New to the group with a question...

March 21, 2006

My husband was just diagnosed with AF March 17th. He is 38. His bloodwork came

back normal and is otherwise healthy and very active with exercise and such.

There is a family history of AF so I'm fairly confident this is the cause.

His GP put him on warfarin and a beta blocker since his pulse was 140 (the

name escapes me at the moment...). I was familiar with warfarin and didn't

understand why this was the drug of choice over aspirin. There are many in his

family with AF and no one has ever been put on warfarin. All are on aspirin.

The GP wouldn't answer my question directly. He just insisted that warfarin and

the beta blocker were the protocol of choice. End of discussion.

It seems that is the case from reading the threads here. But I do see many

people on aspirin instead. So if I may ask a basic question, why warfarin vs.

aspirin?

His first appt with a cardiologist is Apr 5. I'm sure I'll have more

questions then.

Thanks so much in advance!

Karyn

March 21, 2006

I should add he is in sales and travels all over the US every week

which makes timely blood testing tricky. But the GP really didn't

want to hear any of my concerns re warfarin...a story for another

time!

>

> My husband was just diagnosed with AF March 17th. He is 38. His

bloodwork came back normal and is otherwise healthy and very active

with exercise and such. There is a family history of AF so I'm

fairly confident this is the cause.

>

> His GP put him on warfarin and a beta blocker since his pulse was

140 (the name escapes me at the moment...). I was familiar with

warfarin and didn't understand why this was the drug of choice over

aspirin. There are many in his family with AF and no one has ever

been put on warfarin. All are on aspirin. The GP wouldn't answer my

question directly. He just insisted that warfarin and the beta

blocker were the protocol of choice. End of discussion.

>

> It seems that is the case from reading the threads here. But I

do see many people on aspirin instead. So if I may ask a basic

question, why warfarin vs. aspirin?

>

> His first appt with a cardiologist is Apr 5. I'm sure I'll have

more questions then.

>

> Thanks so much in advance!

>

> Karyn

>

March 21, 2006

Drs are keen to put you on Wafarin it is better than aspirin,(dare I risk a

deluge of attack from the board on this statement).

Your dr is trying to prevent a stroke. The thinking is its better and easier

to treat AF but not a stroke.

JC

My husband was just diagnosed with AF March 17th. He is 38. His bloodwork

came back normal and is otherwise healthy and very active with exercise and

such. There is a family history of AF so I'm fairly confident this is the

cause.

His GP put him on warfarin and a beta blocker since his pulse was 140

(the name escapes me at the moment...). I was familiar with warfarin and

didn't understand why this was the drug of choice over aspirin. There are

many in his family with AF and no one has ever been put on warfarin. All

are on aspirin. The GP wouldn't answer my question directly. He just

insisted that warfarin and the beta blocker were the protocol of choice.

End of discussion.

It seems that is the case from reading the threads here. But I do see

many people on aspirin instead. So if I may ask a basic question, why

warfarin vs. aspirin?

His first appt with a cardiologist is Apr 5. I'm sure I'll have more

questions then.

Thanks so much in advance!

Karyn

March 21, 2006

I have applied for a home machine to check coumadin level. may or

amy not be approved.. MEdicare and Blue Cross pay for them for

certainpatients.. and one of the specific qualifiers is someone who

travels..they cost around $5000.00. test strips are 6.00 each but

the company that sells it also acts a the lab between patient amd

physician, immediated results and instructions

> I should add he is in sales and travels all over the US every week

> which makes timely blood testing tricky. But the GP really didn't

> want to hear any of my concerns re warfarin...a story for another

> time!

>

> >

> > My husband was just diagnosed with AF March 17th. He is 38.

His

> bloodwork came back normal and is otherwise healthy and very

active

> with exercise and such. There is a family history of AF so I'm

> fairly confident this is the cause.

> >

> > His GP put him on warfarin and a beta blocker since his pulse

was

> 140 (the name escapes me at the moment...). I was familiar with

> warfarin and didn't understand why this was the drug of choice

over

> aspirin. There are many in his family with AF and no one has ever

> been put on warfarin. All are on aspirin. The GP wouldn't answer

my

> question directly. He just insisted that warfarin and the beta

> blocker were the protocol of choice. End of discussion.

> >

> > It seems that is the case from reading the threads here. But

I

> do see many people on aspirin instead. So if I may ask a basic

> question, why warfarin vs. aspirin?

> >

> > His first appt with a cardiologist is Apr 5. I'm sure I'll

have

> more questions then.

> >

> > Thanks so much in advance!

> >

> > Karyn

> >

March 21, 2006

On Tue, 2006-03-21 at 22:28 +0000, charles Codling wrote:

>

> Drs are keen to put you on Wafarin it is better than aspirin,(dare I risk a

> deluge of attack from the board on this statement).

>

> Your dr is trying to prevent a stroke. The thinking is its better and easier

> to treat AF but not a stroke.

>

> JC

Well I'll start the deluge

Warfarin is not better or worse than aspirin - it's just different.

The BEST drug to be given is the one that is most appropriate to the

individual. In the eight years I've been reading about this I've not

found a single piece of research that suggests that warfarin should be

given to everyone with AF. (please feel free to forward any links). Yes

it's true the a lot of people (maybe 75% or so) with AF should be taking

warfarin but it's just plain wrong to think that everyone with AF should

be on it.

Karyn, if you want my advice, I'd suggest you download a copy of the

NICE (National Institute for Health and Clinical Excellence) guidelines

for AF.

details can be found here

http://www.nice.org.uk/page.aspx?o=287543

the full version at 177 pages is guaranteed to cure insomnia (but it

does have useful pointers to the research used in the decision process)

http://www.nice.org.uk/pdf/Atrial_fibrillation_full_guideline_2nd_consultation_0\

106.pdf

a short version (47 pages)

http://www.nice.org.uk/pdf/Atrial_fibrillation_NICE_guideline_second_consultatio\

n_0106.pdf

gives a reasonably straight forward flow chart on page 46. You might

want to print it out and ask your husband's GP again why he is

recommending warfarin. If he's not prepared to answer the question

directly then find a new doctor (it's a perfectly reasonable question to

ask!). Just because your husband is 38 and healthy doesn't automatically

discount warfarin use though, for example, a large left atrial volume

could increase the risk of an adverse event. 5th April is not far away

though so maybe you'll get a more informed response from your

cardiologist.

I hope the communication with the doctor improves - there are many

decisions that an AF patient has to make but hopefully it's with the

support of well informed medical professionals guiding them.

This feels like one of those emails where I should say I'm not medically

qualified so feel free to disregard any or all of what I've written

--

D

March 21, 2006

> I should add he is in sales and travels all over the US every week

> which makes timely blood testing tricky. But the GP really didn't

> want to hear any of my concerns re warfarin...a story for another

> time!

>

sorry Karyn, I didn't spot you were on the other side of the pond

Instead of the UK guidelines you might want to browse the American

one...

ACC/AHA/ESC Guidelines for the Management of Patients with Atrial

Fibrillation

http://www.acc.org/clinical/guidelines/atrial_fib/VIII_management.htm#VIII_G

it's another cure for insomnia but comes to a similar conclusion to the

UK guidelines

the short page to print is probably this one...

Risk-Based Approach to Antithrombotic Therapy in Patients With Atrial

Fibrillation

http://www.acc.org/clinical/guidelines/atrial_fib/table19.htm

--

D

March 21, 2006

______________________________________________________________________

Karyn, this is a subject that you will get several different

approaches to the answer. This is a good indication that there is

no hard factual rule that covers all types of AF, or the difference

in patients. The difference in patients would include age,

physicial condition, and history, including family history.

Some physicians will tend to be overcautious, maybe for the patient's

benefit, and maybe to cover themselves. It is hard to tell what

motivates some decisions.

I was a afib patient for most of my life, and medicated for it

approximately 29 years before I had the maze procedure in 1998, at

the age of 64 and have been cured ever since.

My EP, cardiologist never DXed any stroke preventative except

aspirin. I did ask him about it, and his answer was, IF YOU ARE

UNDER THE AGE OF 65 AND YOUR EPISODES ARE NOT MORE THAN A FEW HOURS,

ASPIRIN IS SUFFICIENT.

I think the danger time is episodes of 36 hours or longer.

Research the subject, and educated yourself enough to make, or for

your husband to make a informed choice. He is the final person who

must decide what his medication will be. Just don't make

decisions until you are well informed.

Best wishes and prayers

Jack

______________________________________________________________________

> It seems that is the case from reading the threads here. But I

do see many people on aspirin instead. So if I may ask a basic

question, why warfarin vs. aspirin?

>

> His first appt with a cardiologist is Apr 5. I'm sure I'll have

more questions then.

>

> Thanks so much in advance!

>

> Karyn

>

March 21, 2006

I used to take aspirin, and then a blood clot broke off, which is when I

went on warfarin.

RE: New to the group with a question...

Drs are keen to put you on Wafarin it is better than aspirin,(dare I risk a

deluge of attack from the board on this statement).

Your dr is trying to prevent a stroke. The thinking is its better and easier

to treat AF but not a stroke.

JC

My husband was just diagnosed with AF March 17th. He is 38. His bloodwork

came back normal and is otherwise healthy and very active with exercise and

such. There is a family history of AF so I'm fairly confident this is the

cause.

His GP put him on warfarin and a beta blocker since his pulse was 140 (the

name escapes me at the moment...). I was familiar with warfarin and didn't

understand why this was the drug of choice over aspirin. There are many in

his family with AF and no one has ever been put on warfarin. All are on

aspirin. The GP wouldn't answer my question directly. He just insisted

that warfarin and the beta blocker were the protocol of choice.

End of discussion.

It seems that is the case from reading the threads here. But I do see

many people on aspirin instead. So if I may ask a basic question, why

warfarin vs. aspirin?

His first appt with a cardiologist is Apr 5. I'm sure I'll have more

questions then.

Thanks so much in advance!

Karyn

March 22, 2006

Dear louisianapainter,

You may want to check out the home testing machine at

www.hometestmed.comhttp://www.hometestmed.com/> I have one and they work great.

The cost was around $2,000.00 when I bought mine in 2003.

They have a new model that is even less I believe.

There are other sources for home testing also, search google/yahoo, i.e., " INR

home testing machine " you will find numerous sources. I saw one at $1,450.00

today.

Fred T. (Northern California)

Re: New to the group with a question...

I have applied for a home machine to check coumadin level. may or

amy not be approved.. MEdicare and Blue Cross pay for them for

certainpatients.. and one of the specific qualifiers is someone who

travels..they cost around $5000.00. test strips are 6.00 each but

the company that sells it also acts a the lab between patient amd

physician, immediated results and instructions

March 22, 2006

Lester, I would lean that way to. Those were my words as well " I want my

life back " , prior to my PVA. I did it and have had no regrets.

Emory is ranked 12th in the US for Heart issues. It's one of the best. You

should feel good!

Keep us informed of your decisions.

Rich O

March 22, 2006

If you have been told that Warfarin is life long and you are a younger

Afib suffer, it is worth considering the cost of the machine against

time lost go to the clinic to get the PT test. Having said that is may

be worth searching for the best deal. I thought they were available in

the UK for around £400. That was in 2003 and I am sorry but I cannot

remember the website.

ine

Dear louisianapainter,

You may want to check out the home testing machine at

www.hometestmed.comhttp://www.hometestmed.com/> I have one and they

work great.

The cost was around $2,000.00 when I bought mine in 2003.

They have a new model that is even less I believe.

There are other sources for home testing also, search google/yahoo,

i.e., " INR home testing machine " you will find numerous sources. I saw

one at $1,450.00 today.

Fred T. (Northern California)

Re: New to the group with a question...

I have applied for a home machine to check coumadin level. may or

amy not be approved.. MEdicare and Blue Cross pay for them for

certainpatients.. and one of the specific qualifiers is someone who

travels..they cost around $5000.00. test strips are 6.00 each but

the company that sells it also acts a the lab between patient amd

physician, immediated results and instructions

March 22, 2006

What do you have to pay for the testing supplies?

in Portland OR

Re: Re: New to the group with a question...

Dear louisianapainter,

You may want to check out the home testing machine at

www.hometestmed.comhttp://www.hometestmed.com/> I have one and they work great.

The cost was around $2,000.00 when I bought mine in 2003.

March 22, 2006

My Home Health Nurse says the strips are 6.00 each..Baton Rouge, LA

judi , just had cardioversion yesterday

> Re: Re: New to the group with a

question...

>

> Dear louisianapainter,

>

> You may want to check out the home testing machine at

www.hometestmed.comhttp://www.hometestmed.com/> I have one and they

work great.

> The cost was around $2,000.00 when I bought mine in 2003.

>

March 22, 2006

Advice please,

This is Lester. 54 yo male with diagnosis of lone afib about 3 years ago.

Presently on Toprol LX 100mg daily and ASA 325mg. I've been having more

frequent episodes of adrenergic and vagally mediated afib to the point of

affecting my general activity beyond sitting on the couch and at the computer.

Wanted " my life back " . I visited my EP today who offered me the choice between

going on Flecainide or having an ablation. He said I was a prime candidate for

the procedure. He's done over 200 in the last couple of years and conservatively

asesses his success at 70%. He says he's had 2 cases with asymptomatic pulmonary

stenosis in one vessel, and no esophageal fistulae. And he's a really nice guy

with a very patient and thorough bedside manner. He operates out of the Emory

Heart Center in Atlanta. I must admit that I'm leaning toward the ablation.

Thanks.

March 22, 2006

a good choice! I'm three weeks out from mine and feeling pretty good.

I still have a little pericarditis, but nothing to worry about! Just

remember that an ablation is not necessarily a cure... in a perfect

world you will have no more afib and no more medication, but it might

just be that an ablation will make whatever medication you take actually

work! Or make your events mild and spontaneously ending, or less

frequent, or of less duration.. all kinds of improvements that are

wonderful, but fall outside the range of " cure. "

best of luck in your decision.

_____

From: AFIBsupport [mailto:AFIBsupport ]

On Behalf Of Lester on

Sent: Wednesday, March 22, 2006 4:20 PM

To: AFIBsupport

Subject: Re: Re: New to the group with a question...

Advice please,

This is Lester. 54 yo male with diagnosis of lone afib about 3 years

ago. Presently on Toprol LX 100mg daily and ASA 325mg. I've been having

more frequent episodes of adrenergic and vagally mediated afib to the

point of affecting my general activity beyond sitting on the couch and

at the computer. Wanted " my life back " . I visited my EP today who

offered me the choice between going on Flecainide or having an ablation.

He said I was a prime candidate for the procedure. He's done over 200 in

the last couple of years and conservatively asesses his success at 70%.

He says he's had 2 cases with asymptomatic pulmonary stenosis in one

vessel, and no esophageal fistulae. And he's a really nice guy with a

very patient and thorough bedside manner. He operates out of the Emory

Heart Center in Atlanta. I must admit that I'm leaning toward the

ablation.

Thanks.

March 22, 2006

Thank you all so much for the information, links and support.

If he has to stay on warfarin, then a home machine would be the way

to go as far as testing goes. I'm hopeful (or deluded) that he won't

have to stay on it though. He's an avid skier and I don't think he'd

be able to ski anymore on warfarin, among other things.

He's very upset about his diagnosis. And the drugs are making him

tired and cold all the time. He's distracted at work. He has a very

high pressure job. I listen and encourage him but I'm not always sure

of what to say. We really don't know anything until we get in with a

specialist and that's 2 weeks away. No point to this, just a vent!

We see his GP on Friday and another clotting test is tomorrow. They

upped the warfarin so hopefully now he's in the right range.

Thanks again and good luck to everyone.

Karyn

Husband-38 with AF, on warfarin and beta blocker

>

> Lester, I would lean that way to. Those were my words as well " I

want my

> life back " , prior to my PVA. I did it and have had no regrets.

> Emory is ranked 12th in the US for Heart issues. It's one of the

best. You

> should feel good!

> Keep us informed of your decisions.

> Rich O

>

March 22, 2006

Stef,

I didn't know that you were having pericarditis. That's not normally a

side effect of ablation. What does Dr. Calkins tell you about that?

>

> a good choice! I'm three weeks out from mine and feeling pretty good.

> I still have a little pericarditis, but nothing to worry about!

March 23, 2006

Good for Lester! I'm sure all will go well. I'll be sure to say a few

prayers.

Rich O

March 23, 2006

apparently it IS a side effect of the procedure.. they told me to expect it, and

were not at all surprised when I had it. Now granted, I have not gone in for

any " testing " to say for sure this is what I have.. I just described my symptoms

of " an ache, similar to the ache one might get after running in very cold

weather " ... you know.. that kinda ache like your lungs and heart got too cold

from the inside out? That's all it feels like.. nothing major and it's

certainly not keeping me from doing anything! Heck.. it could just be normal

healing... I'm not worried, and they aren't worried, so we're all happy!

On a side note, I will let the group know that less than three weeks from my

ablation date, I painted the inside of an entire apartment without any problems!

I did have a very very short " something " ... not sure I'd call it an event.. it

was about 3 beats total, and so quick I didn't have time to figure out what it

was, but that was it! I was up and down ladders all day, pushing that darned

roller, arms over my head .. I was bone dead tired by the end of the weekend...

drooling in your sleep tired... but rock solid in the heart department!

Prior to the ablation, even pushing the vacuum was enough to make my heart

feel " fragile " for hours afterward, if not throw me into afib.

Stef

susanr20z03 srichards@...> wrote:

Stef,

I didn't know that you were having pericarditis. That's not normally a

side effect of ablation. What does Dr. Calkins tell you about that?

>

> a good choice! I'm three weeks out from mine and feeling pretty good.

> I still have a little pericarditis, but nothing to worry about!

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

March 23, 2006

Hey Gang,

I've made my decision and am scheduled for ablation on May 1. Don't need to be

on coumadin before the procedure; they just heparinize you on that day. I'll get

an MRI a couple of weeks before to help with the mapping of the pulmonary veins.

I'll spend one night in the hospital and I think I'll be on blood thinners for a

month or so after the procedure. The only other procedure is another MRI 3

months later to check for pulmonary stenosis. It all sounds pretty routine,

which in the medical world is usually a good thing. This is at Emory in Atlanta

with Dr. Angel Leon who is the EP as well as chief of cardiology.

Lester

March 23, 2006

Lester,

It sounds like Dr. Leon is an honest and forthright EP with a good bit

of experience doing ablations and no significant complications.

You should be in good hands. Let us know how it goes.

>

> Hey Gang,

>

> I've made my decision and am scheduled for ablation on May 1.

March 23, 2006

Good luck Lester!

it's funny how the same procedure has such different treatment!

I was heparinized for 4 days prior to the procedure (but I WAS on coumadin

before that, though, so perhaps that was the difference for me). I got a CT

scan the day before the procedure, with an extra high dose of the contrast dye

to show every little thing.... they wanted it the day of to be completely

timely, but my surgery was at 7am so that made things a little difficult! I

will also be on my heart medication for 3 months, and then get weaned off (not

sure how long that will take), and probably 6 months for the coumadin. I will

then have a 24 hour holtor monitor test at 3 months, 6 months, 9 months and 12

months, and then yearly afterward. I know the CT for stenosis is on the books

too, but I can't remember when I get them. I think at 6 months and perhaps 12

months.. I know there is a full year followup for my procedure, since the actual

healing can take 6 to 9 months in reality!

May you be blessed with no reaction to the anesthesia too..

Stef

Lester on lrobert@...> wrote: Hey Gang,