Friday, December 20, 2013

Ablation for heart flutter in the U.S. and Canada

Health care is expensive. That is a given. How a society covers the cost of health care is the big question facing both Canada and the United States. The Americans, prior to Obama, essentially relied on insurance companies to solve the problem. The solution wasn't perfect but for many Americans it worked.

Unfortunately, if you were dropped by your insurance company and you were unable to replace your coverage, you were in deep trouble. If you had a preexisting condition, the very health issue for which you needed covered, you might not be able to get that coverage. And if you could not afford the insurance premiums, you went without. The result was that in the States something between 35 and 40 percent of all Americans took a pass on health care; They didn't go to the doctor, to the dentist, or the hospital and if they did go they didn't get their prescriptions filled afterwards.

Canada has taken a different tack. It is called the single payer system, I believe. It isn't socialized medicine but Yanks see it that way. Because so many more Canadians as a proportion of society have health care coverage, the demand for health care in Canada is swamping the health care system. The U.S. system isn't swamped but then almost 40 percent of Americans are being kept on the sidelines. Comparing the Canadian system to the American one is a complex problem. The results of an indepth examination of the two systems really depends upon how you approach the issue.

My take on Canadian health care is from the angle of an aging heart patient. Treating my heart disease is time consuming and expensive. Suffering from a genetic-based heart disease (ARVC), my heart muscle is being slowly converted into fibrous tissue and fat. Neither materials are found to any great extent in strong, healthy heart tissue. As the muscle breaksdown, the weakened heart expands and fails.

I have given up jogging. Asking the heart to pump a lot of blood in a short period of time stresses the heart. It expands with resulting small tears. The small tears heal with fibrous tissue and fat filling the space.

Keeping my heart rate down and keeping a lid on my blood pressure are both important. I'm losing weight to easy the burden on my heart. I'm down to 195 pounds. I take a powerful drug to depress my heart rate. I take Lipitor to keep my cholesterol in check. And I take a blood thinner, Pradaxa, to prevent blood clots forming in my poorly functioning heart.

With my condition, heart arrhythmias are common. I suffer from a heart arrhythmia known as flutter. Arrhythmias cause the blood to swirl and stagnate in the heart. In about five percent of the time, this swirling results in the formation of blood clots which then move to the brain causing a serious stroke. Blood thinner slashes the chance of this occurring.

Sometimes, my heart can runaway. When this happens my heart must be hit with a brief but intense electric shock. In California a defibrillator was used in the Sonoma Hospital emergency room to force my heart back into sinus rhythm. If my heart is not returned to sinus rhythm within about ten minutes I can suffer irreparable brain damage and, within a few more minutes, death.

To prevent this, the doctors in Canada installed an ICD in my chest. ICD stands for
implantable cardioverter defibrillator. My personal defibrillator has stopped my heart from racing and has returned it to sinus rhythm at least three times. The ICD has also acted early to correct potential runaway heart problems, stopping the events from continuing into the life threatening stage.

Oddly enough, when my heart isn't racing, it is hardly beating at all. My heart rate can drop into the thirties! This isn't good. My ICD is programed to notice this problem and at these times it acts like a pacemaker. In one three month period it was found that my ICD paced my heart 98 percent of the time.

Last Friday, a week ago, the cardiac specialists at the London Health Sciences Centre gave me a reprieve from my constant heart flutter. They performed a catheter ablation procedure on my heart. Opening a small hole in a major vein in my groin, the cardiac team threaded fine wires through the vein up into my heart. They found the bad electrical pathway in the heart and burned a path across it. Scar tissue will form and this barrier should prevent my heart from returning to flutter for sometime. Eventually the heart may find another route or another path may form as my heart continues to expand. A second procedure may be necessary.

Today, I feel much better. My heart is out of flutter. My chest feels, for the most part, relaxed. But, more to the point, I am relaxed. Living in Canada, I had to be patient as the doctors went about the task of extending my life but, in the end, I was not saddled with an impossible to pay bill. Nor did I face the possibility of being dropped by my insurance company or seeing my premiums climb into the stratosphere.

What a contrast to the situation resulting from my medical treatment received in California. There the doctors were also excellent, the hospital first rate, the equipment state of the art but the bill was unbelievable. And I do mean unbelievable. When I told my Canadian doctors that I was able to run up a bill closing in on $30,000 in less than 48 hours, they were totally amazed.

After dumping almost $30,000 in California and finding no reason for my V-tach event, my health insurer was exceedingly unhappy. I believe, if I were American, I would have been at risk of having my insurance coverage revoked. On my own, I could never have afforded the wealth of tests that eventually were needed to discover the genetic cause of my problem. I certainly could not have afforded the ICD that has saved my life a number of times. And I could not have paid for the ablation therapy I had last week.

Health care is a complex issue. The stories in the media are more entertaining than informative. I cannot speak for all areas of health care in Canada. But, I can tell you that in London, Ontario, the cardiac doctors at the LHCS are first-rate, the treatment excellent and the options offered very compete.

The LHSC will be mentioned in my will and today I make do by making annual donations to both the hospital and to the Robarts Research Institute which is connected to both the hospital and to the nearby university.

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