changing doctors not easy

I tried to get a EP locally where I live as the EP I have been seeing is affiliated with U of Michigan Hospital, he also has another EP at U of M that I can see. The problem is it is about an hours drive to see them, so I have been trying to get an EP locally, the problem is this EP wants me to cut all ties with the previous doctors, he wants to be the only one that I would see. I don't know this doctor, he would be someone new and I don't know if I would like/or want him as my only EP. They wanted to get all of my records in order to set up an appt. and gave me an appt. on March 3rd. after thinking it all over I cancelled this appt. I guess this is the way all of these doctors are, they want to be the sole doc. I can understand that they think that there could be some conflict, but this is my body and I want the best advise.

Liz

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Elizabeth
I guess this is the way all of these doctors are, they want to be the sole doc. I can understand that they think that there could be some conflict, but this is my body and I want the best advise.

I think you were right in canceling your appointment as this is not how all EPs are and it looks like a pointer away from this doctor. Good on you for respecting your intuition.

Daisy is right, they are not always like that, unless maybe you are constantly going back and forth and the situation has become confused, then you would need to pick a primary Doctor. His stance sounds sounds too extreme.

Thanks Daisy:

Afib:
No, this is the first time I have looked into a EP that would be close by. For the last 20 years I always converted back into NSR after an episode of AF, so I had this one and only EP for all of those years and saw him just twice a year as I was ok. The people making the appts of this new EP wanted all of my records from my primary doc. which they got, then they wanted all the records from my EP (20 years worth?), then they said I had to stop seeing that EP. I had enough, I will drive the hour that it takes.

Liz

I agree with the others. Asking for your records is perfectly reasonable and to be expected, but demanding you stop seeing the other EP is not. I can see him being concerned about you shopping for the advice or prescriptions you want, or even getting dual prescriptions that might conflict, but he should be able to address that if and when it happens.

Thanks Carey and all that responded:

I wasn't sure if this was the way that doctors are going, as I have always had the same doctor. This really surprised me that I was told if I wanted this new EP then I had to stop seeing any other EP, when I said I couldn't do that they wouldn't give me an Appt., you know, I could have lied about that but I don't like liars and couldn't do it.

I did finally speak with a person from the office of the U of M EP about my failed cardioversion and she said they don't do another one until they try another anti-arrhythmic drug first, (I was taking Propafenone) but it wasn't doing any good, so they will get back with me and let me know what drug they have in mind. I could go to the ER near me to get cardioverted but as my heart rate is under 100 they probably will have me sit there waiting a long time or maybe they won't do it either. I really don't want to go the ER at the present time because of this virus that is starting in our country as well, there are usually a lot of sick people in the ER, so I would rather stay away from there.

Liz

Liz, wonder what the local guy's office would say if you asked for an appointment with him for a second opinion on ablation & med options. If they said yes, then you could then make choices who you could see after you met. When you meet, you could ask directly why he doesn't want you to see others. Second opinions are common on big decisions. I concur with everyone else, I don't like the attitude going in.

George:

Well, that is an idea, I could try it.

Liz

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Elizabeth
I could go to the ER near me to get cardioverted but as my heart rate is under 100 they probably will have me sit there waiting a long time or maybe they won't do it either.

Yep, that's the most likely outcome. They'll put you on a diltiazem drip and let you lay there for hours. But since you're not in physical distress and don't have a high heart rate, they'll be reluctant to cardiovert you. So eight hours later they'll send you home with a recommendation to see your cardiologist without having done anything meaningful. I wouldn't go for the ER unless you're truly in distress.

Liz:

If you really want to try another Cardioversion, go back to your original EP, and tell him firmly that is what you want.
You were self-converting in a short amount of time in many instances for 20 years, that is a very good indication.

I know your HR in AFIB is low, as I understand it, your AFIB is primarily Vagally triggered?

If your Vagal, then a possible change to your strategy would be to not take an Anti-Arrythmic after your are back in NSR.
That would be a change from what you have been doing previously, which is what your EP wanted before doing another ECV. The extra 1/2 dose of Propafenone you were taking, recently may have made your AFIB worse. I think it is wise to consider the concept of only taking an AAM drug when you are actually in AFIB, and not preventively. All of these AAM Drugs have Beta-Blocking properties which can make Vagal AFIB worse. The exception is Flecainide, although many Doctors want you to take a Beta-Blocker with it to prevent the possibility a Atral Flutter at a 1:1 conduction ratio. Also in some people like me, it slowed down my HR too much at higher doses, and reduced Cardiac Output. "Susan. d" also had a similar experience with the Flecainide.

I just spoke with the nurse from my EP;s office in Ann Arbor (U of M. Hospital), the EP would put me on Tikosyn then I spend the 3 days in the hospital and then they would cardiovert me, 3 nights and 4 days,. I thought they wait and see if the drug will convert you, but that isn't what they plan to do. Is this being the correct way as I don't know, I told her I would call her back, I also may look for a cardiologist locally so that I could have that all done near where I live. I don't know if a cardiologist will do all of what I will need and work with the EP in Ann Arbor. I hate hospitals and don't want to spend even a day there, but one has to do what one has to. Also, do you all think this protocol will work?

Liz

I would go to the UM for the Tikosyn. The Hospitals/Doctors have to have special training to administer it. The local Hospitals may not offer it anyway. I think the usual protocol is the ECV the Patient after the 3 days, before you go home. Some self-convert during the 3 day stay.

Thanks Anti-fib, I guess that is what I will do, I wonder if they will want me on Tikosyn for very long. You were on that drug did you have any bad experiences with it?

Liz

You'll very likely convert on your own during the stay. If you don't, they'll cardiovert you before you leave. After all, you're there, so why make a separate trip back? Most likely that will work and the Tikosyn will keep you in NSR from there on out.

If the Tikosyn works for you without unwanted side effects, you should expect to remain on it indefinitely, or until you have an ablation. I had no bad experiences with it and can't think of anyone I know of who did.

Liz:

I actually was never on the Tikosyn, I just contemplated it. I would make your final decision after a sit down visit with your EP, if you can get an Appointment soon. The Nurses give general info, although maybe she did consult with your EP, nevertheless the Dr. is the one that enables your treatment, giving the Orders, whether it is a simple ECV, or Tikosyn administration.

I am leery of this drug:

Torsades de pointes is the most serious side effect of dofetilide therapy. The incidence of torsades de pointes is 0.3-10.5% and is dose-related, with increased incidence associated with higher doses. The majority of episodes of torsades de pointes have occurred within the first three days of initial dosing. Patients should be hospitalized and monitored for the first three days after starting dofetilide.[10]

The risk of inducing torsades de pointes can be decreased by taking precautions when initiating therapy, such as hospitalizing individuals for a minimum of three days for serial creatinine measurement, continuous telemetry monitoring and availability of cardiac resuscitation. ,

I really am unsure of what to do, I don't really want to take this drug. This EP advocating this drug is not the one that I have seen for 20 years he is affiliated with U of Michigan and doesn't really know me and I don't know him. My old EP did set up the meeting with him. When I saw my old EP last week he did not say anything about Dofetilide, he just wanted to give me a low dose of Aminodorone that was all, he thought this drug would convert me, perhaps it won't be as bad as Dofetilide.

Liz

Carey said:
If the Tikosyn works for you without unwanted side effects, you should expect to remain on it indefinitely, or until you have an ablation. I had no bad experiences with it and can't think of anyone I know of who did.

Why would I have to stay on the drug indefinitely? If I convert and stay AF free, couldn't I then stop this drug, or do you think that this drug would be the only think keeping a person in NSR and once stopped AF returns? Why did you stop the drug was it before your ablation with Dr. Natalie?

Liz, you have afib. I said you should expect to remain on Tikosyn indefinitely unless you get an ablation because there's no reason to think your afib will just go away on its own. It won't. The cardioversion just stops the afib going on now. It doesn't prevent future episodes but the Tikosyn does. That's the whole idea. Get you on Tikosyn to prevent future episodes and then cardiovert you to stop the ongoing one. The end result is (hopefully) freedom from afib as long as you take the Tikosyn.

I stopped Tikosyn because Natale told me to stop it before my ablation. After the ablation, I never needed it again.

The scary stuff you posted about Tikosyn is why they require you to be monitored in the hospital for 3 days. If you develop signs of those scary things, they'll stop the drug and discharge you. If you don't develop signs of the scary things, you'll be safe to take it indefinitely.

Liz:

What was the circumstance with going from the EP you had for 20 years, to another one several months ago?

It sounds like the easiest thing to do would be to call up your EP's office and tell them you will start the Amio, or possibly Flecainide immediately, and that you want to be Cardioverted right away. After the ECV, you could stop the Amio if you are having side effects, or still don't feel right about it.



Edited 1 time(s). Last edit at 02/19/2020 02:47AM by The Anti-Fib.

Flecainide is okay but I sure wouldn't choose amiodarone over Tikosyn. And there's almost no point in doing a cardioversion and then stopping whatever drug you're on. That's just a stopgap measure; the afib will be back.

Afib::

The doctor I have had for 20 years is phasing out his practice, I had asked him who he would recommend as he is not available much anymore. He gave me this doctor's name that will order the cardioversion/tikosyn, I could consult with this new doc. when needed.. Tikosyn and Flecainide both sound like nasty drugs. There are a lot of people that take a blood thinner and live with their AF, I could do that as my AF is not very bad, I hardly feel it, I just get a little more tried, but I could pace myself. If I could get Cardioverted and then get off the drug, I wouldn't hesitate but to think I have to be on a drug like tikosyn forever is not something I would look forward to. I have a call in to this new Doctor about whether I would have to remain on this drug after the cardioversion. I am looking at all options.

Liz

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Elizabeth
Tikosyn and Flecainide both sound like nasty drugs.

They are only nasty if you are one of those who react to them negatively--which you discover very quickly! I have taken flecainide for a few years and don't notice anything from it other than staying in NSR--but then I am on a relatively low dose.

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Elizabeth
There are a lot of people that take a blood thinner and live with their AF, I could do that as my AF is not very bad, I hardly feel it, I just get a little more tried, but I could pace myself. If I could get Cardioverted and then get off the drug, I wouldn't hesitate but to think I have to be on a drug like tikosyn forever is not something I would look forward to.

It's not a reasonable expectation that you could be cardioverted then stop the drug and remain afib-free forever. Cardioversion isn't a treatment. It's just an interruption of the ongoing episode. Once you stop the drug, the afib will almost certainly be back sooner or later.

Frankly, if you're okay with living with the afib and an anticoagulant, I would strongly consider doing that if I were in your shoes and your circumstances.

Carey:

I may not even be able to take the anticoagulant, I am taking it now. I don't know if I posted that I have had some blood from my rectum when going to the bathroom not always but it has happened a few times. I have never, ever, had anything like this in 50 years, it may be from the Xeralto, I don't know. I spoke today with an assistant in my doctors office about it. I had made an appt. with a gastro locally, however, after talking with this assistant she said she could get an appt. for me with a gastro at U of M, that way all my records will be there.. I had talked with the EP doctor previously about a Watchman and at that time he said I wasn't a candidate for it, if Xeralto is causing this bleeding then sounds like I might be able to get the Watchman. So, I am not doing anything until I get checked then I will decide what to do.

Liz

How can this guys heart function be normal, his treatment is only a blood thinner (is that a treatment), wonder why he didn't get an ablation.


About 1 in 10 people 65 or older in the U.S. have atrial fibrillation, a type of irregular heartbeat that is treatable but can potentially be serious. Gidwani said that because tests show Bloomberg’s heart function is normal, the atrial fibrillation can be successfully treated with use of a blood thinner to prevent the most worrisome risk, blood clots and stroke.

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Elizabeth
How can this guys heart function be normal, his treatment is only a blood thinner (is that a treatment), wonder why he didn't get an ablation.

Turns out he's on a beta blocker (and also a statin), which would act as rate control. Rate control & blood thinner is a pretty common treatment for afib. Same article mentioned George W Bush developed afib during his presidency. GW worked out quite a bit, so that may have been his trigger.