how to diplomatically handle being followed by 2 drs post ablation

Hi,

I am about 5 months post ablation now. Since 2 weeks after getting home from my ablation, I have been followed by my cardiologist & of course also checking in with Natale's staff.

I do find it difficult at times & lately it is getting more confusing as to what protocol to employ in order to be cared for closely at home & also be followed by Dr. Natale (whenever I say Natale, it means "his NPs or nurses, etc., not directly him). A few things have happened to me since the ablation and my local cardiologist has been the one directlly taking care of me here, I am his patient (before the ablation), & I need scripts sometimes, orders for cardioversion at hospital, that kind of thing. I can't just use him for some stuff & then tell him my orders from Natale differ some from his, so I am not going to follow them. I do respect my cardiologist and need him and he is also doing a good job of following & communicating with me re my concerns in detail at his office visits.

The usual protocol when 2 doctors are following a patient is for them to communicate with each other by either written orders or by phone, not by emails from his staff. I find myself feeling between a rock and a hard place sometimes & am going to ask my Natale NP if she can have their orders for my medication protocol at this time sent to my doctor here with Dr. Natale's signature on them.

Example: I had atrial flutter for 15 days at almost the 4th month out from my ablation. My cardiologist here set up a hospital visit for TEE & cardioversion when it was needed, but then for my followup afterwards, I want a blending of Natale & my local dr with both of their blessings on the treatment. I managed to chemically convert the day before my hospitalization for the 2 procedures, but mainly because my local dr upped my medicine more, even after Natale had upped it & I ended up converting. Now he wants me to stay on this regimen for 3 more months bec he says since I had this episode so far out from the ablation he feels this caution is right. He says if I have other orders from Natale, it would be nice to see those written orders from him. I only have an email from his staff.

Let me say, what Natale is willing to give me is something I was asking for - to reduce the dosage of one med & possibly get off the other med because of side effects I experience. Natale said we could try reducing dosage for a week & see how I was doing before deciding on the other med or what to do next. But my doctor here as I said wants me to keep the same regimen for the next 3 months (well, he may let me drop the extra beta blocker or reduce it depending on my BP report back to him). My meds are sotalol 120 mg BID & carvedilol 12.5 mg bid.

So, is it asking too much for the Natale end to more formally communicate with our local cardiologists who are more directly executing our care. It would show respect for the work the cardiologist is doing & I don't see any problem with that. After all, they are the ones we will be staying in touch with in the end for maintenance unless we need something like a touchup ablation from Natale. I am not sure these 2 drs couldn't easily come to an agreement on what to do now, but you can see how word of mouth via email communication between me & Natale back to my local dr does not constitute the same thing as direct communication from Natale's office to my cardiologist. Basically, I think they are on the same page, but I want to know how to handle this kind of thing in a proper way & one that won't make me feel so odd & anxious about offending anyone each time the next step in my care is taken.

Granted, it is not a huge discrepancy in orders right now. I will be getting the Holter 2nd week in Jan & my dr said he would be fine after seeing that report from Natale to let me off the Xarelto if they want to, but he is firmer on the antiarrhythmic point. Also, I am NOT saying Natale would not agree with him if they were to have more direct communication over this.

So, basically is anyone else experiencing this kind of difficulty & how do you handle it? It does not seem to be asking too much for Natale staff to send a direct request over an order change to my local dr's office. I have not asked my NP what to do yet.

Thanks.

Hmm, i can see your dilemma. FWIW i would go with your local EP because he knows you better than the NP (in case Natale isn't talking to him directly).
For myself, i just reduce when i think it's reasonable regardless of what they are telling me but bearing their advise in mind. It's my body, it's my risk either way. In my case, the doctors will generally err on the safe side (for me and them) i.e. ask the patient to take more meds rather than reduce them.

We are in the same boat. My EP could have had done my ablation but I asked him if he was better than natale and the reply was I would be in good hands and natale is more experienced. So natale ablated me September 18th.

When I have any issues I ask natale’s office NP first. But I remain seeing my primary EP who has twice given me his opinion-multaq for 6 months not 2. Also I am on my primary EP Kardia program and he gets my daily ekgs.

I contacted and saw natale’s NP who said natale is ok for a longer run in multaq since my local EP mentioned it but it wasn’t any advise, just a comment his patients remain for 6 months. He has made it clear natale is in charge. Friday I saw my local EP and my PVCs are a violent freak show, he now scrapped the 6 month comment and to stop multaq. he thinks it is causing my PVCs but he is ok when I told him I’m flying to the Middle East with no close by hospital and I would like multaq as a crutch until I return.

The second advise that is not natale’s possible (I don’t know) regiment in staying on Eliquis until my local EP says otherwise. I asked my local EP on Friday 6 months post ablation?... and he said since he doesn’t know if my LAA was touched at least 9 months after my ablation. He will discuss further in that time. He gave me his advice once before and I didn’t take it (2 EPs) and I ended up 3 days in cardiac ICU—so now he reminds me frequently that I do not listen to him.

So I am going through the same having two EPs...but my local made it clear to listen to natale first.

I have been fortunate regarding this situation. MY local EP had bowed out on doing any further ablations on me. He felt that he had done all that he could for me but was willing to try to find someone that could. He felt that possibly a minimally invasive ablation would be a possibility for me. When we had this conversation he did not realize that I had already been in contact with Dr. Natale.

Whenever I mentioned this to him he sort of lit up and was very enthusiastic about me being able to get in to see Dr. Natale. he was very familiar with him and has followed all that Natale has done for me. All files are shared between both Natales office and my local EP.