Appointment with New Cardiologist Today

[PJmomrunner]

Well, I took the plunge and switched cardiologists and had my first appointment with the new guy today. Some may remember that the old cardio said dumb things like, "aneurysms like yours don't dissect" and "the aneurysm is your body's way of compensating for your bum valve and increasing the blood supply...kinda like opening another lane on the freeway."

Anyway...the new guy seemed less than stellar and also said dumb things like, "they operate on abdominal aortic aneurysms sooner--around 5cm-- than ascending--5.5cm or 6cm--because the ascending is a lot more complicated." When I told him I had read the exact opposite and been told the opposite by the surgeon whose care I'm under, he kind of back-tracked and said my surgeon might operate sooner on someone like me because I'm such a good candidate...and he remarked several times how young I am to have this aneurysm. (Huh? The surgeon would operate sooner on me cause I'm so young I'd be likely to live??? I'm not sure what his point was...)

I realize none of this is anywhere near glowing...(Is it possible that he looks at me--43, not obese, "in pretty good shape"--and knows I've got years to got before he needs to give my case some real thought???)...but he did say that the key to the stability of the valve as well as the aneurysm is blood pressure control (which is when I told him about Dr. Raissi's assertion that maintaining systolic BP at an average of 105 to 110 results in an exercising systolic BP that stays below 135 and this is usually achieved by beta blockade PLUS ace inhibitors). He responded by saying he was just going to suggest adding an ace inhibitor (I guess I should be glad my BP was 128/82 when the "medical assistant" took it. ((What's a "medical assistant" anyway? Someone who was taught on their first day on the job how to weigh a patient and take their pulse and BP???)

So, I'm happy to get the ace inhibitor (Altace 2.5mg) added to my regimen and hope that has the impact Dr. Raissi predicts. I'm also happy that I felt comfortable saying "that's not what I read" to the new guy and he did not seem put off by that. I feel like as long as I'm on an annual recheck on the aneurysm/valve with the surgeon and I see the cardio twice a year for medical management (which amounts to blood pressure management in my case), then he'll do.

Comments?

(Oh, BTW, I suppose I'm doing a bit of self-triage right now--putting the aneurysm/valve on the back burner until I find out at next month's appointment with a neurosurgeon whether a "2.3cm paraspinal neurogenic tumor at the level of the aortic arch on T4" deserves equal billing.)

 

[Mary]

I'm sorry this fella didn't measure up P.J. I suppose you need to focus on the positives he provides, but another question I have is, "Will you feel comfortable with him as your cardiologist after surgery?" I am on my third cardiologist, and I trust him to supervise my care until I have my bovine replaced at some later date. I realize that trade offs are sometimes necessary; the trick is to know which trade offs and when.

I'm not sure what a paraspinal neurogenic tumor is. Would you mind elaborating? A benign tumor was found in my brain a few years ago; apparently it has a genetic basis but is causing me no problems.

 

[bvdr]

Well, it seems you definitely have mixed review on the visit. It just reinforces that we have personal responsibility of knowing our own medical condition to the best of our abilities. The time when people relied on doctors to know everything is over. There is too much out there to know and there is no way a doctor can know each patient and each disorder to that extent.

I know what you mean about putting things on the back burner while something else is addressed. I hope your paraspinal tumor turns out to be not to difficult a fix. Are you having symptoms?

 

[PJmomrunner]

"Will you feel comfortable with him as your cardiologist after surgery?"

Well, not at this point, but word on the street is that this guy is the best, so maybe he will demonstrate some reason for deserving that distinction in the future. I have to keep reminding myself (and observing the population in the waiting room helps) that in a small community like mine a cardiologist is not likely to have a lot, or even any, experience with a case like mine.

I know very little about neurogenic tumors except that in the posterior mediastinum (where mine is) they are largely benign but can be problematic. In a perfect world it would be easily removed and take all my back pain with it!

 

[Marguerite53]

Well, I'm sorry that your weren't enthusiastically impressed with the second guy, but kudos to you for standing up to him and forcing a more detailed discourse.

For me, what it all boils down to is which one do I trust? Reputation has its merits in my book. Experience certainly. Background has its merits. Where were these doctors educated. Oftentimes there are blurbs online, or clinic brochures, etc.. You cannot change what is available to you in your town. You can listen to your gut.

If it is a question between the two, perhaps one can be named heads, and one tails. Toss a coin and let it land on the ground. If you are instantly pleased or disappointed with the result...there is your answer!! I know this sounds VERY silly, but it works for me!

Keep us posted on the effects of the ace inhibitor. I hope that gives you some emotional relief. You are due some!!

Marguerite

 

[PJmomrunner]

I hope your paraspinal tumor turns out to be not to difficult a fix. Are you having symptoms?

That's my hope too, Betty. I have had back pain for so long in various parts of my back and neck that I had basically just accepted it and decided to live with it since it is worst at night and gets a lot better after waking. I am awakened every morning by back pain and when I can't take it anymore I get up and then I'm fine until I do something for any length of time--sit at the computer, drive, chop veggies, throw pots, etc... My neck always hurts on the left side, probably a 3 or 4 at most on a scale of 10. I figured it was arthritis like mom, dad, uncle, cousin etc. have, until the incidental finding of the tumor on a recent CT, which coincided with my conscious decision to get my back pain figured out so that I could distinguish what was back pain and what might be related to this aneurysm I get to drag around with me for a while.

 

[Karlynn]

I went to a handful of "Best" cardiologists who didn't know as much about valve disease as they did about CVD. A cardiologist is only "the best" for you if he/she knows a lot about your particular situation. This new guy may have a very good rep for CVD, but may not have much experience (which it sounds like it) with your issues. To highly exaggerate the point - It's kind of like seeing the best oral surgeon for the ringing in your ears. The fact that his work is in the head area, doesn't mean he knows ears too.

 

[Debster]

Hi! My mom was recently put on Altace-2.5mg also. She is also on Coreg and it has had exactly the effects your dr said. My mom takes her bp every morning at it runs about 100/55 or so each day. Down a LOT from what hers used to be. She had mitral valve replacement last April. Good luck and keep us posted! Debbie

 

[PJmomrunner]

I know you are right, Karlynn. I guess I need to ask around and find some folks who've had valve replacements--if I get lucky maybe I'll even find a repaired asc. aneurysm--and find out who their cardiologists are.

Debster, that's good to know! Does she feel sluggish or anything?

 

[bvdr]

P.J., I forget to mention that I have taken Altace since last Oct. My B/P is now on the low side and I don't think I can think of any real side effects that have bothered me. I didn't check if you are on a potassium supplement as sometimes that can cause your potassium blood level to become too high.

 

[Debster]

Hi PJ! She was kind of weak at first and thought it might have been the Altace but now she really isn't sure. She had retained fluid that she is getting rid of with lasix . She is feeling better and now is really glad to have started on the Altace-she has chf and can really tell a difference (for the better )
Hope this helps!! Deb

 

[mntbiker]

Hey PJ,
Just out of curiosity who recommended the new cardio? If you haven?t already, ask the surgeon for a referral - since he deals with more cases like ours each year he should know the cardio?s that deal with it more often.

I hope everything works out for you with the spine.

 

[PJmomrunner]

Hey MtnBiker!

New Guy was recommended by an acquaintance who's a cardiac care nurse as well as by a friend who's husband's a retired ortho surgeon. Seemed like they'd be "in the know." Who knows, maybe he's studying up on BAV's right now. At least he was on-board with the ace inhibitor. Unfortunately, the surgeon's almost 3 hours away--not too likely he'd know anyone out here in the boondocks, I'm afraid. Can't hurt to see, I suppose, but I'm in no hurry since my next CT/echo recheck will be Nov. '06, though.

Thanks. For some reason I'm not worrying about the spine really...yet, anyway.

 

[aussigal]

Hi PJ...


Gee...this second guy doesnt sound much more useful or enthusiastic than the first really does he....

I am about to return to my original cardio...due to his more rigid screening schedules and the fact he wasnt in denial about the possibilities of an operation being needed...I really dont want to trial too many before i settle on one ...my fiorst cardio is more approachable and has less of an ego in the way...

I do hate it when they dont give you the whole story though ...me...I wanna know everything!

My BP meds were switched over a few months back now and finally my BP responded how it was sposed to and dropped down to the 110's/60's...I am a little dopey ...but thats OK...keeps me slowed-down...I get a wave of sleepiness about 3-4 in the afternoon but helps my nap-time!..I also notice i "operate" more slowly so as to avoid any dizzys.

I take metoprolol (beta-blocker) & perindopril with indapam ( ace inhib.)..

i'm due back at the cardio office on Monday for a BP check and adjustment til we get the bp settled around the above-mentioned figures...BP's decided to ignore the meds and go back to its preferred levels:

trouble being it wont stay there seems to prefer the low 140's which would be fine if i were a regular non-aneurised person...

dont you just love being "special" ...
...minute I move it goes Up up up up...

 

[Gail in Ca]

At age 34, my aneurysm was at 6 when it was discovered. I was placed on tenormin and 6 wks later had surgery to replace my aortic valve and fix the aneurysm. My ascending aorta FELL APART in my surgeons hands. That's how close to dissecting it was at 6. I'm sure the latest size, especially for women, is smaller than it used to be, for repairing ascending aneurysms.
Did you ask your surgeon which cardiologist he would use if he needed to see one?
Gail

 

[aussigal]

Did you ask your surgeon which cardiologist he would use if he needed to see one?
Gail

I think THIS is an EXCELLENT suggestion!


I am gonna ask mine that question

 

[gijanet]

Pj

Pj

You lost me about half way through, so I'm just sending lots ofhugs. Just a thought, though. If you are only seeing the card twice a year, have you thought of switching to one a bit further, say at the UofM? Just a thought. Hugs and prayers. J.

 

[PJmomrunner]

Several people have suggested switching to a cardiologist 2 to 3 hours away to get someone more, shall we say, "tuned in". This does make sense to me except in the context of post-op care, where I'm not sure. What do you all think about having no one at the local hospital on board? And what about if I have an emergency "in the waiting room"?

 

[Mary]

Several people have suggested switching to a cardiologist 2 to 3 hours away to get someone more, shall we say, "tuned in". This does make sense to me except in the context of post-op care, where I'm not sure. What do you all think about having no one at the local hospital on board? And what about if I have an emergency "in the waiting room"?

Why don't you try to find someone a few hours away first, then decide whether you want to switch?
I was prepared to go with a St. Louis cardiologist (two hours away) if I didn't think my new cardiologist was up to speed. This was post surgery, when I had a real appreciation for the importance of having expert follow up care.
If you had an emergency, you could always use your PCP. If it was anything very serious, you'd probably be shipped out anyway.

 

[Guest]

Ah, distances.

My cardiologist is approximately an hour away from me, depending on traffic. Luckily, she only wants to see me every 6 months. Unless of "emergencies", as in the gallbladder surgery a couple weeks ago or so.

My cardiologist and PCP work together, from what I know, anyway. As far as I know, both of 'em update the other, whenever I have an appointment....

Currently, I'm in a city that has 2 great hospitals ... which is good. I can always go there if I need to.....

So, while distance needs to be weighed into your factoring, keep in mind that sometimes quality outweights distance....

Unless, of course, the hospital your cardiologist is at suddenly forgets you have health insurance, as apparently mind has. Remember I went in to see a cardiologist (mine was on vacation) on December 28 to get the OK for the gallbladder surgery? Well, guess what I received in the mail today...a letter...from that dang hospital. What did it say? "Enclosed is an itemized bill for your recent hospital services. Our records indicate you have no health insurance for these services." Of course, they provide a non-toll-free number for me to call if I want to dispute it. Please. What the heck is up with this? I paid a COPAY the day I was there ... and you know darn well they wouldn't have allowed another cardiologist to see me if I didn't provide proof of insurance. More money and time wasted. Bah.

Yeah, maybe I'm a bit upset. Sorry for the rant...heh.


Cort, "Mr MC" / "Mr Road Trip", 32swm/pig valve/pacemaker
MC:family.IL.guide.future = http://www.chevyasylum.com/cort/
chdQB = http://www.chevyasylum.com/cort/quilt.html
"I can?t stop driving" ... New Radicals ... 'Someday We'll Know'