Recent (probable) TIA

I was diagnosed with a-fib in November 2010. I quickly found this website, subscribed, and read virtually everything. I used a variety of supplements and experimented with my diet. I felt my pulse regularly and used a blood pressure monitor which also measured my pulse and irregular heartbeats. I had a number of recurrences since, or added symptoms, and would go to the emergency room whenever it got too alarming. (I've learned to hate the emergency room - as well as the hospital rooms I'm occasionally admitted to!) My cardiologist (one of several over the years) prescribed metoprolol - 50 mg twice a day - plus daily baby aspirin. I thought I knew more than him, and took 25 mg twice a day, then 25 mg daily, then none at all. I even stopped the baby aspirin. Anyway, to make a long story shorter, last year, after I noticed my blood pressure was sometimes too high, as well as the fact that I had a lot of readings with irregular heartbeats, I started the baby aspirin again, and the metoprolol - but only 25 mg daily. The metoprolol usually worked at bringing my blood pressure down, as well as my pulse, but didn't help that much with the irregular heartbeats. Last Sunday, a few hours before the Super Bowl, I was on the phone and, after raising my voice, felt the phone drop to the ground. Amazed, I tried to pick it up, and finally did, while struggling to put it back on the receiver. I then wandered around my apartment, bewildered. (I live alone and am 61 - can't believe it but I am; I was just 21.) I felt my right hand and it was totally numb. It seemed my right side was numb (at least the part I felt), but not my left side. I realized I had to get to the emergency room and, after sitting down on my bed for a few minutes, finally got up and managed to get out the door (actually several doors) to the yard, where I staggered around, finally meeting a neighbor who called 911. I won't go into the ambulance ride, except to say it was very frustrating. They kept asking me questions, one with an attitude, even though it was obvious I couldn't say much. I could only talk out of the left side of my mouth, and the words were all garbled. I could think pretty clearly; I just couldn't say much. At the emergency room, the episode resolved with 2-4 hours and I was talking normally again. After I was admitted (many hours later), someone told me they were going to do TPA on me but saw it was reversing and didn't. I had a CAT scan and MRI over the next few days, as well as an EKG and (I seem to remember) some other tests. Everything was negative, but they inferred it was a TIA anyway and my cardiologist finally came and put me on Amiadarone, Xarelto, Metoprolol, and baby aspirin. (At the beginning, there was some Plavix too.) Most of the week (Sunday night until Thursday), they had me on a Cardizem drip (I.V.), which annoyed me no end. I was tethered to this machine and had to stay in bed all day, which made them inject me with Heparin to prevent leg clots. One alarming thing, among others, was that my heart rate varied from 90-130+ all week, even when lying down, and one of the nurses told me I was in almost continual a-fib. Sometimes, she said, it would stop, but not for long. This, I believe, was the background for my "TIA." Silent a-fib. (My cardiologist once told me that 90% of a-fib is silent. I wish I believed him at the time.) So it may not have been the raised voice of the phone call, or some additional tension I had been feeling that weekend. If this is true, then maybe I've been in silent a-fib more or less continually since 2010/2011. Or, at least, in the last year. The Cardizem drip didn't seem to help. (Nor did the attitude of the nurses and doctors. Jackie - that's something I'd like to ask you about sometime - the attitude of the personnel at hospitals. Not just nurses, of course, but they can be very patronizing, talking to you (or me) as if I was a child. Maybe they're just feeding off the attitude of the doctors. One nurse, after giving me the little packets of pills I mentioned earlier - didn't like me reading the labels. "Do you think I'm lying?," she asked me. Incredulous, I said no, but I wanted to know what they were, the dosages, etc. Why I even had to explain this to her I didn't know, but I was ill and wasn't in a position to argue. The directions said the pills should be eaten with food, and I hadn't eaten in over an hour (8:30 a.m. breakfast; 10:00 a.m. pills), so wouldn't it be better to eat something first, I thought. She took them away, saying that she'd get in trouble if she left them there. Another nurse came in, we talked, and I did end up taking the pills. She said I don't have to eat a lot; a protein bar would be fine.)

I went home late Thursday afternoon, very happy to be out of the hospital. Yet, over the next few days, I've had a lot of difficult thoughts about the past week, as well as the past 3+ years, and need to share them with someone or I may go out of my mind. I'll highlight my worries, because I don't want to make this too long for you to read, but I do need to discuss them with someone.

1) Xarelto is a pretty new drug (only 1-2 years old), so there's no generic form yet. There's no antidote for it (my cardiologist didn't tell me this - why?), and what if it ends up being like Pradaxa? How do I know what it will really do (or is doing now) to me? Does it make me much more susceptible to internal bleeding, including brain hemorrhage? My cardiologist had enough samples of it in his office to last me the rest of the month, which will save me some money, but what confidence should that give me? So the company gave him a lot of samples. So what? I've read that 80% Pradaxa goes through the liver, 66% Xarelto, and 25%(?) Equis. But none has an antidote. What if I fall or hit my head? I'm 6' tall, much of the world isn't built for people 6' tall, and it is possible to accidentally brush your head against something once in a while. It happens. Every few years, I'll hit my head on the overhead bar when getting up from my seat in the subway. I'm aware of the concept of risk-reward, but isn't there a better way I - and a cardiologist - can manage this than with such a dangerous drug? Aren't there any "holistic" cardiologists around? (I live in New York.)

2) Amiadarone is not new, but, from what I've read in the last few days, is very dangerous. The instructions say it should only be prescribed after trying "alternative medicines." Well, the only "alternative medicine" I've tried has been Metoprolol. That's "alternative medicine," not "medicines." Then there came a point over the weekend that I had to stop reading the adverse effects. The worse ones are in bright yellow! (That point came pretty quickly with Xarelto as well.) The nurse at the hospital told me Amiadarone takes one month to start working. I also read that it takes three(?) months to get out of your system. The instructions also say not to get too much direct sun when using this drug. How much is too much? Should I stay indoors this summer? Does anyone have any experience with Amiadarone? Or Xarelto? Or know anyone who does?

3) My cardiologist said to take the baby aspirin as well, but I've stopped that because I read that if combined with something like Xarelto, it adds an additional bleeding risk, and I don't need any more bleeding risks at this point. I really don't.

4) I've more or less kept the 25 mg of Metoprolol, at least once a day, to help with rate control. For some reason, my pulse rate has stayed high: 90-100, ever since the hospital visit, and I'm wondering if the new drugs might be a part of that, even though they're supposed to help.

5) I've felt some real side effects, though all seem manageable. My left arm and hand tingle a lot. Then, last night, after doing a lot of writing (I write with my left hand), my left thumb started to sting, right in the crease, or where I was holding the pen. This continued for a while, on and off, but finally stopped when I went to sleep. It might have just been increased tingling. I sometimes feel a bit woozy. (When asked, the pharmacist told me that dizziness was the main complaint she's heard with Amiadarone.)

6) I've stopped virtually all of my supplements, because I don't want anything to interfere with the drugs, or make their effects worse. Of course, no grapefruit. (And I love grapefruit.) I've kept up the Magnesium Taurate (about 750 mg daily), and D-Ribose (4 grams daily) (one of Dr. Sinatra's ideas), as well as Brewer's Yeast and Blackstrap Molasses, but stopped the Acetyl L-Carnitine, Alpha Lipoic Acid, (Dr. Weil had suggested that Alpha Lipoic Acid and Carnitine, when taken together, are good for the brain - he calls it Juvenal, but I just combine the ingredients myself), Ubiquinol, Vitamin E, Vitamin D (2000 mg twice daily), Turmeric (Meriva) capsules, Lecithin granules, Kyolic, Ginger Force, Rhodiola Extract (250 mg), etc. I've also cut out salmon (canned sockeye). I had read about astaxanthin, so was eating 1/2 cup daily for about six months, but I don't feel I can risk any Omega-3s at this point, so stopped. I lose the astaxanthin, as well as the creatine I recently read it contains. I also stopped Flax seeds, Chia seeds, or most anything else with Omega-3 in it. I do still take 3-4 tablespoons of Olive Oil daily, and one tablespoon of Avocado Oil. I was taking Rice Bran Oil and Sesame Oil to keep my blood pressure low after reading about that combination on the Internet, but I stopped that as well. I drink Teeccino (from Whole Foods) too, having read that was good for a regular heart beat. I've stopped onions and garlic. I still get a lot of potassium through foods - watermelon, blackstrap molasses, cantaloupe or honeydew, bananas, vegetable juice, etc. I've recently started adding more meat to my diet, partially following the Paleo diet. Lean organic, grass-fed beef (Buffalo sometimes, but it's three dollars more so I opt for the other one), turkey (from Trader Joe's), and some beef liver. I do have some carbohydrate rich foods - dried fruits: peaches, prunes, raisins, apricots. And I eat a lot of nuts daily: walnuts (1/4 cup), Brazil nuts, almonds (1/4 cup). Also, I cook beans: garbanzo beans, black beans, red (kidney) beans. I hear they're a good protective against cancer and heart disease. I take Spirulina daily, as well as Matcha (green) tea, but have cut out some other teas lately - black tea, Yerba Mate, Hawthorne, Rooibos. I eat honey, but stopped the unsweetened cocoa. I've also stopped Chile Powder and Cayenne Pepper, which are supposed to be good for the heart, because they thin the blood. And I had just started adding them to my food. I take Pomegranate Concentrate and Cranberry Concentrate. I eat almost a cup of blueberries daily, and some strawberries as well. I stopped a Multi-Enzyme digestive tablet (The Vitamin Shoppe) because I don't know its effect on the medications. I eat a lot of green vegetables - broccoli, etc, but am not sure about their blood thinning properties either. I eat about one egg a day, as well as 1-2 apples a day (not organic, but washed with a vegetable rinse.

7) I found an old diagnosis a few years ago, under a pile of papers, that indicated I had been diagnosed with a-fib years before 2010. But I don't recall it was ever really explained to me. I had had paroxysmal tachycardia since my mid twenties, but that was seen as normal for men in their 20s and 30s then and I probably just thought it was similar and also benign, which probably allowed it to get worse over time.

8) The trigger for my late 2010 E.R. visit was coffee. I had been reading some new research indicating how good it was for you so I added it to my diet, which was a mistake.

9) I had an angiogram done in February 2011, which turned out fine. There was no underlying heart disease.

10) There are occasionally comments about "earthing" on this website, so I wanted to share my experiences with it. I thought it would be a good anti-coagulant, and maybe it was. But I tried much of the indoor gear, and the results were strange. Using the floor mat seemed to "work" - no adverse effects. But the bed sheet would make me feel awful every time I used it for more than a night or two. I tried it a number of times the past few years, but it always made me feel worse. The wrist strip also had a bad effect. Among other effects, they would make me feel hyper all day. They would also produce a strange sensation in my chest and back that I could never quite pin down, but which would make me feel very uncomfortable. Standing outside on a sunny day, on grass (not treated with pesticides), or at the beach, always seemed to work the best, but I never had my blood tested specifically for what "earthing" is supposed to accomplish so I don't know that it had any effect, objectively. Interestingly, I had been using the floor mat for forty-five minutes to an hour a day recently, and seemed to feel just fine, but then I had my TIA, and now, sadly, because of the medications, that's gone out the window too. (As well as the eight months of doing it outside under a warm sun that I had so been looking forward to!) I still think there's something to it, maybe a lot, but I can't risk thinning my blood any more than it now is. I won't even be able to stand barefoot at the beach anymore! In fairness, I don't think "earthing" can reverse a-fib, at least not my kind. But I thought it, along with the baby aspirin, would act as an anti-coagulant. Which, who knows, it might have. Especially in the spring, summer, and fall, when I did it quite a lot under a warm sun. But I can't do it outside in the winter, and it's the winter months that, for some reason, are the worst for my a-fib and when I find myself running to the emergency room.

11) I listen to Dr. Ronald Hoffman on the radio a lot, and go into Dr. Andrew Weil's website. But they don't say a lot about a-fib. Since I got home from the hospital this time, I've read more blogs about a-fib, including a doctor named "Dr. John." He seems interesting, but I don't know his success rate. I'd like to see a doctor who's both holistic and conventional, like Dr. Hoffman, who may also be able to recommend a more "holistic" cardiologist. But I don't have insurance right now, or the money to pay out-of-pocket for that kind of workup, so I'll just have to bide my time a while longer. Maybe till next year. (I'm still reeling from thoughts of the bills I'll soon be getting from the hospital. They kept me at least a day longer than they should have because they wanted to do a test that they decided not to do.)

12) Getting an ablation is very tempting to me (even after reading Dr. John's blog), but there's a cost issue. When I search for cost for ablations, it's generally in the $17,000 - $21,000 range, though I realize from reading the comments here that Dr. Natale is about $40,000. This puts him well outside of my price range now, but maybe not in a year or so. (Though if my paroxysmal to apparently persistent a-fib becomes anything worse in that time, such as permanent, it may not matter anymore whom I see. I'm thinking now that I probably waited too long.) (I called Dr. Natale's office about a move to New York after reading a comment here about it, but they weren't aware of anything.) I lost my job in the financial crash, and it's been difficult financially since. (That was the reason I stopped subscribing. To save $50 on a subscription!) So I've been putting in a lot of hours to come back from it, but now, with the TIA, and these horrible medications, I just can't be sure of anything and it can be very, very depressing. The doctors never explain anything to me, just give me these horrible pills. With all the snow we've had recently in New York, I'm so nervous about falling on the ice that I walk like a very old man when outside. Why don't doctors - cardiologists, electrocardiologists, or whatever they prefer to be called - ever explain anything? Especially when they're giving me drugs that could destroy my liver, kidneys, or brain? Or me? Is it too much to ask these guys for an explanation once in a while? Is it? (Sorry. I'm ranting now. I'll stop.) It gets me really upset to think about how one gets treated by doctors. How would they like to be treated this way? I remember reading a book in the early 80s by a doctor who was diagnosed with cancer and suddenly began to learn how doctors treat their patients. His own colleagues! He wasn't a person anymore! I was in my early 30s at the time, still very, very healthy, and remember being very moved by his writing.

13) There are a few home a-fib detectors I wanted to ask about:

a) The Heart Check Pen;
b) a home EKG called the MD100b (which includes chest electrodes and "Keep-It-Easy" software);
c) Alive Cor;
d) the Polar S810i, and Freeze Framer, both of which George talked about in a post from about six years ago (and which I found very informative and helpful - thanks for the post);
e) Watch BP;
f) Lechnologies A-Fib Alert; and
f) anything else on the market now that I haven't heard of. I just want something I can hook up, press a button and tell if I'm in a-fib or not. And that I can carry around with me, because, until I can find permanent work again, I can be on call on a 24/7 basis.

14) I'm thinking of buying a "Life Alert," because I live alone and do fear that the - probably persistent now - a-fib may one day cause a stroke.

15) Sorry this post has become so rambling, but I needed to share at least some of what I've been going through the past 3+ years, especially in the last week. I had written a long post a few years ago, mistakenly deleted it, gave up and continued "lurking." (I really dislike that phrase, but it's used, I know, to describe people like me who go into and read websites without contributing anything.) I decided to use minimal editing, thereby reducing the time need to compose it, and to hit the SEND button before deciding otherwise. (I'll probably feel this way the day before my ablation, if I still qualify for one. Just hit the SEND button before deciding otherwise.) I'd like to become a contributing member - in some small way - of this site. I'm not as knowledgeable as most of the people here. After all, it's from this site that I've learned most of what I know. (And I've been reading a lot of the comments I missed from the past few years.) But, hopefully, someone could benefit from my experiences as much as I've benefited from yours. I never heard of A-fib until I was diagnosed with it three years ago, and now it's all I seem to think about.

16) There is another thing I learned from being in the hospital, both this time and all the times previous. There are a lot of people also struggling deeply with health issues - just a few doors down I heard a family crying because someone had unexpectedly died - and it's important never to feel too sorry for yourself, as I sometimes do.

My dad had a stroke similar to yours and the hospital couldn't find any proof of same with instruments or imaging. When he went to his eye doctor for an unrelated issue, the eye doctor nearly immediately asked him if he'd had a stroke.

re: EKG called the MD100b

I've used one extensively -
Pros: when connected via chest electrodes it works well and will display and printout (via computer printer) an EKG sheet of professional quality. I used mine to justify and obtain a second "touch up" ablation.

Cons: Sometimes my computer won't recognize that it's connected... I often need to hear the computer drive respond to the connection to be sure it will function, or I get a device not connected message from the software.

The software is a bit non-intuitive and takes some time to get the jist of it, but it is simple to use.

There is a newer version (check amazon, they sell both) of the MD100B which, by most accounts, works better. It costs more, but I'd bet they got rid of some of the minor bugs associated with the first model.

If you are familiar with your pulse rate, a sports pulse oximeter (very inexpensive) can immediately show if its higher than normal...then you can delve further into the situation with the EKG or a stethoscope (inexpensive too). Afib has a very pronounced rhythm that is easy to recognize by ear.

Tom

Hi Portofcall,

Well, it is good to get things off your chest from time to time and sorry you have had a rough go of it lately. Glad the TIA wasn't a full blown stroke, but was a wake up call that you likely had more underlying AFIB activity than you were aware of.

Its a shame you lost your insurance as well and perhaps you might check into one of the affordable care act policies when available next? With persistent AFIB, which from the sounds of it seems to describe where you pretty much are these days, the number one thing is stroke prevention while trying to arrange for yourself the chance for a good persistent AF ablation with an elite EP such as Dr Natale, preferentially, or one of the other top tier EP colleagues who have vast experiecne and have a very good track record for excellence and success with these more challenging ablations.

In the meantime, it seems you are fairly well connected to supplemental and dietary avenues for helping support overall health that also help convey heart-sustaining benefits. However, these supplemental protocols so many of us greatly benefit from, do have their limits with regard to regaining true control over persistent AFIB, in most cases, with these natural means alone. Very often, when it reaches this stage, a good ablation is by far your best option and cornerstone for jumping over to the other side of the fence and being able to put the genie back in the bottle to a very satisfactory degree, in addition to maintaining the benefits of a good diet, stress reduction and mineral repleting, anti-inflammatory and anti-oxidant supplements.

I realize how overwhelming it can seem, especially when your options are limited by insurance or financial difficulties. Let that be your focus too going forward, in trying to arrange however you can, and if at all possible over time, the means at hand for getting this fixed. Maybe with the Affordable Care Act, you can fine a policy that would cover an ablation too, Im not sure but its certainly worth a looking into thoroughly. And also, keep learning about all the ways you can improve your overall health here as well, even if they may not quell the beast in the process, they are still very much worth making a part of your life.

In addition, the Alivecor IPhone or Android smartphone ECG monitor is very handy and has a nice app with it that makes checking your rhythm and even emailing it straight to your EP or cardio, and/or to a pay by incident Cardio or Cardio tech you can access via ALivecor for quick interpretation of your ECG. I highly recommend it for anyone with anything close to active AFIB. The have recently fixed etch one glitch they had with the iPhone 5 cases developing cracks, the new version work fine and will not crack at all.

Best wishes and hang in there.
Shannon



Edited 2 time(s). Last edit at 02/10/2014 09:58PM by Shannon.

PortofCall, I agree with Shannon, you needed to ventilate and share and you came to the right place. Of course it's scary and understandably you have lots of questions and concerns about the new medication regimen etc. You'll need to be a on a blood thinner to protect against another TIA. Obviously, it's a trade-off since Xarelto carries a bleeding risk. I'm on Xarelto right now, don't want to be, but that's the reality for now. If you are at a higher risk for another cerebrovascular event than you are of a major side effect from Xarelto, that's probably an acceptable trade-off, (though I don't know if anyone has quantified your stroke risk as things stand now). As for the amiodarone, I'm not sure why you were prescribed that versus one of the other anti-arrhythmics...I'd ask your doctor. All of the anti-arrhythmics carry risks, again it's that trade-off. As for the attitude and behavior of some of your health care providers, they're out there, it's unfortunate. But there are also some great ones who don't patronize and who treat patients well. When you find the latter, ally with them as much as possible. As for the former, it might help to remind yourself that they haven't been in your shoes and may not know what it's like from the patient perspective. There was that surgeon in the movie starring William Hurt who was diagnosed with a malignancy and suddenly found himself on the other side of the fence...

Having your TIA and subsequent medical care, plus the new medications, all wrapped up in one is an emotional assault on one's psyche. You've just felt the acute stress of it. I had my moments for sure. Now it's time to start practicing some stress management and start easing things down and working towards calm. I know, peace in the midst of a raging storm isn't easy...but you can make good strides in that direction. You will also need to accept having less control over your situation than before, it's hard to give it up but can be done. Finally, as you work with doctors going forward, resolve to stay level headed, and ask all the questions you need to. And if at all possible work towards that ablation as Shannon said.

Hi Portofcall, sorry about all you difficulties. I know how you feel about hospitals. My frequent afib hospitalizations, when I first started my afib journey were very frustrating because I missed a week of work and was put through the same series of tests each time. Eventually I gained some control of my afib management with the PIP protocol and did not see the inside of a hospital for about 5 years.
The most significant identifiable AF trigger for me is stress. Even though I work at avoiding stress it still sneaks up on me and I find myself getting worked up about small and large issues. The more aware i became about how much stress affected my health the better I got at identifing what stressors i should be able to eliminate. I gave up playing chess because I could feel myself getting worked up during a game and I didn't take loosing well. I didn't loose my temper or anything I just felt lousy and unhappy after a loss. Even when i won i felt all worked up inside. I had several AF attacks after playing chess over several days I had no choice chess had to go. When my NY Rangers loose a hockey game I feel unhappy. I still look forward to watching them on TV but if they are not playing well I will change the channel and watch something else When I encounter a rude or insensitive person I try really hard to not let them get to me. The last thing I want to do is allow that person to affect my health. With some coworkers, friends or family members I may have to deal with frustration from time to time. However stress from a total stranger or service person or nurse or doctor is avoidable. They are just not important enough in my life to allow them to affect my health.
If you continue to let rude and insensitive people get to you you better move to the country. I am a native NY'er and I love it here but we are not known for our patience. If I were you i'd work at stress reduction. Best of luck to you. Dennis

Portofcall:

Why not take Coumadin as your blood thinner, it at least has an antidote. Instead of Amiadorone why not ask your doctor for Flecainide or Rythmol those two drugs do not have the side effects of Amiadorone. Flec. is taken by a number of posters here, I am vagal and take one tab. of Propafenone (Rythmol) at night before bed, I am not in AF all the time, I go into AF occassionaly.

You take and have taken a lot of supplements, sounds like you had a good diet as well. I believe more in a good diet---you have to be careful of what kind of supplements you buy, a lot of supplements may not have what they claim to have. Some supplements can have arsenic, cyanide, mercury, one has to be careful, your supplements should have on their label NSF, USP.

Why take so much oil, too much can cause plaque to accumulate in your arteries.

You have had a TIA and are recovering, my brother had a TIA, doesn't have AF, his wife had one a year earlier with no AF, they both have recovered and are doing very well.

Good luck to you and keep us informed.\
Liz

In your supplements I didn't see that you take a Whole B-vitamin complex, you do need that for heart health, although I guess Brewers yeast has vitamin B, I don't know if it contains all of the Vitamin Bs', vitamin B4 is critical for the heart. I still think eating salmon and chia seeds are good to take.

Liz

Thank you for all your responses.

Tom - I'm going to look into the equipment you suggested. There was some debate on Amazon about how long it lasts, but the feedback overall seems to be pretty good. There's also a good deal on both of them, which I'm finding tempting. I hope your father has recovered and is very well. Thanks!

Shannon - Thanks for the encouragement. I keep hoping that if I wait a year or two, the ablation procedure will become less risky, or there will be a non-invasive breakthrough in the treatment of a-fib. Probably wishful thinking. It's like checking out one deal after another on the internet to get a lower price, even though the need for the product is right now and the time frame for using it successfully is about to pass. I'm checking into the insurance. I called Dr. Natale's office and spoke in depth with one of the nurses. She was very helpful with my questions. Apparently, he recommends Xarelto over Pradaxa now, and she told me it's been extensively researched and not to worry about light head taps, just serious accidents (car, etc.) involving the head. I'm going to be extra careful though, anywhere I am. I've been fine tuning my "sixth sense" ever since I got home. Also, I read that an antidote was discovered in 2011, but needed more testing. I wonder if any more information is available now, over two years later. I do worry about how it leaves the body, with 66% being excreted through the kidneys, less than with Coumadin (80%), but a lot higher than with Eliquis (26%). I don't want this drug to destroy my kidneys (or liver). So I'm thinking of asking the cardiologist about Eliquis, but I don't know if it's available in the U.S. Also, Dr. Natale apparently was at St. Luke's here in NYC in 2013 - I wish I knew this last year, and would have if I had still been subscribing to this website - but, for whatever reason, he's not there now, and she had no further information about it. I've read about the center in India - it was probably discussed on the website a few years ago - and that it's very cheap, but excellent, and that it caters to Westerners. I don't know if they can handle complex procedures though. I called the office of "Dr. John" in Kentucky, and may send him my medical records for an opinion as well. There are a few known ablationists here in New York, so I'll be looking into that too. My cardiologist, who doesn't perform ablations anymore, suggested Warren Jackman, who's in Oklahoma. I looked up his website, so maybe I'll call him too. He told me that Dr. Jackman performs them all the time and is very good.

Elizabeth - I'll ask the cardiologist about the Flecainide or Rythmol, I've read a lot about those drugs on this website. But it's all so new - it's still feels so much like a shock to the system, a punch in the gut - that I haven't yet reached the second-guess-my-cardiologist stage. When you step into a boxing ring, you expect to get hit in the gut, but not when you're on the phone, with your lunch quietly cooking on the stove in the next room. Also, even though I get good information through the internet, it's hard to face someone with decades of experience and learning and question their judgment, suggest they might be wrong. I have no supporting (of me) textbook to produce. They do. Also, almost every time I've ever mentioned supplements or the web to doctors, I'm met with patronizing responses - about WebMD, among others. So I've given up with that. It's frustrating, because you would think that since the 60s, with all the advances made both in conventional and alternative medicine, there'd be some "meeting of the minds" and not just all this silly "one-upsmanship" between doctors and specialties. That they would band together, bury their professional (and personal) differences, at least some of those differences, and try to help their patients by combining the best of both. I don't know if that will ever happen. I think it's just human nature (me included). But it can be more frustrating than I can describe in an e-mail. Because, at some point, and sadly, you realize it will probably always be this way. (I used to be much more optimistic.)

About the oils, they're mostly Olive Oil, with some Avocado Oil. I've read that monounsaturated fat is good for you, and that Olive Oil in particular, is great for the heart: 2-4 tablespoons a day. So about two years ago, I started taking it.

I wish your brother and sister-in-law well!

And, thanks for your response!

Randy - thanks for your response. I guess - or am hoping - that Xarelto is the best choice right now. I read that they've got an antidote (2011), but that it needs more research. I'm going to keep looking for a cardiologist with a more "holistic" view, one with whom I can speak more in depth. I appreciate your suggesting ways to counter the stress. It's still too early though, and the wound feels too raw. A few years ago, when I was first diagnosed, I tried to deal with it by myself, and didn't post on this website, which was a mistake. So, despite my misgivings, I felt that "venting" would be a risk worth taking this time. Also, being home, without being prodded day and night by doctors and nurses and phlebotomists and whoever else had to come into the room, and being on a 24/7 I.V., has been relaxing in itself. I take the pills once a day, then try to forget about them for the next 24 hours. The instructions say to take the Xeralto at the same time each evening with dinner, but they were originally given to me at 10:00 a.m., and now I find it more comfortable to take between 12:00 noon - 1:00 p.m., with lunch. I hope the switching hasn't affected anything. I also did eat a lot of salmon, but have since stopped, wondering if that would thin the blood too much. Maybe I'll call the company and ask.

I'm going to rent the movie you suggested. It sounded a lot like the book I read in the late 70s, or early 80s, by the doctor who developed cancer and was disturbed at the impersonal treatment he was receiving by his peers.

I know an ablation would be best. I've also been reading a blog by "Dr. John," who lists its disadvantages. But, as you say, there are always trade-offs.

Dennis - I'm glad you didn't have to go to a hospital for five years. I keep telling myself that this will be the last time but, since late 2010, it's been, without fail, at least once a year. So I've become more realistic about it.

You're right about the difference between strangers and those we care about. I'll definitely keep it in mind.

Stress is a big trigger for me too. There was probably more stress for me than I realized last weekend. But, in addition, I got cervical spinal stenosis a few years ago, along with the a-fib. It involves my neck and head, so I could never tell if the pains I experienced were from the stenosis or the a-fib, and was reluctant to go to the emergency room each time my neck or head hurt. I haven't been able to do heavy sports ever since, restricting myself to brisk walking, stair walking, and some - mild - home resistance training. But I'll just do the walking now. I can't swim anymore because I can't keep turning my neck. It's frustrating, because I was always very active, but, as with the a-fib, I've learned to live with it. (A bunch of things happened in the last five years or so, which probably contributed greatly to the development of the a-fib.)

Thanks for your response!

Hi PortofCall,

Waiting for a better tomorrow in ablation technology when you are entering or already persistent AFIB is a major false bargain! DONT do it! Go for the very best ablationist you can who specializes in persistent AFIB with outstanding track record and be prepared to travel for 5 days to get it done.

Dr John, has a lot of good insights into medical issues overall and is a good and entertaining as well as educational blogger and I enjoy a lot of his takes and appreciate his issue with respect to big pharma and the overuse of drugs and procedures generally. He is, however, not a super experienced EP ablationist with, at last estimate, still a good deal under 1,000 total AFIB ablation procedures and most of those of the PVI-only variety.

Im sure he is a great guy and likely a very good overall physician and EP and he sounds like a compassionate and friendly doc with a good bedside manner. However, he would not at all be on my list for a persistent AFIB expert ablationist. He is quite possibly a decent straight forward paroxysmal AFIB ablationist as well, doing basic anatomical PVIs or PVAI only ablations, but from many of his comments over the last couple of years regarding ablation and his own experience and the inclinations and opinions he has developed as a result of those experiences, I for one, would not include those as attributes in search for my own persistent AFIB ablationist.

This is an area you don't want to compromise. Dr John strongly believes in a 'less is more' philosophy with medicine and with ablation strategy at least conceptually, and while I wholeheartedly agree with that outlook in many areas of medicine, and other areas of life too, nevertheless in AFIB ablation ... particularly persistent AF ablations ... that is exactly the wrong impluse to follow in guiding one's approach to an effective persistent AF ablation solution in my view.

You want a very experienced EP .. such as Natale as the top example available to you with around 9,000 AFIB ablations under his belt and the vast majority of those of the most challenging difficult variety as so many patients are referred to him to get fixed after multiple ablations with other EPs and that still have not worked. EPs from all over refer people to him with cases they would never touch with a 10 foot pole and I was one of those. Or use his experience as a model to choose another top EP closer to you. Which ever way you go, you want a man or women who is fully confident with great skill and with years of non-stop experience in doing this nearly every day.

And you want an EP whose guiding philosophy is not to see how few burns he can skimp by with, but who understands that he will need to do as much as is necessary to give the best chance for long term success and not one burn less than that!!

The "less is more' philosophy in this field sounds appealing on the surface, but it's a misquided attitude in my view and is often shared by those who are not confident of where to ablate outside of straight forward anatomical PV isolation and thus find the idea of doing less ablation all the more attractive.

Everyone would like to narrow this down to one or two burns and be done, or convert persistent AFIB into a simple right atrial SVT (supra-ventricular tachycardia) -type ablation where only a few targeted burns gives a total cure 98% of the time, and many EPs are trying to envision that approach for AFIB. But Im afraid that in doing so, they are trying too hard to fit a square peg into a round hole and their patients will wind up having to endure more than a few piecemeal ablations before getting close to their goal of relative freedom from the beast long term. As such, by the end of their ablation process, people with persistent AFIB that go to the 'less is more' group of EPs are likely to wind up with far more ablation work done and with much greater overall radiation exposure and a lot more added risk from having to repeat the whole procedure and process more than a few times!! Not to mention the added cost and both physical and psychological toll that takes on the patient!

Its a bad bargain based on a well meaning but naive assessment of what the current state of the art requires for good long term results.

These guys touting one or two burns in a 10 minute ablation and you are done kind of mapping and ablation approach for persistent AFIB are being misleading, even if they are fully genuine and have mislead themselves at this point. Let's see their data at 2 years out, then we can talk turkey. Not just cherry picking a few anecdotal quick AF terminations which nearly every EP has experienced periodically. Some of which don't hold even to the end of the procedure before acting up again, much less for years of quiet.

AFIB and particularly persistent AFIB is NOT like SVT or even typical right sided CTI flutter, and the conceptual idea that if we work hard enough we can find a way to make AFIB ablation as simple as those kind of right-sided ablations, while understandable and may one day be closer to the mark, is not a smart endpoint to shoot for now. If during the course of our ongoing development and understanding of AFIB we can make the procedures shorter and more targeted with great long term results then, of course, that is great and is happening already to some degree each year, but don't set out with that being the assumed endpoint and then wind up bending what you are seeing and doing to try and make it fit that preconceived concept, which is what I see happening in some instances. It's their patients then that will suffer and carry the burden of all those excess repeat ablations needed from their EP being too timid and overly reticent from the outset or just looking at this down the wrong end of the gun barrel, or who are just not experienced and skilled enough to trust in their own expertise in taking care of more challenging problems in anywhere from one to two ablations... three tops in some less frequent cases.

I just checked with Dr Sonny Jackman's front office and indeed he is still doing some ablations, though the last I heard it was not at the clip of earlier years, so check on that if you are interested in going there. He is a well respected physician and pioneer in this field and at least he is still doing ablations when needed, He also has a wide field of research interests, and so if you consider going to him confirm how many persistent AFIB ablations he has done and how many ablations overall per year these days. Again, he is a super guy and a respected doc, but I'm not sure how much of his time is focused on actually doing front-line ablations at this point, not so much is my sense from other reports and based on the fact that we simply don't hear of him much any longer as a frontline high in-demand ablationist, he never really was a high in-demand ablationist with many hundreds of AFIB ablations a year to my knowledge, so its good to inquire at least.

Dr Jackman has done a lot of research work focusing on ablating ganglionated plexi. So far the message seems mixed with ganglionated plexi ablation, there is some impact for sure, but other top EPs have said that they don't get very consistent results in addressing the GP ablation targets, though for sure Dr Jackman would not do only GP spots alone in any ablation, and in any event, most other top EPs automatically address key GP areas that are part of their standard PVAI procedure ablation pathway even when not intentional. As such, the role of GP ablation is still a work in progress.

The India ablation junket idea can sound appealing too but is a huge risk too. You can no doubt get a good deal on an ablation there, money-wise at least, but you don't have any assurance of who is going to do the procedure and what their real experience and qualifications are. The top EPs in the world are hardly likely to remain happy at a budget ablation mill in India or Thailand, regardless of how much tender loving care and wonderful patient suites and limo rides to and from the airport the hospital catering to westerners shower on you!

This field of AFIB ablation is one of the most technically challenging and most skill-dependent medical procedures in all of medicine. There are a growing number of very skilled ablationists available in the North America and Europe, but still not that many, and your best bet is to stick with those with the most experience and the highest regard internationally for excellence. Anything less is progressively more and more risky the further down the food chain you are willing to compromise yourself.

Keep this recent stat in mind from an eye-opening 10 year ablation safety study. Out of 80,000 ablations surveyed across the US over 10 years from 2,000 to 2010, 80% were done at small hospitals doing less than 50 ablations a year and by EPs who do less than 25 ablations a year!!!! That is literally shocking to me! And of this 80% group who did not choose one of the top volume ablation centers and, most importantly, did not choose a top-tier experienced ablationist, 1 out of around 243 of those patients never left the hospital alive!! While that is still less than the mortality of quite a few other common procedures, like say hip replacement surgery I believe, its still dramatically worse stats than for the top group of EPs available. Also, other less lethal complications were progressively much more common with the less the experience of the ablation EP.

Don't get too enamored by a few nice blog posts or articles here or there, drill down and find the best ablationist you can. After all, you already know who that is and called his office, so you do know where to set your sights Portofcall. If you can't, or don't want to, travel to see Dr N then at least use his career and experience as a model for choosing an the next best alternative you will be happy with. Some of his close colleagues like Dr Robert Schweikart in Akron Ohio (a trained with Natale), Dr JD Burkhardt in Austin or Steven Hao in San Fran (both of whom were also mentored by Natale) are good choices as well, so is Sergio Penski at Cleveland Clinic Florida. David Callans at Univ is Penn is good as well .... Its hard to go wrong with top EPs Natale has mentored as you know they will follow a progressive strategy with persistent AF ablation, and there are quite a few others, but in your case with persistent AFIB at hand, I would aim for the very best possible. Also Saibal Kar at UCLA and the folks at Sequoia Hospital in Palo Alto area just south of the Bay Area at Roger Winkle's group of EPs have a good safety record as well.

It is possible Dr N will be back in NYC before too long as well, though that has not yet been fixed in stone so yo cant bank on it for sure until if and when it is official.

Also, while its good to learn all about the drugs, don't be so intimated by the long side effects sheet that you would rather stay in full blown AFIB than use them, the vast majority of people don't experience the full list of side effects anyway, and the odds are you will need them for only a period of time if you are aiming to arrange an ablation in the next couple of years or sooner. At this point, the sooner the better for you to get a good ablation. Xeralto is much preferred over Pradaxa and most EPs don't even prescribe Pradaxa any more from the excess GI bleeding issues and overall GI complaints, alone, not to mention that a fully approved antidote seems farther away for that drug than for Xeralto or Eliquis where an effective agent is ready now for clinical trials at least.

Best wishes,
Shannon



Edited 7 time(s). Last edit at 02/16/2014 06:34AM by Shannon.

Hi Portofcall,

Something to think about...800,000 people a year have strokes, and 140,000 of them die from these strokes. And fully one third of strokes are preceded by a TIA. IMO, and hopefully I can be blunt, you shouldn't worry so much about hitting your head or car accidents, you really should worry about your risk of stroke though, especially with your silent a-fib and previous TIA. In my 56 years I have never been in a serious car accident where I could bleed out, but I come home usually by 11:00 pm or so to avoid the drunk drivers, and I don't play excessively with table saws and sharp knifes! And I've taken Xarelto for 11 months with zero issues. I had an ablation two months ago with the gifted EP Dr. Natale, and at the 6 month mark or thereabouts he will evaluate if it's good for me to come off Xarelto...and not a day before!

As far as a "holistic" cardiologist, that probably does not exist. Cardiologists are busy disease oriented doctors, trained in rapid fire diagnosing of a myriad of heart diseases, inserting stents, pacemakers...they are not really preventive wellness doctors, they get patients referred when people are already quite ill and past the point of preventive medicine. My wife and I do see a D.O. wellness doctor every six months though that manages our D3 level, checks our hormones, CBC, got us on magnesium, Omega-3 and other supplements and co-factors (methyl B-complex, Vit. A, Curcumin, and others). We starting seeing him because of my wife's headaches and early menopausal symptoms, my wife was a complex case that other doctors had failed. He is a wellness doctor in the extreme and practices preventive medicine all the way, we view him as an adjunct to our cardiologists and EP. And guess what? He fully supports me taking Xarelto! He prescribes it in his practice for atrial fibrillation and DVT all the time! He says that fully one third of patients taking Warfarin at any point in time are not fully optimized with their INR. He sees patients that have strokes while being on Warfarin, and just about zero taking Xarelto.

If I were you I'd keep my BP low, take rate control meds, and ALWAYS take Xarelto!



Edited 1 time(s). Last edit at 02/11/2014 09:17PM by onewaypockets.

"He sees patients that have strokes while being on Warfarin, and just about zero taking Xarelto", that's probably because Xarelto hasn't been on the market too long whereas Warfarin is a very old drug.

Liz

Yes, Liz, you are surely right. All the NOACs have a short track record compared to a Cardios many years of warfarin experience and plenty of those with people who were poorly optimized and had unstable INRs making up the lion's share of the 'strokes' this doc has likely seen in making that off the cuff comparison remark. Recent analysis comparing the absolute performance of warfarin vs NOACs in contrast to the original 'relative benefit view .. 'numbers needed to treat' ... that is used in much of the NOAC data, reveals significantly smaller real world benefit to the new drugs compared to well managed Warfarin.

Of course, the new drugs are easier to take and thus should lead to better compliance which is a big potential plus overall, and hopefully the big caveat of still having no fast safe and widely available in every ambulance and ER in the world reversal agent, while a very real concern should be mitigated considerably when the Factor Xa reversal agent under development right now by Portola pharmaceuticals makes it far enough through clinical trials to qualify for fast track approval and dissemination.

The truth is, we really don't and won't know all the long term 'gotchas' with these drugs yet and in that sense if a person tolerates Warfarin well and us disciplined enough to do weekly at home testing a strong argument can be made in that favor too. Human nature bring as it is though, the inconvenience and variability of Warfarin will always result in poor compliance and thus coverage.

Shannon

PS Portofcall, just wondering who your Cardiologist in NYC is?



Edited 2 time(s). Last edit at 02/12/2014 12:34AM by Shannon.

onewaypockets - thanks for your response. I'm very aware of the concept of risk-reward. One of the problems of commenting on the Internet is the problem of subjectivity vs. objectivity. For instance, three years ago, when I found this site, I composed a very long post regarding my condition. It was then paroxysmal. I wrote it and rewrote it, over and over, trying to make all the words fit, add all the proper qualifications. Trying to combine the subjective (my feelings on discovering I had a-fib, something I had never heard of till then) with the objective (my research on the condition itself as well as the medications prescribed). Then, accidentally, I deleted it from my system and decided not to try again - after all that effort. This time, as I said in my initial post, I decided to use "minimal editing" and to hit the SEND button before any more accidents happened. One, there are time constraints, both for me and those who will be reading it. But two, because I wanted to set a more casual, subjective, readable tone. So I didn't add all the qualifications I could have, as if I were writing a non-fiction piece for a magazine or newspaper. This website has places for that, in the Conference Rooms and General Health Forum, as well as in the Afib Resources section. One of the beauties of the Comments section in many blogs, when they're allowed, is the feel, the spontaneity of the response to the blogger. The person can be wrong, or "merely" venting, but they can also be shedding light on something that the blogger missed. And even if they're not shedding any light, you sometimes find yourself saying: "That's true! That's really true!" But the problem of the Comments section is the same as its strength: it is subjective. And, without all the added qualifications that a good blogger will add, it is usually prone to - objective - error. I guess that defines the difference between a good "moderator" and a bad "moderator." So I debated whether to make the tone of my post personal. Or to keep it more objective, at a distance. And I decided to make it personal, keeping it pretty close to the original "draft." Which meant that I left out all the qualifications. That was my fault. I've never thought of stopping the Xarelto. I was merely saying that it was a new drug for me, that it was a big - and very sudden - step up from aspirin, and that I was wondering about its side effects. I have had side effects ("adverse effects" is actually the term the FDA uses) from it - minor, so far, but very clear. I have constant tingling in my left arm and hand, which does seem minor. And, when closing a cardboard box yesterday after removing some objects which I had been storing, I accidentally, when on my knees, let the top fall on the bridge of my nose. Again, I know this seems very minor, but the sensation that apparently minor tap caused to my nose and face felt very clear, and it lasted over an hour. It might have been the Amiadarone, though I don't think so. But I can live with it. I guess I'll have to. One - or both - of the drugs just seems to have made my body more sensitive to slight nicks and bruises. Maybe it's just me. I do have cervical spinal stenosis (which I developed around the time the a-fib was diagnosed; it's true that "when it rains, it pours" - I lost a long-time job at the same time, at the height of the financial crash), which always confuses me when I have any head or neck - or chest - pain. Is it the stenosis?, I ask myself. Or is it the a-fib? Or is it nothing at all? I'd like one day to be able to stop asking myself those questions. But I will ask my cardiologist about it when I see him in the next week or two. I also was wondering about the effect it will have on my kidneys while being excreted from the body. Pradaxa excretes 80% through the kidneys, Xarelto 66%, and Eliquis 25%. So, since none of them has an antidote as of yet, the latter may be the better choice for the future health of my kidneys.

As for my remark about finding an "holistic" cardiologist, I specifically said a "cardiologist with a more 'holistic' view." Randy had put it very well, much better, in fact, than I did, about health care providers, that there are some great ones out there. So that's really what I'm looking for. The great health providers. You - and your wife - seem to have found one. So there's hope for me (and everyone else) too!

Your last statement did really hit home, though, about always staying on the Xarelto, as well as the fact that you've taken it for 11 months with no problems. I'm glad about that, along with the fact that you had an ablation with Dr. Natale. I sincerely hope it proves to be successful. I'm hoping to do the same in the next year or two. (And that he returns to New York.)

Anyway, hope all remains well, and thanks for the post.

portofcall - One consideration now that you mention cervical stenosis is that any misalignment of the Atlas or cervical compression will impinge on the vagus nerve which travels through that area and also innervtes the heart. You may find that a spinal alignment practitioner who can manipulate the atlas back to it's normal position would give you reliev after several treatments.


Integrative Cardiologists... there are some well known... probably many others known locally but not in the spotlight.

Stephen Sinatra, MD, is an Integrative Cardiologist and although he no longer sees patients, his advice is widely availalble online, in his newsletters and books.

James C. Roberts, MD, Toledo, Ohio is an Integrative Cardiologist actively treating patients. His website was mentioned in the Methylation Dysfunction report... www.heartfixer.com

Derrick DeSilva, Jr., M.D.
Co-Chair, Depart of Complimentary Medicine and Senior Attending Staff, Raritan Bay Medical Center, Perth Amboy, NJ
Teaching Faculty, JFK Medical Center, Edison, NJ

Treats his heart patients with Cardiac Nutrients...
He says:
The heart is a muscle that requires a steady infusion of nutrients in order to function optimally. As we age, the nutrient status of the heart diminishes and very few pay attention to this critical issue. The aging process along with the nutrients that are depleted from the use and abuse of an send the heart into “life support” if this situation is not corrected. Inotropic along with chronotropic nutrients.

Jackie

Roger Penski typo?? Dr. Sergio Pinski
Please let me know
Erika

erika101 Wrote:
-------------------------------------------------------
> Roger Penski typo?? Dr. Sergio Pinski
> Please let me know
> Erika


Ha, thanks Erica yes its Sergio Penski at CC Florida, not Roger Penski the famous race car driver and automobile dealership tycoon who is my Audi dealer here in Arizona :-). My wife and I enjoy Audis and have our eye out for a new one for her soon so Roger P has been floating through the memory banks lately ..

Cheers' Shannon



Edited 2 time(s). Last edit at 02/16/2014 01:51PM by Shannon.

Hi Portofcall,

I was prescribed Amiodarone myself, it worked well as a long term medication but I wasn't at all keen on it, like you I had read upon it and didn't like what I read. After about six months on it I called my GP and suggested that it wasn't suiting me, I commented to him that I was getting visual disturbances (I wasn't but thought I'd get a change of meds to something less toxic), he contacted my cardiologist and after a consultation we decided that an on demand PIP regime using Flecainide would be more suitable.

Good luck.

Rob - thanks for your response. I have had some definite side effects from it (but it could also be the Xarelto), and will speak to my doctor in the next week or two about it. I went from metoprolol straight to the Amiodarone, but wish the cardiologist had tried something first. He probably did it because I was in persistent afib for the 4+ days I was in the hospital. It seems to have quieted down since I got home, after a few bad days. Did you have paroxysmal or persistent afib? The flecainide (or PIP approach) may only work if it's paroxysmal. I'm thinking of asking him about trying Relaxin(?). Maybe (a long shot, I know) it can reverse the fibrosis. I count the days when I don't have to take the medication anymore.

Hope all is well.

Portifcall,

Amioderone certainly is the gold standard for quieting down the beast for a while, but it does have a definite double-edged sword as you know.

While Relaxin would be nice to try to help long term
With the substrate reverse remodeling, it is a long way from being available for use in the US. Your doc could not prescribe it even in the off chance he has even heard about it yet for use in AFIB.. This is more like three to five years down the road for front line use and only if clinical trials confirm the initial enthusiasm which well may happen. You need help now though and I doubt you intend to wait long enough for Relaxin to come out and it may work best at preventing fibrosis and help some but likely not with a total reversal of persistent AF related fibrosis even in the best case scenario.

Don't mean to deflate that hope but Alas we all have to wait a while longer before Big Pharma makes either Relaxin, or its recombinant DNA analog, Serelaxin available to patients for prescription.

Shannon

PS Portofcall, just saw your PM and thanks, I'll have time to reply tomorrow. Take care Shannon



Edited 3 time(s). Last edit at 02/17/2014 03:08AM by Shannon.

Hi Portofcall, yes I suffer with Lone AF so the PIP approach is ideal. In fact I'm just waiting for the Flec to kick me into sinus as I type this message. This AF is no friend to timekeeping is it...

Regards,

Rob

Thanks for your response, Rob. My thinking (or hoping) it would just re-remodel itself over the years, or that it was a mistaken diagnosis, was just self-deception.

Take care.

Portofcall, Sorry to see you go through your ordeal. Because of the old diagnosis that you dug up and your mention of paroxysmal tachycardia since your 20's (I do not consider that normal for any age), I would be very careful with taking any Amiodarone because of its linkage with Torsades. Regarding top notch EPs close to NYC, Chinitz and Steinberg do high volumes and well respected..

Researcher,

Thanks for your response, and concern. I'll look them both up. I had been assured by doctors and cardiologists that paroxysmal tachycardia was normal for men in their 20s, but that was the 1970s. I'm sure there's newer research now.

Hope all is well.

All is well. Thanks. 1970's would explain a lot about why your doctor said it was OK. There was nothing he could or should do about it then. Angioplasty was still in its infancy in the late 70's. Catheters for EP interventions would be like science fiction then.

Hello poc, eliquis is definitely available in the US, i have been taking it for some months now without any negative effects that i can notice.

Also while i was taking pradaxa, i had a 2 week double vision event that was later described by my doctor as having been probably a stroke. Must have been a TIA if so because the double vision resolved by itself and no other stroke symptoms accompanied the episode. An MRI was recommended so as to tell whether the double vision episode had been a stroke. I refused to have an MRI because the previous one had been a harrowing experience. I am somewhat claustrophobic and when i lie flat i get quite painful muscle spasms in the small of my back . When the MRI was again recommended to me as the only way to tell whether the double vision episode had been a stroke or not, i asked what treatment would be given if it turned out that the episode had been a stroke. The answer to that question was that no treatment was recommended. Since i think i can do 'no treatment' all by myself without anybody's assistance, i declined to have the MRI.

I never have been a good patient and am probably not going to start being one now, incidentally. I do not recommend that anybody else should be like me in that respect. All of you must deal with your own doctors as you think best. While i sympathize with their curiosity about whether that episode was a stroke or not, since my treatment will not differ whether it was or whether it wasn't, i am personally not curious enough to let them load me into a drum while lying too flat on a gurney, and then stay inside that drum, still painfully flat, for 30 to 45 minutes while some fool beats on the outside of the drum with what sounds like a real big hammer. That reverberating sound inside the drum is painful in itself. Phooey on that.

The Old Crank,
PeggyM