iRhythm "success", Part II

Exhaustion has been my best friend since the hospitalization in November 2010.  Being instructed to go to the local emergency room is where I left off in my last entry regarding the iRhythm, so here is the rest of the story, as Paul Harvey would say.

We arrived at the local emergency room (after having to walk through several cigarette smokers at the entrance - who does that!?).  Unlike past trips to the emergency room (E.R.), as soon as I told the staff my name they took me directly into a bed.  My spouse found it amusing (for lack of a better word) that as the E.R. staff were taking me back, I found it necessary to make them aware of the aforementioned smokers.  I have zero tolerance for smokers, much less individuals huddled around the entrance to a hospital.  We live in California for heaven's sake, so it's not as though it was freezing outside (not that it would matter to me if it were a blizzard; get away from the building!).  

It was a long night.  We arrived before midnight and I was finally moved to a hospital bed around 4:30 A.M.  I always feel so guilty being moved into a room in the middle of the night where another patient is already sleeping.  Fortunately I was sharing a room with a woman who didn't seem to mind my arrival as she began to talk to my non-stop asking who I was and what was wrong with me.  I could write a coffee table book regarding some of the odd roommates I've had in hospitals (I'm sure many have plenty of stories!).  Once I had a woman who kept meowing like a cat.  I digress...


The only negative experience I had at the hospital was with the radiology technician.  Around 2:00A.M. the radiology technician arrived and stated he would be taking images of my heart.  He turned around, at which time I assumed he was reaching to get an apron for our baby, but instead he pushed the button on the mobile x-ray device.  At the same moment my spouse tried to stop him, exclaiming, "She's pregnant".  I was speechless.  It takes a lot to leave me speechless.  The radiology technician told us that nobody had told him I was pregnant.  So, my new rule is to tell everyone I am pregnant.  I don't know why he didn't ask the obligatory, 'Are you pregnant?  Is there a chance you could be pregnant?', which are the two questions I have been asked every time I've had x-rays (including dental) since young adulthood.  I try to tell medical personnel everything I can think of as a rule.  Now I state what should be obvious, "I'm pregnant!".   My spouse has tried to reassure me that no harm was done to our baby as have the doctors I told following the incident.

I was very happy with the nursing staff, they have been wonderful at my local hospital.  I am thankful for them and everything they do.  My heart (and vitals) in addition to our baby were monitored the entire time at the hospital.  To my knowledge, Ventricular Tachycardia (V-Tach) was not detected once at the hospital.  Good news!  In layman's terms, my body/heart had automatically reset itself following the V-Tach detected using the iRhythm.  I am so thankful my cardiologist provided me with the iRhythm!  I struggle on a daily basis with wondering if something I am experiencing is or isn't life threatening.  I imagine other's feel the same way trying to decipher the signals being sent to the good old central nervous system.  While I have never solely depended on a diagnostic device such as the iRhythm to alert me to a medical emergency, it does give me a sense of relief.


It has been two and a half years since the myocardial infarction (heart attack) I had and until Thanksgiving, there had not been any detection of V-Tach from my heart.   As I understand it, an anti nausea medication (Ondansetron) prescribed by my Obstetrics/Gynecology physician is to blame for the V-Tach.  I only took the medication as needed rather than full strength as prescribed, so I can't imagine if I'd taken it full strength how my heart would have felt.  I don't like to take medications period, so I have really tried to avoid everything (including over the counter remedies such as Tylenol).  I don't drink coffee or consume caffeine (I don't even like chocolate unless it is hot cocoa).  Following the myocardial infarction, the hospital nutritionist and nurse practitioner at the cardiology office went down a list of things I should avoid.  [Un]fortunately, I already avoided them.
   
I was released from the hospital and continued to use the iRhythm heart monitoring device for a couple of weeks.  I've continued to experience palpitations since November.  My cardiologist has partnered with another cardiologist who was on-call over Thanksgiving.  I greatly admire both cardiologists.  The newer cardiologist came to the hospital to run tests prior to releasing me.  I was re-prescribed a beta-blocker (I had stopped taking Sotalol due to the pregnancy).  I don't have high blood pressure, in fact my blood pressure has always been very good, if not on the low side.  The beta-blocker is prescribed for other reasons.  The same evening, before my new prescription was ready, the cardiologist phoned my spouse to say that he didn't want me to take what he had prescribed as he had spoken with an electrophysicist who didn't believe it was a good medication during pregnancy.  I greatly respect the new cardiologist for following up, as well as being forthcoming regarding changing to a different medication due to my pregnancy.  It's wonderful to have physicians who aren't afraid to admit that they are human!  

that rock

Where my health is concerned, I've had a solid week of feeling like Sisyphus (thus, the reason for "hybernating" from the world).  I've been doing my best to not let my imagination get the better of me.  Maybe things aren't even as bad as they feel, however, collectively I feel like I am in my twelfth round of a boxing match, having already been knocked out.

cardiologist appt

went very well all things considered!

Warning: Attention Grabbing Headline Below

Who's at risk of dropping dead?
Take the test online:

The HeartAware test is a free online screening available to anyone but especially recommended for men over 40 and women over 50. It takes about seven minutes. Those who test at higher risk of heart disease can receive a free screening from the University of Miami. You can take the test at www.umiamihospital.com.

BY TERESA MEARStmears@mindspring.com

Everyone seems to know someone who appeared healthy and then suffered a sudden fatal heart attack. The death of celebrities such as NBC news commentator Tim Russert at 58 and TV product pitchman Billie Mays at 50 has brought new attention to the issue of sudden cardiac death.

It's an issue we're likely to hear about more as more Baby Boomers reach the vulnerable age for heart problems, 40 for men and 50 for women.

Dr. William W. O'Neill is executive dean for clinical affairs, professor of medicine and chief medical officer of the University of Miami Health System. He is a leader in interventional cardiology and in research into the diagnosis and treatment of obstructed heart arteries.

He also has a personal interest in heart disease. His father had a heart attack at 47, and his mother suffered from heart problems. When he and his three brothers underwent CT screening, three of them were fine but his youngest brother needed heart surgery, even though he had suffered no symptoms.

We asked O'Neill about sudden cardiac death. His answers have been edited for space.

Q: Everybody seems to know someone who appeared healthy and one day dropped dead of a heart attack. How common is that?

A: It's not surprising that everybody knows somebody because in the United States about 300,000 people a year drop over dead with sudden cardiac death.

Q: What causes sudden cardiac death?

A: The overwhelming culprit, in 90 percent of cases, is blockages of coronary arteries and a plaque rupture. The sudden rupture of a plaque in a blood vessel causes blood flow to lessen acutely in one of the arteries and leads to a severe irregularity of the heartbeat called ventricular fibrillation. The plaque ruptures, a severe arrhythmia occurs, and the people drop over dead. In about 10 percent of cases, there are other abnormalities, such as congenital problems or myocarditis, an intense inflammation of the heart muscle.

Q: Are there any symptoms?

A: About a third of the time, people have described symptoms that they ignored: pressure in the chest or discomfort while exercising. Unfortunately, more than half the time the first manifestation of the problem is sudden death.

Q: Are some people more at risk than others?

A: This is an illness of middle-aged people. In men it starts around age 40 and in women it starts around age 50. The risk factors for sudden death are the same as the risk factors for coronary artery disease: diabetes, high blood pressure, family history of heart disease, smoking, high cholesterol.

Q: What causes some people with those risk factors to suffer sudden cardiac death while others live a long life?

A: In people who drop over dead, blockages occur at very specific locations in the arteries that supply blood to the heart, the left main coronary artery and the anterior descending artery. We don't know why some people with coronary disease develop these plaques in these specific locations and other people in less dangerous locations. We think there may be some genes that predispose people to develop blockages in particular areas.

Q: What should people do if they fall into the high-risk group?

A: The best thing you can do is try to control risk factors. If you're got high blood pressure, be on medication. If your cholesterol is high, get it down with pills. If you're smoking, stop. If you're not exercising, try to do moderate regular exercise. It's not sexy. But those are the things you can do to dramatically lessen your risk. If you really have a concern, I'm a very strong advocate of CT angiography, a noninvasive procedure that puts dye in the veins to look specifically at the coronary arteries to see if there is plaque in dangerous locations.

Q: For which patients do you recommend CT angiography?

A: People who have three or more risk factors for heart disease.

Q: What is the HeartAware program?

A: There are a lot of people who don't even know they have risk factors for heart disease. We offer this online test and we offer a free screening where a nurse will actually check a blood pressure and do some other very simple things to let people know whether they have a risk for heart disease. If they're at medium or high risk for heart disease, then more screening can be performed.

Q: Beyond research into a genetic link, what other research is under way?

A: The holy grail that cardiology is facing now is to try to predict why a plaque would rupture. There are lots of plaques in the blood supply. Inexplicably, some of these plaques break open. If they break open in a dangerous location, people drop over dead. There is a lot of interest in trying to identify people with these vulnerable plaques.

Q: What's the most important thing for people to know?

A: Get to know your risk factors and modify them. There are a lot of risk factors that can be very easily modified while we're waiting for the major answer and the magic cure for sudden cardiac death.

Health Q&A runs every other week.

© 2009 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com

As a Patient, Advocate for Yourself!

Posted on Tue, Feb. 09, 2010

Cardiologist's advice about No. 1 killer of women

BY TERESA MEARStmears@mindspring.com

The leading killer of women isn't breast cancer or any other kind of cancer, but heart disease, which kills nearly twice as many women each year as die from all forms of cancer combined. During February, which is American Heart Month, many groups focus on women's heart health with screenings and the American Heart Association's ``Go Red'' movement to raise awareness. There was a time when women didn't respond well to treatment such as heart bypasses and stents, but that is changing, says Dr. Stratego ``Stacey'' Castanes, an interventional cardiologist who has been active in Miami-Dade heart health awareness events. ``One of the reasons we're doing better is patient education, women being advocates for themselves,'' says Castanes, who is in private practice and is also associated with the South Miami Heart Center. We talked to Castanes about women and heart disease. Her answers have been edited for space. Q: How is heart disease different in women than in men? A: The biggest difference is the symptoms, especially of heart attacks. The things that we classically describe to patients -- chest discomfort like an elephant sitting on the chest, radiation to the jaw and down the arm -- aren't quite the symptoms women feel. We still don't know how to describe the classic symptoms women feel. I've had women who were having a massive heart attack and they just felt as if all they needed to do was burp and it would get better. It fools everyone. My recommendation to women is if you're feeling bad enough to think that something's wrong and it's persistent and it continues to make you feel worse -- women still feel some kind of chest discomfort and some type of shortness of breath -- you should go to the emergency room. Q: What is the most important thing women can do to protect their hearts? A: The most important thing is exercise. Exercise can decrease your risk for breast cancer, treat depression, prevent heart attacks and strokes, control blood pressure, prevent adult-onset diabetes. The other important thing is having the same due diligence that women have for seeing their ob-gyn to seeing a cardiologist to determine their risk. Q: What are the risk factors for women? A: Smoking brings on heart disease, 10 to 20 years earlier. Strong family history of heart disease is a risk factor. Post-menopausal for women is a strong risk factor. Diabetes. High blood pressure. High cholesterol. The risk factors are basically the same for men. Q: Who needs cholesterol-lowering medication? A: There was an interesting study done in 2007 where they used criteria to determine if someone was low risk, intermediate risk or high risk for heart disease. Then they looked at patients who had reported a heart attack or stroke. The scariest part of the study was that 80 percent of the people, before their event, were considered low risk. Cholesterol is one of those things where there is no such thing as normal. Depending on the risk factors, you have to make the decision of whether to treat cholesterol. A cholesterol of 130 might be OK for one person but for another person who has a family risk of heart disease and is a smoker, that's not OK and that cholesterol needs to be treated. Q: Should women take a daily aspirin to lower their risk of heart disease? A: We have gone back and forth and been very confused throughout the years about what to recommend. For men it's very clear-cut. If you're in your 40s you should be on aspirin to prevent heart attack and stroke. Women tend to get heart disease later in life and there's an increased risk of bleeding with the aspirin. We initially didn't have clear-cut guidelines. Now the guidelines say if you're above 60 with one risk factor for coronary disease you should consider aspirin. If you have two risk factors, you should definitely be on aspirin. Q: What is the link between diabetes and heart disease? A: Basically we consider diabetes equivalent to heart disease. Diabetics are three to five times more likely to have coronary disease than their counterparts with all the same problems but not diabetes. Blood pressure needs to be very tightly controlled, even tighter than usual. Cholesterol needs to be tightly controlled. It seems that a lot of heart disease is linked to an inflammatory process. Diabetes is a constant inflammatory process. The endothelium, the tissue in the lining of the arteries, needs to work a certain way for the heart to function normally. Inflammatory states such as diabetes cause dysfunction of that endothelium, which results in coronary artery disease. Q: Why is blood pressure important? A: Blood pressure is important because it's so closely linked to increased risk of heart attack or stroke. On a very basic level, the endothelium gets pounded with these high blood pressures all day, which results in inflammation and damage to the endothelium. Q: What's your advice about diet? A: Physicians are always asked about diet, and the sad thing is we take less of a month of it in medical school. Nutritionists know this much better. One of the simplest things is that you should have as much color on your plate as possible. Yellow all over the plate -- pasta, corn, potatoes -- is not good.

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© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com

Quick Chest Pain Test Simplifies Discharge Decision

Hallelujah!  Which of my local hospitals will be offering this 'simple, inexpensive test'?  Moreover, will it be available at my cardiologist's office?!  It's so frustrating being told to go to the emergency room (where the emergency room doctor's call my cardiologist and ask what to do...).  A lot of waste (especially when I've gone in at night, they automatically admit me into the hospital overnight, no if's, and's or but's.  Quite a lot of expense in the end.  I don't want it to sound like I make a bee line for the ER every time my heart skips a beat (I've gone twice since my heart attack, for my heart).  I'm very happy for all heart patients about this new test!  Article below:

Quick Chest Pain Test Simplifies Discharge Decision

Thursday, February 11, 2010

CT scan lets doctors see any blockage in arteries, study finds

A simple, inexpensive test can tell doctors whether it's safe to discharge a patient who has come to the emergency room with chest pain, a new study shows.

The coronary artery calcium scoring (CACS) test detects coronary artery disease. A CT scan is used to quickly provide doctors with a detailed image of the heart that shows calcium build-up in the coronary arteries.

This study of 1,031 chest pain patients found that those with a CACS score of zero can be safely sent home without further heart testing. Of the patients in the study, 61 percent had a CACS of zero.

"It is imperative to accurately diagnose patients who come to the emergency department with chest pain. Unfortunately, diagnosing chest pain is often expensive and time-consuming. This new data could save millions of health-care dollars and countless hours spent waiting on unnecessary tests," principal investigator Dr. John Mahmarian, a cardiologist at the Methodist DeBakey Heart & Vascular Institute in Houston, said in a news release.

The study was published online Feb. 8 in the Annals of Emergency Medicine.

Pay the Rent, Eat or Buy Medicine?

Years ago I recall seeing elderly persons at the pharmacy telling a pharmacist that they weren't taking their medications as prescribed because they couldn't afford to; my heart would go out for them.  Now it seems like everyone, including me, is faced with tough decisions if they find themselves unhealthy.  I've heard the comments from the "naysayers", 'they should have planned better for retirement' (in reference to the elderly who don't have the means to pay for proper medical care.  I don't buy it.  I don't buy how a person can be a warm blooded human being and feel that universal medical care is not a basic human right and need.  

Please visit Hearts for Healthcare to learn more about how the American Heart Association has become involved in making the United States Congress aware of the health care crisis faced by Americans.

Heart patients worry about health costs

WASHINGTON (Reuters) - The monthly mortgage payment is the heaviest expense facing the average U.S. family but for heart patient Frank Amend, an engineer from North Carolina, the biggest cost is healthcare.

That's why Amend and tens of thousands of patients with similar conditions find themselves at the center of debate over how to reform the $2.5 trillion U.S. healthcare sector -- and whether the country can afford it.

Amend, 48, has insurance through his employer but since suffering a heart attack in 2003, his monthly out-of-pocket costs for premiums and medications have grown to consume as much as 20 percent of his wages, and he has become a strong advocate for broad healthcare overhaul.

He says he would like to start his own consulting firm, but can't because the cost of obtaining health insurance for him and his family would be "financial suicide."

A survey of heart patients by the American Heart Association shows that Amend is not alone. Cost of insurance premiums and medication is the top concern of heart patients, said the poll, made available to Reuters before its release on Thursday.

The online survey of 1,105 adults who said they had a heart condition, stroke or high blood pressure showed that 56 percent had trouble paying for prescription drugs or other medical care in the past few years. It was conducted from December 29, 2009 to January 5, 2010.

Stroke patients -- 69 percent -- were most likely to report having trouble paying medical bills.

Almost two thirds of heart patients -- 64 percent -- said making healthcare costs more affordable was a top priority for them.

AHA officials say they hope the survey will help jumpstart the drive for a more comprehensive approach to healthcare reform.

"The problem has not gone away," association president Dr. Clyde Yancy said in an interview.

Nearly 10 percent of heart disease patients eventually file for bankruptcy, said AHA spokeswoman Suzanne Ffolkes.

'ENTITLEMENT EXPANSION'

But a push by President Barack Obama and congressional Democrats to overhaul the sector to rein in costs and expand coverage to the uninsured has stalled in the face of Republican opposition and falling public support, denying Democrats victory on the top legislative priority.

Republicans say it is a mistake to expand the role of government in healthcare and oppose the roughly $1 trillion 10-year cost of expanding health insurance coverage at a time of record budget deficits.

"I don't know how you spend a trillion dollars to create a new entitlement ... That's not really reform, that's entitlement expansion," Representative Dave Camp said in an interview this week. He and other Republicans are pushing for less sweeping legislation that focuses on costs.

COSTS DISCOURAGE PATIENTS

About 46 percent of those who said they had trouble paying medical bills said they had to delay getting needed healthcare and 43 percent said they failed to fill a prescription because of the expense.

"The high cost of healthcare is forcing many of our patients to not take advantage of, or to forego, life-saving treatments and medications," Nancy Brown, chief executive of the Heart Association said in an interview. "They really are making life and death decisions because of the cost of healthcare."

The majority of those surveyed said they had some form of health insurance. About 16 percent of the non-elderly adults surveyed said they had no medical insurance.

Some 46 million people in the United States lack health insurance and many with coverage find it inadequate when it comes to preventive care or when struck by major illness.

"Everyone believes that if you have insurance, there's no issue here," Dr. Yancy said. "There is a big, big problem with the underinsured -- those who have insurance and are still having difficulty receiving care."

The Heart Association and other healthcare advocacy groups are pushing for broad healthcare reform.

The U.S. Senate and House of Representatives have passed sweeping reform measures but efforts to merge the two bills into a single piece of legislation stalled when Democrats lost their "supermajority" of 60 seats in the Senate after a special Massachusetts election last month.

The online survey conducted by research firm Synovate had a margin of error of plus or minus 3 percentage points. It is available at www.americanheart.org/accesstocare.

(Editing by Matthew Bigg, Xavier Briand and Eric Walsh)