Health !
What health?
No really; I’m a 6 foot 2½ inch, 15 stone healthy guy.
My heart/pacemaker story may be of some interest if only to prove how resilient your body is in dealing with anomalies and how modern medicine can help. This story represents about 0.0001% of a very happy and fulfilling life and needs to be read in this context.
I was a very active youngster; up to the age of 18 doing much sport including playing in the 1st fifteen rugby team for my school. When I went to college I took a break but gently reintroduced myself to exercise after a year or two.
First signs of a problem came to light when I went jogging on Boxing day in 1973. I had hardly set off across the fields, running into a head wind, when I suddenly found myself getting up from the ground. Surprised, but not to be put off, I continued with my run.
This event became a bit too regular to ignore and I eventually sought advice when at college in Durham and spent several days under observation in hospital. I was told that my heart was ‘stopping’ and that I might need a cardiac pacemaker one day. This was the early days of this technology and not something to be rushed into. I had a regular heart rhythm at rest of just under 40 beats per minute (cf 72 bpm typical/normal), a symptom of ‘sick-sinus syndrome’; the sinus node is the source of the electrical impulses in the heart.
Not long after starting work (in North Yorkshire), after more of these ‘episodes’, I again felt obliged to seek advice and I was taken to Durham Hospital again for more tests and subsequently to Shotley Bridge Hospital (now defunct) and fitted with my first pacemaker (April 1977).
My first and second pacemakers were ‘demand’ pacemakers; they sat, buried in my right armpit, watching my heart and waiting to ‘pace’ my heart should it falter. These pacemakers were connected to my heart via a wire fed down through the veins in my right arm which passed through the heart valves and went down into the base of my right ventricle; the bottom, large chamber of the heart. The wire delivered a pulse of electricity to my heart as required to stimulate the muscle. The fitting of the wiring and an initial external pacemaker box were all done using only local anaesthetic at the incision point in my right arm. I was able to see everything, the scanning of the heart, the careful positioning of the wires, the subsequent testing and to discuss and be told of all the finer points. It was quite an experience.
Problem was : that even though my heart could not in theory stop I still managed to have similar short ‘blackouts’ over the years. The forerunner was always a period of very swift ‘fluttering’ of the heart, ventricular tachycardia, the ventricles going into quite violent fast rhythm say of 220 bpm (not real beats) which could last for minutes or even hours at times. These events weren’t much fun and when they stopped I sometimes blacked out. I took ‘beta-blockers’, regularly used drugs to calm the rhythms of a heart, but this was not the solution.
When due for my third pacemaker, in January 1994, my consultant, Dr McComb of Freeman Hospital, Newcastle, recommended a change of function for the pacemaker. To knock on the head the fluttering ventricles, she suggested that I have an ‘AV node ablation’ to separate the function of the top and bottom chambers of my heart. (Remember my sinus node is ‘sick’ and the AV node, a secondary source of electrical impulses is making a bad job of covering for the operation of the sinus node).
Down side was that I would rely entirely on the pacemaker to drive my heart. (No need to be too concerned – these pacemakers come with a lifetime guarantee – ha! ha!). Also I would have 100% heart block; I would rely entirely on my ventricles to provide my beats (my atria would just flop around). Also my heart could not speed up of its own accord, I would rely on a ‘switch’ in the pacemaker which would sense my movements and speed up in response to any ‘action’. (Problem is : a pretty girl wouldn’t speed up my heart but an old rickety bus would – maybe I would have to take up train spotting)
This new pacemaker is buried in the muscle on my front left chest and I had a new wire fitted from this location. The ‘ablation’ was achieved using another special wire, acting like a small soldering iron, it ‘burnt out’ the AV node to stop it functioning. This, again, was all done using only local anaesthetics and I could watch and be told of all the finer points as the ‘operation’ proceeded.
I had a good idea at the time (at least it seemed like a good idea); why not leave the old demand pacemaker under my right arm? If, for whatever reason, the new pacemaker faltered, the old demand pacemaker would cover for it. I had two pacemakers; a double lifetime guarantee!
Problem was : suddenly one evening I started to blackout time and time again without any of my usual symptoms. I was rushed first to Northallerton Hospital and then Stockton Hospital before the problem was resolved in the early hours of the morning. This was an entirely man made problem and my heart was an innocent bystander. I had been given my ‘new’ pacemaker because my old pacemaker was fading away; its batteries were getting low. Unfortunately as the batteries faded, since its primary function was to sit and watch, it stopped doing this and decided that its services were required. However it didn’t have enough ‘umph’ to make my heart beat but it did have enough ‘umph’ to stop my ‘new’ pacemaker working (which also works ‘on demand’ if appropriate). The nett effect was no heart beats.
After a night of trying to rationalise what was happening (many blackouts later and after an ambulance breaking down), I eventually arrived back at Freeman Hospital and had my old pacemaker removed.
Problem was : early in 2001 I had ‘episodes’ which left me with a poor memory. It is still not clear to me what the basis for these episodes was; theory ranges from panic attacks to blood clots thrown off by my heart.
For the panic attacks I have tried to change the way I see my life; that’s partly why I have become determined to run the London Marathon (what’s more I’ve started Morris dancing).
For the blood clots I take warfarin to thin my blood. Hopefully I will be able to leave this off when I have a new double lead pacemaker later in the spring. The double leads means that both my atria and ventricles contribute to my heart beat and clots won’t be able to form in the atria which is presently effectively redundant and just flutters around.
Sounds like a disaster but its not at all. Although I run with 100% heart block I feel great, at least on the shorter runs I’ve done so far. My heart does speed up reliably in response to my running and I just have to find a balance between my level of exertion and my bodily systems which means I can continue indefinitely. I’m sure it won’t be quite as easy as it sounds over the longer distances!