Out of State Drs Co-operation.

[esvaja]

Have you found that if you do choose to have your valve surgery done away/out of state from your primary, that the drs usually don't get their noses bent out of shape?
My issue is I work for a large University Hospital, it's very good but not the best for aortic valve & co surgeries. So against their recommendations I went for a 2nd opinion & have chosen to have my valve replaced at CC. The surgery is scheduled for 4/6/11. I have called in a couple times with concerns regarding racing heart, palpitations, rt hand fingernail beds turning blue. I either get polite interest & thrown into the hospital where I'm left alone on a monitor that has battery issues, or all the leads aren't connected or the attending says they don't want to "step on Cleveland Clinics toes" so just try and get an appt with my primary or the cardiologist in the next week.
I'm not getting a warm fuzzy re: aftercare in this situation. Aftercare after the surgery is just as important as the surgeon isn't it????

Daiva:

 

[kfay]

Well, hopefully, your aftercare will be with your cardio that you already have a relationship with and not some random ER Dr. I would suggest you have a conversation with your cardio now, before you leave for CC, to ask if he is going to be supportive of you once you come back from having your surgery at CC.

I found that my local cardio was fine with the Mayo being involved with my care and still welcomes their input to this day. However, the EP's in his group are a different story. I definitely think they have some ego issues with taking directions from my Dr.s at the Mayo clinic, which is too bad for them. I don't have time for that kind of nonsense, so I just refuse to see any of them and the Mayo EP's direct any med changes to my local cardio. If I need anything more than that, I just take a trip back up there.

 

[joanie]

I had my surgery at the CC and live in South Carolina. My cardiologist and internist here at home were very supportive of my having the surgery in Cleveland and provided great care when I returned. I agree with kfay, have a talk with your cardiologist who will be caring for you and make sure there are no problems.

Good luck!

 

[mainframe]

I live in Seattle and had my 2nd surgery at Stanford which is not exactly local at 800 miles away. When I decided to go elsewhere I emailed my cardio and told him I wasn’t going to use his recommended guy as I was less than comfortable with him and I was either going to CC or Stanford.. CC couldn't accommodate me until a month later than Stanford which made the decision between the two pretty easy. I probably wouldn't have lasted the extra month. The cardio did warn me about "if there were complications" of which I had a few, and ended up staying in the bay area for almost 3 months rather than the 3 - 4 weeks that I expected to.

Once I got back the cardio and his staff was o.k. to work with, but they didn't really want to hear about what Stanford thought about much. They preferred to be on their own island where they called the shots. Fortunately I think the cardio is a good one else I would have definitely looked for one that was willing to work with Stanford a bit closer in my after care.

 

[Lionheart]

I think my cardio was a little perturbed that I was not staying local. He said CC was a valve factory, and I though - EXACTLY, that's why I wanted to go there rather than to the local by-pass factory. He seems to have gotten over those jealous feeling with time. I suggest that you have a heart to heart talk with your cardio and if he can't handle it then fire him.

[EDIT- As far as Post-Op,] I figured that any typical, minor complications could be dealt with by my local guys and if there were major post-op problems then I would call CC for advice, which I did when I was having A-fib issues. Apparently CC will send a medical jet to pick up some patients.
Best,
John

 

[LUVMyBirman]

Always wondered about this scenario. Sounds like reactions will be individualized. I completely respect my cardiologist. He is the best at what he does. Unfortunately, if I were having surgery. Could not do it at the community hospital. Hopefully he will be supportive when that time arrives!

 

[Debbrn]

I live in Alabama and went to Boston for my surgery. My local cardio is completely comfortable with their capability to take care of me. I think otherwise. I was very scared to go outside the state and tick off my doctor's, but i decided that my life was at stake. I was just going to have to deal with the consequences because not going to Boston would not allow me the chance at the best outcome to say the least. Boston will perform all the testing they want to do without consulting Alabama, but they will not change a treatment plan until they consult Alabama. Luckily my local cardio in Alabama is not so arrogant to go against the opinion of the #1 center in the country. Alabama may tell me one opinion, but after Boston calls them and gives them their opinion they magically agree with Boston. One time my local cardio waited to write the note from my visit with him until he received all the information from my visit to Boston. The clinic note did not reflect anything that he had told me at the visit. He changed it to reflect Boston's opinion of the situation. My Boston doc automatically sends my info to Alabama, but I have to ask my Alabama doc to send any info to Boston.

Debbie

 

[daveguy14]

You will encounter a variety of reactions. In a field like this, there are a lot egos flying around, and there are few doctors who think they--or their guy--aren't capable of handling it. And I'm sure 9 times out of 10, the community hospital would be fine. But at the end of the day, it's your life, and there IS a difference between high-volume centers and not-so-high-volume centers. There's no way to know ahead of time whether you'll be the one for whom the best center makes a difference, and when the surgery is this high-stakes, you should feel no guilt for disregarding a local doctor's opinion.

 

[Michelle D]

I live in Florida and was lucky to find a cardiologist trained at the Cleveland Clinic, I was diagnosed with severe mitral regurg at the local hospital after being admitted from the ER with chest pains. I didn't have a cardiologist at the time. My husband knew about the CC so he called them and found a cardiologist near by that was very supportive about me going to CC. She was great, the Cleveland Clinic was AMAZING and Dr. Gillinov is my hero. After coming home from surgery I had complications that led me back into the ER a few times. I had the CC print out all my records before I left and brought them with me to the hospital here. Dealing with my local hospital was a cluster####, and it didn't help that my cardiologist didn't belong to that hospital group. I think that for your after care as long as you have a great cardiologist and go to their hospital things will go well. Now if I ever have to go the the ER I will take the hour drive to her hospital.

 

[ejc61]

I initially picked a surgeon that did surgery at Hospital A. My cardiologist is at Hospital A. Two days before surgery, I changed my mind and picked a surgeon at the same practice that did surgery at Hospital B two days later. I chose a different technique. Hospital A did it several ways. Hospital B offered the same plus robotic. Hospital A & B are 10 miles apart both within the city I live in. My cardiologist at Hospital A was upset. My cardiologist wanted a timeline of events leading up to surgery date. He was openly unhappy to the point that I had to chose another cardiologist. I moved my PCP and cardiologist to Hospital B. I would do it again if I had too. No disrespect to any doctors, but you need to go with your gut feeling and trust the surgeon first. It's difficult and sometimes someone's feeling may be hurt. Just be prepared for that.

 

[Michellemar]

Oh, hello!!!!! This is the page I was looking for. I have a Cardio, but having had radiation and also ankylosing spondylitis ...that's both hips replaced... And a stenosed valve such that in 2 wks...April19, Dr. Starnes at USC with aortic valve replacement... At .8 now, 33 whatever that is that is supposed to mean only moderate.... And I live 130 miles away from USC. I got the same "factory" type statement, and surely hope my longtime Cardio here...who IS good...will BE there for me....but do I move to USC area???? Is that what it's gonna take???? My long time arthritis Dr. Said if anything went wrong no cardio would touch me around here. Is that comforting or what?!(NOT?!) I'm 62, female and live alone but have my pets... Is this ..,like, open-heart and apartment hunting TOO??! 2 wks to prepare, and I'm in bed all day either from the STRESS/ get exhausted if up..depressed...scared silly. Family scatters about now, dependency is equated with weakness in my 9 brother/sister family. Can you believe that? Yeah, dumping alot of stuff here, but if anyone has any ideas or more experiences, tips... Also hopefully a pre-op can if choosing away from home get this looked into for themselves!!!
Thanks for listeniing... I sing in a dynamite Chorale and our concert is in a month-w/o me as of last week. I want to get
back and sing, darn it! I was just getting my mezzo voice up where real mezzos can sing!! At least I have (had, get
dizzy now) lung power and don't want to hurt my heart. I'm even worried can I make it DOWN to USC... Well, friend
does have a backseat I can lie down on. In the WAiting room....and best surgeon there is for radiated hearts.

 

[Michellemar]

Daiva, you'll be in pre-op now, so you'll see this later. I will be praying for you tonight, your post helped me... Same problem you had. May His hands guide your surgery and aftercare. In Him. Michellmar

 

[Michellemar]

Do look into this a month or two before... I mean, get it DOWN before or if you do choose distance. Commute time? Aftercare at the surgery end? Are you married, with children, aftercare near the hospital if need be needs a look-at. Pets? If I have to go away as long as Chris (mainframe).. That 800 mi trek!!! (I don't personally, but I DO have 130 mi thru LA (groan!) traffic...do you have pets... Some hospitals have area hotels where long-term patients may stay, to be close to the hospital, and some may take pets... Just stuff to file away, for later.... Thank God(and I do mean that) that I found his site.... Well guess what, we're Americans, our pioneer forebears had to move for THEIR lives, too... I guess we can do the same even if we've forgotten our roots! Breathe, think of the good for our families that we return to them healthy and strong, because we determined to have the best for all of us even if it's pain in the short run.!!