Doctors who would rather not be bothered on the weekend?

[fdegranville]

Hello all,

Hope everyone is doing well.

I had a serious bout of A-fib late Thursday night. Violently irregular 150 bpm that lasted six hours. I kept thinking it would stop, so did not want to call my doctor -midnight snowstorm etc.. I did the next morning and left a message. I spoke to her at the end of the day and she said she would phone in a script for digoxin. She also said to call her if it happened again. I said: "if it lasts an hour or how long?" She said: "Oh no (in a tone that said, are you kidding, on a weekend?) only if it lasts as long or longer"... Is it reasonable to let someone go through that for that long, twice in one week. I have uncorrected mitral stenosis and aortic regurg (in waiting room since 1999).

Maybe I'm being unreasonable??
~fdeg

 

[Ross]

I think it's time for a new Doctor! That is unacceptable in my eyes and I'm sure it is in many others eyes also.

 

[geebee]

Atrial fib is not something to be taken lightly which is what your doctor seems to be doing. In addition to simply making you feel exhausted, atrial fib can cause blood clots to form and therefore a possible stroke. Although it is not a common problem with short term and occasional afib, it is not impossible.

At least your doctor has treated the afib once the time was convenient for her. Unfortunately, good timing for medical conditions rarely happens.

I have never accepted any doctor who indicates I am bothering them with my medical issues. I have fired many a doctor for less.

You should start looking for a replacement.

 

[ALCapshaw2]

The BIG question is whether you are on Coumadin or NOT.

If you are NOT on Coumadin, then whenever you are in A-Fib, there is the potential risk of beginning to form blood clots. Then you probably need to be put on Coumadin in addition to some medication to prevent your A-Fib (I take Sotalol which is generic for BetaPace).

RATE control with a Beta Blocker and Coumadin for clot prevention is another alternative treatment for A-Fib.

IF you are on Coumadin, and the A-Fib is NOT continuous, i.e. you do revert to normal sinus rhythm most of the time, then you are protected and the risk is substantially less, i.e., your cardiologist will feel a lesser sense of urgency.

Hope this helps.

'AL Capshaw'

 

[hensylee]

I misspoke. I thought you had spoken to his nurse - sorry.

My bro was in ER in Nov and dr got very concerned immediately when he found bro in a-fib. Bro was admitted to ICU and given increased digoxin meds to fix it. He was in 3 days. (Bro is also on coumadin).

This is what I said before: I bet she was speaking for herself and not the doctor. I would certainly ask HIM and then let him know what she said.

 

[tobagotwo]

Hensylee, you're such a sexist!

fdeg,

I would first ask her why she felt okay giving you that advice. She does know your case, and perhaps felt that you were safe, if uncomfortable. If you like her as a doctor, you may want to hear her out first.

Do make sure she's not downplaying your complaint because you're female, though. (Yes, woman doctors do that, too...)

Best wishes,

 

[Nan]

I have also had a-fib...on and off...initially my cardio treated me very aggressively as he was concerned I would go into CHF....he has now seen that that does not happen and says I could wait 6-8 hours or so to call him, BUT that if I felt at all uncomfortable to go to the ER. I am on coumadin (warfarin) and Betapace also.

So, I guess it depends on your particular situation.

I would probably go to the ER if I were feeling what you described! Very uncomfortable and frightening!

 

[Nancy]

You know what??? If you are having bouts of afib at 150 bpm and they are lasting for 6 hours, or even one hour, you need to get some help, especailly since you have known heart problems. Too darned bad that they might be happening on a weekend or any other inconvenient time. You didn't plan it that way. That's just they way they are happening and, "DOCTOR--that's the way the cookie crumbles."

If this one finds your medical problems "inconvenient", then find someone who wants to help you.

You are not in the least unreasonable, you have serious problems.

There are excellent doctors out there, and this is not one of them. Sorry

 

[hensylee]

Bob - have you ever seen the footprints that show evolution? They start at the seashore and eventually end up being high heel footprints. The women get it done - see Nancy's post above.

However, I do try to say she/he when mentioning dr when I remember. But then I am old so must be forgiven when I forget.

How's that for CYA!

 

[MelissaM]

Being treated rudely by a doc on call sucks. Period.

Having said that, a friend of mine in the medical field gave me some insight to "being on call." Because of malpractice, if there is anything that is slightly irregular, she defaults to sending her patients to the ER. After all, she explains, she isn't a soothsayer and can't be expected to get more than a cursory grasp of what is happening through the telephone.

As for orneriness, she said for every one patient who calls in dire straights, she gets three who call for runny noses, etc.

None of the above excuses poor behavoir, but her advice to me was, "if you think something is wrong, go to the ER, because I am probably going to send you there anyway."

 

[Harpoon]

Before we tar and feather another doctor, maybe we should look at what Al Capshaw said...


What else is there besides the periods of a-fib?

How long are they lasting, how frequent? Are there other symptoms related to it, shortness of breath, a feeling of tightness or pressure in the chest, pain in the chest or jaw sometimes radiating down the left side? How about edema (fluid retention)? Dizziness, vomiting, lethargy or fatigue?

Periods of a-fib, even those that may last an hour or more, may not neccesarily indicate an immediate threat to life. I was generally in a-fib for almost two weeks before I had my valve replacement. The atria simply couldn't pump in sync with the rest of my heart for very long because the back-flow from my (disintegrating) tricuspid valve was throwing my heart out of rhythm....

Everyone knew about it and the only truly effective treatment for it at the time was valve replacement, which I was already scheduled for.


You need to know if your doctor is following your progress closely. She's aware of the situation and she advised you to sit tight. If you're not comfortable with that answer, ask her.

It's easy to disregard a doctor's advice as ill-informed on something that SOUNDS like it shouldn't be right. A-fib is NOT a natural heart rhythm, it's an indication of a real problem within the heart. However, it may not always be the sort of thing that needs immediate medical attention. The severity varies a lot. I was in some form of a-fib off and on for several months AFTER my surgery. It was in part due to the fact that I had had surgery and my heart was recovering from the massive impact that had. I was on anticoagulants and being monitored closely. It took about a year or so for the "problem" to really go away or at least become so minimal it's more of an occassional skipped beat now.

Ask for more info.

 

[fdegranville]

Thank you for your insight!

Thank you for your insight!

I don't want to tar and feather her, that's why I asked the question, "Am I being unreasonable?"

Because of the questions I had, I sent an email to my former cardio asking him his opinion (I moved away). He did not expressly comment on the length of time I should wait to go to the ER. His biggest concern, was A. was I on Coumadin (yes, because of the size of my atrium and mitral stenosis, and B. he said "there are many good medicines out there that can minimize or even prevent afib, digoxin is not one of them. it has nothing more than a placebo affect, by slowing down the ventricular rate". He said that is so important to minimize the length of time in afib because the longer you are in it, the more likely you are to stay in it and he said once that happens I would become a new species of patient and would not be able to function well at all, with or without valve replacement.

I have not heard back from my doctor since she prescribed the dig, so it's obvious she has no worries...I'm sure it is no big deal to her because she sees it every day (she specializes in valve disease), but for those of us who have it, it is kinda hard to deal with, not to mention how exhausted it leaves you.

Thanks again everyone!
~fdeg

Before we tar and feather another doctor, maybe we should look at what Al Capshaw said...


What else is there besides the periods of a-fib?

How long are they lasting, how frequent? Are there other symptoms related to it, shortness of breath, a feeling of tightness or pressure in the chest, pain in the chest or jaw sometimes radiating down the left side? How about edema (fluid retention)? Dizziness, vomiting, lethargy or fatigue?

Periods of a-fib, even those that may last an hour or more, may not neccesarily indicate an immediate threat to life. I was generally in a-fib for almost two weeks before I had my valve replacement. The atria simply couldn't pump in sync with the rest of my heart for very long because the back-flow from my (disintegrating) tricuspid valve was throwing my heart out of rhythm....

Everyone knew about it and the only truly effective treatment for it at the time was valve replacement, which I was already scheduled for.


You need to know if your doctor is following your progress closely. She's aware of the situation and she advised you to sit tight. If you're not comfortable with that answer, ask her.

It's easy to disregard a doctor's advice as ill-informed on something that SOUNDS like it shouldn't be right. A-fib is NOT a natural heart rhythm, it's an indication of a real problem within the heart. However, it may not always be the sort of thing that needs immediate medical attention. The severity varies a lot. I was in some form of a-fib off and on for several months AFTER my surgery. It was in part due to the fact that I had had surgery and my heart was recovering from the massive impact that had. I was on anticoagulants and being monitored closely. It took about a year or so for the "problem" to really go away or at least become so minimal it's more of an occassional skipped beat now.

Ask for more info.

 

[ALCapshaw2]

If you do a GOOGLE search for Atrial Fibrilation you will find there are TWO primary treatment methods:

RATE CONTROL and RHYTHM CONTROL

Rate Control merely limits the heart rate but does not actually prevent Atrial Fibrilation. Beta Blockers usually work to control run away heart rate. Studies indicate that if you are ANTICOAGULATED and have a nominal heart rate, that this is AS EFFECTIVE at preventing blood clots as PREVENTING Atrial Fibrilation.

There are medications which target Atrial Fibrilation. BetaPace (generic form is named Sotalol) is what I take for A-Fib and it has worked well for me, although it did take several weeks before I fully adjusted to it and the side effects subsided. Amiodarone is the "SLEDGE HAMMER" of antiarrhythmics but can have SERIOUS side effects if taken in high doses or for a prolonged period of time, not to mention a VERY LONG Half Life (6 months if I remember correctly).

You may want to ask your Cardiologist about antiarrhythmic medications, starting with the ones with the least serious side effects such as Betapace.

If medications fail, Ablation techniques are sometimes effective. The MAZE procedure is another alternative but that requires another FULL Open Heart Surgery.

'AL Capshaw'

 

[Gail in Ca]

Dr available

Dr available

I have only needed to contact my cardiologist twice when office hours were over. Once, at 3 am the ER called my HMO and they had him call the ER, which he did right away, the 2nd time was after my surgery and I was at home. I called to talk to him on the 4th of July, and he called me back real quick.
gail

 

[geebee]

I have been in constant A-fib for about a year now. I do not usually even notice it now unless I do strenuous exercise.

Since I was already on coumadin and Inderal, my doctor just decided to up the Inderal dose a little and now maintains my INR between 3.0 & 4.0.

Long-term or regular A-fib needs treatment. Either a drug to get you out of it or coumadin to prevent clotting from A-fib, otherwise you are the proverbial "ticking bomb".

 

[fdegranville]

A-fib

A-fib

Dear Gina,
It seems you have been dealing with this for a long time. You have had mechanical valves for so long. Were you in afib before your first replacement. I do not understand why doctors let the enlargement of the heart progress when they know it leads to permanent afib, especially in mitral stenosis? Because we know that once it is permanent, it stays permanent even with valve replacement. It seems that the time to replace the valve is before it gets to that point. When they did my valvuloplasty they put me on Coumadin because my left atrium was huge. My valve area is now 1.1 with 2+ MR and 3+ AI and an enlarged LV. I know the surgery is risky, (the surgeon at NYPH hospital I would be referred to is Dr. Oz, the same surgeon in the sad story of Kathy's mother), but it is not likely that they think it is not going to progress?

Anyway, I'm glad your afib is not too bothersome for you.
Thanks for your insight.
~fdeg

I have been in constant A-fib for about a year now. I do not usually even notice it now unless I do strenuous exercise.

Since I was already on coumadin and Inderal, my doctor just decided to up the Inderal dose a little and now maintains my INR between 3.0 & 4.0.

Long-term or regular A-fib needs treatment. Either a drug to get you out of it or coumadin to prevent clotting from A-fib, otherwise you are the proverbial "ticking bomb".

 

[geebee]

I was in occasional A-fib prior to my first surgery. The reason my mitral valve got so bad before surgery was because I was so fanatical about taking my meds and I had restricted my activities so much, I reported that I was relatively asymptomatic when my doctors asked. I did not know how sick I really was until after my surgery when I was able to walk without getting breathless. The tests back then were not as detailed as today so they went more by how we said we felt than anything else.

My surgeon went in to my first surgery convinced he could repair my valve. Once he got in, he was shocked at how bad the valve was and had to replace it. My atrium was enlarged at that point and it has just gotten worse over the years. It is now so stretched that the doctor feels I will never get out of A-fib. However, since I have so little problems with it, we have chosen to merely prevent clots and keep the rate down as much as possible with Inderal. I do not really want to add another pill to my "drug diet" so I am happy with his choice.

I do not want to do anything surgically either since I am really tired of having my sternum cracked. I am hoping I am through with OHS for this life.

Every one is different and my choices may not work for even one other person. However, it is something that works for me and I am happy to share my experiences in the hopes that some part of it may help someone else.

Take care.

 

[McCln]

You do not need to call your doctor for an emerency, get to an emergency room the next time. Do not wait for the following Monday. There may not be a following Monday to see. Please, next time, go to the emergency room. If the doctor was in his office, his nurse would have told you the same thing. Never wait long when having problems like that. Promise me. We care that you are safe and healthy.

 

[fdegranville]

Afib

Afib

Caroline,

You are right. In hindsight I know now that I should have done something; but I was sure it was going to stop. There was a huge snow storm going on and it was 12:30 at night. I don't drive and I probably would not have been able to get a taxi, and no doubt, by the time I would have gotten there it probably would have stopped. Next time, I will do the right thing, I promise ,
thank you for your concern.
~fdeg

You do not need to call your doctor for an emerency, get to an emergency room the next time. Do not wait for the following Monday. There may not be a following Monday to see. Please, next time, go to the emergency room. If the doctor was in his office, his nurse would have told you the same thing. Never wait long when having problems like that. Promise me. We care that you are safe and healthy.