Fifty Plus (50+) - Harrowing Experience - Update On Palpitations

Some of you may have been following my palpitations experiences in the traiing and nutrition forum.

In summary, I have been having continuous palpitations, and have sent two separate Fax's to my supposed kAISER doc fully describing them - and they were continuous, with heart rate up to 155, and a very irregular heart rhythm. Then I talked with the doc on the phone, who said she saw "nothing remarkable" in what my heart was doing!!!

So, I received two posts on BFN a couple of days ago from folks in the medical field, strongly urging me to see someone about this problem. I got in yesterday pm with another doc at the Kaiser Clinc. In about 10 minutes he had ordered an ambulance, and in short order I was headed to the hospital.

It turns out I have been having continuous atrial fibrillation for 30+ days, which sort of means that the ventricles and atria aren't comminucating too well, and the atria is totally aflutter about this whole lack of communication. One way of looking at it is that I have been operating on 1/2 a heart (my words, not the docs). The two portions of the heart are out of sync.

What sort if amazed them is that I have been doing 20 and 25 mile bike rides, with no chest complaints, shortness of breath or any other symptoms except I just have not had quite the energy level I have had, and I noticed I was getting passed a little more than usual.

The danger here is that, since the atria is not pushing the blood out properly, the blood stagnates in certain portions of the atria and can clot. If my heart starts pumping real efficiently all of a sudden, and gets in sync, then blood clots can be pushed out into my brain (meaning stroke).

So, I am on blood thinners (warfarin and heparin initially), and a beta blocker to slow down my heart. Even with marked dosages of beta blocker, my heart is still beating at 120 bpm. I will go in for an EKG next week to see, but my heart already feels better in my chest. In about 3 weeks, I will likely get a "cardioversion (sp)" where they put me to sleep and shock the heart to get it back in rhythm. If this works (about 95% initial success rate and then 50% after a year) I can go off of the warfarin.

If not, I will be on the warfarin the rest of my life, or until there is another medical miracle cure.

The night in the CCU in the hospital was absolute heck! I didn't get out of the emergency room until 9:00 pm, then had to get something to eat and get hooked up to machines, and try to settle down. I asked for, and got, a sleeping pill and took it, but it didn't help. only made me groggy today.

People come and go in and out of your room constantly, and about 1:00 pm, another patient arrived, with obvious signs of heart distress - radiating pain, pressure, etc. They contiuously worked on him with nitroglycerin and other stuff, and finally transferred him to the coronary ICU unit in the morning. I slept about 1 hour from 4-5 am.

The good news is that the ticker, besides the electrical disturbances, is in great shape. No signs of coronary artery disease or anything like tha.

I need to lose weight, and I guess this is the final motivation to do that, but that was not the prime cause. In fact, they do not know the prime cause! May be hypertension or just getting older or genetic????

Anyway, I am switching Primary Care Doctors. By chance I had the copies of the faxes we had sent to my PCP about my condition, and you could see the looks of amazement on the other MD's that nothing had been done by my primary PCP!

My release says "physical activity as tolerated" so I can't wait to get a ride in soon.

Anyway, thanks to those folks who wrote telling me to get things checked out!

Darn you work so hard ot stay in shape, eat right, don't smoke, etc., amd you get caught by something like this.

The cardiologist stated:

"Think of this as only a minor annoyance, not as a major problem!"

Amen!

Welcome to the world of HMO's!!! And people wonder why patients want to sue their HMO's.

Hope you get better fast. Here's to your first ride back!!!

Welcome to the world of HMO's!!! And people wonder why patients want to sue their HMO's.

Hope you get better fast. Here's to your first ride back!!!

I firmly believe that not being able to sue a HMO makes a REAL negative difference in the standard of care.

Dnvr,

Whoa, missed all that in the T&N forum (where I haven't been in a while).
Glad you're doing ok, and that someone finally took notice of the abnormal
EKG.
Arrythmias in and of themselves are not major (when compared to say an infarction)
I would venture to say that your overall cardiac health (due to biking?) played
a major roll in this not being a major event.
Again, glad you are doing well, hang in there and you'll be climbing
passes out of denver soon enough.

Marty

Dnvr,

Whoa, missed all that in the T&N forum (where I haven't been in a while).
Glad you're doing ok, and that someone finally took notice of the abnormal
EKG.
Arrythmias in and of themselves are not major (when compared to say an infarction)
I would venture to say that your overall cardiac health (due to biking?) played
a major roll in this not being a major event.
Again, glad you are doing well, hang in there and you'll be climbing
passes out of denver soon enough.

Marty

The major concern I have is the long-term use of the cumadin and the beta blocker. You can easily bleed to death with the blood anti coagulant if you are injured, particularly an internal head injury can be critical.

Just don't know enough yet to be sure about anything!

Dnvr,


Arrythmias in and of themselves are not major (when compared to say an infarction)
I would venture to say that your overall cardiac health (due to biking?) played
a major roll in this not being a major event.


I'm not trying to be argumentative, but this statement just isn't true. There are many different heart rhythms, some dangerous, some not so. Ventricular tachycardia, 2nd and 3rd degree heart block, ventricular fibrillation, asystole are all examples of rhythms that can be lethal. That being said, I have patients that I see that have been in atrial fibrillation for 30 years and live completely normal, active lives.

Dnvr, I'm glad to see everything is working out for you and best of luck with the cardioversion. I wouldn't be too worried about being on the extra meds. I see 1000's of patients every year who are on beta blockers. Although you can have side effects to just about any med, most do not have problems with them. Maybe just a little fatigue. Feel free to PM me.

Hang in there, DF!

I have some small insight into what you're going through. About 6-7 years ago, I was doing a lot of cardio stuff, in particular a lot on the stair climber. I felt good, but once in a while I got some palpitations where I got that "flutter" going. It probably wasn't a big deal, but the more you start thinking about how vulnerable you are and how your heart has been beating for decades... well, it just starts to cause more anxiety which in turn aggravates the situation. Although my situation was not as severe as yours, I got the same response from the medical establishment - as though I were wasting their time. In my case, because it was intermittent, it would be fine at the doctor's office, then driving home... (the broken TV syndrome). It settled down eventually after a year or two (knock on wood), but "harrowing" wasn't a strong enough word.

Good luck and try to relax!

-Jim

They should have put you on a Holter monitor, to record 24 hours.

In my case, it is there constantly - I mean ALL THE TIME.

Thanks for your input.

The heart rate has slowed today.

Hlweyl

I probably misspoke when I said arrythmias, I should have been more
specific and said Atrial arrythmias.
That said, I'm not a physician, cardiologist and I don't play one on television.
I didn't even stay at holiday in last night. . . .

Marty

No problem lotek. I thought you might have even meant sinus arrhythmias which are quite common. I knew you were trying to give sound advice and I hope that people venturing to forums to try and find their diagnosis take all the advice with a grain of salt.

There is no substitute for seeing a good physician.

There are plenty of readily available effective nonprescription blood thinners, including garlic and aspirin.

I pay extra health insurance premiums to be on a PPO, which gives me direct access to any G.P. or specialist I choose, without some bloody gatekeeper intervening. Don't get me started on HMOs, as I detest and reject the entire paternalistic premise on which they are based.

I'm glad you're feeling better now. I'll keep you in my thoughts. Sometimes I think the best we can hope for as we get older is that whatever parts of us break can be fixed so we can, in effect, continue our lives with the help of the pharmacalogical and surgical equivalents of baling wire and duct tape.

I don't undersrand all the jargon Denver but I can understand that you may have a heart prob. glad you are feeling better & hope its nothing serious
all the best with it anyway .

There are plenty of readily available effective nonprescription blood thinners, including garlic and aspirin.

I pay extra health insurance premiums to be on a PPO, which gives me direct access to any G.P. or specialist I choose, without some bloody gatekeeper intervening. Don't get me started on HMOs, as I detest and reject the entire paternalistic premise on which they are based.

As you approach medicare, choices get markedly limited!

Hang in there Dnvrfox. Listen to the doc (find one that will listen to YOU). It's hard to keep a good rider down.

'bent Brian

Have officially changed my Doc. Took a fax to the president of Kaiser, but I got it done.

Am now on Warfarin (rat poison, literally) therapy - which means if I have a crash and have internal head bleeding I am literally done for, as the bleeding in the head will not coagulate!

Must be very careful where I ride, and wear that helmet!

I sincerely Wish You Well DF. Hang in there. (I know I don't have to say that, I KNOW you will!!)

Any chance you were taking VIOXX?
Hockey

Any chance you were taking VIOXX?
Hockey

no

Dnvr,

Two things:

1. Thank the politians for not being able to sue your HMO. The HMO put so much pressure on Congress, they just buckled. The HMO's say they can not provide care or compete if people can sue. Of course the fact they keep denying life sustaining procedures and improper care all in the name of the buck has nothing to do with it.

2. Since you are riding while using Cumidin you show have some sort of a medical ID alert on your wrist or some other very visible place. If you should require emergency medical care and can not respond to the EMT's questions, you will be long gone before they figure out why they can not stop the bleeding. Without a blood test, which they will not be able to do on the road there is no other way for them to know your on Cumidin!!! Even if you have to make one up or pin a tag to your bike riding outfit you should not be riding without it.

Dnvr,

2. Since you are riding while using Cumidin you show have some sort of a medical ID alert on your wrist or some other very visible place. If you should require emergency medical care and can not respond to the EMT's questions, you will be long gone before they figure out why they can not stop the bleeding. Without a blood test, which they will not be able to do on the road there is no other way for them to know your on Cumidin!!! Even if you have to make one up or pin a tag to your bike riding outfit you should not be riding without it.

I now carry a Medical Alert card in my wallet, which I have with me at all times, even riding. If the cardioversion does not work, and I need to remain on Cumidin, I have the information to get a formal MedicAlert bracelet and will implement that procedure. The cardioversion is scheduled in 3 weeks or so.

Thanks for the reminder.

I HAVE gotten a couple of nice bike rides in, and many long walks.

Today -

2.5 mile walk,

Also, did an hour at the gym - bike, elliptical and treadmill.

Fox,

You are more than welcome.

Hope things work well for you and you get off Cumidin ASAP. Do not forget about the monthly Cumidin Level Monitoring Blood Tests. They are very important, especially in the being to establish the correct levels.

Fox,

You are more than welcome.

Hope things work well for you and you get off Cumidin ASAP. Do not forget about the monthly Cumidin Level Monitoring Blood Tests. They are very important, especially in the being to establish the correct levels.

Kaiser does have a whole "Anti-coagulation" service monitored by pharmacists, which calls me regularly, scheduling appropriate blood tests and adjusting my cumadin dosage.

Then I talked with the doc on the phone, who said she saw "nothing remarkable" in what my heart was doing!!!

That's why they call it practicing medicine.

So, I am on blood thinners (warfarin and heparin initially), and a beta blocker to slow down my heart. Even with marked dosages of beta blocker, my heart is still beating at 120 bpm. I will go in for an EKG next week to see, but my heart already feels better in my chest. In about 3 weeks, I will likely get a "cardioversion (sp)" where they put me to sleep and shock the heart to get it back in rhythm.

If this works (about 95% initial success rate and then 50% after a year) I can go off of the warfarin.

Ha! Your doctors are blowing large puffs of smoke up your posterior about the year. As for the rat poison, you can use other treatments to stop the arrhythmia. None of them are risk free. There is the RF ablation (they run a catheter up your femoral artery(vein?) and burn the electrical connections in the atrium.) There is also other anti arrhythmic medications that if you read the warnings will scare you into rhythm.

If not, I will be on the warfarin the rest of my life, or until there is another medical miracle cure.

There are other meds for thinning the blood that are not as dangerous as warfarin. It nearly killed my father-in-law. He started bleeding on the brain. He only lost a few months out of his life.

The good news is that the ticker, besides the electrical disturbances, is in great shape. No signs of coronary artery disease or anything like tha(t).

It's the riding.

I need to lose weight, and I guess this is the final motivation to do that, but that was not the prime cause. In fact, they do not know the prime cause! May be hypertension or just getting older or genetic????

I go back to the practicing theory.

My release says "physical activity as tolerated" so I can't wait to get a ride in soon.

Do be careful about crashes. I got off the rat poison after three months of a class three anti arrythic med. I had the ablation and the beta blockers. All the beta bolcker did was make me tired. The anti arrhythmic (arrhythmetic - who knows) med is scary in its own right. Thirty percent of the people cannot tolerate it.

Darn you work so hard ot stay in shape, eat right, don't smoke, etc., amd you get caught by something like this.

Stress and alcohol did it to me. Quit the alcohol and still had the problem. Ended up retiring to relieve the stress.

The cardiologist stated:

"Think of this as only a minor annoyance, not as a major problem!"

That's because it's not him with the problem.

As a member of the "Heart Med" club for some 15 years I know what you guys are going through. My problem is not the heart itself but my pressure, which is causing everything to go crazy.

I'm currently on 3 meds as previously stated and have started to notice something. On the days I ride for at least an 1 1/2 hours my pressure drops. Without riding and taking my meds, my pressure at it's best is around 130/90. When I ride and take my meds before I ride, my pressure some two hours or more after the ride is around 115/70. Big difference!!!

I think I'm going to start tracking it so I can talk to the cardiologist about it during my next visit.

Has anyone else noticed this type of drop?

What happens when you ride is a normal physiological response. During exercise you stretch your arteries from the exercise, so your pressure goes down. I think we all experience this. It is normal.

I had the ablation and the beta blockers

Did the ablation work?

Did the ablation work?

The RFA worked for the one type of arrhythmia that I had(a short circuit in the atrium), but not on the other(that mysterious 'unknown' cause). To me, it was a choice of being hit with the paddles every month or so or medication for the rest of my life. I thought I'd give surgery a try. They don't know if it will work until they have gone in. Even then if you have the type that comes and goes and is not a simple short circuit, it may not work. They fixed my short circuit, but not the unknown cause for the rest of the problem. I personally think it has a lot to do with stress.

Keep in mind that there is a 1 in a 100 chance of you checking out from the surgery. Paddles just didn't seem appealing to me on a regular basis. I took the chance (I never have won any lottery drawings either; figured it was a safe bet), but am on a killer drug as long as I can afford it and my body doesn't start rejecting itself because of the drug.

The RFA worked for the one type of arrhythmia that I had

Since this is relatively new to me, I want to try the cardioversion first. I do know some folks for whom it has worked long-term. Perhpas I will be one of the lucky ones.

Not too anxious to have stuff dragged through my heart, unless absolutely necessary.

i also have been in continuous a-fib since early june or before. had the cardioversion sometime in july that only lasted 4 days before it failed. i also have a low resting heart rate, aprox in the lower 40's. before i could take any of the beta blockers i needed a pacemaker to keep the heart rate from going lower. that has helped with the daily fatigue factor off the bike. now there seems to be a high heart rate when riding my bike so the next step in the process is to do an ablation. in 3 weeks i will do the holter monitor agian if it is still the same with high heart rate then they would like to do the ablation. so the question i have has anyone had this done? if so does it bring you back to somewhat normal? what are your feeling on a extended ride ride of 2 hours and more? thanks
dharleyd

Anyone keep Vitamin K around for an emergency?

My blood test showed my INR scale at 7.7 - off the charts again!

Pharmacist consultant wanted to know if I was bleeding anywhere, and said that Vitamin E will not accomplish what the Coumadin does???

I will be skipping the Coumadin for 3 days with another blood test on Monday.

if so does it bring you back to somewhat normal? what are your feeling on a extended ride ride of 2 hours and more? thanks
dharleyd

Normal? I hope not! It worked for me on the intermittent fib. I only ride at 15-18 mph. I feel good after 38 to 50 miles as long as I hydrate and fuel myself. We rode a 55 mile over hill and dale with a heat index of 104.... I only slightly bonked at mile fifty because I did not bring enough gu along.

Anyone keep Vitamin K around for an emergency?

My blood test showed my INR scale at 7.7 - off the charts again!

Pharmacist consultant wanted to know if I was bleeding anywhere, and said that Vitamin E will not accomplish what the Coumadin does???

I will be skipping the Coumadin for 3 days with another blood test on Monday.

Eat more greens! Didn't they tell you not to change your eating habits. If you don't eat green leafy veggies, you need to tell them.

Eat more greens! Didn't they tell you not to change your eating habits. If you don't eat green leafy veggies, you need to tell them.

Right now, we are still trying to get the dosage for the coumadin adjusted to my body and diet. They told me to eat my normal diet, which I am doing, and not to change my eating habits, which I haven't.

I fail to see your point.

I am doing as they ask as far as eating. The worst thing would be to eat a whole lor more greens than usual, and get a false "reading" for my coumadin dosage.

First you tell me to 1."eat more greens" and then you say 2. "Didn't they tell you not to change your eating habits."

Which is it, I can't do both?

And I still pose my question about the Vitamin K. I asked the pharmacist what the medical folks would do if I was bleeding and it wouldn't stop, and she replied that first they would give me Vitamin K - 2.5 mg orally (assuming I could take it orally) and then another 2.5 mg orally. If I was unconscious, they would give me injectable along with a whole blood transfusion.

So, do any of you keep Vitamin K with you in case the emergency medical personnel can't get to you?

"First you tell me to 1."eat more greens" and then you say 2. "Didn't they tell you not to change your eating habits."

Which is it, I can't do both?"

My apologies. Vitamin K is in leafy green veggies. The first was a poor attempt at humor. If you are bleeding internally/externally I would suggest a rapid trip to the Emergency room. Vitamin K doesn't get absorbed that fast. My understanding of how the stuff works is limited. I am not a doctor or a pharmacist. I did play one on stage one time, though. :rolleyes: I have also stayed at a Holiday Inn. ;)

I'm sure your rat poison lab has given you all the advice you should have on the dosage and diet. Don't try to second guess them with advice from a bunch of people who ride bikes and may or may not have credentials to give advice. If you have questions like this, ask the doctors. They 'should' have the answers, but as you know from a few of my earlier posts; that's why they call it practicing medicine. We don't even practice, so how good do you think we are?

Yes, I am aware of K in leafy green veggies.

I was asking in case I could not get to an emergency room. There are some big wide open spaces around here. Sometimes 100 - 200 miles between emergency rooms. When we go to CA through western CO and Utah, there just are NO emergency rooms to be found.

So, I was interested "just in case."

Thanks.

Yes, I am aware of K in leafy green veggies.

I was asking in case I could not get to an emergency room. There are some big wide open spaces around here. Sometimes 100 - 200 miles between emergency rooms. When we go to CA through western CO and Utah, there just are NO emergency rooms to be found.

So, I was interested "just in case."

Thanks.

Ah! then this may answer your question... From www.drug.com: "Vitamin K promotes the hepatic formation of active prothrombin (factor II), proconvertin (factor VII), plasma thromboplastin component or Christmas factor (factor IX), and Stuart factor (factor X) {01** {02** {04** {05** {06** , which are required for normal blood clotting. Vitamin K is an essential cofactor for a hepatic microsomal enzyme that catalyzes the post-translational carboxylation of multiple, specific, peptide-bound glutamic acid residues in inactive hepatic precursor proteins of factors II, VII, IX, and X. The resulting gamma-carboxyglutamic acid residues convert the precursor proteins to active coagulation factors that subsequently are secreted by liver cells into the blood. {01**

In healthy individuals, supplemental vitamin K is virtually devoid of pharmacodynamic activity. However, in the presence of vitamin K deficiency, or in the presence of coumarin- or indanedione-derivative anticoagulants, the pharmacologic activity of vitamin K is related to its normal physiological function, which is to promote the hepatic formation of vitamin K-dependent clotting factors {01** .

Vitamin K does not return abnormal platelet function to normal. Vitamin K does not counteract the anticoagulant activity of heparin. "

In other words, don't stress the envelope of the protoplasm enough to cause leakage in the afore mentioned areas that does not have the any medical facilities.
:rolleyes:

Came onto to this late.

First of all, atrial fibrillation confers a five fold increase in risk of stroke and studies with other blood thinners, including asprin, just don't hold up when compared to the efficacy of coumadin. With that said, it is a difficult and dangerous drug and must be monitored carefully on a monthly basis and is affected by vit k rich foods. However, should you have to stay on a blood thinner (if the cardioversion does not work) there is another alternative that has been out in europe for a long time and is making its way here. http://www.drugdevelopment-technology.com/projects/exanta/

Exanta does not need the monthly monitoring and is not affected by vit k rich foods. Thus, it is not prone to flucuations that are inherent to a drug such as coumadin since it is a direct thrombin inhibitor. It has been well studied in atrial fibrillation and stroke prevention.

As for catheter ablation of atrial fibrialltion, it is stilll in the investigational phase. It is only reserved for those patients who have failed cardioversion and rate control with drugs (high rate atrial fibrilllation where the heart rate is left to tick along at a very fast rate can lead to atrial fibrillation cardiomyopathy). In addition, unlike av nodal rentrant tachycardia or wolf parkinson white syndrome and other arrythmias, in atrial fibrillation it is hard to map out the focus or origin of the abnormal electrical signals. I think the clinical trials out there have ablated the pulmonary vein (felt to be the source of much of the focus of atrial fibrillation) and or ablated the av node which still requireds a person to be on a blood thinner (only helps with rate control) and the subsequent need for a pacemaker.

Let's hope the cardioversion works. If not, I know quite a few active patients with atrial fibrillation on coumadin.

Thanks so much for your input!

It is very helpful.

My INR rating yesterday was finally in the 2-3 range at 2.6. Hopefully, I will be able to experience the electro cardioversion soon.

What do you think of the drugs that are also supposed to provide cardioversion?

I have seen people cardiovert with the medicines who did not respond to the electrical cardioversion but I am not sure of the perecentage success rate, it differs among the different agents used, so I may not be very helpful there.

By the way, with regards to carrying around vit k to reverse the coumadin in case of an emergency,it is not really that helpful. Oral replacement takes a few days to work and even injected vit k can take up to a day to work, so if you are bleeding out somewhere, the ER or doc will give fresh frozen plasma which reverses it instantaneously.

By the way, with regards to carrying around vit k to reverse the coumadin in case of an emergency,it is not really that helpful. Oral replacement takes a few days to work and even injected vit k can take up to a day to work, so if you are bleeding out somewhere, the ER or doc will give fresh frozen plasma which reverses it instantaneously.

Thanks.

Unfortunately, I do go places where the ER doc may be a couple of hours away. I guess that is a risk of living.

I truly appreciate your input.

Searching the web, you come across all sort of weird responses when it comes to AFib - and any other medical topics, for that matter.

There is an entire group of AFib'ers who have had all their mercury amalgam fillings removed in order to reverse AFib!

There are others into herbal remedies, and a whole bunch of other stuff.

By the way, any comment on the usage of magnesium? Another group out there claims success with magnesium.

It is most difficult to even talk with the cardiologists and the internists - we received absolutely contradictory advice from two different internists in the hospital on two different days. First one said - "try the cardioversion." Second said "don't" - the AFFIRM study says you do better without CV."

What is a patient to do?

Cardiologist (whom we had to specially request, even though we were on the cardio ward) said to give it a try.

First of all, if a healthy active person has a choice between being on lifetime blood thinners and a chance to cardiovert to sinus rythem and stay off, I would go for it.

The cardiologist is right.

As the for the Affirm trial it has nothing to do with your situation. It studied elderly, over age 69, men with afib and looked to see if rate control vs rhythm control was superior over the other in terms of survival. It found there was no survival benefit of rhythm control over just controlling the rate when comparing two different arms: one group on rate control with beta blockers etc and those on antiarrythmic medicines. There was no seperate arm for those undergoing successful cardioversion and I believe these people were excluded from the study. That is the only conclusion that can be drawn from that study.

First of all, if a healthy active person has a choice between being on lifetime blood thinners and a chance to cardiovert to sinus rythem and stay off, I would go for it.

The cardiologist is right.

As the for the Affirm trial it has nothing to do with your situation. It studied elderly, over age 69, men with afib and looked to see if rate control vs rhythm control was superior over the other in terms of survival. It found there was no survival benefit of rhythm control over just controlling the rate when comparing two different arms: one group on rate control with beta blockers etc and those on antiarrythmic medicines. There was no seperate arm for those undergoing successful cardioversion and I believe these people were excluded from the study. That is the only conclusion that can be drawn from that study.

I have Kaiser Permanente, and am trying to make an appointment to see the cardiologist to review things with me.

It is like trying to make an appointment with God, although I am sure God is more readily available.

Right now, we have been turned down for an appointment and are awaiting a return call from the "nurse."

Their philosophy is that an internist should be able to fully manage the atrial fibrillation.

Incidentally, I am 65 - almost to 69! :D

Again, thanks for your thoughts. It is more than I have gotten from Kaiser.

I have Kaiser Permanente, and am trying to make an appointment to see the cardiologist to review things with me.

It is like trying to make an appointment with God, although I am sure God is more readily available.

Right now, we have been turned down for an appointment and are awaiting a return call from the "nurse."



Kaiser refused to make an appointment with a cardiologist with me, so today we took the steps necessary to unbind ourselves from Kaiser Permanente and go on another major medical plan as of 11/1/2004. Have already made an appointment with a real (non Kaiser) cardiologist, wasn't hard at all!

KP, is the largest of the HMO and is supposedly the role model for many of the HMO's out there.

While HMO's have there place in todays medical world, as far as I am concerned that place is far down the list of choices. I do not want my medical care decided by business people looking at their bottom line, rather than medical issues.

If you can find an affordable Fee for Service Plan go for it, if not a good PPO should do.

KP, is the largest of the HMO and is supposedly the role model for many of the HMO's out there.

While HMO's have there place in todays medical world, as far as I am concerned that place is far down the list of choices. I do not want my medical care decided by business people looking at their bottom line, rather than medical issues.

If you can find an affordable Fee for Service Plan go for it, if not a good PPO should do.

The greatest thing KP has is a well-paid publicity department.

Our choices on medicare (for which I am eligible 11/1/2004) are quite limited, but we think we have found a better plan. We did private pay yesterday to meet a PCP, and discussed with him if he can easily attain referrals to cardios and the like. He, and the insurance clerk, said they have no problem with that.

The comprehensive FFS Medicare suplement plans are so prohibitively costly that it is out of our range.

Wish we did have freedom of choice, but it just doesn't happen with medicare, unless you want the very limited coverage under the basic medicare coverage. And, a whole bunch of MD's refuse medicare patients under the basic plan. We still have to pay $329 per month in addition to the medicare contribution, but it does provide full coverage for drugs, therapy, lab, hospitalization, etc.

There is a tremendous choice of MD's, hospitals and specialists under the plan we have chosen.

Many of the cheap medicare supplements do NOT provide good drug coverage, etc., which we need.

Thanks for your input.

keep me updated on what he or she decides to do! I am very curious

keep me updated on what he or she decides to do! I am very curious

Well, I had a long talk with the intake clerk yesterday, and it appears as if things are headed towards a CV. Of course, have to wait until I am seen, but CV is certanly in their repertoire!

Fox,

Needless to say your health is fact number 1!!! You are correct, the market open to people 65 and over is very limited. If the numbers are doable than the plan you selected sounds great. See if there is an option will let you increase your Co-pays and/or Deductibles for a lower Premium. Depending on the increases and premium cuts it may be worth it.

Also, with Rx's are there any kinds of Caps (Annual Max's, Lifetime Max's, etc)? Heart meds are not cheap and you can eat into a $1,000 or so Annual Cap (which is not uncommon in Medicare Supplement and/or replacement Plans) very quickly. Also, see if you can get your Rx's through a Maintance Plan (usually a Mail Order option, where you can order multiple months (usually up to 90 days) for less than what 3 months would cost you at the Pharmacy. Some plans even have it through a Pharmacy. Check if Rx's have multiple Co-pays (usually 2 or 3 tiers, 1 for Brand Names, 1 for Single Source (meds with no Generic subsitute) and 1 for Generics). If yes, check with the Doc to see where your meds fit and if there is a Generic for each Rx.

Hey, 30 years of dealing Employee Benefits (Life, Health, RX, etc) has to pay off at some point!

Fox,

Needless to say your health is fact number 1!!! You are correct, the market open to people 65 and over is very limited. If the numbers are doable than the plan you selected sounds great. See if there is an option will let you increase your Co-pays and/or Deductibles for a lower Premium. Depending on the increases and premium cuts it may be worth it.

Sorry, there are not any different options available under this plan. I am a bit limited, because my retirement pays for a portion of the cost of the plan, and they only offer a limited selection of plans for medicare retirees.



Also, with Rx's are there any kinds of Caps (Annual Max's, Lifetime Max's, etc)? Heart meds are not cheap and you can eat into a $1,000 or so Annual Cap (which is not uncommon in Medicare Supplement and/or replacement Plans) very quickly. Also, see if you can get your Rx's through a Maintance Plan (usually a Mail Order option, where you can order multiple months (usually up to 90 days) for less than what 3 months would cost you at the Pharmacy. Some plans even have it through a Pharmacy. Check if Rx's have multiple Co-pays (usually 2 or 3 tiers, 1 for Brand Names, 1 for Single Source (meds with no Generic subsitute) and 1 for Generics). If yes, check with the Doc to see where your meds fit and if there is a Generic for each Rx.



The RX's have no cap, either annual or lifetime, which is one of the reasons we selected it.

Yes, there are 3 levels of copay, as you describe.

My problem right now is that I am switching medications regularly, and until I see if the cardioversion works, I may be doing that - even IF the CV works, I may be trying new meds to see what is best. Therefore, it makes no sense to get a 90 day mail-order supply right now, but it is available when things, hopefully, settle down.

I also have a number of years of experience selling and analyzing mm plans.