Walking shoes, Liquid Plum’r, and Cholesterol

There was a pretty big announcement at the American Heart Association’s Scientific Sessions 2010 meetings last week: the new drug Anacetrapib is very good at raising “Good” cholesterol (HDL) while at the same time lowering “Bad” cholesterol (LDL) with very little side effects!

Why is this important? (Part 1): Here’s a good way to remember the difference: HDL is Happy Cholesterol and LDL is Lousy Cholesterol. Lousy Cholesterol gunks up your blood vessels and causes blockages. Blocked arteries are official, certified BAD THINGS. Happy Cholesterol, on the other hand, eats Lousy Cholesterol and then drops it off in the liver, where it is processed out of the body.

Why is this important? (Part 2): Drugs don’t always work like you think they will. A few years ago there was a big clinical trial for a new drug that would also raise your HDL while lowering your LDL. Suddenly the trial was cancelled… a significant percentage of the trial participants suffered from high blood pressure and/or heart attacks. Some of them actually died.

Ouch.

So there was a lot of excitement when anacetrapib came through the clinical trial with acceptable results. Dr. John M. has a good post on the new drug, including how it is more like Liquid Plum’r. Or maybe Pac-Man.

We’re still a long way from this drug going to market, the next step is another clinical trial involving 30,000 people. But in a few years it will be available – and someone will promote it as “an alternative to exercise.”

In the words of the great philosopher, Mr. Bruce Hornsby, “…don’t you believe them.” A pill can not replace exercise, no matter how much LDL it gets rid of. Your heart and lungs are muscles – If you push them just a little past their optimal range of use on a regular basis, they’ll get stronger. If you don’t – if you sit on the couch and take your pill – they’ll slowly wear out. It’s a rule of life; you can’t stop it. We all age, but some of us do what we can to slow it down.

The new drug won’t be cheap. New drugs never are, there is too much Research and Development funding sunk into it. No one knows what the price will be yet, so let’s make a guess. The new anticoagulation drug Dabigatran will probably cost about $240 per month. That’s not taking into account any insurance plan you may use, but if you walked up to the pharmacy counter with your prescription and paid cash.

Using this as our estimate, a one year supply of Dabigatran would cost $2,800 per year. You can figure that Anacetrapib’s price will probably be somewhere in that range.

But one pair of good walking shoes will cost you $85. Shoot, let’s splurge a bit and get one of the more expensive brands. That will cost us $130. If we just use them for our high intensity walks, they’ll last a while. If we use them as our everyday shoes, we may need a new pair in a year. Cost of drug: $2,800 per year. Cost of shoes: possibly $260 per year, more likely to be less.

Exercise is cheaper than drugs – and a lot more fun!

Let’s do it again!

“All this has happened before; and it will happen again.” – Battlestar Galactica

I’ll give you three guesses to figure out what I have been doing today.

Today, I went to the doctor’s office to have blood drawn; I bought medication;  and I bought groceries. The groceries I don’t mind – we all have to eat, of course. But since I am on a blood thinning medication (Warfarin) I have to go in every so often and have my INR number checked. Warfarin is a delicate drug – it’s really rat poison – and it seems to be able to go up and down on its own. Tie your shoes, the number goes up. Cross your legs, it goes back down. It seems like anything can affect it.

So you must have your Prothrombin Time (PT) checked. The results are given as the INR Number (which stands for International Normalized Ratio.) If the INR falls within you Therapeutic Range, everything is good. If it doesn’t… your doctor is going to adjust your medication and you’ll have to have a retest, usually in two weeks. My INR number has been riding a rollercoaster lately, and I’m feeling like a pin cushion.

If you are lucky, you can do the test at home. You test your blood much as a diabetic would, only you are looking for the INR number, not a Blood Sugar level.  I haven’t been lucky – My hemoglobin is too high, and it makes the testing machine go crazy. So I have to drive 20 miles for the privilege of having a needle stuck in my arm.

My medications tend to make my head spin, too. I take 14 different medications a day, and if I could figure a way to get the same amount of pills for each prescription, I think I could figure a way to refill them all at once. But no – some of them are 30 day prescriptions; a couple are 60 day; and a few are 90 day prescriptions. I think I go to the Drug Store every two weeks! It’s not difficult (if you keep close track of when you need refill and prescription renewals) but is sure is inconvenient!

This probably sounds like a whine, and it very well could be – it seems that as soon as I get through one “cycle” of refills or blood draws, it’s time for another. And my heart problems aren’t going away, so I’ll be doing this forever. But doing these things are extremely important, and they allow me to live my life. I enjoy life – I just get frustrated at the repetition.

But it is an important part of not giving up. These drugs and the blood tests allow me to do things like go to Houston for Hearts Re-United 2010. I recently got a new laptop bag, and one of the things that was important to me was to get one that had plenty of room for medication. The old one didn’t, and trips longer than 4 days required some creative packing on my part. (NEVER pack your medication in your checked baggage if you are flying. If you go to Detroit and your bag goes to Dallas, you’re in trouble!)

So yes, I’ll whine a little about blood tests and prescription refills – but I’ll still do it. I’m having too much fun to let my bum heart win!

A Replacement for Warfarin?

A lot of people dislike Warfarin. Also known by its brand name Coumadin, it is the most prescribed anticoagulant (Blood thinner) in North America. If you can get past the fact that you are taking something that is also used as rat poison, the constant monitoring and dosage adjustments are a pain in the butt. Every six weeks you must have a blood test, and it reacts with nearly everything. Other medications and even your choice of foods can make the drug more or less effective. This requires you to adjust your medication and have another blood test. It’s enough to make you yell!

But there are two new anticoagulants being developed that could replace Warfarin. The first is Dabigatran, which is marketed in Europe as Pradaxa. Dabigatran was approved for use in Europe and Canada in 2008 and is currently being considered here in the United States by the Food and Drug Administration.

Dabigatran has all the appearances of a wonder drug. It has done well in scientific studies: the RE-LY clinical trail shows that it performs better than Warfarin at some dosage levels; the RECOVER study proves that there is no need for the constant monitoring and no food/drug interactions.

If you’re waiting on the other shoe to drop, here it comes: Dabigatran is expensive. Great Britain’s National Health Service pays £4.20 per day for Dabigatran, and about £1 per day for Warfarin.

Ugh. Now that’s a problem.There are several theories that the cost difference can be recouped not only through the savings in monitoring costs, but the costs associated with stroke recovery. The simpler a medical therapy is to use, the more likely someone is to follow the instructions and benefit from it. Warfarin is difficult to maintain, while Dabigatran wouldn’t be. Just take your pill and go about your business.

The other new drug is Betrixaban, which is still being developed. It’s a joint venture between Merck and Co. and Portola, and like Dabigatran requires no monitoring and has almost no interactions. But it is still in Phase 2 testing, a long way from public use. Also, Portola is developing an “off switch”; another drug that can be administered in case of a heavy bleed and deactivate Betrixaban.

The potential market for any company that can develop a Warfarin replacement that has less interaction and less monitoring needs is wide open. Hopefully market forces will not only benefit the companies developing new drugs, but those of us who rely on them.

Flip the Switch

Nobody likes Amiodarone, not even the doctors who prescribe it. I recently wrote a post about it and all the side effects it can cause. A newer drug, Dronedarone, is usually recommended for younger patients. The longer you are on Amiodarone, the better the chances that the side effects will show. Dronedarone isn’t as effective as Amiodrone in controlling Atrial Fibrillation, but has less side effects.

New research released today at the ACC10 meeting in Atlanta shows that in two seperate trial studies, patients with controlled Atrial Fibrilation can safely switch from Amiodarone to Dronedarone in as little as two days.  If you have a slow heart rate (Bradyarrhythmia) or a long QT interval, the 48 hour guideline probably isn’t the best therapy for you. Your own cardiologist will be your best source of information.

The Devil’s Drug

Woe to the CHDer who develops an arrhythmia. (irregular heart beat) The problem is, it seems we all develop one sooner or later, and the choices we have to combat it are limited. Certainly pacemakers and ICDs are available, but those are expensive. So is an ablation; so often, we start with a drug regimen.

One of the best Antiarrhythmia drugs is Amiodarone, because it can control the irregular beats fairly well and there is less of a chance of a proarrhythmia. A proarrhythmia is a new or more frequently occurring arrhythmia that is triggered by the use of antiarrhythmia drugs. It’s diabolical – using the drugs that can calm down an irregular heartbeat can actually cause more irregular beats!

Oh, boy.

Amiodarone is pretty good about not causing proarrhythmia, but that is probably it’s one positive factor. Dr. Rich is convinced that Satan himself invented it – it’s that nasty!

For the drug to become effective, it has to saturate the body. So at first you are given a “loading dose” – a high dosage of the medication to get the patient to the proper level of the drug in their blood quickly.

Most of the time a drug is eliminated through the bloodstream, taken to the kidneys where it is filtered out, and the eliminated through the body’s natural waste disposal system. Not Amiodarone, no sir. The only way you get rid of it is by getting rid of cells. That’s a naturally occurring process, but it is slow and you can’t speed it up. Sometimes it takes a year for the Amio to completely clear your system.

And while it is in your system, it sets up shop in every organ of your body.

Possible liver damage? Yep!

Possible lung damage? Got you covered!

Thyroid damage? Amio is on top of that, too! In fact, you know that rough spot on the bottom of your left foot… well, you probably can’t blame Amiodarone for that one.

But every year you are on the drug, you’ll be visiting your eye doctor for an examination. Not the usual eye exam, mind you, but he’ll be looking for deposits in your eyes caused by the drug.

And you’ll have a lung function test every year, also. You’ll sit in a small walled in area that looks like a phone booth with a plastic tube in front of you. You’ll be asked blow as hard as possible into the tube, blow, blow, come’on empty your lungs! Then you’ll inhale as much as possible; you’ll hold your breath then blow it out – several different lung exercises. You’ll want to bring a friend with you – there’s no reason that you can’t drive home yourself, but you’ll be exhausted from the exercises. And they’ll repeat this test every year to make sure that your lungs aren’t being damaged by the Amiodarone.

If you haven’t guessed, this stuff isn’t very usuer friendly. There are newer drugs available that do not cause proarrhythmia (Yay!) and do not have the side effects of Amio (Yay again!) but isn’t as effective. (Aw, man!)

So if this drug is recommended to you by your doctor, you probably do need it. But have a long, honest discussion with your physician about the benefits and side effects of Amiodarone.

Becoming a Heart Warrior, Part II

When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things. – 1st Corinthians 13:11

When you were a child, your parents took care of you. This probably included organizing your medications, making sure that you took them at the proper times, and picking up refills from the drugstore. But now that you are older, that responsibility should shift to you – and if you have any desire to be independent, you should welcome it!

But there is a flip side to the coin: These medications are confusing, difficult to obtain, and extremely important. They keep you going, and thought of taking control of your medication needs can be daunting. But don’t worry – its a little bit easier than it looks, if you have a system.

One thing you might find useful is this document: Drug Chart (.PDF file) Click the link, and a .PDF file will appear that you can use to organize your medications depending on the time of day that you need to take them.

Before you fill this chart out, make several blank copies or save it to your computer. Your doctor will change your medication, and you’ll need a fresh chart to write the new schedule on. At the top, near where it says “Medication List for” write your name – and write the date, too. If you go several months without having a medication change (lucky you!) you should still update the chart occasionally and change the date, so that everyone can tell that you keep your chart current.

Sit down and organize your meds, grouping them by when you take them. If this is your first time or the instructions on the bottles are confusing, get your parents to help. We’re not going to jump into this with no guidance at all; after all, you are learning how to take control of your health. It’s a process, and it is perfectly fine to get help until you feel comfortable.

Once you have the meds organized, have someone familiar with your routine double-check your efforts, and then fill the chart out. Now, I can take all of your pill bottles and mix them up, but as long as you have that chart, you should be able to quickly figure what you are supposed to take – and when!

A lot of CHDers organize a weeks worth of pills at a time, usually on the weekend. If this is the way your family does it, take over – but not all at once. One weekend a month, you take charge of organizing your pills for the week. As you gain confidence, work up to organizing all of your medications yourself.

Next, you need to learn how to take over getting your refills. You’ll need an index card (You can even cut it in half) and a calender. Not the family calender hanging next to the telephone, but a blank calender with enough space to write in the date blocks.

The easy part is examine every drug bottle and note how many refills that prescription has left. Write it down on your index card and keep the card in a safe place. This is easy, you’ll have a list that reads like this:

Nausea-B-Gone  8

NiceBeat  4

Blood Pressure 5

Every time you get a refill, take your list and reduce that prescription’s number by one. When you hit 0, you need a new prescription. Depending on the medication, you may be able to call the doctor’s office and ask for a new prescription. Or he/she may want you to come in for an appointment first. So as soon as you write 0, call the doctor’s office! That gives you plenty of time to see the doctor if that is what he/she wants.

Now you need your calender. Take your pill bottle and determine how many days worth of medication you have. If you have 90 pills and you take it twice a day, you have 45 days worth of medication. Count forward 45 days from today… now back up ten days. That’s the day you want to start thinking about getting your next refill of that medication from the drugstore – it gives you a ten-day “window” in case there is a problem getting the next refill.

Most drugstores don’t have an automatic refill policy, you will have to tell them that you need a refill. That can usually be done over the phone, by calling the pharmacy refill line and following the recorded directions. You usually type the prescription number (it’s on the bottle, following the letters RX) into the phone’s keypad and never speak to a person. Simple and easy!

I’ve made this explanation as simple as possible, almost to the point that readers might roll their eyes and wonder if I believe they know anything. I’m not writing for you today – I’m writing for those who realize that they will eventually have to take control of their own healthcare and may never have done any of this before. It is a lot of responsibility – don’t be afraid to ask for help and guidance as you learn. Because one day, this job will be yours, no matter if you are ready or not.

And – which is more – you’ll be a Man, my son! – If, Rudyard Kipling (1910)

Traveling the extra mile

So where do you get your medication?

Heart Parents and Heart Warriors know our pharmacy like we know the backs of our hands – it seems that we almost live there! It seems no matter how hard we try, there’s just no way to get everything coordinated. Everything runs out at different times, and with eleven different drugs, it seems that I am at the drugstore two or three times a month. So you may be surprised to learn that I travel 68 miles (one way) to fill my prescriptions.

That’s a pretty nice trip, and yes, there are drug stores that are closer. As you may guess, there’s a reason I travel that far.

In the summer of 2002 I was a patient at Emory University Hospital after having a pacemaker implanted. I had been in heart failure at my community hospital, they had admitted me and placed me in the ICU until I stabilized. Four days later, things were getting worse and I was moved to Emory. So now I was in Emory’s ICU recovering from the pacemaker implant when I had a small stroke.

They had gotten me up and sat me in a chair, and since I was less than 24 hours post surgery, I wasn’t sat the top of my game. My foot fell asleep; but I figured it was just twisted under me at a bad angle. I certainly didn’t feel like moving it around. A nurse walked by and stopped, looking in my little cubicle. “Smile at me,” she said.

The next thing I know this five foot tall nurse was throwing me back in the bed. “I think you need to lie back down,” she said, and a moment later someone was checking my eyes with one of those little flashlights.

My right side “turned off” for three days – and that is the best way to describe it. I couldn’t feel or move anything on the right side of my body. I didn’t “fight back” – I really couldn’t get my head around it. Stroke? Couldn’t be… all that I knew was that my foot had fallen asleep. I hadn’t felt anything else, no problems breathing, didn’t feel any heart pain or funny beats. Nothing.

Then as suddenly as it turned off, my body turned back on. My doc asked me to squeeze her hand on the fourth morning, and without thinking my brain sent the proper signals to my right hand. And this time it worked!

“Whoa! Do that again!” I could move, I felt pain… it was working but it was like my system had rebooted. Everything worked, but my right side wasn’t following orders. I was assured that this was pretty normal and that good Physical Rehabilitation could get everything back in working order. I did a week of rehab at Emory- their plan was to get me started on the path to getting better, once that was established I could be transferred to a facility closer to home to continue my rehabilitation.

That day quickly came. I was able to stand and walk just a couple of steps (with help) but they helped me out of the wheelchair and into our van. Emory’s Rehabilitation Unit and one of their “Ambassadors” (Social Workers) had been in contact with The Big Rehabilitation Hospital close to home, and they had my records, knew that I was “medically fragile”, and were prepared to evaluate me and make a rehab plan. I’m only going to identify them The Big Rehabilitation Hospital (TBRH) and that’s all – you’ll see why in a moment.

We got to TBRH and dad dropped me and mom off – he was going home and make sure all was ok, and check on our house and the pets before returning to pick us up. The nurse who met us was friendly and things were going well until she said “Let’s get you to your room.”

Whoa! Timeout… on our end in Atlanta, we were under the impression that there was going to be an evaluation and then the plan would be decided. No one had said anything about being admitted as soon as we arrived.

“Oh, we received your records and looked them over, it’s all planned out!” At the same moment she’s pushing my wheelchair towards my room. Hold  on, wait just a moment… you guys understand that my docs want –

“We’re TBRH, we cure everybody! You’ll be in good hands!”

We wanted her to slow down, take a breath, listen to us – we had been told about this evaluation (which we assumed that we would be a part of and have some input into) and told to take it nice and slow until the pacer incisions were healed, and this nurse was talking about hitting the ground running. And her response to everything seemed to be “We’re TBRH, we can cure anybody!”

“Wait just a damn minute!” – that had come out of my momma’s mouth! “We want to talk to a supervisor.”

The nurse looked a bit miffed but did as we asked, and it wasn’t very long before the supervisor appeared. He listened, but I had already been evaluated – sight unseen. As soon as my medical records had come in, they had put me on a rehab track –

That’s it, I said. My voice wasn’t working very well because of the stroke, and it took me a long time to say even a simple sentence. It sounds like I’ve been placed on a preplanned course of treatment. That worries me.

Well, you don’t have to stay here if you don’t agree with our policies, he said.

That’s what we’ll do. When my dad gets back we’ll go home, and I’ll call my Cardiology team. If my doctors say this is OK with them, we’ll come back here.

Well, you can’t come back tomorrow, he said, no one will be in the front office. You can lose track of time in a hospital pretty quickly; it took me a moment to realize that the next day would be July 4th.

We figured a little over an hour for dad to get home, about 30 minutes to check everything and feed the animals if they needed it, and an hour back. During the time he was gone, the nurse brought dinner in for my almost-roommate.

“Since you aren’t a patient here, we don’t have anything for you,” she said. That very well could have been the rules or a TBRH policy, but the way she said it sounded a lot like two can play this game, bub. Or I could have just been overly sensitive after the “evaluation” confusion.

Dad got back and we told him the entire story. “Do you know if he has had his evening medications?” Dad asked the nurse.

She shook her head. “TBRH does not provide drugs to non-patients.”

The next thing I know, I’m back in the van and we are burning rubber for a big box retailer about a mile away. I didn’t even get out of the van – how could I, I was barely moving – but my parents rushed in and got to the Pharmacy counter about 3 minutes before closing time.

“I need to get fourteen different medications for my son, who was released from the hospital today. Can you help me?” (I wrote eleven at the top of the page; thankfully I’ve been able to drop a few since this happened).

“They didn’t prescribe the drugs?” the Pharmacist asked, incredulously.

“Not their policy,” Daddy said, skipping the long explanation.

“No problem,” the druggist answered, even though she was just moments from the end of her day. And that is why we travel almost 70 miles to fill my prescriptions… because they were willing to help when I needed them.

I debated if I should write this post or not – it’s human nature to present yourself in the best light possible, especially if you are the one telling the story.  We don’t look very good, and neither does TBRH. I could have been confused , tired, still not thinking right because of the stroke, or just plain wrong. Maybe a little of each. It’s been seven years and I still don’t know.

But the Pharmacy did go Above and Beyond the call of duty, and it is really appreciated. Thank you for helping a customer!

You’re never too old!

My family was understandably worried when my 84 year old grandma had heart surgery a few years ago, it turns out that we didn’t have to be.

When you need help you call 911, even in bad weather. Paramedic SuperMonkey and his partner answer a call during hurricane force winds, and in the process they earn Oregon’s Medal of Valor!

Paramedic SuperMonkey strikes again when one of his patients turns out to be more than he expects…

Sean over at Poked and Prodded says that filling out the medical paperwork is just as much fun as having a tooth yanked. He’s getting ready for 2009 right now…

The Angry Pharmacist has some advice for you if you are trying to snowjob him into early refills of narcotics: “Lie better next time!” (WARNING: The pharmacist isn’t gentle, and sensitive ears might want to skip this one!)

But in The Kingdom of Saudi Arabia, they know how to deal with addicts! (Especially the royal ones!)

Kevin, MD wonders why American Football players (who have access to some of the best medical care there is) are suddenly prone to infections. Could it be all those fancy diagnostic tools?

Now that you’re caught up on the news, go check on Katie!

Electro-Doc

A recent appointment with my Adult Congenital Heart Defect Cardiologist in Atlanta was going wonderfully, right up to the moment I got the ECG. (ECG stands for Electrocardiogram; it used to be popular to refer to it as an EKG, but ECG seems to be the favored term now.) The doc came back into the examining room carrying the ECG sheet, stroking his chin and saying “Hmmm….”

I cringed. Long ago, I learned that “Hmmm…” is doctor-speak for “Ut-oh.” Finally after a few moments, he says, “Looks like you are the proud owner of an Atrial Flutter.”

Proud owner? Yeah, right! Normally, the Atriums (the two top chambers of the heart) contract a few milliseconds before the ventricles do. With a Flutter – you can have an Atrial Flutter if the problem is in the top chambers of the heart, or a Ventricular Flutter if it is confined to the lower chambers – the two cycles become unsynchronized. One is slightly faster than the other, and the two halves of the heart aren’t working in tandem anymore. When it is mild it is a Flutter, and when it is more pronounced, it is a Fibrillation. Flutters can turn into Fibrillation, and a Fibrillation can be deadly.

“Double your dose of Amiodarone and have another ECG in two weeks,” the doctor instructed. “Have them fax the results to me. If it’s good, we’ll set up an appointment in six months.”

And if it is not?

“Be prepared to come down within a week, and perhaps stay a few days.”

There’s no need to worry about an ECG because nothing you do can affect the test. So in two weeks, I get the test done and have the results faxed to the ACHD Doctor. Later that day, the telephone rings: Be in his office on Thursday, I’m scheduled to see the Electrophysiologist.

I have no idea what an Electrophysiologist does, so I look it up. According to the dictionary, he “studies the electrical system of the body, concentrating on the heart.” Ok, but there is no description of exactly how he conducts his studies. I’d like to know if he is going to plug an extension cord into a live power source and then hand me the bare wire ends. “Here, hold this,” he tells me as he watches all of my hair stand on end. Things like that you just need to know.

Thankfully it isn’t that bad. Electro-Doc (my nickname for him, since Electrophysiologist ties my tongue in knots) starts by giving me a 12 lead Electrocardiogram. It works just like a regular ECG does, but there are a few more little wires running to your body. He also listens to my heart for a while longer than the usual exam, and questions me pretty closely about my health. After about half an hour, he excuses himself to consult with my regular Adult Congenital Cardiologist. The Adult Cardiology Clinic normally sees patients on Mondays and Wednesdays, but Electro-Doc is only in area on Thursdays. And on Thursdays, my doc is in an entirely different hospital. Thanks to the cell phone, this fact really isn’t a problem.

The minutes later he is back, and admits that he’s in a bit of a quandary. With an Atrial Flutter I should feel dizzy and lightheaded when the Flutter kicks in. I don’t. And I should be able to feel a Flutter when my heartbeat changes. I can’t. So after putting their heads together, he and my Adult Congenital doc have decided (drum roll, please) not to do anything at this time.

That may sound like a cop-out, but I don’t see it that way. Electro-Doc is going to proceed by how I’m feeling, not what the ECG tells him. The evidence – the ECG, his training, and what he’s hearing through his stethoscope – tell him that I am having an Atrial Flutter. But I’m telling him that I don’t even feel it. so instead of paying attention to the machinery, he’s going to pay attention to me…what a novel idea!

“Since it doesn’t seem to be affecting your heart rate, stop taking the Amiodarone,” he says. “Get an ECG in two weeks, if it looks the same, we’ll just drop that drug altogether.”

With that statement, Electro-Doc has just become my new best friend! Amiodarone is a very effective anti-arrhythmia drug… but it has some nasty side effects. It can cause damage to your eyes, your liver, your lungs, and your thyroid.

Every year that you are on Amiodarone, you must get an eye exam to determine if it has started to damage your eyes. Take a friend with you; they will put those drops in your eyes that cause your pupils to expand. They only expand your pupils for a few hours but during that time you are very sensitive to light and your close-in vision is worthless. Good luck reading a book or a magazine – or a dashboard, for that matter.

You’re also due for a breathing test every year if you are taking Amiodarone. You sit in a small circular box- actually a tube – about the size of a phone booth. (Remember those?) There is a breathing tube mounted in front of you; usually adjusted to be about a half inch higher than your mouth, so you have to sit up nice and tall to place your mouth on it. The technician will tell you to do various breathing exercises. A favorite one is “Take a deep breath and hold it, and when I tell you blow it out as hard as you can. Ready? Deep breath… hold it, hold it… now BLOW! Keep blowing, empty your lungs!” You actually blow out so much air that you involuntarily begin to cough before you can draw a breath. You’ll also see the computer generate many cool-looking graphs and charts while you are doing your breathing exercises, but you won’t have a clue what they mean. Take a friend to this test, also; after an hour and a half of various breathing exercises you are usually exhausted. It’s not unusual to nap in the car while heading home.

Your liver and thyroid are checked by blood tests. That’s nothing new to a ACHD patient, so you just roll up your sleeve a few more times a year.

My two-week ECG reading was the same as it was before Electro-Doc told me to quit taking the Amiodarone, so I no longer take that drug. But that doesn’t mean it’s gone. It can take as much as 100 days (over 3 months!) from the time you stop taking it for it to be completly gone from your system. By my count I’ve got about two more weeks, and then that nasty stuff is gone… hopefully forever!

Friday Night Links

I’m busy today!

I’ve been working on my speech for Baltimore, checking to make sure my good suit still fits (Where did that spot come from?!?! It’s been stored in a garment bag, for crying out loud!) and getting some last minute paperwork done. The paperwork isn’t due until early October, but if I get it done now it won’t be on my mind later.

But I’m not going to leave you hanging! I’ve found some interesting links to pass on to you:

* From March 2007, surgeon Sid Schwab describes how a surgeon clears his mind and prepares for the crucial moment.

* EchoDoc wants to remind us that blood-thinners and antibiotics don’t mix. (Read this one it is important!)

* Researchers in Canada and the United Kingdom report that CHD patients tend to see the doctor more often. (Really?) They also say they have been “hampered by a lack of reliable data.” Hmm… sounds like they need a patient registry!

* Another one from Sid Schwab, this one from August 2006. When the doctor’s phone rings in the middle of the night…

* The Food and Drug Adminstration has banned drugs from two factories in India because of manufacturing problems. A list of the banned drugs is here. The good news is that the drugs currently in the US are safe and our drugmakers can replace what has been banned.

* For those of you who have Congestive Heart Failure and are considering “natural” remedies, EchoDoc has a few words of advice.

* Exercise is good for you, especially if you have a Funky Heart. So tap your toes to Tom Cochrane’s Life is a Highway!