I’m on coumadin, aspirin and plavix. I bruise if you look at me. Haven’t worn shorts this year beause the bruises on my legs are so heinous. I get an INR/PTT once a month. The docs told me that I can at vitamin K-rich foods, but I just need to be consistent from day to day in the amount I consume.
I have a combo defib/pacer, but it’s just set to defib at this point.
DH has a CPAP (diabetes, mild HBP). He had severe sleep apnea with scary numbers. They are better now, but I expect down the road that he will have issues because he just doesn’t take care of himself.
@dstark–I know, but I think it helps me parse through stuff he probably knows already, and as a story-teller myself, I learn best through other people’s stories. Plus, as someone said above, docs are not always the best patients!
Garland, I learned a couple of years ago that I am constantly in a-fib – discovered during a doctor’s visit, I was and am never aware of it. Wore a halter monitor for a bit to track it – perhaps your H will do that . The shock treatment did not work for me, but I am under control using meds. Had it not gotten under control via meds a pacemaker would have been considered. I was on coumadin and then my doc shifted me to Pradaxa. Frankly, I am cynical and wonder of the drug companies are pushing docs to switch to these newer meds. One issue with the newer blood thinners is that there is apparently no immediate reversal medication, as there is for coumadin. Of course your H must be on top of this, but that potentially serious concern seems to me to outweigh the inconvenience of frequent blood testing. (Of course, I remain on Pradaxa, as I have not yet made an issue of this concern with my doc.)
My H is on xarelto just temporarily for a DVT incident – freaky, apparently related to a brace he was wearing for an orthopedic issue (was a frequent runner and paid for it with knee and ankle problems), as he is in excellent general health and should have been at very low risk for a DVT. Sometimes the treatment can be the cause of a new problem!
I guess as we are all aging these things are cropping up.
^I think our consensus is he needs to get off the Xeralto–will push this at this next cardiologist appt. More and more, it is looking like scary stuff with that inability to reverse.
Funny that this seems to be so common. My father was diagnosed with A-fib a few years ago. Put on medication - but he didn’t think he needed it. So he didn’t take it. He had a stroke last October - fortunately for him, he’s fine physically. The unfortunate effect is that his short term memory is really badly affected. He’s almost 80, a lawyer who’s still working and used to have an incredible memory - now, he can’t remember what he had for breakfast. It hurts to see him like this…
Cardinal Fang - H’s surgeon mentioned that the endurance athletes he has dealt with have shown up in his office “sicker” because they are further along before showing symptoms. H has been a runner and competitive cyclist all of his adult life. Of course we know the issues now but I wonder if the possibility of all of this would have changed his behavior. I think he would have taken his chances and pursued endurance athletics anyway.
Unfortunately poor H will have to go in for another shot at a repair in the not too distant future…the mesh ring that was put in place two years ago as a support structure for the valve has maintained its integrity but as his heart healed it seems that some scar tissue may have formed or the valve was so bad that it needed more “structure” so, once again, it is not doing the job. He is young enough (early sixties) that all of his doctors are still recommending another shot at a repair over replacement. His doctor is one of the best known mitral valve specialists in the country and has an outstanding success rate. As our MD daughter has said, it is very bad luck and a very sick mitral valve.
The one good thing is that the MAZE worked beautifully. A number of our friends (also runners) with afib but not the deteriorating valve component have had good results with ablation. On New Year’s Eve we were all together and no joke, it seemed like half of the people who had marathoned for decades were talking about their heart issues. Fun times.
Elleneast, my bil had a maze procedure done also. I am so happy it worked for your husband. It’s amazing how far medical technology has come and all the wonderful outcomes people have with them. I had to comment because you don’t meet many people who have had a MAZE.
It was not successful for my bil but he had other problems and it was not a typical outcome.
I am on a beta blocker for hypertension and PSVT. Doctor told me to take the beta blocker before bed because it might cause sleepiness. I take it about an hour before bedtime and it works like a gentle sleeping aid! Love it.
Doctor mentioned ablation when psvt was diagnosed but the beta blocker has been controlling it. The psvt was never too bad to begin with.
@CardinalFang, afib can be continuous or intermittent. I think the intermittent kind is more noticeable because one perceives the change in rhythm. Mine is continuous, and I don’t perceive it at all unless I check my pulse. If the intermittent type is suspected, but doesn’t show up in the doctor’s office, I imagine a patient would wear a Holter monitor for a day to catch the episodes.
That Cleveland Clinic website has lots of good explanatory info.
My mother had intermittent a-fib. When she was 81, on coumadin, she fell and even though her head never struck the ground, it caused a massive brain bleed and the next morning she was unresponsive. They performed a craniotomy and despite the 10-1 odds she survived, with some locomotion issues. After that, they took her off thinners and put her on Pacerone (amiodarone) which is not a thinner but seemed to do the trick. She’s now 91, and they took her off the meds prior to neck surgery this January. They never put her back on meds and she hasn’t had any episodes. My theory is that her heart has just slowed down on it’s own and doesn’t need any pharmaceutical help.
I came down with a-fib 4 years ago - triggered by inflammation from a ruptured appendix. Cardioversion zapped it back into sinus (normal) rhythm on the first try. It stayed that way for four years, and I was eventually weaned off all medications except the beta blocker, which I had already been on anyway for hypertension. Doc thought my a-fib was cured. But I had a 2-day relapse a few months ago - triggered by I don’t know what. It went back to sinus rhythm on it’s own. But for now I’m back on anti-coagulants, in my case Eliquis. And the doc is fiddling with stronger beta blockers. Hopefully the a-fib wll stay gone for at least another 4 years.
The big risk with all the blood thinners, warfarin, Xarelto, Eliquis, and Pradaxa is the risk of serious bleeding. Warfarin may be tried and true but it also carries a very serious bleeding risk. Warfarin is also the one your insurance company will push you to because it’s a lot cheaper.
If the goal is to get off Xarelto, I’d take a look at Eliquis. It has a significantly lower bleeding risk than warfarin with better stroke prevention. Xarelto by contrast has a bleeding risk that’s a little higher than warfarin. Plus, as was mentioned in post #49, they have developed a reversal agent for Eliquis to quickly stop the bleeding, although that is not yet FDA approved and thus not yet available.
Interesting blog. I started one here on this topic a few years ago and only got a few responses - including dstark. I go to both a cardiologist and a electrophysiologist (specialization is arrythmias) at Yale - New Haven. I’ve talked with him so much about this topic that he jokingly says that I know more about afib the 90% of cardiologists. I started having episodes almost 10 years ago and progressed from beta blockers to calcium blockers to sodium blockers. In December 2013, I decided to get an ablation which was scheduled for March 2014 because I was having 8 hour totally incapacitating episodes every couple of days. At this point I was taking metoprolol, diltiazem and when needed propafenone. My doctor suggested also taking flecanide in place of propafenone, but twice daily. I didn’t have another episode until last week for a couple of hours. So for nearly 1.5 years not a single episode which allowed me to get my life back and become more physically fit. The past couple of years have seen promising developments in ablation including the FIRM procedure which specifically specifically targets the sources of afib - rotors as opposed to ablating larger regions. I’ve been told the success rate is 80% or greater. As some here know, a number of well known centers for ablations had success rates that were skewed because patients would travel to these centers and when afib would come back, would be treated in their local hospitals. This was not statistically included in their data because they were unaware of it.
As far as blood thinners, they become more necessary as your chads number increases. I’m currently at a 3% risk but do not take any thinners. Next year when I turn 65 that adds another point and increases the risk of a stroke. I’ve been delaying taking blood thinners for some of the reasons stated above. Neither of my doctors recommends taking warfarin. Both say it is not as effective and I’ve seen some results confirming this. These other thinners are very expensive as they do not have generic options. As some have said above, there are indications that warfarin is more dangerous than drugs like xarelto.
Another interesting tibit from my cardiologist this past week was that it seems the idea that strokes occur from clots occurring in the heart because of blood pooling may not be the whole picture. Apparently, the probability of a stroke is the same if you have one episode or many afib episodes. Apparently there is some other mechanism that is causing both to occur. I haven’t checked any literature to see if this is true.
If you have seen one stroke, you know how crucial prevention can be. My mom had a thankfully smaller stoke before her a fib was diagnosed. But still, she battled with word finding for years afterwards, and I really think she is not as sharp, though had no physical deficits. We have talked about stroke risk vs bleeding risk, more so as she is 92. My feeling is that as she is very high stroke risk, she needs to stay on warfarin. We’ll take the bleeding risk.
As she is a natural healing fanatic of the first order, there have been some plans advanced to get her off warfarin from a naturopath. Not interested, and I have not minced words as to the chances taken. After discussion, she has come around to agreeing with me and her cardiologist.
@great lakes mom: That’s a very interesting article. I had never heard of CHADs before. However, the article is from 2009. Do you know if it is still considered current??
Sorry, didn’t look at the date. This was a more layperson friendly article. Chad scoring has been revamped a few times. It looks like the current model, has been used since 2009, but I don’t keep up with journal articles, this is casual googling. Chad=2-vasc is the name of the most current model. http://www.mdcalc.com/cha2ds2-vasc-score-for-atrial-fibrillation-stroke-risk/
