Thanks for the response 'vagal or adrenergic'. I was pretty sure I am 'mixed', and your responses helped confirm that. My wife and I just returned from a New Year's trip. Thank you all again for your feedback.
Another topic - appointment with my cardiologist:
This week I am going to be talking with my cardiologist. After seeing me on December 3(I had begunn a two month medical leave on December 1), seeing my Holter Monitor test, and hearing that I was in AFIB a lot of the time he wants to put me on metrolopol - 25 mg a day to control the rate and reduce stress on the heart. When I first heard this it made sense. Then I read a post in the LAF forum where metrolopolol was contraindicated for adrenergic afibbers. My cardiologist had not told me there were different varieties of AFIB. I'm not sure he knows the difference between adrenergic and vagal.
Anyway, when I saw him on December 4 I was just coming off a month-long period in November where my AFIB was the worst it had been in five years On some days in those last two weeks of November I estimate I was in AFIB 70% of the time. During November I was also on 12.5mg of metrolopolol a day as prescribed by my Family Practice doctor. I mentioned this to a heart surgeon, who is a friend, and he said a small dose of 12.5 mgs was like licking a piece of candy. However, it was during that time when I was taking that small dose in the month of November that my episodes escalated to the worst they had ever been. Even though I was also under a lot of stress, in hindsight I now suspect that even that small dose of metro may have contributed to AFIB episodes of increasing frequency and duration.
Since I have been on leave of absence from work in the past four weeks my episodes have gradually and, I think, significantly, diminished - from a peak of about 70% to about 20 - 33% of the time in the last week. By the way, I did quit taking the 12.5 mgs of metrolopolol just as I began the 'leave' on Dec. 1. The cardiologist new I was discontinuing the small dose. Again, at that time I did not suspect that the metrolopolol might have been a contributor.
I sent an email to the cardiologist's nurse practitioner with one of the posts from Hans describing how metro is contraindicated for adrenergic afibbers. Since I have read the "book" I have learned that it may be of some benefit for some mixed afibbers. But, I have doubts (and fears) that it will not work for me based on my past experience. I don't want to go through drug-induced episodes. Nevertheless, I'm not sure but that those most severe episodes might have been just stress-induced.
I followed up the email to the Nurse Practitioner with another phone call - informing her that I wanted to let the 'changes' I have made play themselves out for 6 - 8 weeks before trying the metrolopolol again. She 'seemed' amenable to that. However, today I received a letter from her, on behalf of the cardiologist, again, suggesting that I go on 25 mgs of metrolopolol with no mention of a 6 - 8 week trial based on diet, supplements and other changes. I suspeect the NP and the cardiologist may not be talking with each other.
One of the wrinkles which complicates this is that I am going to apply for temporary partial disability through the disability plan at work - which is somewhat progressive. I believe and hope that if I have some more time (and this is one of my questions below) that I can continue to reduce symptoms and establish a high enough quality of life through diet, supplementation and life-style changes that I won't have to be on meds. However, I also conjecture that the disability plan people are much more 'western medicine' friendly. And, their folks will be in touch with my cardiologist to determine whether I qualify. I am not sure about his attitude and knowledge of the disease and that, at worst, he may view me as 'non-compliant' and not recommend a temporary 'partial' disability to give me time to see 1) how I tolerate similar stresses while working at a similar job part time and 2) give the changes time to take effect.
So, I have two question - which I will pose below.
But, first, FYI here are some of the changes I've made in working with a young bright MD working in a wholistic center. The diet and nutritional supplements were her suggestions.
1) low glycemic load 'balanced' diet.
2) cut out caffeine, alchohol, aspartame, MSG, etc.
3a)120 mgs and 10 mgs calcium Magnesium glycinate 4 times per day(AM and PM 30 minutes before mealtime),
3b) CoQ 10 (120mgs) two times a day (Puritans pride brand),
3c) Vitamin E complex 1:1 ratio of alpha (400IU) and gamma (270 mg) tocopherols once a day (metagenics brand),
3d) Zy-zyme (zinc gluconate and aspartate) 1 tablet - 15 mg before each meal - chewed),
3e) B-12 sub-lingual two times per day before breakfast and supper (metabolics brand),
3f) Folate 800 mgs once a day in the AM (metagenics brand),
3g) Balanced B-Complex formula one time a day in the AM (metagenics brand,
3h) Fish Oil - EPA (600mgs)-DHA (400 mgs) 3 times a day 2 tablets after breakfast and 1 in the evening, and
On my own I have resumed:
1) regular slow stretch yoga,
2) regular moderate exercise,
3) moderate weight lifting (for toning and metabolism), and
6) wearing the CPAP machine.
My three primary questions are:
1. How to deal with the cardiologist?
Comment: (My plan is to talk with him directly and
a) see if he talked with the NP about the metrolopolol, ask him what he knows, and, if necessary, tell him what I've learned, b) check my plan out with him, and c) see if he's open (ie. compliant) to working with that plan.
2. How much time would you recommend I need to let these life-style changes have maximum impact.
3. And, as a follow up to number 2, would you recommend I be looking a temporary 'full time' or temporary 'partial' disability?
Comment: Work was clearly the primary stressor before I took the 12.5 mgs of metrolopolol. However, I've been in this job as a pastor of this congregation for nine years including the five years I've had AFIB, and it has only been in the last six months that the stress has escalated along with the episodes. I know I can't function as pastor of this congregation under the same circumstances. However, I think I can probably function OK if I am working part time - at least initially. But, I'm not sure. When a strong episode of AF hits I am extremely short of breath, and it's difficult to think straight.
I know this is long and drawn out. But, I'm at a critical point that can mean better management of the illness and a higher quality life in the years ahead.
Thanks for your help!
john