Dang It

After many months of good control, I'm back in Afib. I had an adrenegenic episode this past Wed., and today I've been in and out of afib, set off by indigestion. I'm back on the Magnesium; taking Mag. Glycinate, but even 100mg of that is giving me horrible gas and diarrhea. Potassium intake has been good.

I have Medicaid, and as such, the docs are not of the best caliber. I want to stay out of the ER if at all possible; they swing the hammer and they swing it hard...half the meds I received during last year's initial attack were unneeded, according to the cardiologist who did my follow-up visits before my insurance changed (he does not take Medicaid, and I would not trust a Mediacaid cardiologist anyway).

Any quick tips to get this thing to settle down. Walking around seems to help, as did bouncing my newphew's soccer ball on my knee when he was over earlier today, which tips me off that this current bout may be vagal in nature. I would love to be able to sleep tonight, so any input anyone may have will help. Every time I've eaten today, it has set off another round of irregular beats. Would love to be able to stop walking around and to sit for a change. I'm getting tired.

Today's bout started in the shower; had a premature beat that took my breath away momentarily and it's been downhill ever since with periods of relief.

Heart rate is normal; not elevated in any way..hanging out in the high 6os/low 70s, which is normal for me. I took 25 mg. of Lopressor during Wednesday's episode due to the high heart rate and converated back to NSR within 30 min.

Any input or reassurance will help. I've noticed today that sitting bolt upright in a chair quiets things down, but the minute I eat or settle back more comfortably in my chair or in bed..bam! it starts up again. I want some sleep tonight.
***I know people mean well, but ablation is not practical for me. Would you want a MedicAid doctor to ablate you? I didn't think so, so please don't suggest ablation. I will jump off that bridge when and if I get to it. Thanks.**

Thank you!

I live alone, so there is the fear element too.



Edited 3 time(s). Last edit at 09/01/2014 04:15AM by Kittymama.

Only thing that worked for me was ablation or Flec PIP which use was getting more frequent. So I had ablation. Does Medicaid cover it?

MedicAid covers dirt-basic medical care, and whatever "specialists" they have are bottom of the barrel. Hardly the caliber of doctor I would trust with any aspect of my medical care. My MedicAid network is affiliated with some of the worst hospitals in my region, yet another reason to stay away.

I was defaulted onto MedicAid by way of the ACA; definitely not my first choice for coverage. Hoping to have a better year so I can get some real insurance.

The reason for tonight's post is I'm looking for ways to get out of this current episode that started this a.m. I have a beta-blocker as PIP (no flec as medicaid wouldn't cover the hospitalization required to test the drug on me and make sure it doesn't do more harm than good). Beta-blocker tonight would lower my heart rate too much since it is already in the mid-60s.

What often worked for me was to load up on trace minerals with the potassium. I used concentrace ionic minerals. Sometimes I combined it with ionic magnesium and the potassium. If you don't have the minerals, I've also had some success with making a cucumber/ celery juice.
Hope you feel better.

John

I don't think beta blockers work with AF, at least most of the time. Before I used the PIP I would sometimes be able to get out of AF doing a spell on the exercise bike, or taking a swim, but it didn't always work. If you were in Massachusetts I know Mass General takes Medicaid and they have a good EP Lab - maybe the same in some other states with good EP hospitals.
But that may not be much help as Medicaid is a joint Fed-State program without the flexibility of Medicare to go where you like.

btw I don't get why you would need a hospital admission for Flecainide? I certainly didn't. While it can be proarrhythmic not all prescriibing doctors require a hospital stay.



Edited 3 time(s). Last edit at 09/01/2014 02:10PM by afhound99.

I don't think ablation is warranted for me a total of three episodes of AF, and please remember this. I am no hurry to consider ablation, especially since I lack the financial and social resources to ensure a safe procedure and a smooth recovery. Methinks that doesn't hold true for some on this board.
Also remember that MedicAid varies from state to state. California's form of MedicAid, Medi-Cal, is frought with fraud, abuse, and poor-quality doctors. Hoping my earnings this year are enough to boost me out of the ranks of Medi-Cal.

I had flec confused with Tikosyn, the latter usually requiring a hospital stay to make sure the stuff doesn't kill ya.

Thanks, John! I made good use of my juicer last night and juiced just about everything in my veggie drawer and got a huge hit of potassium that way, along with oral Mag. glycinate, 100mg. The latter really gave me GI hell, but things are quieter today.

My neighbor, a retired CCU nurse, suggested I grab an ice pack and place it on my upper chest and throat (good for vagaleps.) and believe it or not, it calmed things down. I was impressed!

Sometimes the best and least harmful remedies can be found in our refrigerators and cupboards...

This is from the Europace study 2011 Journal:

"In AF, oral flecainide should be administered in a hospital setting with
rhythm monitoring, starting at 50 mg BID and increased by 50 mg BID
every 4 days until efficacy is achieved. After administration of
flecainide heart rhythm should be monitored for at least 8 h but
physicians should check their local guidance for mandatory
hospitalization during titration. The maximum recommended oral dose
is 300 mg/day."

I think that advice should be taken, although a Cardio i saw a few years ago told me to take 300mg at home. Well, it's not him that would have to suffer the consequences if there was to be an adverse effect. My GP told me to call the ambulance and take the pill in hospital.
Also a Registrar in the E.R. room made me blow into the end of a syringe barrel. He said to try to blow the plunger out of it! Surprisingly that slowed my heartrate and made the disrythmia much less severe.

@John: That ER registrar had a great idea. I have some straws around here somewhere that I will keep on hand.

Re: flec. In my readings, it's been stated that flec is nothing to mess with, especially for women. We have a longer QR (or is it QRS?) interval, which makes introducing an anti-arrythmic drug a bit trickier since some of them tend to mess with that interval. Scary stuff indeed. I knew a trial hospitalization with needed for titrating Tikosyn, but I had no idea for Flec. Thanks for the link to the study!

Being that I have crappy insurance with even crappier doctors, most of the time I'm left to navigate this wilderness on my own. My Medi-Cal panel has only one EP, and she has under 10 years under her belt at that. I'd be better off on my own. Cookie-cutter medicine at the hands of an inexperienced EP? Double the danger.

Kittymama,

Im sorry to hear of your challenges finding and affording good care, that is a tough situation for sure. Don't give up looking for a good doc as in time you will likely find one who can help you even if just in better management of your AFIB. Keep a positive outlook and take it one step at a time and you just never know when the door opens to something unexpected. That has been my experience through a long road of roller-coaster challenges as well.

In the meantime you noted you get gas and GI issues from oral magnesium What kind of potassium are you taking or is it solely dietary? Potassium gluconate powder typically is easier on the stomach and keep in mind the actual IC potassium levels can vary widely intraday.

I recommend buying a good topical magnesium formula to spray and rub on the skin and soak with in a small foot bath or in a tube for a full body soak with warm water around 105 degrees F max ( too hot and it will close your pores and not allow as good of absorption) .

'Ancient Minerals' is a good brand and they have number of formulations of it for spray on or as mag flakes for putting in soaking baths. But my favorite is from Magnesium Infusion which is highly absorptive as a spray on topical with Magnesium Chloride Hexahydrate form which is more assimilable than any other form of topical magnesium and really does soak into the skin quickly after spraying around 20 to 25 spray on your torso and upper body or inner thighs and then rubbing in briskly for 30 seconds or so. Within a minute or two max it is full absorbed and leaves no sticky or tachy residue.

As you will see in the link, it comes in a small 125ml spray bottle and you should also buy several of the larger 500ml bottles to refill the small 125ml spray bottle with and occasionally put 2 ounces of the liquid into a small warm footpath like the kind you can get at drug stores like Walgreens or Longs in California. When doing a full soak bath you would want around 4 to 6 ounces. It might be more economical for full bath soaks to use either the Ancient minerals or even epson salts readily available at any pharmacy, but the Magnesium Infusion from Activation Products is a superior form of topical magnesium for spray on.

I recommend 25 spray in the morning right after you shower and then another 15 to 25 spray in the evening just after a quick evening rinse in the shower before bed.

This will help bypass the GI issues you are having and greatly improve magnesium IC absorption which could possibly make a huge difference for you at your stage of this condition with still more basic paroxysmal AFIB that doesn't seem to have progressed a great deal yet.

Insuring either with that method or getting IV magnesium at 2 to 4 grams Magnesium Sulfate combined with a Myers cocktail at least once every two weeks for the first couple months and then perhaps once a month for the next few months along with liberal uses of daily topical magnesium could really help not only restore you likely deplete IC magnesium levels if you can only tolerate 100mg orally per day, but will also greatly help make potassium a better help in quietening your ectopics and arrhythmia triggering sensitivity as well.

Potassium only works well for quietening the heart in the presence of sufficient IC magnesium and taking in too much potassium with a low overall IC magnesium level can be pro-arrhythmic for sure.

Also, add in supplements like L-Theanine and such to help with adrenaline reduction and stress reduction and if you do not do yoga or meditation or some other forms of good calming relaxation such as Tai Chi of Chi Kung, even palates etc, those could be a big help as well as regular additions to your everyday life.

Avoid all the triggers you know of, obviously, and just work on reducing systemic inflammation as well with the various good supplements which are focused on addressing such wide spread inflammation.

Those steps could well help you regain many more of those calmer periods you had not too long ago, at least for a good while.

I agree too you are not ready for an ablation anyway with the relatively few and infrequent episodes you have had. You will likely have to get much further down the line before your feelings about ablation begin to change. I was very much like you for many early years and would not even dream of an ablation and did everything under the sun to avoid one for at least 4 or 5 years longer than was in my best interest.

At some point, if and when your episodes become more frequent and longer duration with increasingly intolerable symptoms, Ill be willing to bet your attitude towards considering an ablation as the best step for you will take a 180 degree turn. Hopefully, you will never get that far and will find a natural formula of living that will keep things well under control for your for the long term Kittymama.

And if it does become more progressive at some point, as this beast of a condition is so apt to do, I really hope that your financial or insurance situation has improved enough by then to widen your options to include all those choices that might then truly be your best bet for the long term.

Best wishes,

Shannon



Edited 2 time(s). Last edit at 09/03/2014 03:45PM by Shannon.

HI Shannon-

I was taking 1 tsp. of potassium gluconate powder in addition to eating potassium-rich foods. Problem was I went hypotensive from the postassium. Was taking 100mg oral Mag. glycinate (Dr.'s Best) and tolerating it poorly, so I've started with Epsom salt footbaths and am looking at topical mag. Wish I could IV infusion every couple of weeks, but the cost is astronomical and my crappy insurance won't even dream of covering it, unless delivered as part of an ER visit...go figure.

I went thru my symptom diary, and hot weather tends to set things off: I must have sweat out any electrolytes I was taking in via food sources, etc. My stress level has also been off the charts, and that doesn't help. Last week's episode was adrenegenic (job interview, wearing a suit, hot office, hot weather, lots of stress) and Sunday's episode was more vagal in nature and was more of a bear to convert. Feeling better physically but am wrung out emotionally.

Converted to NSR with a beta-blocker for the adrenegenic episode last week and Sunday's vagal episode finally calmed down on its own after walking around, etc. Fortunately, I stayed with a neighbor during that episode. Hoping to stay the hell away from the ER; they tend to swing the hammer a little high for me. (Drug-sensitive to many medications).

Thanks for your insight and input; I will take a look at the link you gave me.

"I don't think ablation is warranted for me a total of three episodes of AF, and please remember this. I am no hurry to consider ablation"

Got it, sorry. I wouldn't think about it either if you just had 3 episodes .... especially if infrequent and far apart..



Edited 1 time(s). Last edit at 09/03/2014 03:51AM by afhound99.

Hi Kittymama.
If you are getting hypotensive directly from 1 teaspoon of K Gluconate and 100mg of magnesium glycinate it could be you have very low sodium and potentially low aldosterone.

DO you feel dizzy or lightheaded often after standing up quickly or do you notice that when stanind or sitting upright ( like at a a computer for hours) that your mind thens to go a little blank and you get foggy headed and feel the need to lay down? Also do you have to pee frequently shortly after drinking a glass of water?

These are just a few of the possible signs of an adrenal deficiency of which sodium depletion and low aldosterone 'could' be a manifestation of. In addition such adrenal insufficiency can also very much predispose to AFIB when periodic low dips in cortisol levels too can trigger an increase in adrenaline release as a fall back hormones used for back up stress reduction, and with your heavy stress you report that raises another red flag for a possible association here.

In any event not only will such periods of big dips in cortisol and/or aldosterone levels tend to crash blood pressure and lead to increased spikes in adrenaline ( think isoproterenol which is an adrenaline-like drug used to trigger AFIB during an ablation), but low cortisol periods will also increase the conversion of your thyroid T4 hormone, which is the inactive storage form of the cellularly bio-active Thyroid T3 hormone, from T4 too rapidly into spikes of T3. T3 spikes or excesses, even temporarily can, on their own easily trigger AFIB/Flutter and when combined with periodic increased spikes of adrenaline , such an adrenal insufficiency scenario, which is far too common can easily trigger AFIB.

Don't let you sodium get too low and just keep your potassium intake at 4 to 1 above an solid level of sodium intake too should you be found to have weak cortisol/aldosterone output..

Shannon

HI Shannon-

What you said makes so much sense! I felt much better and wasn't hypotensive when I dc'ed the K gluconate. Made a world of difference.

Unfortunately, MedicAid's idea of a thyroid test is the TSH level, which as you know, is only part of the story. They won't cover a T3 and/or T4 draw, which is just stupid and short-sighted. I could grab the bloodwork through RequestATest.com, but I don't have the cash resources. Would also love to get cortisol and aldosterone levels tested because my stress level has been off the charts the past few months...either physiological stress (hot weather is my enemy) or emotional stress.

Fortunately, I don't get dizzy or lightheaded when rising quickly ever since I dc'ed the K gluconate. I was on it for about three weeks before I realized I was hypotensive; went off for a awhile and BP went back up to a nice normal for me: 115/65 or thereabouts.

The cortisol dips could also explain the out-of-left field panic attacks over the past year...I had never been prone to them before then.

Lots of interesting information and a much easier approach than just jumping on meds; I have a very low tolerence for most meds and get ill from a "normal" adult dose. Would rather approach things metabolically, as decribed above.

Thank you, thank you for the valuable input. I had some spare cash squirreled away for blood work not covered by MedicAid, but one of the companies I work for (I have two jobs) just drastially cut everyone's hours, so available resources are going toward the basics right now :/

At any rate, thank you again for this info. Printing it out and putting it in my file.

You are welcome Kittymama.

Best of luck on sorting it all out, the key is hiking up with a good integrative or functional medicine doc who is fellowship trained in BHRT ( bio-indentical hormone replacement therapy) to help you in sorting this all out.

I know the sad story with TSH-only or TSH + Total T4-only testing all too well. The thing is, if you can just get most thinking docs to listen to the obvious physiological rationale behind more comprehensive thyroid and adrenal testing and treatment and are able to get them to at least try it on some appropriate patients, it almost always causes a true revelation in their view of all this and can often break open a whole new appreciation of getting back to the basics of core biochemistry and physiology first and foremost in their diagnostic and treatment protocols.

Fortunately, there is an every increasing number of smart MDs from most every specialty that are wising up and learning to add these essential protocols and learn how these hormones and nutrients properly, such as at the large BHRT conference in Phoenix I will be at next week.

Best wishes,
Shannon

Unfortunately, BHRT is out of the question...it is WAY beyond my means, and Medi-Cal doesn't have any BHRT docs. It's a luxury I can only think about. It's the approach I've been wanting to use all along, but my eyes are bigger than my wallet.