General Medical issues thread

[QF WP]

Sorry to hear it. No matter how prepared you are, and how treatable the doctors tell you it is, it’s still very hard to hear that you have cancer. So I can really empathise with your brother.

And of course you must feel some worries for yourself with your family history.

I totally agree #fckcncr.

He's pretty prosaic about the situation. I've already had Cancer (malignant melanoma in 2000), so it's his turn.

He's emailed all of our cousins (females and well as males), so they can get themselves (or their partners) checked.

 

[prozac]

Checked over by my cardiologist last week. Apparently chemo has damaged my heart and my "ejection rate" is now below average. I have started taking Bisoprolol which he thinks might repair the damage. Fingers crossed.

 

[TheRealTMA]

He's pretty prosaic about the situation. I've already had Cancer (malignant melanoma in 2000), so it's his turn.

He's emailed all of our cousins (females and well as males), so they can get themselves (or their partners) checked.

FWIW: These days, while it is always a shock, tumours in the prostate are treated much more specifically than in the past and Urologists are much less prone to rush to surgery. Depends on the type of mutation and how aggressive it is etc. Maybe worth getting some genomics done on the biopsy tissue to get a better understanding of activity and possible treatment options.

 

[Quickstatus]

Bisoprolol

Was so good at reducing cardiac related deaths in patients with congestive heart failure, the double blind randomised CIBIS-II study was stopped. (Because it would have been unethical to continue the placebo arm of the trial)

(CIBIS = cardiac insufficiency bisoprolol study)

 

[prozac]

Was so good at reducing cardiac related deaths in patients with congestive heart failure, the double blind randomised CIBIS-II study was stopped. (Because it would have been unethical to continue the placebo arm of the trial)

(CIBIS = cardiac insufficiency bisoprolol study)

But is it likely to "fix" the chemo damage (reduced movement)?

 

[Quickstatus]

But is it likely to "fix" the chemo damage

I don't have info re specifically Bisoprolol and chemo induced cardiomyopathy. But to the extent that Bisoprolol is beneficial in cardiomyopathy related heart failure generally, I can only say that it should be of benefit.

 

[prozac]

I don't have info re specifically Bisoprolol and chemo induced cardiomyopathy. But to the extent that Bisoprolol is beneficial in cardiomyopathy related heart failure generally, I can only say that it should be of benefit.

I am banking on it (hoping) being temporary. Really not happy if it is not.
Back to see cardio late Feb. Hopefully he will tell me then that everything is back to normal.

 

[Quickstatus]

I am banking on it (hoping) being temporary. Really not happy if it is not.

The theory behind the beneficial effect is the heart is able to relax a bit allowing the heart wall to remodel itself
Take bisoprolol forever?, time will tell..

 

[Bundy Bear]

Went to the Dr yesterday and now on a different set of antibiotics, “doxycyc…” still feel tired and sluggish today at least I got up and did the washing. I did take 2 of the night time day/night chemist drugs which gave me my best sleep in 3 weeks maybe thats why I am feeling terrible today.

 

[drron]

I am banking on it (hoping) being temporary. Really not happy if it is not.
Back to see cardio late Feb. Hopefully he will tell me then that everything is back to normal.

Different chemotherapy drugs have differing effects on the heart. For instance with Herceptin induced heart failure 80% have the heart going back to normal when it is ceased. Not so with the other agents.
Certainly there is evidence of effective heart failure treatment improving heart function in chemotherapy induced heart failure. much more likely if the treatment is started early on after the developement of heart failure.
But effective heart failure isn't a beta blocker alone. Should at least be taking an ACE inhibitor as well.

 

[Quickstatus]

Combo beta blocker and angiotensin blocker have good data in stable heart failure.

 

[RooFlyer]

OK, while our sages are thinking about heart issues:

I had 3 episodes of atrial flutter 5 years ago, cured by 2 x atrial reversions, 1 x extra dose of beta blocker. Only occasional bursts lasting seconds since then. None is past 6+ months; I'm not concerned.

I have a 'minor' blockage of one smaller heart artery ('minimal stenosis' CAD RAD score of 1). On stains and Xeralto as precautions.

But I've had issues with ectopic beats since then. Atrial and ventricular; can't say the proportions. I have a 6 channel 'Kardia' ECG device which I can send readings to my cardiologist if necessary or prior to a particular appointment.

I can get a lot of ectopics - every second beat over a few minutes, then various numbers on-and-off over hours; a couple of hours later, more. I call them 'swarms'. They bug me, especially when I am trying to sleep, with the 'thump' of the catch-up beat impossible to ignore.

I was on Sotalol beta blocker after the atrial flutter and increased dosages helped with the ectopics. Eventually they 'broke through' that; tried metoprolol but no help; back to Sotalol, then back they came - talking over a year or two so far here. Changed to amiodarone for about 2 months and that stopped the ectopics, at least the ones I noticed. Checked thyroid - OK. Came off the amiodarone (I know it not great to take) and the ectopics held off for about 3 months, then returned. Cardiologist disappointed. Back on Sotalol, stopped the ectopics again. But after several months, back they came.

So I'm back on amiodarone but it hasn't stopped them this time. Not the 'constant' runs but plenty, and often 'heavy'.

Cardiologist said a while back they they don't now of any particular causative agent for increased ectopics, although I see a positive correlation with being tired (in general, or after a particular bad night's sleep) and/or being hot.

SO: I'm not looking for any particular advice here about what to do, but I'm seeing my cardiologist in the new year and we'll be discussing situation. What are some things I can mention, ask about, explore with him? Other therapies? I've heard about an operation to 'cauterise' the extra beat-initiating locii within the heart - is that just for atrial flutter, or possible for ectopics?

And thank you every one for tuning in

 

[JohnM]

Looks like I have joined a fairly large club. Gleason of 3 +4. PET scan next Friday... Physio consult for the pelvic floor strengthening exercises next month. Next meeting with the Surgeon 8 January. He's the local head of Robotic Surgery. Concerned about side effects....but thats life. Some comfort with these posts...thanks!

Don't hesitate to reach out by PM.

 

[prozac]

Don't hesitate to reach out by PM.

Happy to say my prostate figures are great.

 

[Quickstatus]

I've heard about an operation to 'cauterise' the extra beat-initiating locii within the heart - is that just for atrial flutter, or possible for ectopics?

@RooFlyer
Time to see an electrophysiological cardiologist and get them to do a radiofrequency ablation of the source of the ectopics.

RFA - through the groin as a general anaesthetic. General easier than being awake because it can take a while to be on the table trying to stay perfectly still. . They insert wires and map for the source of the ectopics and then zap it with radiofrequency energy.

 

[RooFlyer]

. They insert wires and map for the source of the ectopics and then zap it with radiofrequency energy

thanks, I guess if the heart doesn’t perform (the ectopics) at the critical moment they can’t map them and there wouldn’t be a result?

 

[Quickstatus]

they can’t map them and there wouldn’t be a result?

Oh yes they can. They can induce ectopics or arrhythmia by applying a small electric current in various spots and their sensor electrodes can then pinpoint where the ectopics are coming from.

In some people they can even trigger ventricular tachycardia or fibrillation - which is why a general anaesthetic is also better because when that happens your heart stops and they have to shock it back and you don't want to be awake for that

Do any of your ventricular ectopics turn into a run of VT?

 

[CaptainCurtis]

thanks, I guess if the heart doesn’t perform (the ectopics) at the critical moment they can’t map them and there wouldn’t be a result?

It's no guarantee, but generally they can - either electrically or through medication. If your ectopics aren't causing other issues, I'm not sure an ablation is worth the risk. Personal opinion though - I was petrified for mine, although it wasn't for ectopics.

 

[Quickstatus]

If your ectopics aren't causing other issues

Generally they will offer the electricity when the ectopics are symptomatic and not controlled with the various drugs

 

[RooFlyer]

Do any of your ventricular ectopics turn into a run of VT?

No.

I didn't mention that I had a day with a monitor attached but of course the ectopics didn't 'perform' much that day. But I have plenty of evidence via the Kardia unit. Its brilliant. Size of a thin wafer biscuit, it takes 6 channel EKG, saves as a PDF that I can e-mail from the app if I want to. Will suggest a number of various arrhythmias if thinks present.

EKG Anywhere, Anytime

Created by cardiologists, it’s heart care you can trust. Get accurate EKG results from home and detect 6 of the most common arrhythmias.

kardia.com

The following is just a random sample; not necessarily electrically stable.