This year I had a significant illness and had to undergo surgery. This was quite a remarkable experience and one that I have been reflecting on from time to time, as the flow of life allows. Colleagues (e.g., D. Linnell, personal communication, 3/10/04) have suggested that I write about my experiences as a medical patient. I had been writing email updates to various groups to keep them apprised of my health. With these as the back bone, in the relatively limited confines of this column, I will continue to experiment with writing about this experience (Levant, in press). As I would like to do more writing in this vein, your feedback will be appreciated (levantr@nova.edu)

     I have had a heart rhythm problem for many years, over a decade. It had first been diagnosed as supra-ventricular tachycardia. My heart would start beating rapidly and erratically every few months and this would last a few hours. This was quite scary at first, but the cardiologist back in Boston told me the arrhythmia was “completely benign. Just bash about in your life, and don’t worry about it.” As it came more frequently over the years he prescribed a beta blocker (Sectral, 200 mg), which seemed to help restore normal rhythm, but I am not really sure it did, or whether it went away naturally, because it always took quite awhile to act.

     In the last two years, as my job as dean had become much more demanding and stressful, my arrhythmia came more frequently and lasted longer and was getting to be a royal pain in the you know what. After a series of tests the new Florida cardiologist determined that I was now suffering from atrial fibrillation (“”), a more serious arrhythmia, which, because blood collects in the fibrillating (quivering) atrium, can thereby clot, and could lead to strokes. He recommended that I see an electro-physiologist (EP), which is a new sub-specialty of cardiology that didn’t exist when I first developed this problem. He also suggested I get on a blood thinner, like Coumadin. I put this off for a little while due to the press of daily life, when suddenly the arrhythmia took hold of my throat and demanded that I pay attention to it. I was in , had taken the Sectral and was at home alone when I suddenly felt very short of breath and very light-headed, so much so that I had to hold on to the kitchen counter to get to the phone. I went to the ER, was told I was in , and was held there for a few hours. The symptoms (shortness of breath and lightheadedness) dissipated fairly quickly and didn’t return that day.

     Two weeks later, while at work, the shortness of breath and lightheadedness came back. By this time I was already hooked up with the electrophysiology and heart pacing department at Cleveland Clinic Florida, so I went out there. They put me on a Holter Monitor, which captures heart rhythms over a 24 hour period. The results were that I was indeed in , but even more alarming, my heart was now pausing for up to 4 seconds, several times a night. I could actually see the tracings where the heart rate went flat. Very scary, indeed. The EP told me that was quite dangerous. If my heart paused much longer I could black out. The standard procedure was a pacemaker, and I would have to take Coumadin plus an anti-arrhythmia agent, such as Flecainide, for the . I didn’t like this option because I was concerned about the long term use of these drugs, so I asked the doctor what else he could recommend. He suggested a catheter ablation procedure, which was fairly new, actually developed at Cleveland Clinic in Ohio, among other places. As surgery, it was relatively non-invasive, and involved going in through the femoral arteries and using radio frequencies to ablate (remove) neurons which are causing the atrial fibrillation. It had a 60-70% success rate, could be redone if needed, and I could always go the pacemaker and drug route if it didn’t work. So I went with it.

     With that as background, I’ll turn now to the emails which tell the next part of the story.

Email # 1 (2/10).
Hi Folks: I wanted to let you know that I am having surgery tomorrow (2/11) I am having a catheter ablation procedure for treating Atrial Fibrillation, which is complicated by a heart pausing problem that I developed in the last month. Because of the latter, there is urgency about doing this soon. I’ll be at the Cleveland Clinic Hospital, Weston, FL, probably until Saturday. I’ll let you know how it goes.
Silly me: I was originally thinking that I could attend the Board and Council meetings, but I have now come to my senses and realize that would be foolish. I am sorry because I was really looking forward to seeing you all. I was especially looking forward to thanking my supporters for the presidential race in person.
At any rate, have a great meeting, and I’ll catch up with you soon. Sincerely,
Ron

Email #2. (2/14) (with some details corrected)
Hi Folks: Thank you for all of your calls and emails. I really appreciate hearing from you, and receiving your care and concern! It is difficult for me to spend much time at the computer, hence I will not be able to write individual notes, so please accept this group acknowledgement, thank you, and update. Also I do like to hear from you so please feel free to write, but please don’t expect individual replies, at least not right away, OK? I was released from the hospital yesterday. I have been experiencing atrial fibrillation every day since the surgery on Wednesday (2/11), which is par for the course, due to the post surgical inflammation (for which I am taking prednisone). Pretty much anything I do other than lie in bed sets it off: brushing my teeth, walking around the house, etc. This can continue for up to three months post op (UGH!). The good news is that when I cease the activity and lie down my heart does return to normal sinus rhythm most of the time. Other times I have to take an extra dose of the anti-arrhythmic as well. I will have weekly follow ups, stress tests, Holter monitors, Coumadin (blood thinner) clinic, etc. Hopefully, if I am a good patient and confine myself to bed-rest (which is very hard for me to), I’ll see some significant improvement within 2 weeks.
The surgery was quite interesting. For those who don’t like these kinds of details, you may want to skip this paragraph. There were three MD’s plus a couple nurses and an anesthesiology tech, a team of 6 in all. One of the MD’s flew in from Atlanta, as he is a rare radiological expert in intra-cardiac echocardiograms (ICE). They ran catheters up both femoral arteries. The ICE probe went in one artery, and the other contained both the pacing and recording catheter and the radio frequency ablater, which were controlled by the EP. The echo guy acted as navigator telling the EP how to move. I was awake then and could see the echocardiogram (which was just to the left of my head) and hear him say things like “OK you are near the fossa ovale, rotate ten degrees and hook a right.” I thought this was way cool! Just like two guys maneuvering a big truck! Then the third MD came in, the anesthesiologist, and they drugged me out, for which I am glad because the operation took 8 hours, much longer than normal (2-6 hrs). What they did is both ablate (excise) the neurons which act as ectopic excitation sites in both the left and right atria, and then encircle the pulmonary veins in the left atrium. My procedure took so long because my pulmonary veins were “the largest they had ever seen.” (I was kind of pleased with that last statement because as you know, for many of us guys, size always matters, no matter what is being measured.)
That’s all the news for now. I‘ll send regular updates.
Warmly,
Ron

Email # 3. Early March.
Hi Folks: Good news! I am feeling much better and will be ending my medical leave. I plan to attend an APA meeting on Monday and Tuesday and will be back at work on Wednesday. I will need to take it easy for awhile and cannot do as much as I am used to doing (and it’s OK for you to remind me ). My physician indicated that I might continue to experience occasional atrial fibrillation for several months, which, when severe, can cause shortness of breath and dizziness. If that should happen I would simply go to my room and take additional medications until it passes.
Sincerely,
Ron

Email # 4, to Diane Halpern and the APA Board, May 24
Thanks for the heads up, Diane. I hope everything works out for the delivery of your grandson. I need to give you a heads up too. I may have to have the abalation surgery redone. I still have though it’s less severe (slower, more organized) but it is more persistent (I have been in continuous since 5/3). Today we did an electro cardio conversion and if that holds, I am good to go; If not I’ll have the ablation redone, probably first of June, which will mean missing the June Mtg. I’ll keep you posted
Best,
Ron
P.S. After typing this, I thought it best to let the Board and EMG know so I am ccing them.

Email # 5. June 20
Hi Folks: Please forgive the cross posting. As you know, in February I had an operation (cardiac catheter ablation) to treat atrial fibrillation (). After 4 weeks of recovery with limited activity, I had a good period for about 25 days in April. But then the problem returned, albeit in a less severe (i.e. slower & better organized) but more persistent pattern in May, and I have been in continuous since 5/3, with HR 80 (whereas before it was 0, when it paused, and went up to 140 if I exerted myself). I had an electro-cardio-conversion on May 24, hoping that once my heart was set back in normal sinus rhythm it might hold, but such was not to be as I went back into the next day. My EP (electro-physiologist) was planning a second surgery, August probably. The fact that it can be delayed is indicative that there has been some improvement.
But then an extraordinary thing happened. Around 2:30 am Saturday morning I woke up and felt different. No . Can this be? I took my pulse lying in bed and it seemed normal, so I got up and go out my trusty blood pressure monitor (which actually shows the heart beats, so you can see the pacing), and sure enough I was in normal sinus rhythm. I have no idea why this happened, unless it took a bit longer post surgery to see the results; the surgeon said 3 months, and it took 4. It could also be the result of all of my friends and relatives out there praying for me. If it stays like this I will not have to have the second surgery.
With fingers, toes, and eyes crossed, I remain
Sincerely yours,
Ron

Comment, July 5.
I have been in and out of since 6/19. My view is that my heart is still trying to right itself, and it does seem to be getting better in stages. I am certainly improved from before the surgery in that my heart is no longer pausing, and further, the which I have is now better organized, and I do not have every day. It may turn out that I will need a second ablation but for now I think I will wait and let my heart heal on its own.

Email # 6. August 6
Hi Folks: It was great seeing friends and colleagues in Honolulu. What a terrific convention! I wanted to let you all know I will have a pre-op procedure next Tuesday (August 10) in preparation for admission for surgery the following morning. Since the initial surgery last February I have experienced significant improvement, in that the is less severe and life-impacting. However, it still persists, which warrants further surgery. My hope is that this procedure will cure it and I will be able to get off the medications. The surgery will not be as extensive as the first time and so my recovery period should be shorter.
I’ll keep you posted
Best regards,
Ron

Current Status
I had the second catheter ablation on August 11. The EP reported that the isolation of the pulmonary veins done in February was holding, and that they found a few areas on the bottom of the veins that needed to be done. The procedure was much shorter and the hospital stay was as well. I was released on Thursday August 12. Given the inflammation that comes after surgery, I went into shortly after discharge, but returned to normal rhythm the next day. Now it’s a matter of waiting to see if this will work, which, like the first time, could take up to 90 days.

Reflections
One of my colleagues (D.Linnell, 7/5/04) noted that: “When you talk about the various clinical things happening to your body and the treatment being thrust upon you to deal with it, it comes across like the professor part of your work. How about adding some reality to it?”
OK, Debbie, I will. This experience brought with it an at-times intense fear and also an ongoing sense of vulnerability. I was most afraid the evening I went to the ER unable to breath, and this heightened fear lasted until I understood what was going on and had a plan to deal with it two weeks later. The sense of vulnerability continues to this day, as I am not out of the woods yet. I also had a hard time with the loss of control that comes with being in a hospital. Hospitals simply take your life over. The nurses and techs wake you in the middle of the night to give you sleep medicine, and (actually in my case), lose your blood work and have to do it over. And forget about trying to get even simple questions answered. Either you get no answer or you get crazy answers. This was, by the way, very much in contrast to my experience in the operating and recovery rooms, where the staff was very professional, kind, and helpful.

Lessons Learned (so far)

1. Work stress can be dangerous to your health. Due to political issues at my workplace, I felt ambushed, trapped, hopeless, and unable to make myself heard, while at the same time feeling that the future of my program was on the line, and that, therefore what happened mattered greatly.
2. Traditional masculinity can be hazardous to your health. Despite decades of professional work on the psychology of men and masculinity, as well as my own personal therapy and analysis, I still find that I have some stubborn traditional masculine traits, such as minimizing and ignoring my health needs.
3. Being healthy is now my number one priority. People who know me may wonder about this, because I have always valued health. But they may not know that, due to factors mentioned in item 2 above, I was reluctant to go to physicians when I had a health problem, preferring to wait or “tough it out.”
4. Love, support, and care from family, friends, and colleagues is wonderful, and truly beneficial.
5. As my colleague Jo Johnson noted (personal communication, 7/5/04): “You're an excellent example of the current research on the power of prayer even when one is unaware of being prayed for. There are lots of us out there praying for your physical health and peace of mind.”
6. Becoming an educated healthcare consumer is very helpful. It is amazing how easy it is to access medical information on one’s condition. I was able to rapidly amass a six inch stack of articles and a book, which I devoured. Being proactive in seeking information and learning about my condition helped enormously in dealing with my sense of vulnerability. It also gave me a conceptual framework and an overview of the various treatment options and their relative efficacies and risks. Finally, it helped me communicate better with my physician.
7. Maintaining a positive attitude is very important. Hard to do, of course, but emotional and cognitive self-management skills really do help
8. Having a good relationship and good communication with your main MD is absolutely key. The first EP I went to had the personality of an onion. He even got into an argument with me in the visit. Needless to say that was also the last visit.
9. Living is not for sissies. In fact, as we age, if we are lucky we will develop an illness. The alternative is much worse.

Reference
Levant, F. (In Press). Washington Update: On being a medical patient. The Independent Practitioner.

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Ronald F. Levant, Ed.D., M.B.A., A.B.P.P., is President-Elect of the American Psychological Association. He was the Chair of the APA Committee for the Advancement of Professional Practice (CAPP) from 1993-95, a member at large of the APA Board of Directors (1995-97), and APA Recording Secretary for two terms (1998-2000, 2000-2003). He is Dean and Professor, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL.

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