BajaNomad

Cardio- versions in La Paz ?

BajaBlanca - 5-10-2014 at 12:49 PM

Hi folks, Les's heart is racing again (too much love for me, I know). And we need a cardio-version.

Has anyone had one done in La Paz or Cabo?

What was the total cost?

Dr name and contact info?

We are trying to decide whether Les should just go to the states via plane where we have insurance or whether it is financially viable to do the procedure here.

Gracias to all.

EnsenadaDr - 5-10-2014 at 12:54 PM

Baja I would suggest going to the nearest ER immediately. at times, Atrial Fibrillation can be controlled with Diltiazem or Verapamil. Let the ER decide whether to cardiovert, but medication should be the first consideration. Get to an ER right away, the heart can decompensate rapidly and turn into Vfib or Vtach, which can be deadly. You need an EKG to determine what kind of arrhythmia he has.

BajaBlanca - 5-10-2014 at 12:56 PM

No worries, we have a cardiologist in La Paz and one in San Diego. Both on the alert.

EnsenadaDr - 5-10-2014 at 12:58 PM

ok but I know a few Nomads have recommended some good hospitals down that way and Les needs to be hooked up right away to a monitor. Especially today being Dia de Las Madres, and the US not very close, I wouldn't wait for a return call. Keep him in the A/C and out of the hot sun!!

[Edited on 5-10-2014 by EnsenadaDr]

[Edited on 5-10-2014 by EnsenadaDr]

Mulegena - 5-10-2014 at 01:00 PM

I'm sure your La Paz cardiologist will best advise you.

Good luck, dear friends.
Keep us posted.

BajaBlanca - 5-10-2014 at 01:10 PM

Yes, his advice was to go to Cabo for the esophagus testing and then return to La Paz, his estimate was about $20 - $25,000 pesos. Just wanted to see if anyone had any specific experiences.

EnsenadaDr - 5-10-2014 at 01:19 PM

I always advise my patients to try the Valsalva maneuver in a fast arrhythmia, bear down as having a bowel movement, it puts pressure on the vagal nerve and can break the rapid heartbeat. I had a young man come into the Maneadero clinic about 22 years old and his heart rate was clearly too rapid and abnormal. I told him to go into the bathroom and bear down as he was having a bowel movement, and he did it once and it didn't work. He tried it again, and his heart rate returned to normal. As there were no medications or cardioversion equipment appropriate for his condition, this was a tried and true method for many doctors to suggest in an emergency situation where someone's heart was racing and no access to treatment.

Mulegena - 5-10-2014 at 01:35 PM

History of a racing heart that needed cardio-version... doctor suggests a trip to Cabo and an esophagus test...

Won't the doctor meet you in a La Paz emergency room in a hospital in which he has privileges?

This makes me very uncomfortable.

Suggest Les does the maneuver described by Janene and head to Fidepaz Hospital now.

Advise the doctor(s) of your plans.


[Edited on 5-11-2014 by Mulegena]

rts551 - 5-10-2014 at 01:44 PM

beware free medical advice.

DENNIS - 5-10-2014 at 01:44 PM

Quote:
Originally posted by BajaBlanca
esophagus testing



For those who wonder: they put a camera about the size of a Vienna Sausage down your throat to look at the heart from the back side, making sure no blood has pooled and solidified at the bottom. The shock could break that loose and go to the brain. Very deadly.

redmesa - 5-10-2014 at 02:05 PM

Blanca , John just died of a heart attack after 4 years of AFib. The advice always was to head to the nearest emergency room and get cardio-vert. I know you guys have had lots of experience with heart conditions. John and I decided when we went to Baja that the first sign of high blood pressure or AFib he would fly quickly home to Canada and into the nearest emergency room, which he did several time. This is from a woman who has been through this with her husband for many years.

Udo - 5-10-2014 at 02:12 PM

At least you and Les are in a majorly populated area with great medical care, not in La Bocana.

Mula - 5-10-2014 at 02:20 PM

I wouldn't worry about cost . . . I'd just get to the nearest ER.

But maybe that's just me!!!!

redmesa - 5-10-2014 at 02:27 PM

Yes, Mula you are so right. There is no reason to delay. We were in Bahia Asuncion so we were very alert to any changes in John's health. He died of an unpredictable heart attack on a beach in Hawaii. So you just do the best you can when you can.

EnsenadaDr - 5-10-2014 at 02:53 PM

Or TGE, Transesophageal Echocardiogram. The closest point of contact to the Left Atrium is the esophagus where most emboli of the heart occur and can be visualized well from that vantage point.

However, this is done after the arrhythmia is controlled.
Quote:
Originally posted by DENNIS
Quote:
Originally posted by BajaBlanca
esophagus testing



For those who wonder: they put a camera about the size of a Vienna Sausage down your throat to look at the heart from the back side, making sure no blood has pooled and solidified at the bottom. The shock could break that loose and go to the brain. Very deadly.

redmesa - 5-10-2014 at 03:07 PM

It has depended on us whether John had been on blood thinners or not. He had a TGE once but other times he did not before a cardio-vers. A TGE is not pleasant and John had to be put under an anesthesia to have it done before his Cardio-version.

EnsenadaDr - 5-10-2014 at 03:10 PM

redmesa I am so sorry for the loss of your husband. Once they establish there are or there are no blood clots in the heart then they don't have to repeat the test. If they do find blood clots, they will put the person on blood thinners and usually they do not have to repeat the test once they have a baseline.

DENNIS - 5-10-2014 at 03:25 PM

Quote:
Originally posted by EnsenadaDr

However, this is done after the arrhythmia is controlled.



To me, they did it right before they pulled the shock trigger. I was not in sinus rhythm at that point.

EnsenadaDr - 5-10-2014 at 03:33 PM

You had a scheduled cardioversion. This was after you had been diagnosed. If someone is decompensating, they will try and get the arrhythmia under control first.

They can do it either way.

http://intermountainhealthcare.org/ext/Dcmnt?ncid=521046279

BajaBlanca - 5-10-2014 at 08:42 PM

Les has the best doc in sandiego. The guy is considered the Pope of docs and travels the world teaching about ablations as he is head of the dept at UCSD, he knows Les forward and backwards.

I just wanted some info specific to La Paz. How can you do a cardio version here when the local doc told us one can only get the esphogus test done in Cabo? If anyone has soecific info to this area, it would be appreciated (((:

EnsenadaDr - 5-10-2014 at 08:58 PM

Blanca you only do Cardioversion with a doctor's order. You can't order a doctor to give your husband a Cardioversion. They have to hook him up to a monitor and see what he has. Go to the ER and have them put him on a monitor. A cardioversion is not like getting an enema, it is a very serious procedure that needs to be monitored closely. It is essentially an emergency procedure. It is only done when medications and other options do not work. I wouldn't chance it in Mexico unless no other treatments have worked. Sometimes an injection of Diltiazem will slow the atrial fibrillation down to an acceptable level till you can get him back to the US. Most likely you got this answer from the Cardiologist because it isn't an option in his hospital. Get back to the United States if you absolutely insist on a cardioversion. Make sure he is well hydrated and is not drinking alcohol and stays out of the heat. Guaranteed Les' doctor in San Diego would advise the ER as well.

[Edited on 5-11-2014 by EnsenadaDr]

mtgoat666 - 5-10-2014 at 09:11 PM

What are you waiting for?!?!?!?
Fly to San Diego!!!!
Crikey! Use common sense! Get to a real hospital!

DENNIS - 5-11-2014 at 06:28 AM

Quote:
Originally posted by EnsenadaDr
Blanca you only do Cardioversion with a doctor's order.


But they'll sell a de-fib machine to any kid who walks in off the street?

DENNIS - 5-11-2014 at 06:35 AM

Blanca and Les are showing all of us the importance of MediVac insurance.

oladulce - 5-11-2014 at 07:16 AM

Quote:
Originally posted by mtgoat666
What are you waiting for?!?!?!?
Fly to San Diego!!!!
Crikey! Use common sense! Get to a real hospital!


Sheesh, Blanca isn't an idiot.

Chances are she's looking at flights while at the same time posting here to see if anybody has found an expeditious way to have the procedure done locally. They're in La Paz, so think about it- she has to consider landing in TJ and taxi to the border, walking across the border, and a taxi on the other side... Maybe Les' CA cardiologist told her if they flew up there they couldn't get him on the schedule for elective cardioversion (see below) for a few more days so in the meantime she's looking at possible local options.

She's never said what his heart rate or rhythm is, or what his normal rhythm is. His normal rhythm could possibly be atrial fib which is why his doctors are recommending optimizing the conditions before cardioverting due to the increased potential for dislodging blood clots. He could have been in atrial fib for the past 20 years and be tolerating it fine, but has switched to a different rhythm which is causing his symptoms. Without obtaining Les' complete past history along with all his present signs and symptoms, there are too many variables to give her responsible input.

There is emergent cardioversion for life threatening conditions, and elective cardioversion for situations where the heart has kicked in to a rapid rhythm, but the patient is tolerating it fairly well and there would be risks to start shocking the heart. Of course his rapid rhythm needs to be treated but it's always best to have as many facts and as much control as you can before performing a procedure that has it's own inherent risks.
They can't just grab the paddles.

It sounds like his doctors are being cautious before proceeding and she is trying to figure out the logistics and wondered if anyone has already been through this and could offer advice. I'm sorry Blanca, wish i could help.

rts551 - 5-11-2014 at 08:20 AM

Quit YELLING you guys...sounds like dinner and drinks went just fine.

http://forums.bajanomad.com/viewthread.php?tid=73372&pag...

EnsenadaDr - 5-11-2014 at 08:35 AM

The doctors shouldn't be deciding anything before hooking him up to a monitor. They don't know if he has SVT, PVC's,PAC's. uncontrolled atrial fibrillation, or Ventricular tachycardia. Doubt he has Ventricular fibirillation because he only would last a few minutes with that. Just because cardioversion has worked in the past doesn't mean he's a candidate for it each time. I have seen it done dozens of times in the US but never once in all the facilities I have been in Mexico. How could the doctors be deciding what to do when they don't even know what they're dealing with.

[Edited on 5-11-2014 by EnsenadaDr]

DENNIS - 5-11-2014 at 08:46 AM

Quote:
Originally posted by rts551
Quit YELLING you guys...sounds like dinner and drinks went just fine.

http://forums.bajanomad.com/viewthread.php?tid=73372&pag...



You OK, Ralph? Are you having a bad dream? :lol:

BajaBlanca - 5-11-2014 at 09:00 AM

Thanks, Oladulce.


You hit it on the nail. Absolutely brilliant and I could not have said it better. Les is elective as the docs sayhe could live forever just like he is. He does not want to. Hence, elective.


Les has checked into flights and San Diego doc is indeed calling us Monday with a date.

I simply wanted a future plan B for La Paz. This is bound to happen again.

We did find a local place that does ECGs for 100 pesos, right around the corner and have done them consistently the last couple days.

Les is on blood thinners in preparation for San Diego. We have been around the block, folks, no one is playing around. The heart rate is high but not that high.

Dinner and drinks were fabulous, that was right on the nail too (((:

All that being said: the doc here, before we heard back from our san diego cardiologist (who said it would not work in Les's case) suggested Les try to control the arrythmia (sp) with meds. It was horrible. Terrible. Beyond scary. He could not take 2 steps without being winded. We wish we had never started this option. I would not wish it on my worst enemy.

[Edited on 5-11-2014 by BajaBlanca]

EnsenadaDr - 5-11-2014 at 09:20 AM

Alcohol after a scare like that? Anyone knows that alcohol exacerbates atrial fibrillation. and a huge dinner should be avoided as well.

http://www.everydayhealth.com/health-report/atrial-fibrillat...

rts551 - 5-11-2014 at 09:27 AM

Quote:
Originally posted by DENNIS
Quote:
Originally posted by rts551
Quit YELLING you guys...sounds like dinner and drinks went just fine.

http://forums.bajanomad.com/viewthread.php?tid=73372&pag...



You OK, Ralph? Are you having a bad dream? :lol:



Between internet sleuthing for missing people, forum medical diagnosis, and a continuing theme of economic downsizing I think it was a night mare. But I have a remedy....cooler full of beer, couple of burritos, the boat and a fishing pole.

EnsenadaDr - 5-11-2014 at 09:38 AM

If that is all you have to do with your time, have at it. Remember the beer might just jumpstart atrial fibrillation though!! Have a great Mother's Day! OH yeah watch out for the lard laden burritos as well.
Quote:
Originally posted by rts551
Quote:
Originally posted by DENNIS
Quote:
Originally posted by rts551
Quit YELLING you guys...sounds like dinner and drinks went just fine.

http://forums.bajanomad.com/viewthread.php?tid=73372&pag...



You OK, Ralph? Are you having a bad dream? :lol:



Between internet sleuthing for missing people, forum medical diagnosis, and a continuing theme of economic downsizing I think it was a night mare. But I have a remedy....cooler full of beer, couple of burritos, the boat and a fishing pole.


[Edited on 5-11-2014 by EnsenadaDr]

EnsenadaDr - 5-11-2014 at 09:52 AM

Another thing I would like to mention is shortness of breath. Many might want to relate it to being medicine induced but it is the actual atrial fibrillation that causes shortness of breath especially when it isn't controlled. Your heart is pumping ineffectively therefore not enough oxygen is being distributed to the tissues hence shortness of breath. Get the rhythm and rate controlled and you will not have problems feeling short of breath!

rts551 - 5-11-2014 at 09:53 AM

Quote:
Originally posted by EnsenadaDr
If that is all you have to do with your time, have at it. Remember the beer might just jumpstart atrial fibrillation though!! Have a great Mother's Day! OH yeah watch out for the lard laden burritos as well.
Quote:
Originally posted by rts551
Quote:
Originally posted by DENNIS
Quote:
Originally posted by rts551
Quit YELLING you guys...sounds like dinner and drinks went just fine.

http://forums.bajanomad.com/viewthread.php?tid=73372&pag...



You OK, Ralph? Are you having a bad dream? :lol:



Between internet sleuthing for missing people, forum medical diagnosis, and a continuing theme of economic downsizing I think it was a night mare. But I have a remedy....cooler full of beer, couple of burritos, the boat and a fishing pole.


[Edited on 5-11-2014 by EnsenadaDr]


Yes there is more to life than the internet!

redmesa - 5-11-2014 at 04:02 PM

Blanca do you have a good blood pressure gauge? John kept his blood pressure daily, weighed himself, and definitely was aware of shortness of breath and swelling. Our BP gauge also has a AFib alert on it so that helped if he was unsure. After 3, week long stays in ICU, 2 heart ablations, 4 or 5 cardioversions, many ECGs, 24hr heart monitors, stress tests etc. several medications for arrhythmia including amioderone (which should be avoided) I feel I am a minor expert. We were also schooled and prepped for a study group for efficacy of ablations + or - medication support.