Pick My Poison

Newbie here; sorry, this will be long. I’m a 70 year old female (so CHADS score 2) who had my first A-fib episode on Christmas night 2017. It lasted around 40 minutes and I basically wrote it off as stress (but knew that wasn’t likely). Cue second episode a few weeks later and a visit to a cardiologist who put me on a monitor for 2 weeks. The monitor recorded a 4 hour episode during the early morning hours, but I slept through half of it. Since then, I’ve had 3 more episodes, all waking me in the early morning hours and converting within 2 hours.

Before I go into my current issues, I should mention that I’m extremely sensitive to medications and generally try to avoid them if at all possible. I also have an unclassified autoimmune disorder and wet Age Related Macular Degeneration, for which I receive injections in both eyes every 5 weeks. In spite of these issues, I’ve been an energetic and busy person...traveling internationally, going to grandkids sports events, taking part in community activities and volunteering. I only mention this because I was actively enjoying every minute of retirement until A-fib showed up to ruin the party.

My cardiologist prescribed Atenolol 25mg qd, while she waited for the results of my blood work, Echo and Stress EKG. All were normal, so then she added Flecainide 50mg bid and Pradaxa 250mg bid. Three days later, I experienced bleeding while using the toilet, saw my PCP who noted a rectal fissure and speculated that the blood thinner was the culprit, but ordered a colonoscopy just to be on the safe side. Pradaxa was DC’d and 81mg aspirin substituted...no bleeding problem since and colonoscopy is tomorrow.

I was pleasantly surprised that the beta blocker didn’t seem to be causing me any problems...until about 10 days in when I noticed that several fingers on both hands had gone numb and turned blue. The Atenolol was discontinued and DILT-XR 120mg qd replaced it.

I tried to stick with the Flecainide, hoping that if I could power through the first few weeks, the side effects would stabilize but i just couldn’t deal with feeling like a zombie and the insomnia. I felt like I was hyped up on steroids, jittery and not functioning well. The Flecainide was discontinued after two weeks and I felt almost human again.

So, I’m currently taking Dilt-XR (which does make me feel weird; how can a person feel both wired and fatigued at the same time?) and aspirin, but I have a phone appointment with my cardiologist after my colonoscopy tomorrow. I know that once those results come back ok, she will want to revisit my medications, probably adding a different antiarrythmic and resuming the blood thinner. I’d be fine with trying other antiarrythmic meds, but we are taking a 3 week family trip to Europe in July. This is a big deal; I’ve been planning this vacation with our children and grandchildren for almost a year and really just want to be able to enjoy it without worrying about side effects of new meds. It’s pretty tempting to just put off making any med changes until after the trip.

My biggest concern, however, is my wet macular degeneration. Since this is caused by the formation of abnormal blood vessels in the eye that can leak, causing permanent loss of vision, taking a blood thinner increases the risk of blindness. In spite of the eye injections that are supposed to prevent leakage, I’ve unfortunately experienced vision loss in one eye, so consider myself to be higher risk for leakage. I’m super concerned about the possibility of becoming blind in both eyes if I take blood thinners (I’m aware that aspirin is also a risk).

This medication dance has been going on for four months and I know my cardiologist isn’t comfortable with me being on just a calcium channel blocker and aspirin. I’m not ok with risking my vision, but it looks like I’m faced with two bad options...risking a stroke or risking blindness. I realize that it can take time and adjustments to find a workable treatment plan, but this has been really stressful and I don’t see a good solution.

Sorry to read about your problems. Have you considered natural i.e. dietary anticoagulants?
Don't know nor fully understand how reliable blood clotting analysis is but i think it may be a start given your eye problem? Did your specialist mention/consider it?
Some food can be very efficacious anticoagulants. So much so that surgeons recommend not to eat them a few days prior to surgery.

Sucks, except I read that there's no interaction between warfarin and avastin, and I know it's used in very small doses for mac degeneration. Both are so common in older people, I would hope there's some solution.

I checked with my retina specialist, who said that many of her elderly patients with macular degeneration take blood thinners and that it “should” be ok. Somehow, that isn’t terribly reassuring since I “shouldn’t” have lost the vision in my left eye while receiving the injections. For that reason, “shouldn’t be a problem” doesn’t exactly fill me with confidence! One article I read, written by a doctor, said that he’d choose to risk his vision over a stroke...I just don’t feel prepared to make that decision. I guess in the end there just won’t be a definitive answer.

I appreciate that you and Joe took the time to respond; I’ll keep you posted after I speak with my cardiologist on Friday

Thumper:

There are some natural supplements that you could take for a blood thinner, Jackie wrote this a few days ago, : scroll down and tap on the heading of the article that she wrote:

Jackie [ PM ]
Lumbrokinase for Clot Risk Prevention
May 08, 2018 01:13PM

I have a problem taking a blood thinner and I take an aspirin, I am interested in this supplement also. It sounds like you are not in AF very long so that is good.

You could get an ablation, the best around that does many ablations and the people on this board go to him, his name is Dr. Natalie and he is in Texas. If you are interested, ask and many will help you.

Do you take any supplements like Magnesium, Potassium, Magnesium has helped me a lot many people are low in this electrolyte. There will be others that will respond to you with many helpful ideas. You sound like a very tough lady, keep fighting.

Liz



Edited 1 time(s). Last edit at 05/23/2018 11:11PM by Elizabeth.

Thanks for the info and support, Liz. I’ve been reading about the supplements on this forum and intend to start those; I just need to get past my colonoscopy tomorrow and then I can focus on getting better informed.

Regarding ablation, I’m not sure what the criteria is for qualifying for the procedure. My issue with going to Dr. Natale is that I have Kaiser Senior Advantage for my Medicare coverage, so even if an ablation was merited in my case, I’d have to drop Kaiser during open enrollment and pick up the insurance that Dr. Natale accepts. I would seriously consider doing this, because it’s obvious that he has the best credentials and optimum outcomes, but I’m just not sure I want to consider ablation at this point.

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Thumper
This is a big deal; I’ve been planning this vacation with our children and grandchildren for almost a year and really just want to be able to enjoy it without worrying about side effects of new medou's. It’s pretty tempting to just put off making any med changes until after the trip.

My biggest concern, however, is my wet macular degeneration.

Hi Thumper, welcome to the forum.

You've got a tough set of decisions to make. I don't pretend to know what you should do in the long term, but in the short term I would urge you to do the vacation you've planned. You're too close to the vacation date to play with med changes unless they're really essential.

Thumper:

I am sure that you are taking supplements for your eyes, like Lutein, Bilberry and Blueberry concentrates. Traditional Chinese medicines has also been used to treat AMD. Some of these meds include chrysanthemum flower, wolfberry, mulberry and Gordon Euryale seed . Drink plenty of alkaline water, keeping your body alkaline will slow down the deterioration process of the body from low pH levels (acidic), an acidic body can be detrimental to your eyes and can cause extreme damage. Antioxidants are essential for eye health, antioxidants are found in Vit. C, A, E, selenium and zinc.

Stay away from trans-fats. Eat fish, nuts, healthy oils and green leafy veggies, they are Omega-3 fatty acids which are able to reduce inflammation which can cause a host of problems such as reduced blood flow to vessels throughout the body.

I have a problem with dry eyes so I have been doing some reading and am starting to take some supplements for my eyes.

Liz

Welcome, Thumper... sorry for your woes. I have great empathy. On the ARMD, I was diagnosed a long time ago with the dry form and eventually consulted with a retinal specialist who prescribed specific nutrients versus the traditional ophthalmologist who just did the periodic eye exam. The recommended nutrients have definitely helped. With the last exam, I had actually improved by two levels so we both were thrilled.

You can send me a PM if you want the details.

Jackie

Sometimes we are faced with a situation where there does not seem to be an easy answer. It seems that you are in such a situation, Thumper, and I hope all turns out well for you. Taking the family vacation to Europe seems like something that will be a wonderful experience for all of you. I hope that you can be stable on your medicines and enjoy this special time with your children and grandchildren. You can take some comfort in knowing that there are good medical doctors and facilities where you will be traveling and in the case of an emergency (which may never happen), good care will be available. Between now and your July vacation, stay in touch with your doctors and hopefully they can advise you wisely. When you get back, you can begin once again to address finding a solution for your dilemma. I hope you will be feeling well on your trip and have a wonderful time with your family!

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JustMeToo
Sometimes we are faced with a situation where there does not seem to be an easy answer. It seems that you are in such a situation, Thumper, and I hope all turns out well for you. Taking the family vacation to Europe seems like something that will be a wonderful experience for all of you. I hope that you can be stable on your medicines and enjoy this special time with your children and grandchildren. You can take some comfort in knowing that there are good medical doctors and facilities where you will be traveling and in the case of an emergency (which may never happen), good care will be available. Between now and your July vacation, stay in touch with your doctors and hopefully they can advise you wisely. When you get back, you can begin once again to address finding a solution for your dilemma. I hope you will be feeling well on your trip and have a wonderful time with your family!

Well said. I hope you enjoy your vacation Thumper and find a healthy path that resolves in in a great way for you.

Just a brief non-update...my colonoscopy went well so my cardiologist wants me back on Pradaxa and an antiarrythmic. She agreed that the new meds could wait until after we return from our European cruise, so I have an appointment in early August. I’m still really uneasy about the blood thinner, but have an appointment with my retina specialist on
Tuesday so will discuss it more with her then.

It’s been 4+ weeks since my last, pretty mild, AF episode. Shortly after that, I gave up drinking my favorite, oh-so-refreshing, diet caffeine free cola and switched to water. I’d been drinking at least two cans of soda a day for many years; it was my go-to beverage since I don’t drink coffee, tea or alcohol and was never too fond of water either. I didn’t think it would be so easy to quit but I found that I don’t mind water if it’s ice cold, so I carry around an insulated water bottle now and really don’t miss the soda. I ‘m sure that all of that aspartame and phosphoric acid wasn’t doing my body any favors.

So, now I’m ready to check out the recommended magnesium and taurine supplements (type, brand, dose). If anyone cares to post a link, that would be awesome, but I’m sure I can find the info by searching the forum. Again, thanks to everyone for the kind words and encouragement!

Aspartame is evil. Stay away! Excellent choice there.

Yes - and beware that now some bottlers of low calorie sugar free drinks and "healthy" water options are now labeling Aspartame or Splenda, as Sucralose. Sucralose still has all the detrimental properties.


.... "Now, a study has raised the possibility that artificial sweeteners in diet beverages may increase the risk of dementia and stroke." [www.ncbi.nlm.nih.gov]

Stroke. 2017 May;48(5):1139-1146. doi: 10.1161/STROKEAHA.116.016027.
Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study.
[www.health.harvard.edu]

Jackie

Be careful not to jump to conclusions too quickly.

From Jackie's posted Harvard Study:

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Of course, there’s more to the story

Before you despair or give up your favorite diet beverage forever, keep in mind that a study of this sort has some major limitations that can lead to faulty conclusions. For example:

It’s impossible to account for every factor that could affect the results. For example, maybe people with diabetes or a family history of diabetes chose sugar-free soft drinks more often than people without diabetes would. So it could be their diabetes and family history, not the diet soft drink consumption, that was responsible for their higher rates of stroke and dementia.

This type of study cannot establish cause and effect. Even if there is a higher rate of brain disease in people who drink more diet soft drinks, we can’t be sure that the diet soft drinks were the cause.

This study did not look at the overall health effects of diet soft drinks; it’s possible they are still a healthier choice than sugar-sweetened beverages.

This study was conducted when most artificially sweetened beverages contained saccharin (Sweet’N Low, Sweet Twin), acesulfame-K (Sunett, Sweet One), or aspartame (NutraSweet, Equal). Newer sweeteners, such as sucralose (as in Splenda) were unlikely to have been included.

While the risk of stroke or dementia was higher among those consuming diet soft drinks, only about 3% of the studied population had strokes and about 5% developed dementia. So, while a higher risk was observed among diet beverage drinkers, the overall risk in those who did or did not drink diet beverages was relatively low.

This study only looked at artificially sweetened soft drinks. It didn’t look at use of artificial sweeteners in foods or beverages other than soft drinks.

Edited 1 time(s). Last edit at 05/27/2018 10:44AM by Ken.

Good points Ken. But i for one will not be the guinea pig to settle the argument. Happy for others to do the long term testing.

My first diet drink was Diet Rite Cola (came out in 1962) in the early 60's. I don't drink a lot of diet drinks, but I have consumed them somewhat regularly for the last 50 years. A guinea pig? No down side that I have found. I am 73, take no prescription meds, excellent health and fitness and less than 15% body fat. Currently drinking a coffee sweetened with Truvia, which I like more than the other sweeteners.

Joe - I know two people who could be considered long-term test cases. Both ended up with Alzheimer's. One died after six years and the other is still living but mentally (Alzheimer's) and physically incapacitated. Both were active, athletic, smart and viable people....but always preferred "diet" cola type beverages and drank several every day.

The first, developed her mental disability starting around age 60... and then full-blown Alz around 67... rapidly declining to Stage 7 Alz and died in a nursing home at age 70. The other just celebrated her 75th birthday living at home with constant care as she is unable to do anything for herself and is mentally and physically 'gone.' She started with forgetfulness around age 60 and slowly went downhill from there.

True, these are just two people but having witnessed this, I certainly would not recommend anyone use these sweeteners.

Neurosurgeon, Russell Blaylock, MD retired to do research on the neurotoxcities that promote mental disabilities as his parents both died early from Parkinson's. His newsletter, The Blaylock Wellness Report as well as his book... "Excitotoxins - the Taste that Kills" covers all of these types of exposures one can get from various sources that are excitotoxic to the body.... including heart tissue... so it makes sense to pay attention to the potentials that can certainly influence arrhythmia... and help protect our brain as a side benefit... since the food and beverage companies are certainly not interested in doing that.

Jackie

Comments from a more current look at the first study that Jackie posted: "Now, a study has raised the possibility that artificial sweeteners in diet beverages may increase the risk of dementia and stroke." [www.ncbi.nlm.nih.gov]

From: http://www.diabetesincontrol.com/stroke-and-dementia-risks-with-sugars-and-artificial-sweeteners-fact-or-fiction/

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From the results, it was concluded that artificially sweetened soft drink consumption was associated with a higher risk of stroke and dementia.

While preliminary research found a link between daily intake and increased risk, the chain of evidence is not as strong as reported. The researchers analyzed data from an ongoing U.S. cohort study to see if consumption of sugar or artificially sweetened drinks was linked with risk of stroke or dementia 10 years later. Several thousand people were included in the study, and during follow-up 3% had a stroke and 5% developed dementia. Overall, when taking account of all health and lifestyle factors that could have an influence, contrary to the results offered, the researchers actually found no link between artificially sweetened drinks and risk of dementia.

The figures reported in the media came from a model that wasn’t adjusted for all confounders, such as diabetes, that could explain part of the link. For stroke, the links with artificially sweetened drinks were inconsistent. There were no overall links when looking at longer-term patterns. The study does not give definitive “cause and effect” proof that drinking artificially sweetened drinks will lead to stroke or dementia. Still, the lead author’s reported statement that it is healthier (not to mention cheaper) to just drink water is sound advice.

This was all started by the study which was carried out by researchers from Boston University School of Medicine and Tufts University, Boston. The study was published in Stroke, a peer-reviewed journal of the American Heart Association, on an open-access basis. The Guardian gave a good overview of the research while making clear that no cause and effect had been proven.

Actually, I’m pretty curious about whether long term consumption of phosphoric acid in cola soft drinks has any effect on AF (could it possibly affect magnesium absorption)? I only found one study that mentions serum phosphorus and AF:

[www.ncbi.nlm.nih.gov]

Anyone care to chime in on this?

It's beyond my pay grade to assess these studies both somewhat positive and negative ones and the funding/potential conflicts of interest.

I used to drink 'energy' drinks prior to afib but stopped since. Just going by gut instinct and observing others with health problems. In any case, not drinking them is definitely not a health hazard.

My point is that there are many, many "scientific" studies that suggest that "X is good for you", or that "Y is bad for you". However, anyone that buys into any study that hasn't been supported by dozens of follow up studies confirming the original hypothesis, should be taken with a ton of skepticism.

Event now, we continually see contradictions/retractions of what was at one time "settled science". I also believe that there are government funded studies that have a preconceived result, such that the study is designed to come up with that outcome.

I could be wrong, but nothing I have seen in the last 50 years about non sugar sweeteners has deterred me from occasionally using them. "not drinking then is definitely not a health hazard" Tell that to the huge percentage of Americans that are obese because of sugar.

Ken - These artificial sweeteners are known to contribute to weight gain so the sugar argument is not true.
There are many studies done over 25+ years that support that finding.. There is also disturbance in other metabolic problems exist as well... including the fact that those chemicals accumulate and are toxic in some individuals and contribute to gut issues because it blocks a functional enzyme.

Here's one of many similar study findings. [www.ncbi.nlm.nih.gov]

Occasional use is one thing, but many drink large quantities daily...plus food containing as well is not helping the masses avoid obesity.

Jackie

Jackie, from the last line of the study you posted: These findings raise the question whether AS use might be fueling--rather than fighting--our escalating obesity epidemic.

When you look at all of the studies, you find wording like: might me; could; seems; appeared to; suggests. The studies seem to established few if any facts, but do promote relationships.

From another recent study in US News and World Report - Headline: Study: Artificial Sweeteners Linked to Diabetes, Obesity

The conclusion: Hoffman cautioned that there is no simple answer to "Which is worse, sugar or artificial sweeteners?" A diet high in sugar has negative health outcomes and the study shows a diet high in artificial sugars has the same.

I am still a skeptic, but that could change over time.

Ken - It's smart to be a skeptic.

I am, for sure.... because as we know from what Shannon's shared about studies... they do not always present the whole picture and can be manipulated to shed a favorable light on the outcome so that vested interests are protected. In the case of these artificial sweeteners... that's big business... so it makes sense not to discourage the use of them. However, if you look at the obese population today....along with the consumption of diet drinks and various foods with artificial sweeteners that people think spare them from weight gain because they avoid sugar, it's obvious something is amiss.

The functional medicine physicians that practice nutritional medicine see great improvements in their patients who don't use artificial sweeteners. There's enough of that evidence to make it worth serious consideration if one is genuinely interested in optimizing one's health and longevity.

Jackie

Jackie,

Again, the last line of the study you posted says: These findings raise the question whether AS use might be fueling--rather than fighting--our escalating obesity epidemic.

No findings of why the correlation exists, just that it MIGHT be fueling - rather than fighting. I have read that in some cases overweight people that use AS eat more calories believing that by cutting AS calories, they can eat more without consequences. One day, we may know a lot more about the cause and effect of AS.

Again, buying in to an un proven hypothesis is not in my nature. Those that choose to alter their diet because of these studies, good for you, it may or may not be a worthwhile move. Those that can maintain a healthy weight with sugar and no AS, why not. If you are overweight and avoiding calories cutting/burning techniques, not so good for you.

To me, obesity is a much bigger problem than using AS.

Nobody ever got fat by not eating. Yes, i know it's not as simple as that. Getting all the nutrition with calorie restriction by regular fasting or smaller meals etc.