Category Archives: Medicine

Medicine

Melatonin for Jet Lag: The short and simple answer.

I am going to be doing a few red-eye flights in the near future, to time zones far from my own. I decided to review the scientific recommendations around melatonin for jet lag. Unfortunately, most of the articles that have the needed information are behind paywalls, so I bit the bullet and bought a review article. Now I can share the important information with you, dear readers. Here it is:

  • Take 2-5 mg of fast-dissolving or liquid melatonin about 30 minutes before sleep.
  • Do this when you’re ready to sleep on the red-eye flight
  • Do this every day at your destination for the first 3-4 days
  • Maybe avoid caffeine and alcohol
  • Do NOT take melatonin earlier in the day, or at any other day or time beside what is listed above. This includes not taking any in the days before your flight.
  • Try to get dark when you should be sleeping and light when you should be awake (by the time zone you’re adjusting to).

That’s it. Lots of long-winded discussion exists on the internet. Many abstracts tease at this information but don’t give it. But now you have it. Happy travels.

The Heart Rhythm Podcast Without iTunes

The Heart Rhythm Society has an interesting podcast, wherein the author of an article in each issue is interviewed, often by Dr. Doug Zipes. I tried to sign up for it here, but it only gives directions for subscribing with iTunes. I don’t care for iTunes these days, so I went about finding the real RSS feed for the podcast.

If you want it, here it is:

http://podcasts.elsevierhealth.com/HRTHM/hrthm_rss.xml

Hopefully the webmaster at HRS will wise up and post this link as well. Enjoy!

Cool story on ablation outside of treatment guidelines

I read Dr.Wes’ blog to get better insight into the professional lives and needs of clinical cardiologists and EPs. This week, Dr.Wes posted an excerpt from and commented on this interesting account of ablation in a baby. I’ll repeat the excerpt because it’s worth showing:

All of the planned means of tackling Stellan’s SVT today during his ablation failed initially. Heart block was induced each and every time from each and every angle they tried to ablate. Dr. A and his team were left with little choice but to ablate Stellan’s AV node in order to get rid of his accessory pathway. But before they did, one of Dr. A’s colleagues threw out a wild idea.

“Let’s try to go through his aorta.”

Not in the plan. Not even in the possible or hypothetical plans. Not considered safe or feasible or wise on a 10 kilo baby. But with few options left before destroying Stellan’s node, they decided to risk it.

To be honest, I’m glad I didn’t know about it at the time.

So from his groin, they threaded the catheter up into his aorta, down into his atrium and through his valve toward his ventricle. From that angle, even though Dr. A said they were in the exact same spot as they’d tried ablating earlier, there was a money shot. He tried cryoablation. It started to zap his SVT with no heart block. So he tried a little more cryo. Again, no heart block.

So Dr. A pulled out the big dog. The radio frequency ablation catheter. His ultimate goal was to get 2 to 3 seconds of ablating done, even if it destroyed his node.

1 second. 2 seconds. 3, 4, 5.

From that angle, through the aorta, Stellan’s AV node remained untouched.

Unbelievably, Dr. A was able to crank up the wattage and ablate Stellan’s extra pathway for one solid minute before declaring his pathway dead on arrival.

And his AV node is as happy as the day is long.

Dr.Wes aptly notes that this sort of thing does not meet with the idealized always-follow-the-guidelines-or-else strategy being espoused by Washington of late. On the one hand, I’m all for evidence-based medicine and adhering to known best practices. On the other, this is a clear example of the variability that occurs from patient to patient, and the importance of experience and skill on the part of physicians enabling them to know when to bend or break the guidelines. Bravo.