Atrial fibrillation poses risk for stroke
Dear Dr. Roach: I’m a man, 71, with a bovine aortic value that was installed 11 years ago. I went into atrial fibrillation six years ago and had an electric shock to stop it. That lasted a week, and was followed by an ablation, which kept me out of atrial fibrillation for five years. I went into atrial fibrillation again last year, and the shock I got is still working. I am now on Xarelto as before, but my cardiologist will not allow me to quit this time, even with electronic surveillance equipment. His only explanation is that the risk of stroke as a result of going back into unrecognized AFib is too great.
Is he just being old-fashioned? I can buy the monitor app and still have money left over compared with the monthly cost of Xarelto, not to mention the side effects and risks.
B.K. I think I agree with your oldfashioned cardiologist. Since you have gone back into atrial fibrillation — a lack of rhythm of the heart that predisposes to clot formation — despite an ablation procedure, it is likely you will do so again. People who go in and out of atrial fibrillation are at similar risk for stroke as those who are in atrial fibrillation all the time. The risk for stroke is a few percent per year. Strokes can be devastating: The expense of Xarelto, and its attendant (small) risks, are outweighed by the reduction in stroke risk.
Dear Dr. Roach: I read your column daily. It seems that most of the people ask questions after researching them on the internet. Do these people not ask their doctor about their condition before they research it on their own? I understand asking for a second or third opinion. Not talking to your doctor about your condition or about medicine you take is wrong.
E.T. Most of the questions I get are asking for second or third opinions, or when a person’s doctor has been unable to explain or hasn’t done so in a way that a person could really understand. Sometimes I am asked to comment when a person’s physicians have disagreed. Often, however, people ask me questions they are embarrassed to ask their doctors — and I tell them to ask and not to be embarrassed. I also think many people forget that their pharmacist has a world of knowledge available to them.
Sometimes, people ask questions when they remember them, which might be long after or well before a doctor’s appointment. It’s true that many people have done some internet research before they write in. The quality of information on the internet is highly variable, as there is a great deal of misinformation that appears plausible and comes from sources that may appear authoritative.
I answer questions in my column the way I would if I had a patient in front of me. At least, that is my goal. Although a few of my own patients have asked me questions for the column, the deep understanding a doctor should have about a patient’s complete medical history, exam results, family history and many other salient points is lacking in the general format of a newspaper column. I point out that my answer will be limited without that information, and there are some questions that simply cannot be answered by mail.