Cardiac services on board

[Clampram]

If your husband is currently in atrial fibrillation and his rate is "controlled" (lowered enough by medications so that he is less symptomatic) and he is anticoagulated then his physician will most likely let him travel.

If your husband is currently in atrial fibrillation and his rate is "not controlled" (not lowered enough yet by meds so that his symptoms persist, like shortness of breath, exercise intolerance, etc), then he should not be travelling or working or doing any strenuous activity.

If your husband is currently not in atrial fibrillation but is on meds to lower his heart rate then his physician will most likely let him travel. If he should go back into atrial fibrillation while he is travelling, he will most likely be at a much lower heart rate because of the meds and he will tolerate the atrial fibrillation better than he did without meds.

In the situation where he suddenly goes back into atrial fibrillation and is symptomatic, then his rate rate can be lowered with additional meds so that he can tolerate the atrial fib better. The decision to cardiovert ( defibrillate) for atrial fibrillation is only considered if there is sufficient evidence of anticoagulation for an extended period of time, as well as a normal looking echo. No physician will cardiovert him without a normal echo and at least 6 weeks worth of anticoagulation as that would be dangerous and could provoke a stroke.

A cardioversion for atrial fibrillation would not be done on the ship since they do not have the facilities to do the echo and they do not have an anesthesiologist to assist. It wouldn't be safe.

A defibrillation for a terminal arrhythmia can be done on a ship with the equipment that they have. Atrial fib does not meet that criteria.

Hope this makes it clearer for you. Bottom line is your physician will decide based on how he does in the next few weeks. My bet is that he will make the trip!

Edited September 29, 2019 by Clampram
forgot something

[lbfluffy]

1 hour ago, Daniel A said:

People live with AFIB for a long time even without an ablation.  Ignore the advice you get on Cruise Critic, except the advice to speak to your cardiologist.  The type of defibrillator used in a hospital and the type they have on planes and cruise ships are completely different animals.  In a hospital setting where they do inversions, they use a defibrillator that will deliver a shock "on demand" at the number of joules which are manually selected.  AEDs (Automated External Defibrillators) have a computer programmed to detect VFIB not AFIB.  If the AED computer chip does not see VFIB, it will not fire.  AEDs were designed to treat VFIB, not AFIB and should not be relied on to treat AFIB.  Again, I strongly suggest that you speak to your cardiologist about taking the cruise.  He/she will have the definitive answer based on your husband's particular situation.

 

As an aside, research is establishing a connection between AFIB and sleep apnea.  Has your husband had a sleep study performed?  You may want to look into this.

 

Enjoy your cruise and I'm sure your husband will be just fine if he follows the doctor's orders.

yes he has sleep apnea. He’s on a machine.

 

He does not want to be on medication his entire life. He’s hoping an ablation works. We see dr Wednesday 

[lbfluffy]

20 minutes ago, cristine said:

I’ve had AFIB 30 years and cruised 280+ days on Princess alone.

It’s fairly common. 

 

 

 

I just wanted advice from the cc members. I know this is a doctor discussion, but just wanted feedback. I kind of feel like an idiot now.

 

I see many of you all lived with AFIB for years, but my husband wants to be back to normal without meds. We see dr Wednesday with a ton of questions 

[Clampram]

1 minute ago, lbfluffy said:

 

I just wanted advice from the cc members. I know this is a doctor discussion, but just wanted feedback. I kind of feel like an idiot now.

 

I see many of you all lived with AFIB for years, but my husband wants to be back to normal without meds. We see dr Wednesday with a ton of questions 

You shouldn't feel badly about asking the questions...…….when these issues arise it is normal to seek more info and to be very concerned. An aggressive approach to atrial fib that includes ablation is the best option and it sounds like you are on that road. I wish your husband well!

[cristine]

8 minutes ago, lbfluffy said:

 

I just wanted advice from the cc members. I know this is a doctor discussion, but just wanted feedback. I kind of feel like an idiot now.

 

I see many of you all lived with AFIB for years, but my husband wants to be back to normal without meds. We see dr Wednesday with a ton of questions 

It’s great you asked advice, it’s different for everyone and can be scary in the beginning.

just wanted you to know it’s manageable it doesn’t have to change the things he enjoys.

Wish you both all the best

[Daniel A]

22 minutes ago, lbfluffy said:

 

I just wanted advice from the cc members. I know this is a doctor discussion, but just wanted feedback. I kind of feel like an idiot now.

 

You shouldn't feel that way at all.  You had a concern about your husband and looked for information from others who may be in the same situation.  Your concern for your husband is worthy of praise.  As I said before, I'm sure you and your husband will enjoy a wonderful cruise.

[lbfluffy]

Thank you all. This cruise is my husband’s bucket list cruise. He has wanted to do the Panama Canal for several years. We booked over a year ago when we found an amazing deal. We really thought things were just fine with his heart. He had SVT and had an ablation a couple years ago. Now all of a sudden he is diagnosed with AFIB. And the dr has put him on a higher dose of meds plus a blood thinner in hopes to do an ablation. It’s all new to us. I know this isn’t a medical forum just wanted feedback. But if the dr says no to the cruise we will cancel. We will find out more answers Wednesday. I appreciate your help. 

[1emerald1]

15 hours ago, lbfluffy said:

We are scheduled to go on the Coral on November 17th this year. My husband was just diagnosed with AFIB. They are controlling in with meds to suppress the rate for 90 days until they try an ablation. So if he needs to be Cardio inverted (shocked) does the ship have that capability. 

I have Afib and had the cardiac ablation and it all but stopped the arrhythmias completely,  I highly recommend the ablation when you get back.  And do go and enjoy yourselves.

[lbfluffy]

16 minutes ago, 1emerald1 said:

I have Afib and had the cardiac ablation and it all but stopped the arrhythmias completely,  I highly recommend the ablation when you get back.  And do go and enjoy yourselves.

yes we are hoping ablation works. However he’s quite a bit overweight. Dr said the success rate of ablation is lower if you are overweight. He’s been trying to lose weight. He’s lost 25 pounds so far and exercises regularly. 

[compozer]

My mom had AFIB for 25 years.  Never had an issue.    Lived to 90.   

 

[lbfluffy]

11 minutes ago, compozer said:

My mom had AFIB for 25 years.  Never had an issue.    Lived to 90.   

 

Good to know. I know it’s common. 

[JoRoy218]

Just my two cents here. We took an Ultimate Ship Tour on the Grand in April, which included their medical center. I’m an RN and did over 30 yrs in critical care. The first thing I spotted was a crash cart with all the expected supplies. The defibrillator was a slightly older model than in our hospital but surely quite functional. They actually had two patients present. I noticed their cardiac rhythms were being monitored continuously. They were staffed with two ED certified Physicians. The types of medications they had in stock were quite impressive. Hopefully your hubby and you will be reassured about going on that special cruise.

[lbfluffy]

3 hours ago, JoRoy218 said:

Just my two cents here. We took an Ultimate Ship Tour on the Grand in April, which included their medical center. I’m an RN and did over 30 yrs in critical care. The first thing I spotted was a crash cart with all the expected supplies. The defibrillator was a slightly older model than in our hospital but surely quite functional. They actually had two patients present. I noticed their cardiac rhythms were being monitored continuously. They were staffed with two ED certified Physicians. The types of medications they had in stock were quite impressive. Hopefully your hubby and you will be reassured about going on that special cruise.

Thank you. He has emergency meds. Plus I bet by the time we cruise the meds should be worked out. He’s a bit concerned he’s over medicated since his resting rate in in 40’s. But the dr knows best.

[donswife]

My dad has had intermittent afib for many years. He takes one cardiac med for his blood pressure, and he has another cardiac med to take only when he goes into afib. He usually goes months between episodes. His doctor wanted him to go on one of the newer blood thinners (I think elequis), but we decided it was a bad idea for him, because his risk of bleeding out from a fall is higher than his risk of throwing a clot. I'm glad you have an appointment coming up to discuss all this. By the way, my parents are on a trip in Montreal as I write this.

[Pansy2801]

14 hours ago, lbfluffy said:

My husband has an Apple Watch. That’s what notified him his heart was not in sinus rhythm. This was last Sunday. We went to dr and he admitted him. He tried ablation, but did not work since it was AFIB. A couple years ago he had SVT which was a heart rate that stayed high. He had an ablation and we thought he was all fixed. We had a 15 Hawaii cruise planned and the cardiologist said he was fine to go and that cruise lines have the equipment for such emergencies. I will double check if the Coral has the equipment. I was just wondering if any of you all had experiences. We see the doctor for the follow up in a couple days. We will see what he thinks. But right now the medication is doing its job, maybe a bit low, but we will revisit that.

 

thank you all.

As I previously said, I went to Medical Center on Royal with an Afib episode. Medication worked for me. The care was similar to one I had when going to a hospital ER. Regarding ablation the advice I received was that is the last resort if medication does not work.  Because ablation does not work for everyone and has risks and does not eliminate the risk of having a stroke. 

I never liked taking any medications even vitamins. Now I set on my apple watch the alarm for the times I have to take medication and go about my day. If I have to be away from home just take it in a small ziplock bag in my purse. I also have always in my purse a small container with several of the drugs I take just in case I forget or I am away longer that I planned.

I know you and your husband are scared now, but as other have said this is not a death sentence and you learn to live with it. And do the best you can. Ask the doctor about dietary recommendations: yes or not to caffeine and alcohol for example. Ask for reading materials on the subject. Of course Mayo Clinic website is a reliable source. Good luck. 

[donaldsc]

14 hours ago, Clampram said:

If your husband is currently in atrial fibrillation and his rate is "controlled" (lowered enough by medications so that he is less symptomatic) and he is anticoagulated then his physician will most likely let him travel.

If your husband is currently in atrial fibrillation and his rate is "not controlled" (not lowered enough yet by meds so that his symptoms persist, like shortness of breath, exercise intolerance, etc), then he should not be travelling or working or doing any strenuous activity.

If your husband is currently not in atrial fibrillation but is on meds to lower his heart rate then his physician will most likely let him travel. If he should go back into atrial fibrillation while he is travelling, he will most likely be at a much lower heart rate because of the meds and he will tolerate the atrial fibrillation better than he did without meds.

In the situation where he suddenly goes back into atrial fibrillation and is symptomatic, then his rate rate can be lowered with additional meds so that he can tolerate the atrial fib better. The decision to cardiovert ( defibrillate) for atrial fibrillation is only considered if there is sufficient evidence of anticoagulation for an extended period of time, as well as a normal looking echo. No physician will cardiovert him without a normal echo and at least 6 weeks worth of anticoagulation as that would be dangerous and could provoke a stroke.

A cardioversion for atrial fibrillation would not be done on the ship since they do not have the facilities to do the echo and they do not have an anesthesiologist to assist. It wouldn't be safe.

A defibrillation for a terminal arrhythmia can be done on a ship with the equipment that they have. Atrial fib does not meet that criteria.

Hope this makes it clearer for you. Bottom line is your physician will decide based on how he does in the next few weeks. My bet is that he will make the trip!

 

Are you a physician?

 

DON

[Nightengale31]

I am an R.N. of 42 years and the 1st 20 of those years was an ER nurse. Last year while on the Crown Princess waiting for a spa treatment got chatting with the ship's physician who happened to be in the spa when I was waiting for my massage. This physician was actually a general surgeon who had a practice in AZ and arranged to take two months off from his practice during the winter to work on the ship. He told me the ship's infirmary is very equipped to handle most emergencies, but the goal is always stabilization then transfer to the nearest hospital. That being said, even if your husband has a bout of rapid A-Fib and rate can be lowered with medication, the ship's physician will more than likely require him to be transferred to a hospital at the next port for further evaluation and treatment. And the expense for that treatment and return home expenses will be the responsibility of your husband. So be sure you have the necessary insurance coverage to handle these types of emergency medical needs along with a few credit cards in the event that the hospital where your husband may be taken to wants some upfront payment. Unlike most hospital ERs in the US that are bound by EMTALA laws which pretty much means they are obligated to treat 1st in an emergency situation and seek payment later, foreign countries may have very different laws regarding extending emergency care so it is best to be prepared in advance. Also, be sure your husband carries on him at all times the progress note from his most recent cardiologist's visit that he had prior to leaving for the cruise. That progress note will contain pertinent medical history, current medications, and allergies which is extremely helpful in expediting his care at a facility that does not have the ability to access his medical records via an online patient portal.

Edited September 30, 2019 by Nightengale31
add word

[Clampram]

5 hours ago, Pansy2801 said:

As I previously said, I went to Medical Center on Royal with an Afib episode. Medication worked for me. The care was similar to one I had when going to a hospital ER. Regarding ablation the advice I received was that is the last resort if medication does not work.  Because ablation does not work for everyone and has risks and does not eliminate the risk of having a stroke. 

I never liked taking any medications even vitamins. Now I set on my apple watch the alarm for the times I have to take medication and go about my day. If I have to be away from home just take it in a small ziplock bag in my purse. I also have always in my purse a small container with several of the drugs I take just in case I forget or I am away longer that I planned.

I know you and your husband are scared now, but as other have said this is not a death sentence and you learn to live with it. And do the best you can. Ask the doctor about dietary recommendations: yes or not to caffeine and alcohol for example. Ask for reading materials on the subject. Of course Mayo Clinic website is a reliable source. Good luck. 

The treatment for atrial fibrillation should provide the optimal chance for complete elimination of the arrhythmia. First line of treatment is drugs, followed by ablation. It is not the last resort. The chance for forming a clot which can lead to stroke is significantly diminished following a successful ablation and that is the goal.

[Daniel A]

2 hours ago, Nightengale31 said:

I am an R.N. of 42 years and the 1st 20 of those years was an ER nurse. Last year while on the Crown Princess waiting for a spa treatment got chatting with the ship's physician who happened to be in the spa when I was waiting for my massage. This physician was actually a general surgeon who had a practice in AZ and arranged to take two months off from his practice during the winter to work on the ship. He told me the ship's infirmary is very equipped to handle most emergencies, but the goal is always stabilization then transfer to the nearest hospital. That being said, even if your husband has a bout of rapid A-Fib and rate can be lowered with medication, the ship's physician will more than likely require him to be transferred to a hospital at the next port for further evaluation and treatment. And the expense for that treatment and return home expenses will be the responsibility of your husband. So be sure you have the necessary insurance coverage to handle these types of emergency medical needs along with a few credit cards in the event that the hospital where your husband may be taken to wants some upfront payment. Unlike most hospital ERs in the US that are bound by EMTALA laws which pretty much means they are obligated to treat 1st in an emergency situation and seek payment later, foreign countries may have very different laws regarding extending emergency care so it is best to be prepared in advance. Also, be sure your husband carries on him at all times the progress note from his most recent cardiologist's visit that he had prior to leaving for the cruise. That progress note will contain pertinent medical history, current medications, and allergies which is extremely helpful in expediting his care at a facility that does not have the ability to access his medical records via an online patient portal.

Very good advice about the credit cards.  Medicare does not pay for services provided outside the U.S.  My health insurance policy will cover treatment and hospitalization outside the U.S. - But they will only reimburse me for what I spent.  I would have to give the insurance company receipts for payment PLUS I have to pay for certified translations of all the documents the insurance company wants to see in order to evaluate the claim.  (By the way, Medicare does not cover treatment at the ship's medical center.  It's outside the U.S.)  Check with your travel insurance and see if they provide primary or secondary coverage and what they want to have for documentation.

[Pansy2801]

3 hours ago, Clampram said:

The treatment for atrial fibrillation should provide the optimal chance for complete elimination of the arrhythmia. First line of treatment is drugs, followed by ablation. It is not the last resort. The chance for forming a clot which can lead to stroke is significantly diminished following a successful ablation and that is the goal.

I don’t think that we should argue here about the afib treatment. Each person is different and the treatment is different. If the medication stop occurring afib episodes ablation is not necessary. There are several drugs and drugs combinations that should be tested. On one of these combinations I did not have an afib episode for 3 years. Ablation is not always successful, and is reversible. If ablation does not work you have to go back to medication. The chance to forming a blood clot( stroke) is not improved with ablation but by taking blood thinner. 

The OP wanted the opinion of someone who had an afib experience on a Princess ship and that is why I answered.   

[Clampram]

I think we are saying the same thing but you are right...…...no need to detail cases on this board...…..we are supposed to be having fun planning our cruises!

[ChaserX]

Before you go to see your doctor Wednesday, write or print out a list of questions. Make a copy, and at some point during your appointment give it to your doctor. Or, give it to your nurse or receptionist before you see your doctor. The doctor can read your list faster than you can read it out loud. Check off and note the answers to each question. If you go in without a written list, there's a good chance that there are one or more questions you will forget to ask.

 

Good luck!

 

Sean

[Haboob]

On 9/29/2019 at 8:33 AM, 1025cruise said:

I would assume that if there were an emergency, that yes, the medical center should be able to assist. I would also assume that the next stop for the patient will be the local hospital at whichever port you happen to be in or en route to.

 

Yup.

 

I would also assume that if he needed defibrillation at sea, he would likely not still be on the ship when it docked.

[lbfluffy]

We have insurance for the cruise through our credit card company. However we will be looking into extra medical coverage. My husband did go to the infirmary a while back for a cut that wouldn’t stop bleeding. We paid out of pocket and my medical insurance reimbursed us.

[Colo Cruiser]

We always get Medjet for medical evacuation coverage.