Friday, July 20, 2012

The Buzzard Goes Bionic

So, finally sucked it up and followed the doctor's recommendations.  Went in on Wednesday and had an implantable cardioverter-defibrillator (ICD) put in.  So, what does that mean????

Well, as part of my reduced heart function (left ventricular ejection fraction of 35% +-), I'm at an increased risk of Sudden Cardiac Arrest.  Even though their underlying heart conditions were different, SCA is what struck down Ryan Shay at the 2008 Oly Trials and Micah True (Caballo Blanco from Born To Run).  Alberto Salazar suffered through an SCA episode (but got lucky due to very quick medical attention and survived).  Two international soccer players recently suffered SCA episodes on the field.  One survived, the other wasn't so lucky. 

Although the risk of an episode in my case is less than 1% in any given year, - there is a risk.  And, if you have an episode, it's usually fatal unless you happen to be somewhere with trained responders and/or an AED.   But, an SCA episode can also be treated by and ICD.  Under the right conditions (which have been programmed into the device), your heart will get a jolt or other form of electrical signal to bring it back into the correct rhythm.

The device is implanted on the left side of my chest, below my collar bone and above the breast.  Here's a pic with the dressing over the incision.



I was pleasantly surprised because I expected there to be more of a protrusion/bump from the device.  It will probably be a bit more evident once the dressing is off; but, it's not as bas as I thought that it might be.

The device really isn't that big.  It's a bit bigger than my Garmin 405 GPS Watch; and, about the thickness of a USB thumb drive.  Here's a few pix of a device sample that they gave me at discharge (it's an actual device, sans battery and leads.)




From the plastic piece on the top of the device are a set of leads that they thread through a vein and into the heart.  In my case, there is a lead to the atrium and a lead to the ventricle.  There's a very, very small "screw" that attaches to the wall of the heart. 

So, basically, here's how it works.  The ICD continuously monitors my heart rate.  If, for some reason, it starts to beat too fast (an indicator of the onset of Sudden Cardiac Arrest), the ICD tries to "pace" the heart back to a normal heart rate.  If that doesn't work, then, the device sends a shock to the heart to shock it back into a normal rhythm.  In my case, the "fast" rates have been set at 190 and 210 beats per minute.  (That shouldn't be a problem with running for me.  Since I've been on some of the heart meds, my max HR is now at around 155 to 160.)  Again, the risk of experiencing SCA is pretty small; but, this device is a good insurance device just in case it does happen.

The procedure went well.  Dr. Simone Musco from St. Patricks International Heart Institute did a great job.  He's been great to work with and has been really flexible in setting this whole thing up in a way that will minimize the impact on my day to day lifestyle; and, will still allow me to run.

They don't put you completely out during the procedure.  You are sedated; and, I don't really remember much of the 90 minute surgery.  I think I slept through most of it; but, I do vividly recall them forming the skin pocket and putting in the device.  It didn't really hurt; but, man, this thing doesn't gently slip under the skin.  There is some serious pushing to get the damn thing in place.

I came out of the procedure wide awake and ready to go.  Seems like I kind of get amped up on the back side of the sedative.  I was talking and visiting and all kinds of awake.  Within about an hour, I was pretty well back with it; and was already sending out some texts and making calls.   

I didn't seem to have any significant after effects of the sedatives; but, my left chest was pretty sore.  Finally wore down about 10:00 at night and was hopeful of getting at least some sleep.  But, it was not to be.  First, there was the IV antibiotic that they hooked me up to at midnight.  Then vitals at 2:30 a.m. and 4:30 a.m.  And, they wanted to do a chest X-ray at 5:30 a.m.  But, that wasn't the worst of it.  The bed in the room had an air mattress and was set up to almost continuously adjust the air pressure within the mattress (I'm sure to help avoid bed sores).  Every 30 seconds a small air pump would come on and pump air into or out of the mattress.  And, this wasn't some quite little pump.  It was like the battery operated pumps that you can use to blow up air mattresses for home or camping.  With that going on twice a minute, there was no sleep in my night.

Yesterday, my chest was still a bit sore; but, manageable with just Tylenol.  But, I was quite tired with no sleep.  Was able to get a bit of work done in the morning (email mostly)  Was home by about 2:00 p.m.  Took about an hour nap and did some more work in the early evening.  Then to bed pretty early.

So, here it is on Friday.  The pain is pretty minor.  Took 2 Tylenol early this morning; and, that's been it.  I'm still a bit fatigued; but, was able to get in a full days worth of work.  With a full weekend of rest, I should be back at it full force by Monday.

I do have a few short term restrictions.  I can't run for 5 or 6 days (although I can walk or do recumbent bike before that).  I can't shower or get the incision site wet for a week.  I do have an appointment on Wednesday to check the wound site and to double check the device programming.  Once that is done, I should be able to get back to regular running and normal activities.

But, for 4 to 6 weeks I can't lift my left arm above my shoulder; and, I can't lift more than 10 to 15 pounds with my left hand.  That's to make sure that the lead wires "set in" properly and don't move out of place.  After that, there should be no real restrictions on my previous lifestyle.

The ICD doesn't fix the underlying problem; and, I still expect that my performance/racing will be limited by heart function.  But, it does give me some peace of mind knowing that the risk of kicking over and dying out on a run has been significantly reduced.

At any rate, it's now another part of this big journey; and, I'm hopefully that the future road blocks are minimal. 

And, in just a few more days...............................I'll see you back out on the roads, tracks and trails.

The Muddy Buzzard

1 comment:

H T Walsh said...

Awesome. Glad you are feeeling good. I can hardly wait to run an easy 8 woth you (boy am I funny) love ya
your charming sister
aka Teri