Erin's Ablation

Erin had her ablation last Monday, June 19th, so I thought I would recap the day for her future reference.  We hope this was a one-time thing and will all be a distant memory very soon!  It all started back in March 2016 when I took her in for a flu test when she was sick, and the pediatrician noticed her rapid heart rate.  They sent us to the ER, but it had self-corrected by the time we got there.  Fast-forward to September 2016: repeat performance, except the arrhythmia continued in the ER, so she got two rounds of adenosine, which converted her back to a normal rhythm, followed by a night in the PICU (September post).  She was on oral atenolol between September and April at varying doses, and had two rounds of portable monitoring during that time to help tweak the dose, until she had a good checkup in April and was taken off of it.  We spoke too soon though, because in May 2017, the SVT returned during a stomach bug, buying her 6 rounds of adenosine, an esmolol drip, another overnight hospital stay, and resuming the daily atenolol at home (May post).  We had already decided to have the ablation after the April checkup, but she didn't quite make it to the scheduled date in June before having that one last hurrah in May.

Here's how I understand the condition, aka Supraventricular Tachycardia, or SVT.  The specific type that she has is called AV Nodal Reentrant Tachycardia, due to the location of the circular path.  Either she was born with or her body developed a physical piece of tissue in the heart that causes the electrical system in the heart to "short circuit" when her body is under stress due to heat, fatigue, sickness, etc.  When all is well, her heart beats in a normal rhythm.  When it's not, the electrical signal that drives the heart beat conducts through this "bad tissue", causing the heart to beat too quickly.  It is not life-threatening, but the pediatrician described it as feeling like she's sprinting as hard as she can for as long as it's happening, and her heart is very tired after.  So, it's not something you want to be happening for an extended period on a regular basis.  Her heart rate was measured around 210-260 beats per minute during the episodes, where a normal rate for a kid her age is around 70-110 beats per minute.  There are ways to stop an episode when it's happening - ice to the face, standing on your head, vagal maneuvers, coughing, blowing through a straw, etc.  We tried each of these each time without much success.  It is tricky at times to get Erin to understand what we wanted her to do, plus it always happens when she's sick and feeling yucky anyway.  Regardless, the non-medical tricks did not work.  They tried them in the ER too to no avail.

Atenolol, the beta blocker she was on between September and April, basically slowed her heart down and made it less susceptible to being triggered into SVT.  It did seem to work, as she had the flu in March and did not have an episode.  However, she was on a very low dose and had been doing well, which prompted the cardiologist to discontinue it in April.  The cardiologist explained the ablation in detail during that visit, and we decided to go ahead and try it during the summer, since the risks were relatively low and the chance of achieving a permanent fix to the SVT from the procedure was very high.

So, in we went, back to UNC (refer to Anna's story 2-1/2 years ago!), though this time to the Electrophysiology Lab, which is different from a regular cath lab.  They still do procedures via catheterization, but it has different equipment.  The lab handles adult and child cases.  We arrived at 10am for the 11am procedure, got checked and prepped, and finally went back at 12:30pm.  Erin handled the waiting and pre-op like a pro.  The entire procedure lasted from 12:30-3:30pm, including putting her to sleep with the mask, starting the IV, etc. Dr. Ferns came out at 3:30 saying that she was able to locate and burn the tissue, but it was tricky because Erin was "very sensitive" to the catheter.  When she would advance the catheter, even without doing anything, Erin would go into heart block, which is where the electrical signals literally get blocked and the heart rate slows down.  It would resolve and she could continue, but the process sounded like it was pretty stop-and-go.  The bad spot was very close to the AV node - I'm not sure if that's what made her so sensitive to the catheter or not, but she said this sensitivity only happens to her about once every 2 or so years.  However, she was able to burn the site, which is preferred over freezing (freezing is necessary when the spot is too close to heart muscle tissue).

It took Erin a little while to wake up, but she did great once she did wake up.  I'd say she started waking up around 4:00 (they gave her extra propofol to keep her sleepy since she had to lay flat for an hour after the procedure) and was nearly back to herself by 6:30 or 7:00.  She had 3 tiny pin-prick-type incisions in each side of her groin without any stitches.  She had a pressure dressing over each site - the right side had minimal bleeding that afternoon, but the other one didn't have any.  We loaded her up and were home eating Chick-Fila by 7:30pm, she was in bed shortly after, slept great, and was back to herself the next day!  We were able to remove the dressings Tuesday morning and she was clear to play other than no heavy lifting, running, jumping, baths, or swimming for 5 days.  We were told to watch for signs of hematoma, infection, and/or skipped heart beats (that's normal).  She also was supposed to keep moving gently when awake to reduce the risk of blood clots (no long car trips for a few days).  She healed great, and so far, no signs of any SVT recurrence!  She has a follow-up appointment 4 weeks after the procedure, and at that point, they'll be able to tell if there is any regrowth.

I'm not sure how long this link will be active, but here is a short article and video featuring the doctor who did Erin's procedure, where you can get a peek at the EP lab.  The equipment can measure down to the tenth of a millimeter!  http://news.unchealthcare.org/uncchildrens/news/care-2015/issue-2/heart

We aren't sure if Erin has had this her whole life and we just didn't realize it, or if it started recently.  I know she's had rapid heart rate in the past when she's been sick, but I always chalked it up to dehydration.  I know better now!  I maintain that I have learned so much since having kids, and this is just another example.  Modern technology is amazing, and so is Erin!  We are so very proud of how she has handled all of this, and again, we hope this is soon to be a distant memory and a fun story to tell!

Anna Turns 7 (belated)!

Our baby, Anna, turned 7 last month!  She had a month of celebrations fit for the princess that she is.  The partying started on May 6th when we went to Concord for a bonanza of Ansley's First Communion, Logan's birthday, Anna's birthday, Leslie's birthday, Bob's birthday, AND Mother's Day!  They had a super fun party!



The following weekend, she had a party at our house with neighbors and school friends.  The weather was a little iffy for the mermaid water party, but we gave it a try anyway and most of the girls weren't too cold.







Finally, on her actual birthday, which was a Thursday, she got to have Grandma A. take her to school and sit with her at school Mass because we were with Erin at the hospital.  She also got to wear her recital costume to ballet that evening and got her beloved ice cream sandwich cake.  I think she enjoyed her birthday!

Her ballet recital was 2 days after her birthday, so that was kind of in there too:



She had her checkup yesterday and weighs in at 68 pounds (94th percentile) and is 51-1/2" tall (also the 94th percentile).  She checked out good with vision, hearing, blood pressure, and on her physical exam.  She got her yearly reminder to eat fruits and veggies and to get lots of exercise.  She is excited to start tennis lessons this summer, so we think that will be more of a workout for her than ballet was.

So, Anna in a nutshell...she is delightful, intense, sensitive, and incredibly social.  She craves interaction with kids and adults and feeds off of it.  Being alone is a punishment for her.  The other 3 less outgoing people in this house do not understand it!  She is creative and artistic and always likes to have a project going on, with several more lined up behind it.  She enjoyed first grade this year, though each year is less fun for her than the year prior (due to more work and higher expectations).  She has a way of being a quiet leader - and sometimes a not-so-quiet leader.  Even though she's younger than Erin, she definitely runs the show.  She is always thoughtful and generous, and she really looks out for other people.  Her emotions still sometimes get the best of her, but she just feels so much!  We love her so much and are very, very proud of her!

May!

May was busy...and, it's over!  Two good things.  We started out the month with Bob's only travel for the month, to Boston.  We ladies had the usual activities during the week, then a fun trip to Concord on Friday-Saturday for Ansley's beautiful First Communion, plus a fun combo party for that, Logan's birthday, and Anna's birthday too!  Adult birthdays (Leslie and Bob) and Mother's Day were more in the background of the other more major events.  We came back for Anna's dance picture day on the 7th, and Bob's actual birthday.



The week of the 8th was more of the usual, plus a yummy BBQ at Anna's old preschool that Friday and a little party for neighbor Drew's birthday that evening.  Anna gave us a scare on Thursday by jabbing herself in the arm with some scissors, but the urgent care told us that it didn't require stitches.  Whew!  Saturday the 13th was Anna's friend party at our house.  After much angst regarding the weather, we went ahead with the plan to have slip and slides and baby pool, though it was pretty chilly.  The girls also liked painting treasure chests and playing mermaid bingo.  There were some very serious bingo players among them!  We had our neighborhood pool debut on Mother's Day, though the water was pretty chilly.







The week of the 15th was pretty wild with Bob, Erin, and I all getting sick...and unfortunately, due to that, Erin had another episode of SVT on Wednesday morning.  After trying some things at home without success, we took her to the WakeMed Childrens ED where it took 6 rounds of adenosine and then some oral atenolol and a beta blocker drip to get her rebooted.  All of that excitement bought us a night in the PICU just like in September.  She did not have any further episodes, and we came home on Thursday morning.  She will have an outpatient ablation on June 19th that will hopefully fix this problem permanently.

Anna's actual birthday was Thursday the 18th, which was almost overshadowed by Erin being in the hospital, but thankfully Grandma A. came up and saved the day by taking Anna to school on her birthday, joining her at school Mass, and making her requested ice cream sandwich cake.  She got to open a few presents from us after school and also did a dress rehearsal for her dance recital that evening, so that was fun!

After much mulling, we let her have a sleepover at her friend Olivia's that Friday as planned, which was helpful because Olivia's family took them both to their First Communion retreat the next morning while Bob and I took Anna to her first (and possibly last) dance recital.  It was super cute and Anna did a great job!  Here she is with friend Erzsi from Little Flowers, who was in the other first grade ballet class:



After that, Anna insisted on going to her friend and desk neighbor Julianna's birthday party at Bounce U.  Busy!  Sunday the 21st, we had Danny's fun 4th birthday party at Crowder Park, and then our final Little Flowers meeting for the year.

The following week was the usual, plus a couple of church meetings and book club in the evenings.  Erin also had her school mass celebration for First Communion followed by a second grade breakfast, which was very sweet and special.  Friday the 26th, they had field day at school, and I was able to go because poor Sawyer was sick.  It was a beautiful morning and we all had a great time!  Bob and Chris took a short trip to Nashville over Memorial Day weekend to see an Eric Church concert, while we girls went to Erin's last gymnastics class and then to Dalton's First Communion party on Saturday, dog-sat the neighbor dog Bear, and church to witness Olivia's First Communion and neighborhood party on Sunday!  Monday, we had lunch at Olivia's house and also dinner at Ella's house.  Tuesday and Wednesday were two days of their last week at school.

And that was May!  It was even extra exciting this year with all of the First Communions and Erin's hospital stay.  Next year we expect more First Communion fun with Anna, but we hope for no more hospitalizations!