Is this phrenic nerve damage?

[southofthedowns]

Hi all

I had catheter ablation for AF last July ( UK - NHS).

Whole thing was a dogs dinner, the pain was unbelievable. In the evening had spectacular hiccups and terrible reflux - had to sleep on my back propped up on pillows or drown in my last meal.

Two days later back in hospital with total heart block - pacemaker fitted against my will.

Within four months heart block had resolved and pacemaker removed. Like I said - a dogs dinner...

Situation now is that any exertion or even getting down on the floor and back up again causes: Pain in my middle, nausea, breathlessness and burping. I also have a near-permanent bloated feeling.

I am an active 60 year old male with a physical job and hobbies (I like to work on my cars - hence my comment about getting down on the floor and back up again).

My question is this: Is this likely to be phrenic nerve damage and if so does it resolve over time? Or could it be something else? I have a phone call booked with local gastro department in a couple of weeks and I would like to go into the conversation as informed as possible. When lockdown ends here I have to go back to work - I'm not sure I can manage.

[Hidden]

Breathlessness due to phrenic nerve damage at AFib ablation, usually becomes apparent in the early weeks after the procedure. Paralysis of the hemidiaphragm would have been evident on your Chest X-ray (assuming you had one) when your PM was removed. I would say phrenic nerve damage was unlikely but not impossible, but then I am not a doctor.

ncbi.nlm.nih.gov/pmc/articl...

[CDreamer]

Sounds as though you had a very unfortunate experience.

I’m not a medic but from what you say it’s unlikely to be severe Phrenic Nerve damage - but could be irritation and I think that is not unusual. You will make things a whole lot worse by bending down. Also consider Vagus nerve irritation.

All I can say is that I had reflux for many months after ablation, it eventually eased very gradually but took over 9 months and I was left with a dry cough. My GP suspects I now have silent reflux. I certainly find lying prone makes things a lot worse and staying upright eases things. I am currently fighting being on PPI’s so take Liquid Gaviscon before bed, which helps but evidently that’s not a solution long term.

Also look at your eating - any carbohydrates can worsen symptoms if it is vagus irritation.

You may find this site helpful in preparation for your appointment verywellhealth.com/phrenic-...

[BobD Volunteer]

Sounds much more like oesophageal problems than phrenic nerve which usually affects breathing. You need to discuss with your medical team.

At 76 next week I don't do laying under cars any more, I just stand and build engines and gearaboxes on the bench or stand.

[southofthedowns in reply to BobD]

Hi

I fitted new shells into a Land Rover engine a couple of days ago - working at bench height. Just torquing up the main bearing caps made me unwell...

[Jalia]

Oh dear , that sounds horrific! Where did you have it done , if I may ask ?!

[southofthedowns in reply to Jalia]

Butchery occurred at Eastbourne DGH. Butcher a clown called Furniss- avoid at all costs.

[MarkS in reply to southofthedowns]

I'm a little surprised by that, Dr Steven Furniss used to be at Newcastle where he had a good reputation. Presumably you had sedation rather than a GA if you felt the catheter. It could be you weren't given adequate sedation which would be the anaesthetist rather than the EP?

[Ppiman]

I was interested to read your post as I've also been having broadly similar symptoms, but my ablation was in 2019. I've been putting my problems down to my hiatus hernia, which feels like it might have become much worse since helping my son and his family move to a new house in late November last year.

Since then, I have suffered frequent nausea with a feeling of pressure below my left rib, sometimes the nausea is replaced by stitch-like feelings and discomfort that go right round into my back, add in chest discomfort around the sternum and the need to breathe in deeply.

I've had similar symptoms but for shorter duration since my ablation and it had made me wonder if that procedure hadn't weakened something in the diaphragm region. I had CT and MRI last year, though, which reported very little of concern except diverticula and gall stones.

Steve

[southofthedowns in reply to Ppiman]

Hi Steve

I have a small hiatus hernia apparently which was detected during a CT scan after implantation of pacemaker.

I believe I have always had an issue around this because when I was younger I found bending down during work would make me puff. I also had reflux which has been treated with PPI for decades. I am now on a very low dose, half a tablet morning and night.

The issue now is magnitudes worse in that it actually makes work too painful to endure.

I think it is likely that some damage to the diaphragm and/or it's nerves has occurred. My concern is that it is getting worse. I have a project which is quite physical and I don't know whether to push through, which hurts and may cause more damage or call it a day, which I would be extremely reluctant to do.

[Ppiman in reply to southofthedowns]

I can relate to the bending issue. My wife always said that whenever I cleaned the car wheels it made me irritable. It took me years to make the connection. It's odd because most doctors and websites claim hiatus hernias in themselves are generally symptomless and that any gastric issues are reflux related. Mine also seems these days to sometimes bring on mild tachycardia. I have it now and have had to take a bisoprolol to calm things down.

I somehow suspect you've not got any nerve damage but that it is the hernia causing this havoc. Have you tried taking extra lansoprazole or whatever PPI you have been prescribed? With your GP's okay, you can take up to 60mg a day to see if that helps. If it does, then you will know it's acid related. Taking it half an hour before any food or drink first thing in the morning is the best way, I am told.

I do think that gastric issues can cause severe problems at times and can take months to calm down again. My neighbour has been taken into ER on two occasions for suspected heart attacks and each time was sent home being told he has a healthy heart and that it was his hiatus hernia. That doesn't quite fit with them being symptomless, does it?

Life with these issues is difficult, and life with them under lockdown is very much worse. I do hope that you find some kind of answer!

Steve

[EngMac in reply to Ppiman]

Look up Dr. Sarah Myhill and acid reflux or GORD or GERD. She explains why this happens and it is because of too little acid not too much. As we age we produce less stomach acid. PPI’s are harmful. Dr John Bergman in California also explains this. Often apple cider vinegar will stop the reflux.

[Ppiman in reply to EngMac]

Thanks for the tip. I’ll have a look at what she says,

My thoughts are from my own experience as well as talking to other sufferers over the years, that anyone who can control their reflux with a simple remedy really can’t have much of a reflux problem.

I also think it’s not to do with the volume of acid but the weakness of the cardiac sphincter that allows whatever acid is there to flow up into the throat.

I once watched a scan of reflux happening to someone with a hiatus hernia and it showed the nature of the problem well and how difficult it is to control it when the sphincter is weak.

Steve

[Auriculaire in reply to Ppiman]

Have you considered that this might be a mechanical problem ? You say that it started after helping with a housemove. Is it possible that you have damaged cartilage round your ribs and sternum and due to cartilage degeneration ( which sadly occurs as we age and not just in our hips and knees) you have not healed. I wonder because I have had similar symptoms for several years and thought at first that I had a stomach problem . My GP poked me in the area and said he was sure the problem was in my rib cartilage.

[Ppiman in reply to Auriculaire]

That’s an interesting thought, thank you, and it was kind of you to suggest it. The focus of the nausea is a spot that is lower than the ribs. I really don’t know what to think. I could do without it as I’m a worrier, but digestive problems aren’t new to me. Why it sometimes sparks off tachycardia, I just don’t know. It feels like the diaphragm is involved.

These things, eh? Time will sort it one way out another, I guess.

Steve

[Slidingdoors99]

I can’t shine any light on your situation, but just wanted to say how sorry I am about your nightmare story.... just terrible.

[Jacnc]

Boy, sorry to hear that- I don’t know, the P nerve controls the diaphragm -so I am on continuous oxygen and a ventilator at night-but I have no pain,