It’s the call that sends chills down the spine of every parent of a new teen driver.
In April 2023, Franklin Landers received “the call” from his daughter. Her car had stalled, and she was stranded in highway traffic. Franklin, a dad and WakeMed pharmacist, immediately went to the scene.
“She’s a brand new driver, and she called me completely freaked out,” says Franklin. “Once I arrived, I tried to push her car to the shoulder of the highway to get it off of the main road. I ended up in gravel and fell on my side pretty hard.”
In time, the car was picked up by tow truck services, and the pair went home.
Franklin shares, “Once back at home, I bent over to take care of something and thought to myself, ‘Something doesn’t feel right.’ My ribs and chest were hurting severely, so I whipped out my phone and checked the WakeMed app for emergency care wait times. Apex had the shortest wait and was also closest to me.”
As Franklin rushed to the clinic, he began to feel increasingly worse. He felt a wave of nausea sweep over him, and his heart felt as though it were beating out of his chest. He was also short of breath and delirious.
Upon arrival, he heaved himself out of his vehicle and checked himself in, explaining to the staff that he had terrible chest pain and shortness of breath.
“They immediately got me into the triage and did an electrocardiogram (EKG),” Franklin recalls. “At that point, they explained to me that I was in atrial fibrillation.”
Michelle Deans, PA-C, remarks, “Some people go in and out of atrial fibrillation at random while others have triggers that start atrial fibrillation. Triggers include too much caffeine, lack of sleep, stress, stimulants or illicit drug use. So, Franklin pushing the vehicle didn’t cause atrial fibrillation, but it could have “triggered” it. Vigorous, high intensity, endurance activities are tricky because they can cause abnormal tissue to form in the heart leading to atrial fibrillation, but they can also be a trigger for atrial fibrillation.”
Atrial Fibrillation Explained
Atrial fibrillation (AFib) is one of the most common types of heart rhythm disorders, and it can happen to anyone. It’s characterized by an irregular heartbeat, which occurs when the heart muscles fail to contract in a strong, rhythmic way.
When the heart enters into an irregular heartbeat or rhythm, it may be a sign that insufficient blood is being pumped throughout the body. When this happens, blood can begin to pool inside the heart, forming a clot. When a blood clot is pumped out of the heart, it can become lodged in the arteries, preventing oxygen-rich blood from getting to vital organs and putting a person at a higher risk of stroke. Over time, AFib can cause the heart to weaken and eventually malfunction.
A Swirl of Emergency Visits
The team at the WakeMed Apex Healthplex Emergency Department continued to monitor him and eventually placed him in a patient room.
Franklin shares, “The provider said they needed to get me back into sinus rhythm, so they gave me IV medication. As soon as they administered it, I went right back into sinus rhythm and felt markedly better. They kept me there for observation for a couple of hours and then sent me home to follow up with my provider.”
Since this was Franklin’s first AFib experience, he had converted quickly and because he didn’t have any other risk factors, the care team felt comfortable sending him home with directions to schedule a follow-up visit.
Within five days, however, Franklin ended up at WakeMed Raleigh Campus Emergency Department with nearly identical symptoms.
Franklin recalls, “They admitted me for observation in 1A. I spent about 12 hours there as they worked to convert me over to sinus rhythm. They kept me on an EKG continuously.”
While he was being monitored, WakeMed interventional and structural cardiologist Frances Wood, MD, FACC, visited with Franklin and ordered several tests. It was determined that he had other conditions beyond his heart issue that needed further evaluation by his primary care physician. Dr. Wood prescribed medication for AFib, ensured he was safely in sinus rhythm and sent him home with orders to follow up with his primary care provider.
His daily rhythm and schedule resumed, but little did Franklin know it was merely the calm before the storm.
“In May, I was driving to meet up with my wife and started feeling really badly almost immediately, so I checked my smart watch. It said I was in AFib and had a heart rate of 150 beats per minute. When I saw my wife, I showed her the data. Concerned, we headed to WakeMed Urgent Care – Kildaire.”
The team immediately triaged Franklin and performed an EKG, but they were not equipped to convert Franklin, so they had an ambulance take him to WakeMed Raleigh Campus Emergency Department. The team gave Franklin oral medication, and he converted almost immediately. Not too long afterward, he met Michelle Deans, PA-C, who specializes in AFib at WakeMed’s Atrial Fibrillation Center.
“Michelle said I was a perfect AFib Center candidate and got me set up and scheduled for a visit on Tuesday, May 30.” Franklin comments.
Deans shares, “When I met Mr. Landers, I knew that he had new onset AFib, and he was not aware of management options long term. He was the perfect patient because our main goal at the center is to educate both new patients and those who have had the condition for a while who are not aware of their options. Our appointments are an hour long and our goal is to help patients understand what to be aware of on a daily basis, what to be aware of long term and management options over the course of the disease. Since AFib is patient-specific, we tailored a treatment based on Mr. Landers’ patient history and personal preferences. Our multidisciplinary team can assist patients with pre-existing risk factors, and when they go through the center, we can get them in to see these specialists much more quickly.”
Unfortunately, the weekend prior to his appointment, Franklin had yet another episode and went to WakeMed Raleigh Campus Emergency Department. It took upwards of eight hours for him to convert with a continual infusion of medication. He remained at the hospital overnight.
AFib Ablation
A couple of days later, when he went for his appointment with Deans, Franklin informed her that he’d been admitted the previous weekend. She was disheartened that it happened since it indicated his symptoms were progressing.
Franklin says, “She explained, ‘It’s happening more often, and you’re not converting as quickly, so we’ll need to do an ablation if you consent.'”
Franklin received computed tomography (CT) imaging on May 31, at WakeMed Imaging – Garner and was scheduled for his ablation the following day, Thursday, June 1. The two-and-a-half-hour procedure, led by Complex Arrhythmia specialist Kevin Manocha, MD, was done at the WakeMed Heart Center. Franklin was discharged the same day.
Dr. Manocha explains, “Mr. Landers has symptomatic AFib episodes causing fatigue, palpitations and shortness of breath. Options for treatment include medications, pacemaker installation and ablation. Mr. Landers is relatively young and healthy with sleep apnea and a slow heart rate. This latter condition prevents us from giving him certain medications. Furthermore, since he is still young, he prefers not to be on long-term medications to suppress his AFib.
“As such, his options prior to surgery were ablation or a pacemaker. He chose ablation to minimize long-term medications and improve his symptoms. The AFib Center was important in identifying him early, getting him in to meet with one of our advanced practice providers to address underlying causes and risk factors and connecting him with our sleep medicine colleagues. Now that we have done his ablation successfully, we only need to optimize his risk factors for long-term suppression of his AFib.”
A Return to Normal
Today, Franklin is back at work as a WakeMed pharmacist, but he is taking it easy for a bit. He looks forward to camping, sailing and playing tennis and softball with his daughters and friends once he recovers fully.
He also continues to see WakeMed primary care provider, Ioanna Kessler, DO, FACOFP, who has provided him referrals for specialized ailments identified during his various tests. She also runs regular labs to ensure his levels are in the safe zone. Of particular importance, she supports his mental health since he has quite a bit of stress as the primary caregiver for his aging parents.
Dr. Kessler states, “Patients should feel comfortable in their relationships with their primary care provider. They should feel confident seeking care, understanding their diagnosis and knowing their options. It is my job to ensure my patients are educated and have access to needed services. This relationship allows for mutual respect between provider and patient to make decisions that will best benefit and direct the plan of care. I help my patients put all the pieces together and work to ensure they are successful with this care, supporting them along the way to achieve their health goals.”
Reflecting on his experience, Franklin says, “I can’t say enough good things about all the care I have had over all of the different emergency department visits. From physicians, including Dr. Wood and Dr. Manocha, to the advanced practice providers, including Natalie Staples, PA, and Michelle Deans, PA-C, to the nurses, radiology technicians, and everyone else, I have received nothing but the very best care at WakeMed.”
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