the how-to's in getting the TEE orders done outside of St. David's

Hello,

I have had a lot of success so far in facilitating my 6-mo TEE to be done in my hometown.

1. I found the Watchman placers here from the Boston Scientific list.

2. I contacted the doctors' nurses at my clinic doing the Watchmans to see who did their TEEs.

3. I was given names.

4. I saw my cardiologist (yes, not an EP bec we had a couple yrs' hx together by time I needed an EP & chose Dr. Natale, so I just stuck with him as my facilitator & local cardio doc & he has followed all my Austin proceedings) & now he is facilitating my gettng the TEE done by the person who does them for the Watchman EP placers at the same clinic as him. And that was good bec when I first tried to contact the names I was given, I was told the Dr. only did the TEEs for their doctors placing Watchmans. My cardiologist also does TEEs, but I maintained I wanted the person who did them for the Watchmans all the time bec Dr. Natale needed specific images & might reject the TEE if it did not meet standards. Tiny awkward moment, but he understood.

5. I contacted my nurses to give them the fax # of my cardiologist to send over the orders. That is what I have understood all along from this group - that Dr. Natale would send specific orders about the images he needed. My nurse put Kimberly Hansen on the email to make her aware.
Quote fr email: " ...I'm including Kimberly Hansen, Dr. Natale’s clinic nurse, on this email, as she sends orders/specifications for TEE imaging and reviews the disk of images with Dr. Natale when it arrives."

6. I contacted Kimberly and made sure this was all good & also asked her about any trouble viewing images from the out of town discs of the TEEs. another quote: " It is rare that we are not able to via the images on the CDs, we use a DICOM viewing system and something if they are not in that format then we cannot review. But like I said that is rare, I have only had that happen a few times and not in a while."

7. I was given other instructions which I already was going to do:
quote: " It is also generally best for you to request a disk of images for you to pick up at medical records/radiology after the imaging is performed and mail to us with tracking number, as they often get delayed otherwise."

8. Last week I gave a call to the Watchman nurse here to see if she had gotten my "orders fr Natale that were sent to my Dr. Salazar here"

9. The local Watchman nurse called me today & gave me a date for my TEE. Then I asked her if she had gotten the orders Dr. Salazar sent that Dr. Natale was to send over re what he needed. (Response on next line bec this is what puzzles me & what I am asking you about.)

10. She said yes, she got everything from Dr. Salazar, but she said there were no "orders per se" or "requests for certain images that Dr. Natale wanted gotten". She said what they got was just my Discharge Summary from my Watchman procedure in January. I am puzzled by that bec I have heard from St. Ds & on this group that was what he would do, send his specific requests.

11. I said maybe since this person doing the TEEs for their Watchmans routinely would follow the exact same orders that Dr. Natale and anyone else doing these kind of TEEs would do. The Watchman nurse said anyone doing their TEEs had been specifically trained in a course from Boston Scientific to do them for Watchmans. They have 2 doctors doing them for about 4 of the EPs placing them.

I just want to hear your experiences - those of you who have gone through the out-of-town Watchman TEEs. This is not a doctor that Dr. Natale told me to use - I found all this out myself since he did not know anyone in my area. But I relayed all this research information to the St. Ds people and from the start it has seemed like it would work. Before I had my Watchman and had my TeleMed visit with Shannon Peres, she was the first one to say to me, if they came from Boston Scientific list, they would be following the same instructions.

But we all know how specific Dr. Natale is & I am just asking what you think & if this all sounds correct & likely to work out. And maybe this information about what I have done could be helpful to anyone trying to do same soon.

Thanks.

I had Dr Natale place my Watchman 2-16-22. Following 8-6-21 LAA
He rather reluctantly said yes to my request of 6 week TEE here in Charlotte
My ep places watchman has done hundreds of TEE so Dr Holshouser did it at 6 weeks
Im now at 15.5 months
Last week my yrly with Holshouser: he said if i ever need a cardioversion that a CT would be needed to still rule out clot

Madeline:

Just curious if you had your "local TEE" yet. If so, how did it go? Were there any hiccups at all, or did everything go smoothly? I'm considering a local TEE as well but the whole process seems cumbersome.

Travis

Quote
Madeline


9. The local Watchman nurse called me today & gave me a date for my TEE. Then I asked her if she had gotten the orders Dr. Salazar sent that Dr. Natale was to send over re what he needed. (Response on next line bec this is what puzzles me & what I am asking you about.)

Quote
tvanslooten
Madeline:

Just curious if you had your "local TEE" yet. If so, how did it go? Were there any hiccups at all, or did everything go smoothly? I'm considering a local TEE as well but the whole process seems cumbersome.

Travis


Hi Travis,

Yes, I got the 6-mo TEE 7/31, Monday before last. The doctor was very thorough. She also generated a report very quickly. Before going home, we were able to get a disk & a typed report. The report showed me she got lots of angles & views. Here is a small sample of findings in left ventricle to show you how detailed:
LAA and Watchman device were visualized in 0, 45, 90 and 135 degree in 2D
and 3D views. There is no thrombus on or around Watchman device.
The Watchman LAA occlusion device was seen in a good and secure position,
and there is no peri-device blood flow per color Doppler.

There is tons more detail in the whole report, more than the one I got in Austin.

One comment scares me & I have to wait til Dr. Natale gets back next week so that he can look at disk (hoping he can read the CD all right) & tell me what he sees and thinks. "RVSP ~ 70-75 mmHg. There is severe pulmonary hypertension."

In April, I only had this comment fr Austin doc re above: There is mild to moderately elevated pulmonic pressures approximately 50-
55mmHg.

I know that is extraneous to the info you are seeking, but maybe someone will have a comment on that for me.

My only qualm was the anesthesia given by a CRNA (many yrs experience, he told me). I felt awful after the TEE was over. My mouth felt like it had glue in it. I was disoriented, nauseated, headachey, etc. Not good. He gave me propofol, Robinul, and ketamine. Not sure, but I always though Austin just gave propofol, no other drugs. I have actually had 2 TEEs in Austin & felt fine after each.

I think the local guy added extra stuff that was not necessary - whatever, I can just say I felt bad.

My husband made copies of the CD for us & mailed the CD & report via Priority Mail on a Tuesday, with tracking & it was delivered Saturday & I heard back from Annie Falkstein on Monday that they got it & she put it on Natale's desk for when he returns.

So far, it was all good except for the anesthesia. I will let you know if Dr. Natale can read the disk & if he is satisfied.