My ablation & CCF experience with Michelle & Dr. Natale-plus update

I have to put Michelle’s name down right along with Dr. Natale because she is his“conciliator”. It seems to be hard to see or talk to Dr. Natale without first going through Michelle. It seems everytime I try to talk with Natale himself, Michelle is always there. Maybe Dr. Natale doesn’t have time for “small talk”. He just does what he does best-ablations-and leaves everything else to Michelle. Everytime I spoke with Dr. Natale
a nurse was always present.

I personally found the ablation procedure fascinating, and Newman is right, Versed is
your best friend during this procedure. I was asleep when they put the catheters in, but
became conscious at some point during the procedure. I kept my eyes closed because I wanted to hear what was going on in the room. I could hear Dr. Natale talking to someone about the bubbles he could see, but I don’t remember much else. I finally opened my eyes, but laid very still. I could feel a faint pain in my chest, but no burning. I could see the overhead fluoroscope machine(I assume that is what it was), and from
time to time it would revolve from one side of my body to the other. I would hear a steady noise from time to time and wondered if it was the RF being applied to my heart because it was then that I could feel the slight pain in my chest. At the time, I remember feeling greatful that I was finally having this proceure done, people were working on me to finally stop the AF I have had for 15+ years. I couldn’t see Dr. Natale, but from time to
time the nurses(or fellows) would come around to make sure I was still & ok. I remember someone told me to not move my neck to the left(I guess because of the catheter), but everyone said I was doing so well because I wasn’t moving & my breathing was perfect-that really made me feel good. Then I was put back to sleep because the next thing I remember was there were three nurses putting pressure on my groin(one on each
side) and one holding my neck where the other catheter was. It seemed they did this for some time. Finally I was wheeled out to the room where my wife was, and soon Dr. Natale came and told us everything went very well and that he felt very good about the procedure. I never saw him after that.

I was wheeled up to my room and everything was fine until about 2:00am when I awoke with a 101 fever, HR at 85. My chest hurt everytime I would take a deep breath, but the fever concerned me the most. By morning the fever droped to around 100. I was visited by a very young, cocky doctor(EP) who discharged me, and gave me a script for lipitor. I
asked this EP about my fever, why, etc. He had no clue and wasn’t concerned. I asked him how many ablations he had done & he said around 100. I asked him what his success rate was, and he said it was the same as the CCF because they all grouped in their ablations together. Something told me I wouldn’t want him to do one on me. Then I got
to thinking, how do these guys start doing ablations? Do they go into the room with Dr. Natale, or one of the other “noted” doctors while the patient is asleep and are instructed by Natale & Co.? Actually pick up the catheter for the first time & burn? Or would the patient have to be notified first? Anyone care to guess, cause I sure don’t know. Heck, just like Newman said, it could have been the local buss driver doing the ablation for all I
know. But I do wonder who Dr. Natale was talking to back in the EP lab during my procedure. Maybe it was all a dream.

The CCF, it is a BIG place.

My wife & I went back to our room at the Quest House. I still had a slight fever that night & my chest would hurt when I tried to take deep breaths. We caught the plane the next morning at 7:05am. Lucky Lois, a taxi cab driver picked us up at the airport when we arrived. I liked her name, thought it was a good omen, and had her pick us back up
for the return trip to the airport. On the plane, I went into AF which lasted for 12 hrs. The pain in my chest, and all other symptoms were completely gone. Had another episode 4 days later which also lasted 12 hrs. Then yesterday, a few hours after having my INR checked(BP was 120/70 & HR 72)-10 days after the procedure, I had another episode which lasted 24 hrs. I called Dr. Natale’s extension-not Michells’, but yeah you got it, Michelle answered. Hey, I just talked to her yesterday after the episode started, but what’s a fellow to do. So I talked to her again. Told her it seemed like the episodes should be getting shorter-not longer! Told her I thought that maybe remodeling might start taking place through the “burns” Dr. Natale created if the episodes kept getting longer and longer. Hmmmm. “What did I tell you yesterday?” she boomed. “There is
no rhyme or reason as to how your heart is going to act during this phase. You are just going to have to be patient and wait two months. You will see, everything will be ok.”
So, what else could I say to this woman?

I’m just going to keep my fingers crossed. If it doesn’t work this time, I’ll definitely be back. 95%, right?

Everyone be good,

Jim W.

Hi Jim,

Thanks for the update on your procedure.

I am still wondering about your current meds. No Norpace, right? Did they say why? Other EPs seem to keep you on it for a time - even if there is no AFIB. Also, I assume you are on coumadin? Or how about a betablocker?

Also, does the AFIB feel different to you? In fact, does your heart feel different to you - like it's not the one you grew up with?

Just wondering.

Again, good luck to you.

BillB
48;A;2000

Am very surprised that you were discharged with a fever.

Yes, doctors in training do take over while the senior doctor instructs. That is how they learn. So, yes, unless you specifiy in writing that you want the entire procedure to be done by the doctor of your choosing, you may have someone else practice on you. That is a fact.

A friend of mine had a vein punctured during an ablation procedure at Mass General Hospital. His doctor was not in charge. He then had to have major open heart surgery on the spot and developed an infection and fever. It was a very close call. He said that from now on he would always specify who was to do an operation or procedure.

Carol

Carol- I wish I had known that before my ablation at CCF! That is really frightening. At least I do remember seeing the doctor I thought was doing the procedure right before I was wheeled out of the operating room. He gave me 2 baby aspirin. I hope to God he did more than just that. Because I was totally out before I saw or heard any doctors.

Jim - I think I know how you feel about not being able to talk directly to the doctor. And what it's like to be boomed at by someone who is suppossed to have your best interests at heart. As I told them, I felt abandoned. And I never saw the doctor I hired after he gave me the baby aspirin. I finally got fed up with that system and sent a letter--certified with return receipt requested to my doctor -- not his assistant or her assistants(or whatever they are). It's too bad a person has to fight so hard to get the attention they need.

I think it might have done some good because my 3 month postablation visit was moved up about 4 weeks (it had been delayed about 5 1/2 weeks)when I called to check today. However, that was just a verbal appointment. I don't believe them until I see it in writing.

Well, I do have some definate good news to report. My small banana sized hematoma on the left side of my groin is definatley diminishing. And I think I am in sinus much more than I was. I do have some chest pressure/pain which was diagnosed as GERD at CCF ER one month after the ablation. But I question that diagnosis.

Sorry things didn't go better for you Jim. I also had a short curt doctor discharge me & give me an RX for Lipitor. I took my last Lipitor last nite.

I feel like I made a trip to see the Wizard of Oz. But I'm not sure if I got what I asked for yet.

good luck, Jim

njb

Jim,

It is good to hear from you. Let me make a few comments:

(1) I concur completely with your comment about the doctor who discharged you from the hospital. I'm sure I had the same guy. He was young and cocky (and I will add arrogant). He gave me the same instructions that Dr. Natale had previously given me. He did not state why he was there or why he was even talking to me. He was not friendly. The CCF should replace him. He is definitely bad for their P.R.

(2) I am also surprised that they would discharge you with an above normal temperature.

(3) I was also surprised that they gave me no antibiotics, although maybe they did via the IV. I am no doctor, of course, so these are comments by an amateur. I'm sure there is a good explanation.

(4) If I was Dr. Natale and did as many ablations as he does, I too would have a nurse who would shield me from patients, much like executives and businessmen do with their secretaries. He is an expert at ablations, and he should spend most of his time doing ablations. If he accepted phone calls from all of his patients whenever they have a question, it would drive him crazy. I had a nice conversation with him at my consultation before the ablation, and a nice conversation with him after my ablation. This is all that I expected. As important as these questions seem to be to us, they are routine to his nurses and I think they probably hear the same questions over and over and over. I viewed Michelle as highly competent and I would trust her answers. I am sure if you had an unusual symptom, she would communicate it to him. She should remain responsive to your questions since she is the go between.

(5) During the consultation, I asked Dr. Natale if he would be doing my ablation, and he said yes. I would not be happy if I discovered that a trainee did some or all of it without my knowledge. They all have to learn, but let them learn on someone else. However, Dr. Natale does have a great reputation, and therefore I don't think he would jeapordize it by allowing assistants or trainees to make mistakes. Whether he, or an understudy, did it, I am sure the quality of the ablation would not be compromised. Hell, maybe his assistant is better at ablations than he is, so he lets his assistant do them and he takes the credit! Anyway, however he does it, I like him and I like his results. He's the captain, and I'll go with his decisions.

(6) The "over 80% success rate" and the "2% serious complication rate" and the "95% success rate after touchups" is impressive. I think the cocky doctor was correct. These are the numbers for the CCF as a whole. I don't know what Dr. Natale's record is. So all EPs lump their results together, the good ones and the not so good ones. It would be nice to find out what the EPs' nurses opinions are of the various EPs. They know who the good ones are. And they know who the not so good ones are.

(7) The ablation is behind you. You picked your EP of choice and let him do his best. Now it is a waiting game. You know the odds and they are good. The CCF consistently said and says that fibrillation after ablation is not unusual. That doesn't help your confidence level much when you do have AF now, but IT IS NOT UNUSUAL. There is a good chance that you are one of their success stories.

Keep the faith, Amigo.

Newman

It looks like Jim, NJB and I all were discharged by the same " Mr. Personality" EP at the CCF hospital. I'll call him Dr. Lipitor, since it appears that giving each of us a prescription for Lipitor was the only useful thing that he did for us.

Jim, what meds are you on and for how long? Dr. Natale put me on Coumadin, Toprol XL, and Lipitor. I had been on Coumadin, Toprol XL and Lanoxin before the ablation. The plan is to stop Toprol XL after two months if I am doing well. Then, after three months, if it looks like I am cured, he will O.K. me to stop Coumadin. One of his nurses told me to take Lipitor for three months and then stop taking it. It seems like Dr. Natale said to stop it after two months, but I can't remember for sure. How long were you instructed to take Lipitor?

Newman

Hi Newman,

Thanks for your encouraging remarks, and I must say I do agree with you.
Frankly, I chose the CCF because I believe they are a step ahead of everyone else. I would bet in a few years no one else will be doing any mapping either. The procedure time is much shorter(1hr 40min) and a total time on the table of under 4 hours. Many other places-maybe most-are double that timewise. My cardiologist here in Asheville felt the less time you are on the table the better.

Anyway to answer your question & Bills, I was on 500mg Norpace, 240mg diltiazem, & coumadin before the ablation. I am now on diltiazem, coumadin & lipitor. I was only given a 30 day supply of lipitor and assumed I was only to take it for the 30 day period. Let me know if you hear otherwise.

*Note- I asked Michelle if I should take Norpace and she said I could if I wanted to. It didn't seem to make any difference to her. If I have another episode I may take 300mg Norpace on demand-not sure what I will do.

Jim

Hi Bill,

The answer to your first questions are in my reply to Newmans last post on this thread.

My heart feels the same- no difference. The AF is the same. My HR is the same. The first couple of days after the procedure is was definitely faster. It is now in the 68-72 range.

Jim

Dear Jim - thanks for your report and observations. I can hardly wait until I am discharge by "Dr. Personality." As outspoken as I am, I will probably have a comment or two for him.

As I mentioned previously, we all know that they tell us it is not uncommon to experience afib after ablation. My neighbor had it very two or three months. It was noticeable but not anything she worried about.

Probably, because we are all sooo ready to be rid of it, we hope and expect 100% performance. I'm sure it will just take time.

After reading these three testimonials about ablation at the CCF with Dr. Natale, I feel a bit more prepared...thanks to everyone...I'll be on my guard and I think I'll probably ask for that signature that "guarantees" Dr. Natale only, does the surgery.

I agree with Newman, I think that talking to Michelle is probably better than Dr. Natale. He has other things on his mind. Her job is hand-holding and she certainly has the brains and experience to handle ablation patients.

NJB - I liked your analogy of a trip to Oz.... I'm about to embark down that yellow brick road.... Let you all know how it goes.

Take care, Jim.... hang in there. I have every confidence afib will be a thing of the past. Just don't dwell on it... I know - easy for me to say.

Best regards, Jackie

The experience I had at CCF was exactly as I had been told. The Cleveland Clinic is massive and scary. I was given a blow by blow description of what to expect before, during and after. Michelle, Charlene, and Minerva, the atrial fib nurses working in Cleveland support the docs so they can do what is important. ..the actual ablation procedure. The nurses in the procedure room were great. The office workers helping the afib nurses are always friendly and willing to solve my problems.
The "cocky" guy discharged me too. Maybe his problem is lack of sleep and food. If the docs answer phone calls allday and personally discharge patients then who will be doing the procedures? I waited 51/2 months for Dr Natale and I'm glad I had his uninterrupted attention for the 5 hours it took to do my case...that's what matters. And I feel the education, emotional support, and attention to my concerns I received by his nursing team was the best in the world! Be greatful there are nurses in Cleveland to help him ....Ngb SHAME ON YOU!

Gillian - thanks for weighing in. I'm really pleased that you are satisfied with your CCF treatment. That gives me great support. Thanks.

I am comfortable with what I know of the CCF, Dr. Natale and the procedure. I've been very impressed so far with the EP nurses. Perhaps because I'm a resident of the area, and have been seeing doctors at the CCF for years, it isn't scary to me...but it sure is big and growing all the time. A behemoth to be sure, but since each specialty is a unit in and of itself, breaking it down this way creates some degree of personalization, at least I think so.

However, I can see how it could be intimidating to patients coming in from small towns since the CCF is about the size of a very small town.

Are you doing well after your ablation? Hope the answer is positive.

Thanks again. Jackie