would be ideal to take it easy. I mentioned if my work allowed to go to 4 days/week if that might help. He said that he would medically approve if my work needed that as support. I think my original plan of working back the full 5 days was aggressive and maybe pre-mature not knowing what could be in place. In fact I had lunch with Erroll a couple of weeks ago and we compared our AFib stories as he was 3 weeks post ablation and was recovering well and following the blog to figure out how far to push and using my experience as his baseline. We compared our work strategies and I discovered that maybe I was pushing myself and just not realizing that I'm not getting younger and that I really need to give the body time.

Since it was a long weekend I've asked to meet with my bosses and propose my idea and see what happens. So for now I'll just keep myself in turtle mode and do what I'm allowed to do and to keep myself active...so stay tuned.

I'm Back

Physiotherapy Assessment - Part 2

The new normal

It's been a couple of weeks since my last update and nothing much has changed until today! February 19th I went in for my actual PT assessment after completing my Bloodwork, Fitness Stress test and attending my nutrition and stress classes.

Oh and of course this is was the day that there was the United Convoy heading from Arnprior to protest on Parliament Hill and possible traffic disruptions. Well the convoy did not disrupt me as there was more than enough warning to let people know that there was going to be oh about 200 vehicles coming down the 417 EB to head downtown. So luckily I left extra early on Tuesday and got to work early enough to leave and head out to my appointment at the Heart Institute. Oh and the parking as usual was a nightmare. I managed to find a spot, but with all the snow we had the last couple of weeks it made for street parking sketchy, but it worked. As usual I paid my fee and went up to the Cardiac Rehab centre where I met with Guy-Anne who was assigned to me to go over my results.

We had spoke on the phone a week before the appointment and discussed what Roxanne had taken from my intake appointment. We reviewed my vitals and she asked if my HR was still elevated. But as you know from my last post my HR returned to "normal" or at least it dropped down to a "normal" resting HR.

Having all those details in mind we reviewed my results. First up the stress test which is going to help determine what sort of fitness I can do. Since the test was abnormal when I took it as my ECG demonstrated Atrial Flutter it was hard to get the "normal". Seeing the trend here with the "normal"? Well there was a lot of calculations that was done and now the interpretation by my PT were that from the data of the stress test based on the start to the max output and I would be able to do 9 METS (Metabolic Equivalents).

As defined by PubMed:

One metabolic equivalent (MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2 per kg body weight x min. The MET concept represents a simple, practical, and easily understood procedure for expressing the energy cost of physical activities as a multiple of the resting metabolic rate. The energy cost of an activity can be determined by dividing the relative oxygen cost of the activity (ml O2/kg/min) x by 3.5. This article summarizes and presents energy expenditure values for numerous household and recreational activities in both METS and watts units. Also, the intensity levels (in METS) for selected exercise protocols are compared stage by stage. In spite of its limitations, the MET concept provides a convenient method to describe the functional capacity or exercise tolerance of an individual as determined from progressive exercise testing and to define a repertoire of physical activities in which a person may participate safely, without exceeding a prescribed intensity level.

Your science lesson of the day. So 9 METS is or is my current max "normal". I was given a nice chart to compare my exercise output and maintain a moderate exercise regime. So I will be studying that chart to get a good feel for this new "normal".
Next up my Aerobic Exercise Guidelines! Priority One is to ensure I do a proper warm up and cool down. I know if I'm in a class that is not a problem, but really I don't spend a lot of time doing this on my own so this will be a new challenge to tackle. In general, I need to exercise 5-7x/week at MICE (moderate intensity continuous exercise) and for HIIT 3-4x a week.
Can you feel the excitement in my blog?
Now with that in mind, my moderate HR zone should be 120-136 bpm for MICE and 126-142 for Hi HIIT and back to 90-105 for low HIIT (recovery). So this will be a bit tricky with my OTF, but Guy Anne has reminded me that not to hit those high rates so for OTF standards staying in my Green zone and below. So if I can still carry on a conversation then I'm good, but if I'm gasping then it's not so good. The message is clear that slow build back to to me is required. I don't know if I'll get back to the old me, but I'm just happy that I can get back to it again.
So on a side note, my blood work which I did almost a month ago showed amazing results. When I say amazing I have to admit my diet as an endurance runner has been terrible. So I've learned from my nutrition classes that I need to change that, but also follow the 80/20 rule and try to be healthier. So not only have I got a bit of a slow build, but I need to work on my diet and it's true. I have the next several months to change and I'm in no rush as part of the nutrition classes that fad diets may work in the short term, but long term effects are not the greatest. Now that my heart condition is potentially controlled. My best chance is to make sure I keep it that way so nutrition and exercise are important.
Now that I've been given a program it was now on to moving to getting the 2nd ECG. We called up to my EP and they agreed to get a 2nd follow up from my assessment in January to see if I was back in Normal sinus rhythm.
I was escorted by Guy-Anne to the waiting area where I waited to be served. Since it was the lunch hour I wasn't sure how long it would be and so I waited. In the meantime I was checking my email and I was supposed to meet up with a Comms person who had the hoodie I ordered. I wanted a memento to remind me of my journey at the Heart Institute so I ordered myself a hoodie.
So I met Judith who thanked me for being a social media ambassador and gave me my hoodie! It was awesome!

My new HI swag hoodie

 After meeting Judith I went up and got to the room where they wired me up and took my ECG which really only takes like a minute to do a capture and it would be read by the nurse/doctor to see what it showed, but I requested a 2nd copy and provided it to Guy-Anne and gave her the results and she gave me her interpretation and said it looked good, but since she's not qualified to actually tell me the official results until she confirmed it. So I sent it to Nurse TK and she told my P waves are back. So in layman's terms I'm back in rhythm.

I have rhythm

So to confirm I get a call the next day from Guy-Anne and she confirmed I am back in normal sinus rhythm. It is a huge relief and again another message to work with my new "normal" and rebuild and get back to training. I'm in no rush, but hopefully with some MICE and HIIT I'm well on my way. I think the best medicine for me has been prescribed and now to keep moving forward. One foot in front of the other. For now I'll enjoy the moderate exercise and will be on my recovery rebuild.

Cardiac Rehab - Setback

Six Weeks and some change

Dec 6th 2018 seems so far away now. But yesterday January 22nd I visited the Heart Institute for the first time since leaving after my Ablation. However, mother nature stymied me and it was a Polar Vortex the past three days so that meant traffic was a lot slower in addition to black ice and of course the usual winter long drives. I even gave myself extra time and it still took a lot longer to get to the destination. Long story short I pulled up to the meter parking and if you've used the PayByPhone app I punched in the 5 digit number and maxed out my visit and away I went. I was only a couple of minutes late.

Rewind to around January 13th when I registered my last run for the Lululemon 40/80 challenge and sadly ended my RORunStreak, but I did manage to log in just over 40 K for the Lulu challenge which meant a nice discount for the girls!

However since I started back running and HIIT training my HR has been spiking higher than normal

Now back to the Cardiac Rehab centre. I met with Roxanne, a physiotherapist, who asked me A LOT of questions and basically my fitness activities. So here is pretty much the laundry list of what I do.

• running
• HIIT training a la OrangeTheory Fitness (run, row, body weights)
• snowshoeing
• trail running
• snowboarding
• cycling
• skating

Given that I used to train almost 5-6 times a week I was getting about 2-4 times, but of course with the RORunStreak I was trying to get back to where I left off prior to the diagnosis.

So in addition to the in person questions I answered a questionnaire online prior to my appointment and we went over that as well. Apparently that one was about stress and depression. Of course I didn't realize those questions were being scored! 😨

Here's the bottom line--my scores indicated stress and depression!

My reaction was mixed. Part of me was stunned and the other part of me was anxious! It was like a flood of emotions that it was happening again. The palpitations, racing heart, crack in my voice. 

So now what?

Roxanne informed me that the Cardiac Rehab centre is not just for getting you back to a more healthy lifestyle. They have a variety of programs:

• Nutrition counselling
• Stress management
• Smoking cessation
• Vocational counselling
• Psychological counselling
• Social work counselling

I was quite surprised and apparently I'm covered by this if I so choose. We talked a lot for more than an hour on options, but ultimately this is my plan of action.

I will beginning a Brief Program, but before any of that I need some bloodwork done and in addition to that I have my sleep study report to follow up with. That will most likely be in a future post.

Once I get the blood work done then my next step is another Fitness Stress Test. 

Roxanne wants to measure my fitness level at just a walk and see how my heart handles the exercise. After all it is a test of my fitness. Keep in mind the last couple of weeks my heart rate has been abnormally high and has not been able to come down. So we will see.

Next will be a follow up appointment with a new PT names Guy-Anne and then we'll see from my test results what I should be doing.

Once I get onto the program then I will have a follow up several weeks on my progress. However, before I could leave the rehab centre I had to have all my vitals taken and after Roxanne showed me how to check my pulse/heart rate and to recognize that my heart is skipping a beat. So after Roxanne consulted with a nurse they decided that I should get an ECG just to make sure that everything is going according to my EP's plan. I just have to remind myself that the healing could take as long as three months or more before my heart figures it out.

So I took my lovely requisistion and went around the corner to another waiting room and waited for my turn for the ECG.

SVP

I had about 35 minutes left on my meter and as I checked I was given number 64. Guess what number they called when I got there for ECG. 48!😧 I waited and when they got to like 54 I ducked out and fed the meter as the time was ticking! Of course time ran out again, BUT my number was called. So now what?? I rolled the dice again as I always do when I come to this place and the gamble paid off as |I got my ECG and rushed it back to the rehab centre and gave it to the admin and went on my way. I left there pretty much three hours later and not really the answers I was hoping, but more of a reality check that I'm not quite ready. I messaged the usual crew Kiera and of course work my results and I was offered by Therese to help me read my ECG or at least interpret to me what all those waves really mean as Normal has been a long way since my Ablation. I did learn about the alphabet. P QRS and T. It seems one of those letters seems to be missing in my ECG. What does that mean, well according to Therese my heart seems to be trying to work around the Ablation which may be trying to go the opposite direction that the electrical charge wants to go. So for those that haven't been following along AFib basically means that my electrical system in my heart isn't working or more that it's overworking/stimulating my heart; hence the high heart rate as of late. Of course the EP will need to verify so I went online to my ottawa heart page to see if there was anything on my ECG or a report, but nothing, but did find other interesting diagnostic reports and my operative summary. Very cool to read these. I didn't understand a lot of the lingo, but it was all medical jargon.

So for the moment I have been fasting and await with probably my elders aka other seniors for the line up to get blood drawn for my blood test.

Oh joy! In the meantime I now just relax and take it easy!😒