Am I going to die and if not how in debt am I going to be to not die?
March 6, 2010 9:32 AM   Subscribe

I've had PSVT for about 9 years. Recently it has become significantly worse. I am uninsured, and very scared. What to expect financially from treatment, and am I going to die?

Previous to last Wednesday, my PSVT was the low end, manageable kind. Anywhere between 1-10 episode a year, max BPM of around 180, max time elapsed of around 2.5 minutes. I've always been able to reset my heart via vagus nerve maneuver.

Fast forward to last Wednesday, and I'm sitting in my desk chair when a new one starts. Immediately I'm not concerned. This happens.

I time my heartbeat because it feels a little faster than normal, and this time it is thumping at 245 BPM. Now I'm getting worried, and anxiety is the last thing I want in this situation. Okay. I go to the restroom to bear down for vagus nerve reset. No dice. I took my phone with me to the restroom just in case. We're coming up on minute 4 now, holding steady around 215 bpm.

At minute 6, I begin to feel dizzy. At minute 8, I call 911 and ask for EMS because I am concerned I am going to pass out. At minute 12, the bottom drops out with what was (to me) an audible THUNK followed by a sensation of falling, and my heart is down to 123 bpm. EMS arrives, hooks me up, and I'm fluctuating between 95 and 130.

They tell me that I've pretty much left the stage of the condition where I can self-regulate my heart. I need to get meds, they say, and maybe a procedure (radial ablation I think is what they said).

So I'm going on Monday morning first thing to my GP, whom I imagine is just going to check my vitals, write a thing, and refer me to a cardiologist. I guess there's adenosine treatments, maybe something about beta blockers or some other pill you can take at onset....I'm not really sure.

So the questions.

1. I am uninsured. What am I looking at financially? Am I going to be paying this off for the rest of my life? What is the outlay of medicine vs surgery costs?

2. I am very scared. This keeps getting me panicky, lame as it sounds. My concern is...that I will have another PSVT spike, and this time something else in my heart will break, and I will die. Is that a valid concern? Does that happen? Any ideas on how to reduce my feelings of anxiety and terror?

Thank you for any helpful advice in advance.
posted by lazaruslong to Health & Fitness (27 answers total) 2 users marked this as a favorite
Oh, and I'm a fairly healthy 26 year old white male, if it matters. I've completely cut out Aleve and caffeine since Wednesday.
posted by lazaruslong at 9:35 AM on March 6, 2010

What does medical bankruptcy mean? I can get treatment without having money? I mean, I have a good job for someone my age I think (managing a small business, decent money but not above 30k a year) but I'm guessing your saying this is going to cost much much more. Can you keep a job while declaring bankruptcy?

If these are all things I should just talk to a lawyer about, that's fine too.
posted by lazaruslong at 9:45 AM on March 6, 2010

Well, I've had issues with atrial fibrillation, and I don't know that compares in severity with PSVT. The cardiologist wanted to try controlling with medicine first, in fact surgery was never even offered as an option...I think they would exhaust the medicine options first. So I take a beta blocker (metroprolol) twice a day. And it works really well for me.

These medicines are very common and, therefore, CHEAP. Metoprolol and Propanolol are both on the Walmart $4/month drug list, for example. So you won't go broke if they prescribe a beta blocker.
posted by cabingirl at 9:47 AM on March 6, 2010 [1 favorite]

Check with your local hospital - it might have a "Charity Care" program. If it does, the program will have a max income level for participation in the program; you might be over that level but it doesn't hurt to check into it. I know that in Jersey, the Charity Care program fully covers all medical expenses incurred at the hospital within one year of enrollment in the program. The doctors are also well aware of how to obtain free or low-cost meds for uninsured folks (I received six months of a medication for free from the maker because I had no insurance; my doctor certified that I needed it and couldn't afford it).

If there isn't a Charity Care program, then you might need to incur the expenses of surgery or whatever treatment will help you manage this and then, at some point, file for bankruptcy to avoid those bills. There is no 'medical bankruptcy'; you'll have to see a bankruptcy attorney or figure out the bankruptcy rules on your own.
posted by LOLAttorney2009 at 9:51 AM on March 6, 2010 [1 favorite]

As far as the anxiety...well...I know the feeling. I had never had heart trouble in my life before I ended up in the ER that time. What has helped me long-term is the fact that the ER docs and the cardiologist all seem very nonplussed by it. I think we're conditioned to think "oh god, the heart's going to just break" and apparently that's not the case.

In the short term, just be prepared. Can you get yourself to the ER if it happens again? Is there a friend close by who can take you? Do you have to dial 911? Think through exactly what you have to do to get help if it happens and maybe that will help you relax.
posted by cabingirl at 9:55 AM on March 6, 2010 [1 favorite]

Can you keep a job while declaring bankruptcy?

Yes, you can. Bankruptcy is intended to give debtors a clean start. Nowadays, with the 'new' rules in place (I think they were changed in 2003 or 2004), bankruptcy merely gives most debtors a five-year payment plan. Some debtors can completely wipe out their debt. I'm not a bankruptcy attorney, so I'm not familiar with the rules. But, yes, you can keep your job.

From your profile, I'll guess that you're in North Carolina. I'm not sure if this will help: PDF link to stuff in NC. There are phone numbers there for a program that helps uninsured folks get medical treatment and for medication assistance programs. Hopefully that helps.
posted by LOLAttorney2009 at 10:01 AM on March 6, 2010 [2 favorites]

That is a pretty random answer about medical bankruptcy. Talk to your doctor, discuss options, discuss cost and make a plan. If you really need insurance there may be a way for you to get it.

You and your doctor may decide that the best treatment is something conservative and affordable. Or it may be something that will cost you a few thousand dollars, but be curative, limited, and -hence- manageable.

Also, nothing in you heart is going to break. But call the paramedics a little quicker the next time. Passing out is not healthy for animals, small children and 26 year olds.

Be an optimist until pessimism is required. (Hint: it is almost never required)
posted by SLC Mom at 10:04 AM on March 6, 2010 [1 favorite]

I'm kind of teary right now with relief and appreciation for the thoughtful answers so far. I'm sure it's said a lot on Ask, but thank you, so very much, for taking the time. You really make a difference.
posted by lazaruslong at 10:07 AM on March 6, 2010 [2 favorites]

LOLAttorney2009: Thank you so much for that link. This one looks perfect!! Chronic disease management for the uninsured, pulmonary, acute adult care? Yes please!

The Free Clinics 697-8422
841 Case St., Hendersonville, NC 28792
Adult acute care, mental health acute care, specialty clinics
for diabetes, orthopedics, ophthalmology and pulmonary;
case management for chronic disease management;
for the uninsured.

posted by lazaruslong at 10:09 AM on March 6, 2010 [1 favorite]

I'm sorry this is happening -- it sounds scary.

My concern is...that I will have another PSVT spike, and this time something else in my heart will break, and I will die. Is that a valid concern? Does that happen? Any ideas on how to reduce my feelings of anxiety and terror?

I think that if this were something that happens, they wouldn't have just sent you home with advice to call your GP. They would have taken you to the hospital for monitoring, and a doctor there would have given you whatever prescriptions you're going to need. So that's what I'd remind myself of in the short term, until you have a chance to see your doctor and ask him questions about your risks. Also, I'd carry my phone around with me, for further assurance -- and at least for the next couple of days, go ahead and call 911 as soon as an episode starts.

By the way, if you're uninsured, why do you need to see your GP? You don't need a referral for insurance purposes. Can they just give you the name of a cardiologist, or even make an early appointment for you? This would at least save the cost of the appointment with the GP.

Best of luck with your treatment, and try not to worry about money -- it may be that all you need are medications with a generic option, which would mean some very small amount of money.
posted by palliser at 10:11 AM on March 6, 2010 [1 favorite]

You're right I guess. The EMTs told me to see a GP to get a referral, and I told them I was uninsured, so I just assumed that's the way it had to be done. It's only been a few days, and if I was thinking more clearly I would have researched it better to make sure that was the case, but my head's all fucked up.
posted by lazaruslong at 10:14 AM on March 6, 2010

Oh, yeah, and medical bankruptcy is a far-off-maybe-type worry that is not worth your attention right now. At all. There are always options when it comes to money -- and not always when it comes to health, so it's great that for your condition, it sounds like there are effective treatments for you to try with your doctors. Focus on that, and figure out money after you have a medical plan and therefore a better idea what things are going to cost.
posted by palliser at 10:17 AM on March 6, 2010 [2 favorites]

Well, one advantage of going through the GP is that they know the magic words to get you an early appointment with a cardiologist. That is worth a lot. So it might be worth calling and seeing if they'd be willing to contact the cardiologist and say the magic words without seeing you first.
posted by palliser at 10:19 AM on March 6, 2010

Question to everyone -- is the OP absolutely screwed as far as not getting any coverage due to pre-existing conditions? Because if there's any avenue for pre-existing conditions, then he might be able to look at landing a place on a group policy somewhere with an employer or a spouse. The OP is young and that's a big thing he has going for him.

Some of the more exotic things I'm thinking of for permanent care are:

1. Marrying someone abroad to get access to foreign health care. This probably won't fly with some countries, but it's still worth looking at as regular access to doctors in someplace like Poland has got to be orders of magnitude better than trying to go it alone in the US with a serious problem.

2. Being a legally working expatriate overseas and using that health care system, which in many cases would be a lot cheaper than paying out of pocket in the US, and better for one's own survival.

3. Relocating to a state or county that has favorable programs for disadvantaged or low-income.

Man, how can this happen in our country? Good god.
posted by crapmatic at 10:35 AM on March 6, 2010 [3 favorites]

It's your LIFE here, don't cheap out. Pay what it costs to get effective treatment and do it now instead of relying on the much more expensive forms of acute care. Like anything else, shop around for the most cost effective treatment. There are usually many options.

It's appalling how many people will spend hours online searching for the cheapest way to buy merchandise but won't do squat to figure out their true medical expense choices.

That said, a friend was scheduled for electro-shock treatment of his similar ailment. But they went for one last round of drug treatment. The drugs worked, much to everyone's pleasant surprise.
posted by wkearney99 at 10:44 AM on March 6, 2010 [1 favorite]

  1. You may be eligible for Medicaid with your income level
  2. You are exactly the kind of person state health insurance risk pools were invented for. Yours is NCHIRP.

posted by miyabo at 10:48 AM on March 6, 2010 [3 favorites]

There are other advantages of seeing your GP first. The most obvious one is that you have a Monday morning appointment. Someone will see you sooner rather than later. Second, your GP may have seen this before and be able either to treat it or give you meds to mediate the symptoms while you wait to see a specialist. Next, there are other parts of your body that might need a look see. A GP is good for summarizing your general health before the specialist zooms in on your heart.

I am now 2 1/2 years from my heart valve surgery and all of the testing and anxiety that was attendant thereto. What I have learned in that time is that just about everyone I meet is carrying around some kind of special disease. Just as your friends and co-workers can't see it in you (it doesn't cause you to limp or stutter or something) you can't see it in them. So don't think of yourself as different or at death's door. You are just acutely aware of what your special issue is. If you recognize that we are all in the same boat as you (only sitting in different seats) and you don't notice the rest of us dropping like flies, maybe you can relax and take your symptoms a step at a time. Be aware and alert, but don't be panicked. As was suggested above, don't wait until you are in dire need to call 911. Be aware that there are meds out there that will attack the problem. I take a beta-blocker that is different from the ones mentioned above, but is still a $4 generic. I have to see my cardiologist every 9 months now and it is mostly for him to smile and tell me how good I look.

I went from panicked to philosophical. You will too. Keep your appointment on Monday. Express your fears and concerns. Explain your financial issues and listen very carefully to what the doctor tells you. Then tap-dance out of the office in relief. There are a lot of small steps between "Here, take this pill" and "I think you will need surgery." Don't take any mental short cuts.
posted by Old Geezer at 10:53 AM on March 6, 2010 [2 favorites]

I have the same condition. It's usually responsive to the vagus nerve maneuver, and/or a cold wet washcloth to the face (prompting mammalian dive reflex). I have declined to have the ablation as long as it's manageable. I carry a beta blocker in case I can't manage it myself. I've also taken Valium, to reduce anxiety, and help me get it under control. My Mom had it, had the ablation, and was fine.

I went to a cardiologist who said prolonged episodes can damage the heart, and recommended I go to the emergency room if it lasts an hour. I've had that same hard thunk when my heart reverts to normal rhythm. To help manage anxiety, I try to meditate regularly. In periods of stress, I definitely have more episodes.

Go see your doctor. Ask every medical practitioner you see to at least reduce your rates to what they'd be if you had an insurance company negotiating for you. You may be able to stave off the ablation. I don't blame you for being freaked out; it's your heart. Some states require that insurance companies accept you, regardless of pre-existing conditions. It's worth checking.
posted by theora55 at 11:18 AM on March 6, 2010 [1 favorite]

Unless you have children, I don't believe you are eligible for Medicaid. However, I'm not familiar with North Carolina's specific rules on this so I may be wrong.

I'd like to second the suggestion of charity care programs offered by hospitals, in the event you need surgery. I am a former patient advocate and I have seen tens of thousands of dollars in patients' bills completely written off by the hospital because of the patients' inability to pay. So, if you do end up needing surgery, just keep in mind that the hospital will most likely be willing to work with you to find a way to get the bills taken care of. You should be worried about getting the medical care you need first and foremost.

As for the anxiety, as Old Geezer said, everyone has health problems. This isn't to say that your problem isn't important, it's to say that we're all in this together. I'm sure if you talked to friends and coworkers about your condition you would discover that they have had similar experiences, no matter how young and healthy they seem to be. Having a healthy fear of death is good because it's what keeps you alive, but don't let it destroy your life. When you get the treatment you need, you'll be okay. I know that's probably little reassurance but I hope it helps.
posted by Lobster Garden at 11:18 AM on March 6, 2010 [1 favorite]

Any hospital will have financial counselors on staff, as will some physicians that are part of larger physician groups. They're going to be your best resource for navigating the money side of this, as they see people in your situation every day, and are most familiar with all the state assistance programs you might be eligible for, as well their own discount policies.

Most hospitals will have a financial assistance or charity care policy that will qualify you for a substantial, or possibly even complete, discount at your income level. I don't know about the situation in Asheville, but as an example, according to Forsyth Medical Center in Winston-Salem's charity care guidelines, they will write off 100% of patient balances for uninsured patients with an income under 300% of the Federal Poverty Level. If you make less than $30K a year, you would qualify, though I imagine they also have some restrictions based on asset levels. (Full disclosure, in the past I've had a business relationship with Forsyth's parent company, Novant Health)

That would cover the hospital fees if you needed to have this procedure, not the physician fees or the cost of any medications you need to take on a long-term maintenance basis, but it's a start; I'm sure you could find a cardiologist with a similar sliding-scale discount policy for the uninsured, though not necessarily one that would offer a complete write-off.
posted by strangely stunted trees at 11:25 AM on March 6, 2010 [1 favorite]

I used to have episodes of SVT which became increasingly lengthy over the years. Do not wait an hour to go to the ER. If it doesn't resolve within about ten minutes, start heading to the ER. It can be treated medically to a point. I did have the cadiac ablation after an episode that lasted about 45 minutes. If you go to the ER, be VERY specific about what is happening to you so that you are not sent to the waiting room. On the other hand, in most places in the US, if you call the ambulance, if they are certified as paramedics, they should be able to administer medication to stop the episode, insurance or no insurance.

The cardiac ablation was not too tramatic but would have been expensive without insurance. This is basically an electrical problem with the heart rhythm. Your heart will not explode but SVT can degenerate into fibrillation if not treated. You have lots of options even without insurance. See your GP, likely they will refer you to a cardiologist, who will try medicine to control your episodes first. Again, if you cannot get the rhythm to "convert", go to the ER or call the ambulance.

In addition to the vagal maneuver, try dunking your entire face into a tub of ice water and keeping it there as long as you can stand it. This is another trick to convert the heart rhythm. IAMNAD but a former fellow sufferer. YMMV
posted by tamitang at 12:59 PM on March 6, 2010 [1 favorite]

I've completely cut out Aleve and caffeine since Wednesday.
"since Wednesday" is the wrong answer.

I used to have frequent incidents of SVT. I eliminated caffeine from my diet - at the advice of a cardiologist - for a long period of time and the rate of incidence dropped precipitously. I now suffer less than one occurrence per year. In fact, it's probably been several years since I've had an occurrence.

Do whatever you have to do to eliminate caffeine permanently from your diet.

Finally, and I'm a little reticent about disclosing this, but I accidentally discovered what was for me an almost certain way to arrest this arrhythmia (pun not intended). For all I know, this is insanely dangerous, so don't even think of doing it without consulting a doctor.

That said, when stricken, I stand at the end of my bed with arms outstretched and collapse backward onto the bed. The only time this failed for me was when the height of the bed exceeded that of my lower leg.
posted by coolgeek at 7:28 PM on March 6, 2010 [1 favorite]

RN here, but remember I'm not a doctor nor am I your doctor. Or your RN. But I will give you a view from 15+ years of cardiovascular ICU work. The other SVT MeFis here have given you great advice from their experiences, so let me see if I can help too.

First, your heart isn't going to break. It's not going to explode, shatter, shred, melt or do anything like that. Period. At least not from PSVT. :-)

The electrical system that makes your heart contract has a problem. It's supposed to keep your atria and ventricles pumping and working in sync, so the max amount of blood can get into your arteries to keep you upright.

Your heart has some cells that are firing when they should not be firing. When that happens, the atria just quiver, kind of like a bowl of Jell-O, and the blood they contain just trickles into the ventricles a bit at a time. That means the ventricles can't fill with the blood they need to pump to get to your brain to keep you from getting dizzy or fainting.

The other worry is that the blood sitting in the atria can clot. Those clots can get into the bloodstream and move to the brain or lungs, causing stroke or pulmonary embolism. But that's not in view for you right now.

You are way, way ahead of yourself by worrying about bankruptcy and job loss. The first line of treatment for SVT is medication, especially since you've had only one hemodynamically significant episode. There are dozens of meds to try and the first-line drugs are inexpensive. One episode of PSVT does not automatically put you at the head of the line to the EP lab (or the cath lab).

Adenosine is only used in the middle of an episode. If your rhythm is atrial, adenosine will break it and stop it, but *only* if it's atrial in nature. The effect of the drug only lasts for a few seconds - very, very short half-life - and if it's not atrial it won't do a darn thing at all. Some states allow paramedics to administer it in the field, and some don't. It's a great drug for PSVT, and it's very interesting to watch it work.

Cardioversion (shocking with the paddles, like in a code, only it's done a specific way and *always* with sedation for you) and ablation (threading a little catheter into your heart to zap the specific cardiac cells that are causing your tachycardia) are down the road. Don't worry about that now.

Good luck - learn all you can about SVT. The more you know, the less scary it's going to be. Don't be afraid to ask questions of your regular doctor or your cardiologist. And you can send MeFi mail if you have more questions for a nurse. Hang in there. :-)
posted by lambchop1 at 10:29 PM on March 6, 2010 [1 favorite]

Thanks to everyone who posted here and sent MeMails.

I feel the following:

1. A greater sense of perspective with regards to the mortal seriousness (or lack thereof) of PSVT.

2. A greater sense of hope with regards to my ability to pay for treatment.

3. A lessened sense of anxiety in my day to day anticipation of another episode.

4. A great deal of love for the community here, and your selflessness and wisdom.

Thank you all, so very much. From the bottom of my quiverin' lil heart.
posted by lazaruslong at 9:40 AM on March 7, 2010

Nice comment, Lazarus. Please do post followup.
posted by theora55 at 4:45 AM on March 8, 2010

Update #1:

This morning I woke up super early and got to the free clinic an hour before opening. I was still about 9th in line. Since it was my first time there, I had to fill out a brief patient file form which meant that everyone behind me in line that was a repeat visitor went ahead of me. I was not annoyed at this, because my care was free and everyone on staff was incredibly kind.

I've been given a 2 week prescription of Atenolol, which is a funny drug to me because it has lol in the name. Its only a a 2 week scrip because I have a follow up with the same doc in two weeks who will then write me a big scrip. It cost me nothing to get so far, and if I do end up paying for it, its only 32 bucks a month.

The doc was concerned by the fact that I have chest pains during attacks. He wants to make sure I don't have a blood clot or something else going on in addition to the PSVT. Therefore he ordered an EKG and full blood panel.

The amazing thing? Both are free. The wrote referrals to the hospital and blood lab for me. All I have to do is show up, and the clinic pays for it. Simply amazing.

So I'm starting the beta blockers, and going in for the EKG / Blood work next week. Will update then. Cross your fingers for me that there's no clot.
posted by lazaruslong at 9:44 AM on March 9, 2010 [4 favorites]

Post an update!!!
posted by Mrs. Much-too-Busy at 10:05 PM on March 16, 2010

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