Ablation treatment for atrial fibrillation
DEAR DR. DONOHUE: In November of 2010, I was diagnosed with atrial fibrillation. For one year, things were fine, but the atrial fib returned. After five months of hell and reactions to meds, I agreed to have ablation. I was told it was 80 percent effective; I'm in the 20 percent. Now the doctors recommend a repeat ablation. I hesitate, because I have gotten worse since the first procedure. Would you recommend a second try? -- K.S.
ANSWER: Atrial fibrillation is near the top of the list when it comes to heartbeat disturbances. It's a rapid and erratic beat. The speed of the beat compromises heart pumping, and its irregularity sets the scene for a stroke. The upper heart chambers -- the atria -- are not contracting; they're squirming. Blood stagnates in the atria and forms clots. Pieces of the clots can be swept into the circulation to the brain, where they cause a stroke.
Sometimes, if a normal beat can't be restored, slowing the fib restores adequate blood pumping, but the stroke threat remains. That's the reason for putting people on the anticoagulant Coumadin.
Catheter radiofrequency ablation is an attractive choice for restoration of a normal heartbeat. A thin, flexible tube -- a catheter -- is inserted into a groin blood vessel and carefully advanced to the heart's left atrium, where the irregular beat originates. The catheter is equipped to emit high-frequency current that ablates tissue responsible for fibrillation. "Ablation" means "destruction."
One ablation treatment restores a normal beat 80 percent of the time. You fell into the 20 percent group. A second attempt achieves success 90 percent of the time. With those odds, I would jump at the chance of a second go with ablation. The odds are greatly in your favor. If a normal beat is restored, you can stop taking medicines, with their potential for side effects. You also can stop taking the anticoagulant, since the stroke threat will have gone.
The booklet on heartbeat irregularities explains what happens in atrial fibrillation and its treatment. Readers can obtain a copy by writing: Dr. Donohue -- No. 107, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Enclosed is a notice for a book that promotes the idea of wheat being bad for the body, especially for osteoporosis. Everything I have read tells us to consume whole grains, including wheat. I have osteopenia and take Evista, vitamin D and calcium. I also exercise. Is this doctor's advice sound? -- M.P.
ANSWER: I haven't read the book, but I do know that it has become very popular. The author blames wheat for obesity and a long list of other illnesses. I don't believe those charges. I am waiting to hear the response of nutrition experts. Furthermore, I don't believe wheat is responsible for osteoporosis. Osteopenia is a stage between normal and osteoporosis. If I were you, I'd stick with your present osteopenia regimen. If you want to try the diet, do so. See if you lose weight. See if your osteopenia responds. I have doubts that either will happen.
When one culprit is used to explain so many different health problems, I become quite skeptical, particularly when that culprit has been part of the human diet for so long.
DEAR DR. DONOHUE: My 60-year-old daughter has Wegener's granulomatosis. She was hospitalized for three weeks before they discovered the cause. It started with a sinus infection. I would like to know more about Wegener's. -- C.M.
ANSWER: Wegener's is a somewhat-rare disease in which blood vessels are inflamed and granuloma form. Granulomas are small mounds of heaped-up dead cells. The process often starts in the nose, throat and sinuses. The lungs often are involved. In addition, the kidneys become inflamed. Its cause has yet to be discovered.
Drugs that target the immune system are the ones most often prescribed. Prednisone and cyclophosphamide are two examples.
Your daughter sounds like she's on the road to recovery.
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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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