When I moved to this central-Virginia city in June of 2003, I didn’t have any medical problems that I knew of. I also didn’t have a doctor. Prior to moving here, I had only gone to a doctor when I had a serious reason to go, like strep throat.
In August, 2004, I had my first episode of A-fib (atrial fibrillation). A-fib not only causes quite disagreeable symptoms, it can also cause a stroke. In fact, a person with untreated A-fib has a six percent chance of having an embolic (blood clot) stroke. That’s six percent per year: 18 percent in three years – a nearly one in five chance of stroke. Not treating A-fib is like playing Russian roulette. Treatment involves taking an anticoagulant like Coumadin, or one of the new, “novel” anticoagulants like Pradaxa, Xarelto, or Eliquis. That will lower the risk of stroke to less than 2%.
At the time, I didn’t know what A-fib was, I only knew something was very wrong in my chest. I couldn’t walk more than 50 feet without stopping to catch my breath. I drove to the ER and landed in the hospital with a resting pulse rate of 160. The docs gave me an IV drip to bring down my pulse, and my heart converted back to normal sinus rhythm the next morning. I went home with a prescription for metoprolol, an inexpensive beta-blocker, and I was fine – for a while.
In October, 2011, I had my second episode of A-fib. I landed in the hospital again, and again my heart converted back to sinus rhythm, and I went home with a second prescription: diltiazem, a calcium channel blocker.
In June, 2013, I had my third episode of A-fib. Back to the ER and into the hospital. Again, my heart responded to the meds and converted to sinus rhythm and I went home. I was on the same meds as before but was taking a stronger dose of diltiazem. When I left the hospital, my PCP told me to stop taking metoprolol. Her advice was delivered through a nurse, so I couldn’t question her about it. But I thought her advice was strange, because metoprolol was the medicine I was originally given to keep my heart stable. Nevertheless, I followed her advice and discontinued the metoprolol. Two days later the A-fib was back (fourth episode), and I was pretty sure the cause was stopping the metoprolol. So I took a pill before driving to the ER. While I was in the ER, my heart returned to sinus rhythm. The ER doctor and I agreed that stopping metoprolol was probably what triggered the A-fib and taking the pill was probably what ended it. So I kept taking it.
In March, 2014, I had my fifth episode of A-fib. This time the ER doctors said there was nothing they could do because my heart rate wasn’t high enough to justify medications. And, anyway, I was already taking the medications they likely would have wanted to give me. They wanted to admit me overnight so my cardiologist could see me first thing in the morning. And indeed, both my cardiologist and my PCP stopped by my bedside early the next morning. My PCP wrote me a prescription for an anticoagulant and told me to go home. There was nothing else they could do.
I went to the pharmacy to fill the prescription, but the drug was so expensive ($360/month) that I told them to keep it. Over the course of the day, my heart felt more and more normal, until by the end of the day it felt completely normal.
My sixth, seventh, and eighth episodes of A-fib hit me in May, June, and July, 2015. Episode six lasted 12 hours and episode seven lasted 18 hours. When episode eight hit, I decided to try an experiment. I had noticed that when I drank alcohol, just as the alcohol wore off my heart would beat strongly and very steadily for about ten minutes. So I thought, if I have a few drinks, then maybe that strong, steady heartbeat will return and terminate the A-fib. I drank three shots of vodka. Three hours later, my heart returned to sinus rhythm. Maybe I had “fixed” my heart rhythm; maybe it was coincidence.
My heart’s ninth episode of A-fib hit me in April, 2016. I didn’t go to the ER because the previous time I went there, they could do nothing for me. The earliest appointment I could get with my cardiologist was three weeks away. When I went to see him, I was still A-fibbing and he gave me medical orders and told me to go to the hospital.
At the hospital, I got an echocardiogram, a TEE (trans-esophageal echocardiogram), and a cardio-version to electrically shock my heart into a normal rhythm. That worked but only for five hours. I had a tickle in my throat that made me cough, and the cough triggered the A-fib again. I was discharged with a prescription for Eliquis and advised by my cardiologist to see him in two weeks.
When I saw my cardiologist two weeks later, he told me my heart was beating too fast – the resting rate was over 100 and just walking around would bring it up to 130 or 140. He said my heart would wear out unless the rate was brought down. I said, “Okay, but it will take years, right?” The doctor said, “No – it will be months or weeks.” Frankly, I don’t believe he is correct about the time frame, but he’s the heart doctor and I’m paying him for his advice, so I left his office with a prescription for amiodarone. It’s a drug that can have very severe side effects. After researching it online, I realize I don’t want to take it. I have to see the doctor again in six weeks, and I may ask him to switch me to digoxin. I have more research to do.
So far, my episodes of A-fib have produced medical bills totaling $146,714. Insurance has covered most of that. I am out-of-pocket $12,622 not including medications nor my most recent doctor visits. At this point, it appears medications will cost about $2,000 out-of-pocket annually. In the past year, drug prices have risen sharply, so that $2,000 could double in the next three to six months. In fact, with medicines it appears the sky’s the limit.
Some doctors say A-fib is not a disease but is the result of disease. They say A-fib is the heart’s response to risk factors such as inflammation, hypertension, diabetes, excessive drinking, smoking, sleep apnea, etc. Even growing older is a risk factor. I have metabolic syndrome and perhaps that has affected my heart.
I’ve dieted many times without success. At first the weight comes off, then the weight loss slows down, then the weight loss stops, then, even though I’m consuming the same number of calories, my weight begins increasing! At the same time, I become excessively tired and lacking in energy. It is clear what is happening: my body has decreased its metabolism – its energy usage – in order to regain its original weight. The experience is disappointing but, nevertheless, I may try another diet. I may even try some manner of exercise, but the A-fib leaves my body a little short of oxygen and works my heart harder than normal, even when I’m resting, so I don’t know about that. I’ll give it thought.
I have that end-of-the-road feeling. Like I’m on the edge of a precipice. I’m not having dark thoughts, it’s just how I feel. Maybe I’m not at the end of the road, but I feel it’s in sight.
Time will tell.
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