DEAR DR. DONOHUE: Last fall, my heart started to jump around, and I took it that I had palpitations, although I wasn’t sure what palpitations were. It turns out I had atrial fibrillation. Since then, I have been on many medicines for the atrial fibrillation plus Coumadin, a blood thinner. The Coumadin requires frequent trips to the lab. I have a hard time getting around. I don’t drive. My doctor suggests ablation. What are your thoughts? — H.M.
ANSWER: Atrial fibrillation is in either first or second place when it comes to heart questions. It means the heart beats rapidly and irregularly. The rapid heart pumps less effectively, and the irregular beat promotes the formation of blood clots in the upper heart chambers. Those clots, or pieces of them, can be carried through the circulation to the brain, where they cause a stroke.
Treatment for atrial fibrillation aims to slow the heart, get it to beat regularly and prevent clots from forming if a regular rhythm cannot be attained.
Medicines sometimes can both slow the heart and restore a normal rhythm. If a normal rhythm is not achieved, the patient will still do well if the heart beats slowly. That patient, however, must add to his or her treatment a blood thinner like Coumadin to prevent clots and a stroke.
Your doctor has suggested a way to restore a regular beat — ablation. A heart doctor inches a special catheter — a thin, pliable tube — from a surface blood vessel to the heart. The catheter is equipped to emit radio waves, which make a series of scars to prevent the generation of erratic signals that spawn atrial fib. The result, when the procedure is effective, is a normal, regular heartbeat. The patient can then kiss Coumadin goodbye. My thoughts are that it’s worth serious consideration.
You can also get rid of Coumadin by switching to Pradaxa, a blood thinner that doesn’t require lab testing. It’s new and is somewhat expensive.
The booklet on heartbeat irregularities explains atrial fibrillation in detail. To order a copy, write to: Dr. Donohue — No. 107W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6. Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I’m a 34-year-old male and am going bald. What is your opinion on hair transplants? Do they last? How successful are they? — L.K.
ANSWER: Male hair loss occurs because male hormones shrivel hair follicles, the home for each hair. The hair thins, is shorter and falls out well before its time. Sensitivity to this male hormone action is genetically programmed, and in some men, it takes place at young ages.
Have you considered using minoxidil, which is applied to the scalp, or finasteride, an oral medicine?
Hair transplantation works well. The hair is taken from the back of the head, where hair follicles have a long life. It’s very successful.
It would be wise to check with a doctor to see if your hair loss really is something you inherited, or if it’s a sign of something else.
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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