New EP appointment

Prepared

by Lavender - 2023-01-03 22:13:51

I write in my iphone notes any time I have concerns that I want to discuss with my dr or cardiologist. A day or two before my appointment, I transfer maybe three very direct questions to paper. I walk in with that in hand. I ask permission to discuss it. It only takes a few minutes to ask and receive answers from the dr. Whittling the concerns down to just three succinct questions takes time. Prioritize. 
 

I hate that we have to tiptoe around and almost be intimidated about asking questions of medical professionals. My pcp is awesome and never acts hurried. My cardiologist can be rather dismissive and usually always mentions how many hours she works in a day. I will not be put off though. I'm there to seek help. Keeping it to just a few concerns seems to be the answer. 
 

I suppose we can always make another appointment with a nurse practitioner or other personnel/staff if we have a longer list. 

new EP

by new to pace.... - 2023-01-03 23:12:17

If you can take someone with you to write down their answers to your questions.  One time i just gave my typed questions to the doctor for him to write the answers.   left a couple of lines between the questions. Much faster that way also asked him to write legibly .

Good luck.

new to pace

Prioritize

by AgentX86 - 2023-01-04 01:06:33

Absolutely.  Also, if possible follow important threads, based on the answers but not too far.  There are more questions.  The trips down the rabit hole may answer others.  It's best to memorize the questions and just have a crib.  It's not an easy thing if you only have 10min (can't imagine being rushed like that).

Lavender

by Gemita - 2023-01-04 06:09:24

Lavender, thank you for your sound advice as always. Like you I jot down questions I want answering over a long period and then closer to my appointment day, I carefully select just a few to take with me.  I agree, I can always ask to go back and probably will be invited to do so, so I must try not to feel under pressure during an all too brief appointment. 

I like your suggestion of asking permission to discuss my questions first.  That will help me to stay focused on why I am there and will help my EP to know how best to help me.  I want to try to get away from focusing mainly on my symptoms this time as important as these are, and to focus more on treatment options including any possible pacing changes which might just help before going down the surgical route.

New to Pace

by Gemita - 2023-01-04 06:19:34

New to Pace, your tips are really helpful and thank you for your kind wishes. I will try to take someone with me.  As I can suffer from brain fog with my arrhythmias, I even thought about asking permission to record the appointment on my iPhone so that I could play it back and not forget what was said, but I suppose that might be invasive and put the new EP off, so I probably won't do this.

I know I need more time to process complex information and playing back a recording would certainly help.  I appreciate doctors always write a report after a consultation to confirm what was discussed.  Unfortunately these reports do not always arrive in the post and I am still not able to fully access my own GP records here in the UK even though I have an online account 

AgentX86

by Gemita - 2023-01-04 06:23:50

AgentX86, excellent points too.  I know I need to prioritise and not to try to cover too much with limited time and then come away feeling disappointed. 

I will try not to enter the consulting room with a long list of questions.  It just wouldn’t set the right tone.  I will certainly try to memorise a couple of important questions and to keep these firmly in mind throughout my appointment.  I hope I don’t go off track and find myself lost.  I am prone to doing this when I feel under pressure. If the EP is nice, that will make such a difference to the outcome I am certain

Big Decisions - Buy Time!

by Penguin - 2023-01-04 07:50:32

A few suggestions: 

Re: New EP -  Have you looked your new EP up on one of the private doctor sites which provide bio's, CVs, specialisms and areas of research interest and a photo?You may be able to find out the EPs ablation success rates too. Knowing a bit more about the EP evens up the balance of power a bit and gives you insight into the person.  It helps take the edge off meeting someone new.  

Re: Time Pressure - State that you are concerned that you have too many issues to raise in such a short time frame and that you feel pressured. You won't be the first or last UK patient to say this. Acknowledge how stressful it must be for the EP too, but stress that you haven't been seen for a very long time and need your Q's answered.

Perhaps then say something like, 'Can I tell you what I'd like from this appointment?' .

Tell him that you'd like a run down of the options available to you for treatment of your increasing arrhythmia and for him to itemise those options alongside the risk/benefits and likely outcomes. You could then throw this open to the EP.  

Outcomes: Tell him you'd like a re-cap in writing of the risk/benefits of each and the likely outcome in his clinic letter and a time frame to make some decisions.

Ask for his secretary's details in case you have further queries and obtain permission to contact her. 

During your discussion write down each treatment option and offer him a copy of this at the end. It's a bit contractual but it helps to focus everyone on the options that need to be explained in his letter. 

I'd also ask for a review date should you decide to try a new setting that might be suggested. Especially as waiting times for procedures such as ablations may be extended and you may opt to try something else first. 

The big question is the risks/benefits of the procedure - an ablation.  This is a significant discussion on it's own. I'd want a run down of the risks/benefits of an ablation and whether or not a different pacemaker with the settings you mention in your post (above) might remove the need for an ablation before considering an ablation.

I'm in the same boat - it's undeniably difficult to focus on the important stuff and not to go down rabbit holes which go nowhere. Let's see if I manage to follow my own advice .. or not! 

Hope this helps a little.  

All of the Above!

by benedeni - 2023-01-04 08:33:39

Gemita, I agree completely with all the well thought out replies above.  You will do just fine I'm sure.  Having read your response to Millie's post this morning I only can suggest giving hubby a hug, an "I love you but I'll see you when I get back!" 

What a wonderful soul mate he must be!  Fingers crossed you will really like and respect your new EP and that you get answers to all these questions.  Let us know for sure!

Penguin

by Gemita - 2023-01-04 10:30:42

Hi Penguin,

Thank you for your valuable contribution.  

Yes I have looked the new guy up.  He seems quite young to be a consultant cardiologist and electrophysiologist.  He trained in cardiac rhythm management at Barts Heart Centre and was a Consultant at the Royal Brompton and Harefield Hospitals prior to taking up his current position at Guy’s & St. Thomas.  He is a frequent speaker at national and international meetings and has written many research papers.   I have even managed to find a You Tube video of him interviewing one of my hospital consultants. 

Fortunately I already have some knowledge of what to expect from a regular pulmonary vein isolation ablation since I had an EP Study done a few years ago.  I was told by my former EP that I would probably require a minimum of two ablations to achieve a high level of control of my AF, but technology has no doubt moved on and a new pair of eyes may have other thoughts.

We are both at a turning point and how we proceed could affect our long term health.  I hope we both make the right decisions.  I think your appointment is probably earlier than mine, so I hope you will follow your own excellent advice Penguin and I will be keeping my fingers crossed for you too

Benedeni

by Gemita - 2023-01-04 10:42:05

Benedeni, thank you.  Hubby never likes being left at home, but on this occasion this will be the best place for him.  

Yes that is all I hope for, to respect, trust and have a good rapport with my new EP.  I like so far what I have seen and heard.  The only concern I have really is how my heart might behave if I have an ablation, whether I would really be better off.  I have been given mixed messages so far so I will value the new EP's opinion.  I will of course post an update after my appointment

Your two cents worth were well worth receiving

by Gemita - 2023-01-05 13:30:34

Thank you Mary, yes I will be hard pressed to get through everything in 10 mins, but perhaps he will allow more time if the waiting area is quiet.  It is a late morning appointment, so I will probably be the last on his list (hope he isn’t hungry).  

I have got some excellent advice now to plan how I approach my appointment and I am sure with careful prioritising I will cover what is important and leave behind what is not.  I will take with me all essential paperwork on past medical history, to save him having to go through my thick file to locate it;  that should save time.

The new consultant looks and sounds really caring, so may be it is a blessing that my former EP has departed and that a younger, more dynamic doctor has taken over.  I am sure he will come up with new ideas and will have an opinion on how best to proceed.  

I received a letter yesterday about a change in the location of my appointment because of disruption due to nursing strikes in the main London hospital.  At first I thought it was a cancellation but the new location will actually be better for me travel wise.

I hope you are doing well Mary and have recovered from your fall?  I will write privately with all our news when I get a moment.

New EP Appointment

by Flo - 2023-01-05 20:50:59

Gemita,  I am glad you have the appointment with the new EP and hope it works out well.  I also haven’t seen the EP since before covid but see the Cardiologist or his NP every 6 months. The Cardiologist is preferred as he and his staff work with me.  I am still nervous though because of the white coat syndrome and the time spent concerning high blood pressure from that.  The last PM check in Nov. showed zero episodes of afib however.

There are good comments here, I will just say that I take a list of questions with the most important ones at the top. Some of the questions get answered before asking.  

I would like to hear what your EP says about your atrial tachy arrhythmias.  Best wishes.

Flo

by Gemita - 2023-01-06 11:43:44

Flo, thank you for your kind wishes.  You are doing well with your AF and that tells me that you probably have your blood pressure under firm control because high blood pressure can be a trigger.  A one off spike at your appointments shouldn't cause any harm and most doctors know all about white coat syndrome anyway and usually want patients to take their own blood pressure at home for at least a week to see whether their blood pressure is really of concern.

Yes I think I am well prepared for my appointment now and I will certainly post an update after my appointment and hope it will be packed full of good information for other members with AF. 

Questions, questions...

by FG - 2023-01-06 16:15:51

Hi Gemita! Thank you so much for welcoming me on this site when I first joined. Seems we both are in need of some answers re: aFib and pacing. I agree with the above try to have 2-3 questions of the main concerns. Any more and my EP starts sighing. I started a new thread. Please let us know the results of your visit with the new doctor. I wish you the best. Remember it's your body and you deserve to get answers. I am keenly interested in what he thinks of pacemaker and medical combination to maintain NSR after cardioversion.

FG

FG

by Gemita - 2023-01-07 10:32:04

Thank you so much.  It has been a long wait to see my EP, but hopefully it will be worth it.  

I have added another comment on AF to your new thread in case it helps.  You still have time before the date of your implant to get some more information from your EP/clinic if you wish, although I appreciate there may be a certain reluctance from your EP to say much more at this stage until he can assess the results of LBB pacing.  

I will try to cover pacemaker/medical combination of treatments to maintain NSR during my appointment FG, since I am also very interested in learning just how much a pacemaker can do for us.  There are some fancy algorithms, programmes, settings that can be adjusted to suit each one of us, depending on our pacemaker age, manufacturer and model.

seeing EP

by new to pace.... - 2023-01-07 14:07:16

i have not seen an EP since i had the implantion of the Pacemaker in Aug.2019.  See the cardiolgist once a year.  Also the yearly in office Pacemaker check.

new to pace

New to Pace

by Gemita - 2023-01-08 15:56:54

That is a good sign that your arrhythmias are relatively well controlled.  An EP doesn't usually have to see us unless we need specialised treatment.  My new EP is also a consultant cardiologist so hopefully he will have a few answers.  

Some of us may never see an EP because a cardiologist is well able to look after pacemaker patients with arrhythmias.  Hubby has never seen an EP for his arrhythmias.