Wednesday, May 15, 2013

An ICD storm and a positive spin to slowly dying in Canada

When I was in California in the summer of 2010, I had a V-tach event. The heart reaches a frighteningly high, but very inefficient, heart rate. I needed medical help within ten minutes to prevent permanent brain damage or death from occurring.

Taken to emerg, the medical staff took my pulse, they got a reading of 300 beats per minute. They immediately placed defibrillator paddles on my chest and hit me with 200 joules of electricity. The jolt put my heart back in normal sinus rhythm.

In emerg in Marin County General in CA.
From the emerg in a hospital in Sonoma, California, I was taken by ambulance to Marin County General. I was kept overnight and given a number of fancy tests. Although no cause was found for my V-tach event, the cost of treatment reached almost $30 thousand U.S.

The battle to save my life was easy compared to the fight to have my insurance company cover the cost of my treatment. It was the better part of a year before the travel insurance provider provided the coverage for which they had been paid.

Yesterday I had another V-tach event at about seven in the evening. My ICD, implantable cardioverter-defibrillator, hit me with an electrical jolt that caused me to tumble from the bed to the floor. Wow! When I regained my composure, it was off to emerg for an EKG.

No heart damage was evident on the graph and the flutter which had plagued my heart for the past few months was gone. I'd had a successful do-it-at-home cardioversion. In no immediate danger, I was sent home with instructions to contact the hospital's cardiac unit as early as possible the next morning.

At midnight I had another V-tach event. I was not knocked out of bed but the jolt left me unnerved. I had a hard time getting back to sleep. Two events in just under five hours. Not good. Just one more jolt and I would be in the midst of a full-blown ICD storm.

At seven thirty the bedroom phone rang. It was the hospital. They wanted me to come in for eight thirty. At the hospital they downloaded the memory records from my ICD. It confirmed my two V-tach events and added a turbo event at three thirty in the morning. In the so-called turbo event, the ICD gained control of my heart without resorting to a full-blown electrical jolt. Once in control, the ICD paced the heart down.

Three events in about eight hours, this was getting serious. I was in the midst of an ICD storm, defined as 3 or more ICD jolts in 24 hours or less.

The doctor and nurse, working together, reprogrammed my ICD and the doctor upped my daily dose of sotalol by fifty percent. Sotalol is the drug I take to keep my runaway heart in check. Clearly it wasn't working at the former dosage.

I am now back home, my heart is again beating at its usual, sluggishly slow, mid 50s bpm and my blood pressure is also down. I seem to be out of danger for the time being. I see a cardiac specialist on the 23rd of this month to discuss my meds and next month I touch base with the ICD department of the London Health Sciences Centre.

I must rest today and tomorrow. I can't do anything strenuous. I have been left with one big question: How much would all this health care cost in the States?

In early 2003, I had robotic surgery to correct a failed mitral heart valve. The DaVinci medical robot used to perform this medical miracle is not cheap. I have a very small scar despite having had open heart surgery. The government health care system has a very big scar from where it must have bled big bucks paying for my excellent state-of-the-art care.

In mid 2010 the search for the cause of my V-tach event in California commenced. The American doctors failed to find a cause but then they had less then thirty hours to search. It took the Canadian doctors months to track down the cause. Eventually it required a high-tech, oh-so-expensive, experimental 7T MRI to suggest the cause and it took genetic testing to pinpoint it. My heart is breaking down because of a relatively rare genetic condition. The disintegration of my heart muscle is disrupting the heart's electrical system.

My ICD is similar to this one.
In early 2011 an ICD was implanted in my chest and a wire screwed into my heart muscle. I understand the ICD, a Medtronic Protecta XT VR, is among the best on the market. It didn't come cheap. The hospital doesn't say what they paid for this baby but I have seen figures indicating it might have set the government back about $26,500.

Since having the implant, I must go to the hospital ICD department every six months. They download the ICD memory and modify my treatment as seems reasonable.

My drugs are expensive. Luckily for me, unluckily for the government, I'm a senior. I pay only $4.11 for my prescriptions, but there is a once a year $100 deductible. The drug benefit is a perk of being old in Ontario. To keep costs down the government has certain restrictions and sometimes one is forced to take a cheaper alternative to what may have been the doctor's drug of choice. I say the government is paying the bill, at least most of it, I'm not going to bad mouth them for trying to get the most bang, or should I say the most drug, for the buck.

One reads a lot of bad stuff about the government health plan in Canada and Ontario. There are problems, no argument. Still, if I lived in the States would I still be alive? Would I have had the ICD implanted or would my insurance have been canceled after the incident in California? If all my recent health expenses had fallen on my shoulders, I could never have afforded the necessary treatment.

In the States, I would have been out of money after the first 24-hours of treatment. Those first doctors in California would have picked my financial bones clean.

Sometimes it is wonderful to be living, and slowing dying, in Canada.

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