how do you get a new doctor?

Hi
I've posted about my current afib episode and gotten some great ideas.
I discovered that there are two EP docs at the Heart Institute where I am usually seen.
How do I go about requesting a change from the cardiologist I currently see to one of the EPs?
I really like the cardiologist I've been seeing, but he's not an EP so I might do better with one who is. I don't want to hurt my doc's feelings though.
How do you address something like this?
thanks,

This has also been my dilemma for the past two weeks. Because I've been seeing the same cardio for about 30 years, I'm just going to ask him if he has any recommendations. He will still be my primary care but lately, I really need a second opinion and maybe a medication change. I'm in the Boston area so there should be some good EP's out there but which one is the big question.

You tell your cardiologist that you're interested in taking the next step towards getting an ablation and ask her to recommend a good EP. That's what I did. I ended up at MGH and did a little research and feel I got a top EP in Dr Mansour. Only 2 weeks since my ablation but so far so good.

Althea, One way to find an ep is to internet search. I just googled " find an electrophysiologist in boston area " and ended up with this site.

EP"s in the Boston Area

The only problem with finding a doctor this way is you still don't know very much about them. I would rather have someone recommend a good EP than to try to find one on my own. Especially if you are thinking about having an ablation sometime in the future.

Cheers

a long way from Boston (pun intended)

Adrian

Dr Mansour is a good one out of Mass General.

IMO they all are good at MGH. So far so good (Ablation done Oct 19th and counting).

Here's a link to their EP Lab docs

[www.massgeneral.org]



Edited 1 time(s). Last edit at 11/11/2012 11:47PM by afhound99.

MichaelS Wrote:
-------------------------------------------------------
> You tell your cardiologist that you're interested
> in taking the next step towards getting an
> ablation and ask her to recommend a good EP.
> That's what I did. I ended up at MGH and did a
> little research and feel I got a top EP in Dr
> Mansour. Only 2 weeks since my ablation but so
> far so good.

**********
so if you're not interested in an ablation, would you even need an EP?

I don't want to have an ablation, I've only had a very few episodes. Also my insurance wouldn't cover it.

Im far from an expert but I see no reason to have an EP if you're not having an ablation.

Michael,

Actually, there is a significant difference in the skill set of cardiologists and electrophysiologists (EPs). A cardiologist deals with heart disease, heart failure, atherosclerosis and hypertension - essentially problems of blood flow whereas an electrophysiologist deals with rhythm problems which are essentially problems involving faulty electrical circuits. You could liken the cardiologist to a plumber and the electrophysiologist to an electrician. I don't think you would want to have a plumber rewire your house!

As an example, an electrophysiologist is far more likely to be aware of the difference between adrenergic and vagal afib and thus prescribe the correct drugs for these conditions.

Hans

Hi Althea, ( i posted this below in your original thread but the topic fits here too so am re-posting it here)

I agree with the list of recommendations that Murray and Hans reference on the ECV preparations, the only exception being starting at such a high joule rate as 300 joules. No doubt that is likely to do the job with one shot, BUT if you first insist on getting your magnesium levels up with a Magnesium sulfate IV and sufficient potassium when they will give you a Potassium Chloride time-released pill of 20MilliEquivalent dose, then you should just as easily convert with 150 joules, or possibly even less, on the first zap and then if you need another zap they can immediately dial it up to a higher joule level and zap you until you convert while under teh same anesthesia. You wont feel a thing.

With sufficient magnesium and potassium on board studies show the ability to reliably convert to NSR with significantly less shock energy. I fully understand the rationale for starting at 300 joules to be one and done for sure on teh zaps, but that is a whopping dose of energy as it is. And my hunch is that the studies showing greater first zap conversion rates into NSR at 250 to 300 joules were done mostly with a study group of patients who had not had confirmed IV magnesium infusion and potassium repletion prior to ECV ??

Anyway, I would personally prefer using the magnesium and potassium repletion routine first which is what I did prior to a total of 16 electro-cardioversion I have had and never once did I need more than 150 joules on one zap to get it done.

Also, having taken an AAR drug like Flec or Sotalol prior to the ECV can also help insure success, but you will need to discuss this with your doc. The regular cardios can certainly handle the ECV no problem but you still need a good EP for sure.

What you should do now, if you are still in arrhythmia, is to get on Coumadin for a month with your cardio's help and aks him to refer you to tjhe best EP he can in your area, and then get the ECV as soon as he will do it.

At this stage past 48 hours from teh start of your AFIB episode they will want you on Coumadin regardless but you could also ask for .. insist on ... a trans-esophageal echo-cardiogram (TEE) as soon as possible which is what I would really demand in order to rule out any possible clot formation within the left atrial appendage and left atrium, in which case, they could go ahead and do the ECV immediately after the TEE results are known.

That way, you don't have to wait so long before getting the cardioversion since during all of this time you are in AFIB/Flutter your heart tissue is continuing to remodel to accept AFIB as your normal rhythm making it easier and easier to get triggered into AFIB and harder and harder to convert back to NSR until eventually you might well convert into 24/7 persistent AFIB which it sounds like you are starting to move toward already with the longer times of each episode before you can convert and if I understand you correctly you are still in AFIB now for almost a week??

Your two Cardio's at CMC both may be decent general cardiologists though both seem quite young judging by their photos, but regardless how good they are in their area of cardiology you definitely need a good electro-physiologist PERIOD!! Don't settle for an interventional cardiologist (stent squishers) for your condition ... if you had cardiovascular disease then by all means use them ... but they will not be as up to speed on your issue as a true specialist in arrhythmia which is what an EP is. Insist on the best EP they can refer you too in your region, if your situation doesn't allow you the flexibility and freedom to go anywhere in the US to connect with the very best EP available.

Shannon

Lots of good info in this thread. After reading and checking out various EP's in the Boston area, I called MGH and have my first appointment booked with Dr. Conor Barrett at the Heart Center in January. Also, I was excited to read that he will be participating in the AF Symposium 2013 Boston. I don't believe that I need an ablation at this point in time but my episodes are becoming more frequent but always self converting within an hour or so.
Cheers,
Ralph