Medi-Go-Round

Finding just the right combination of just the right meds can be a challenge. There have been several adjustments in the 5 years plus since my A-Fib diagnosis. I was very lucky in my timing, having my first ER visit on my 65th birthday, just a few days after going from no insurance to Medicare.

First, there was the decision to take me off the diuretic that was controlling my BP, under the supposition that it was - after about 15 years - interfering with my electrolytes. It was replaced by a beta blocker, Metoprolol, which has the main effect of keeping my heartbeat slowed to between 50 and 60 bpm. Since the a-fib attacks boosted it to around 130 bpm, this was a logical choice. I'm still on that one.

It wasn't very good, however, at controlling my blood pressure. Add Lisinopril. Double the pill dose. Double the pill number.  Add Amlodipine, with regular BP monitoring, in case the dose needed to boost from one daily to two, or drop back again.

The Metoprolol also wasn't good at regulating the cardiac rhythm. Irregularities progressed for a couple years until, while on vacation back in Minnesota, I required an ambulance ride during which I kept nearly passing out about once a minute. I've got some real interesting EKG tapes from that ride to take home to my Arizona cardiologist so he could see just what had been happening. You may have read here earlier that his response was, "Well, it's not flatline, but it's just as bad." It was enough to scare the crap out of me.

Luckily I had a relationship with a cardiologist in Minnesota that enabled me to slip in an appointment the very next day in their clinic office. They prescribed Amiodarone. It worked so well that after 6 months of no irregularity whatsoever - and I'm one of those who can tell it's happening - I was taken off the Warfarin, prescribed to prevent strokes. Stopping that was fine, since we never did get to the point of regulating what the proper dose for me was.

So now everything was stable, and for several years. End of story, right?  Well, not exactly. My eye surgeon, the one who replace my cataract, in a regular follow-up visit, noted brown spots accumulating in the back of my eyes. It's a symptom of Amiodarone toxicity. There are other nasty effects when your body decided it's toxic. Last spring, before heading north again, I discussed with my cardiologist my desire to go off Amiodarone. Just, not until I was back for 9 months for medical supervision. The toxicity wasn't going to drastically change while on vacation.

A month ago, the process started. The plan was a half pill for 2 weeks, then cold turkey. The medication stays in the system for weeks anyway, so the effect would be a gradual tapering off.

Theories are great. Life doesn't always cooperate. Within just a few days I was getting episodes of arrhythmia, prompting a call to my cardiologist. Each day's episode was more extreme. She took me seriously, put me back on my Amiodarone, doubling the dose to make up for the tapering off, before settling back down to normal dose. That is what prompted my going back on Warfarin as well.

Fortunately I had the foresight to keep the medic alert bracelet I wore last time I was on Warfarin.

The rhythms are back to normal. INR levels not so much. Those are getting monitored twice weekly, as opposed to every two weeks or even less often for most other people. After two weeks, my numbers which should have been between 2 and 3, with one being unmedicated normal, were over 7. My blood's ability to clot was so low that the regular BP cuff was enough to raise a bruise. The lab tech who took that reading told me to start eating with a spoon because I didn't want to stab myself with a fork.

I confirmed that wasn't a joke.

Today we started Plan B for weaning me off Amiodarone. It involves replacing it immediately with Cardizem. It's expensive. However, it's also stronger than what I've been taking at lowering BP. So, I also quit the Amlodipine and cut the Lisinopril in half. Not that they get thrown out, but instead are kept around in case this doesn't exactly work out. All in all, the cost is close to a wash. Plus, the cardiologist and I had a long discussion on the desirable range of BP readings, now that too low is an actual possibility. So that will be checked twice daily, and the Lisinopril intake will be modified accordingly.

I'm just a work in progress.