Jumping through hoops, dealing with cardio wanting to give me another pill

Hi, everyone

I had my cardiologist consultation yesterday at Kaiser and I told him I had some questions, and the consult was just a step to get a referral to an EP. He was fine with that. He asked me some questions, did a brief listen to my ticker, and then I asked him if he could order lab work for an RBC Magnesium test, and a C-Reactive Protein. I explained my reasons why. He said he never heard of an RBC Magnesium test and I told him about it and then said, in a joking way, 'well, if you aren't familiar with this test, you sure won't know about the EXA test.' He said I didn't really need those two tests I requested. I said I'd like them for a baseline, if for nothing else. Again, that request was not happening so I dropped it.

I'm 67 and he asked me if I had any family history of a-fib or other heart issues, etc. Nope. No family history.

During our consult, he asked me about how the metoprolol did when I first took it, and now, the metoprolol ER that I'm taking once a day. I said the extended release was working much better that it had been when I was taking it twice a day, so I was okay with it.

I also added that I have some a-fib episodes maybe 2 or 3 times a week maximum, lasting less than 2 minutes and then they resolved I'm back to "normal." I have also been having BOOM BOOM BOOM tachycardia, which is infrequent, doesn't last longer than a couple of minutes maximum, and also resolves quickly.

He wanted to put me on digoxin -- I'm currently taking pradaxa and metoprolol (and I'm also taking lisinopril and simvastatin). I asked why and he explained how it might help when I have those a-fib episodes and the pounding tachycardia. I countered with my thoughts that it seemed perhaps I'm not there yet, and I asked where I'd find a major benefit for taking it, because I'm not having daily episodes. He said it would most likely eliminate those a-fib and tachycardia episodes. He wrote a "paper Rx" for me in case I changed my mind and wanted to fill it at the pharmacy. He seemed very quick to prescribe this, but I don't know if this is usual for cardiologists or what.

I asked about four of the local EPs at Kaiser and he said he would not go to Dr. (name) because he was just too conservative. I don't know what that meant, but okay. The cardiologist did mention that the best local EP guy for cardiac procedures is Dr. Feld at UCSD, but that's not a Kaiser doctor. The cardiologist had heard of Dr. Natale, and mentioned that some of the other EPs who are with Kaiser and work out of Scripps La Jolla probably know Dr. N. or have worked with him. That's a plus as I continue this hoop jumping, and establish a doctor-patient relationship with an EP in case I need one to do a procedure... and will try to get Dr. Natale involved with this in some way through Kaiser. Not sure if that's pie in the sky or not, but it's worth looking into this. Meanwhile, I will be doing more research on the EPs that Kaiser has, based on input from Shannon in a reply he made to one of my other posts.

What say you good folks here about digoxin?
Am I fooling myself that a-fib maybe won't progress, or if it does, it will be slow?
Thanks!
Sue

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SueChef
What say you good folks here about digoxin?
Am I fooling myself that a-fib maybe won't progress, or if it does, it will be slow?

Sigh.... Another cardiologist whose only knowledge of afib is what he learned in med school 30 years go.

Do not take digoxin. First, it has no proven benefit for afib and second, it increases mortality. There are much better antiarrhythmic drugs that are proven to work and don't increase mortality. Any good EP will be familiar with them. Personally, I wouldn't bother asking that cardiologist anything about afib again.

No one can predict whether your afib will progress and if so how rapidly, but hoping that it won't is most likely a false hope because it virtually always does. The speed is very variable, however. I know of people who went from their first episode to persistence in a matter of months, while others remain paroxysmal for years. I myself experienced only 1-2 episodes per year from 2002 to 2008, but then in 2008 the frequency started increasing and the episodes started getting longer. By 2010 I was having multiple episodes per week.

Thanks for the reply, Carey. Yup, after my appointment, I did some reading about digoxin and saw some of the abstracts that linked the use of digoxin to mortality in older adults.
As I said, I had to jump through the *consult with a cardiologist* hoop in order to get a referral to an EP.

Well, darn it all, so a-fib is a sure thing progressive...and with variable speeds! Good to know.

For me, I thought and believed that my a-fib of last July was linked to the unbelievable constant stress I had been experiencing since 2013, when "someone's" deliberate decisions egregiously hurt me beyond anything I would have ever imagined, and traumatized me as well. I guess it was silly to think that once that stress had diminished (over time) and I was dealing with things better, I could go back to my days without a-fib. Stress almost all gone, a-fib gone, too, right? (sigh-- nope)

Thank you for sharing your experience with me.
Sue

Sorry to hear about your experience with Dr. Flintstone.

I hope you get the consult with the EP and it goes well!

I wouldn't go back to that Cardiologist. I agree with Carey in that he is not up to date with his AFIB knowledge. I wouldn't expect a Cardio to know about the EXA Test, but I would expect he know about, or look into the RBC Mg. Only takes a minute to look up the test at one of the Labs Websites.

His advice on referring you to an EP may have been sound though.

As for the AFIB progression, your play here is to be positive, and deal with it as best you can and not worry about your odds. If you negatively progress, then you can deal with it at that stage, but I wouldn't sell yourself short, for believing that it may not progress. Maybe too early to tell if the severe Stress reduction will lessen the AFIB. 2-3 minutes Episodes is very little AFIB, and you are returning to NSR on your own after such a short period of time which is good.

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wolfpack
Sorry to hear about your experience with Dr. Flintstone.

LOL ! ! Dr. Flintstone!!!!
I did also think it was really weird that he so quickly wanted to give me an Rx, when I wasn't *complaining* but just sharing my symptoms.
Sue



Edited 1 time(s). Last edit at 03/03/2018 04:16AM by SueChef.

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The Anti-Fib
I wouldn't go back to that Cardiologist. I agree with Carey in that he is not up to date with his AFIB knowledge. I wouldn't expect a Cardio to know about the EXA Test, but I would expect he know about, or look into the RBC Mg. Only takes a minute to look up the test at one of the Labs Websites.

^^^^^^ For someone so young (mid 30s maybe), I would have thought this cardiologist would be more up to date on stuff.

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As for the AFIB progression, your play here is to be positive, and deal with it as best you can and not worry about your odds. If you negatively progress, then you can deal with it at that stage, but I wouldn't sell yourself short, for believing that it may not progress. Maybe too early to tell if the severe Stress reduction will lessen the AFIB. 2-3 minutes Episodes is very little AFIB, and you are returning to NSR on your own after such a short period of time which is good.

Thank you for your kind words as well as encouragement ... worrying never does accomplish much, does it?
Sue

If you have not read it yet, here it is. Digoxin: The Medicine from Hell?
[www.afibbers.org]

Thanks for the link, afibbers!
Sue

I searched this phrase, Digoxin: The Medicine from Hell and there is a ton of stuff saying about the same thing, and . a lot more stuff to go through.
[www.google.com]

I concur with Carey and the others, DO NOT TAKE DIGOXIN!

In 2004, I went to a highly recommended cardio who told me digoxin was his favorite afib med. I had researched enough then to know that for my vagal afib, it was highly contraindicated. We would have hour long discussions where I refused his script. He finally got tired of me and referred me to his EP partner. When I related my story, the EP said, "you are obviously vagal and there are certain meds we will not prescribe for you." I thanked him profusely and had to bite my tongue to keep from suggesting he needed to give his partner an in-service to get him in the current century.

George

Sure makes ya wonder, doesn't it, George!? We really have to be our own advocates in many ways!
Sue

Simple...you need a different Doctor. Or you need to tell him/her again what you want and insist he arranges or at least tells you where to get them done.

I have been in hospital and had Drs trying to give me Digoxin...I have been adamant and outright refused to allow them to do it. They call me difficult and non compliant.

My initial Cardio who I see very rarely these days will not even discuss issues around my condition and tells me I don't know what I'm talking about in a round about way.

I regret very much not stepping outside the box in my early days of AF and having an ablation. He always maintained it would't work or I was too old or I could die! He also told me the only sensible path for me "eventually" was to have a node ablation and a pacemaker. I said NO to that. So here I am in my late 70's still suffering this damned condition with other chronic illnesses that mean I may not be able to have one.

I would advise anyone to be very aggressive in the pursuit of a cure for their condition and if it seems a reasonable way to go with the best medical advice, don't play the waiting game.

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JoyWin
I would advise anyone to be very aggressive in the pursuit of a cure for their condition and if it seems a reasonable way to go with the best medical advice, don't play the waiting game.

I second this.

I only suffered AF for about 6 months, but I couldn’t wait for an ablation. It may be the “nuclear option”, but I pushed that button the second it was laid in front of me.

If someone had told me there was a bigger bomb to drop, I’d have done that too. One could fairly argue, though, that I’m a bit bull-headed...

Seriously, the meds are nasty and really only marginally effective. If there’s another way, take it.

Thank you JoyWin for your helpful information, and I'm sorry to read about your current situation!

Thank you also to wolfpack and sharing your experience as well!

Sue