- Thank you for visiting this video segment for Dr. AFib.
I'm Dr. Morales and today's video segment
we're going to be talking about
something a little bit different.
We're going to talk about my personal career
and how AFib has changed my career
or molded my career.
I've been in practice for over five years now
and have treated thousands and thousands of patients
with atrial fibrillation.
But I didn't start my career thinking that I was
only going to manage atrial fibrillation
or particularly specialize so much in atrial fibrillation.
I'm board certified in cardiology as well as
electrophysiology and I've discussed in other segments
that electrophysiologist were a little bit more
specific and sub specialize in rhythm issues of the heart
and more particular atrial fibrillation.
So when I first started off several years ago,
I thought that I was gonna have a broad mix of things
dealing with, manage people who have pacemakers
and defibrillators and other types of arrhythmias.
But as, even in within my first year of practicing,
I noticed how much was that need for someone to manage
atrial fibrillation, how big the scope was.
More people are being diagnosed with
atrial fibrillation everyday.
And what I saw out there in terms of
how other doctors are managing atrial fibrillation
I found that a lot of people manage it very conservatively
and their patients aren't getting the proper treatment or
given the proper options for managing atrial fibrillation.
Patients will be get treated with the same medication
for ever and ever and they keep getting hospitalization,
they keep getting episodes of AFib and its clearly not
working, so something has to change
something has to be different and that's sort of why
I started put so much emphasis into managing
atrial fibrillation, because I felt that there was
a lot of need out there, a lot of education
that needed to be out there, not only from a
patient standpoint, but also from a doctor
standpoint as well.
Your general medicine doctor even some of your
general cardiologist out there are ultra conservative
on managing atrial fibrillation and
although it's a good initial strategy,
over time that strategy has to change
if we're gonna give the patient a better
long term benefit.
So how is my own strategies changed over the years?
I think that number one would be that
I've more focused on individualizing your care.
AFib is not the same for everybody.
I kind of stopped looking at it as a more of a
science disease or diagnosis, and looking at
how does this individual patient, why are they having
atrial fibrillation and what do I need to manage better
in them to help improve their symptoms and
improve their risk of stroke.
Everybody's atrial fibrillation is different
and that sort of why success rates are different
'cause you can't treat everybody exactly the same way
and expect the same result.
For some people an ablation works great
for some people medication might work better for them.
And many people you really have to talk about
risk factor modifications in order to really improve
their symptoms and their episodes of atrial fibrillation.
So you really have to kind of customize it
and make sure that we're discussing your individual needs.
A second thing that I really have begun to more emphasize
as the years has gone by is early intervention,
early treatment.
I've talked several times about the stages
of atrial fibrillation and inherently the more people
have episodes of atrial fibrillation, the more
your heart changes, the more it gets used to it.
If you're in AFib consistently, something that's called
persistent atrial fibrillation, your heart is really
changing in a cellular molecular level
and it makes it a lot harder to have treatment
strategies to minimize or reverse that damage.
So earlier treatment, which can involve
more aggressive medication to slow down
the disease process, or even ablation procedures,
have a higher success rate when you're earlier
in this disease process.
So that's just something that I've had to kind of
emphasize on educating patients as well as
educating other doctors that the earlier
you do something about atrial fibrillation
the better your long term success rate is from it.
And you may have hear stories,
people say, "Oh my ablation didn't work."
Or, "This procedure didn't work."
Again, you're stage and when you do something
matters in terms of whether you're gonna have
a more successful long term outcome.
Third thing that has changed over the years
is that the way I manage sicker patients.
You know there are many people out there
who have atrial fibrillation who also have a lot of
other medical conditions as well.
Such as COPD, or significant lung disease,
or what's called congestive heart failure,
which is commonly termed as a weak heart
and atrial fibrillation just makes those other
health care conditions even worse.
People are more likely to be in the hospital
who have congestive heart failure or COPD,
when they are also having atrial fibrillation.
And do I've become a little more aggressive
to treat these patients whether it be with medications,
or even with procedures, with the goal of
keeping these patients out of the hospital,
because their conditions is much worse
when they are also having atrial fibrillation.
Next thing that has changed over the years
has been to set expectations.
I really wanna make sure I'm clear with patients
about what I can offer to them.
I've had to walk patients through
a very difficult road from diagnosis of atrial fibrillation
to stable condition.
Many times that I've met many patients
who have been, who are very, very sick
at the very beginning when they are first diagnosed
with atrial fibrillation, I've had to walk them
through a very difficult process, which may involve
changing medications, just not feeling well,
procedures to help them get back to where they wanna be.
But I also emphasize to them that this is something that
we have to deal with and that this is something that
you're gonna have to live with and we can control it
a lot better with medication but you have to
assume that there is no 100% cure,
meaning it's gone forever, you're never gonna see it again
for the rest of your life.
It can be dramatically improved and you can be doing
a lot better but it's gonna take some time
and may take medications or procedures,
sometimes even more than one procedure to get
things under good control.
So I think that in setting expectations
is a very important thing.
And then the last thing that is really emphasized
and changed for me over the years
is really emphasizing lifestyle issues,
lifestyle modifications which really
are necessary to in order to give you
a better success and management of your atrial fibrillation.
You can have ten ablation procedures, which may not work,
but some people, lifestyle modifications have
a better effect than that.
There is a lot of good data to support
these lifestyle modifications.
There's several data out there to showing
how much weight loss can be effective
in reducing atrial fibrillation.
There's a lot of data out there about sleep apnea
and how managing your sleep apnea or treating it
can reduce the amount of atrial fibrillation.
Also it's important to reduce things such as
smoking and alcohol which can trigger also
episodes of atrial fibrillation and managing your
traditional risk factors like high blood pressure
and diabetes, which again, all of these are
rick factors for developing atrial fibrillation
or making it worse.
And so managing these risk factors are very important
for your long term treatment.
And the last thing is actually managing
people's stress and anxiety.
People get a lot of worries and stress
related to atrial fibrillation and people have to understand
that that's something that also needs to be managed as well.
People inherently have more episodes of atrial fibrillation
when they're having stress than
when they're not having as much stress.
So it's very important to emphasize that
in terms of your stress and your mental well being
in order for you yo better manage your atrial fibrillation.
Thank you for visiting this video segment for Dr. AFib.
I'll see you next time.