31. Sinus Bradycardia

Mile 28 – I don’t think any of us expected this mile to be so hot.

I first heard the term years ago, after a visit to the GP. The secretary called to say that the doctor had written a note on some test results, something in Latin, about my heart, and I had better call in at the surgery. I dropped everything at work and was there like a shot, only to be told not to worry, it just meant I did plenty of exercise. Sinus bradycardia is the medical term for a slow resting heart rate, below 60 beats per minute.

I’m not a medical expert, but as I understand it, all that cardio exercise equips a runner with a heart big enough to power a racehorse, so at rest it pumps with slow powerful thrusts to circulate blood, a bit like a Ducati motorcycle idling, if you have ever heard one of those. I know a few runners who have mentioned slow heart rates, but I guess there must be quite a number of us.

A few years back my average resting heart rate (according to my Garmin) was around 44, but it seems to have crept up to about 49, still low enough to solicit comment when I had an ECG back in February, and it was mentioned again this week when I had my MUGA heart scan at the end of the week, in this little beauty (pictured below). The nurse told me that it was 53 while I was in the machine and joked that it was probably so high because I was stressed.

This week’s blog is dedicated to Sue. This week she has hosted a committee meeting for a local almshouses association, for which she is clerk, then driven to see her mum in Shropshire, and, on her return, she accompanied me to UCLH for some more tests. She works so hard to keep everything together, so a big thanks to her. 

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To recap on the plan for my treatment, I have completed the stem cell harvest, as well as various tests – bone marrow, blood, and this week kidney and heart function – so all that remains is to visit UCLH next week to sign the consent forms, and then start the stem cell transplant shortly after that.

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The medical action was at the end of the week, with a trip to UCLH’s Nuclear Medicine department, in London, in a heat wave. These tests are part of the standard routine before the transplant. I have therefore been drinking two to three litres of water a day (for the kidneys) and exercising (for the heart) to try to improve my scores. I won’t find out whether this has done any good until my results come through next week. 

We arrived mid-morning and started with the estimated glomerular filtration rate test (eGFR) for the kidneys. I had a cannula fitted to my left arm, and a very low dose of radioactive material was injected into my bloodstream. I was then to go away, and return in two hours, during which time we could have lunch, but I had to avoid caffeine, only drink water, and, with the cannula still fitted, try not to bend my arm. Sue had a craving for McDonald’s, so we headed off for Big Macs. Back in the hospital, I had a catheter fitted to the other arm from which they took a blood sample, which left me looking a bit like “the Mummy” with my arms bandaged and straight out by my sides. The process was repeated twice more at hourly intervals, and we tried to find air-conditioned places to sit and wait, but with little joy. The samples are tested to see how quickly the radioactive isotope decays, presumably as the kidneys filter it out of the blood.

Next, we waited for the radiographers to give the okay for the multigated acquisition (MUGA) scan of my heart to be started. For that I was first injected with Sodium Pyrophosphate in my right arm, which attached itself to my red blood cells. After a twenty-minute wait, for that to mix with my blood, I was given the radioactive tracer Technetium Pertechnetate.  This tracer attaches itself to the Pyrophosphate and allows pictures to be taken of the blood in the heart as it circulates through the different chambers. The nurse explained that this injection was very “sticky” and it involved lots of flushing the syringe with saline. To give the nurse a fighting chance, the syringe with the radioactive tracer had a protective cover. Here he is at work, with both the tracer and the saline, and he would repeatedly inject, turn the white dial, and wash the syringes through.

I was given more instructions with this one: don’t sit close to pregnant women or young children, and when I went to the WC, I had to sit down (to avoid splashes), and flush twice. At home I was to use a different WC from Sue, at least until the next day.

The nurse also gave me some tips on the Spiderman wrist thing, but I couldn’t make that work.

Then it was straight off to see the radiographers around the corner, with that machine I showed you at the start, in the coolest air-conditioned room that I had visited all day. Unlike an x-ray that would pick up radiation fired through me, the big unit positioned to my left is a gamma camera, sensitive to the nuclear radiation emitting from me. I was also fitted with some sensors on my chest for an Electrocardiogram (ECG) to be carried out at the same time. The radiographer was able to aim the camera at my heart, then I lay there for ten minutes or so while images were taken, and processed by the computer into a video format that the doctor could watch, in line with my ECG. The purpose of it all was to measure my ejection fraction (EF), i.e. when my heart filled with blood, what percentage was pumped out. Typically, that would be between 50% and 75%.

I would have liked to ask more questions, and to look at the results, but the radiographer was very busy, so I didn’t have a chance. However, I did find this image of a MUGA output from somebody else’s heart on the internet, which was like that on the right of the screen on my machine and gives you some idea. 

I would continue to emit radiation for a while after, but it’s only the amount you would reasonably expect to receive over a five year period, and the benefits far outweigh the disadvantages.

After that we were free to go, but not before we had followed the advice of one of the nurses and looked at the view to the west by the lifts on the 16^th floor of the tower block. It was a bit hazy in the heat, but we could make out a few landmarks, and see the Macmillan Cancer Centre and the Cotton Rooms Hotel, where I’ll be for the Stem Cell Transplant.

We stopped off for something to eat on the way home, and sat outside Casa Tua, a lovely Italian restaurant close to St. Pancras, to share a pizza. We may well return. Then onto the train, where we chose a quiet carriage at the back, and kept a careful look out for pregnant women and children.

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I don’t know what it was about Friday, but in both places where we sat outside to eat we ended up with annoying people sitting next to us. The first announced he had joined a Zoom call on audio only, then proceeded to shout random words, and applaud, very loudly, for half an hour. The second told his companion his life story, from fame to ruin, again so loudly that we couldn’t miss it, or think about anything else.

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I received two sets of test results this week. My bone marrow results from the biopsy the other week were in, and they were very good. To remind us all:

“Myeloma arises from plasma cells, a type of cell found in our bone marrow. Plasma cells form part of our immune system producing proteins called antibodies (immunoglobulins) to help our body fight infection.

In myeloma, these plasma cells become abnormal, multiply uncontrollably and produce a large amount of a single type of antibody (known as paraprotein or M-protein) which has no useful function. It is often through the measurement of paraprotein in the blood or urine that myeloma is diagnosed and monitored.”

Courtesy Myeloma UK.

Here is a good picture of plasma cells from a US site.

Back in February those abnormal plasma cells formed 70-80% of the plasma cells in my bone marrow, but after the induction chemotherapy, they are now below 5%. No wonder I feel much better.

I also received my blood test results, from all those vials they took. Mostly they were good, but I see I am still way below the normal range for my red blood cell count, as I have been since January. (They are the ones that deliver oxygen to the body.) This probably explains the raised resting heart rate this year, as the heart would have to work faster to deliver enough oxygen to my body, and why I seem to have lost my sprint finish when out for a cycle ride, as I did in the heat of Thursday afternoon. I felt quite washed out by the time I arrived home and didn’t really recover until mid-morning on Friday. (And yes, when I overtook a cyclist on the Lewes Road, he called out “nice vintage bike!”)

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This week I had my last call with my coach at ALVIE, the cancer support organisation who work with Vitality, and you may remember that previously her advice was to prepare for life after the treatment. I have followed up this week with the local library to act as a Digital Volunteer and met with the co-ordinator. It sounds quite fun: typically, I’ll work for three sessions with (usually elderly) customers who want help operating their PCs, phones or tablets. I can begin with some on-line training while I am in isolation after the stem cell transplant, and perhaps be ready to start in the new year, or as soon as I am ready.

In addition, I had a couple of calls with the camera club, where I’ll help with their website, another task with no urgent deadline, and something I can do at home, which allows me to be involved, while I won’t be able to attend face to face group meetings.

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While Sue was away, I was a good boy: I prepared the house for when I’m back from hospital. I cleaned the insides of the windows and their frames, then fixed the WC that didn’t flush properly. It’s amazing how long a job like that can take when you don’t do it very often, and I must have reconnected everything three times before all the leaks had stopped.

My sister Liz and I met up for coffee, so it was time to revisit Pitfield Barn with their floral cakes. We had a good catch up, kept to the shade where we could, then enjoyed a stroll around the flowers. We agreed our mum would have loved it there.

I also kept up with my NHS exercises, and went for plenty of walks, once along the top of the South Downs by Jack and Jill, and again with the walking group for a 5-mile hike around Staplefield.

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I am so glad I started this blog, with Sue’s help. On a few occasions I’ve chatted with people I haven’t seen for a while who have told me they’ve seen it, which saves me from having to explain the situation from scratch each time. It also gives us the occasional unexpected laugh: last week I published my post and, within an hour, went for a walk, where I bumped into a friend who said he had already read it, and it had reminded him to go and buy some bananas!

Thanks for reading and take care.