Sunday, October 24, 2010

Update on Cardiac Status & Atrial Fibrillation

The only report on my cardiac status in this file was on 12/4/08, almost two years ago. Subsequently I continued to have frequent extrasystoles but was able to maintain a fairly stable level of exercise, walking 2+ miles each day and doing weight work about twice weekly.

In the summer of 2010 we had scheduled a rather grueling vacation agenda, first going to a cottage on Upper Saranac Lake, NY to be with our son’s family and then on to Dallas for a reunion of Patti’s students of some 30 years ago. After the latter and on the flight back from Dallas to Portland, I went into atrial fibrillation. Perhaps this was due to the low oxygen in the plane cabin? As noted previously, I had an ablation on the right side of the heart in 2006 to abort a. fib. which was unsuccessful so I was then cardioverted successfully.

Now it was decided that I should have an ablation in the left atrial, pulmonary vein area. This was a 5 hour procedure and it took me about 5 days to fully awaken from the anesthesia. The ablation was unsuccessful and so I was again cardioverted successfully.

I had felt weaker and more tired with the onset of the a. fib. and on returning to a NSR I felt significantly better (after I recovered from the anesthesia). Unfortunately, the a. fib. returned in about a week and a half, noting again increased weakness and tiredness. This occurred after our usual 2 mile walk. It was then decided to place me on Amioderone, as an anti-arrhythmic agent, and then do another cardioversion which is scheduled for tomorrow, 10/25/10. I had started Warfarin with the onset of the first a. fib.

My hope now is to return to my prior NSR status and that the Amioderone will prevent the a. fib. from recurring.

Update on Peripheral Neuropathy due to Gammopathy

I stopped the IVIG in June 2010, first because Medicare was going to stop coverage in several months, undoubtedly due to the excessive cost. Secondly I was not sure it was doing anything anymore. We decided to make another attempt at Retuximab in the fall, the intervening time to be spent obtaining a new baseline. It became apparent about a month out that the numbness was increasing slightly, particularly in the fingers and after 3 months going from a 2 to a 4 in the left hand and a 0-1 to a 2 on the right. Balance seemed a little worse with two falls during the summer months (first falls).

In September we started the first of 4 weekly infusions of Retuximab, finishing on 10/22/10. With the second infusion I had a reaction, shaking chills and a low grade fever. A CBC showed a pancytopenia. I was loaded up with antihistamines for the last two infusions and had no further reactions or abnormal blood results.

A month or so out we will check markers, IgM, AMAG and B cell count most likely. My symptoms are stable and did not change with the infusions. My hope is that symptoms will remain stable.