My cardiologist went AWOL

I had some flippy flops and irregular heartbeats over the weekend. Never had them before-so when my normally low bp went up, I called the cardiologist on call. It's a two cardiologist practice-with each seeing their own patients but they take turns being on call.

The male dr happened to be on call and nicely explained to me what to do and the plan forward. I was to check and write down my bp for two days. He said the monitor company would be in touch with the practice if it caught anything. He also asked me if I have A fib...and I said I have never had it before. 

We both agreed it may be stress related-having just learned that my boyfriend has an unerupted brain aneurysm-AND -in finding that out-it was learned that he is congenitally missing part of his carotid artery as well as having missing or undeveloped other arteries in his head😵‍💫. I'm also having extra stress with other family matters du jour. The cardiologist said to call the office this morning. 

I actually really like the male doc and his calm manner and reputation for excellence. He wasn't taking new patients, so I ended up with his female partner a few years ago when my cardiac journey started with pericarditis. 

The female cardiologist is excellent as well but is really nasty with yelling and intimidating people. I've had to stand my ground with her more than once. She will be there in the hospital and fight for good care in the hospital but her bedside manner is atrocious. I offered to leave her practice before but she apologized to me for her manner...and my pcp encouraged me to stick with her. 

So things calmed down and I kept a journal of bp readings-and called in this morning.  I asked for the usual smarmy nurse who is in charge of getting monitor readings. I was told she's no longer working there.  Then I asked about relaying my message to my cardiologist. To my shock-I was told SHE is no longer there or even in our city. Apparently, she left the practice in December and said that she was sending letters to her patients and telling them -if they wish, they could see her in her new city-and the hospital there.

She never sent the letters out and the practice didn't know that, assuming she was contacting patients. So I haven't had a cardiologist for a month and didn't know it🙄

The male cardiologist is seeing anyone who calls in and the practice is scrambling to call all scheduled patients and offering the choice to see him or travel to see her (twice as far from my home). They hired in a PA to help out and they're gradually notifying patients with already scheduled procedures and visits.

In any case, I am delighted to know that the male doctor is taking me on as his patient.  I am stunned that the female left without notifying her patients! (I don't care if I see a male or female doc, just designating them that way so they can remain anonymous!)



Quite a Post!!

by Penguin - 2023-01-23 16:20:46

Wow, not sure how to react to that.  You've had an eventful time for sure.

So sorry to hear about your boyfriend btw. No wonder you're stressed. He must be too! I hope that you both get some answers that help him. 

In terms of your AWOL Doctor - do doctors usually contact their patients when they change location in the US private system?  We don't get notified in the UK on the NHS, they just leave - in droves currently!   Of course it could be personal and they don't want the hundreds of patients they're allocated to follow and are more than pleased to leave such an enormous workload behind!  However, it's clearly unusual in the US - hence your post and surprise! 

Seriously though, I'm pleased you've got the doctor you always wanted. 



Private doctors

by Lavender - 2023-01-23 16:29:28

We don't have national health care. It's privately chosen doctors in independent practices or in some cases, they're employees of bigger systems. 

If a cardiologist leaves the area, you seek out a new one based on the pcp's recommendation or just choosing your own. Some folks get suggestions from their friends. Lol 

I was surprised to hear that my monitor results may take two days to get back to me. If it was a true emergency, they would know right away. So, I am thinking they found nothing. 

Thx I am pleased too, Penguin. I'm apt to choose a doctor based on expertise, not just bedside manner. But this should be nice having both for a change! 


by AgentX86 - 2023-01-23 16:41:02

It's unusual for a PCP to pack up and leave in the middle of the night but fairly normal for specialists, unless perhaps you're a regular. PCPs have a more intimate relationship with their patents and give warning so another can be found before the doctor actually leaves. Mine was a little differen. He died in a car crash. 😵

Patients with appointments with specialists will usually be warned and rescheduled with someone else, if possible.

I had a thoracic surgeon with an abysmal bedside manner but I didn't care.  He wasn't auditioning to be my BFF.  I only saw him three times (once before, once just before, and once several weeks after) so I didn't care about his personality.  OTOH, my cardiologist is the nicest guy you'd want to know. My EP was pretty good, too.

IME, PAs are very good.  They don't tend to have a God complex and have more time to spend with patients than doctors.  I see my neurologist's and vascular surgeon's PA about half the time. Other specialists I see don't have PAs.

Yes, stress can cause all of these problems.  I suggest that you make sure you're eating reasonably well and make sure you're well hydrated and that includes adequate electrolytes and not from "sports drinks".


Wishing you and the family lots of strength

by Gemita - 2023-01-23 17:13:30

Lavender I am so sorry to hear your news. That sounds really worrying about your boyfriend.  Do they intend keeping an eye on things, or are they going to treat the aneurysm?   

Not a respectful way to treat patients and I was surprised to read about your female cardiologist but it seems that the outcome will be a favourable one for you, so perhaps it was meant to be.

With regards to the unusually high BP, when I get an arrhythmia like AF, it is usually the first thing I notice:  an unusually high Blood Pressure.  In fact it can be so volatile going from one extreme to the other, either hitting the roof or the floor, no wonder it can be so dangerous and lead to strokes.  Perhaps that is why your cardiologist asked whether you have AF?  Both blood pressure and heart rate can take off or crash with AF.  It happened once when I was actually in hospital seeing my cardiologist and they couldn't believe my Blood Pressure figures and I am a patient who suffers from severe hypotension!

Lavender I send you lots of strength to get through your difficulties and hope that your boyfriend’s problems can be controlled and that you will both, and all the family, remain safe.  You are usually so good at dealing with stress and giving advice, so please promise me you will practise what you usually recommend for others? xx

Thank you

by Lavender - 2023-01-23 18:51:55

Thanks for all your input. 💜🌸
My BF (long term cohabiting lifepartner) saw the neurosurgeon today. He said that we have four arteries to the brain. BF is missing two-the right carotid and the right vertebral. To compensate, the remaining ones are larger. The formation in his brain which was diagnosed as an aneurysm might well be a malformation of the blood system. (It’s in an area between the eyes low on the forehead.) 

To further rule out whether this is a true aneurysm or not, the neurosurgeon ordered brain MRI and MRA’s with dye to check the blood system from the chest up through the brain. It may help see a possible cause for the intermittent double vision he has experienced.

Thankfully, the neurosurgeon said he doesn’t want to miss anything but thinks it might be ok. In any case, it would be monitored yearly with CT scans. God is watching over and we are both so glad to have such a knowledgeable efficient neurosurgeon who’s checking in detail to make sure.

As for A Fib, I do wonder if it was that. Not ever having it, I don't know what it feels like. My heart felt like it would beat out of my chest, I wasn't dizzy or in pain, there were strings of real hard beats which didn't feel like PVCs-which I do recognize.  The heart felt like it was doing jumping jacks. It was impossible to ignore. The more it did that intermittently, the more anxious I got noticing it. It was off and on for 19 hrs-part of which was me sleeping at night. My normal bp is 124/78 pulse 60's. It went to 192/96 pulse 94 and I called the cardiologist emergency number.

Just his voice calmed me. 
Soon it went down to 144/75 pulse 79 as he spoke to me. This morning it's my normal 122/77 pulse 67. 

I don't usually outwardly show stress in crying or yelling or reacting. I'm laid back. I think I am fine but my sneaky subconscious reacts. It's been a highly stressful week-dealing with being executor closing bank stuff, paying inheritance tax for some relatives who inherited their uncle's estate (as a favor to BFs uncle), having nursing home mishaps with my mom, other family matters. The worst was the DX of BFs aneurysm which now we know, may not be as deadly as thought. 

Whew. I'm hoping that I'm not developing A Fib but if I do-will cross that bridge. Assuming nothing showed on monitor and male cardiologist thought A fib WOULD show up on it. 
Meanwhile, I took a Ferris Bueller's day off and canceled all plans for a few days to live in pajamas and enjoy seeing the beautiful snow.  


God Bless

by Good Dog - 2023-01-23 20:51:02

I am sorry to hear the troubling news about your BF. Although it did sound a little more encouraging in your last post. I think that we all are occasionally reminded that there are no guarantees in life. All we have is today. Really, just this moment. My stroke last month was certainly a reminder for me. I was very fortunate to have survived that, especially without any serious disability. We really do need to try to live each day to the fullest. BTW: I love reading your posts. You are always so thoughtful, kind and helpful to others. Both of you will be in my thoughts and prayers!

As for the possibility of you having AF, I am sure you know that stress can create all kinds of different horrible symptoms that absolutely mimic almost exactly similar more serious disorders. When really stressed-out, I have experinced shortness-of-breath, gastrointestinal disorders, lots of benign but really troubling palpitations, high blood pressure and more! Only to eventually find-out it was all stress related. My point is; you may be pleasantly surprised if your stress decreases or just goes-away, hopefully so will your AF symptoms!

BTW: I had the same experience with a female cardiologist almost twenty-years ago. I went for a scheduled appt and was informed that she was gone! Nobody would tell me anything. I was able to find her in a different practice about 6 months later, but it was nowhere close-by. Actually, I have lost multiple doctors (at least three cardiologists that just stopped practicing to go into the private sector), but only one in which I was not notified. It seems that doctors leaving their practice is happening more frequently of late here in the states. Not sure exactly why, but I surmise it is about $$$.

Anyway, I hope you have many happy days ahead. You deserve them!



Much appreciated!

by Lavender - 2023-01-23 21:18:49

Agentx86-yes staying hydrated is so important! I only drink water or herbal teas-no other beverages. I'm more relaxed at knowing there's not imminent danger of a brain aneurysm erupting.

I'm shocked that a cardiologist would just abandon her patients! I worked for a dentist who was getting old and worried about who would care for his patients when he couldn't work anymore. He stayed and stayed on...too long really, he vetted replacements for his practice, but felt responsible for his patients. 
One night he died in his sleep. I ended up helping sell his practice to a young dentist. Being responsible for your patients would seem to be paramount. 

Dave-your kind words are very comforting. After my first post...we got the consultation with the neurosurgeon this afternoon-who even let us tape his entire commentary. So good to know we can listen to it and catch anything we might not have processed. He thinks all will be well. BF is more at ease, too. 

Anxiety sneaks up sometimes in weird ways. Last night I was asleep and woke up with adrenaline type tremors.  Shook uncontrollably for 20 minutes. This has happened before and my neurologist told me it's a result of fear and anxiety. I'm sound asleep and it's happened! Having those was what led me to meditation tapes, cognitive behavioral therapy and other self help forms of relaxation. 

The thing is that now with the pacemaker, I am not knowing if it's the heart or anxiety. As you said, conditions can mimic each other. I honestly couldn't tell the cardiologist if it was A fib because I don't know what that feels like. I also was surprised to know that my latitude monitor can report A fib. 

What does AF feel like?

by Gemita - 2023-01-24 05:32:22

Your partner’s condition sounds complex and I am so glad it has been found and will be watched.  Clearly he has started getting symptoms and your neurosurgeon isn’t leaving any stone unturned.  You are indeed in a safe pair of hands.  Please keep us updated.

It is important that we don’t focus on a condition like AF that you may never get.  Many of us may slide into an arrhythmia like AF during a stressful period and this type of AF is often referred to as “Lone AF”.  It may happen only once and never again, or it could be the start of having intermittent episodes of AF.  As long these episodes start and stop on their own in an otherwise structurally normal heart and you are anti coagulated if you have risk factors and can control the heart rate and blood pressure during episodes, you should have no problems.  This has certainly been my experience as a "Lone Afibber".

What does AF feel like?  It seems as though your arrhythmia episode was significant because of your difficult symptoms and the fact that you say the symptoms continued on and off for 19 hours. 

My personal brand of AF starts with a horrible sinking feeling, a noticeable slowing, pausing, irregular heart beat which is initially felt in my epigastric area, then rapidly spreads across my chest, up into my neck and head.  My chest feels like it is quivering, fibrillating, vibrating, thumping, pounding, fluttering and the heart rhythm starts racing, slowing, skipping, stopping, starting, flipping, flopping, irregularly beating.  It is the “irregularity of rhythm” that affects me most and usually confirms AF although benign atrial and ventricular premature beats can also cause similar symptoms for some of us.  Because my blood flow during AF episodes is adversely affected, I can always expect both tachycardia and bradycardia symptoms, even with a pacemaker.  With an irregular heart beat, how can blood flow ever run smoothly?  Result, just as with our heart rate, blood pressure becomes volatile too, surging/crashing which is why AF can be so dangerous.  And our pacemakers cannot do anything about high or low blood pressure, nor high heart rates.

When I was in hospital seeing my EP on one occasion trying to get my medication sorted, my blood pressure suddenly soared to around 220 over 125 as it was being measured and my heart rate was doing somersaults as my AF suddenly started.  Fortunately this doesn’t happen too often any more.  I think this would be stroke territory if it wasn’t controlled.  Are you hitting the menopause Lavender?  I first noticed heart rhythm changes around this time, especially when my cardiologist stopped the HRT patches.  Everything seemed to deteriorate from then on.

Long term monitoring will be the key to finding the culprit, but if you can find that inner peace, you might be able to avoid deteriorating symptoms like this happening again xx

Gemita, your halo is showing 💜

by Lavender - 2023-01-24 08:58:03

Gemita, my first thought in "meeting " you is that you're an angel. Unseen, not in person, messages of hope and understanding come through to encourage and uplift. Yep, you're an angel. 

You perfectly understand my confusion in what A Fib can feel like. What you describe:

"My chest feels like it is quivering, fibrillating, vibrating, thumping, pounding, fluttering and the heart rhythm starts racing, slowing, skipping, stopping, starting, flipping, flopping, irregularly beating."

That's it! That perfectly states what I felt. Lone AF induced by stress sounds right. Thank you for putting into words the heart gymnastics that I couldn't adequately describe. It was not painful in any way, but it was exhausting! Before it started, I was suddenly extremely tired and slept a couple day time hours. Once the pounding and vibrations started, it was relentless. I'm hoping it was a one and done. Not hearing that there was anything amiss on my monitor report is reassuring too.

Menopause is almost two decades in my rear view mirror so that adventure can't be blamed. 😘. I'm open to wherever this life journey leads, but I'm sure grateful there are people on the path ahead of me taking my hand and leading me through the wilderness. 

💜 Lavender

by Gemita - 2023-01-24 13:57:30

Oh Lavender, am I really an angel.  Can you tell my husband?  He doesn’t seem to appreciate my qualities at all, especially when I inject insulin, withhold his favourite foods and make him dizzy with his blood pressure meds.

I certainly understand the confusion we find ourselves in when an arrhythmia like AF strikes and I am glad I have managed to pull you out of the wilderness.   But you describe so well yourself the fatigue that comes with an arrhythmia like AF.  Most patients with AF mention the overwhelming fatigue they feel after an episode of AF which can last for hours.

Thank you so much for your lovely post.  You have made my day xx

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