Issues of the Heart Chapter One

A TESTIMONY TO GOD’S FAITHFULNESS

(This was written in 1991 after my first major bout with heart related issues.)

I’ve decided to write some thoughts and details about my experiences of the last nine months in order to keep you up to date on what has happened and to give testimony to God’s faithfulness and grace. In the way of background – I’ve had an unexplained rapid heartbeat for a number of years, dating back to the mid 1970’s. The episodes came roughly every 3-4 weeks and last for 5-15 minutes at a time. I went through the cardiac unit at St. Joseph Hospital in Omaha in the summer of 1977 before we were married in an attempt to find the cause and was told at that time I had PAT or just a rapid unexplainable heartbeat.

Over the past years I’ve worn Holter monitors and been on medication but neither has been of any value. The real story of what has happened has occurred in the past nine months (1990) as God has put together a chain of events that has led to the discovery of the cause of my problem and its solution.

On February 2nd, 1990 I had an appointment with Dr. Gary DeVoss in Council Bluffs to pick up a portable heart monitor to carry with me in an attempt to record the episodes I’ve been having. I learned of this new monitor technology from his nurse and friend, who encouraged me to come in for an appointment. The following morning, I had an episode that was recorded with an average rate of 273 beats per minute.

The way the monitor works is fascinating. Whenever I feel a change in my heart, I take out the monitor (which fits in my shirt pocket) and hold it on my chest. It records the heart rate for 38 seconds and stores the information until it is reset. It can then be transmitted over the phone to the company’s office in New York where they analyze the information and make a decision on calling the ambulance and doctor.

This episode in February provided a very clear pattern and gave a good steady EKG. Nothing was done by the doctors at this time – only instructions to record anything unusual. Since the monitor is rented for a monthly period, I had planned to return it on March 2nd which was the end of my month but didn’t get it done. Dr. DeVoss felt he had the needed information to begin a medication therapy and attempt to control it.

But on Monday, March 5, 1 had another episode and decided to record it. I was working across the road at my brother’s place and wasn’t carrying the monitor, so I climbed on the tractor and drove home to get the recording device. This one showed a more erratic rate, going over 300 beats per minute during part of the episode. After a normal episode, I was usually tired but able to return to work in a matter of minutes. This particular episode was much stronger and for the remainder of that day I didn’t feel well, with my heart running at varying rates, not really settling down like it normally did. Dr. DeVoss consulted with a cardiologist and called me into his office Tuesday morning. He put me on medication and scheduled an appointment for me to see the cardiologist later that week.

The next day, Wednesday, March 7th, Dr. DeVoss’ office called and requested that I check into the telemetry floor of Mercy Hospital in Council Bluffs so my heart could be monitored 24 hours a day. I was admitted to the hospital about noon that day. I spent the afternoon going through test after test, all of which gave normal results. Dr. Hibbard, the cardiologist, determined that I might have a disorder in the electrical system of my heart. This can affect the heart’s rate and/or rhythm and is called an “arrhythmia”. He recommended that an electrophysiologic study (EPS) be performed, and because of the extremely rapid heart rate during my last episode, he recommended I go to either Salt Lake City or St. Louis where he knew they were doing more of these studies than were being handled in the Council Bluffs/Omaha area.

On Monday, we boarded a plane for Salt Lake City and the University of Utah Medical Center. We arrived at the hospital about 3 p.m. and I was again put on telemetry.  The University of Utah Medical Center is a teaching hospital so there was no shortage of doctors and students who wanted to check me over. (But since my problem wasn’t detectable from the outside, all but my main doctors basically left me alone after the first day, which suited me fine!) I was given a very thorough physical exam that afternoon and met with Drs. Freedman and Kosak who would be doing my EPS the next morning. They explained the procedure and planned it for 9 a.m. on Tuesday – no waiting around.

The EPS test is a very state of the art test that very few hospitals are doing. I was taken to the heart cath lab and they placed 5 cath tubes into my veins with 3 in my right groin, 1 in my left groin, and one in my neck. Through these tubes they ran electrical wires up into my heart and stimulated and recorded the heart’s electrical activity to determine the precise location and cause of the arrhythmia. This was all done while I was awake, and it was uncomfortable to say the least. The procedure lasted 6 hours and I was tied down at the wrists and ankles and unable to move my head for that entire period. 

After they positioned the tubes and wires, it didn’t take long to find the problem. I had an accessory nerve pathway near my AV node that was the culprit. They spent a couple hours looking for other areas of abnormality, speeding up and slowing down my heart dozens of times. The fastest rate they could achieve was 280 beats per minute which would have translated to well over 300 had I not been lying on my back in a motionless position. The doctors spent the next couple hours testing different medications to see which ones would work to slow the rate.

They found one they wanted to use and ended the test. I was then returned to my room and instructed to lie still for 4 more hours to allow the veins to heal. It was a very long day and I really appreciated the freedom of being able to move again that evening

The doctors came in and shared the results and options later that evening. They had found the accessory pathway that was causing the episodes and had isolated it to near the AV node itself. In a normal heart, the AV node intercepts the electrical impulse sent from the atrium that instructs the ventricle to pump. In my heart, there is a short circuit that would go around the normal protection mechanism and allow the rate to go at excessively fast speeds.  They gave several options to deal with the problem:     

1. Use drug therapy for the rest of my life.

      2. Do open heart surgery and destroy the AV node and put in a pacemaker.    

3. Do a heart catheterization and destroy the accessory pathways around the AV node with high frequency radio waves – which meant traveling to Oklahoma, the only place this procedure was being done at the time.

Since I certainly had no interest in open heart surgery, there were only two options to consider – drugs or catheterization surgery. I felt all along that being on medication the rest of my life was not acceptable, and there was only one other alternative so I opted for the catheter ablation surgery which had to be done in Oklahoma City by Dr. Warren Jackman.  Upon calling him, it was discovered he could not do the procedure until at least May, so l had to be placed on drugs in an attempt to control my rate until the time for the procedure came.

The drug of choice was an experimental drug called flecainide which had worked very effectively during the EP study. I was placed on a large dosage of this medication on Wednesday evening with the plan to be discharged from Utah on Saturday. On Thursday morning I had broken out with hives in an allergic response to the drug, so was immediately taken off that drug and placed on another of the drugs used during the study called Procainamide.

It was the drug I was sent home on, although I certainly didn’t feel well while taking it. After going through hallucinations on Friday night in the hospital, and Saturday night at home, I called my cardiologist in Omaha and was again changed to another medication — one that hadn’t been studied in the EP test – so he had no real idea if it would be effective or not. But it seemed to do the job during the next couple of months in limiting my heart rate and preventing any major episodes.

The catheterization procedure was scheduled for Oklahoma City on May 21, 1990. Nancy and I flew down from Kansas City on May 19th and l checked into Oklahoma Memorial Hospital on Sunday the 20th. The nurse that was assigned to me that first afternoon was one who had the exact procedure performed on her the previous summer. That was a comforting way to be admitted – seeing someone who had it done and lived to talk about it. Several of Dr. Jackman’s associates came in late Sunday afternoon and evening, and a number of tests were done to prepare for the following morning.

On Monday morning, they came early and took me off to the cath lab. Unlike the Utah experience l was to be knocked out and able to sleep through the entire procedure, for which I was extremely thankful.  Things didn’t work out that way, since I regained consciousness, a little after noon, only halfway through the procedure, but I was glad I had missed the first part, anyway.

Dr. Jackman spent 9 hours working on the nerve pathways in my heart during the procedure. He found that there were a number of extra nerves, running through the heart, but was able to isolate the one causing the problem and destroy it with radio waves. This procedure is state of the art the latest available to correct the type of problem I was experiencing. Dr. Jackman was the only doctor in the United States doing the procedure this way at the time I came in. I was only the 25th person to have the procedure performed. He has since been training other doctors in the U.S. and literally around the world on the procedure. It will someday be the procedure of choice to repair a number of problems that occur in the heart and will replace much of the open-heart surgery that is being done now.

Since there were so many nerves, Dr. Jackman chose not to spend the time necessary to destroy all the accessory nerves, as it would have taken many more hours to get the job done. He felt confident he had destroyed the one doing the damage at the present time but had some concern that the other nerves could possibly begin to conduct and cause a repeat problem over time. As he talked with us after the procedure, he explained, that possibility and suggested I come back in a couple of months to have another EP study done to see what changes had occurred.

I remained in the hospital for one day after surgery, during which they did a test to look at the back side of my heart and see what damage, if any, had occurred during the procedure. The test was called a transesophageal electrocardiogram and consisted of swallowing a small tube with a camera on the end so they could look around inside and see the back side of my heart. The test is about as fun as it sounds—not much—but they did put me partially out during it, which was a welcome idea. It showed no irregularities, and I was able to go home the following day, Thursday, with the orders to do whatever I felt up to.

That was amazing considering what I had envisioned with a heart procedure. I was tired and sore but climbed onto the tractor and planted beans as soon as it dried out enough which was on Monday, one week after the procedure was completed.

On July 30th, we headed back to Oklahoma City via Kansas City (air fares are much cheaper there). We arrived’ early on Monday morning and went to the hospital for pre-op testing of blood work, EKG and x-rays. The follow-up EPS was done on Tuesday, July 31. Due to some scheduling problems, I was put on hold throughout the day and finally was called to the hospital from our motel room about 4:30 that afternoon. Dr. Jackman and crew were finishing an ablation on an 18-year-old that had taken longer than expected, so I’d spent the entire day learning another lesson in patience, which certainly isn’t my strong suit. But at 5:00 I was taken into the surgical prep room and things began to take place. I have a strong dislike for needles, so the nurse made three attempts to put an IV in before finally deciding I maybe didn’t need one after all.

Since my veins had constricted so much in the prep room, they decided to let me experience this EP study with only the help of local anesthesia, much like the one I went through in Utah earlier. I prefer to be completely out when they begin to place the tubes and wires up my veins but didn’t have that luxury this time. The procedure went smoothly, with only one nerve causing any suspicion for the doctors at all. It was determined that the nerve wasn’t strong enough to cause my rate to exceed 150 and couldn’t sustain tachycardia over any period.  So about 2 hours after things began, I was taken to a room and kept overnight, being discharged the following morning. As things now stand, there are no more scheduled checkups or EP studies, and this will hopefully close this chapter in my life. I’m sure Oklahoma is a nice place to visit, but I really don’t care to see it again for a good long time.

God has been very faithful during this whole ordeal. It just happened that in 1977 when I went through the cardiac unit in Omaha they couldn’t find the problem. If they had, open heart surgery would have been the only solution available at that time. But God provided a friend in 1990 who just happened to work in a clinic that just happened to begin working with the portable heart monitors that year. I just happened to have an appointment to pick up the monitor the day before the first recording took place, and just happened to not return the monitor, even though I had intended to, a couple of days before the second recording occurred. The cardiologist I just happened to be referred to in Omaha, just happened to hear about Dr. Freedman in Utah and decided to send me there – although he admitted several times he wasn’t sure why he felt that way. He had only read about Dr. Freedman and had no previous contact with him. Dr. Freedman just happened to suggest we go to Oklahoma and get things corrected. Dr. Jackman just happened to be performing this procedure and correcting the very type of problem I had and just happened to be able to fit me into his schedule in May.

I returned in the summer of 1991 to have one additional nerve burned off with a third cath ablation process, but since that time have had zero arrhythmia episodes which is a fantastic outcome from what was considered experimental, and by some in the medical community, a dangerous and quacky procedure.

This entire episode has been a series of things that just happened, just happened because a faithful God was in complete and total control of every detail and caused people that didn’t even know one another to direct my path in order to be made whole and have the problem corrected.  I have to admit that at times while going through it, things seemed totally out of control. Doctors couldn’t agree on the correct treatments and solutions, and at times were totally in disagreement with one another. Yet God was able to weave what appeared to be a disaster into a blessing and a healing experience and has proven what He says in His word – that He is faithful and can be trusted. There is little doubt in my mind that He is in control of all things!