How to talk with this cardiologist.

Thanks for the response 'vagal or adrenergic'. I was pretty sure I am 'mixed', and your responses helped confirm that. My wife and I just returned from a New Year's trip. Thank you all again for your feedback.

Another topic - appointment with my cardiologist:

This week I am going to be talking with my cardiologist. After seeing me on December 3(I had begunn a two month medical leave on December 1), seeing my Holter Monitor test, and hearing that I was in AFIB a lot of the time he wants to put me on metrolopol - 25 mg a day to control the rate and reduce stress on the heart. When I first heard this it made sense. Then I read a post in the LAF forum where metrolopolol was contraindicated for adrenergic afibbers. My cardiologist had not told me there were different varieties of AFIB. I'm not sure he knows the difference between adrenergic and vagal.

Anyway, when I saw him on December 4 I was just coming off a month-long period in November where my AFIB was the worst it had been in five years On some days in those last two weeks of November I estimate I was in AFIB 70% of the time. During November I was also on 12.5mg of metrolopolol a day as prescribed by my Family Practice doctor. I mentioned this to a heart surgeon, who is a friend, and he said a small dose of 12.5 mgs was like licking a piece of candy. However, it was during that time when I was taking that small dose in the month of November that my episodes escalated to the worst they had ever been. Even though I was also under a lot of stress, in hindsight I now suspect that even that small dose of metro may have contributed to AFIB episodes of increasing frequency and duration.

Since I have been on leave of absence from work in the past four weeks my episodes have gradually and, I think, significantly, diminished - from a peak of about 70% to about 20 - 33% of the time in the last week. By the way, I did quit taking the 12.5 mgs of metrolopolol just as I began the 'leave' on Dec. 1. The cardiologist new I was discontinuing the small dose. Again, at that time I did not suspect that the metrolopolol might have been a contributor.

I sent an email to the cardiologist's nurse practitioner with one of the posts from Hans describing how metro is contraindicated for adrenergic afibbers. Since I have read the "book" I have learned that it may be of some benefit for some mixed afibbers. But, I have doubts (and fears) that it will not work for me based on my past experience. I don't want to go through drug-induced episodes. Nevertheless, I'm not sure but that those most severe episodes might have been just stress-induced.

I followed up the email to the Nurse Practitioner with another phone call - informing her that I wanted to let the 'changes' I have made play themselves out for 6 - 8 weeks before trying the metrolopolol again. She 'seemed' amenable to that. However, today I received a letter from her, on behalf of the cardiologist, again, suggesting that I go on 25 mgs of metrolopolol with no mention of a 6 - 8 week trial based on diet, supplements and other changes. I suspeect the NP and the cardiologist may not be talking with each other.

One of the wrinkles which complicates this is that I am going to apply for temporary partial disability through the disability plan at work - which is somewhat progressive. I believe and hope that if I have some more time (and this is one of my questions below) that I can continue to reduce symptoms and establish a high enough quality of life through diet, supplementation and life-style changes that I won't have to be on meds. However, I also conjecture that the disability plan people are much more 'western medicine' friendly. And, their folks will be in touch with my cardiologist to determine whether I qualify. I am not sure about his attitude and knowledge of the disease and that, at worst, he may view me as 'non-compliant' and not recommend a temporary 'partial' disability to give me time to see 1) how I tolerate similar stresses while working at a similar job part time and 2) give the changes time to take effect.

So, I have two question - which I will pose below.

But, first, FYI here are some of the changes I've made in working with a young bright MD working in a wholistic center. The diet and nutritional supplements were her suggestions.

1) low glycemic load 'balanced' diet.

2) cut out caffeine, alchohol, aspartame, MSG, etc.

3a)120 mgs and 10 mgs calcium Magnesium glycinate 4 times per day(AM and PM 30 minutes before mealtime),

3b) CoQ 10 (120mgs) two times a day (Puritans pride brand),

3c) Vitamin E complex 1:1 ratio of alpha (400IU) and gamma (270 mg) tocopherols once a day (metagenics brand),

3d) Zy-zyme (zinc gluconate and aspartate) 1 tablet - 15 mg before each meal - chewed),

3e) B-12 sub-lingual two times per day before breakfast and supper (metabolics brand),

3f) Folate 800 mgs once a day in the AM (metagenics brand),

3g) Balanced B-Complex formula one time a day in the AM (metagenics brand,

3h) Fish Oil - EPA (600mgs)-DHA (400 mgs) 3 times a day 2 tablets after breakfast and 1 in the evening, and

On my own I have resumed:

1) regular slow stretch yoga,
2) regular moderate exercise,
3) moderate weight lifting (for toning and metabolism), and
6) wearing the CPAP machine.

My three primary questions are:

1. How to deal with the cardiologist?

Comment: (My plan is to talk with him directly and
a) see if he talked with the NP about the metrolopolol, ask him what he knows, and, if necessary, tell him what I've learned, b) check my plan out with him, and c) see if he's open (ie. compliant) to working with that plan.

2. How much time would you recommend I need to let these life-style changes have maximum impact.

3. And, as a follow up to number 2, would you recommend I be looking a temporary 'full time' or temporary 'partial' disability?

Comment: Work was clearly the primary stressor before I took the 12.5 mgs of metrolopolol. However, I've been in this job as a pastor of this congregation for nine years including the five years I've had AFIB, and it has only been in the last six months that the stress has escalated along with the episodes. I know I can't function as pastor of this congregation under the same circumstances. However, I think I can probably function OK if I am working part time - at least initially. But, I'm not sure. When a strong episode of AF hits I am extremely short of breath, and it's difficult to think straight.

I know this is long and drawn out. But, I'm at a critical point that can mean better management of the illness and a higher quality life in the years ahead.

Thanks for your help!

john

PS: At the cardiologist's recommendation I did have a stress-echo cardiagram on December 10, which, while it showed I was in AFIB after "strenuous" exercise (I was on the machine for 14 minutes while they ran it up to 11 minute miles), did not reveal any underlying coronary disease. It was after reviewing the stress-echo, the Holter, and my verbal report that he recommended 25 mgs of metrolopolol per day.

john

John - Welcome and very nice explanation of your strategy. Wonderful that you have a holistic doctor who actually recommends supplements.

First, metoporol is contraindicated for vagal - if you are mostly adregeneric, it seems not to be a problem. On page 83 of Hans' book, Drugs in Adrenergic LAF , he says..in a concluding statement:

"...there is a trend for some drugs to be beneficial for adrenergic afibbers. The most successful would apppear to be metoprolol (Lopressor, Toprol.)

If you don't own his book, I strongly urge youto order it now. With what you have planned and outlined here, you need to read it and understand it ...and you can show it to your doctors as well.


You have identified that you have job stress. Certainly, stress depletes magnesium. Join the crowd.

Afib after strenuous exercise can be an indication of magnesium deficiency, potassium deficiency or both along with other electrolytes including sodium.

Overall, I think your plan looks good - encouraging - A few comments though....

3a. The first thing that jumps out at me is the calcium in the magnesium supplement. Since you are using metagenics - why not see if you can use just the plain magnesium glycinate with no added calcium. Calcium tends to be excitatory to afibbers and supplementing with it (most of us have found) is not helpful. Also- I think you should work up to more than the magnesium numbers you were given... in the event you are deficient, at doses that are not at least 600 - 800 and often higher, you won't replenish enough not to remain deficient.

3d - don't take any form of anything that contains an aspartate or aspartic designation...since that goes to the aspartame derivitave. I'm sure you can find another enzyme to accomplish your needs here. And watch the quantity of zinc.... ask the doc again if that level is really okay.

I think the physical activity routine looks good. Don't push it, do as much as you feel good doing. Exercise is considered a form of stress so you don't want to undo the good your are accomplishing. But, exercise in moderation and as it seems right to do is a very good thing to actually reduce stress.

As far as talking to the cardiologist, I think that you may be disappointed in his response to the holistic approach you plan to take. I hope I'm wrong, but my experience is that most, don't think supplements help at all and want you to do the drugs. If you begin to sense that, it is better not to become stressed over it, but just store the information and continue on with your nutritional solution. You may need the cardiologist and you don't want to burn bridges.

Let us know how this goes.

This is a great support group. You've come to the right place!

Jackie

John - please be sure to read my post dated today about Cortisol/Stress/Magnesium...... it will be helpful to your situation as well.

Jackie

John

Metoprolol is a beta-blocker and is contraindicated for Vagal, not Adrenergic A-Fibbers. (P47 Hans' book) Metoprolol is most effective with adrenergic per Hans' survey (p. 83)

Most AFibbers are mixed (Dr. Coumel)

12.5 mg is a very small dose and is probably like licking candy. 25 mgs is also small and the cardiologist may want to know your reaction. Work with the cardiologist and worry about your health, not your insurance.

The regimen you mention seems healthy unless it produces worry and stress just trying to keep up with it. Relaxation techniques and prayer are effective stress reducers as I'm sure you've told others.

Good luck, Anton

John,

I would give 50 mg/day of TOPROL XL (time-release metoprolol) a try. It just might work for you. Make sure it is the time-release version though. Just 50 mg/day of regular metoprolol (Toprol) is likely to make things worse.

Hans

It is clear that the stress in your life is what is causing your problem.
The nutritional / supplementation program is great as long as you don't
obsess about it like many on this board do. I think that nutritional changes
benefit only a small minority of people and quite frankly, when I hear the
rigidity of the approach and the narrow range of foods that can be consumed, it is not worth spending months on a dietary change that will
probably have no impact on Afib. Take the supplements (esp. fish oil)
as part of overall good health plan. If you can stop coffee , that is good,
particularly if you are adrenergic. Alchohol seems to have greater impact
on vagal, so a stressed out person like yourself might benefit from moderate alcohol consumption. My suggestion is to spend a month or two
avoiding these things and getting used to the supplementation routine.
Then you can work some of the things that you like back into your life.
don't let Afib turn you into a food / drink obsessed person who looks for every possible trigger every time they put something in their mouth.
And if you find that once in a while, moderate coffee consumption kicks off
an episode, big deal. Too many Afibbers are obsessed about doing everything they can to see that they never have another episode agian,
which is likely impossible and not that big of a deal. The idea is to adopt
a non-stressed balanced lifestyle that hopefullly will reduce the frequency and severity of the episodes.

Kerry said "The idea is to adopt
a non-stressed balanced lifestyle that hopefullly will reduce the frequency and severity of the episodes."

Exactly what I did and guess what NO more AF. Why do you feel the need to poo poo strategies that work for others. A balanced life style which ommits foods that cause stress on the body is not rigid. In fact it is liberating - and I don't know anyone who has a narrow range of food. I think that perhaps I have a wider range of foods than most here - just don't eat grains etc - but that only omits bread, biscuits, cakes, chips, crisps and processed food etc. I probably have a wider range of foods than all of you and probably eat foods that perhaps you have never even heard of.....

It seems with your negativity you have a long way to go to combat your own stress levels...... You have built a box around you and are now constrained by its walls.....

Sorry if this is cheeky - but I take snipes from you all the time.

Fran

Again, thanks for the responses: the clarification regarding Toprol XL (I will give it a try), the observation around the calcium in the magnesium glycinate, striking a healthier balance, and the caution not to be to 'obsessive about it all.

John

Hans...the Toprol XL was great in my case...after my ablation it has kept everything 98% under control