Saturday, February 16, 2019

matters of the heart and other things


I got a phone call from the cardiologist RNP's office Wednesday morning, they had my referral and I could come back in that day if I wanted. I wanted. I finished my interview with the assistant, told her I was currently having an episode (which started up on my way to the office), she hurried me into the EKG room and finally! got it recorded. The RNC came in with the printout, sat down, looked at me and said I was in atrial fibrillation (heart rate 125 with normal being 60 - 100) and she wanted me to go immediately to the emergency room after she started me on a blood thinner for a chemical ablation (intravenous) in order to stop it immediately since oral medication would take too long. Whoa nellie! Not exactly what I wanted to hear. I balked. I really don't want to go to the ER and I really don't want to go on blood thinners. The blood thinner, she explained, was because when a heart is in afib, blood pools in the upper chamber, and gets gooey I guess, and could throw a clot and cause a stroke. Hmmm. I still didn't want to go to the ER (expensive and because SOP is 'cover your ass' they would want to admit me and run every test they could think of, also expensive even with insurance, and I would be there for days if not a week) but I agreed to go on the blood thinner while we discussed meds and other more invasive procedures that might be done if it couldn't be controlled with meds. I told her I was confident that the current episode would pass soon enough because that was the pattern of the last three months and that I would prefer to start with the least invasive approach which was the oral beta blocker combined with the blood thinner but that if two or three hours from then I was still in afib, I would go to the ER (said mostly to ease her mind). I left with a sample packet of blood thinner while she called in the scrip for the beta blocker and, as I expected, the episode passed soon enough. So now I'm on two new meds and I go back to see her next Thursday. So far, so good.

Last Thursday was Garden Club meeting day and Estate Sale day where I found this iguana 


so I was gone most of the day though in between I did get the rest of the roses pruned back as well as the ground spreading lantana and the water sprouts off one of the crepe myrtles while Marc mowed over at the shop.

Foggy and overcast and drippy yesterday morning, and this morning, which has been the norm lately but cleared up and finished trimming around the crepe myrtles. My poor raised garden beds are a disaster 


so I worked over there most the day yesterday 


and plan to again today once it clears up and if it's not too wet from the current foggy drizzle.





26 comments:

  1. Well now that's alarming! I mean the iguana (primordial freakiness!), but also your heart situation. I hope the new meds get it under control!

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    1. they aren't nearly as scary as the ones I was having before and after the Hawai'i trip.

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  2. Oh, Ellen. Dammit. I did not want to hear that news about your heart but I am SO glad that you got it recorded and have meds. Be watchful and be wary.

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    1. yeah, bummer. not what I wanted to hear either but I am addressing it and it seems many people live fine with afib. baby steps. they haven't completely stopped yet but it's only been a few days. and it wss only usually one episode a day for a few hours or less.

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  3. Not something to play with heart stuff. I have had a clot and it is even more scary.i have taken blood thinners for years, but go in on a regular basis for checkups.None of my siblings made it out of their 50's because of heart.

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    1. both parents died from stroke or TIAs so I'm definitely interested in getting it regulated.

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  4. Wow, you got there at the right time! Well done and here is hoping for the best! How about a 24hr ECG? Just to be on the safe side?

    I take one teeny beta blocker every morning and have no side effects to report other than that fervent wish that I don't want to go back to the intensive cardiology ever again.

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    1. no, my sister, who had a heart attack at 50, tells me I won't like it. I don't think a longer EKG is necessary since I know when they are happening. and I don't think a longer recording would tell them anything more than the short one.

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  5. It can be a relief to know exactly what the medical issue is and make one's decisions based on that knowledge. I take your approach with medical issues, especially after reading Being Mortal, by Atul Gawande, at the suggestion of a good friend who found the freedom to decide for herself how she wanted to live fully with her medical diagnosis.

    Working in your garden is good medicine.

    I am sure she would join me in saying with you, so far so good! She would also say that love is good medicine. Sending love to you. Why not?

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    1. thanks am. my father was a doctor, a pathologist, but still he was a part of the medical community and I got a healthy dose of skepticism about it from him. plus I know my body way better than a doctor I've only seen once. I've had two minor episodes since being on the meds but it's early days still and with the blood thinner and the beta blocker I'm not completely unprotected.

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  6. I like your approach. I think it far better to come to a good understanding and resolution with one practitioner than to wrangle it out with an anonymous ER team that you won't see again. Not the same ones, that is. When you and the RNC have a good understanding, start paying attention to the afib drugs. They all come at it from a different direction. Calcium channel blockers, ACE inhibitors, BETA blockers, bla bla bla. They all have different side affects. Don't put up with anything you don't like; don't be afraid to switch to another drug that does essentially the same job. End of my two cents. Good job getting a shovel up on the raised beds. And it's still February.

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    1. I agree about being at the mercy of unknown hospital staff and when I asked her if I should let her know if I was headed to the ER, she said I could if I wanted, that doctors didn't really follow their patients to the hospital anymore, not have hospital privileges anymore I guess she meant, and that if you get admitted, the hospital staff takes over. I'm unfamiliar with the type of meds besides beta blockers so I guess I'll have to read up on them but so far no side effects but I'm on a low dose, half what my sister takes. they haven't stopped completely so far but seem to be fewer.

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  7. I like that you made an informed decision about your own health and I hope everything goes well. Afib is nothing to fool around with (my husband has had episodes), but I am sure your doctor will give you the best advice. Decisions, though, should never be based on the financial aspect of treatment. If you “need” more intervention, you should not hesitate to get it.

    You did a terrific job on the raised bed. I can’t wait to start my spring outside cleaning.

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    1. I am not awed by doctors and I knew what was going on before it got diagnosed and had read up on it and I also had the knowledge of my personal experience. to the RNP it seemed like something that needed to be stopped immediately while I knew that it would subside in an hour or so. and only rarely has it made me feel bad. if it starts up severe and continues for longer than 6-8 hours I'll definitely get more immediate care regardless of cost.

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  8. I just looked at this coming week's forecast, and I think you can cross garden work off your list. I like your approach to the medical issues, too. As long as you were willing to go to the ER if things didn't settle down, there was no reason NOT to give them a chance to settle down. And they did, just as you said. The truth is, we know ourselves pretty darned well -- at least some of us do, and you clearly know yourself.

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    1. it finally cleared up late Sunday afternoon and I managed to get the one finished and started on a second but yeah, I have one more day according to the forecast and then from Tuesday on...forgeddaboutit. my dad was a doctor and I grew up with a healthy dose of skepticism towards doctors and the medical community. plus I knew what was going on before it was finally diagnosed and had already read quite a bit about the condition. I knew my episodes weren't severe and they were short lived. but you need presence of mind and self confidence in knowing yourself when faced with the mythos of doctors.

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  9. Damn, my long comment disappeared.
    Ellen, I have had AF for years. It seems to come out of nothing but I now know that there are triggers: a sudden rush of adrenaline (anger, happiness, laughter, (yes, the helpless kind of laughter), harder work without a break, like gardening. I take beta blockers and blood thinners and have regular blood test about the consistency of my blood. I don’t go to the doctor now unless the episode last for more than 12 hours (I’ve had 24 hours in the past) or I have chest pain, then I must go immediately.
    I now watch myself a bit and the episodes have been short (3-4 hours) and infrequent. Infections can also cause them, even a heavy cold.

    I am not giving advice here, that’s for your practitioners to do, but if you can afford it, take the blood thinners and the beta blockers; at least you won’t have to worry about strokes or heart attacks.

    Living with AF is not that difficult, I am not even so very afraid as I was early on. Just watch yourself and you’ll get the hang of it.

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    1. I remember when it first started happening to you. and yeah, it comes out of nowhere. I haven't noticed any triggers. if I'm having one and some sort of adrenaline producing emotion happens it will get worse sometimes but other times not. I was ranting and raving on Friday with nary a blip. mine seem to last a couple of hours or less and usually only one episode a day and some days none. this is the pattern that's been going on for about 3 months and it seemed to start up out of nowhere as life is good. I am taking the blood thinner and the beta blocker. I'm not sure how much the Eliquis is going to cost til I talk to my insurance but just a cursory investigation, it's pretty pricey. right now I'm taking samples from the RNP. thanks for your perspective!

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  10. I'm glad you finally got the appointment and your episode was perfectly timed;) I know someone who for years has been on meds for just what you described. She hasn't had surgery, just the medication. Occasionally she needs an IV if an episode goes on for too long. You will know what you need.

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    1. I knew what it was before it got diagnosed and had read up on it so I wasn't too worried. none of my episodes have lasted more than a couple of hours and now I'm on meds so hopefully the occurrences will diminish.

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  11. What the heck is "chemical ablation?" I've been ablated twice, once with the RF catheter and the second time with cryoablation. Ablate means to burn (except when they're freezing.) You're right, the ER is about the worst place to go. In my limited experience they don't know much about it, and will want to bring out the big guns. I will offer an unrequested advice: If the AF persists and gets worse, you really need a cardiac electro-physiologist and not just a regular cardiologist. Learned that one the hard way.

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    1. especially the ER in this or the next small town. she was referring to an IV beta blocker as she felt the oral med would not act fast enough. although she did talk about the RF catheter but I don't think that's what she was sending me to the ER for, that would be the next step if it couldn't be controlled with drugs. I'll keep in mind your advice about the kind of cardiologist to go to.

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  12. Oh dear. I am glad the meds seem to be helping, but please stay on top of this. We came through our own heart odyssey over here. Maybe instead of the ER go and see a heart specialist for a second opinion? Be well, my friend.

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  13. I agree with your approach. I have a-fib, but only take the beta blocker. I was in the hospital for 4 miserable days while they did every test known to man and I ended up with a $40,000 hospital bill (my part). It was outrageous, since my insurance did not want to cover it because the ER and hospital the ambulance took me to was not in my "network". The poor EMT's were anxious to get me out of their care, as they were convinced I was having a heart attack and they were not able to get an IV started. I fought, I won and I only paid 10% of that. In also told my cardiologist that I was interested in trying any new drugs, just give me the tried and true old ones. I was very fatigued at first, but after my body got used to the drug, I got my energy back …. well, most of it! I will be thinking of you now very time I swallow that pill and hoping you continue to do well!

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I opened my big mouth, now it's your turn.