As I write this, it’s been 2 1/2 years since I had breast cancer surgery. And on May 22nd, it will be two years since I finished both the chemo and radiation I was given after my cancer turned out to be the triple negative variety. (I have other blogs where I talk about my journey and the side effects.)
Roughly a year after I finished the chemo, I was just beginning to feel more energy and more “brain.” I went back to writing my LoveChild blogs, started to think about working on a book, and even did some marketing.
By July, 2020, in spite of the pandemic, I was feeling almost normal. I'd even finished and published a middle grade fantasy.
However, on August 16, 2020, I had the first of what were planned to be six injections of zoledronic acid—a drug that helps prevent bone cancer and also treats osteoporosis (which chemo can cause or make worse). Immediately after the injection, I went back to having very low energy and very little brain.
When I say "low energy," I mean that at any given moment, while I could think of 20 things I really wanted to do and should do, most of the time, I'd reject them all in favour of reading another light mystery novel on my Kindle. And no, it didn't have to be a good novel.
Since then, I’ve been gradually getting a little more energy, but still not much. So I was very reluctant to get the second zoledronic acid injection in February when it was scheduled.
As it turned out, Covid pushed my appointment into May, and I can’t say I was sorry. Which brings me to this month.
Routine Blood Test
On Monday, April 12, I had an appointment at the hospital cancer unit at 1:30 to have some blood tests done. That's standard for getting chemo or zoledronic acid. Normally, you have the blood test, see the oncologist an hour later, and if everything's good, have the treatment after that.
However, back in February, when I got the phone call delaying the appointment, I was told that the blood test would be on Monday and I'd see the oncologist and get the zoledronic acid the following day.
This was new, so I questioned the times, and read what I'd written down, and was told I’d written the times down correctly. So I just assumed that because of the pandemic, they didn’t want people hanging around the hospital for an hour. Since we live about a ten-minute walk from the hospital, it was no problem either way.
That Monday was a somewhat rainy and chilly day, so Les dropped me off at the hospital and drove off to park a couple of blocks away and walk in the area. (Since he hasn't been able to swim for the last year, he's been forced to walk every day instead.) We expected me to be there only a few minutes, so he'd be handy to pick me up when I was done.
Mix-up about My Appointment with the Oncologist
When I checked in at 1:15, they told me I’d have the blood test right there (instead of in the usual outpatient lab) and I’d see my oncologist at 2:15.
I said, “But my appointment with the oncologist is tomorrow at 1:30.”
“No, you’re having the zoledronic acid tomorrow at 1:30, but you’ll see the oncologist today.”
It was clear they thought I’d made a mistake, but I was just as certain that I hadn’t. I always write down my appointments in Trello, an app on my phone, and then I read back what I’ve written to make sure it's right. I remember doing it this time because it was different. It wasn’t a problem, but I did feel a bit annoyed that they thought I’d made a mistake when I was certain I hadn't.
The other annoying thing was that I’d been going to spend some time that afternoon talking to Les about the zoledronic acid pros and cons, and writing down what I wanted to ask the oncologist. The bottom line was that I really didn’t want to go back to the extreme tiredness and brain fog I'd had after the first injection. I was just beginning to feel somewhat “normal.” But at least I’d have half an hour or so before the appointment to text Les and marshall my thoughts.
My Phone's Battery
Oops! After I sat down to wait for the nurse to come and get me to take my blood, I sent Les a quick text to let him know I'd be seeing the doctor, and noticed that my phone was down to 14%. Still lots of battery to let Les know when I was ready to go home, but not great if I wanted to talk to him before I saw the oncologist.
A nurse came to get me for the blood work. A few minutes later, I was just going back to sit down in the waiting room when a second nurse, who looked about my granddaughters' age, called me and took me into one of the appointment rooms my oncologist uses.
Okay, that was quick. I wasn't going to have time to talk to Les or even do much thinking.
High Blood Pressure?
The nurse gave me a gown, and came back as soon as I’d changed. She asked how I was doing and took my blood pressure. It was 167, which is higher than normal. She asked me if I was under a lot of stress.
I wasn’t sure what to say. ”Not until I got here?” But, honestly, I rarely ever get stressed. If the milk spills, I clean it up. I don't have high blood pressure, and I wasn't really stressed, was I? I mean, there'd been a small mix-up, but it really wasn't that big a big deal. At the same time, the inside of my head felt kind of hot and I seemed to have difficulty figuring out what to say.
When the nurse went out, I had time to text Les about what was happening, but as I went to do it, I noticed that my phone had jumped down to only 4%! Not a problem if he’d been at home, but he was walking nearby and I have to confess, I don’t know his cell number if I had to call from another phone. I texted "in," then shut my phone and sat there trying to remember what I needed to ask the oncologist.
My Oncologist Arrives
However, my oncologist came in and immediately threw me a curve. If I was anxious (presumably because of my elevated blood pressure?) about having zoledronic acid, I didn’t need to have it. The percentage it helps is only 2-4% and my cancer was caught very early. Then he mentioned a new study that was looking at whether just one injection might be enough.
But I'd been scheduled to have six! That was the normal treatment for triple negative cancer.
Okay, so what should I do? There was also osteoporosis. I had been borderline before the chemo so it was likely worse. Zoledronic acid helps with that.
I felt confused, my head seemed to be hot, and I didn't know what to say…
Then he suggested he give me a quick check-up.
First thing was the stethoscope. He had me lay back, and I suddenly realized I could feel my heart beating really fast. Neither of us spoke. He had me sit up straight so he could listen from the back. My heart was now pounding like a jack hammer. I wanted to say, “Do you hear what I hear?” But that was crazy. It must be thundering in this ear.
The next minute he was telling me that my heart was going too fast and there was a chance I could have a stroke. He asked if I was able to get dressed and walk down the hall to the outpatient lab to get an ECG (electrocardiogram).
I said I could. It was already slowing somewhat.
I told him I'd had something similar about 6 or 7 years ago. Highish blood pressure, heart very fast.
That time, I was at home, and I got Les to drive me to Emergency. They did an ECG, blood tests, and an X-ray, and referred me to a cardiologist who had them do an echocardiogram, a stress test, and a Holter monitor.
They didn’t find any problems then, so I felt fairly confident that there would be no problems this time, too.
I texted Les to tell him I was going to get an ECG and that he needed to go home because my battery was now at 1%! I said I'd have a nurse call him when I was done. Then the nurse, who seemed as concerned as my oncologist, walked me the short distance down a hallway and left me at the entrance to the outpatient lab.
After the ECG, I went back to the cancer clinic and, after a short wait, saw my oncologist again. He said that based on the ECG results, he’d spoken with a cardiologist and I was to go straight to Emergency.
The nurse got me to sit in the hallway while we waited for a porter to bring a wheelchair and take me there. (Emergency is on the opposite side of the hospital and up one level).
I was surprised to see I still had 1% battery on my phone, so I texted Les to tell him I was going to Emergency and someone would call him when he could pick me up. (Yes, he was going a bit crazy at home because all he knew was that something was wrong and my oncologist had sent me to Emergency!)
There was a short wait for the porter, but he finally arrived and took me on a long journey through the hospital to Emergency.
My Visit to Emergency
When we got there, I realized that I was standing right in front of the front doors in the triage line. Hmm. Since I still had 1% battery (!), I quickly texted Les. "Meet me at Emergency and switch phones. Bring my water bottle.” At least now we'd be able to keep in touch!
No one was allowed to accompany a patient inside Emergency without permission, but when Les arrived, I was able to reach through the door to exchange phones, grab my water bottle, and assure him I felt fine.
After a long wait, standing six feet from the other people in the waiting line, I saw the triage nurse. By then, my heartbeat was pretty close to normal, but my blood pressure was still a bit high. The waiting room was all socially distanced, with a range of people from a sleeping infant to an elderly lady in a wheel chair.
I sat in the waiting room for what seemed like ages, but was likely half an hour. At least I could text with Les and use his phone to check on the news.
Eventually, they did another ECG and took blood for new tests.
Then another long wait in a new area until I saw a young nurse practitioner who examined me and then checked with a doctor who asked her to send me to get an X-ray. Then more waiting.
At about 7:45, when I finally saw the cardiologist who was on duty, he said that my heart and blood test results looked good, and my second ECG was normal, but because the first ECG had caught a "flutter,” they would be scheduling more tests.
So, yes, I was at the hospital from 1:15 to nearly 8:00. A very long day, with only a few sips of water and nothing to eat since a small lunch. I was exhausted when I got home, but my heart and blood pressure were back to normal.
The next day, I got a phone call telling me I was booked for an echocardiogram and a stress test on the following Monday.
The day after that, my oncologist's nurse phoned to make sure I was okay and that I was being looked after.
Tests and Results
Monday at 1:00, Les dropped me off at the hospital and I headed to the Central Waiting Room. I waited about half an hour and then a nice young man who looked to be in his mid-twenties came to get me for the echocardiogram. For some reason, we ended up talking about experiences with physiotherapists before he started telling me when to breathe and when to hold my breath so he could take a picture.
When that was done, a slightly older woman (thirties maybe) came to get me for the stress test. Since I'd had one before, I'd come prepared with shorts and a light top under my flannel shirt and sweatpants. She took readings, then connected me and the blood pressure cuff to the treadmill, and started it. Every few minutes, she increased the speed and the angle until my heart rate finally reached 147, which was the goal. She took my blood pressure during and after the test. Then I was free to go. My heartbeat was fast, but this time it had a reason to be. And it slowed down as I walked to the entrance to the hospital.
The next day, a cardiologist phoned to tell me I did have atrial flutter. (Not fibrillation, which is similar but a bit more serious).
He gave me a prescription for a beta-blocker and blood thinner until he could schedule an ablation with a specialist to fix it. Hopefully in around 3 months when they can do elective surgeries again.
(Note: Les had a "flutter” nearly two years ago, although his was somewhat different. The same cardiologist saw him and they did an ablation on him 18 months ago! It fixed his problem.)
How I Am Now
The good news is the medicines the cardiologist has given me should keep me from getting a blood clot and keep my heart from speeding up too fast, either of which can lead to a stroke. I've been taking both of them for a week and there haven't been any problems.
Naturally, the main side effect of the medications will be fatigue, but that won’t be new. In fact, it’s entirely possible that the fatigue I’ve been blaming on the chemo and zoledronic acid was actually coming from my heart, so I might even feel less fatigue!
I'm scheduled to have the second zoledronic acid on May 4th. We'll see how it goes this time.
So What Happened?
I have no idea what caused my heart to start going so fast. Was it because of the appointment mix-up? My concern about having another bout of fatigue after the zoledronic acid? My phone battery's being so low? A combination of all three? Or did it just happen out of the blue? All I know is the timing was absolutely perfect and my oncologist and his nurse did everything right!
The bottom line is that because my heart started pounding while a doctor was actually listening to it with his stethoscope, and because he immediately sent me to get an ECG, they caught the flutter! I have no idea how long I've had it. At least 6 or 7 years. Possibly longer. And I could have had a stroke at any time without warning.
Lots more info about atrial flutter at: https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/atrial-flutter-1.html