Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and former television broadcaster Gina Galaviz will share information to improve your health and well-being. And now here are Gina Galaviz and Dr. Rajay Seudath.

GINA GALAVIZ EISENBERG
Welcome to the award winning Docs in a Pod, presented by WellMed. I'm your host, Gina Galaviz Eisenberg. Ron Aaron is usually on special assignment when I'm here, and he is, but he'll be joining us in just a minute. So, I gave you a little teaser there. We're on the radio in several Texas cities and in Florida. Each week we talk about a variety of health and wellness issues that impact Medicare eligible seniors and others. We welcome our Docs in a Pod co-host, Dr. Rajay Seudath. This is going to be a fun show, even though we're talking about something very serious, which is atrial fibrillation.

DR. RAJAY SEUDATH
Yes. A very serious and prevalent disease throughout all age groups, but specifically in our senior groups as well.

GINA GALAVIZ EISENBERG
We refer to it as AFib. But before we start talking about it, I just want to toot your horn a bit. Dr. Seudath is a board certified family medicine physician. He's a Tampa native and current lead physician for Optum. So, stop by and say hello or become a patient. He's at the university location in Tampa. Dr. Seudath received his medical degree from the University of South Florida Morsani College of Medicine. He has a passion for primary care and guiding his patients to meet their health care goals while maintaining his patientsÕ values. He enjoys educating people as patients and caregivers on a variety of health and wellness topics, which is why he's just so good here on Docs in a Pod. Before his career in medicine, he was an English teacher, which inspired you to help all of us, Dr. Seudath. Welcome back. So glad you're here.

DR. RAJAY SEUDATH
So glad to be here. Thank you for having me on.

GINA GALAVIZ EISENBERG
Ron Aaron is with us today. Ron Eisenberg, my better half. I'll call him for today. Dr. Seudath, he is like so many of your patients. When he first got AFib, I had no idea what it was. Explain to us what it is medically and how does this happen?

DR. RAJAY SEUDATH
Medically, I want you to think about the heart. If you can visualize the heart in your mind, if you put the stethoscope on your heart, or you put your fingers in your ears, sometimes you can hear your heartbeat. You hear a lub dub, lub dub, lub dub, lub dub. I want you to think of that as the top of the heart and the bottom of the heart. Lub dub, lub dub, lub dub. AFib is the top of the heart's kind of doing its own thing, and the bottom of the heart is still in rhythm. ThatÕs kind of what is happening. That's a very simplified version of it. AFib is an electricity problem of the heart, where for whatever reason, the top of the heart, the atrium, is beating out of sync with the ventricles. Because it's beating out of sync, the blood is not flowing in a nice uniform fashion. If you think about it if you have a bottle of water and you were sucking out of a straw and then you suddenly squeezed the bottle and a bunch of that came out of the straw. It's not all going in one direction. It's kind of going in a bunch of different directions. It's coming out of the bottle, in the straw, all over the place. That's kind of how AFib is working in your heart. That change in direction can cause problems.

GINA GALAVIZ EISENBERG
It's a pretty scary thing when someone you love with it. It's scary. You're like, AFib, what is that? You feel like you're at a loss because you don't know how to help.

DR. RAJAY SEUDATH
Right. So, that simplified explanation doesn't encompass what a person feels or how they experience AFib. Because I'll tell you, I have patients, they'll be in AFib and their heart rate's in the 110s, and they don't feel any different.

RON AARON
That's me.

DR. RAJAY SEUDATH
Yeah. You'll have a person with AFib, and their heart rate is in the 90s and they feel like they're having a heart attack. So, I think it's important to hear your story, Ron, as to how things had developed and your story as how it was discovered.

RON AARON
Well, this is a few years ago. I had just a regular appointment with my PCP at a clinic in San Antonio. I went in and I sat down. The nurse came in and was taking my vitals. Whenever a nurse looks at you and says with their eyes as wide open as you can imagine, I'll be right back. She went out of the room and came back with the doctor, and he said, do you feel your heart racing? I said, no, it feels fine. I was going at 145 beats a minute. I didn't feel a thing. He said, I need to get you to the E.R. I think you may have AFib. And he explained what it is.

GINA GALAVIZ EISENBERG
We're going to stop right there and continue after that because we're just going to reintroduce all of us. If you just joined us, you're listening to the award winning Docs in a Pod with our co-host, Dr. Rajay Seudath. I'm Gina Galaviz Eisenberg. Our podcast is available wherever you get your podcast. Our special guest today is Ron Aaron Eisenberg, who's talking about his AFib and how he first discovered it. Take it away, bear.

RON AARON
So, there I am, sitting in the PCP's exam room. He made a couple of calls. He tracked down a cardiologist at the clinic and asked if there was something he could give me to slow my heart down, and he did. Metoprolol was the medication that he gave me. Then he said, you need to go to the E.R., but I don't want you driving there. Call your wife. This is a sidebar to the story. So, I called Gina. She doesn't pick up. I call her again. She doesn't pick up.

GINA GALAVIZ EISENBERG
I was busy. I was on a call. I called her again. She doesn't pick up.

RON AARON
Finally, on like the third or fourth or fifth try, she answered and said, well, I was on the phone with Kelly, and I figured it wasn't important. I said, well, let me hand the phone to the doctor. She got there in about a minute and a half.

DR. RAJAY SEUDATH
Oh, wow.

RON AARON
We're smart enough to take Uber so we didn't have two cars parked at the clinic. We got in the car. She took me to a local hospital emergency room where they had sent me. The nice thing about a man, there was no waiting. They got me right in.

DR. RAJAY SEUDATH
That's correct. That's absolutely correct.

RON AARON
And that began the journey.

DR. RAJAY SEUDATH
Yes.

GINA GALAVIZ EISENBERG
But he never had any problems before.

RON AARON
I never had any problems that I knew of.

DR. RAJAY SEUDATH
Right. That's the thing. It can be silent like that. You wouldn't think that my heart's beating at 140 beats per second. For some people, they might say, well, is that really a bad thing? When I jog, it gets that high. But you're just sitting still. Your heart can only beat like that for so long before it tires out. So, that's a very specific part of AFib called AFib with RVR. Atrial fibrillation with rapid ventricular response. Meaning typically the lub dub lub dub, top bottom top bottom. The top tells the bottom when to beat. In AFib, the top is just kind of doing its thing, but the bottom is still staying relatively in sync. Our VR takes over, rapid ventricular response, when the bottom starts to mimic the speed of the top, and that's when both of them are beating at the super high rate. That is a dangerous situation. So, that's absolutely right.

RON AARON
It was interesting because they ran an EKG on me. Hooked me up to all those little pads, and I could see on the graph what looked like scribbles by a two-year-old, which represented what my heart was doing. That was scary.

DR. RAJAY SEUDATH
Yes. You're like, that doesn't look like the beep-beep thing I usually see. This this thing looks like the tides of a hacksaw.

RON AARON
Exactly. So, it took a while to get the right kind of medication to keep me in a regular sinus rhythm. On a couple of occasions, I went in for what's called a cardioversion, where they shocked my heart. They literally shock it, stop it, and started again to get me back into a normal sinus rhythm. Which was pretty good because I really like propofol. So, they hooked me up with propofol, the anesthesia. Then boom, they'd slap me with the electrodes, and I would go back into a normal sinus rhythm. I can now tell when my heart has gone into AFib. I can feel it because I'm more aware of it now. And it still happens from time to time.

GINA GALAVIZ EISENBERG
I can tell just by the way you breathe. Because sometimes he sounds like kind of like he's wheezing or something. It's almost like his breathing kind of changes a little bit and I'll ask., are you on AFib?

RON AARON
The other thing they diagnosed when I went into the hospital was, I didn't know I had it, I also have sleep apnea.

DR. RAJAY SEUDATH
Right.

RON AARON
And that was a contributing factor.

DR. RAJAY SEUDATH
Absolutely. Just to go back with the cardioversion. Now, when a person gets a cardioversion, you are out with the propofol. But did you feel any discomfort afterwards with the electric shock on your skin or anything like that?

RON AARON
You know what's interesting? No, nothing. Yet, you see in the movies where they put the paddles on their chest, and they bounce up off the mat right.

GINA GALAVIZ EISENBERG
I wanted to see that.

RON AARON
You were in the room when they shocked me.

GINA GALAVIZ EISENBERG
No, they wouldn't let me in. I had to leave. They gave you the propofol said, you need to stand out here. I'm like, but I want to watch this.

RON AARON
I don't know if I bang the back of the bed or not.

GINA GALAVIZ EISENBERG
No. And they won't tell me.

DR. RAJAY SEUDATH
I just wanted to bring that to a point because some people are scared about cardioversion. There are two types of cardioversions: chemical and electric.

RON AARON
This was electric.

DR. RAJAY SEUDATH
Yes. Chemical cardioversion, they'll give you a medicine to kind of basically slow the heart and try and get it back to normal. Then there's the electric where they try to reset it. They're trying to set the heart so that it's going to set on the right time and get it back to its normal rhythm.

RON AARON
ItÕs like rebooting your computer.

DR. RAJAY SEUDATH
Absolutely. It's important for people to know if they have AFib and their cardiologist is suggesting this. No, you're not going to have burns on your chest. You're not going to be sore afterwards. But I wanted to just confirm that with you because patients have come back, and they tell me, no, it was it was fine. I didn't have any pain afterwards.

RON AARON
It's like putting you in the big chair at the death chamber at the prison but it doesn't take you out.

GINA GALAVIZ EISENBERG
Kind of, but not really.

DR. RAJAY SEUDATH
Right. It just dims the lights.

GINA GALAVIZ EISENBERG
Yeah. If you want me to tell you the lights did dim, then okay.

DR. RAJAY SEUDATH
ThatÕs great. Ron, you brought up a great point about the CPAP. A lot of people who develop AFib also have concurrent sleep apnea.

RON AARON
For those who don't know, what is sleep apnea?

DR. RAJAY SEUDATH
Sleep apnea is when you basically stop breathing. There are two types of sleep apnea. Central sleep apnea. Then there's obstructive sleep apnea.

RON AARON
ThatÕs what I have.

DR. RAJAY SEUDATH
Either of those basically stops a person from getting the air in and out of their body.

GINA GALAVIZ EISENBERG
We're going to talk a little bit more about what this is. We're just going to take a short little break. We will continue in just a moment. I'm Gina Galaviz Eisenberg with Dr. Rajay Seudath, and we're talking about AFib. We'll be right back.

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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts, and this is one you're definitely going to want to listen to several times. I'm Gina Galaviz Eisenberg. Back to AFib. Dr. Seudath, what are we calling this? Ron's odyssey of AFib into now sleep apnea.

DR. RAJAY SEUDATH
Yes.

GINA GALAVIZ EISENBERG
Take it away.

RON AARON
Well, one of the things they found, Dr. Seudath, when I went into the hospital, having been diagnosed with AFib by my PCP when they began treating me, they found that my carbon dioxide, CO2, was very, very high, which is not a good thing, right?

DR. RAJAY SEUDATH
No, absolutely not. Carbon dioxide is a waste. It's a waste product and it's acidic, right? When you're drinking that soda or that carbonated water, you drink an acid. So, that causes problems in your body. The part of that extra CO2 and decreased oxygen, it can push your heart further into an AFib. It can worsen the AFib. It can worsen heart disease. It can make your blood pressure go higher. I mean, it's one of the things that can really cause a lot of metabolic derangements in your body. In fact, now, when we diagnose a person with AFib, we automatically send them for a sleep study. Almost always.

RON AARON
Interesting.

DR. RAJAY SEUDATH
Yes.

RON AARON
Well, they said I didn't need a sleep study. It was obvious.

DR. RAJAY SEUDATH
It was obvious with you.

RON AARON
You mentioned CPAP. They prescribed and I now sleep with a CPAP machine that regulates the amount of oxygen I get and keeps my airway open.

DR. RAJAY SEUDATH
Yes.

RON AARON
My CAP is my friend.

DR. RAJAY SEUDATH
Absolutely. Do you feel that your restfulness after you sleep has improved with the CPAP?

RON AARON
Yes. Gina will tell you this, before the diagnosis and the addition of that CPAP to my routine, I would fall asleep in the middle of the day. We'd be in a meeting and Gina would say, Ron. Ron. And IÕd say, what? What?

GINA GALAVIZ EISENBERG
IÕd give him a little flick on the head and say wake up.

RON AARON
Now with the CPAP, obviously, I get a lot better sleep.

GINA GALAVIZ EISENBERG
IÕll just tell you, WellMed saved his life. Really saved his life. I learned so much. Now he has a pacemaker, but I said, once they start getting those beats going, I think you're going to be breathing a little bit better. It was just a whole full circle. Luckily with WellMed, you have that continuum of care.

DR. RAJAY SEUDATH
Absolutely.

GINA GALAVIZ EISENBERG
It sounds like I'm plugging, but it's true. It's a firsthand testimonial here. They saved his life. You doctors saved his life.

DR. RAJAY SEUDATH
Absolutely.

RON AARON
I got a pacemaker because my heart rate had gone down so much. The medication they were using to treat my AFib, flecainide, one of the drugs I take, they said, when your heart rate is down in the 50s and sometimes 40s, unless you're a marathon runner, that's not a good thing. So, my pacemaker keeps me at 60 and over.

DR. RAJAY SEUDATH
Right. That's and that's kind of the balance of AFib. We give you medicines to keep the rate under control. So again, we talked about RVR, rapid ventricular rate. When your heart's in the one 120s or 140s, that's dangerous for your heart. So, we give you medicines to slow the rate down. But sometimes it slows down so much you start to have low heartbeat problems, which is dizziness, low energy. You feel sluggish. So, the pacemaker allows you to have a baseline amount of support for your heart rate, so it doesn't go down so low. That's actually very, very common for people who have AFib disease can have what's called six sinus syndrome, bradycardia, other things that are slowing your heart.

RON AARON
It's interesting. Former President Biden was diagnosed with AFib and at a news conference, obviously while he was still in the Oval Office, people said, well, what's that mark on your face? And it was the pressure from the mask from his CPAP, which goes away during the day, but when you wake up, you've got that mark there.

DR. RAJAY SEUDATH
Yes. Speaking of the masks, because this is an important point, a lot of people when they think about a CPAP, when they think about, oh, I have to wear this mask. I'm too claustrophobic for that. I don't want to wear this Hannibal Lecter device on my face. How did you respond to that initial, I have to wear this mask. That kind of thing.

RON AARON
It's a good question because when they first gave me one in the hospital, the first night I was there they said, we have to put this on you. I didn't like it. During the night, I would take it off, and then the alarms would go off and they'd come in and put it back on. But I adjusted to it very quickly, and then I went from a full-face mask to I have one now that covers my mouth and the bottom of my nose. So, it isn't covering my whole face. It's a lot more comfortable. I made that switch maybe two months ago.

DR. RAJAY SEUDATH
Oh, wow. So, thatÕs fairly recent.

GINA GALAVIZ EISENBERG
It's a process. ItÕll take you a while before you finally feel comfortable.

RON AARON
However, as they explained to me, the option is death. So, you could sleep with the mask and live or not wear it and ultimately, you're going to die from too much CO2.

DR. RAJAY SEUDATH
It's wonderful that you say that because I had a patient who said something similar to me, and I didn't say it in so many words, but he said, doc, I have to wear this mask, and I have to take this medicine and all this stuff. What would you have done for me 50 years ago? And I said, well, 50 years ago you'd been dead by now. He said, oh, I guess I'll take the ladder. So, I just wanted to bring that up for our listening audience that there are different masks. There are different levels of comfort that we have. Sometimes it is a little bit of a process to find the one that works for you. One of the things I often tell my patients who have to start one up is you don't necessarily have to sleep eight hours the first time you use it. For patients who are like, doc, I just cannot use this thing at night. Sometimes I'll tell them, hey, put it on during the day. Put it on while you're watching your midday soap operas. Put it on while you're watching game shows. Take 15 to 30 minutes and just put it on while you're awake. Oftentimes, their sleep apnea is so bad they're falling asleep during the middle of the day anyway. Now they're putting this thing on and they're napping during the day with their CPAP on. If you're able to nap during the day, let's try at night. Lo and behold, they're able to do it at night. That's been a way of kind of gently introducing it as a part of your lifestyle.

RON AARON
Now, the other piece of this that we should mention, and I'm not a doctor, and I don't even play one on TV.

GINA GALAVIZ EISENBERG
Thank goodness.

RON AARON
The need for blood thinners if you are on the kind of medication that I'm on for AFib.

GINA GALAVIZ EISENBERG
Also, the water. Remember the swelling of the legs? That was another issue.

DR. RAJAY SEUDATH
Yes. So again, if your heart is not beating in sync, it's not going in one direction. If the top beating faster than the bottom, the blood flow is kind of turbulent. It's going all over the place. As that blood is crashing into each other like river rapids, it can create a blood clot. So, people who have uncontrolled AFib who have paroxysm AFib, meaning sometimes you're in AFib, sometimes you're not, we anticoagulant those people. We put them on a blood thinner so that they will not get a heart attack or a stroke, specifically the stroke. That's really what we're looking to prevent, because a blood clot in your heart could go to your brain. So, the blood thinner helps to prevent that. It is a risk. There's a risk score that we calculate for people. But almost always the benefit outweighs the risk. Unless somebody is having bleeding in their stomach. They're having multiple falls. They have blood diseases where they can't take blood thinners. Almost a great majority of patients will need to be on some sort of blood thinner. There are different ones that are once a day, twice a day. There's another one called warfarin that has dietary restrictions.

RON AARON
It's rat poison.

DR. RAJSY SEUDATH
Yes, it is rat poison. But remember, every medicine at the wrong dose is a poison. Every poison at the right dose is a medicine.

RON AARON
Good point.

GINA GALAVIZ EISENBERG
Amen.

DR. RAJSY SEUDATH
I'll be the first person to tell my patients, hey, all this stuff is poison. Less is more.

RON AARON
For those who are listening who wonder, can you help perhaps your spouse, your friend, your son, your daughter, whatever. If you think they have AFib, how would and what would you tell them to do?

DR. RAJSY SEUDATH
If you think that they're having problems with their heart, whether it's AFib, heart failure, coronary artery disease, a heart attack, ask them to see their doctor. If you feel comfortable enough, call their doctor. Bring it to their attention because they may have a visit two months from now. But if you call and leave a message with them, they'll put that with your chart and say, hey, I got a call from someone saying you're having X, Y, and Z type of symptom. I'd like to talk to you about that. If you have a relationship with your doctor or your health care provider, that should be an easy conversation. Because I always say the more the merrier. I love it when families come to visit. They tell on each other. I hear there's my version, your version of the truth, right? One more thing I did want to touch on, though. We talked about cardioversion. We talked about anticoagulation. The last one is ablation. For AFib, sometimes people will have an ablation where we go into the heart, and we actually inactivate by burning parts of the heart that's overactive. That can be sometimes a permanent fix. For some people, they may need what's called a watchman procedure, which is a surgical procedure to remove part of the heart. That actually makes the risk of heart blood clots a lot less. So, those are other, more high level, more invasive procedures, but something that you could talk with your cardiologist about and may be necessary for some people. But for the majority of people, we keep the rate controlled. We thin out their blood, we give them their CPAP, and they're living good, happy lives.

GINA GALAVIZ EISENBERG
And Ron is a testament to that. And guess what? We're out of time.

DR. RAJSY SEUDATH
Oh, my gosh.

GINA GALAVIZ EISENBERG
That went by so fast.

DR. RAJAY SEUDATH
Yes, it did.

RON AARON
More time.

GINA GALAVIZ EISENBERG
Another time. Thanks for joining us today on the award winning Docs in the Pod. I'm Gina Galaviz Eisenberg along with Dr. Rajay Seudath. Thanks to our special guest, Ron Aaron Eisenberg. And in the words of the late Charles Osgood, I'll see you on the radio.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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