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Alas, AFIB pays a visit to our house once again ... but this time it's not me!
Posted by Shannon
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Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 15, 2017 03:00PM |
Admin Registered: 11 years ago Posts: 2,779 |
Fortunately, I still remain in blissful NSR going on 9 years now of total freedom from all AFIB (not a single beat of AFIB has been felt by me, nor recorded on my inboard pacemaker, since the day of my extensive index ablation for a then 16 years progressive AFIB that had progressed to aggressive persistent AFIB for some time before finally making it to Dr Natale's ablation lab in Austin ... I will hit 9 years freedom from AFIB this summer, knock on wood! Following my LAA Isolation to resolve my remnant LAA-based left atrial flutter some 3.5 years after the index ablation, I have had zero blips of any Arrhythmia of any kind now for going on 6 years.
Alas, a week ago today around 12:30 noonish, my dear wife Magdalena suddenly triggered into her first ever AFIB episode (at least the first she knows of for sure and the first ever captured). She is in excellent shape and has always eaten very well, indeed, with mostly all organic food and minimal to no processed food for most of her life. She has been taking magnesium supplementally each day as well as a number of key antioxidants and quality supplements but with her focus mostly on great eating.
Luckily, I was home when she triggered and was able to catch the AFIB on my Alivecor monitor. I then quickly took her to a local Urgent Care center not far from our home in Sedona and was able to capture a full 12 lead EKG formally documenting her AFIB ranging from 129bpm to 145bpm. I took her home to rest and the usual countermeasures including loading her up with magnesium and Cardiokinase etc, but mostly to watch her for a bit and see if she did not convert to NSR on her own. As early evening rolled around it was clear she wasn't likely to convert without help so I whisked her off to the closest regional ER in Cottonwood AZ where the process was predictable for a new AFIB patient like her in a country ER to be there for possible cardioversion prior to the 24 hour golden window for an ECV expired.
After checking her into the hospital when they assumed she had experienced more AFIB that she didn't feel, the plan was to do an Echo the following morning and then a TEE that afternoon followed by an ECV cardioversion if she had not converted by then.
Fortunately, she did convert on her own with no drugs on board almost exactly 24 hours after the episode started and we were allowed to go home. They had given her one IV push bolus of Cardizem (the brand name for Diltiazem) which is a calcium channel blocker as most of you no doubt know first hand. But all that did, predictably, was to lower her heart rate and any conversion to NSR while on Cardizem would have only been by chance, and not have been directly caused by the Cardizem which is a rate control drug and not an anti-arrhythmic drug.
One issue that raised a red flag as to a possible trigger for this somewhat surprising episode, was noted in her labs taken in the hospital showing a very low TSH and very low Free T4 with a normal range Free T3.
From roughly day 14 to day 9 prior to this first documented AFIB episode, my wife had noted what she described as three very brief "fluttery feelings" in her chest over the 4 to 5 days ending 9 days prior to this documented AFIB. The first of these steady but fast and very brief Heart rate 'flutters' she experienced lasted 40 seconds, with the second one two days later lasted just 20 seconds and the third and final 'fluttery feeling" lasted just shy of 3 minutes on the 9th day prior to the full blown AFIB episode.
After hearing of these three short early signals I asked her at the time, with her endo's agreement, to reduce her thyroid meds to about half her normal dose to see if, perhaps, her hypothyroid dosing needs may have reduced over the last 9 months since her last thyroid labs. This, in spite of the fact that her thyroid dosing had been rock stable for the past 6 years since first being diagnosed with moderate hypothyroidism.
These 3 brief stable "flutters" were much too quick for me to capture any of them, but I did test her often throughout each day and before bed, prior to the big AFIB trigger occurrence last Wednesday and only found NSR and no sign of AFIB/Flutter, nor even ectopy, on my Alivecor. Also, she reported no symptoms and she had been very precisely symptomatic in knowing just when those three short early blips had started and when they stopped.
Her stable thyroid dose had included a mix of T4 with a small T3 dose in the morning, and a final small T3 dose in early afternoon, which she did very well on with no issues at all the prior 6 years. Having cut her overall dosing in half, I was surprised to see the lab results which were more consistent for someone taking ONLY T3.
Both the Cardiologist who only saw her briefly right after she had converted to NSR the day after we arrived at the ER, and just in time to say we could go home, was nevertheless right on point, in my view, in what he would have recommended had she not converted. And the Hospitalist MD assigned to her was very good too, and he understood the nuances of thyroid treatment much better than most internists in my experience, and we quickly agreed on her next steps regarding thyroid adjustment.
I was still wondering how those labs would have shown such low TSH and Free T4, and so when we got home I asked her for show me her two small pill bottles in her purse that she kept some vitamins in one and another small white pill in another. Lo and behold in the small pill container with her other small white tablet, there were a number of the similarly white and small sized Cytomel T3 pills that she had inadvertently added to her other pill container!
We don't know for sure, but if she had taken one or more extra Cytomel on last Wednesday morning, that might well explain not only the oddly very low TSH and very low Free T4 under this scenario, and it also very much could have contributed to triggering her AFIB episode.
The caveat to this assumption is she would have had to take two full extra Cytomels by mistake that day to equal her prior effective dose, and she does not recall taking two of any white pills that day. However, it remains a real possibility she may have inadvertently made that mistake.
The reason for this level of detail here is to emphasize to any thyroid med users to not only remain careful not to take more than one's required dose to feel well and as prescribed by your doctor, but also that even after many years of stability in thyroid dosing it may be best to still do testing twice a year, rather than relax to once a year testing as we had done over the past two years when each of her prior test had been so consistent year by year.
While Magdalena has done very well since we got home last Thursday afternoon, we are in a waiting pattern now in hopes this was truly a one-off event. And I know, too, that even if it was mostly an excess T3-mediated AFIB episode, while that would be preferable of course, it is still not a guarantee that she is immune to any more AFIB and that it will not go on to manifest as gradually paroxysmal AFIB even with a well-controlled thyroid function from here on out.
The fact that this first episode took a full 24 hours to convert on its own might also suggest she is now more prone to triggering than she had been up to this point, especially now that we are both in our 'golden years'.
While watching Magdalena on her ER bed, the thought briefly flashed through my mind ... "Shucks, I had hoped after my long saga with AFIB all these years we might have earned a virtual 'family pass' on any more visits from the beast!" :-) We may still get lucky yet, and we are both hoping this was just a one day indoctrination for her into what all this fuss with AFIB is all about, yet never to return again ... time will tell!
Shannon
Edited 1 time(s). Last edit at 02/15/2017 07:04PM by Shannon.
Alas, a week ago today around 12:30 noonish, my dear wife Magdalena suddenly triggered into her first ever AFIB episode (at least the first she knows of for sure and the first ever captured). She is in excellent shape and has always eaten very well, indeed, with mostly all organic food and minimal to no processed food for most of her life. She has been taking magnesium supplementally each day as well as a number of key antioxidants and quality supplements but with her focus mostly on great eating.
Luckily, I was home when she triggered and was able to catch the AFIB on my Alivecor monitor. I then quickly took her to a local Urgent Care center not far from our home in Sedona and was able to capture a full 12 lead EKG formally documenting her AFIB ranging from 129bpm to 145bpm. I took her home to rest and the usual countermeasures including loading her up with magnesium and Cardiokinase etc, but mostly to watch her for a bit and see if she did not convert to NSR on her own. As early evening rolled around it was clear she wasn't likely to convert without help so I whisked her off to the closest regional ER in Cottonwood AZ where the process was predictable for a new AFIB patient like her in a country ER to be there for possible cardioversion prior to the 24 hour golden window for an ECV expired.
After checking her into the hospital when they assumed she had experienced more AFIB that she didn't feel, the plan was to do an Echo the following morning and then a TEE that afternoon followed by an ECV cardioversion if she had not converted by then.
Fortunately, she did convert on her own with no drugs on board almost exactly 24 hours after the episode started and we were allowed to go home. They had given her one IV push bolus of Cardizem (the brand name for Diltiazem) which is a calcium channel blocker as most of you no doubt know first hand. But all that did, predictably, was to lower her heart rate and any conversion to NSR while on Cardizem would have only been by chance, and not have been directly caused by the Cardizem which is a rate control drug and not an anti-arrhythmic drug.
One issue that raised a red flag as to a possible trigger for this somewhat surprising episode, was noted in her labs taken in the hospital showing a very low TSH and very low Free T4 with a normal range Free T3.
From roughly day 14 to day 9 prior to this first documented AFIB episode, my wife had noted what she described as three very brief "fluttery feelings" in her chest over the 4 to 5 days ending 9 days prior to this documented AFIB. The first of these steady but fast and very brief Heart rate 'flutters' she experienced lasted 40 seconds, with the second one two days later lasted just 20 seconds and the third and final 'fluttery feeling" lasted just shy of 3 minutes on the 9th day prior to the full blown AFIB episode.
After hearing of these three short early signals I asked her at the time, with her endo's agreement, to reduce her thyroid meds to about half her normal dose to see if, perhaps, her hypothyroid dosing needs may have reduced over the last 9 months since her last thyroid labs. This, in spite of the fact that her thyroid dosing had been rock stable for the past 6 years since first being diagnosed with moderate hypothyroidism.
These 3 brief stable "flutters" were much too quick for me to capture any of them, but I did test her often throughout each day and before bed, prior to the big AFIB trigger occurrence last Wednesday and only found NSR and no sign of AFIB/Flutter, nor even ectopy, on my Alivecor. Also, she reported no symptoms and she had been very precisely symptomatic in knowing just when those three short early blips had started and when they stopped.
Her stable thyroid dose had included a mix of T4 with a small T3 dose in the morning, and a final small T3 dose in early afternoon, which she did very well on with no issues at all the prior 6 years. Having cut her overall dosing in half, I was surprised to see the lab results which were more consistent for someone taking ONLY T3.
Both the Cardiologist who only saw her briefly right after she had converted to NSR the day after we arrived at the ER, and just in time to say we could go home, was nevertheless right on point, in my view, in what he would have recommended had she not converted. And the Hospitalist MD assigned to her was very good too, and he understood the nuances of thyroid treatment much better than most internists in my experience, and we quickly agreed on her next steps regarding thyroid adjustment.
I was still wondering how those labs would have shown such low TSH and Free T4, and so when we got home I asked her for show me her two small pill bottles in her purse that she kept some vitamins in one and another small white pill in another. Lo and behold in the small pill container with her other small white tablet, there were a number of the similarly white and small sized Cytomel T3 pills that she had inadvertently added to her other pill container!
We don't know for sure, but if she had taken one or more extra Cytomel on last Wednesday morning, that might well explain not only the oddly very low TSH and very low Free T4 under this scenario, and it also very much could have contributed to triggering her AFIB episode.
The caveat to this assumption is she would have had to take two full extra Cytomels by mistake that day to equal her prior effective dose, and she does not recall taking two of any white pills that day. However, it remains a real possibility she may have inadvertently made that mistake.
The reason for this level of detail here is to emphasize to any thyroid med users to not only remain careful not to take more than one's required dose to feel well and as prescribed by your doctor, but also that even after many years of stability in thyroid dosing it may be best to still do testing twice a year, rather than relax to once a year testing as we had done over the past two years when each of her prior test had been so consistent year by year.
While Magdalena has done very well since we got home last Thursday afternoon, we are in a waiting pattern now in hopes this was truly a one-off event. And I know, too, that even if it was mostly an excess T3-mediated AFIB episode, while that would be preferable of course, it is still not a guarantee that she is immune to any more AFIB and that it will not go on to manifest as gradually paroxysmal AFIB even with a well-controlled thyroid function from here on out.
The fact that this first episode took a full 24 hours to convert on its own might also suggest she is now more prone to triggering than she had been up to this point, especially now that we are both in our 'golden years'.
While watching Magdalena on her ER bed, the thought briefly flashed through my mind ... "Shucks, I had hoped after my long saga with AFIB all these years we might have earned a virtual 'family pass' on any more visits from the beast!" :-) We may still get lucky yet, and we are both hoping this was just a one day indoctrination for her into what all this fuss with AFIB is all about, yet never to return again ... time will tell!
Shannon
Edited 1 time(s). Last edit at 02/15/2017 07:04PM by Shannon.
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 15, 2017 10:17PM |
Registered: 11 years ago Posts: 4,221 |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 15, 2017 10:47PM |
Registered: 10 years ago Posts: 1,748 |
Shannon:
Sorry that your wife had to experience AF---that is how I got to know AF, feeling a little tried I increased my thyroid meds then one day my heart started flip flopping and sped up, I went to the doctor and he said I was in AF, I did convert on my own, didn't take too long. I was fine for a number of months but it caught me again, throughout the years I maybe would go into AF only a few times a year then I got it more and more. After finding this site, I started on Mag. and my episodes lessened, still get AF. I have been able to terminate my episodes in half the time of previous episodes by chewing my pill of Propafenone and drinking some warm water, it does work.
Thyroid meds are very powerful and you are right Shannon we have to get tested at least twice a year or perhaps 3 times. I know I went into AF because of my meds which I had increased, never again. The funny thing is that when I had Graves disease and my TSH was almost zero, yet I did not go into AF. I went into AF when I was taking meds, there is a difference, meds must be more potent.
All the best to your wife.
Liz
Sorry that your wife had to experience AF---that is how I got to know AF, feeling a little tried I increased my thyroid meds then one day my heart started flip flopping and sped up, I went to the doctor and he said I was in AF, I did convert on my own, didn't take too long. I was fine for a number of months but it caught me again, throughout the years I maybe would go into AF only a few times a year then I got it more and more. After finding this site, I started on Mag. and my episodes lessened, still get AF. I have been able to terminate my episodes in half the time of previous episodes by chewing my pill of Propafenone and drinking some warm water, it does work.
Thyroid meds are very powerful and you are right Shannon we have to get tested at least twice a year or perhaps 3 times. I know I went into AF because of my meds which I had increased, never again. The funny thing is that when I had Graves disease and my TSH was almost zero, yet I did not go into AF. I went into AF when I was taking meds, there is a difference, meds must be more potent.
All the best to your wife.
Liz
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 16, 2017 12:23PM |
Registered: 10 years ago Posts: 836 |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 16, 2017 01:09PM |
Registered: 6 years ago Posts: 18,881 |
Hi Shannon - So sorry to read this story. I'm strongly suspicious of the thyroid involvement. As I mentioned to you, my FM MD had me go off Armour thyroid when I had the second ablation as she said that people around and over 70 seem to have arrhythmia problems and she didn't want to be responsible for contributing to mine.
Now I'm stuck looking for a safe alternative and the natural glandulars that she's recommended don't seem to work well enough so I'm between a rock and a hard place....but thankful (at least) for no Afib or flutter.
I'll be watching for your next installment on Magdalena's progress and I certainly hope and pray this is not a trend but rather was brought on by the possible overdose.
Best to you both,
Jackie
Now I'm stuck looking for a safe alternative and the natural glandulars that she's recommended don't seem to work well enough so I'm between a rock and a hard place....but thankful (at least) for no Afib or flutter.
I'll be watching for your next installment on Magdalena's progress and I certainly hope and pray this is not a trend but rather was brought on by the possible overdose.
Best to you both,
Jackie
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 16, 2017 08:27PM |
Registered: 12 years ago Posts: 172 |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 16, 2017 10:22PM |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 17, 2017 03:50PM |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 17, 2017 07:02PM |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 17, 2017 10:06PM |
Registered: 8 years ago Posts: 1,102 |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 18, 2017 10:24AM |
Registered: 12 years ago Posts: 616 |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 20, 2017 09:15PM |
Registered: 7 years ago Posts: 9 |
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 21, 2017 04:42PM |
Registered: 11 years ago Posts: 142 |
Hi Shannon, Sorry about Magdalena's experience. Hope that she is one of those fortunate people who have it never return. Speaking of our golden years and AF my 77 year old brother just had a minor stroke. He lives alone and one evening he realized that he was not walking a straight line. He didn't call any of us because he has had several episodes of vertigo and thought that he got it again. He went to bed early and woke up still unable to walk a straight line and now his left leg was weak. He called one of his children and off to the hospital they went where he was diagnosed with an ischemic stroke. He was discharged to a rehab facility where he did very well. He is driving already and virtually as good as new. They could find no cause of the stroke at the hospital and his cardiologist is betting it was caused by undiagnosed AF. He is presently wearing a 30 day monitor.
Magdalena is in good hands. All the best to both of you. Dennis
Magdalena is in good hands. All the best to both of you. Dennis
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Re: Alas, AFIB pays a visit to our house once again ... but this time it's not me! February 22, 2017 12:29PM |
Admin Registered: 11 years ago Posts: 2,779 |
Many thanks Folks, from Magdalena and I for the best wishes for her!
So far so good, with Magdalena having felt no hiccups and no runs of AF at all since her, so far, one and only documented 24 hr duration AFIB episode two weeks ago today. And with repeated AliveCor Kardia EKG samples over the last two weeks, with handful of EKG strips done each day over these first two weeks after her AFIB episode, has only captured pure NSR so far and not even any ectopic beats.
.
She is gradually adjusting to her lower thyroid hormone meds dosing, though with understandably feeling a bit more tired than previously, but she s doing okay overall.
She asked me to pass along her sincere appreciation for the kind good wishes from the forum, and we are both keeping our fingers crossed that this really was a 'one-off' event from her possibly taking an excess thyroid med dose on Wednesday two weeks ago.
Cheers!
Shannon and Magdalena
So far so good, with Magdalena having felt no hiccups and no runs of AF at all since her, so far, one and only documented 24 hr duration AFIB episode two weeks ago today. And with repeated AliveCor Kardia EKG samples over the last two weeks, with handful of EKG strips done each day over these first two weeks after her AFIB episode, has only captured pure NSR so far and not even any ectopic beats.
.
She is gradually adjusting to her lower thyroid hormone meds dosing, though with understandably feeling a bit more tired than previously, but she s doing okay overall.
She asked me to pass along her sincere appreciation for the kind good wishes from the forum, and we are both keeping our fingers crossed that this really was a 'one-off' event from her possibly taking an excess thyroid med dose on Wednesday two weeks ago.
Cheers!
Shannon and Magdalena
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