My mvr story so far.

[DaveLee]

"US has its 200k patients awaiting heart surgery but they are not on the radar because they dare not go to the doctor."

Can you please give a source for your claim ? I was on the table 8 days after my GP found the problem in the USA.
"because they dare not go to the doctor" I have a real problem with this, please give a GOOD source.

 

[pellicle]

So there is much debate on how to get a better system and avoid some of the issues you went through and are still going through.

from where I sit its a thorny issue with no real debate other than "we should have one" vs "we should not have one"

What I don't see discussed by the "we should have one" crowd are:

1. will it be state or federally funded (or to what ratios)
2. will the taxation levied for that be born equally across the society (as in my view it should)
3. who will complain about that (or perhaps better phrased as "how much are they willing to pay)
4. will the public adapt to a society where their (unhealthy) actions are inevitably someones financial burden

I think much of that needs to be thrashed out early because if it isn't then if something gets passed it may then stall when people understand the implications.

I'm assuming that the data for this link is based on total spending (private and public) and so it would seem that the USA spends a LOT on healthcare but somehow its not delivered evenly?

 

[Pete.C]

I saw the cardiologist on Monday and came away a little confused and disappointed.
He was not the same cardiologist I saw the first time so had explain my history so far. He asked how far I could walk on the flat, when I said 6 or 7 miles, he laughed and said I am very fit!
He looked at the echocardiogram from April, he didn’t want to do another while I was there because the previous one was only 3 months old!

Anyway he said the valve was no worse but the lv had got bigger. My problem was with the atrial fibrillation which was causing my shortness of breath, he basically said nothing could be done with afib, as any operation would only be successful short term and symptoms would return.

He has arranged for a 24hr holter ecg test again, the appointment time came yesterday, September 6th!
Then an appointment after that with the cardiology surgeon to “convince him that I need the mitral valve operation“ his words.

The above is all with the NHS, I have an appointment to see a cardiology surgeon privately in three weeks, I hope it goes better.

 

[Chuck C]

He was not the same cardiologist I saw the first time so had explain my history so far.

Is this standard to be shuffled around to different cardiologists in the NHS?

He asked how far I could walk on the flat, when I said 6 or 7 miles, he laughed and said I am very fit!

Yet, as you have explained in your original post, you now get out of breath climbing just one flight of stairs, which is a new development for you. You were previously diagnosed with moderate to severe mitral regurgitation and have also been fainting. It sounds like he is being dismissive of your condition to me.

My problem was with the atrial fibrillation which was causing my shortness of breath, he basically said nothing could be done with afib, as any operation would only be successful short term and symptoms would return.

I doubt that it would be possible to rule out the moderate to severe mitral regurgitation as being a contributing factor to your shortness of breath. Nothing can be done about your afib? I think it's time to ditch this guy or, at the very least get second opinion, if the system allows for that.

He looked at the echocardiogram from April, he didn’t want to do another while I was there because the previous one was only 3 months old!

So the previous echo took 6 months before a cardiologist looked at it. This new cardiologist has now evaluated your echo that was done about 3 months ago in April. Seems foolish for him to hold off on another echo. If he orders it now, maybe he will get around to evaluating it in 3-6 months from now. The more I hear about the NHS, the less I'm impressed.

He has arranged for a 24hr holter ecg test again, the appointment time came yesterday, September 6th!

And their not able to schedule your holter ecg until September 6th?

How much will it cost for you to get a second opinion from a private cardiologist? Ideally, you would get your complete echo results and forward them to the private cardiologist prior to the appointment. Does the NHS give you your records upon request?

 

[Pete.C]

I’m already booked to see a surgeon cardiologist privately on July 18th at Liverpool Heart and Chest hospital.
He does a ecg and echocardiogram beforehand, so I am hopeful of a better outcome.
The NHS will not give me a copy of the last echocardiogram until the first cardiologist has seen it and then sent his findings to my GP, I’ve no idea how long that will take.

 

[Chuck C]

The NHS will not give me a copy of the last echocardiogram until the first cardiologist has seen it and then sent his findings to my GP, I’ve no idea how long that will take.

That's unfortunate. In the US HIPAA gives us the right to obtain all of our own medical records.

"Health insurers and providers who are covered entities must comply with your right to:

• Ask to see and get a copy of your health records"

https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

 

[Mister_James]

The doctor is right. If you say you walk 6 to 7 miles you are fit.
He can see the valve in the echo and he can read the radiologists review. Heart surgery is not an elective procedure. Your natural poor valve is still better than a new artificial prosthesis.
1. You are asymptomatic. If you are walking over 6 miles regularly.
2. Occasional AFib is almost never treated if it resolves shortly.
Heart issues are scary but wait and see is almost the universal approach unless the condition warrants intervention.

 

[Mister_James]

"US has its 200k patients awaiting heart surgery but they are not on the radar because they dare not go to the doctor."

Can you please give a source for your claim ? I was on the table 8 days after my GP found the problem in the USA.
"because they dare not go to the doctor" I have a real problem with this, please give a GOOD source.

Why don't you search "Americans skipping on healthcare" and have your fill of sources you would find acceptable?
I work in one of the largest academic health systems and I have had my fill of these issues.
If it really bothers you because you care about health access or it bothers you because you just feel good ol' US is being demonized...look into diabetic amputations and ask yourself why for a disease that can be managed. Then compare US to a close cousins up north. We eat about the same.
Conclusion: 1/3 of Americans delay/postpone healthcare because of associated cost.
The reason why roads are congested is not related to how we pay for the vehicles, it is more people driving. More people drive because cars are more affordable. The argument for longer "wait" times is because more people getting into the pipeline to seek healthcare and if you have no wait time, it is because the system has culled out a section of the population NOT to receive healthcare. All health insurances do the same thing, review the procedure, deem it necessary, approve it and tell the hospital how much they think they will pay - public or private...no difference.
Happy 4th of July folks.

 

[Pete.C]

The doctor is right. If you say you walk 6 to 7 miles you are fit.
He can see the valve in the echo and he can read the radiologists review. Heart surgery is not an elective procedure. Your natural poor valve is still better than a new artificial prosthesis.
1. You are asymptomatic. If you are walking over 6 miles regularly.
2. Occasional AFib is almost never treated if it resolves shortly.
Heart issues are scary but wait and see is almost the universal approach unless the condition warrants intervention.

I think I can manage 6 or 7 miles on the flat, because I was pretty fit before my first bout of afib. But conversely, I struggle for breath when climbing a flight of stairs.
I think I would have said I was asymptomatic before the afib which is now persistent and doesn’t look as if it will go away of its own accord after 6 months.
I will just have to wait for the surgeon cardiologists verdict.

 

[pellicle]

... I struggle for breath when climbing a flight of stairs.
I think I would have said I was asymptomatic before the afib which is now persistent and doesn’t look as if it will go away of its own accord after 6 months.

your bio doesn't mention much, so depending on your age and if you're on beta blockers this will influence any view of if this is expectable or unexpected

 

[Midpack]

I’m already booked to see a surgeon cardiologist privately on July 18th at Liverpool Heart and Chest hospital.
He does a ecg and echocardiogram beforehand, so I am hopeful of a better outcome.
The NHS will not give me a copy of the last echocardiogram until the first cardiologist has seen it and then sent his findings to my GP, I’ve no idea how long that will take.

In my country, your are allways given your own medical studies and you bring them to your doctor. I prefer this way. The only downside is that lot of people (myself certainly included) google about their results and get, most of the times, unnecessarily scared...

 

[pellicle]

The only downside is that lot of people (myself certainly included) google about their results and get, most of the times, unnecessarily scared...

well that and I know plenty of people who'd lose them. In Oz now we've moved over to electronic data formats (I know ... really I know) which are (in theory) persistent and available with your consent to other practitioners.

Oh, and long time no see dude ... hope you're well

 

[Deepak khanka]

In my country, your are allways given your own medical studies and you bring them to your doctor. I prefer this way. The only downside is that lot of people (myself certainly included) google about their results and get, most of the times, unnecessarily scared...

Hi Pete, where are you located in England. You have a choice to use choose and book option via gp and you could go to any surgeon and any hospital. NHS is having a big back log and if you want to do a private echo and have the results there and then ask your gp to refer you to a BHUPA clinic . It’s £500 to £700 . Liver pool heart and lung is a good hospital. I had mine at Harefield hospital and my surgeon wa mr Bahrami

 

[carolinemc]

In my country, your are allways given your own medical studies and you bring them to your doctor. I prefer this way. The only downside is that lot of people (myself certainly included) google about their results and get, most of the times, unnecessarily scared...

Studies? Or Medical Records. For in the USA we can have copies of our medical records to use for reference when visiting a new doctor and keeping up with your medical records.

 

[Midpack]

Studies? Or Medical Records. For in the USA we can have copies of our medical records to use for reference when visiting a new doctor and keeping up with your medical records.

Any medical study: X-ray, MRI, CT, Echos, Blood work, whatever. They give you a printed copy (or more often, nowadays, send it by mail) and it is you who brings it to the doctor that ordered it. And, during the visit, your doctor look at it, takes his notes, and gives it back to you. This is pretty convenient if you want a second opinion.

Regards

 

[Chuck C]

Any medical study: X-ray, MRI, CT, Echos, Blood work, whatever. They give you a printed copy (or more often, nowadays, send it by mail) and it is you who brings it to the doctor that ordered it. And, during the visit, your doctor look at it, takes his notes, and gives it back to you. This is pretty convenient if you want a second opinion.

Here, typically electronic records are used. If you are to see another doctor you greenlight the release of medical records, an electronic record is sent to said doctor's office ahead of the visit. You are also entitled to receive a printed copy or electronic. It would seem to me that the problem with: " your doctor look at it, takes his notes, and gives it back to you" is if the physical record gets lost by the patient. I would think this would be common. It would seem appropriate that each doctor should have an electronic record, in addition to the physical one that they give you.

 

[carolinemc]

Any medical study: X-ray, MRI, CT, Echos, Blood work, whatever. They give you a printed copy (or more often, nowadays, send it by mail) and it is you who brings it to the doctor that ordered it. And, during the visit, your doctor look at it, takes his notes, and gives it back to you. This is pretty convenient if you want a second opinion.

Regards

I get the electronic file, not the paper on everything done. I can get copies of my records online or in person.

 

[Humboldtgrrl]

I am a physician in the US with as one can see an extensive cardiac history. I also happened to have spent some time in the UK for some medical training on two different times in my career. So I know a bit about how things work in the UK albeit somewhat dated.

First as far as the mitral regurgitation goes it can be stable for a long time and then suddenly cause the heart to go into failure with a major uptick in symptoms.

The BNP is a hormone associated with heart failure and is used as a marker for heart function. It is useful say in tracking chronic mitral regurg. but with frank heart failure it would be very surprising if it was not very high. So the BNP is just confirmation for what is already obvious.

There are a variety of options for mitral regurgitation. Repair, Replacement (surgical or possibly soon via catheter) or Mitral Clip. I had significant mitral regurg for years without any real issues then within a week I went into major heart failure. I was scheduled for my fourth open heart by one of the busiest mitral surgeons in the US. Nobody was very interested in doing surgery for the 4th time on a 67 year old retinal surgeon. I spoke with people at Cleveland Clinic and other places. A few days before my surgery was scheduled I got a call from the mitral surgeon suggesting I consider the Mitral Clip option. Fortunately for me I had been in touch with the number 1 by volume Mitral Clip cardiologist in the US at the time who was eager for me to have the procedure. I had it done two days later! (Not the NHS). For me it was miraculous. Symptoms completely abated and the procedure from my standpoint was a piece of cake. Out and home the next day.

Now six years later it still is working perfectly with very little regurgitation seen on ultrasound and little mitral stenosis.
A lot depends on the interventional cardiologist who places the clip. I had two clips placed and I found out that my cardiologist sweated through the procedure due to oddities in the anatomy preventing optimal visualization in my case. But now the procedure is being done at my local hospital with several hundred cases under their belts.

I have not been following the literature on this over the last six years but I believe it is still a very viable alternative to surgery. So at least discuss your options.

Finally we have real problems in the US with people without medical coverage. This is clearly not acceptable but we also are fearful of a system that is not very responsive to individual needs. So there is much debate on how to get a better system and avoid some of the issues you went through and are still going through.
Good luck.

@vitdoc - any thots re Coselli for rework of a one year old aneurysm stent that has developed aneurysms at both ends (4.9/5.3)?? Can not tell if I successfully sent you a PM about this a month ago on behalf of my sister (toadhall) , but have had no reply that I can view. TIA