DEAR DR. DONOHUE: Will you please discuss heart fibrillation? I take a medicine for high blood pressure. Medicines for atrial fibrillation made me wild. I also take warfarin for the fibrillation. I’d appreciate any information you have. — M.L.
ANSWER: Atrial fibrillation is one of the most common heartbeat irregularities. The atria are the two upper heart chambers, the site of origin for the electric signal coming from the heart’s inborn pacemaker and producing each heartbeat. Fibrillation is a rapid twitching of the heart muscle. The atria are not contracting; they’re squirming. This decreases the heart’s pumping power.
More dangerously, it also leads to clot formation. Blood stagnates in the squirming atria. Stagnated blood clots. Those clots can be carried in the circulation to a brain artery, which they block. That’s a stroke. That’s why you take warfarin (Coumadin) — to prevent clotting (anticoagulation).
Aging, high blood pressure, heart artery disease, heart valve disorders and an overactive thyroid gland are some of the things that lead to fibrillation.
The goals of therapy are to slow the heart, establish a normal heartbeat and prevent a stroke. Sometimes, simply slowing the heart will restore normal heart pumping without ending the irregular beat. Anticoagulation (blood thinning) is still needed.
I can’t mention all the medicines used to control fib; there are too many. In place of medicines, a shock to the heart sometimes can restore a normal beat. Heart specialists also use a technique called ablation. They thread into the heart a special catheter that has the capability of creating tiny scars with radio waves or ultrasound waves or by freezing tissue. The scars form an impenetrable barrier to the renegade electric signals causing fibrillation.
The booklet on heartbeat irregularities discusses atrial fib and the more common abnormal heartbeats. Readers can obtain a copy by writing: Dr. Donohue — No. 107W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Many months ago, my feet turned numb. The numbness has spread up to my knees. It has made me quite unsteady when I walk. My doctor can’t find a cause or treatment for this. Can you suggest anything? — L.O.
ANSWER: Your description fits peripheral neuropathy, a deterioration of nerve function, often of the leg nerves. The causes for it are many. Frequently, however, a precise cause can’t be determined.
You need to make an appointment to see a neurologist as soon as you can.
DEAR DR. DONOHUE: What does it mean when there are bubbles in the toilet after urinating? Every time I urinate, foaming bubbles appear on the surface of the water. Is this an indication of a medical problem? If so, what should I do? — W.G.
ANSWER: When you pour one liquid from a height onto another, bubbles form. That’s normal.
If the bubbles are dense and as extensive as a head of beer, that can be an indication of protein in the urine. For those kinds of bubbles, a urinalysis, one of the cheapest lab tests, will confirm or refute the presence of urinary protein.
DEAR DR. DONOHUE: What is the difference between anxiety and panic attack? I am claustrophobic, and I need to fly from the West Coast to the East Coast and back. I can’t do so because of my problem.
I have tried therapy several times, but it did not help. I do not want to go that route again.
Can you give me some suggestions on how to be able to fly with this problem? Is there a medicine I could take before I get on the plane? — Anon.
ANSWER: Anxiety is excessive worry. In some cases, worry is appropriate. But with pathological anxiety, the worry is about things that don’t merit worry or about imagined things that truly merit no concern. Under “anxiety disorders” are many different conditions, each with a slightly different set of symptoms. They all share some things in common.
Panic attacks are the sudden onset of terror in places where such terror is inappropriate. The attack builds to a high point in a matter of 10 minutes or less. The attack can take place in a perfectly neutral situation, like shopping in the grocery store. During an attack, the heart beats fast, people become short of breath, and they often sweat and fear they are at death’s door.
Phobias are unreasonable fears of people, places and things that don’t engender fear in others. Claustrophobia is the fear of being in an enclosed space, like an airplane. Phobias can bring on a panic attack. Maybe your phobia is not so much a fear of enclosed space but a fear of flying.
I’m not certain these distinctions are of importance to you. The important thing for you is to uproot whatever it is that paralyzes you when you must board an airplane or to blunt it so you can function. Mental health professionals can get you over anxiety, panic attacks and phobias. I’m not positive what you mean by “going that route” again. Do you mean a detailed probing into your childhood and such matters? That isn’t usually necessary. The doctor might prescribe a medicine that calms you and that you take only when needed. You won’t become dependent on that medicine every day of your life. You use it only for the situation that throws you into such high anxiety.
DEAR DR. DONOHUE: My husband, 78 years old, fell off a ladder, and his head struck the sidewalk. I insisted he go to the emergency room, although he put up a fight.
In the ER, the examining doctor gave him a very complete examination. He ordered a CT scan of his brain. The doctor found nothing wrong, and the scan was said to be normal. They sent us home.
This week we got a report of the scan. It says my husband has brain atrophy. I had to look up the meaning of atrophy. My husband was never an Einstein, but what is the significance of brain atrophy? He carries on a reasonable conversation, and he reads the paper carefully. Need we be concerned? I’m upset. He isn’t. — W.Y.
ANSWER: Atrophy means shrinkage. If everyone your husband’s age had a brain scan, most of their reports would say brain atrophy. It’s something that happens with age.
It doesn’t imply any serious trouble. It shouldn’t scare you or him.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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