HEART TO HEART A few words on the presidential illness


To: President Bush

The White House

1600 Pennsylvania Ave.,

Washington, D.C.

From: Frank D. Roylance

Evening Sun Staff

Dear Mr. President:

I had just stepped out of the shower after mowing the lawn the other night when I heard on the television that you had gone to Bethesda Naval Hospital to get your ticker tuned after a spell of atrial fibrillation.

Since this was your first encounter with atrial fib, Mr. President, I thought I had better drop you a line and reassure you and the White House press corps that it's not such a big deal.

You see, I've been pestered by the same darn thing for the past seven years.

And here's the bottom line: Although it can be very spooky when your heart starts flipping around inside your chest like a bag of gerbils, it's not life-threatening. In fact, the doctors tell me they vTC see lots of healthy people -- even some professional athletes -- with the same problem.

You see, it's some sort of defect in the electrical pathways that control the heart's rhythm.

Normally, the heartbeat starts with an electrical signal to the upper chambers -- the atria. They contract first and send blood to the lower chambers, or ventricles.

Then the electrical impulse is transmitted to the ventricles, causing them to contract and send the blood to the lungs and body.

In atrial fibrillation, for some reason -- doctors don't seem to know why -- the signals get confused and the upper chamber starts fibrillating, or quivering and twitching chaotically.

As long as the ventricles keep beating normally, though, there's enough blood getting to them from the atria so that the heart and body get enough blood and oxygen, so the situation isn't particularly dangerous. Although, as you found out, your heart doesn't work very efficiently like that, and jogging while in atrial fib is too much to ask of it. You need to get it under control.

The biggest risk, my doctors tell me, is that while the atria are in fibrillation, the blood in them isn't moving very much, and there's an increased risk of clotting. And that means a slightly increased risk of stroke. Your cardiologist, like mine did, may want to have you start taking an aspirin or two every day or so; researchers have found it markedly reduces the risk of stroke in atrial fib patients.

The only people who seriously worry about atrial fib patients like you and me, Mr. President, seem to be insurance underwriters, as I've learned this year. You'll find they'll write you a policy, but you'll pay more for it.

Or am I paying for your life insurance, too? Never mind.

As I was saying, the doctors say atrial fib is really pretty common. Some 2 million Americans have it. In fact, they tell me a lot of people have atrial fibrillation all the time and don't even know it.

That's not true in my case. I've been in and out of atrial fib dozens of times in the last seven years and I certainly can feel it. There's a fluttery sensation high in the chest, accompanied by an irregular thumping lower down, from the heart's ventricles, as they try to make sense of the confused signals they're getting from the atria. Sometimes I think people in the next room must feel it. But in truth, the worst thing that's happened is that they made me cut out caffeine.

In fact, that's the first piece of advice I'd pass along to you, Mr. President -- stay away from coffee, tea, and soft drinks that contain caffeine.

And chocolate. It's full of caffeine. I had a big bowl of chocolate macadamia nut crunch ice cream one night back in 1988 and it set my heart going so crazy I finally drove myself to St. Joseph Hospital emergency room to get straightened out. That, as you've found, can take days, although the longest I've gone was six hours.

Most of the time, you'll find your heart is perfectly normal. The digoxin your doctors prescribed for you Saturday night should keep it slow and steady most days. When that's not enough, there are other drugs your doctors will add, though none you'll like as well. You had one of them, Procainamide, over the weekend.

And if your doctors are like mine, you can count on being on digoxin for the rest of your life. Not to worry though -- it's just a tiny little pill you'll take once a day probably, and when it's properly monitored, there are no side effects at all. It's one of mankind's oldest and most-prescribed drugs, derived from the foxglove plant, and you'll never know you're on it.

But you may experience more episodes of atrial fib, even with the digoxin. For me, the digoxin kept things under control for about four years. Then I went to lunch with the boss and had coffee. Bad move.

Since then, there have been other episodes from time to time. When they don't stop on their own after an hour or so, I head for St. Joe's, but Bethesda Naval Hospital will do fine. The docs there will straighten you out again with intravenous drugs.

Then they'll send you home with few if any restrictions on your activities.

I got my ticker tuned at St. Joe's one afternoon last September, then drove to Virginia the next day and climbed Old Rag Mountain with my family.

Marlin Fitzwater told the press Saturday night that fatigue and stress, too, can touch off a bout of atrial fib. And he was right.

I was covering the Hubble Space Telescope last year in Cape Canaveral and they kept delaying the launch. It was also Spring Break and my motel was full of college kids, partying all night long in the next room. I hardly slept a wink. By the time they finally canceled the launch, I was beat. I went into atrial fib during dinner and wound up in Cape Canaveral Hospital over night.

So you may want to ease up on your schedule a little. Make time to relax at home with the wife and kids. Get plenty of sleep and try not to take the job too seriously. Give Dan some work to do. I'll understand.

Warmest regards, Frank

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