12/12/2025
This is so ongoing and no end in sight. more questions added
Let me imagine a medical quiz on the health problems of a 79 year old male and what the possible answers might look like.
1. By history does this almost 80-year-old man have risk factors for atrial fibrillation? How many? Risk factors include, advancing age, hypertension, both obesity, and fast weight loss, fast food processed diet, elevated cholesterol, aspartame found in diet coke, chronic dehydration, excessive caffeine intake, lack of exercise, sunlight vitamin d and magnesium deficiency, chronic-PTSD, chronic stress and insomnia.
a. 4-5 risk factors
b. 6-7 risk factors
c. 8-9 risk factors
d. over 10 risk factors
Answer d. over 10 risk factors. (actually, he has over 14 risk factors)
2. This patient is noted to have hand bruising during an 18-month period. Possible causes include:
Answers
Hand bruising from taking aspirin
Hand bruising from anticoagulants
Answer b. anti-coagulants based on risk factors for AF
3. Why would anticoagulants be prescribed?
a. Atrial fibrillation
b. Stroke prevention
c. Myocardial infarction prevention
Answer a, b, and c. atrial fibrillation- to prevent clot formation, a risk factor for AF
4. What percent of atrial fibrillation in an elderly adult will cause an onset of congestive heart failure, and what is the time period?
Approximately 17.5% to 24% of older adults with atrial fibrillation (AF) develop congestive heart failure (CHF) within a few years of their AF diagnosis, with a significant risk occurring in the first year.
Answer a. in this case onset of congestive heart failure in just under one year
5. Why was this patient noted to have bilateral ankle swelling 11 months after onset of hand bruising was noted, (i.e. after onset of atrial fibrillation and anticoagulation use)?
a. Peripheral vascular disease (PVD)
b. Swelling of ankles, pitting edema type associated with congestive heart failure (CHF)
Answer b. swelling associated with CHF. PVD usually presents with minimal swelling
6. Why would this patient be seen having a battery pack underneath his shirt?
a. Connected to a LVAD (left ventricular assist device) pre heart transplant
b. Hooked up to a Holter monitor to detect arrhythmias
Answer b. Holter monitor
7. Why?
Answer- so his cardiologists can obsessively study the results and make decisions on the perfect way to improve his cardiac health. Which they did, all of them are wizards.
8. Why has there been obvious improvement; including, no further hand bruising or swelling to lower extremities? For the last 3 months?
a. Due to a procedure likely done Labor Day week, catheter ablation to address and correct the atrial fibrillation.
b. See a. insertion of a pacemaker for CHF
Answer a and b. His cardiologists are extremely competent. Patients appeared to have overcome cardiac problems, but only temporarily.
9. Why was an MRI done of heart and abdomen in October 2025?
a. To assess cardiac function, and pacemaker
b. See a.
Answer a.
10. Since the patient is now in normal sinus rhythm and no longer requiring diuretic therapy for lower extremity swelling due to congestive heart failure or anticoagulants for atrial fibrillation, everything is good, right? What could go wrong with this patient?
a. Stroke due to rebound effects of increased clot production in immediate aftermath of discontinuing anti-coagulant.
b. It is almost impossible to understand current clinical neurological evidence, a history of obvious right facial drooping noted September 11, 2025, and incoordination of right arm and right leg. Generally, a stroke affects the opposite side, right face drooping and left side weakness or the opposite however same side affected is the part of this clinical picture I don't get but it is possible with a rare lateral medullary stroke.
c, Bell’s palsy
Answer a. b
11. Was a-TP, the clot buster given almost immediately? Minimizing the stroke effect?
a. yes
b. no
Answer a. yes
12. What is this patient’s risk for dementia?
a. Dementia risk dramatically increases with a history of both atrial fibrillation and congestive heart failure.
b. Cardia polypharmacology (taking numerous cardiac medications), Increases risk of dementia.
c. Decreased kidney function due to cardia polyphamacology also increases dementia risk.
d. All risk factors associated with atrial fibrillation and congestive heart failure, 14 of this patient’s risk factors are all associated with dementia.
e. Stroke dramatically increases the risk of dementia during first year post stroke (increasing risk factors to a total of 15).
f. All of the above
Answer f. all of the above
13. If the patient has dementia, how will this affect the county’s future?
a. Not known, but for sure this patient is not running in 2028, Even Steve Bannon has shut up about it.
b. Either positive or negative
Answer both a and b
14. Why does the patient seem to have a smaller eye on the right?
a. More swelling to the periorbital area on the right,
b. From sleeping on the right-side indication low grade congestive heart failure, as this position decreases shortness of breath
Answer both a and b
15. Between September 2, 2025, and December 2, 2025, no hand bruising is noted. What is the cause of return of hand bruising?
a. Return of atrial fibrillation due to failure of catheter ablation to stop the arrhythmia. Again, on anticoagulants.
b. Consistent with the side effects of Leqembi, a drug used IV to treat early Alzheimer's disease
a. Catheter ablation failure rates vary widely by arrhythmia type, but for common issues like Atrial Fibrillation (AFib), a single procedure might succeed 60-80% of the time, meaning 20-40% fail, often requiring repeat procedures or medication, with persistent AFib
b. administration of Leqembi via IV in his hand. First Leqembi has been available only since January 2025, so it would not explain hand bruising from IV. administer medication for last year and 8 months. Also, this medication is given bi-monthly for the first 18 months. Also, this medication requires MRI to administer IV.
Answer a. when you hear hooves look for a horse, not a zebra called Leqembi.
16. There is a new onset of daytime drowsiness in December, and he falls asleep twice while actively participating in meetings. What is the probable cause?
a. Evidence of worsening chronic kidney disease CKD.
b. Effects of cardia polyphamacology
Answer a and b.
Yes, chronic kidney disease (CKD) can cause sleepiness due to several factors, including the buildup of toxins, anemia, sleep disorders like sleep apnea and restless legs syndrome, and the emotional and physical strain of the disease and its treatments. This can manifest as fatigue, which is a very common symptom, especially in later stages.
And
Yes, sleepiness is a common side effect of cardiac polypharmacy (using many heart medications) due to interactions or drug effects, with common culprits like beta-blockers, ACE inhibitors, and other heart drugs causing fatigue, dizziness, or sluggishness, leading to poor sleep quality, increased falls, and worse heart outcomes, requiring careful medication review.
17. Does this patient know his heath is failing? And what is the evidence?
a. Yes
b. No
Answer a. He wants to name everything after himself as he recognizes he is fading out. Signs of struggle for immortality as he declines.
18. At what point will he not be able to function in his current capacity?
a. Within six months
b. Who knows?
Answer b. Who knows?
further questions 19 & 20
why has the new onset sleepiness coincided with recurrence of hand bruising? If he has been in CHF where is the evidence of SOB? also for sure this is an ongoing inquiry.
Joann Love MD
Hot Springs Wellness Clinic
Truth Or Consequences, NM
