Here is the full video of the drainage of this finger infection on my son (Antonio).

An oldie but a goodie...this is one of my very first videos that went 'viral'.
It is a short procedure showing how to reduce a dislocated finger.

​This patient had a swollen area in his back for years. Recently it became red and sore and that is why he presented to the ER. In this video you will see the procedure to drain this infection from the back.

Patient presented to the ER with a very large infection of the left arm, around the area near the elbow. This had been progressing over a week before I saw him, and he had already been treated with oral antibiotics because, when evaluated at a different ER the area was "not ready to be drained". 

Exercise is key to living with AFib
Atrial fibrillation shouldn’t stop you from pursuing a healthy, active lifestyle. In fact, atrial fibrillation patients can reap many benefits by pursuing an exercise program. Exercise can reduce the frequency and severity of AFib episodes in addition to lowering blood pressure and slowing your resting heart rate.

Of course, none of this means you should launch yourself into running a marathon after years of sedentary living. You need to be careful as you design your exercise program.

Before you exercise, know what type of AFib you have
There are four types of AFib: persistent, paroxysmal, vagal, and adrenergic. Knowing which one you have effects how you should approach your exercise routine.

1. Persistent AFib patients are nearly always in AFib. Since it’s usually best to exercise when one is not suffering from an episode these patients will need to be especially careful to stick to gentle, low-impact programs.

2. Paroxysmal AFib patients have episodes that come and go. Within reason, they can pursue just about any program they like, if they don’t overdo it.

3. Vagal AFib is when your episodes occur mostly during or after a meal or resting after exercise. This type of atrial fibrillation is related to the vagus nerve. For some people with this type of AFib, exercise can actually help stop the episodes.

4. Adrenergic AFib is when your episodes occur mostly during the day and are normally triggered by exercise, exertion, or stimulants. In this type of AFib the adrenaline hormone is the trigger. For some people with this type of AFib, exercise can trigger an episode.

three people doing a yoga pose
How to choose the right exercise program for you
It’s important to start by focusing on light-to-moderate programs like brisk walking, Tai Chi, or yoga. Make sure you don’t get above 50% to 70% of your maximum heart rate. Calculate this by subtracting your age from the number 220. If you’re 40 years old your maximum heart rate is 180 and you don’t want to get above 126 bpm.

If you’re on beta blockers you might have to use the Borg RPE scale as an alternative, since beta blockers exist to keep your heart rate low. The Borg scale is a measure of “perceived exertion.” The CDC offers a lot of information about it, but here’s the bottom line: you should aim to keep your perceived exertion somewhere between 11 and 14 on a 1-20 scale while you work out.

Avoid weight lifting because it can put a great deal of strain on your heart. Strength training is important, but resistance band training is safer and more effective for AFib patients.

Tips for a more successful exercise experience
Be vigilant about taking care of yourself during your exercise time. This means setting realistic goals, staying hydrated, and watching for signs you may be overdoing it such as dizziness. If you’ve been sedentary for a long time, start out slow. Pay attention to weather conditions: the last thing you want to do is overheat.

Think about personal safety, too. If you’re on blood thinners, for example, a major exercising accident could be very dangerous. Wear protective gear and take precautions to ensure you can get help if you have an injury that makes you bleed.

an older man running in a park
Beware of overdoing your exercise
Pushing too hard is the number one reason why exercise may become unsafe for someone with atrial fibrillation. Don’t rely on monitoring methods or Borg scales alone. If you can’t speak a full sentence without gasping for air, then you are overdoing it. Lightheadedness, excessive sweating, and chest pains are other danger signs.

You might feel like you’re “accomplishing more” when you start to push harder, but remember: even if you don’t trigger an episode your body will hit a wall. If you start associating exercise with pain and discomfort you won’t want to do it, and the least effective exercise is the one you never get around to doing at all.

Keep exercise fun so you’ll want to do it…and don’t let AFib stop you from getting out there and getting active.

Do you know how to handle fatigue with AFib?
Between the sleepiness, fatigue, low energy and general malaise atrial fibrillation can be a draining disorder. While some people won’t detect too much of a difference in their energy levels, many of those who live with AFib complain of frequent fatigue that can interrupt their daily routine.

What’s to blame for your low energy? The frequency and severity of your AFib episodes, your daily activity and habits, and your treatments can all factor into how tired you feel. Understanding what’s at the heart of your AFib fatigue is the first step. Once you know, you can apply some smart strategies to boost your energy.

Where does your fatigue come from?
When your heart beats faster than normal for a long stretch of time, the muscle gets tired. That’s the short answer. However, understanding what exactly is happening with AFib can help you pinpoint the problem (and hopefully help you to treat it).

A rapid heart rate is a primary issue: healthy atria contract between 60 and 80 times a minute, but when your atria are in fibrillation, the contractions are incomplete. Instead, these upper chambers quiver – up to 400 times each minute.

Although your AV node tries to calm this overactivity, it can’t halt every extra electrical impulse. These erratic electrical signals funnel into the ventricles, causing the heart to beat much faster than normal, and that can feel like an exhausting workout.

A rapid heartbeat is only one part of the equation; inefficient blood flow can be another source of fatigue. When the atrial chambers flutter instead of contract, they can’t pump blood as well, which means the oxygen-rich blood your tissues rely on won’t always reach them. When your tissues and organs run out of fuel, you can feel weak and tired.

Is another condition at play?
It’s not unusual for AFib to come with (or from) other chronic conditions, especially if that other issue has been mismanaged or gone untreated. Cardiovascular disease is a significant risk factor for AFib, and it can bring side effects like shortness of breath, and, in turn, decreased energy. Congenital heart defects can also be to blame – for some people, one of the first warning signs of a defect is shortness of breath and fatigue.

Although older age, high blood pressure, and heart disease top the list of fatigue risk factors, other health issues can also drain your energy and encourage AFib symptoms. Sleep apnea, asthma, and COPD can all interfere with how oxygen moves to your tissues, which means they can cause even more fatigue than you’d have with AFib alone.

Change your habits, change your energy levels
Managing your AFib symptoms is a key to improving processes in your body and boosting your energy levels. You can modify your routine to respect your limitations, helping you to conserve more energy to use throughout the day. And by working to keep your symptoms to a minimum, you can avoid the consequences of a prolonged elevated heart rate.

Move in intervals. When you parcel your activity into shorter stretches, your energy stores can last longer. Try to space out your errands through the course of your day. When you exercise, alternate a few minutes of effort with a few minutes of rest, to better balance your cardio benefits with AFib symptom management.

You might find your energy levels are higher at a certain time of day. Pay attention to those patterns – it can help you plan your activities strategically.

Mind your minerals. Many people – and AFib patients in particular – tend to have low levels of magnesium, which can manifest in a number of ways, like muscle twitches, cramps, and fatigue. Since magnesium is crucial for healthy cells, you’ll want to make sure your magnesium level is topped up.

Look out for the warning signs of a magnesium deficiency: when your AFib symptoms come alongside discomforts like muscle spasms, insomnia, and irritability, you might need more magnesium. While a balanced diet can help bring up the level of this electrolyte, it probably won’t be enough. Supplements, in the form of pills or topical spray, can be an easier and more effective way to get magnesium to your tissues and relieve some of the extreme fatigue.

Check in with your sleep
A healthy lifestyle is vital, but focused AFib management plays an important role in your quality of life, too. Sleep is incredibly important for your body to reset and recover. Your sleep needs can change as your age or as your AFib progresses, so it’s a good idea to look closely at your routine to make sure you’ve done what you can to keep symptoms under control.

Explaining heart rhythm problems in young people
Heart problems are often tied to aging. Your risk of several types of cardiovascular events, including atrial fibrillation, climbs higher as you approach middle age. But while atrial fibrillation or AFib risk does go up as you age, this is one heart disorder that could hit at any point in life.
Although the majority of AFib diagnoses happen over the age of 60, more and more young people – even teenagers and 20-somethings – are suffering from the heart condition. This trend could be partly traced to better diagnostic tools and more awareness, but whatever the reason, it’s important to know the facts and challenges surrounding an AFib diagnosis in young adults.
5 causes of AFib in young people
Wear and tear on the heart adds up over the years, which can lead to coronary artery disease, high blood pressure, and heart attacks – some of the most common causes of AFib. However, there are often different reasons behind an early AFib diagnosis, like congenital defects, unhealthy habits, and other illness.
It can be especially difficult to uncover the root cause of AFib in young people, but these are a few of the most commonly detected sources:

1. Stress. Stress is a major trigger of many conditions. Experts agree that it can have a direct and severe impact on AFib. Of course, stress comes in different packages at different stages of life, and for young people, the mix of school, social dynamics, and future planning can bring an overwhelming dose of stress.
How does stress lead to AFib? The stress response can activate the heart, jumpstarting electrical signals and encouraging AFib symptoms in those prone to them. Both mental and physical stress can cause this response, and in either case, you may need behavioural treatment as well as medication to resolve the issue.
2. Mineral imbalance. A fine balance of minerals, vitamins, water, and calories helps your body to function well. Unfortunately, it’s relatively easy to let your magnesium, calcium, potassium, and hydration levels lag – and that can set the stage for AFib.
It’s unfair to label young people as poor eaters – many consume a wholesome, balanced diet that serves their physical and mental health. However, many other young people subscribe to a processed food diet, which is usually deficient in many important nutrients.
3. Infection. Pericarditis, an infection that can develop around the heart membrane, could lead to AFib, but so could other bacterial infections that aren’t directly affecting the heart. Research has found that the level of C-reactive protein, an important marker of inflammation, is measurably higher in people with AFib.
Dental infection or disease could also cause trouble. You may have heard that gum disease increases your risk of some cardiovascular disease, but a recent study turned up a link between periodontal health and AFib, too. Experts suggest regular scaling to keep the inflammation down and mitigate your risk of heart rhythm problems.
4. Drug abuse. Illicit and commonly-prescribed drugs can trigger AFib, whether or not you have a pre-existing heart disorder. Stimulants are more often to blame, like nicotine, alcohol, and caffeine. Doctors have also discovered that opioid use can lead to heart rhythm irregularities, and given that more teenagers and young adults are misusing prescribed opioids, this poses a grave danger.

5. Comorbidities. Congenital defects could cause AFib to manifest earlier in life, as can other metabolic disorders, like diabetes. Hypertension, hyperthyroidism, and pulmonary embolism could also be at the root of the problem. For young people who suspect or know they have AFib, it’s important to work closely with your doctor to conduct a thorough examination of your medical history and physical health, in order to uncover any other illnesses that could be complicating matters.

Understanding Lone AFib
When atrial fibrillation develops before the age of 60 and without any related conditions, it’s known as lone AFib. In some cases, lone AFib is associated with a thyroid disorder, viral infections, or stimulant use, or it can be traced to family history. However, in many other cases, there’s simply no clear explanation for early-onset lone AFib.
Your doctor might first want to rule out factors like extreme exercise and sleep apnea – sometimes these are missed in the initial investigation. But even as diagnostic technology advances, little is known about why lone AFib happens. Fortunately for some, a course of medication can eliminate the AFib symptoms; for others, symptoms could come back, sometimes permanently.
Anyone under 60 who experiences AFib symptoms like palpitations, shortness of breath, or dizziness needs to visit a doctor. It can be tempting to ignore the discomfort, especially if it’s mild and you don’t have any other health problems, but the sooner you can start treatment for AFib, the better your chances of preventing it from getting worse.

Similarities, differences, and links between AFib and anxiety attacks
So many common symptoms of atrial fibrillation resemble classic anxiety symptoms that characterize panic attacks: heart palpitations, chest pain, muscle tension, and sweaty palms that come with an adrenaline rush are good examples.
Luckily, these symptoms are generally short-lived, whether it’s an AFib episode or a panic attack. However, in order to treat your body properly and sidestep potential complications down the road, it’s important to distinguish the two conditions.
Looking out for the telltale signs
AFib is notoriously tricky to diagnose on your own, but there are some signs that can help you tell panic attacks and AFib episodes apart. It’s important to keep in mind that the two syndromes stem from different sources: AFib is an electrical disorder that sends a mess of signals through the chambers of the heart, but a panic attack typically won’t have a physical cause. Rather, it’s triggered by events in your environment, stressful situations, or sometimes happens for no apparent reason at all.
Here are a few markers that can help you tell the conditions apart:
Rate of decline. Pay attention to the rate of building and declining symptoms. Since AFib is triggered by a sudden physical event (overactive electrical signals), AFib episodes typically hit suddenly. When the episode subsides, so will the symptoms, but the cycle tends to repeat until treatment is administered. With a panic attack, heart rate can start to creep up as other discomforts manifest, and after the attack hits a peak, heart rate will gradually return to normal as the other symptoms dissipate.

Nature of the heartbeat. The pattern or rhythm of a heart beat can also tell you what’s going on: a panic attack typically brings a constant rapid heart rate, while AFib causes an erratic heart rate. If your heart seems to be skipping beats, or speeding up then slowing down and speeding up again, it’s more likely that AFib is to blame.

Related emotions. Panic attacks often bring what people describe as a sense of doom: a heavy and urgent feeling like something very bad is about to happen. This fear and helplessness is tough to shake and can feed the panic that brought it on. While an erratic heartbeat isn’t pleasant, AFib doesn’t usually bring such a severe emotional response.
Type of pain. AFib and panic disorders can both bring on chest pain as the heart races and muscles tense. A dull chest pain is not uncommon, but everyone experiences pain differently. When AFib hits alongside another heart disorder, the pain can be more specific and intense – and it’s never a good idea to ignore. If you get any chest pain during an attack or episode, see your doctor to investigate further.
Anxiety is a very personal experience, and can be troubling, but take comfort in the fact that it will subside. Unfortunately, AFib may not go away without some help, so you’ll want to make sure you know what you’re dealing with as soon as possible.

Relieve anxiety, reduce AFib
Anxiety and AFib play off each other, and that’s no good for your body or your mind. If you know that anxiety triggers your AFib, make it a priority to get the stressors in your life under control as you craft a more heart-healthy routine.
If anxiety is too much to bear, don’t suffer alone – talk to your doctor about adding anxiety medication to your health management. You may not need to take it every day, only when things get very bad, but knowing that you have something on hand for emergencies can go far to reassuring yourself that you’ll get through the panic should it strike again.
Next, add exercise. Workouts don’t need to be strenuous, but they do need to be regular: you’ll see more positive physical and psychological results when you commit to exercising several times a week. If you’re not sure where to start, you may first want to meet with your doctor and a trainer to measure your current level of fitness, so you can choose an appropriate workout that respects your limits.
Turning a negative into a positive
A panic attack or an AFib episode can bring a rush of frightening energy, as adrenaline courses through your body and your mind jumps to worst case scenarios. You could try to wait it out and distract yourself with an activity, but sometimes it’s impossible to calm your anxious response by sheer will.
Instead, you might try to turn the rush of fear into a rush of excitement: force yourself to think of an exciting event or possibility, or simply start dancing and laughing. It sounds counterintuitive, but you may be able to flip the nature of your feeling from bad to good, and although this probably won’t make your symptoms go away, they will become easier to handle.
Relaxation, support, confidence, and commitment – these are the ingredients of a smart and effective management plan for AFib and for anxiety. If either set of symptoms begins to take over your thoughts and lifestyle, it may be time to seek a new perspective or professional guidance. The good news is that there are plenty of techniques that can interfere with the AFib-anxiety cycle, and help you regain some control.