Using Natale and local EP- how does that work?

I am wondering those that have seen Natale, how does it work with your local EP if you have to get a cardio version or something like that? I have an appt with my local EP this morning and want to approach both that and potentially using someone else at that hosptial. .

Thanks.



Edited 1 time(s). Last edit at 05/23/2022 10:24AM by bettylou4488.

Pretty simple really. I told my local EP prior to the ablation that I was going to Natale. He was actually relieved and gave it his full blessing. I told Natale's office to copy him on everything, which they did. Natale called all the shots on follow-up care, prescriptions, etc. It just happened that I didn't really need my local guy for anything, but had I needed something like a cardioversion I could have called and they would have obliged. I continued to do annual follow-up visits with my local EP until COVID intervened, mainly just to maintain the relationship.

Any EP who can't work with such an arrangement is putting their ego ahead of your well being.

Thanks Carey. This guy doesn't seem to have a large ego and I am going to discuss it with him in about an hour along with a bunch of other things.

Betty there are some EPs that won't take a person if you have another EP. I had an EP at Novi, affilated with U of M hospital. I called a couple of EPs in my area and they wouldn't even give me an appt. because I had another EP, that was one of the first things they asked. Don't think it is about ego, they said that the protocol that they might give is different from my EPs protocol and they did not want that.

Shannon and I have helped dozens and dozens of people get through ablations with Natale and I can only remember 1 or 2 whose local EP objected, and those objections reeked of ego and jealousy (snarky comments about Natale, etc). Mine certainly had no problem with it and fully approved of my decision.

As long as everyone understands that immediately prior to the ablation and throughout the blanking period you are Natale's patient, there should be no issue. There won't be conflicts because the local EP won't be making treatment decisions or even seeing you at all unless a specific need arises, such as a cardioversion. If you needed a cardioversion, you'd have to find an EP who could see you within days, which would be almost impossible if you weren't already their patient. Most likely you'd have to settle for an ER, and ERs aren't always willing to do cardioversions.

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Carey
Shannon and I have helped dozens and dozens of people get through ablations with Natale and I can only remember 1 or 2 whose local EP objected, and those objections reeked of ego and jealousy (snarky comments about Natale, etc). Mine certainly had no problem with it and fully approved of my decision.

As long as everyone understands that immediately prior to the ablation and throughout the blanking period you are Natale's patient, there should be no issue. There won't be conflicts because the local EP won't be making treatment decisions or even seeing you at all unless a specific need arises, such as a cardioversion. If you needed a cardioversion, you'd have to find an EP who could see you within days, which would be almost impossible if you weren't already their patient. Most likely you'd have to settle for an ER, and ERs aren't always willing to do cardioversions.

So that is exactly my concern. Natale manages it but if you need a cardio version, you would have to go with an established EP that isn't following your case and might not if you chose to not do the procedure with them...

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Elizabeth
Betty there are some EPs that won't take a person if you have another EP. I had an EP at Novi, affilated with U of M hospital. I called a couple of EPs in my area and they wouldn't even give me an appt. because I had another EP, that was one of the first things they asked. Don't think it is about ego, they said that the protocol that they might give is different from my EPs protocol and they did not want that.

That is really interesting. I see one from UM and one from Beaumont and they both know about each other. I went to the Beaumont one for a 2nd/3rd opinion and because she was doing pulsed (which I am not a candidate). I just saw the Beaumont one last week and she said how it is hard to have 2 cooks in the kitchen. But was happy to render an opinion... which was way different than UM. Had UM appt today and at least I understand their thinking (this was all in regards to medications). Half the time I don't know what to think!

[quote=Carey
As long as everyone understands that immediately prior to the ablation and throughout the blanking period you are Natale's patient, there should be no issue.


If there are issues during the blanking period and beyond would one still be Dr. Natale’s patient?



Edited 3 time(s). Last edit at 05/23/2022 05:53PM by Pixie.

After my 3rd failed ablation, my local EP tried to tell me Natale could do nothing he couldn't. And maybe we needed to talk to a surgeon, presumably to crack my chest open. Oh the benefits of hindsight.

Long story short, I walked out, never talked to him again and he or his nurse never even reached out again despite me leaving the room respectfully and a 2.5 year relationship. That was actually an eye opener. If I could go back, I might change leaving the room respectfully. Soon it will be 5 years from successful Natale ablation.

I see a local guy every couple years for an EKG and doing an updated Echo this week actually (I was in heart failure with my afib) and I have a PLSVC so not a bad thing to update occasionally. He simply says you were a success case for Natale. I remain on a little Propranolol for headaches and rate reduction and he r/x's that. He fully knows if I ever need more work, off to Austin I will go.

I've had a monitor a couple times here and there since and I always get that from Natale's nurse with a simple email.

My local EP gave me his blessings to use Natale. He is a fan and had been to a seminar Natale had years ago in SF and was highly impressed by Natale’s skill.

I have more to add to my recent post. The EP I had for several years performed 2 ablations on me. Both failed and she did not consider my case complicated. She told me I did not have to go to Austin…..many people just live with it. This was said during the time I was in persistent AFlutter and needing more medication to keep my heart rate in normal range. Shortly before my ablation with Dr. Natale, I needed a cardiologist. I saw her a few times. She, too, thought I was getting good care and did not need to look further. When I was in Austin, my team encouraged me not to return to my local EP and just see the cardiologist, Well, her nurse and I talked her into seeing me, although she kept insisting she was not trained to see EP patients. I assured her that my EP issues would be handled in Austin, etc, so she agreed to the plan.

About 7 weeks after my ablation, I thought one of my EKG readings looked strange. I no longer had after hours access to any on call person in Austin because that ended after 30 days. I called the Nurse Connect line for the cardiologist I was seeing. She asked me to send the reading to her and she would have the on call cardiologist look at it. I received a call back and was told it was normal. However, the next morning I received a call from my cardiologist saying because I had a question, etc, she could not see me because, as she stated previously, she was not trained to handle an EP patient. She would continue to be my cardiologist, however! Remember, my call was for an EKG reading that turned
out to be normal.

Long story short, I still do not have a local EP that I feel understands my needs.

This transitioning process is easy for many people but not for all. At this point, I do not know what I would do without Dr. Natale and staff!

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Pixie
If there are issues during the blanking period and beyond would one still be Dr. Natale’s patient?

Yes. Natale and his staff will continue care as long as needed. I know people who had various issues post-ablation and spent over a year under the care of him and his staff.

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bettylou4488
So that is exactly my concern. Natale manages it but if you need a cardio version, you would have to go with an established EP that isn't following your case and might not if you chose to not do the procedure with them...

That would be extremely unreasonable of your EP. So just tell them in advance what you plan to do and if they have a problem working with Natale, I would find another EP who's willing to put your health ahead of his ego.

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Pixie
I have more to add to my recent post. The EP I had for several years performed 2 ablations on me. Both failed and she did not consider my case complicated.

I find that extremely ironic. That's like saying, "I couldn't solve the two problems I was given but I don't consider the problems complicated." So what is she saying, that she can't solve easy problems?

In my opinion, if you fail two ablations, you are a complicated case, and now you're even more complicated because of the two failed ablations. I wrote almost exactly those words in my 2017 post describing my experiences with multiple ablations.

From personal experience, find your A team first. For me, it's Natale.

Then pick your B team for local, and make sure he/she is genuine in respecting that only the A team does procedures, and is willing to participate in your care, and will communicate with TCAI as needed.

I had to switch local EP's after I learned about Dr. Natale and TCAI from Shannon. My then local EP crossed the line professionally when I told him my plans. First question for the next EP was will you work with TCAI as my part of my team, and what are your thoughts on Dr. Natale? An EP's lack of skill, self-confidence and professional jealousy can derail a doctor/patient relationship in a visit or two.

Thanks all for your help and candid opinions. I have a plan in place right now that I feel good about based on all your input. Thanks again!

Had a Natale ablation in 2011. I live in the Houston area and with assistance from Shannon got the name of an experienced EP cardiologist from Natale. Saw this doctor to establish a point of contract. This was not the same doctor I used prior to my ablation.

Steve
Spring, Tx.

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JAYHAWK
Had a Natale ablation in 2011. I live in the Houston area and with assistance from Shannon got the name of an experienced EP cardiologist from Natale. Saw this doctor to establish a point of contract. This was not the same doctor I used prior to my ablation.

Steve
Spring, Tx.

I live in Madison WI and have tried for a year to get a name of a good EP in my area. I had my Natale ablation……he is my A Team. I still do not have anyone to handle my case here…..B Team. I plan on asking Dr.Natale who he can recommend. Do I ask him directly..work with his staff.. Carey, Shannon???

I can usually advocate for myself, but this has been a difficult situation for me to handle.

Remember, you're not looking for an ablation maestro, and almost any EP can manage afib medically and do all the things you might need from a local EP. Since the U. of Wisconsin is in Madison, that makes the choices easy. I would suggest Jennifer Wright. She's a board certified EP, member of the Heart Rhythm Society, good educational background, solid clinical and research credentials, she's the director of the Electrophysiology & Arrhythmias Service at UW, and afib management is her key research interest.

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Carey

I have more to add to my recent post. The EP I had for several years performed 2 ablations on me. Both failed and she did not consider my case complicated.

I find that extremely ironic. That's like saying, "I couldn't solve the two problems I was given but I don't consider the problems complicated." So what is she saying, that she can't solve easy problems?

In my opinion, if you fail two ablations, you are a complicated case, and now you're even more complicated because of the two failed ablations. I wrote almost exactly those words in my 2017 post describing my experiences with multiple ablations.[/quote

Carey, I am sending you a PM.



Edited 2 time(s). Last edit at 05/25/2022 04:43PM by Pixie.

My experience has not been good. I did not inform my local EP I was going to Natale beforehand. The reason I found this forum and Dr. Natale is I was going through a bad bout and my local EP practice would not see me in any reasonable time frame. It was weeks to see a PA and months to see the Dr. I informed them after my ablation and told them it was nothing personal and I would like to keep working with them as my local caretakers. They said that was fine with them. However, I ended up in flutter 24/7 after my first ablation and they didn't want to treat me the way Dr. Natale did. They hadn't even done an ekg in the first visit after my ablation! Also, they didn't want to treat my flutter unless my heart rate was higher. They finally did the cardioversion that Dr. Natale recommended but the Dr. was very rude. I assume that was because his ego was bruised.

I didn't pick my local EP. I think my primary Dr. referred me over this large EP practice and this guy was the next one up in the que. I've since learned there is a pretty good one in town and know people who know him who say he is very good at his work and extremely kind. However, I fear he won't take me on if he knows I'm under Dr. Natale's care.

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Skford
Also, they didn't want to treat my flutter unless my heart rate was higher.

Lose that guy. Leaving you in flutter indefinitely just because your rate's not super high is bad medicine.

Go see the other one you've had recommended and although he'll likely see it in your records from your current EP, tell him up front about the ablation. If he's got a problem working with Dr. Natale, lose him too and find someone else. Remember what I said to Pixie above: you're not looking for a maestro ablationist. You just need a competent clinical EP and those aren't hard to find in any decent sized city.

Problem is if one’s ablation is not successful due to whatever reason until a second or more ablation(s) are scheduled, a backup local EP may want to try drugs such as amio or worst-an AV ablation. I’ve had that problem. It’s difficult to get an EP to agree to treat you if you won’t accept his drug choice and then won’t give you refills from another EP because he doesn’t want the responsibility.

Then don't ask him what to do. Ask Natale's staff and do what they say. The only reason you need a local EP at all is for things like cardioversions. You shouldn't be consulting with them about your ongoing post-ablation care and they shouldn't be intervening without consulting with Natale first.

My local EP, who I’d seen before, refused to do a CV because another EP (Dr Natale) did my ablation.
My (now former) primary family doctor, who I had seen for years, even refused to let his office do a simple EKG to send to Dr Natale.

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AB Page
From personal experience, find your A team first. For me, it's Natale.

Then pick your B team for local, and make sure he/she is genuine in respecting that only the A team does procedures, and is willing to participate in your care, and will communicate with TCAI as needed.
.

Agree 100%.

If I’m in tachycardia with symptoms (angina/feeling of fainting/difficult breathing) I just show up at the ER and get ecv or ask for a Cardizem push. I never had to ask any of my doctors for permission to go to the ER to get an ECV. I just show up and ask the er doctor to ecv me. All but one time they were ok with it since I’m on Eliquis and the symptoms are bad and my past history an ECV were successful. I was cardioverted 51 times (record an ER doc told me) until I found that a push-not a drip of Cardizem converts me. I’m burned out getting ecv after ecv and am happy that Cardizem works for me.

You need a new cardiologist that is flexible with your needs of staying in nsr.

I am experiencing a little twist of this topic. I have been on the drug lorazepam for anxiety for years. I do not think it is working and I want to wean off of it. had a telemed call with my primary doctor just know. She told mean to stop it slowly and told me how the monthly reduction should be done. I don’t want to get personal, but depression and anxiety, etc. has impacted me because of Covid. I will be seeing someone for this, but her recommendation is to wean off of lorazepam and at the same time start fluoxetine (prozac). I asked about that drug and AFIB and was not told anything negative.

I hung up and then “did my own little trip through google”. It is amazing what I found about AFIB , QT prolongations and Prozac! So,who can give me the best advice about a mental health drug and how it could affect my heart…….a PCP or the staff in Austin? Of course , I would prefer Austin, but is this kind of issue they would help me with? The lines are fuzzy yet for me…..when to use Dr. Natale and when to use local doctors. I want all heart issues taken care of by Natale. Would this kind of med fall into that category? I think it should since it could affect AFIB issues!!



Edited 1 time(s). Last edit at 05/27/2022 11:58AM by Pixie.

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susan.d
If I’m in tachycardia with symptoms (angina/feeling of fainting/difficult breathing) I just show up at the ER and get ecv or ask for a Cardizem push. I never had to ask any of my doctors for permission to go to the ER to get an ECV. I just show up and ask the er doctor to ecv me. All but one time they were ok with it since I’m on Eliquis and the symptoms are bad and my past history an ECV were successful. I was cardioverted 51 times (record an ER doc told me) until I found that a push-not a drip of Cardizem converts me. I’m burned out getting ecv after ecv and am happy that Cardizem works for me.

You need a new cardiologist that is flexible with your needs of staying in nsr.

so glad you found something else that works!

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Pixie

I hung up and then “did my own little trip through google”. It is amazing what I found about AFIB , QT prolongations and Prozac! So,who can give me the best advice about a mental health drug and how it could affect my heart…….a PCP or the staff in Austin? Of course , I would prefer Austin, but is this kind of issue they would help me with? The lines are fuzzy yet for me…..when to use Dr. Natale and when to use local doctors. I want all heart issues taken care of by Natale. Would this kind of med fall into that category? I think it should since it could affect AFIB issues!!

one other option that I have found helpful is a cardiology focused pharmacist. When I was in the hosptial getting on dofetilide 3 years ago there was one on my case. I took her name, email phone etc.. and have called her maybe a dozen times in the last year. Maybe Team Natale has someone like that. But I totally get what you mean. I had a blood thinner question recently and the card. team at local hospital said call my GP. I'm like- you prescribed it. Anyway maybe team Natale has a pharmacist you could call to circumvent either. Just a thought. (That person has been one of THE most helpful people with me and even has a database of supplements and how they interact with meds and such.)

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bettylou4488
one other option that I have found helpful is a cardiology focused pharmacist. When I was in the hosptial getting on dofetilide 3 years ago there was one on my case. I took her name, email phone etc.. and have called her maybe a dozen times in the last year. Maybe Team Natale has someone like that. But I totally get what you mean. I had a blood thinner question recently and the card. team at local hospital said call my GP. I'm like- you prescribed it. Anyway maybe team Natale has a pharmacist you could call to circumvent either. Just a thought. (That person has been one of THE most helpful people with me and even has a database of supplements and how they interact with meds and such.)

I had used a hospital based pharmacist in the past. Maybe I will reach out to her on this one. I use a clinical pharmacist , but I do not want my PCP to find out I did that.
Thank you for your response. I appreciate it.

I saw a new cardiologist today as my EP recently relocated. I chose a general cardiologist at a hospital-based heart group hoping that a general cardiologist would be more likely to liaise with Dr. Natale than an EP who might be miffed that I was not choosing him/her. He wholly supported me going for an ablation with the best—he said, “He’s the king,” and said that he would be happy to work with him, order anything necessary at the local end etc. Dr. Natale had asked for my local cardiologist to prescribe an external monitor for a week in order to get a better picture than my pacemaker interrogations and Kardia strips gave him, and this new guy was happy to do that.

So this might be another option—working with a general cardiologist as a local liaison. Later I may look for an EP, but I was impressed with this guy’s knowledge of arrhythmias.