Seen through foreign eyes

Practise your English
Volume 3

Bohemian Rhapsody......... or

How my heart became excessively enthusiastic in Bohemia .........or

Bohemian Misadventures ......... or

Serious stuff at IKEM ......... or

All you ever wanted to know about my cardiac ablation

On 5 March 2009 I had a cardiac ablation performed at IKEM (Institut Klinicke & Experimentalni Mediciny) in Prague. At the time of writing this 5 days later it appears to have been a great success.

Let me start at the beginning. No, not at the beginning of the beginning, but at the more recent beginning, because I have been to see doctors since my early 30's complaining of cardiac arrhythmia or heart palpitation as I called it back then & was assured my heart was A1 & the best course of action was to ignore the symptoms (get over it & get on with your life).

I had a consultation with a cardiologist, Dr.Lefflerova on 20 Jan 2009 as part of a routine health check up. It was much of an introductory consultation but very important in that I was able to jump the queue & get registered at the prestigious cardiac clinic of IKEM, & this only through Magdalena's family connections. At the time I never quite appreciated this getting to the top by slipping in at the side door because other than a routine examination & ECG the consultation did not reveal anything untoward. But absolute thoroughness was the approach & accordingly arrangements were made to have me fitted with a heart monitor (holter) to be followed by an echo-cardiograph (ultrasound) examination, the results of which would be forwarded to Dr.Lefflerova for her to have something more substantial as a background to my case. The respective dates were 26 Jan 2009 (holter) & 23 Feb 2009 (echo-cardiograph & follow-up consultation with Dr. Lefflerova)

During the echo-cardiograph the doctor doing the examination observed that my heart rate was very high. I, still unaware of the seriousness of my condition, responded that I was probably just nervous. However later in Dr. Lefflerova's rooms the train came off the tracks. I could see the monitor screen & my pulse rate was 160/min. The diagnosis was atrial flutter. The flutter was effectively placing strain on my heart equivalent to running a marathon even though I did not feel any discomfort. The echo-cardiograph had also disclosed impaired function of the left ventricle presumably resulting from the flutter. My pulse remained pegged at 160 & the doctor's recommendation was for an ablation as she was of the opinion that increased medication would not be successful in reversing my condition, & electro-version was also viewed as unlikely to be a long term solution. Also with inefficient pumping there was a risk of blood clotting & a stroke. The decisive element of the diagnosis for me was that the high heart rate of the flutter had already impacted on the functioning of the ventricle & without correction would sooner or later lead to heart failure, & that I was asymptomatic, i.e. unaware of the labouring of my heart.

I agreed that ablation was the way to go & a tentative date for the ablation was set at 6 - 7 days ahead. With my heart continuing to run the marathon I returned home. My heart seemed taken with this marathon running & refused to give it up. I monitored my pulse hourly the whole next day & it remained rock steady at 157/min. The anti-arrhythmics & beta blockers I was taking were having no effect. In the evening Magdalena phoned to report my condition to Dr. L who advised that as the ablation procedure was now scheduled for 5 March it was not a good idea to let me persist in my marathon any longer. Accordingly the following day 25 Feb 2009 I was again flat on my back at IKEM. After a period of monitoring & an unsuccessful attempt to slow the pulse by medication an electro-version (electric shock treatment to restore proper rhythm) was carried out. I was given full anesthetic & when I came to a short while later the monitor reflected a steady pulse of 60/min. Relieved Magdalena & I returned home.

All seemed to go smoothly & the home monitoring of my pulse indicated a rate of 60 -70/min. But when I was admitted to IKEM on 4 March the heart monitor showed that somewhere in between my mischievous heart was back at training for the Comrades. Attempts to get it to quit by feeding it intravenously with discouraging drinks were not sufficient to keep it from pounding away.

Fortunately Magdalena was there to hold my hand throughout & ask & answer all the necessary questions in Czech as there existed a marked deficiency in communication ability in Anglicky among the nursing staff. Even the young doctor who attended me initially could just not fit the words together sufficiently to execute her task of explaining to me the procedure I would undergo in the morning. She gave up & returned later with a young colleague who had a reasonably good command of English. Of course a non-English speaking Czech finding himself in a S African hospital would be faced with a total absence of anyone to communicate with him in his home language.

I was admitted to a three bed ward. Only one of the other beds was occupied initially but in the late afternoon the third bed occupant was wheeled in from theatre where his ablation had just been carried out. My bed was at the large window which had a great view onto a densely wooded hill. The trees were just starting to escape from the clutches of winter but in warmer weather the view must be very pretty & tranquil.

If I must comment on the standard of the IKEM wards, what stood out for me : the heating throughout was perfect : the beds had individual hand-held remotes to control the "backrest" adjustment of the beds : the wards & passages were kept shiny clean by daily attention : there was a separate shower, wc & whb in each ward again scrupulously clean & nicely heated : there was a wall mounted TV (small) : there was a simple table with two chairs for patients to sit down to their meals or for visitors, & a single easy chair. The "hospital food" was straight-forward but good, helpings adequate. There seemed to be little or no restriction on visiting hours. Overall the accommodation & food compared to some of the luxurious SA private hospitals was quite a few rungs down the ladder but is much more in touch with reality. Number one, I was booked into a hospital for medical treatment. I was not booked into a resort hotel or restaurant. Number two, if the hospital fees (R30 all inclusive per day) are taken into account the standard of accommodation & treatment is not a couple of rungs up, but ladders & ladders higher.

As the main ablation catheters are inserted in the femoral arteries in the groin area, shaving of the pubic area is called for. Like most I have had insufficient exposure to public nudity not to feel a bit embarrassed by baring it all to strangers, but the embarrassment or awkwardness appears to have been greater on the side of the young nurse & lady doctor in attendance. Advanced years possibly at last being an advantage.

The day of reckoning dawned. By 08:00 I was flat on my back in theatre being prepped. The procedure is carried out by sedating/calming the patient with intravenous muti but no general anesthetic. Local anesthetic is used at the catheter insertion points.

As far as unaccustomed nudity goes in the theatre it was total most of the time but I felt less uncomfortable with it because of the "down to business atmosphere" in theatre. Genitals are just another body part & prudish sentiment has no place.

The procedure was carried out by a cardiac surgeon & "his young colleague" with 3 theatre nurses in attendance. Very high tech equipment with 7 monitors visible to me & more behind my back. Throughout I was kept informed as to what was being done. At times I wished I wasn't : Like "now I will puncture your groin". I am sure the terminology is 100% correct but somehow the words made my toes curl. A part which impressed me greatly is where they constructed a 3D model of my heart using the catheter probes. The 3D model was then used to position the ablating probes. The procedure was finished just after 12 noon. I was returned to the ward with almost no anesthetic hangover. Then the monitoring, medication, blood samples, on & on but I felt fine. The only other toe-curling experience was when they removed the "catheter guides" (my words) which are left in place for some hours. Along comes this guy, removes the dressing, eases out the plastic end piece, takes a firm grip & yanks out (of the artery) what appeared to be a stretchy tube about 1 metre long!! Again it was not painful but the thought of that rubber tube all the way up there .. my artery !! The toughest part was to then lie as still as possible on your back until the next morning does that bed get hard.

I was admitted on Wed, the ablation was done on Thurs, Friday was monitoring day & Sat lunchtime I was discharged.

The procedure from start to finish was handled very capably & professionally. I was told by someone that the IKEM cardiac unit was considered of the best in Europe, & equal to any worldwide. From my experience I have no quarrel with that statement.

Since discharge I have been totally spoilt by Magdalena being kept from even performing the lightest of light duty tasks. On Sunday I was a bit shaky with chest pains but that had cleared by Monday when I was taken to our GP in a neighbouring village to check my blood thickness (clotting) to adjust the blood thinning medication I was on. The doc tested twice & said my blood was alarmingly thin, & sent me to the closest hospital (Pribram) for further checking. I was not a happy chappy. There was a icy breeze going. I was not dressed warmly enough & really felt the cold but the worst was that Magdalena was mentioning another period of hospitalization until they had stabilized the blood. This prospect made my thin, cold blood run a whole lot colder. But after the test results came in I was allowed home with instructions on how to reduce the medication (& return on Friday for more blood tests). Since then nothing untoward has happened & it has been the easy life sitting around reading & at the PC.


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