Eliquis and my new Cardiologist.

Re: Eliquis and my new Cardiologist.

NotLyingAboutMyAfib — Thu, 16 Jul 2020 13:03:24 +0000

Smackman - I have been through 7 cardiologists in last 2 years. After realizing and backed by the science, that they are the most inept and ignorant of all of the American disease management systems white coat clowns.

EG - 1st cardiologist never followed up on 2015 245 CAC score.

Same group prescribed statins that are proven to accelerate plaque accumulation.

Never addressed primary issues that likely led to AFIB and atherosclerosis in the first f'ing place.. hyperglycemic and hyperinsulinemic spikes!

Said "lifestyle change" but never discussed in detail but only referred to RDs that gave guaranteed to fail 50% carb med diet advice that wouldn't address T2.

Since then - just monkey standard of don't care medicine from every cardiologist I've come across. Current one argues for statins 90% of visit, says CAC regression is impossible (yet there are my 2 scans) and advises a Loma Linda vegan diet which is essentially what put me here in the first damn place.

So don't worry about pissing off a cardiologist. They all need Clockwork Orange style retraining.

Re: Eliquis and my new Cardiologist.

susan.d — Fri, 26 Jun 2020 14:02:43 +0000

You cannot get into Los Robles hospital without a mask. There is a non-social distancing line at the entrance which is a risk. 2 staff workers sit next to each other at a makeshift card table taking temperatures without social distancing among themselves. I was there 4 times during the past 45 days during my two recent ECV (testing one day, ECV the next). However social distancing among staff is pitiful. Nurses and doctors take their masks off when they are among themselves as well but put the masks back on when near patients. Masks are not 100%. Many medical staff have had gotten COVID in the world even when protected by a mask without symptoms. Masks cuts down on covid19 but it isn’t fail safe. I asked a few nurses in the Cath lab when was their last covid19 test? They laughed and said never. The admitting department is strict however and they wipe down the patient tablets between patients.

You don’t know from janitorial to food prep if hospital employees have visited the nearby beaches or malls or practiced social distancing off duty and didn’t wear a mask. The following is a link to the effectiveness of mask types. I feel there are risks.

[filti.com]
Cotton masks are only 2.5% effective -if for example you are near others at public gatherings who are not wearing a mask.

Re: Eliquis and my new Cardiologist.

ggheld — Fri, 26 Jun 2020 12:51:57 +0000

Susan. Thousand Oaks is 30 miles from Ventura beaches by Freeway. The majority of the LA population that go to Ventura or beaches North of Ventura live less than an hour inland from Thousand Oaks so there's no reason for them to stop on the way.
If you don't stop on your way to Los Robles I'd think you'd be safe from that worry as I'm sure you can't get in the hospital without a mask.

Re: Eliquis and my new Cardiologist.

susan.d — Fri, 26 Jun 2020 04:38:29 +0000

Can’t happen. I’m a human zipper for surgeries plus I get regular colonoscopies. Your logic only applies if I get my last surgery and colonoscopy in my lifetime before a LAA ablation.

I’m scheduled in 20 days but my son alerted me on the spike of covid19. Its a 69% spike increase in 2 days. Also Los Robles hospital is near the beach and people trek from Los Angeles to Ventura County, CA spreading the virus...so even a sleepy town like Thousand Oaks is showing a spike.

I don’t see many wearing masks. If they don’t like a mask, they will hate a respirator.

Re: Eliquis and my new Cardiologist.

Carey — Thu, 25 Jun 2020 21:48:02 +0000

As I mentioned before, you should definitely get all needed surgeries and procedures done BEFORE doing an ablation that might leave your LAA isolated.

Re: Eliquis and my new Cardiologist.

susan.d — Thu, 25 Jun 2020 16:02:47 +0000

Quote
Carey
The trouble is, even having that protocol doesn't mean a doctor will be willing to follow it. I've heard from a couple of patients who had surgeons refuse to do procedures despite having the protocol sent to them directly by Austin.

This is why I am very scared to go through my ablation scheduled in a few weeks. I just cannot see myself getting my LAA isolated. From experiencing my family (father having 14 strokes, brother 7, mother etc,) all dying a shell of their former lives and dignity— drooling and losing their control to inexperienced caregivers, I fear the odds of a stroke since I have to have future surgeries and procedures and will be at the mercy of iatrogenic medical staff who is not as experienced and knowledgeable as Natale in the proper bridging and in the future when I am old and decrepit to the mercy of caregivers being compliant in Eliquis dosing.

Re: Eliquis and my new Cardiologist.

Carey — Thu, 25 Jun 2020 14:19:01 +0000

Sure, emergencies are a different thing. Nothing you can do there other than make the doctors aware of your risk factors and hope for the best.

Re: Eliquis and my new Cardiologist.

smackman — Thu, 25 Jun 2020 13:20:58 +0000

It’s more than possible that the emergency means NOW. Unfortunately, I have seen several surgeries that had to happen immediately such as a blockage In the digestive system. So everyone does not have the luxury of going from Hospital to Hospital.

Re: Eliquis and my new Cardiologist.

Carey — Wed, 24 Jun 2020 19:52:19 +0000

With an isolated LAA and low flow velocity, I wouldn't consider stopping Eliquis for even a single day. If the procedure was truly necessary and the doctor refused to follow the bridging protocol, I'd find another, more reasonable doctor. If I had to drive 100 miles, so be it. We both flew to Austin to obtain the best, so a two-hour drive is nothing.

Re: Eliquis and my new Cardiologist.

smackman — Wed, 24 Jun 2020 19:07:12 +0000

Quote
Carey
The trouble is, even having that protocol doesn't mean a doctor will be willing to follow it. I've heard from a couple of patients who had surgeons refuse to do procedures despite having the protocol sent to them directly by Austin.

BINGO! My point from the beginning. I guess my method of communication was subpar. The Question then becomes what does one do? Give in and possibly have a stroke or refuse the procedure/ surgery which could be a life threatening condition.

Re: Eliquis and my new Cardiologist.

Carey — Wed, 24 Jun 2020 18:03:42 +0000

The trouble is, even having that protocol doesn't mean a doctor will be willing to follow it. I've heard from a couple of patients who had surgeons refuse to do procedures despite having the protocol sent to them directly by Austin.

Re: Eliquis and my new Cardiologist.

smackman — Wed, 24 Jun 2020 16:50:43 +0000

Most individuals who go to the emergency room will be appointed a Cardiologist not a EP when coming for Arrhythmia issues. In Monroe, Louisiana I believe there is one EP in the city of almost 100000. This Cardiologist visit was my 1st visit since my 2nd Ablation with Dr. Natale. That was in 2016. I had stop going to my Cardiologist in Monroe because he would take everything so personal if I just mentioned Dr. Natale. I just could not deal with him anymore. His 1st line of Defense for someone in AFIB was Amiodarone, Beta blockers and blood thinner. I would have NEVER knew how bad Amiodarone was if I had not stumbled on this website. Shannon actually took my wife and I under his wing and it was a Godsend.
No one should be put on Amiodarone as a 1st line of defense IMO. My left arm turned grayish blue and I would swell in the sun. Bad 💩.
My knew Cardiologist is out of Shreveport, Louisiana which is a city of 300000. He seems to be sharp and listens but he firmly believes different than Austin on the necessity of bridging. I will always put Austin 1st unless some emergency came up where I would not have a voice due to injury etc. At this point, You are under the protocol of that Hospital. I believe Austin should give LAA ablated individuals the proper info to have on file so the bridging technique will be used.

Re: Eliquis and my new Cardiologist.

wolfpack — Wed, 24 Jun 2020 01:07:15 +0000

My cardiologist admits he doesn’t know much about AF ablation at all. He won’t really listen to what I have to say, but he won’t argue with it either. Last office visit we had a conversation about how best to use expired metoprolol and propafenone as rodenticide. :)

Docs not being current is common. Not listening is also common. Like Carey said, you’ve got to manage the situation. And best to have a great partner or advocate to be able to do the same for you in any sort of emergency situation.

Re: Eliquis and my new Cardiologist.

Carey — Wed, 24 Jun 2020 00:11:06 +0000

Quote
smackman
I listen to my EP’s in Austin but I do wonder why there is such a big divide on what to do.

Because LAA isolation is actually a relatively new approach that most surgeons, PCPs, and even most EPs have never heard of. They heard nothing about it in med school or even during their residency and fellowship, so unless they're an EP who keeps up-to-date with the leading edge ablation literature, they still haven't heard about it and don't understand the risks. That's why your local EP is so sure of himself. He fancies himself a well-trained, up-to-date EP (and he may well be), but here you are telling him you're special and he needs to use some fancy bridging procedure that doesn't fit with his understanding of AF and ablations. So he writes you off as a patient who simply didn't understand what you were told by Natale. Yes, that's arrogance. He should have gone back to his office after your visit and read up on the literature, but we know many docs don't have that level of humility.

This is a great case study in why you have to be the most educated person in the room about your medical conditions even if it does annoy your doctor.

Re: Eliquis and my new Cardiologist.

smackman — Tue, 23 Jun 2020 22:02:54 +0000

Quote
Jake
I had surgery, listened to the surgeon, went off Eliquis, had a stroke before I could start taking it again.[/quote
Was the surgeon the EP that Ablated you? Has your LAA been isolated? I know what my Cardiologist says but my EP Dr. Natale says to Bridge. I listen to my EP’s in Austin but I do wonder why there is such a big divide on what to do. This Bridging Technique needs to be made available freely and a explanation of WHY so someone who is Ablated in Austin goes home 12 Hours away can have a little confidence in there local EP’s recommendation. What does one do in case of a emergency and a family member must make the decision for you? They will listen to the instructions of their local Hospital because there is no way they would know better. It can be a scary situation. Most Ablated in Sustin never return to Austin after the TEE and most do not know about this Great Forum.

Re: Eliquis and my new Cardiologist.

smackman — Tue, 23 Jun 2020 21:52:19 +0000

Quote
PC, MD
Smackman,

Please visit last entry here

Agree to Disagree. My facts are real not statistics. My Wives Arrhythmia’s started 11 weeks after taking 50k iu of Vitamin D a week 1X a week. She never had issues before and the Arrhythmia’s stopped approx 2 weeks after stopping the 50000 iu a week. Our Cardiologist agrees. Also our Primary Physician agrees there had to be some “there there”.

Re: Eliquis and my new Cardiologist.

Jackie — Tue, 23 Jun 2020 15:06:40 +0000

Carey - Thanks for your statement: The consensus now is that AF and AFL are themselves a form of heart disease known as atrial myopathy.

When I was reviewing my AF onset history and the treatment of symptoms I was having prior to my first AF event, the myopathy symptom I had presented as extreme leg muscle fatigue, pain and weakness eventually was found to be the result of a severe Vitamin D deficiency determined by testing. However, prior to the Vitamin D testing, I was referred to a Rheumatologist who ordered EMG and muscle biopsy evaluations and then, prescribed various meds to mask the pain but (obviously) did nothing to address the core cause which remained unknown. I changed to a new primary care MD who tested Vit. D and I began therapeutic restoration of Vit. D levels and I also had my I had my first AF event... so the atrial myopathy would seem to confirm that connection.

I was able to reduce the frequency of the early-stage AF as the D levels began to reach therapeutic range. . I began with D levels of 18 ng/ml and when I reach 32 ng/ml, I started feeling 'human' again but I didn't actually feel healthy until the level was 50. My MD wanted my level to be at least 60-65, so I kept dosing and eventually found that I needed to take 10,000 IU Vitamin D3 in the winter months and could lower to half that in the warmer, sunny months… as I live in NE Ohio. (And along with that, eventually came the info about using the K2 MK7 to avoid the soft tissue/arterial calcifications that can occur with elevated Vit D dosing.)

Jackie

[www.ncbi.nlm.nih.gov]

Re: Eliquis and my new Cardiologist.

Jake — Tue, 23 Jun 2020 14:57:19 +0000

I had surgery, listened to the surgeon, went off Eliquis, had a stroke before I could start taking it again.

Re: Eliquis and my new Cardiologist.

PC, MD — Tue, 23 Jun 2020 01:57:50 +0000

Smackman,

Please visit last entry here

Re: Eliquis and my new Cardiologist.

Elizabeth — Mon, 22 Jun 2020 20:22:08 +0000

Carey said:

By the way, I put "lone" in quotes because it's no longer an accepted term. The consensus now is that AF and AFL are themselves a form of heart disease known as atrial myopathy.

results in electrophysiological and anatomic remodeling of the atria.” (12)

Most of our mechanistic understanding of the atrial myopathic state comes from research conducted either in animal models of AF or from examination of tissue removed from patients with a history of AF. In 1997, Zipes (12) first used the term “atrial myopathy” to describe that AF can lead to myopathy through atrial remodeling. The past 2 decades have seen the concept of atrial myopathy evolving. Several recent studies have demonstrated that the relationship between AF and atrial myopathy is more complex. For example, atrial myopathy may exist without AF and can facilitate the development of AF (13). Anatomical or structural changes, particularly fibrosis, play a major role i

Re: Eliquis and my new Cardiologist.

susan.d — Mon, 22 Jun 2020 17:52:16 +0000

Thank you Carey for educating us

Re: Eliquis and my new Cardiologist.

Carey — Mon, 22 Jun 2020 14:32:01 +0000

Quote
susan.d
Carey does flutter count as “lone AF? What about one time history of dvt?

Flutter (AFL) is generally equated with AF and treated the same. But what makes it "lone" is the absence of other forms of heart disease; eg, heart failure, valve disease, CAD, etc. So if you have AFL and no other heart disease, that would be considered "lone" AF. DVTs can be caused by a number of things, including simply prolonged sitting or lying, so they don't really figure in. A DVT can't originate in the atria.

By the way, I put "lone" in quotes because it's no longer an accepted term. The consensus now is that AF and AFL are themselves a form of heart disease known as atrial myopathy.

Re: Eliquis and my new Cardiologist.

susan.d — Mon, 22 Jun 2020 06:22:17 +0000

Carey does flutter count as “lone AF? What about one time history of dvt?

Re: Eliquis and my new Cardiologist.

Carey — Mon, 22 Jun 2020 04:29:04 +0000

Quote
susan.d
I notice there is no score if you are over 65. I thought that counted as one point. I thought I scored 3 points- age, gender and high blood pressure. According to this link I score 2 not 3.

Clicking age >= 75 gives you 2 points, but clicking age 65-74 gives you 1 point. Note that the two are mutually exclusive. You can't be 65-74 and also be >= 75. So if you click one of them, the algorithm unclicks the other one for you. Not how I would have done it, but that's how it works. I tested it and it works correctly if you answer all the questions correctly. You get a total of 3 if you're >= 75 and have hypertension, or 2 if you're < 75 and have hypertension.

And it's worth noting that under the 2019 revised guidelines, you can ignore the point for being female if your only issue is "lone" AF.

Re: Eliquis and my new Cardiologist.

susan.d — Mon, 22 Jun 2020 01:02:58 +0000

If you go to the link I shared above and click “calculate”, you will see your % risk.

I notice there is no score if you are over 65. I thought that counted as one point. I thought I scored 3 points- age, gender and high blood pressure. According to this link I score 2 not 3.

Re: Eliquis and my new Cardiologist.

Carey — Sun, 21 Jun 2020 19:42:11 +0000

CHADS-Vasc has been shown to be a better predictor of stroke risk, particularly with those who score 1 on the CHADS2 test. There's really no reason to even use CHADS2 anymore.

Re: Eliquis and my new Cardiologist.

Ken — Sun, 21 Jun 2020 19:29:39 +0000

Thanks Susan,

I have seen both CHADS2 AND CHADS-VASC scoring for afib. Why both? Which is most common?

Re: Eliquis and my new Cardiologist.

susan.d — Sun, 21 Jun 2020 15:48:32 +0000

Quote
Ken
What's the difference for afibbers between CHADS2 AND CHADS-VASC scoring?

I am now 75, so I get 2 points on CHADS-VASC and 1 point on CHADS2.

Ken, I hope this helps:
[clincalc.com]

Re: Eliquis and my new Cardiologist.

Ken — Sun, 21 Jun 2020 14:20:43 +0000

What's the difference for afibbers between CHADS2 AND CHADS-VASC scoring?

I am now 75, so I get 2 points on CHADS-VASC and 1 point on CHADS2.

Re: Eliquis and my new Cardiologist.

susan.d — Sun, 21 Jun 2020 13:43:21 +0000

Thank you Carey for your reply and George for this excellent paper link. The article states 27% of AF originates from the LAA while 91% are successful with having their LAA isolated—those who had positive flow and went off OAC and had zero strokes compared to those who had their LAA isolated and poor flowing resulted in having 1.7% strokes while on OAC. There is still a risk while on OAC. This data is useful for one who may jump into the ablation without much thought.