DnvrFox

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.

DnvrFox

Did the ablation work?

crosswater

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.

DnvrFox

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.

dharleyd

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

DnvrFox

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.

crosswater

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.

crosswater

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.

DnvrFox

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?

crosswater

"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. 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?

DnvrFox

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.

crosswater

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.

cbhungry

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. https://www.drugdevelopment-technolog...ojects/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.

DnvrFox

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?

cbhungry

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.

DnvrFox

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.

cbhungry

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.

DnvrFox

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!

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

DnvrFox

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!

Bop Bop

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.

DnvrFox

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.

cbhungry

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

DnvrFox

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!

Bop Bop

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!

DnvrFox

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.


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.