Re: EP visit last Friday

[Guest guest]

In a message dated 8/29/2004 11:24:34 AM Pacific Daylight Time,

trudyjh@... writes:

> or to somehow manage to have the good attitude has.

>

> is really my hero, and just thinking about how she is cheerful

> stiffens my backbone. I know she has times when she has to worry,

> like during her recent uptick, but by and large she really doesn't

> let this defeat her.

>

>

Trudy,

Thanks for the kind words. I am happy that I have been able to help. I

think that my attitude has mainly been the result of trying to imitate my hero

and

role model, my older brother who is in permanent afib. I have seen over the

years how he has managed to live successfully with afib through never giving

up, having a sense of humor, focusing on the important things in his life,

staying active, and keeping an optimistic attitude. Fifteen years ago before

his

afib was diagnosed, he couldn't eat, sleep, or walk up stairs or even across

the floor without becoming breathless. Even then he never complained and tried

to carry on with his life, even going to work on some days because his main

focus is on his external world, not on how he feels. It was I who saw in the

purple color of his face how desperate his situation was becoming, and I took

the initiative to call and make a doctor's appointment for him. It was at that

appointment that he learned he was in permanent afib with a resting pulse

rate of 180. Imagine what his rate must have been when he went about his usual

activities. The doctor prescribed Digoxin and Atenolol, which restored him to

feeling normal within a few days.

Now he is still on Digoxin and only a reduced dose of Atenolol 25 m.g. He is

very active, feels good most of the time, and lives a normal life. However,

I suspect that he often feels just as depressed and down as most afibbers

sometimes feel, but he will not let himself give in to that. He tells me that

some days when he gets up, he just feels like sitting in a chair all day and not

moving, but he forces himself to get up and go about his activities. He calls

this forced activity self-discipline. He says that invariably he forgets

about how tired he is once he gets into his daily activities. Most of the time

he is not aware of being in afib except when he does intense exercise like

running or chopping wood, and he feels a weakness in his arms and legs, which

his

doctor says is because of the 33 percent reduction in pumping capacity of his

heart in permanent afib. Also, two weeks ago when he took me to the emergency

room after my fall escapade, he said he was unusually aware of his irregular

heart beat as he sat in the waiting room while I was being examined. He

thought the intense pulse was due to concern over his crazy sister because he

usually isn't aware of his pulse although he was very aware of it 30 years ago

when

he was developing permanent afib. He says a perk of being in permanent afib

for him is that he is rarely aware of the " mammal in the chest " sensation that

we both experienced in the beginning of afib.

I have really tried to imitate my brother's " can do, " optimistic attitude

because I see what it has done for him. I constantly force myself to do things

I

don't feel like doing, both in afib and out. For example, last weekend I had

to force myself to go to that party at which I went into afib. I had been

feeling bad all day, having ectopics, worried about having another afib episode,

and feeling self-conscious about the large purple, green, yellow, maroon, and

blue swelling around my right eye, which I tried not too successfully to

cover with makeup. My brother urged me to go, saying " You can't live your life

in

fear of afib or other peoples' opinion. " So following my brother's advice, I

went to the party, feeling as if I looked like Dracula's daughter, and indeed

did go into afib, but the afib probably would have happened whether I went to

the party or not. I survived the afib and am no worse for going to the party.

Keeping that thought in mind has helped both my brother and me to be

positive: afib hasn't killed us yet, despite our many forced activities, and,

therefore, probably won't.

Having a role model like my brother has really helped me as I hope to help

others. I have probably been able to avoid permanent afib so far because of the

lifestyle lessons I have learned from him. However, because we are all

different in psychological and physical makeup, it probably is more difficult

for

some people to adopt a positive, invincible attitude like my brother's. It

has been difficult for me, but I think I am better off just for making the

effort and achieving some small degree of success. Although I strive to

imitate

his philosophy and activity level, I am far from mastering his positive

attitude. Even though he is in permanent afib and eleven years older, he is the

one who can outrun me, outwalk me, and cheer me up when I am feeling down.

Ironically, it is frequently he, who is in permanent afib, that frequently gives

me, in sinus most of the time, the pep talks about living life to its fullest

and not worrying about death until death comes. As he says, " We all have to

die sometime, but I am going to live life to its fullest and enjoy every minute

I can until I die. "

Fortunately, for him living life to its fullest means a healthy lifestyle,

whereas to some living life to its fullest might mean excessive drinking,

smoking, and other unhealthy activities. He has been that route and believes

that

the drinking and smoking are the reasons he was in permanent afib by the time

he was my current age whereas I, who have never drunk alcohol or smoked, am

still paroxysmal. Living life to its fullest for him involves work, exercise,

reading, music, traveling, eating healthily, and other healthful activities. I

also try to imitate his healthful lifestyle because I have learned from the

mistakes he made so long ago in living an unhealthy lifestyle. I feel very

fortunate to have had a role model like my brother because he has made all the

difference in my ability to deal with afib. My goal is to help others in the

way

my brother has helped me.

in sinus in Seattle

[Guest guest]

In a message dated 8/29/2004 11:24:34 AM Pacific Daylight Time,

trudyjh@... writes:

> or to somehow manage to have the good attitude has.

>

> is really my hero, and just thinking about how she is cheerful

> stiffens my backbone. I know she has times when she has to worry,

> like during her recent uptick, but by and large she really doesn't

> let this defeat her.

>

>

Trudy,

Thanks for the kind words. I am happy that I have been able to help. I

think that my attitude has mainly been the result of trying to imitate my hero

and

role model, my older brother who is in permanent afib. I have seen over the

years how he has managed to live successfully with afib through never giving

up, having a sense of humor, focusing on the important things in his life,

staying active, and keeping an optimistic attitude. Fifteen years ago before

his

afib was diagnosed, he couldn't eat, sleep, or walk up stairs or even across

the floor without becoming breathless. Even then he never complained and tried

to carry on with his life, even going to work on some days because his main

focus is on his external world, not on how he feels. It was I who saw in the

purple color of his face how desperate his situation was becoming, and I took

the initiative to call and make a doctor's appointment for him. It was at that

appointment that he learned he was in permanent afib with a resting pulse

rate of 180. Imagine what his rate must have been when he went about his usual

activities. The doctor prescribed Digoxin and Atenolol, which restored him to

feeling normal within a few days.

Now he is still on Digoxin and only a reduced dose of Atenolol 25 m.g. He is

very active, feels good most of the time, and lives a normal life. However,

I suspect that he often feels just as depressed and down as most afibbers

sometimes feel, but he will not let himself give in to that. He tells me that

some days when he gets up, he just feels like sitting in a chair all day and not

moving, but he forces himself to get up and go about his activities. He calls

this forced activity self-discipline. He says that invariably he forgets

about how tired he is once he gets into his daily activities. Most of the time

he is not aware of being in afib except when he does intense exercise like

running or chopping wood, and he feels a weakness in his arms and legs, which

his

doctor says is because of the 33 percent reduction in pumping capacity of his

heart in permanent afib. Also, two weeks ago when he took me to the emergency

room after my fall escapade, he said he was unusually aware of his irregular

heart beat as he sat in the waiting room while I was being examined. He

thought the intense pulse was due to concern over his crazy sister because he

usually isn't aware of his pulse although he was very aware of it 30 years ago

when

he was developing permanent afib. He says a perk of being in permanent afib

for him is that he is rarely aware of the " mammal in the chest " sensation that

we both experienced in the beginning of afib.

I have really tried to imitate my brother's " can do, " optimistic attitude

because I see what it has done for him. I constantly force myself to do things

I

don't feel like doing, both in afib and out. For example, last weekend I had

to force myself to go to that party at which I went into afib. I had been

feeling bad all day, having ectopics, worried about having another afib episode,

and feeling self-conscious about the large purple, green, yellow, maroon, and

blue swelling around my right eye, which I tried not too successfully to

cover with makeup. My brother urged me to go, saying " You can't live your life

in

fear of afib or other peoples' opinion. " So following my brother's advice, I

went to the party, feeling as if I looked like Dracula's daughter, and indeed

did go into afib, but the afib probably would have happened whether I went to

the party or not. I survived the afib and am no worse for going to the party.

Keeping that thought in mind has helped both my brother and me to be

positive: afib hasn't killed us yet, despite our many forced activities, and,

therefore, probably won't.

Having a role model like my brother has really helped me as I hope to help

others. I have probably been able to avoid permanent afib so far because of the

lifestyle lessons I have learned from him. However, because we are all

different in psychological and physical makeup, it probably is more difficult

for

some people to adopt a positive, invincible attitude like my brother's. It

has been difficult for me, but I think I am better off just for making the

effort and achieving some small degree of success. Although I strive to

imitate

his philosophy and activity level, I am far from mastering his positive

attitude. Even though he is in permanent afib and eleven years older, he is the

one who can outrun me, outwalk me, and cheer me up when I am feeling down.

Ironically, it is frequently he, who is in permanent afib, that frequently gives

me, in sinus most of the time, the pep talks about living life to its fullest

and not worrying about death until death comes. As he says, " We all have to

die sometime, but I am going to live life to its fullest and enjoy every minute

I can until I die. "

Fortunately, for him living life to its fullest means a healthy lifestyle,

whereas to some living life to its fullest might mean excessive drinking,

smoking, and other unhealthy activities. He has been that route and believes

that

the drinking and smoking are the reasons he was in permanent afib by the time

he was my current age whereas I, who have never drunk alcohol or smoked, am

still paroxysmal. Living life to its fullest for him involves work, exercise,

reading, music, traveling, eating healthily, and other healthful activities. I

also try to imitate his healthful lifestyle because I have learned from the

mistakes he made so long ago in living an unhealthy lifestyle. I feel very

fortunate to have had a role model like my brother because he has made all the

difference in my ability to deal with afib. My goal is to help others in the

way

my brother has helped me.

in sinus in Seattle

[Guest guest]

In a message dated 8/29/2004 11:24:34 AM Pacific Daylight Time,

trudyjh@... writes:

> or to somehow manage to have the good attitude has.

>

> is really my hero, and just thinking about how she is cheerful

> stiffens my backbone. I know she has times when she has to worry,

> like during her recent uptick, but by and large she really doesn't

> let this defeat her.

>

>

Trudy,

Thanks for the kind words. I am happy that I have been able to help. I

think that my attitude has mainly been the result of trying to imitate my hero

and

role model, my older brother who is in permanent afib. I have seen over the

years how he has managed to live successfully with afib through never giving

up, having a sense of humor, focusing on the important things in his life,

staying active, and keeping an optimistic attitude. Fifteen years ago before

his

afib was diagnosed, he couldn't eat, sleep, or walk up stairs or even across

the floor without becoming breathless. Even then he never complained and tried

to carry on with his life, even going to work on some days because his main

focus is on his external world, not on how he feels. It was I who saw in the

purple color of his face how desperate his situation was becoming, and I took

the initiative to call and make a doctor's appointment for him. It was at that

appointment that he learned he was in permanent afib with a resting pulse

rate of 180. Imagine what his rate must have been when he went about his usual

activities. The doctor prescribed Digoxin and Atenolol, which restored him to

feeling normal within a few days.

Now he is still on Digoxin and only a reduced dose of Atenolol 25 m.g. He is

very active, feels good most of the time, and lives a normal life. However,

I suspect that he often feels just as depressed and down as most afibbers

sometimes feel, but he will not let himself give in to that. He tells me that

some days when he gets up, he just feels like sitting in a chair all day and not

moving, but he forces himself to get up and go about his activities. He calls

this forced activity self-discipline. He says that invariably he forgets

about how tired he is once he gets into his daily activities. Most of the time

he is not aware of being in afib except when he does intense exercise like

running or chopping wood, and he feels a weakness in his arms and legs, which

his

doctor says is because of the 33 percent reduction in pumping capacity of his

heart in permanent afib. Also, two weeks ago when he took me to the emergency

room after my fall escapade, he said he was unusually aware of his irregular

heart beat as he sat in the waiting room while I was being examined. He

thought the intense pulse was due to concern over his crazy sister because he

usually isn't aware of his pulse although he was very aware of it 30 years ago

when

he was developing permanent afib. He says a perk of being in permanent afib

for him is that he is rarely aware of the " mammal in the chest " sensation that

we both experienced in the beginning of afib.

I have really tried to imitate my brother's " can do, " optimistic attitude

because I see what it has done for him. I constantly force myself to do things

I

don't feel like doing, both in afib and out. For example, last weekend I had

to force myself to go to that party at which I went into afib. I had been

feeling bad all day, having ectopics, worried about having another afib episode,

and feeling self-conscious about the large purple, green, yellow, maroon, and

blue swelling around my right eye, which I tried not too successfully to

cover with makeup. My brother urged me to go, saying " You can't live your life

in

fear of afib or other peoples' opinion. " So following my brother's advice, I

went to the party, feeling as if I looked like Dracula's daughter, and indeed

did go into afib, but the afib probably would have happened whether I went to

the party or not. I survived the afib and am no worse for going to the party.

Keeping that thought in mind has helped both my brother and me to be

positive: afib hasn't killed us yet, despite our many forced activities, and,

therefore, probably won't.

Having a role model like my brother has really helped me as I hope to help

others. I have probably been able to avoid permanent afib so far because of the

lifestyle lessons I have learned from him. However, because we are all

different in psychological and physical makeup, it probably is more difficult

for

some people to adopt a positive, invincible attitude like my brother's. It

has been difficult for me, but I think I am better off just for making the

effort and achieving some small degree of success. Although I strive to

imitate

his philosophy and activity level, I am far from mastering his positive

attitude. Even though he is in permanent afib and eleven years older, he is the

one who can outrun me, outwalk me, and cheer me up when I am feeling down.

Ironically, it is frequently he, who is in permanent afib, that frequently gives

me, in sinus most of the time, the pep talks about living life to its fullest

and not worrying about death until death comes. As he says, " We all have to

die sometime, but I am going to live life to its fullest and enjoy every minute

I can until I die. "

Fortunately, for him living life to its fullest means a healthy lifestyle,

whereas to some living life to its fullest might mean excessive drinking,

smoking, and other unhealthy activities. He has been that route and believes

that

the drinking and smoking are the reasons he was in permanent afib by the time

he was my current age whereas I, who have never drunk alcohol or smoked, am

still paroxysmal. Living life to its fullest for him involves work, exercise,

reading, music, traveling, eating healthily, and other healthful activities. I

also try to imitate his healthful lifestyle because I have learned from the

mistakes he made so long ago in living an unhealthy lifestyle. I feel very

fortunate to have had a role model like my brother because he has made all the

difference in my ability to deal with afib. My goal is to help others in the

way

my brother has helped me.

in sinus in Seattle

[Guest guest]

> I visited my EP last Friday to discuss ablation.

Hi, Kathleen,

I think you should get a second opinion. I am really concerned about

why he is pushing the av node ablation vs the pvi. Maybe there is

something in your case that warrants it, but maybe it is just that he

is more used to that. (I am remembering how years ago docs used to

do mastectomies even in cases where lumpectomies were just as good,

just because that's what they were used to, and then the woman had to

live with the consequences.)

It can't hurt to get a second opinion, and then you will feel more

comfortable with whatever decision you make. It's your body, and you

want to feel informed.

You could also discuss the question of dofetilide/flecainide or some

other med with the other doc. If it were me, I'd try to see Dr.

Natale for the second opinion, then you've explored that avenue.

I totally understand your feelings of depression/anxiety. This is

something I struggle with most of the time. The only time I feel

okay is when I have had a really good day heartwise. This sucks.

I don't know if it is the meds, my guess it is not, that it is the

effect afib has on our feelings of physical security and mortality,

even though we have been told a zillion times that it is not life

threatening, the fact is that it is quality of life threatening. Who

wouldn't be depressed.

So I think the only way to fix this emotional reaction is to either

get more control over the afib by meds or an ablation or things like

no-dairy, or to somehow manage to have the good attitude has.

is really my hero, and just thinking about how she is cheerful

stiffens my backbone. I know she has times when she has to worry,

like during her recent uptick, but by and large she really doesn't

let this defeat her.

My goal is to be more like . I am very far away from that so

far. If you want to vent more, besides on the list, feel free to

email me any time.

[Guest guest]

> I¹m beginning to wonder whether,

since Dofetilide isn¹t working, am I less likely to benefit from

ablation,

too?

My guess is that that isn't true. Some places require that they

person has had three antiarrhythmic meds fail before they will do an

ablation, so if it were true the ablation success rate would be

terrible.

[Guest guest]

> He seemed mainly interested in reminding me of the risks, including

the

> possibility that I could end up with a pacemaker (or even a heart

> transplant), pulmonary vein stenosis, punctured lung or stroke. He

did not

> push it, but expressed his confidence that an AV node ablation and

pacemaker

> would definitely help me to feel better. He did not make this

promise about

> PVI, I suppose because the outcome is less certain. This certainly

was

> troubling to me.

**********

Kathleen,

I would certainly agree with everything that Trudy told you. I would

certainly seek a second opinion before considering the AV node

ablation and pacemaker. I have never heard of using Flecainide and

Tikosyn together, but I surely don't know everything.

I do understand your feelings of depression. I am a worrier, but have

never been clinically depressed, that I know of. In my own

experience, the dulled-out feeling, the grey cloud that seems to come

with my afib episodes is a physiological thing, due to the decreased

pumping power of the heart while in afib and the effects of less

oxygen getting to all the organs in the body. Because the minute I go

back into NSR, the cloud lifts and I feel terrific again.

Try not to despair. E-mail me anytime. R

[Guest guest]

Hi, . Thank you for your kind offer. I hope you don¹t mind my taking

you up on it so soon! I thought your description of the effect of being in

afib was so apt. Someone else described it as feeling like having the flu,

which may be worse than I feel. I, too, feel better when I go back into

NSR, but I think I have a more than mild depression right now.

I am seriously considering having my EP do the ablation. (I think I would

have to make it clear that I don¹t want to come out of it with a pacemaker!)

I almost feel faint when I think about what it would take, in terms of money

and energy, to go all the way to Cleveland.

Best regards,

Kathleen

>

> I do understand your feelings of depression. I am a worrier, but have

> never been clinically depressed, that I know of. In my own

> experience, the dulled-out feeling, the grey cloud that seems to come

> with my afib episodes is a physiological thing, due to the decreased

> pumping power of the heart while in afib and the effects of less

> oxygen getting to all the organs in the body. Because the minute I go

> back into NSR, the cloud lifts and I feel terrific again.

>

> Try not to despair. E-mail me anytime. R

>

>

[Guest guest]

> Hi, . Thank you for your kind offer. I hope you don¹t mind

my taking

> you up on it so soon! I thought your description of the effect of

being in

> afib was so apt. Someone else described it as feeling like having

the flu,

> which may be worse than I feel. I, too, feel better when I go

back into

> NSR, but I think I have a more than mild depression right now.

>

> I am seriously considering having my EP do the ablation. (I think

I would

> have to make it clear that I don¹t want to come out of it with a

pacemaker!)

> I almost feel faint when I think about what it would take, in terms

of money

> and energy, to go all the way to Cleveland.

*******

Kathleen,

Sorry it has taken me so long to get back to you. I can't remember

right now how long you have had afib, and what other drugs. etc, you

have tried.

I have been trying to think about your comparing afib to the flu.

And you said it wasn't as bad as as the flu. It's been several years,

thank God, since I've had the flu. Although I have had, this summer,

a couple of upper respiratory infections, one after the other, which

felt like flu to me. High temps, body aches, exhaustion. Laid me

right out! I almost never even get so much as a cold, and have been

twice to my doc for antibiotics and other stuff in the last few

weeks, which annoys me no end. I hate being sick,which thankfully

happens very seldom. I hate having afib, which interferes with my

life, and the lives of everyone around me.

And of course, I do get down about it.

But having the flu is self-limiting, and doesn't involve heart

stuff, which is scary.

Sounds like you are having some issues with depression. Are you

getting some treatment for it?

I see that you live down south. Yes, it would be a trip for you to

go to the Cleveland Clinic. Where is the closest teaching hospital to

you down there? I hear that the Cleveland Clinc in Florida, Dr.

Pinski, I think his name is, is excellent.

I live in Delaware, but I have heard so much about the Cleveland

Clinic and Dr. Natale, in this group and the group at afibbers.org,

that I thought that I had to go out there and talk to him. I've

already been to see Dr. Marchlinski at Penn, and also went to see Dr.

Calkins at s Hopkins, who does the Pappone procedure. I was very

impressed with Dr. Natale. Excellent guy.Reminds me of my own EP.

Just talked it all over with my local EP, who is, well, very tall,

dark and handsome. I tell him he's awesome. and he says, , I'm

really not. After reviewing everything and hearing what I had to say

about the doctors, he said, sounds like Dr. Natale is the best choice.

And then he told me, if you are going to the CC, I'd like to go

with you. See Dr. Natale perform one.I can't imagine how he is going

to work this out with his family and his busy schedule. But there it

is.

Well that's my EP. Before you go for an AV node ablation, please

think about having a PVI done by someone who speciizes in those.

I would like to know how you are doing. Hang, Kathleen.

R

[Guest guest]

> Hi, . Thank you for your kind offer. I hope you don¹t mind

my taking

> you up on it so soon! I thought your description of the effect of

being in

> afib was so apt. Someone else described it as feeling like having

the flu,

> which may be worse than I feel. I, too, feel better when I go

back into

> NSR, but I think I have a more than mild depression right now.

>

> I am seriously considering having my EP do the ablation. (I think

I would

> have to make it clear that I don¹t want to come out of it with a

pacemaker!)

> I almost feel faint when I think about what it would take, in terms

of money

> and energy, to go all the way to Cleveland.

*******

Kathleen,

Sorry it has taken me so long to get back to you. I can't remember

right now how long you have had afib, and what other drugs. etc, you

have tried.

I have been trying to think about your comparing afib to the flu.

And you said it wasn't as bad as as the flu. It's been several years,

thank God, since I've had the flu. Although I have had, this summer,

a couple of upper respiratory infections, one after the other, which

felt like flu to me. High temps, body aches, exhaustion. Laid me

right out! I almost never even get so much as a cold, and have been

twice to my doc for antibiotics and other stuff in the last few

weeks, which annoys me no end. I hate being sick,which thankfully

happens very seldom. I hate having afib, which interferes with my

life, and the lives of everyone around me.

And of course, I do get down about it.

But having the flu is self-limiting, and doesn't involve heart

stuff, which is scary.

Sounds like you are having some issues with depression. Are you

getting some treatment for it?

I see that you live down south. Yes, it would be a trip for you to

go to the Cleveland Clinic. Where is the closest teaching hospital to

you down there? I hear that the Cleveland Clinc in Florida, Dr.

Pinski, I think his name is, is excellent.

I live in Delaware, but I have heard so much about the Cleveland

Clinic and Dr. Natale, in this group and the group at afibbers.org,

that I thought that I had to go out there and talk to him. I've

already been to see Dr. Marchlinski at Penn, and also went to see Dr.

Calkins at s Hopkins, who does the Pappone procedure. I was very

impressed with Dr. Natale. Excellent guy.Reminds me of my own EP.

Just talked it all over with my local EP, who is, well, very tall,

dark and handsome. I tell him he's awesome. and he says, , I'm

really not. After reviewing everything and hearing what I had to say

about the doctors, he said, sounds like Dr. Natale is the best choice.

And then he told me, if you are going to the CC, I'd like to go

with you. See Dr. Natale perform one.I can't imagine how he is going

to work this out with his family and his busy schedule. But there it

is.

Well that's my EP. Before you go for an AV node ablation, please

think about having a PVI done by someone who speciizes in those.

I would like to know how you are doing. Hang, Kathleen.

R

[Guest guest]

Hi, !

Thanks for your message. I¹m so sorry you have been sick. Sounds as if

you¹ve had a rough time! I think I¹m having some depression, and I¹m not

taking anything for it, but I see a therapist. Gosh, you have talked with

several of the big names in ablation. I am so impressed with your

determination. I finally got so fed up with afib that I decided to have my

EP do the ablation. He would be happy to help me go elsewhere, but I don¹t

think I want to wait as long as it would take to get it done in Cleveland or

somewhere else. (I certainly won¹t consent to an AV node ablation and

pacemaker.) I can probably get the ablation done in October, which won¹t be

too soon.

My EP has done a number of doctors in that I know of. He seems to

be well respected. I could tell from my conversation with him that he

doesn¹t do one-size-fits-all ablations. And his success rate is the same as

Natale¹s (who, I understand has an 80% success rate after the first ablation

and 95% after the second). Just out of curiosity, does your EP not do

ablations? It seems to be a very common procedure. I would love to have

this done by Dr. Natale, but I am fairly well persuaded (or have

rationalized) that I¹ll probably get good care here. (Wish I didn¹t feel

like a wuss when I say that, though.) When you talked with Dr. Natale and

the others, did they spend a lot of time discussing the risks? I came away

knowing more about the risks than about what my EP will actually do.

I called the Cleveland Clinic to get a sense of how much a PVI will cost

and, after getting handed around for quite a while, I reached (TA DAH!)

somebody¹s voice mail. I was so disgusted that I gave up and took it as a

sign that I may as well stay here and have it done in .

Sick and tired of being sick and tired,

Kathleen Stept

> Kathleen,

> Sorry it has taken me so long to get back to you. I can't remember

> right now how long you have had afib, and what other drugs. etc, you

> have tried.

> I have been trying to think about your comparing afib to the flu.

> And you said it wasn't as bad as as the flu. It's been several years,

> thank God, since I've had the flu. Although I have had, this summer,

> a couple of upper respiratory infections, one after the other, which

> felt like flu to me. High temps, body aches, exhaustion. Laid me

> right out! I almost never even get so much as a cold, and have been

> twice to my doc for antibiotics and other stuff in the last few

> weeks, which annoys me no end. I hate being sick,which thankfully

> happens very seldom. I hate having afib, which interferes with my

> life, and the lives of everyone around me.

> And of course, I do get down about it.

> But having the flu is self-limiting, and doesn't involve heart

> stuff, which is scary.

> Sounds like you are having some issues with depression. Are you

> getting some treatment for it?

> I see that you live down south. Yes, it would be a trip for you to

> go to the Cleveland Clinic. Where is the closest teaching hospital to

> you down there? I hear that the Cleveland Clinc in Florida, Dr.

> Pinski, I think his name is, is excellent.

> I live in Delaware, but I have heard so much about the Cleveland

> Clinic and Dr. Natale, in this group and the group at afibbers.org,

> that I thought that I had to go out there and talk to him. I've

> already been to see Dr. Marchlinski at Penn, and also went to see Dr.

> Calkins at s Hopkins, who does the Pappone procedure. I was very

> impressed with Dr. Natale. Excellent guy.Reminds me of my own EP.

> Just talked it all over with my local EP, who is, well, very tall,

> dark and handsome. I tell him he's awesome. and he says, , I'm

> really not. After reviewing everything and hearing what I had to say

> about the doctors, he said, sounds like Dr. Natale is the best choice.

> And then he told me, if you are going to the CC, I'd like to go

> with you. See Dr. Natale perform one.I can't imagine how he is going

> to work this out with his family and his busy schedule. But there it

> is.

> Well that's my EP. Before you go for an AV node ablation, please

> think about having a PVI done by someone who speciizes in those.

>

> I would like to know how you are doing. Hang, Kathleen.

> R

>

>

>

>

> Web Page - http://www.afibsupport.com

> List owner: AFIBsupport-owner

> For help on how to use the group, including how to drive it via email,

> send a blank email to AFIBsupport-help

>

> Nothing in this message should be considered as medical advice, or should be

> acted upon without consultation with one's physician.

>

>

>

[Guest guest]

Hi, !

Thanks for your message. I¹m so sorry you have been sick. Sounds as if

you¹ve had a rough time! I think I¹m having some depression, and I¹m not

taking anything for it, but I see a therapist. Gosh, you have talked with

several of the big names in ablation. I am so impressed with your

determination. I finally got so fed up with afib that I decided to have my

EP do the ablation. He would be happy to help me go elsewhere, but I don¹t

think I want to wait as long as it would take to get it done in Cleveland or

somewhere else. (I certainly won¹t consent to an AV node ablation and

pacemaker.) I can probably get the ablation done in October, which won¹t be

too soon.

My EP has done a number of doctors in that I know of. He seems to

be well respected. I could tell from my conversation with him that he

doesn¹t do one-size-fits-all ablations. And his success rate is the same as

Natale¹s (who, I understand has an 80% success rate after the first ablation

and 95% after the second). Just out of curiosity, does your EP not do

ablations? It seems to be a very common procedure. I would love to have

this done by Dr. Natale, but I am fairly well persuaded (or have

rationalized) that I¹ll probably get good care here. (Wish I didn¹t feel

like a wuss when I say that, though.) When you talked with Dr. Natale and

the others, did they spend a lot of time discussing the risks? I came away

knowing more about the risks than about what my EP will actually do.

I called the Cleveland Clinic to get a sense of how much a PVI will cost

and, after getting handed around for quite a while, I reached (TA DAH!)

somebody¹s voice mail. I was so disgusted that I gave up and took it as a

sign that I may as well stay here and have it done in .

Sick and tired of being sick and tired,

Kathleen Stept

> Kathleen,

> Sorry it has taken me so long to get back to you. I can't remember

> right now how long you have had afib, and what other drugs. etc, you

> have tried.

> I have been trying to think about your comparing afib to the flu.

> And you said it wasn't as bad as as the flu. It's been several years,

> thank God, since I've had the flu. Although I have had, this summer,

> a couple of upper respiratory infections, one after the other, which

> felt like flu to me. High temps, body aches, exhaustion. Laid me

> right out! I almost never even get so much as a cold, and have been

> twice to my doc for antibiotics and other stuff in the last few

> weeks, which annoys me no end. I hate being sick,which thankfully

> happens very seldom. I hate having afib, which interferes with my

> life, and the lives of everyone around me.

> And of course, I do get down about it.

> But having the flu is self-limiting, and doesn't involve heart

> stuff, which is scary.

> Sounds like you are having some issues with depression. Are you

> getting some treatment for it?

> I see that you live down south. Yes, it would be a trip for you to

> go to the Cleveland Clinic. Where is the closest teaching hospital to

> you down there? I hear that the Cleveland Clinc in Florida, Dr.

> Pinski, I think his name is, is excellent.

> I live in Delaware, but I have heard so much about the Cleveland

> Clinic and Dr. Natale, in this group and the group at afibbers.org,

> that I thought that I had to go out there and talk to him. I've

> already been to see Dr. Marchlinski at Penn, and also went to see Dr.

> Calkins at s Hopkins, who does the Pappone procedure. I was very

> impressed with Dr. Natale. Excellent guy.Reminds me of my own EP.

> Just talked it all over with my local EP, who is, well, very tall,

> dark and handsome. I tell him he's awesome. and he says, , I'm

> really not. After reviewing everything and hearing what I had to say

> about the doctors, he said, sounds like Dr. Natale is the best choice.

> And then he told me, if you are going to the CC, I'd like to go

> with you. See Dr. Natale perform one.I can't imagine how he is going

> to work this out with his family and his busy schedule. But there it

> is.

> Well that's my EP. Before you go for an AV node ablation, please

> think about having a PVI done by someone who speciizes in those.

>

> I would like to know how you are doing. Hang, Kathleen.

> R

>

>

>

>

> Web Page - http://www.afibsupport.com

> List owner: AFIBsupport-owner

> For help on how to use the group, including how to drive it via email,

> send a blank email to AFIBsupport-help

>

> Nothing in this message should be considered as medical advice, or should be

> acted upon without consultation with one's physician.

>

>

>

[Guest guest]

I think I¹m having some depression, and I¹m not

> taking anything for it, but I see a therapist. Gosh, you have

talked with

> several of the big names in ablation. I am so impressed with your

> determination. I finally got so fed up with afib that I decided to

have my

> EP do the ablation. He would be happy to help me go elsewhere, but

I don¹t

> think I want to wait as long as it would take to get it done in

Cleveland or

> somewhere else. (I certainly won¹t consent to an AV node ablation

and

> pacemaker.) I can probably get the ablation done in October, which

won¹t be

> too soon.

********

Kathleen,

Glad to hear that you are feeling better. Yes, my EP does do

ablations, was the first to do afib ablations here in DE. He is

having some considerable success. But he only does 3 to 4 a month, at

this point.He is truly the very soul of a good doctor. But I want to

go to the guy who has done the most. And that seems to be Dr. Natale.

My EP did do an aflutter ablation on me last fall. Completely

successful, very easy on me. Not even the faintest bruise at the

catheter sites. If he comes out to Cleveland with me, am thinking

about asking him to place the catheters himself! Because so many

people who go to the the CC have problems with hematomas at the

catheter sites, which are inserted by the fellows. Well, I know he

won't be able to do that, but hey, it was just a thought.

I wish you very good luck with your own EP, since you seem to be

determined to go down that road. Is he a relatively young guy?

Maybe that's why he is telling you about all the potential

complications, because he's not quite sure of himself yet. That's

not necessarily a bad thing. You do need to know what the risks are.

It is somewhat difficult to get ahold of people at the CC.

Somehow, I just lucked out the day I called, and got through right

away to one of Dr. Natale's PA's, who made an appointment for me with

Dr. Natale on the spot. Unfortunately, when I got out to the CC,

found out that I wasn't on the list for that day. Someone had entered

my appointment on the computer for August 16, not July 16, as they

had told me, and I had confirmed with them. But, they quickly worked

me into the schedule.

Anyway, the best of luck to you, and keep us posted!

[Guest guest]

I think I¹m having some depression, and I¹m not

> taking anything for it, but I see a therapist. Gosh, you have

talked with

> several of the big names in ablation. I am so impressed with your

> determination. I finally got so fed up with afib that I decided to

have my

> EP do the ablation. He would be happy to help me go elsewhere, but

I don¹t

> think I want to wait as long as it would take to get it done in

Cleveland or

> somewhere else. (I certainly won¹t consent to an AV node ablation

and

> pacemaker.) I can probably get the ablation done in October, which

won¹t be

> too soon.

********

Kathleen,

Glad to hear that you are feeling better. Yes, my EP does do

ablations, was the first to do afib ablations here in DE. He is

having some considerable success. But he only does 3 to 4 a month, at

this point.He is truly the very soul of a good doctor. But I want to

go to the guy who has done the most. And that seems to be Dr. Natale.

My EP did do an aflutter ablation on me last fall. Completely

successful, very easy on me. Not even the faintest bruise at the

catheter sites. If he comes out to Cleveland with me, am thinking

about asking him to place the catheters himself! Because so many

people who go to the the CC have problems with hematomas at the

catheter sites, which are inserted by the fellows. Well, I know he

won't be able to do that, but hey, it was just a thought.

I wish you very good luck with your own EP, since you seem to be

determined to go down that road. Is he a relatively young guy?

Maybe that's why he is telling you about all the potential

complications, because he's not quite sure of himself yet. That's

not necessarily a bad thing. You do need to know what the risks are.

It is somewhat difficult to get ahold of people at the CC.

Somehow, I just lucked out the day I called, and got through right

away to one of Dr. Natale's PA's, who made an appointment for me with

Dr. Natale on the spot. Unfortunately, when I got out to the CC,

found out that I wasn't on the list for that day. Someone had entered

my appointment on the computer for August 16, not July 16, as they

had told me, and I had confirmed with them. But, they quickly worked

me into the schedule.

Anyway, the best of luck to you, and keep us posted!

[Guest guest]

> Not even the faintest bruise at the

> catheter sites. If he comes out to Cleveland with me, am thinking

> about asking him to place the catheters himself! Because so many

> people who go to the the CC have problems with hematomas at the

> catheter sites, which are inserted by the fellows. Well, I know he

> won't be able to do that, but hey, it was just a thought.

Why not ask? Easier on you, and it could increase the effectiveness

of the Cleveland people. At least it would bring to their attention

that there's an area where they can improve.

For awhile I was having blood drawn frequently for something else,

and it is amazing how different the skill level is of the

technicians. Some left hardly a mark, and some were guaranteed to

always leave a big bruise.

[Guest guest]

> Not even the faintest bruise at the

> catheter sites. If he comes out to Cleveland with me, am thinking

> about asking him to place the catheters himself! Because so many

> people who go to the the CC have problems with hematomas at the

> catheter sites, which are inserted by the fellows. Well, I know he

> won't be able to do that, but hey, it was just a thought.

Why not ask? Easier on you, and it could increase the effectiveness

of the Cleveland people. At least it would bring to their attention

that there's an area where they can improve.

For awhile I was having blood drawn frequently for something else,

and it is amazing how different the skill level is of the

technicians. Some left hardly a mark, and some were guaranteed to

always leave a big bruise.

[Guest guest]

Kathleen wrote:

<<Sick and tired of being sick and tired>>

Wonderful way to put it Kathleen. I spent much of yesterday in afib and

you describe it perfectly.

As far as ablations being common, I'm not so sure. appears to be

a similar town to Kalamazoo, where I live. Not small, but not a

metropolis either. We have an EP here who does ablations, and the PR the

cardio group puts out to the public is that it is a piece of cake. (I

have not spoken with him directly.) Yet, in a simple, quickly stated

sentence, my cardiologist said I should not let " anyone " in town do a

PVI on myself. No names spoken, no elaboration, no emotion. He did not

want to sully a colleague, but he was honoring his responsibility to me,

his patient, to provide his best judgment. He then offered to refer me

to one of the names that pops up in our group every so often. (Not Dr.

Natale, though. There are others.)

I believe the day will come when our " local " EP is as good as those with

national reps, but I don't want him to practice on me. Your EP may

already have the requisite experience. I don't remember if you ever

asked him. I am not alarmed that yours spent so much time with you

discussing risks as much as I am the suggestion that your AV node might

have to go. I just don't understand why that would even come up at this

point. (But I'm not a doctor, much less an EP.)

The fact yours was willing to be helpful in sending you to someone who

specializes in ablation is a sign of that he has mastered an important

part of the best medical practice. It takes a big ego to be a doctor and

it is obvious your doc knows how to deal with the downside of his.

Myself, I would probably pass out at the first sign of blood from a cut

I made into another human being. I'd recommend everyone go to someone

else. Not out of elegance but out of fear.

Others in our group have reported that CC bills about $60,000 for an

ablation and accepts less than $30,000 from insurance as full payment.

(This is just a general memory.) These kind of discrepancies are common

these days, as part of the rhetoric of health care. Kind of makes the

car dealer who sells the same car for two different prices to two

different customers seem like an amateur deal maker. It is no different

here at my local hospitals, one of which is now threatening to deny Blue

Cross. BTW, CC has a good reputation for accepting insurance.

Having said all this, the probability is that if you have it done

locally you will do fine as long as he stays away from your AV node.

- OU alum in MI

[Guest guest]

> Why not ask? Easier on you, and it could increase the

effectiveness

> of the Cleveland people.

..........................

I can't imagine a hospital letting a doctor that is not on staff

actually take part in an operation for liability reasons.

P <MI>

[Guest guest]

> Why not ask? Easier on you, and it could increase the

effectiveness

> of the Cleveland people.

..........................

I can't imagine a hospital letting a doctor that is not on staff

actually take part in an operation for liability reasons.

P <MI>

[Guest guest]

I've

> already been to see Dr. Marchlinski at Penn, and also went to see

Dr.

> Calkins at s Hopkins, who does the Pappone procedure. I was

very

> impressed with Dr. Natale.

> R

..........................

, did you ask your EP about what we talked about the other

day.......about the different burn patterns in the Frecnh V italian

procedures and about the 2 complete circles around the pulmonary

veins?

P <MI>

[Guest guest]

I've

> already been to see Dr. Marchlinski at Penn, and also went to see

Dr.

> Calkins at s Hopkins, who does the Pappone procedure. I was

very

> impressed with Dr. Natale.

> R

..........................

, did you ask your EP about what we talked about the other

day.......about the different burn patterns in the Frecnh V italian

procedures and about the 2 complete circles around the pulmonary

veins?

P <MI>

[Guest guest]

L and : Thanks for your thoughts on this. Very interesting to

hear how your cardiologist suggested what to do, . I haven¹t picked up

on anything like that with regard to my EP. He had been doing ablations

before coming to several (3 or 4) years ago. Evidently, he does one

or two per week. (, he is probably in his mid- to late forties.) I

did my best to follow Rich¹s advice and get him to sell himself to me, but

he doesn¹t seem like the type of person who is used to blowing his own horn.

He said he likes doing ablations, has a good team in place and has a success

rate comparable to the research centers. He was familiar with the new

equipment I was asking about, but pointed out that the manufacturers give

their equipment to the research centers to promote it. He had already

decided to use a basket catheter (for imaging?) and a low- rather than

high-output radiofrequency generator. He didn¹t seem to be impressed by the

³New Techniques in the Diagnosis and Treatment of Cardiac Arrhythmia² that

some kind person shared a couple of week ago and which I printed.

The cost compared with Cleveland worries me a bit. It¹s only about $5,000

here. Shouldn¹t something really good be really expensive?! (Just kidding,

sort of.) But the biggest concern was the talk about the AV node ablation.

I have to think he was spelling out my options but, like you, , I

wondered why he was talking about it at all. I spoke with one of his nurse

practitioners today and she assured me that I wouldn¹t wake up with an AV

node ablation if he goes in to do a PVI. She also mentioned that he¹s going

to South America this month to learn a new technique‹I¹ll ask about that and

let you know. That was also somewhat reassuring.

Sorry to hear about your afib episode, . I imagine you were at the gym,

getting rid of it! Hope you are feeling better today.

--

Kathleen Stept (Dofetilide 250mcg bid, Diltiazem 120 mg, Coumadin 5mg, baby

aspirin), , Mississippi

> Kathleen wrote: <<Sick and tired of being sick and tired>>

>

> Wonderful way to put it Kathleen. I spent much of yesterday in afib and you

> describe it perfectly.

>

> As far as ablations being common, I'm not so sure. appears to be a

> similar town to Kalamazoo, where I live. Not small, but not a metropolis

> either. We have an EP here who does ablations, and the PR the cardio group

> puts out to the public is that it is a piece of cake. (I have not spoken

> with him directly.) Yet, in a simple, quickly stated sentence, my

> cardiologist said I should not let " anyone " in town do a PVI on myself. No

> names spoken, no elaboration, no emotion. He did not want to sully a

> colleague, but he was honoring his responsibility to me, his patient, to

> provide his best judgment. He then offered to refer me to one of the names

> that pops up in our group every so often. (Not Dr. Natale, though. There are

> others.)

>

> I believe the day will come when our " local " EP is as good as those with

> national reps, but I don't want him to practice on me. Your EP may already

> have the requisite experience. I don't remember if you ever asked him. I am

> not alarmed that yours spent so much time with you discussing risks as much

> as I am the suggestion that your AV node might have to go. I just don't

> understand why that would even come up at this point. (But I'm not a doctor,

> much less an EP.)

>

> The fact yours was willing to be helpful in sending you to someone who

> specializes in ablation is a sign of that he has mastered an important part

> of the best medical practice. It takes a big ego to be a doctor and it is

> obvious your doc knows how to deal with the downside of his. Myself, I would

> probably pass out at the first sign of blood from a cut I made into another

> human being. I'd recommend everyone go to someone else. Not out of elegance

> but out of fear.

>

> Others in our group have reported that CC bills about $60,000 for an

> ablation and accepts less than $30,000 from insurance as full payment. (This

> is just a general memory.) These kind of discrepancies are common these

> days, as part of the rhetoric of health care. Kind of makes the car dealer

> who sells the same car for two different prices to two different customers

> seem like an amateur deal maker. It is no different here at my local

> hospitals, one of which is now threatening to deny Blue Cross. BTW, CC has a

> good reputation for accepting insurance.

>

> Having said all this, the probability is that if you have it done locally

> you will do fine as long as he stays away from your AV node.

>

> - OU alum in MI

>

>

>

>

[Guest guest]

L and : Thanks for your thoughts on this. Very interesting to

hear how your cardiologist suggested what to do, . I haven¹t picked up

on anything like that with regard to my EP. He had been doing ablations

before coming to several (3 or 4) years ago. Evidently, he does one

or two per week. (, he is probably in his mid- to late forties.) I

did my best to follow Rich¹s advice and get him to sell himself to me, but

he doesn¹t seem like the type of person who is used to blowing his own horn.

He said he likes doing ablations, has a good team in place and has a success

rate comparable to the research centers. He was familiar with the new

equipment I was asking about, but pointed out that the manufacturers give

their equipment to the research centers to promote it. He had already

decided to use a basket catheter (for imaging?) and a low- rather than

high-output radiofrequency generator. He didn¹t seem to be impressed by the

³New Techniques in the Diagnosis and Treatment of Cardiac Arrhythmia² that

some kind person shared a couple of week ago and which I printed.

The cost compared with Cleveland worries me a bit. It¹s only about $5,000

here. Shouldn¹t something really good be really expensive?! (Just kidding,

sort of.) But the biggest concern was the talk about the AV node ablation.

I have to think he was spelling out my options but, like you, , I

wondered why he was talking about it at all. I spoke with one of his nurse

practitioners today and she assured me that I wouldn¹t wake up with an AV

node ablation if he goes in to do a PVI. She also mentioned that he¹s going

to South America this month to learn a new technique‹I¹ll ask about that and

let you know. That was also somewhat reassuring.

Sorry to hear about your afib episode, . I imagine you were at the gym,

getting rid of it! Hope you are feeling better today.

--

Kathleen Stept (Dofetilide 250mcg bid, Diltiazem 120 mg, Coumadin 5mg, baby

aspirin), , Mississippi

> Kathleen wrote: <<Sick and tired of being sick and tired>>

>

> Wonderful way to put it Kathleen. I spent much of yesterday in afib and you

> describe it perfectly.

>

> As far as ablations being common, I'm not so sure. appears to be a

> similar town to Kalamazoo, where I live. Not small, but not a metropolis

> either. We have an EP here who does ablations, and the PR the cardio group

> puts out to the public is that it is a piece of cake. (I have not spoken

> with him directly.) Yet, in a simple, quickly stated sentence, my

> cardiologist said I should not let " anyone " in town do a PVI on myself. No

> names spoken, no elaboration, no emotion. He did not want to sully a

> colleague, but he was honoring his responsibility to me, his patient, to

> provide his best judgment. He then offered to refer me to one of the names

> that pops up in our group every so often. (Not Dr. Natale, though. There are

> others.)

>

> I believe the day will come when our " local " EP is as good as those with

> national reps, but I don't want him to practice on me. Your EP may already

> have the requisite experience. I don't remember if you ever asked him. I am

> not alarmed that yours spent so much time with you discussing risks as much

> as I am the suggestion that your AV node might have to go. I just don't

> understand why that would even come up at this point. (But I'm not a doctor,

> much less an EP.)

>

> The fact yours was willing to be helpful in sending you to someone who

> specializes in ablation is a sign of that he has mastered an important part

> of the best medical practice. It takes a big ego to be a doctor and it is

> obvious your doc knows how to deal with the downside of his. Myself, I would

> probably pass out at the first sign of blood from a cut I made into another

> human being. I'd recommend everyone go to someone else. Not out of elegance

> but out of fear.

>

> Others in our group have reported that CC bills about $60,000 for an

> ablation and accepts less than $30,000 from insurance as full payment. (This

> is just a general memory.) These kind of discrepancies are common these

> days, as part of the rhetoric of health care. Kind of makes the car dealer

> who sells the same car for two different prices to two different customers

> seem like an amateur deal maker. It is no different here at my local

> hospitals, one of which is now threatening to deny Blue Cross. BTW, CC has a

> good reputation for accepting insurance.

>

> Having said all this, the probability is that if you have it done locally

> you will do fine as long as he stays away from your AV node.

>

> - OU alum in MI

>

>

>

>

[Guest guest]

L and : Thanks for your thoughts on this. Very interesting to

hear how your cardiologist suggested what to do, . I haven¹t picked up

on anything like that with regard to my EP. He had been doing ablations

before coming to several (3 or 4) years ago. Evidently, he does one

or two per week. (, he is probably in his mid- to late forties.) I

did my best to follow Rich¹s advice and get him to sell himself to me, but

he doesn¹t seem like the type of person who is used to blowing his own horn.

He said he likes doing ablations, has a good team in place and has a success

rate comparable to the research centers. He was familiar with the new

equipment I was asking about, but pointed out that the manufacturers give

their equipment to the research centers to promote it. He had already

decided to use a basket catheter (for imaging?) and a low- rather than

high-output radiofrequency generator. He didn¹t seem to be impressed by the

³New Techniques in the Diagnosis and Treatment of Cardiac Arrhythmia² that

some kind person shared a couple of week ago and which I printed.

The cost compared with Cleveland worries me a bit. It¹s only about $5,000

here. Shouldn¹t something really good be really expensive?! (Just kidding,

sort of.) But the biggest concern was the talk about the AV node ablation.

I have to think he was spelling out my options but, like you, , I

wondered why he was talking about it at all. I spoke with one of his nurse

practitioners today and she assured me that I wouldn¹t wake up with an AV

node ablation if he goes in to do a PVI. She also mentioned that he¹s going

to South America this month to learn a new technique‹I¹ll ask about that and

let you know. That was also somewhat reassuring.

Sorry to hear about your afib episode, . I imagine you were at the gym,

getting rid of it! Hope you are feeling better today.

--

Kathleen Stept (Dofetilide 250mcg bid, Diltiazem 120 mg, Coumadin 5mg, baby

aspirin), , Mississippi

> Kathleen wrote: <<Sick and tired of being sick and tired>>

>

> Wonderful way to put it Kathleen. I spent much of yesterday in afib and you

> describe it perfectly.

>

> As far as ablations being common, I'm not so sure. appears to be a

> similar town to Kalamazoo, where I live. Not small, but not a metropolis

> either. We have an EP here who does ablations, and the PR the cardio group

> puts out to the public is that it is a piece of cake. (I have not spoken

> with him directly.) Yet, in a simple, quickly stated sentence, my

> cardiologist said I should not let " anyone " in town do a PVI on myself. No

> names spoken, no elaboration, no emotion. He did not want to sully a

> colleague, but he was honoring his responsibility to me, his patient, to

> provide his best judgment. He then offered to refer me to one of the names

> that pops up in our group every so often. (Not Dr. Natale, though. There are

> others.)

>

> I believe the day will come when our " local " EP is as good as those with

> national reps, but I don't want him to practice on me. Your EP may already

> have the requisite experience. I don't remember if you ever asked him. I am

> not alarmed that yours spent so much time with you discussing risks as much

> as I am the suggestion that your AV node might have to go. I just don't

> understand why that would even come up at this point. (But I'm not a doctor,

> much less an EP.)

>

> The fact yours was willing to be helpful in sending you to someone who

> specializes in ablation is a sign of that he has mastered an important part

> of the best medical practice. It takes a big ego to be a doctor and it is

> obvious your doc knows how to deal with the downside of his. Myself, I would

> probably pass out at the first sign of blood from a cut I made into another

> human being. I'd recommend everyone go to someone else. Not out of elegance

> but out of fear.

>

> Others in our group have reported that CC bills about $60,000 for an

> ablation and accepts less than $30,000 from insurance as full payment. (This

> is just a general memory.) These kind of discrepancies are common these

> days, as part of the rhetoric of health care. Kind of makes the car dealer

> who sells the same car for two different prices to two different customers

> seem like an amateur deal maker. It is no different here at my local

> hospitals, one of which is now threatening to deny Blue Cross. BTW, CC has a

> good reputation for accepting insurance.

>

> Having said all this, the probability is that if you have it done locally

> you will do fine as long as he stays away from your AV node.

>

> - OU alum in MI

>

>

>

>

[Guest guest]

> , did you ask your EP about what we talked about the other

> day.......about the different burn patterns in the Frecnh V italian

> procedures and about the 2 complete circles around the pulmonary

> veins?

******

Yes, .He said the Pappone definately makes two circles, each

encompassing two pulmonary veins. Which is different from

the " ostial " ablation. Dang, yet another new term! I said, of course

by ostial you mean the French procedure? He said, yes. In the French

procedure, we go around each of the pulmonary veins, closer to the

ostia. He is doing the Pappone procedure now, said the last one he

(and his colleague, they do the afib ablations together) did took

only 2 hours. Says it's much easier that the French, but he is not

sure yet whether the success rates will be better.

[Guest guest]

--- In AFIBsupport , " susanr20z03 " <susanr20z03@y...>

wrote

> Yes, .He said the Pappone definately makes two circles, each

> encompassing two pulmonary veins. Which is different from

> the " ostial " ablation. Dang, yet another new term! I said, of

course

> by ostial you mean the French procedure? He said, yes. In the

French

> procedure, we go around each of the pulmonary veins, closer to the

> ostia.

I wonder if in the Pappone procedure there is less risk of stenosis?