Role of cardiologist?

[kailin]

Hi -- I'm still new here -- was diagnosed with severe BAV stenosis last March. Didn't pay much attention because the young cardiologist I had then said "someday you'll need open heart surgery" but didn't say anything at all about the congenital factor. She encouraged me to keep on exercising, etc. So, I figured I'd have a few years and didn't have symptoms.

Moved to another state, and new primary care MD tried to send me to cardiologist, then a friend who is MD suggested I try to get into the Boston system. When I mentioned that to new primary care MD, he encouraged me to see the head surgeon at the Portsmouth hospital. I did, and he seems exceptionally well qualified, and very helpful as well. Then he sent me to a cardiologist in the group he brought with him, a young MD who graduated from Med School in 2002. He makes me nervous.

So, here's my question -- should I try for a cardiologist who has more experience? I don't want to insult the surgeon, but it seems like I'll have to spend a lot more time with the cardiologist, in terms of meds and post-op care, correct?

Any advice will be appreciated.

==========

Diagnosed 3/2010 with severe bicuspid aortic stenosis, AVA 0.7, peak gradient 59, mean 35
3/2011 AVA 0.6, peak gradient 84, mean 47
My age is 67, had rheumatic fever age 5

 

[skeptic49]

Diagnosed with BAV and severe AS? Seems to me you should be interviewing surgeons. Do you know your numbers? What is your aortic valve area? Gradients? Have you been evaluated for the condition of your aorta? Not to scare you, but severe AS carries with it a risk of sudden death.

Best wishes,

Jim

 

[kailin]

What I was told, before I started reading here, was they were waiting to hear if I had symptoms. Only started noting shortness of breath in exercise recently -- last fall moved myself 8 hours away, loading and unloading car myself, etc. Have talked with a surgeon. Like him, don't know about the cardiologist he sent me to though. Numbers are in my post. Not that worried -- but want to get this organized before mid-summer.

 

[dick0236]

So, here's my question -- should I try for a cardiologist who has more experience? I don't want to insult the surgeon, but it seems like I'll have to spend a lot more time with the cardiologist, in terms of meds and post-op care, correct?

You may need to see the cardiologist only once every year or two after the surgery. After I stabilized after the surgery I normally saw my cardio every two years for followups. Now that I've gotten "old", my schedule has changed to once per year. For me, a good internist is capable of normal post op care. Once the repair is completed, and if there are no other issues, hopefully, your visits will become routine followups.

I understand your reservation about "young cardios":rolleyes2:. I am currently in the process of changing cardios....again(current one left network). My PCP recomended a group to me and when I called for a "new patient" appointment, I was asked if I wanted one "younger" or "older" than me....I'm 75:redface2:. I've been scheduled with an "older" than me doc. I am reasonably sure that he and I can "connect", which I have found difficult with the young ones:frown2:....at least this guy was practicing medicine when I had my valve implanted:tongue2:.

 

[kailin]

Thanks, Dick! Glad to know I'm not the only one who finds more and more people to be soooo young these days!

My cardiologist started as an internist -- I don't know if my primary care doc is though. Will look into it right away.

 

[Jkm7]

You list New England as home which presumably gives you reasonable access to Boston. Two of the highest rated heart centers in the U.S. are located in Boston and you may wish to think about consulting a surgeon and/or cardiologist at either Brigham and Womens or Mass General. It is so important to have faith and trust in your doctors when facing open heartr surgery. To me that is so basic.

 

[DebbyA]

I'm adding on to Jkm7's Boston suggestion. If you have a major heart center available, the staff there will be more experienced in recovering VALVE patients or at least it will have a dedicated cardiac CICU.
As well as considering the age of your prospective cardiologist, you might ask about experience or interest in treating valve patients.
The set-up varies so much from area to area, so ask about 'who your body belongs to' in the period after surgery. For me, it was the surgeon 30 days, cardiologist til 3 month check-up, then back to primary except for yearly echos (which are now every two years because of stable results.)

 

[spartangator]

If I may tack on to Jkm7 and DebbyA's helpful comments, let me also suggest (as Dick does) that you factor in finding a doctor that listens to and understands your perspective on the situation. While no amount of conversation will change the science, it is essential to long-term well-being that the doc at least helps you understand what is happening and why so that you can make informed decisions and feel good about them.

 

[scott.eitman]

I was diagnosed with BAV in 1988 and was in the waiting room for 10 years before my 1st surgery. My, non-CCF, Cardio was mature, but he thought he was God. He was wrong about my need for surgery, even after my surgery. I did not go back to him, I saw him at a Baseball game. My younger, more recently trainED Cardio, knew it was time.

At the Clinic, I had an apointment years ago, my Cardio told me to to tell the trainee (not sure if resident or fellow) my diagnosis. The trainee was able to listen to my heart and could tell it was a Homograft AV. The young guys, when properly trained, are pretty good.

As for the Boston System, I am assuming you are not at the main hospital. The CCF has many hospitals in their system, but those are not CCF Main. I would not go to one of their satelite hospitals for Heart Surgery or for my Cardio. Main is the one nationally recognized for Hearts. I am not pushing for you to go to the CCF, but to make sure you are with the main people at Boston.

As for relying on the Cardio for years, you bet! I believe this is the one you will definately rely on the most pre- and post-op. If you are not comfortable with any of your Drs. move on. Don't be afraid to hurt feelings. It is your life, not theirs. I have been fired by a primary card Dr. for not trusting his "knowledge". It took him 10 years to notice, so he wan't too bright. I just needed an insurance Dr. and he served the purpose.

 

[ottagal]

As for relying on the Cardio for years, you bet! I believe this is the one you will definately rely on the most pre- and post-op. If you are not comfortable with any of your Drs. move on. Don't be afraid to hurt feelings. It is your life, not theirs.

Thanks for the insightful words of wisdom Scott. I,too needed to hear that one!

 

[Lynlw]

I was diagnosed with BAV in 1988 and was in the waiting room for 10 years before my 1st surgery. My, non-CCF, Cardio was mature, but he thought he was God. He was wrong about my need for surgery, even after my surgery. I did not go back to him, I saw him at a Baseball game. My younger, more recently traing Cardio, knew it was time.

At the Clinic, I had an apointment years ago, my Cardio told me to to tell the trainee (not sure if resident or fellow) my diagnosis. The trainee was able to listen to my heart and could tell it was a Homograft AV. The young guys, when properly trained, are pretty good.

As for the Boston System, I am assuming you are not at the main hospital. The CCF has many hospitals in their system, but those are not CCF Main. I would not go to one of their satelite hospitals for Heart Surgery or for my Cardio. Main is the one nationally recognized for Hearts. I am not pushing for you to go to the CCF, but to make sure you are with the main people at Boston.

As for relying on the Cardio for years, you bet! I believe this is the one you will definately rely on the most pre- and post-op. If you are not comfortable with any of your Drs. move on. Don't be afraid to hurt feelings. It is your life, not theirs. I have been fired by a primary card Dr. for not trusting his "knowledge". It took him 10 years to notice, so he wan't too bright. I just needed an insurance Dr. and he served the purpose.

I agree with what Scott wrote. Also I would want a cardiologist that I trusted and felt we understood each other well. Going to a Good surgeon is very immportant, but hopefuly you won't be dealing with the surgeon after you recover from this surgery, but you will be seeing the cardiologist the rest of your life.

As for their age, it depends on many thing including where you go and the cardiologist. Sometimes if the older cardiologists aren't in the larger centers, they may not keep as up to date with everything going on where a younger doctor especially if they went to the major centers for their training, really can be great. Of course there are many older cardiologist that still are the ones doing the research and speaking at the conferneces and some young guys could have been at the bottom of their class, so if possible check out their profiles at the hospitals web sites and see what they are interested in, papers they write if any etc.

One good thing about having a younger cardiologist, (not talking brand new, but younger than you) is you don't have to worry about them retiring and having to find a new doctor all over again. (unless you get ayoung doctor like Justin just did and have to wait for her to get back from having a baby

I don't know if this would help you decide where to go if only to get 2nd opinions,
but US news just did a ranking of hospitals broken down by area. http://health.usnews.com/best-hospitals/area once you click on the closest major city the list of overall best comes up but you can also check how they rank by specialty for example this takes you to Boston area http://health.usnews.com/best-hospitals/area you can then click on hospital by specialties and Gold balls are if they are raned best in the nation, silver is best in the area etc.

PS Like others mentioned, if your valve is sever I would be talking to surgeons now if you haven't.

 

[Dash]

Kailin,

I used the same cardiologist for several years. He was well into his 70's and decided to retire last year. Every year I would have an annual checkup where he would ask me how I'd been doing, tell me I need surgery some day, listen to my heart and bid me farewell. It was like a rendition of "Ground Hog Day". This past year, I saw a new cardiologist who was in his early 40's. He talked to me a little bit about lifestyle, activities, prescriptions, etc... Then he pulled out his computer where he had graphed my last 10 years worth of echo's and showed me how my BAV went from Mild to Severe at each point during the cycle. He showed me some apps on his iphone of different heart applications, live video feeds, activity charts, etc...

He mentioned that my cardiologist was a very recognized and well respected doctor (practiced 49 years). But, being in his mid 70's, he probably wasn't in tune with some of the newer tools that could be used for heart patients and most likely, wasn't looking to new technologies when he had his eyes set on retirement...

Both doctors were effective and got the job done. You will just have to decide which one will fulfill your needs as a patient. I'm a techie, so I like a cardio that can lead me to new tools and options that may assist me in my care.

Good luck on your search!

PS. He gave me this site to take a look at: www.visibleheart.com. Click on "video library" and you can see some amazing videos of the heart.

 

[Jason]

I switched cardiologists after my surgery. My cardio before the surgery was not a very personable guy, and I wasn't too comfortable with him. However, I didn't think I would be having surgery for 20 years or so, so didn't pay it much attention. I went in for my yearly echo, etc. and that was it. Then his nurse called me to let me know that I needed to meet with a surgeon as my aorta had expanded and I would be needing surgery soon. I don't know that I should have expected a call from my cardio instead of his nurse, but she couldn't really answer any of my questions, etc. I went to the surgeon of my choice, and am switching to a cardio in her hospital/clinic. I am happy to be getting another cardio, as I was really soured by the whole experience on my original cardio. However, switching right at surgery time makes it difficult to get all your history, etc. across.

All that being said, I would find someone you are comfortable with, and don't worry about their feelings in this case. You need to be your own best advocate!

 

[yotphix]

I am a little younger than you (41 now) and have a cardiologist about your age. He is fine, and has given me excellent care. He wasn't available immediately following my surgery because of a conference scheduled in advance so young cardio on a fellowship with my regular guy was his stand in. I appreciated the fact that the new cardio whipped out his Blackberry and checked the AHA website to confirm a particular recommendation for me. Later my regular guy countermanded that order but it was clear that it was based on the old thinking on the topic.
My surgeon, by the way, was only 1 year older than me and a cardiac surgical nurse in the hospital I happen to know told me in advance that everyone agrees he is the best there.
If the young guy seems attentive and respectful, don't hold his age against him. At least, I wouldn't. As the others have all said though, it's about YOUR comfort. Prior to my surgery I sought the opinion of a second cardiologist without telling him anything about the first and I trusted my guy!

 

[joanie]

I'm 58 and over the course of the past 3 years all my doctors are now younger - much younger - than I am. I changed cardios twice before finding my current one a month before my surgery. He is 40 and he's a great doctor. My PCP is also 40 (they were med school classmates) and I couldn't be happier with the care I'm getting. Even my surgeon was younger than me (in his late 40s). I agree with what some others have said, the younger docs are more up to date on procedures and technology . . . especially is the medical backwater where I live.

BUT, you MUST be comfortable with your docs, especially your PCP and Cardiologist. I'm not quite a year out from surgery, didn't have any major complications, but have seen my Cardiologist twice since surgery and my PCP a bunch of times (some heart/surgery related, some other stuff) so they'll be a part of your life from now on.

 

[normofthenorth]

I agree with the folks who think it's worth the effort to go to Boston for the surgery. The problem with having a cardiologist who's there is that it's handy to be local to your Cardio, and you won't be. Several people here have a local Cardio and one at the big center, like CCF or Mayo, etc. They may chime in on how that works. I've got the luxury of living in the big Cardio city, so I've never had to solve that problem.

In my experience, the most talented professionals (in any field) can be found anywhere, including in smaller centers. But your odds improve with a talented surgeon (and cardio) AND docs who are experienced enough to have seen a number of patients with your condition, and variations on it. And if they're surrounded by a top team and top facilities, your odds improve again. Most cardiac surgeons do many more stents and bypasses than valve or Aortic Root "jobs", so the surgeons in a small center might not have as much relevant experience as you'd like.

While I was actually IN the hospital, post-op, I was in the care of the hospital's resident Cardiologist rather than my own. (I might as well have been from out of town!) After I moved back home, I saw much more of my PCP/GP (a brand-new and great young replacement for my recently retired great long-time PCP/GP!) than I did of my Cardio. My Cardio met with me a month or two after my discharge, then again at around 3 months to review the results of my 48-hour Holter Monitor test, to make sure I could safely stop taking Warfarin and Metoprolol. By then I'd seen and spoken to my PCP/GP maybe 20 times, including ~ once/wk to discuss my INR results. I'm at 4 months now, and I don't think my Cardio wants to see me until I get a stress echo, maybe a year post-op. So it's a long-time relationship, but not a very intimate one. . .

 

[Jkm7]

I live under an hour from Mass General and while at MGH, I had a cardio appointed by my surgeon. My regular cardio is with MGH associated hospitals but doesn't round at MGH. He knew my surgeon well and they coordinated my care. After discharge, it was a smooth transition for me to return to my usual cardio's care.

 

[drivetopless]

Definitely find a cardiologist you trust. Age is not necessarily the most important thing. Sometimes the seasoned doctors are a little burned out.

Anyway, I was looking at your AVA and your pressure gradients. Looks like you might be close to surgery sooner rather than later even without symptoms. With an AVA of .6cm2 you would definitely be in window.

Good luck!