Watchman approved

A few months ago I had a gallbladder episode that landed me in the ER. I never had gallbladder issues before this. I believe I had a stone that got stuck on the way out. I could feel it moving in the last hour of the episode. On my follow up doctor visits they advise me to have my gallbladder removed. The issue was because I was on Eliquis for a slow LAA, if the gallbladder became infected and I needed emergency surgery, being on Eliquis would make the surgery not possible or highly risky.
I visited a surgeon at Scripps who spoke with Dr Natale about the bridging protocol. The surgeon would not agree to do the surgery using the bridging protocol. The issue was how soon to start the Eliquis after the surgery. The surgeon and Dr Natale agreed the Watchman would be the best course of action for me.

Dr Natale’s office contacted my insurance. Somehow they got it approved!
In about two weeks I will have a Watchman device placed by Dr Natale.

I am a little bit concerned about hearing about clots forming on the device. I have been hearing about this more often lately. It think this is due to poor endothelialization.
I will post how it all goes.

Glad to hear of your watchman approval.The Gall bladder not so much.

Had issues with mine many years ago that landed me in the hospital as well. With removal a couple weeks following.

Best of luck with everything

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gmperf
I am a little bit concerned about hearing about clots forming on the device. I have been hearing about this more often lately. It think this is due to poor endothelialization.

Not sure what you've been hearing and from where, but clots associated with the device are a rare occurrence. Follow the instructions given afterwards religiously and you'll be fine.

I think it's cool that you got approved for the device. It just goes to show that the tide is turning towards accepting the device over lifelong anticoagulants.

Great to hear Gmperf!

Don’t worry so about the rare clot forming on the Watchman device, the odds are very low, and at worse case they might put you back on a half dose of Eliquis longer term after confirming the initial clot is gone once you completed an initial course of full dose Eliquis with confirmed clot dissipation.

In such a rare scenario, you would then, at the worse case, be back to where you were prior to the Watchman install with the decided additional advantage of also being even better protected against any even larger LAA clots from forming due to the inherent protection against such bigger and more dangerous clots forming within a fully open LAA from the inherent LAA occlusion given by the Watchman.

And keep in mind, it is even more rare for an actual embolic event to occur from a residual device-related clot on the surface of an incompletely endothelialized LAA occlusion device like the Watchman or Amulet.

The odds of having a fully successful long term outcome from a Watchman device, especially one installed by a highly experienced operator, is very high indeed!

Even if the very rare worse case scenario outlined above were to occur, the odds are very high that you will still be better protected from embolic clots along with a reduced bleeding risk overall, relative to being only on full dose Eliquis, assuming your LAA mechanical function is less than optimum after LAA Isolation that was required to end your on going struggles with atrial arrhythmia. plus you would not be as subject to the vagaries and risks of missing doses of your blood thinner for the rest of your life.


It is very good news Don that you got approved!
Shannon

Congratulations. I know you’ve been fighting for approval for a long time. Nice little bonus is how easy the procedure is on you. I awoke, and other than the groin insertion site, I couldn’t tell anything had been done.

Thank you Shannon for the reassuring words as I sit in Austin on the eve of my one year TEE!

Keep me posted AB on your TEE this week!

Be well,
Shannon

Thanks everyone for your comments. Sorry for the delayed response. I have been out of town.

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Carey

I am a little bit concerned about hearing about clots forming on the device. I have been hearing about this more often lately. It think this is due to poor endothelialization.

Not sure what you've been hearing and from where, but clots associated with the device are a rare occurrence. Follow the instructions given afterwards religiously and you'll be fine.

I think it's cool that you got approved for the device. It just goes to show that the tide is turning towards accepting the device over lifelong anticoagulants.

I think I may have been more sensitive lately to negative comments and information about the Watchman Device. I have seen a few twitter DRT cases, two patient forum posts with Watchman DRT, and came across this article:
Delayed endothelialization of watchman device identified with cardiac CT
It is always hard as a layperson to extract what is the accurate picture. I know Dr. Natale wouldn't be doing the Watchman device for me if he didn't believe this was the best option for me. There are very few doctors I trust. Dr. Natale I trust 100%.

The last few weeks the gallbladder has been quiet. There wasn't much I could do lifestyle wise to help. I did cut out 99% of all dairy. I went for acupuncture.That is a far as I have gone to pursue any self help gallbladder actions.

Thanks Shannon for your always available help and information. You are greatly appreciated!

Good luck on your TEE AB. Let us know how it went.

I am greatly relieved to potentially be able to stop Eliquis completely. I went onto 1/2 dose Eliquis a year ago after a I had impact trauma to my ears from fly (I descended too rapidly without clearing my ears). The Eliquis would make my ears ring and I felt pressure in my head about an hour after each dose. Then by the time for the next dose, the symptoms were mostly gone. Dr. Natale OK'd me to go on the reduced dose Eliquis. (I now have a 6 month supply of Eliquis stored up)
The other issue I found about being on the Eliquis is so many medical professionals IMO overreact to patients on blood thinners. I once had a dentist refuse to do a cleaning because I was taking Xarelto. I had a doctor refuse to do a cortisone injection in a muscle because I was on Eliquis. He said "if he hit an artery it could be bad".

I will post an update after I have the Watchman "installed" for all those that will probably have one of these in the future.

Don

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Edited 3 time(s). Last edit at 07/16/2019 11:04PM by gmperf.

It will certainly be a huge relief with your gallbladder issues - here's hoping that stays silent until at least a few months after your install. Hope you have an enjoyable upcoming stay. I imagine you'll be in the new EP wing that just opened up. I almost asked for the nickel tour while I was there, but they have much more important business at hand.

My TEE Monday morning went great. As is always the case at TCAI and St. David's, the experience from a patient perspective is exemplary. Dr. Natale and Curry (Carrie?) both said mine is healed over. At the 6 month post implant time, I made the decision to take low dose Eliquis. Dr. Natale was fairly direct and to the point Monday and said it's time to stop the Eliquis and start the low dose daily aspirin regimen. So here I am, after 3 years of Eliquis (minus 4.5 months of dual anti-platelet strategy post-Watchman) finally free of all NOAC's.

I haven't looked at the TEE report yet, and may not. What a journey this has been.

Again, best to you Don. You'll be amazed at how easy on you, and quick, the procedure is.

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AB Page
It will certainly be a huge relief with your gallbladder issues - here's hoping that stays silent until at least a few months after your install. Hope you have an enjoyable upcoming stay. I imagine you'll be in the new EP wing that just opened up. I almost asked for the nickel tour while I was there, but they have much more important business at hand.

My TEE Monday morning went great. As is always the case at TCAI and St. David's, the experience from a patient perspective is exemplary. Dr. Natale and Curry (Carrie?) both said mine is healed over. At the 6 month post implant time, I made the decision to take low dose Eliquis. Dr. Natale was fairly direct and to the point Monday and said it's time to stop the Eliquis and start the low dose daily aspirin regimen. So here I am, after 3 years of Eliquis (minus 4.5 months of dual anti-platelet strategy post-Watchman) finally free of all NOAC's.

I haven't looked at the TEE report yet, and may not. What a journey this has been.

Again, best to you Don. You'll be amazed at how easy on you, and quick, the procedure is.

That is great News AB! It might seem weird to not take Eliquis after so much time on it. Enjoy being off Eliquis!

I had my Watchman procedure at Scripps in La Jolla on Tuesday. All went well. The whole team there is top notch! Dr. Natale's NP Kristi is a fantastic person to work with. She had large shoes to fill replacing Linda who was Dr. Natale's NP prior. She definitely has done that and more.
Dr. Natale before placing the Watchman also checked for any sources of possible arrhythmia. He said he would use the same puncture to check so there would only be the one puncture. He said all was quiet! It has been almost three years since my second ablation and LAA isolation. That seemed to have been the "cure" for the afib/flutter. Good for him to think to check to make sure.
I was the last procedure on his second day of ablation procedures. I know he must have been tired by the time he did my Watchman. The fact he took the time to look for arrhythmia sources before doing the Watchman is just one example of how he puts so much effort into providing his patients with the best care.
It is strange to think I now have this foreign body inside my heart. I can't feel a thing.

My Watchman situation all got started because of a gallbladder attack I had in January. Because of being on Eliquis, waiting to see what the gallbladder would do became risky. But, because of the slow LAA and Eliquis, the surgeon wouldn't operate using the bridging protocol. The gallbladder seems to be fine at the moment. However, Dr. Natale said I could do the surgery in three weeks if I need to. I am hoping that the gallbladder will be a one time event and I won't need surgery. Either way, having the Watchman will give me the option to wait and see. @ 50% of the people I have talked with have needed surgery after a gallbladder attack. 50% have been fine. Those are odds I will wait to see which I fall into.

Hopefully the insurance companies are starting to loosen up on the Watchman for people who would benefit from it verses lifelong blood thinners. There are some health conditions that can come up that really lessens your options when you are on a blood thinner. I found that out with the gallbladder attack.
Now I wait for the 45 day TEE. Dr. Natale has me on 2.5mg BID Eliquis and one baby aspirin a day for now.

Don