Newbie & Need Guidance...Please!!!!

Hi All....I will try to keep this as short as possible but I really need some guidance here!
My husband and I have just moved back to S.California after working & living in Puerto Vallarta Mexico for the past year.
Last November my husband (46 years old) went to see a highly recommended cardiologist in Puerto Vallarta after he finally admitted to me that he had been experiencing tightness in his chest, shortness of breath and overall fatigue for over a year. He has no other health issues but was diagnosed with sleep apnea over 10 years ago and has used a c-pap machine ever since.
My hubby speaks fluent Spanish and thankfully the Cardiologist spoke wonderful English (for my benefit) and diagnosed him with A-Fib.
On his first visit to the Cardiologist she did an EKG and ultrasound. He was diagnosed A-Fib with his heart rate over 150 per min. She ordered labs and prescribed 150 mg propafenone 3x on the first day then just 1x per day after that, also Eliquis 5mg 1x per day and aldactone 25 mg to rid him of the ankle edema that he presented with.
The second visit was a week after starting the medication for a check up.....his heart rate had slowed down considerable\y to 87 per min but his A-Fib was still present though less racing than before the medication.
He has continued with this same Propafenone & Eliquis treatment which has resulted in no more tightness in his chest and not feeling the racing heart like before even though his heart rhythm is still all over the place but slower at least. He saw his Cardiologist 2 weeks ago right before we moved back home to California. She said his blood pressure was elevated where before it had been normal. She added a small dose of bisoprolol 1.25 mg per day to his regimen but made very clear that he was too young to remain on all that medication and suggested that when we return to the US that he really should see an EP and try ablation to improve his quality of life.
When we got back I immediately started researching and found this group and also Dr. Natale up in La Jolla but then found out that he is now only in San Francisco 1 week a month. My husband called their office and explained his treatment in Mexico over the past year. They asked that I fax his insurance card along with any records and list of medications. I contacted the Cardiologist in Puerto Vallarta and she sent over a referral letter, which I faxed along with his insurance info, lab results from the initial cardiology visit, copies of his prescriptions and 3 electrocardiograms from his cardiologist visits . I was told after they received the documentation that the scheduler would call the next day to make an appointment for a consultation with Dr. Natale.
Of most importance, the cardiologist's referral letter stated the following:
patient name, age, that he started treatment with her in Nov 2016 with dysphea, weakness bimaleolar edema in the physical examination and arrhythmia. ECG Atrial Fibrilatin FVM 150 per minute. Echocardiogram ef 55% without thrombus and vegetation. Valves without abnormalities. She wrote that his treatment was Propafenone 150 mg 1x day, Eliquis 5mg BID & diuretic Aldactone. He improved and is continuing with same meds only the diuretic is discontinued. This patient is young, productive and needs a better quality of life. She is referring him to do a electrophysiology test and possible ablation.
We faxed everything over and never heard back for over a week. My husband finally called Dr. Natale's office again to make sure they had received the documents. They confirmed that they had received everything and that the scheduler would call him the next day to make an appointment. Several days later still nothing. He called back and eventually spoke with Cindy???(I think) Dr. Natale's scheduler. I was really shocked when my husband said that she had been really rude to him. Really he is such a super-duper nice guy and is not used to people being unpleasant! (except for his wife! haha)
Anyhow, she told him that he would not be able to make an appointment until he saw a Cardiologist here in the U.S. She said that he needed an echocardiogram image and doctor's visit notes. He explained that he didn't have doctor's visit notes and they would be in Spanish anyway. He only had 3 EKGs but not the ultrasound image though the doctor had included the Echocardiogram findings in her referral letter. She said she didn't care and that he wouldn't be seen until he gets doctor's visit notes and an echocardiogram from a cardiologist here.
I honestly feel like crying. I feel like we have to start this all over again and don't understand why they need anything else before they will give him a darn consult. Surely won't Dr Natale be doing his own testing & echocardiogram??? My husband has been treated by a qualified Cardiologist in Mexico who has referred him to an electrophysiologist but obviously that is not good enough??
So now we have to find a new cardiologist, pay for all that same testing again, possibly have the new cardiologist want to mess around with his medications before giving him a referral. If a referral from his treating cardiologist is not enough then I really wish they would at least have a clear and concise list of exactly what they need for a consult. I feel like they are just trying to make it difficult to be seen by the doctor! The scheduler even said that he has appointments open in September.....how the heck does someone of Dr Natale's expertise have appointments open in September when he is only there 1 week per month???....I guess that maybe they are making these appointments impossible to get!!! So here we are at a crossroads. Hubby remains in persistent A-fib and taking his meds. Please does anyone have any advice?? Should we try and get a consultation with a different EP who will accept the referral as is? We are even considering just going back to Mexico to see an EP in Guadalajara at this point?
Very frustrated.
Natalie

Send a private message to Shannon with a link to what you've posted

Thanks for replying George. I think I sent Shannon a PM with the link...."think" is the key word here. I am apparently not very well versed in this forum stuff!!

There are many qualified EPs out there. It doesnt have to be Natale. I don't even have a cardiologist just an EP. Keep trying.

Natalie, I sent you a PM. Look for it in Private Messages in the upper right hand corner.

Welcome Natalie,

I am very sorry to hear of the difficulty and rude behavior you report encountering by, apparently, one of the staff schedulers at Dr. Natale''s secondary center at CPMC in San Francisco where Dr Natale does ablations 5 days out of every month.

While it is not always possible for any scheduler to always be able to confirm a fixed consult and ablation date right away after the initial phone call that includes the transfer of the requested medical documents, including any recent Echocardiograms and EKGs demonstrating the actual arrhythmia, it is nevertheless very true that there is absolutely no excuse for excessive delay in returning a call well beyond the promised date to get back to you, and even less excuse for any unfriendly or rude behavior for Pete's sake!

And definitely anything other than a courteous, helpful and timely response to a new prospective patient, is a certain violation of what Dr Natale expects and demands from his staff and he will NOT at all be pleased to hear of your experience!

I have sent you a PM as well Natalie, so just click on the link and please send me your cell number so I can speak with you and your husband ASAP to get a better understanding of all that went on with this scheduler during her interactions with either you or your husband and I can assure you we will be this sorted out!

It has been a while since I have been at CPMC and there has been some staff roll over the last couple of years, so I don't know every one there now as I used too, and as I do still at Dr Natale's main center at St Davids Medical Center where the majority of his patients go and find a very consistently positive level of experience with the staff there.

I have seen a few times over the past 3 years where there has been a slow response from one or two of the staff at CPMC, and then issues were taken to correct that at the time with apparent success in those individual cases. And new staff has been brought in.

Since I do not know of anyone there name 'Cindy' that you reported speaking with ... assuming that is the right name ... I am unaware of her history there or even how long she has worked there, but will certainly get to the bottom of this and find out.

One reality is the fact that since Dr Natale is only at CPMC in San Fran 5 days a month, and the other 3 weeks the staff works for Dr Hao and Hongo whom Dr Natale helped mentor there, this gives only a week a month for Dr Natale to exert more of his own guidance on the full staff who only see him 5 days a month.

At St Davids he essentially runs the whole show in Austin and every one of the staff is on the same page and basically work as a well-oiled machine there.

One thing for sure, though, is that where ever Dr Natale is performing ablations including at CPMC, the patients get 110% of his attention, skill and effort the entire time there are in his EP Lab, and that of his entire EP-Lab staff too, so you never need be concerned with that as the testimony of so many hundreds of his patients on this forum can attest too over the years.

And while I can certainly very much appreciate how frustrated you must feel with this surprisingly uninviting interaction with who we presume is one of the schedulers now at CPMC that I am unaware of, one thing for sure too is that she is certainly not representing Dr Natale's wishes and guideline for respectful and courteous treatment of all patients ... at least based on what you have shared with us above.

But at the same time, I urge caution about giving up on trying to secure Dr Natale as your husband's EP which I am sure can be arranged to your satisfaction and without you needing to be referred from some US cardiologist .... when I first went to Dr Natale many years ago I flew in from Amsterdam Netherlands where I was living then and did not need a referring Doc to see him then.

The main point here is that this should not have happened with this staff person, but don't let someone in a clerical staff position dissuade you from connecting directly with Dr Natale for the long term benefit of your husband's heart care!! That would really be a shame. This issue will get sorted out. And I suspect like the large numbers of folks here on this forum can directly attest, you will be very glad you did as it is worth the effort!

There are other good EPs out there for sure, but very few in the same league with Dr Natale in terms of skill level and certainly in terms of overall experience with the most challenging kind of cases such as persistent and long standing persistent AFIB .. I can promise you there are not "lots of great EP choices out there who share a similar level of experience with these challenging cases, such as the kind case apparently your husband has too with his persistent AFIB at the young age of 46!

If you prefer, you could arrange to go to Austin, but your husband will do fine as well with his procedure done at CPMC too ... once this one uncalled for bottle neck is resolved.

I look forward to speaking with you both in the next day or two and no worries!

Be well,

Shannon
email: editor@afibbers.org