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6 days ago · A-fib and exercise in Heart Rhythm Conditions

Hi, @soph and all. The article recommended by @kanaazpereira is a good thumbnail sketch of how exercise and A-fib co-exist in my life. My A-fib is essentially asymptomatic — I rarely feel it or get any warnings from it — but it always appears on an EKG, and it speeds up my heart rate a bit (from a natural 50bpm to sometimes 70bpm). These "symptoms" are influenced by my medication — a beta blocker twice a day and (for hypertension) Lisinopril and a diuretic. I also take an anticoagulant (Warfarin) to discourage clot formation in my heart due to impeded blood flow caused by irregular heart beats.

As to exercise, regular and moderate are in effect with me. A year ago, I thought exercise might have caused a stroke during a brisk walk around the community. But at Urgent Care, echocardiogram and MRI produced a different diagnosis: A "small stroke" (ischemic rather than hemorrhagic) from a small blood clot, attributable not to the exercise from the walk but to a sharp rise in my blood's ability to coagulate. This, in turn, came from a wide swing in the effectiveness of my anticoagulant medication, probably attributable to a couple of glasses of wine with dinner the night before.

Sorry to bother you with these extremely complex factors, but it seems important to make the point that unusual factors raise vexing questions that cry out for expert advice from the best physicians you can find — doctors who not only know their specialty, but have experience with similar cases in the past; doctors who will take the time to listen to your detailed description of how your symptoms behave, discuss them with you thoroughly, and answer your questions completely right away or as soon as diagnostic evidence is available.

Tue, Jul 2 1:28pm · Alcohol and blood thinners in Heart & Blood Health

Thanks for the note, @yoanne. I'm glad you're still exuding insights and advice after such a severe heart problem. My wife and I both have had electrical problems with our hearts — me with A-fib and she with SVT. We're both in manageable conditions now, thanks to her medication (Fecainide) and mine (Carvedilol). And both of us have problems with fine motor skills, even static balance fully upright. But we went bowling this morning and did pretty well. After two lines, though, we both began to worry about losing our balance on the approach. After mentioning above that I quick drinking alcoholic beverages, I woke up this morning to a powerful medical discussion on CBS News that had one central message for all of us: Don't drink alcohol in any amount ever. I looked over my shoulder enroute to the shower and said, "Way ahead of up!" Their plea was based on data showing more people die in the US as a result of alcohol than any other medication of chemical substance. Sold me! Stay strong. Martin

Mon, Jul 1 2:37pm · Alcohol and blood thinners in Heart & Blood Health

In my case, no way. I've been on Warfarin for 5 years after a diagnosis of Atrial fibrillation. My bimonthly lab tests almost always show an INR of 2.3-2.7. Except once! I had two glasses of wine with dinner one evening. The next day, my INR rose to 5.2 — scary. To bring it back down, my doctor told me to skip daily Warfarin for two days. Bad advice. On that second day, out for a common walk of 1.5 miles, I suffered a small stroke — a blood clot apparently lodged in an artery in my brain. I recovered in a few days, but not totally. My balance and coordination — even my hand coordination — is a little off, and I have to be careful to avoid misstepping or dropping a cup of coffee.

Since that happened a year ago, my doctors and I agreed to limit consumption of wine and other alcoholic liquids. I simply swore off of them. Hate it. I'd greatly appreciate a glass of wine with dinner tonight, but no way. My friends in the restaurant and cabaret business are tolerant of me, but not as before. Even so, I'm off alcohol completely and plan on staying that way. Martin

Wed, Jun 26 6:50pm · Facet ablation in Spine Health

Well @lioness, it appears that you and your doctor are working together toward better conditions in your joints. Literature suggests that hyaluronic acid is a good option in many cases, working as a pain killer, tissue rejuvenator, and lubrication proponent. If you have confidence in your doctor, you'll take measured steps toward solutions. For me, avoiding the surgical knife was a primary goal, and so far that's worked! Martin

Sat, Jun 15 1:05pm · Stricture of the urethra, what treatment options have you tried ? in Kidney & Bladder

Victor (@victor1930), sorry to say I just heard about this bypass directly down from the still-whole section of the upper urethra, so I can't provide any useful information. I can say I'd be interested in learning more about it, and I suspect your urologist has access to the information you're seeking. I'll keep my ear to the ground, and if I run across meaningful information, I'll bring it to your attention here. Having just read about your "uro-surgeon" (?) being indisposed to do the new bypass, I'll express the hope that he's more forthcoming about his reasons. A major one could be that the straight-down surgery (depending on where the upper and healthy section of your urethra is located) may pose nerve and blood vessel avoidance problems, compared with a horizontal straight-out catheter through your body wall. That's the kind of question you deserve to have an answer to. Martin

Wed, Jun 12 11:11am · Stricture of the urethra, what treatment options have you tried ? in Kidney & Bladder

Hi @victor1930. Glad you joined us on Mayo Connect and hope we can be helpful by sharing our own experiences with bladder and urethra urinary problems. My urethra gets periodic checking during cystoscope examinations of former cancer sites on the lining of my bladder. I also had transurethral resection of prostate (TURP) procedure that removed prostate tissue through my urethra. That was about 10 years ago, and I have had no serious UTI problems since.

However, my late father had problems that seem identical to yours. When his urethra became useless as a urine pathway, his urologist persuaded him to accept a suprapubic catheter installed to carry his urine through his body wall and into an external bag. While that worked well for a number of years, from time to time he would suffer from infection/inflammation in and around the catheter's path through his body wall. As he passed his 90th birthday, these instances occurred more often and were more serious, perhaps mainly because of his advanced age, declining ability to care for himself, and failure of the medical staff of his final residence hall to help him deal with the problem. He was nearly 95 when he breathed his last — not from infection, so far as we know.

Hopefully my dad's experience will suggest what information you may wish to have before making a decision on a suprapubic catheter. And I hope you have full confidence in the advice and treatment that your urologist offers you. If you have any doubts, you may wish to ask for a second opinion from a disinterested urologist. Martin

Wed, Jun 12 10:29am · Bladder Cancer in Cancer

Hi @2mrbigdog2u. I'd like to share the curiosity that @colleenyoung expressed about the type and stage of the cancer in your diagnosis. Mine was first detected about 10 years ago during and operation to remove prostate tissue protruding into my bladder. When the prostate tissue was out of the way, we could see one pedestal tumor on the lining of my bladder; it was found to be a low-intensity malignancy. A few weeks later, a new view through a cystoscope discovered a dozen more similar tumors, although a handful of them were more intensively malignant. They were removed during walk-in surgery without any complications. In all cases, none of the tumors had grown down through the lining and into the muscle of the bladder, so the urologist and I agreed to five treatments with a BCG solution that kills off any cells that are acting as seeds for future tumors. Since then, regular cystoscope examinations of the inside of my bladder have detected no new tumors. Might your own situation have any similarities with mine? For example, might your tumor(s) be superficial and growing only on the lining of the bladder? Is there any chance that your cancer has taken root in deeper bladder tissues? Or has escaped further into other organs? These are the main questions that I wanted answered by my urologist. I earnestly hope that the answers you get are — like mine — evidence of tumors that can be easily removed and kept out. Martin

Fri, Jun 7 11:05am · stopping Carvedilol (Coreg): When will the effects wear off? in Heart & Blood Health

Hi @plantspec. Thanks for sharing additional information on your situation. It differs from mine. My problem (in addition to hypertension) was/is atrial fibrillation. I had not been on a heart medicine until then, but it clearly seemed necessary. I started on Coreg at 6.25mg twice a day, and over a few weeks, it was raised to 50mg twice a day (where I am now without significant side-effects). Your 3.125mg dose is the smallest available. Do you think your BP problem is an after-effect of the surgery? Or is it more likely from switching your med from Propranolol to Carvedilol? At my age (83), it's not unusual for my BP to run close to 150/90, even with the large Coreg doses. As a result, I don't have the fatigue and lethargy symptoms that sometimes go with low blood pressure. Instead, I'm a little off-balance after a small stroke a year ago (doing special exercises designed to teach my brain how to work with my legs and hands again). My wife is more susceptible to fatigue after suffering onset of supraventricuar tachycardia a few months ago. She's on a different medication regimen — designed to prevent spells of racing heartbeat. Her cardiologist is an electrophysiologist who uses a range of electronic tools to monitor and diagnose her heart conditions. Can you find a heart specialist who'd give you some second opinions?