Hi all, Speaking of stress and 'mental stuff' I have a worry that is keeping me up and would appreciate any and all comments. I suspect my anxiety is partially coming from knowing just enough to make myself crazy. I did have my Watchman Procedure on Jan 15th and it went very well. The problem now is my upcoming TEE (TOE) procedure on Feb 28th at 7:30 am under sedation. I understand why it's necessary-to be sure the Watchman mesh is completely covered with my tissue so I can stop the Coumadin. Past treatment and endoscopies (from past cancer tx has left me fearful (and I mean terrified) of any instrument down my throat unless totally asleep, I have asked to see my surgeon next week to see if I can be put to sleep for this. I suspect the answer will be no but I will ask. The TEE I had prior to the surgery was done under anesthesia. I guess I'm hoping to hear that many of you have had this go smoothly. Please write. As a nurse I should know better but these instruments down my throat are almost a phobia. Am waiting for a reply from my doc's nurse. And am obsessing a little too much. Thanks in advance. I understand they want me awake to help swallow the TEE equipment. But so many things cane be done while asleep. I think I really am asking that everything will go smoothly and painlessly, And how long will the actual procedure take. The dept has set aside 75 minutes. I know part is prep time. But still scary. Thanks again Burma (irina1975). PS I had to be intubated AWAKE in 1999 for some surgery. Looking back I was in a teaching hospital and I suspect it was some anesthesia resident's turn to learn how to do this. I'll never know but it has left a bad taste. ALL experiences welcome good and bad.
experiences from posters who have TEE... - Atrial Fibrillati...
experiences from posters who have TEE's (TOE's in UK) under sedation.
I have had two of these procedures.The first one was carried out by a highly experienced doctor who seemed to lack any human feeling but nonetheless it went well...under sedation. The second ,to see the back of my heart before a heart procedure was much better and all concerned were warm and caring people.I had sedation for both....and I too was terrified.
I think there is something that troubles many people concerning anthing being put into the throat or even up the nose...you are not along.
Thanks 10gingercats. I don't mind a doctor who lacks interpersonal skills if they know what they're doing. Many excellent surgeons I have worked with don't communicate well. Maybe a case of the Universe not giving all gifts to one person. Thanks. BTW, if too personal don't answer but I am assuming you are a cat person. As am I. My user name -irina- was also the name of my favorite companion animal- a Siamese cat named Irina Aleksandrovna who lived 17 years(1977-1995. ) She was very elitist and knew she was a cut above all the other animals we had. Thanks again for responding.
Why can he not see what he needs from an echocardiogram? That was all I had a month after my Amplatzer was fitted. I had asked if I would need a TOE and he said , No that would be cruel.
That's going to be my very first question. He seems to be in tune re not causing unnecessary discomfort as the TEE my surgeon did at the beginning of the procedure to determine the device size I needed could have been done prior to me going to sleep but he said it would be uncomfortable and did it after general anesthesia. I appreciated that. Maybe he doesn't know how I feel and willwork with me on this. Maybe I'm making a mountain out of a molehill. Ireally am a baby about pain. BTW how areyou doing since your Amplatzer surg. Are you in Germany? and is thatwhat the device is called there?
He had of course used TOE during the initial procedure for guidance and to judge the size of the device to use. He initially tried a 25mm device but changed it for a 22mm one that fitted comfortably with the lid occluding the ostium.
Mine is a Watchman made by Boston Scientific as is my pacemaker. My size is a 30 mm. But size numbers may differ according to manufacturer. Thought I'd add a little humor to the whole situation. I had named my pacemaker Seymour and my new Watchman is Sidney. I figure we'll be together for life so they should have names! LOL Take care. irina1975 9name is Burma).
I had an MRI compatible Boston Scientific pacemaker fitted in 2015. When I needed an MRI scan the hospital then told me that they had not agreed a protocol for scanning them. It was supposed to be about to happen but took way over a year. Only one hospital in South East England and London would do it so I had to travel to get it done.
I did not think about giving them names as they are friends I would rather be without
We visited Atlanta around 1985 on our way back from the Mardi Gras.
Used to go to Mardi Gras fairly often when younger-not that long a trip to New Orleans. Had lots of fun, especially knocking back those "Hurricane drinks!LOL"
We also had some great meals in New Orleans
No, I'm in England. The Amplatzer is American and made by St Jude Medical.
medgadget.com/2013/01/ampla...
I don't feel any different heath wise but am happy not to be taking Warfarin any longer. The strange thing is I still bruise easily but the nurse commented that it is now more difficult to take blood from me.
When did you have your procedure.? Are you on aspirin or anything?. It's interesting to me to know how things are done in other countries. Sometimes I think drugs play to big of a role in certain treatments. Just my feelings. My suspicious mind says drugs are such a moneymaker over here that I think Big Pharma finds ways to work them in 'just in case'.I was told it might take up to 6 months for blood/platelets etc to return to normal. Fine with me. The clock's ticking and if the TEE shows complete closure on Feb 28 I can stop Coumadin that day. Then I have a couple of months on Plavix and a baby aspirin daily. Then off the Plavix and just continue on a baby aspirin (81mg) daily. I'll take the coated ones for better stomach protection. I don't feel any different either except excited coumadin is almost out of my life. Will keep my coagucare equipment a litle longer just in case. Then send it back.
Have sedation you won't feel a thing
Plan to. As much as they'll give me, Thanks.
I had my TEE carried out by a professor with not much of a sense of humour but nice enough, to be honest I felt sorry for the trainee doctor helping out who couldn't do anything right in the profs eyes however, in saying that it kept me entertained during the whole of the procedure, I didn't have sedation just straight in 10 minutes for the procedure and back out with a glass of water sat in the waiting room for 10 minutes so they could check I was ok and off to go with no after effects that I would have had with sedation.
Seriously nothing to worry about the worst part for me was the spray they used to numb my throat supposed to be mint taste....yuck.
I can fully understand people's worry and phobias with this procedure but whatever method you choose there is nothing to worry about.
At 07:30am I definitely don't think I would need any artificial sedation.
All the best
Thanks. Knowing it was only about 10 minutes is calming. I guess I can put up with anything for 10 minutes. Thanks again.
As an anaesthetic nurse I don’t know of any anaesthetic doc that would openly choose to do an awake intubation that wasn’t necessary, certainly not to practice, as we have loads of patients that we have to do awake and what we called crash intubation,, we do like to keep it simple, I can assure you. 😛
II agree with you. Was an operating nurse here in the US for 40 years (now retired. When I was scheduled for a hysterectomy in 1999 at the County Hospital here in Atlanta, during my preop visit I was told that because of laryngeal damage from radiation I would have to be tubed awake. I questioned this but, as we say, was at the wrong end of the red pencil. I wouldn't have chosen this hospital except I worked there and that;s where my insurance was. Since that time I've come to believe that the resident possibly needed experience in what we called 'awake' intubation. It was unpleasant I can tell you. I'll never have all the answers to this fiasco but it has left me apprehensive re any throat procedure I am not totally anesthetized for, irina1975
As I said there was a genuine reason for the awake intubation, yes
unpleasant but you came out at the end of it, we only try to intubate for 30 secs if patient has been induce with anaesthetic drugs,, normally that’s all it take but with and unknown damage they would not risk you becoming hypoxtic
Hope all goes well for you, have to say I don’t think I could stand a scope going down my throat but I am a wuzz, lol
So am I! As I wrote earlier I think I had an usual experience. Had had larynx cancer in 1984, didn't smoke and came through it just fine-caught early but radiation in those days did cause a lot more damage than now. And there was no glidescope. Maybe they were being cautiousbut still not a day at the beach. But as you say, here I am many years later so I'm happy to be here. Just have a 'whispery voice. LOL
what as in my case i struggled with the hosepipe going into the throat , it was horrible i was traumatized, insist on totally anesthesia irina
In my experience they think that a light sedation will make you remember nothing from the Tee procedure but the first one i had using very light sedation i remembered everything and was able to tell my cardiologist it was like having a garden hose stuck down my throat, he was so sorry to distress me that the next time he promised it would be propofol the michael Jackson drug and it worked a treat didn't feel a thing out for the count
I;ve had propoful and it works very well . Will ask him about this. Still waiting for the nurse to call me back so I can talk to the surgeon.
If my wife can manage it, anyone can, she’s a total wuss!
Great news about your procedure Irina, not much direct knowledge or experience of the Watchman Procedure here on the forum so your input will be invaluable. Best of luck on the 28th, you will be fine.....John
Ps I’m a cat person too, but sadly, do not have one at the moment.
Hi Flapjack. The Watchman Procedure is the name here in the US for a procedure whose actual name is CLOSURE of THE LEFT ATRIAL APPENDAGE OPENING. Current research suggests that 90% of afib clots form in this appendage -a little pouch connected to the left side of the atrium. The opening that leads into the atrium is closed off with an umbrella-like mesh device and when healed by being sealed over with tissue becomes occluded. The patient can then be weaned off coumadin and eventallyother blood thinners.The device can be inserted by cardiac catheterization. It's a somple procedure but not for everyone. There is a lot of info/videos on the web-better than I can explain it. I've had probs with coumadin and other AC'sand am happy to be gettingoff. The TEE -aout 6 wks post op will let my surgeon know if I can stop the coumadin.
Thanks Irina, it has been performed here in the UK, but it is not a very common procedure. I’ve just realised it’s the middle of the night over there, go to bed!!😉😴
OK soon I promise. I have restless legs syndrome and tend to be up potting around during the night and go to bed between 4-6AM. Since I'm retired I can do this. BTW lots of old people get their sleep hours turned around. And I can nap as needed (cat naps) during the day. And I can be on the computer posting. It seems so many of you are on later times. Works well most of the time. Also there is something about restless leg syndrome. Tends to be bothersome at night then calms down (for me at least) around dawn. There, you've just had my restless legs 101 quick course. LOL
PS me again. I'm also watching Doc Martin reruns on Acorn TV.
Oh Irina. I do sympathise with you! I, like you, have had various tubes down my throat and it is very unpleasant when you are awake. This was, like you, in the latter part of the last century. A friend of mine who is incredible nervous has had two endoscopies recently at our local hospital and found the sedation to be just right and the procedure not at all frightening. I think treatment procedures have improved greatly nowadays. Let us know how you get on. Annel
Thanks, You're so right about procedures coming a long way. I started working as a nurse in 1965 in Florida and retired in 2002 here in Atlanta. The way things were done in the 60's especially seem primitive to me now. Intellectually I understand how much smoother many procedures are now but when I'm the patient often anxiety wins out over common sense LOL
Hi Irina. I did my nursing studies at Mass General in Boston. It is interesting how much research and innovation was taken on by this hospital into A-Fib. The ablation procedure was a venture into the unknown and is now so sophisticated! In the early days you had to swallow a camera down your throat so that they could check your heart for clots. I just couldn't do it! All I remember is a young doctor yelling "give her the juice". I have made it a practice to ask for the "juice" ever since!! Annel
All the newprocedures and simplicity involved with oldtime procedures constantly amaze me.
My uncle went into cardiac arrest and died during an endoscopy in the late 1960's. A GP at a practice I later attended also did.
I'm often told that I should have an endoscopy but I tell them that I can choke when cleaning my teeth. Doctor who did my last barium X-Ray said that he would never have one either.
I'm sorry that you had to go through that experience ith your uncle. Just shows there really are no 'simple' procedures. In the O.R. I saw patients come through big surgeries smoothly and small procedures with unexpected problems. Perhaps the difference when docs explain is who's having the surgery! I had an instructor in nsg school who actually was very good and I learned a lot from. She taught obstetrics. She was always reminding us to refer to patients in labor that they were having 'contractions' NOT labor pains. She felt the word 'pain' would cause more anxiety. Well, the day came when she was the patient having her baby and some of my classmates were present. All of a sudden her contractions became 'pain!' Interesting."YOU have contractions, I have pain." BTW thank you everyone who responded . I have a clear picture of how to approach this issue with my doc without being emotional. Thanks again irina1975 (Burma)
He was only in his 60's but had suffered from angina for a few years but it had not restricted him much.
My wife was a nurse in maternity but had our daughter in another hospital as she did not want her friends to see what a bad patient she was.
Interesting. When I was still working I always felt safer having surgery where I worked. We were allowed to choose our anesthesiologists and I felt well coddled and cared for. There is an old saying about anesthesiologists."You don't pay them to put you to sleep, you pay them to wake you up!" (A little inside humor-LOL).
Hi annel. I had a friend who graduated from Mass General. The thing I remember is her nsg cap. Guess those are a thing of the past,huh!
I have had a TOE on 3 occasions and never awake at the time. I refused to allow them to do it otherwise. They gave me some form of sedative that knocked me out as fast as I can remember him pushing the plunger. I woke up when I was back in the ward.
Thanks Richmert. This is the way I'm leaning. Early on when having a cardioversion they wanted to do a TEE 'to check for clots' Since I had already been on Pradaxa for a month I refused saying I didn't want it and they allowed me to skip the Tee and everything went fine. Si you've strengthened my resolve to go to bat for myself. I know many procedures re medical probs are necessary. Some, in my opinion, are moneymakers .
Well they did the TOE during the ablations but on one occasion I had to have a TOE prior to a cardioversion which they cancelled anyway. I was in hospital at the time and refused point blank to have this bloody great bullet shoved down my throat while I was awake so they knocked me out. I am ok with them going in via a nostril but this thing would not have gone through.
To chance a stroke by not having the TEE seems reckless to me.
You're absolutely right. I will have it. I just want it to be as painess as poss. Really want to be asleep. But if push comes to shove Ido what I have to. Sometimes I do battle beforehand to try and make the procedure easier and I always try to have a discussion. I just don't meekly say "Yes Docotr' right away. My craziness not theirs. Thanks though. Maybe I need to be more adult on this one. I just don't want to feel instruments in my throat. Am hoping for some meds to put me out.
I have had 2 TOE procedures and like yourself was also terrified at the thought. They were both done under sedation and the only recollection I have of the procedure was the mouth guard put in my mouth. Whilst having the 2nd TOE prior to having a cardio version the TOE procedure put me in sinus rhythm and I didn’t need the cardio version. An added benefit. I am due an endoscopy soon and am still nervous about it but my experiences should tell me otherwise. I think we worry unnecessarily but it is hard not to.
I feel just like you. I gag at the thought of anything in my mouth. My EP is very understanding and all 6 of my TOEs have been done under GA.
Thank you!!!! I'm ready for my newest 'medical skirmish'. I think sometimes things are more for the convenience of staff rather than patient comfort. I don' t think this necessarily intentional but maybe procedures become more comfortable over time because enough patients demand change. I will do my part and be a patient advocate.
I certainly understand how you feel about the prospect of a TOE. For my first ablation I was more concerned about this than the actual ablation.
The first time my EP himself did this before commencing the ablation procedure in Cath lab.....all done very swiftly . Ok ....not very pleasant but I just had to get on with it! Second one done a few days before my procedure by technicians (?) who were very good st making me feel comfortable. Third ablation performed under GA so TOE was as well.
Hope you can come to terms with the thought of the procedure. I told myself how necessary it was to detect clots but of course you know all this as a nurse. I recently had problems swallowing a probe for gastroscopy procedure...have very strong gag reflex...couldnt be given more sedative so fentanyl was given which did the trick.
Sandra
It's good finding out more and more people don't enjoy current sedation practices for TOE's?TEE's. It will be interesting to see if changes begin to happen. Thanks everybody.
ditto, first paragraph
I had a TEE in October. All was done under general anesthesia. Although my throat was sore afterwards for about a week, I never felt a thing.
I had 2 TEEs with sedation in the last year. I was nervous beyond reason for the first one. As a GI nurse I used to help with the sedation for TEEs “back in the day”. I thought it was all quite barbaric. Because of my frame of reference I got myself into quite a state prior to the first TEE. Fortunately the staff set my mind at ease and reassured me that the probe used is way smaller than the one I remembered. I was embarrassed by how easy it all was. The sedation (midazolam and fentanyl) is great. I had a sore throat for a few hours after each TEE, but that was it! I hope it goes as well for you.
I like that you pointed out 2 important thoughts. First, as nurses, knowing what we know doesn't always serve us well and 2, most everything medical is much less primitive than what we sometimes remember 'back in the day.
So true!
LorelB interesting to hear how as an ex GI nurse involved with prep for TEES you were petrified of having this procedure!!
I was petrified because 20+ years ago the probes were huge! And my unit only assisted with those cases for a short time. So I had no idea how much the technology had changed.
Hi Irina
I live in Australia but I had my first TOE in Europe. I was awake. It lasted only a few minutes. I gagged the whole time, but recovery was very fast. I had the second in Australia and pleaded to be put to sleep. It was great but recovery in terms of a sore throat took about a week. If I have to have another I would want to be sedated (asleep) much easier, I’d put up with the sore throat for a week.
Good luck. I hope they listen to what you want.
Me too. Thanks. I can be very 'pushy when pain is at hand. LOL
Hi Irina, I had a TEE last January before a cardioversion.it was horrific. No anaesthesia at all other than the goo down my throat to numb it and limit gag reflex. It was the longest 30 minutes I can remember. Thanks to this post I now know strong sedation or GA is possible. I won't be caught again.
Hi Chesson, I'm sorry you had to endure this type of tx. In my opinion in today's world there is NO reason to make a patient suffer needlessly. I think it's important to understand and demand we be treated as gently as possible. Most caregivers, I believe, want your med experiences to be as comfortable as possible But sometimes the philosophy of 'time is money' takes over and saving a little time by cutting short time needed to make a patient comfortable figures into 'the bottom line'. I worked as a nurse for almost 40 years and have seen this. I know what my rights are as a patient and make sure they are met. Sometimes I think we get a caregiver-doc/nurse/whoever who has not yet experienced pain/ suffering in their lives and their empathy levels need a shot in the arm. I don't wish pain and suffering on anyone but when you receive care from someone who has been there and learned from their experience they can be a Godsend! Take care; be your own advocate and demand gebtle tx. It's your right as a patient. Burma (user name irina1975).
Post Op Watchman Device Protocol: DONE
Considering Cather Ablation
Anyone sleep a lot after their ablation?
Lorazepam experiences for one-off use 
