I didn't think I'd be stressed about this, but I am. I'm mainly stressed by the logistics of the day. I am to go to the Oxford hospital, which is a long way for me and which has nightmare traffic issues around and inside the hospital itself. I'm very worried about getting there on time. My husband will have to drive and hates driving in traffic. He wants to use the park and ride. I worry about getting back to the car after an anaesthetic on the bus. Buses make me feel so sick at the best of times.
But I'm also worried by the letter that arrived today. I can't get an answer on the phone number it gives me. I take thyroid hormone every morning and allow an hour before eating or drinking anything else as recommended. I take my Appixaban, Bisoprolol and Digoxin at 11am (second Appixaban at 11pm) every day.
The letter says to take my meds for the day at 6am. To fast from 8am other than water. It also says how important it is not to miss a dose of the Appixaban. If I take it at 6am it will clash with my thyroxin and it will be 5 hours before I normally take it and 7.5 hours before the cardioversion appointment. I don't know what to do. I would be happier taking my Appixaban at the normal time, not so early as this.
Does anyone have any experience to share on this matter?
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FancyPants54
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I don’t know if this is helpful, but my pharmacist says that there are no interactions between thyroid hormone and Apixaban. I take them together at 6:00 in the morning, and my second Apixaban at 6:00 in the evening. Maybe you could ask your pharmacist for advice on the timing of the meds for that day, if you can’t get in touch with the doctor’s office.
No time to ask anyone as letter came today while I was out and my cardioversion is on Monday. I had a phone call with a cardiac nurse last week to clear me for the procedure. She knows what meds I'm on but didn't mention any of this to me.
I am nervous about the anaesthetic you are right. I had one in June for the fitting of a coil and a polyp removal. That wasn't a long procedure but it made me so sick. I was sick several times and felt dreadful despite lots of anti sickness. I could not eat anything. Only sip water. I was last out of the day ward and they gave up on the eating with me.
It being Sunday tomorrow I have no idea how to contact anyone.
I was asked about anaesthetic by the cardiac nurse I spoke to on the phone and I did tell her about my reaction and we talked about it. But she just said I had to have it anyway and it wouldn't be long.
No I haven't been given enough time. She never mentioned any of these timing issues on the phone to me. I thought I might ring the non-emergency NHS line tomorrow or as you say, find the local pharmacy that is open on Sundays.
I agree with Jalia here. It is not really an anaesthetic you are given just heavy sedation and I:m sure that you will have no problems at all with it. You will only be out for less than five minutes, possibly only two.
Thanks BobD. Is it stupid to admit that I'm scared of waking up in NSR because I will then have to live with the fear of the AF coming back. I've been living with it now for nearly a year and most of the time I can't feel it. It's been way easier to deal with than the "bolt from the blue" type. But I need to know how I feel if I can drop the beta blockers for a bit.
This may seem like overkill, but depending on your appointment time, think about staying in a hotel near to the hospital. Leave the car at the hotel and either use public transport or a taxi to get to the hospital and back to the car.
I had a GA for my ablation and I reacted quite badly overnight but the CV was a walk in the park by comparison, but I appreciate we are all different. I can’t help on the medication, but whatever you do, DO NOT miss the Apixaban cos if you do, they will cancel the CV.
I most definitely won't miss the Appixaban. But that's the one that is worrying me the most. I take it at 11am usually and 11pm. That way I can avoid my iron supplements and my thyroid meds. This letter tells me to take it at 6am! That will be so different to normal that it doesn't sound right to me.
I’d go with Bagrat’s tip on modifying the times, it’s what I do when going abroad on holiday with no problems. Then gradually bring it back in line with your normal schedule after the CV.
The first thing would be ring the hospital and ask to be put through to coronary care. The nurses there are very experienced and may even be the ones who do the cardioversion. They will advise. If they don't know I'm sure they could contact a doctor and get back to you
If no joy I know what I would do, remember this is just my thoughts not those of a medic. First I would take todays apixaban 2.5 hours early i.e 8.30 and 8.30 then it won't be a huge change tomorrow. I am over careful with drug times too. My husband not so muchat all!!
Maybe a taxi back to park and ride?? I worry more about logistics than procedures too!
I would 100% call the Coronary Care at the hospital and even though a Sunday don't put the phone down until you get the right answer. I have been in the Cardio unit and Observation units on a Sunday and been seen by a Cardiologist. The stress this is currently causing you will be 20 times worse than the cardioversion and I would make the most of the park and ride for sure. Good luck tomorrow.
Both CV. I was told that the rivaroxaban was essential to have beforehand but that waiting to have the thyroxine until after the CV really wouldn’t hurt for once especially if the CV was in the morning.
Mine is in the afternoon. But I'm fine about taking the thyroxine at 6am if that's what they want. The real stress is being caused by the timing of the Appixaban and to a lesser extent by the Bisoprolol.
I know how difficult it is to park in and around Oxford and it has always been thus since I can remember. I no longer live in that area but even where I live now hospital parking is very difficult - though if you get in early there are parking places. I also understand how hard it can be to get back to the park and ride - one evening I didn't manage to get back from central Oxford- all buses were full and then no buses to Kidlington from that stop and too late to get to the last bus from another stop! Had to walk to the Kidlington Park and Ride! I would book a taxi to get back to the park and ride and hang the expense!
As for the medication you can change your times and I have had to do it before traveling to the US for that I started changing the times a few days before. There should be no problem with taking your medications together maybe call the NHS direct line and ask about this to be sure if you cannot find a pharmacist to ask. I know when I first started with AF medication I tried to keep all medications apart - difficult to do at my age as I am on quite a few. After I went back into AF after first cardioversion (which lasted a year) I read all the packet inserts of my tablets and found I hadn't needed to keep them all apart so don't know why I did or what gave me the impression I should. In your case I would call the coronary care ward at the hospital or NHS non emergency line and ask. The hospital would be best I would think if this is possible as you may speak to one of the nurses who works in the CV clinic.
As for the CV it was a walk in the park. The light sedation lasts just minutes and I also have bad reactions to anaesthetics. The anaesthetist will visit you before your procedure so you can talk to them about it so you will be able to discuss it. Also ask them about prescribing an anti sickness medication so that if possible it is given to you immediately. My wife had a procedure with sedation and a pain pump with morphine once and had asked for anti sickness medication but it wasn't given immediately. Once back on the ward and feeling fine they offered her food about an hour later and she thought the anti sickness medication had been given to her but it hadn't so she didn't keep the food down but once given the medication she was fine so it seems it really should be given a while before eating if you need it. Ask about this so that everything is given in time and works well for you.
I have had two CVs both of which were successful for a good while and made such a difference to me and I am waiting for another and also on the list for an ablation. I do hope you CV is a success and it all goes well for you.
I hope your CV is successful and you get through it all OK. All the best with the Oxford traffic!
Thank you! I am far more worried about the timing of the medications and the travelling to get there than I am about the procedure. Although I do fear the coming round part. I'm just hoping it's not like last time. I will be sure to tell the anaesthetist about it.
Hardly slept last night worrying about the logistics!
If the thought of going into NSR and then reverting into Afib is the root of your anxiety, then you don't have to go through with the cardioversion if you don't want to. I have had constant afib since massive pulmonary embolism last year and tried a cardioversion in November. It worked for three days, then back into Afib, so I'm not trying again, as like you I can live with the Afib. Don't get me wrong the NSR felt great, and for some the cardioversion works for much longer, but you are getting so anxious about everything which is not the best for Afib anyway. I was told on the day not to take any of my meds until after cardioversion had been done, which is what I did with no problems. Also as others have said the anaesthetic is light and wears off very quickly. The burns from the paddles takes longer though!
Try and get some rest. I do yoga breathing which seems to help me. I think your best bet is to get to the park and ride bus in and taxi back. I don't know what time they want you to be in but earlier is better for parking and traffic and knowing that you will get there on time. I am a stickler for being there on time or earlier and my wife always complains about leaving an hour before necessary but once we had a 2 hour delay due to an accident on the motorway so it was just as well we left earlier than needed as we managed to arrive just in time for the appointment (luckily Doc had been delayed on his hospital round too! Just been looking at the leaflet I was given for my first cardioversion and it says that the anaesthetist will get you to complete a questionnaire - of course your hospital may be different so ask when you get there about seeing the anaesthetist.
Hope you come round in NSR. After my 2 cardioversions my nurse was leaning over me giving me the thumbs up each time best sight in the world.
I am hypothyroid and not responding well to thyroxine. Also having a mare of a menopause, so it's really hard to know which condition has robbed me of my energy and made my legs so weak and painful. Also my breathing is rubbish on exertion. The point of this cardioversion is to see how much my symptoms reduce or not.
My first Cardioversion lasted for nearly a year a few weeks off a year actually. The second lasted for about 4 months. I was fitted in for an emergency CV as I wanted to be in NSR for my total knee replacement operation and I am pretty sure that I went back into AFib due to the gruelling physio and amazing pain form the operation. I was to have another CV last Tuesday but Doc off sick so hoping to have one a week Tuesday and also on the list for an ablation which should be in March sometime hopefully. I know when I am going back into Afib as i get breathless in bed at night. Both times I went back into AFib this happened and I went straight downstairs and checked on the monitor and it showed I was in AFib. Despite my age and other ailments I am active and fit and want to stay that way for as long as possible so also on the list for an ablation.
Can sympathise with your menopausal problems as my wife had a heck of a time too. 10 years later and she still gets horrendous hot flushes - I also had them when on Hormone treatment for prostate cancer 3 years ago so can imagine what hell it is.
Thank you everyone. Your helpful advice has been so appreciated. I have spoken to a senior staff nurse in the cardiac suite and she has advised me to bring my Appixaban forward this morning, again a bit further forward tonight and then to take it at 6am tomorrow. She said they will give me more after the cardioversion tomorrow anyway. So now I can relax.
It's stupid how much stress an incomplete instruction can cause in an already stressful situation. I lost my Dad just before Christmas. We were not able to have his funeral until 14th January. Life was very stressful from mid November onwards. I've tried so hard to relax and prepare for this procedure since the funeral, but that went out the window yesterday. I should have been given better instruction over the phone at my pre-op call.
PLEASE don’t worry about taking your thyroxine with any of your other tablets. I’ve been on levythyroxine for about 5/6/7 years and I take all my tablets together (levythyroxine, apixaban, bisoprolol, furosemide, parcetamol)about 8.30am (and my apixaban again at 8.30pm) then my last 2 tablets (pravastatin, losartan) before I go to bed whatever time that may be. No-one has ever told me that I should take my thyroxine an hour before anything else and touch wood blood tests show that all is as it should be.
When I had my ablation I was on rivaroxaban and I was told, if I remember correctly, to just take it as normal.
When I had a cardioversion (both times once when on rivaroxaban and last November when on apixaban) I was NOT told to stop the anti-coagulant. In fact the person doing the emergency cardioversion the second time asked me many times making sure I had taken my anti-coagulant as I was so poorly they didn’t want to take any more time up doing the scan behind the heart to make sure no clots.
Anyway, try not to worry, fancypants54 as a cardioversion is painless and pretty straightforward and such a relief when you feel better.
Good luck
Ps...if you’re stressed about the journey, would it be possible for you to travel the day before and possibly stay the night in B & B or hotel?
PPS.....the anaesthetic or sedation is so little and for probably less than a minute so please don’t worry about that.
Again regarding the anti-coagulant, if you are so set on your timing, again for once don’t worry about that as I had foot and toe surgery last year and was told to stop my apixaban that morning. I was kept in for 2 nights and although I had my tablets with me, the drugs sister wouldn’t let me have my tablets until they were ready with the trolley. I worried, and my husband managed to get hold of a doctor and he said not to worry as they had a 12 hour lifespan anyway and although normally it was important to take every 12 hours, a few hours difference wouldn’t matter for a short while.
I have spoken to a cardiac nurse now and been told to shuffle my Appixaban forward a bit this morning and again a bit more tonight and then to take tomorrow morning's dose at 6am. Which I will do. So I'm feeling more relaxed now.
Thyroid hormone should always be taken on an empty stomach, 2 hours after food or 1 hour before any food, medications or caffeine. Failure to do so affects the absorption of the hormone and makes it hard to control dose. If you take an iron supplement, as I do, it should be taken 4 hours apart from anything else other than vitamin C. All this information is regularly discussed over on the Thyroid group of this health forum. Also all the books on hypothyroidism say the same. Sadly our GP's are so badly ill-informed about thyroid issues that they don't understand the importance of how to take the medications and how and when to test. They say it doesn't matter. It does. Some of the more experienced endocrinologists understand it and tell their patients how to handle it, but not many.
So pleased you are feeling more relaxed. When I was working in hospital always taught that as you walk down the corridor feeling stressed ANY patient you meet will be far more concerned than you are! My cardioversion was just fine ( I was 67)
I have had 2 Cardioversions and was on the Apixaban Bisoprolol Flecinide & Levothyroxine. Mine was a PM appointment. I took all my medication together that morning but was told NOT to take the beta blocker. Check your paperwork again. Don't worry about taking your thyroid hormones at the same time. Truth is they don't mix with anything, it just means they won't work as well. But one day is neither here nor there but DO take them. I would ring the hospital in the morning to check if your paperwork says take the Bisoprolol. It might be we are all different with different heart problems. I have AF and heart failure. Your main issue is transport. When in AF you will be anxious anyway. Get a cab to and from park and ride. As for feeling sick make sure you have a good evening meal as late as the paperwork states the night before. Wake up and take the meds and go back to sleep. When you get up don't attempt to do anything just rest and sip water whilst you can. It's not like a general. But you will speak to the Anaesthetist beforehand just mention it. If it works you will feel amazing afterwards for sure. Good luck think positive and all will be fine. Stressing is not good in this situation.
FancyPants54, did you test positive for the DI02 Gene test? If so you should drop T4 and take T3 only. If negative you should never take T3 as it will cause AFib. Besides you don't need it just take T4. Just thought I would mention it because otherwise the Cardioversion won't last and you will flip back into AFib. No point in asking Cardio Nurses they don't get it, not many Cardiologists do either unless you have a good EP like mine. T3 is very fast acting and you need to increase the dose really slowly. Never take without your Cardiologists knowledge. I cannot take T4 it left me hypothyroid for 20 years and is the cause of my heart failure. On T3 only now but damage already done. Someone taking T3 without the faulty Gene risks the same fate if you see what I mean. I know it's a bit off topic but thought I should mention it. Hope you feel better soon.
I've not had that D102 gene test so I don't know. All I know is that no matter how much levo I take my FT3 level stays almost the exact same, low. Not rock bottom, but not good either. I have had my FT4 level over the top of the reference range and felt bad, and I've had my TSH over 7 and felt bad and both times the FT3 didn't move. It's so frustrating because I feel far from well. Very physically weak and with no stamina. My lower body feels as if I've permanently over exercised and overworked the muscles. Fact is I can't exercise at all now.
You probably do have the gene mutation then, but you need to get the test done privately then they cannot refuse you a NHS prescription. You need to get the result and then get referred to an NHS Endocrinologist who will need to authorize your prescription in order for the GP to prescribe. I would make this a priority once you get the Cardioversion out of they way. If you have the mutation the T4 is just swimming around in your bloodstream creating reverse T3. Not being able to exercise is due to not being in sinus. Your Free T3 should be mid way through the range. Your TSH be well below 7 should be around 1. If you are putting on weight or are unable to lose weight then your levels are wrong. Problem is because you have AFib they will fight you but they cannot refuse you T3 if you have the mutation. You won't get the test done on the NHS. It is dangerous to self medicate T3 if you have heart issues, and can cause heart issues in people who use it and don't need it. You need both your Endocrinologist and Cardiologist working together.
I was going to suggest you moving your Apixiban backwards by half or one hour each dose, depending on how much you have to adjust it.
Yes, Oxford traffic is dreadful and I understand your worry. The thing is, Park and Ride works well, as buses have their priority lanes.
You could use Park and Ride to the hospital and if you are unsure about using P and R after your procedure either, as others have suggested, take a taxi back or, you wait at the hospital whilst your husband fetches the car. With mobiles it is easy to rendez-vous at the hospital so he shouldn't have to park.
Lastly, I am another 'sicky' post anaesthesia. Since explaining how I projectile vomit (can hit a wall ten feet away!) I have been taken seriously and given anti-emetic drugs so have not been sick after operations since. Please do explain your problem so they can help you.
I had it last Monday. So far it's holding, but I've been very stressed when I've had periods of it running fast and adding in extra beats. Every little thing that happens I get anxious. I feel a lot better in NSR after 11 months of persistent AF. I don't want it to go back.
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Confused. Any advice appreciated!
Cardioversion
