Dr. Mandrola, Love your writing, thinking and so appreciate all you do for better medicine. I'm a lay person (former med device rep) that found you during my career trying to learn more on cardiology. I don't need your advice today, but I wish I knew for possible future use who are the EPs, cardiologists you would trust in my neighborhood (northern NJ). Cheers and happy Xmas!
I've had intermittent atrial fibrillation for decades with several failed ablations. I once took blood thinners, but for years, I have relied on high-dose omega-3 to prevent clots as outlined by my good friend Barry Sears:
As a once busy surgeon, I am in awe of your ability to take such great care of your patients and contribute so meaningfully to those of us fortunate enough to have found you on Substack. I appreciate your honesty and intellectual curiosity. I hope your patients have some awareness and gratitude for the care you provide. I loved my patients and my craft and you clearly do as well. My very best holiday wishes to you and your family.
Merry Christmas and thanks for so many great articles this year. Re PFA, I had it done in August. About 2 months later, went back into AFib and returned to normal after cardioversion. I had understood that during the 3 month blanking period this wasn't unusual. Anyway, nothing is perfect!
Merry Christmas and happy new year John. You might add a summary point that if I recall correctly came from the house of God. The key to good healthcare is to quote " do as much nothing as possible" - that seems to be the mantra for a lot of these procedures and the layering of multiple drugs.
The one negative seems to me that our healthcare system either broke after Covid or it's one of those non-causal relationships.
In my retirement, I've almost become a full-time patient advocate. I don't know if it's because the physicians and team are so busy or I'm just getting selected people reaching out. It's kept me reading more than I did when I practiced and I can still feel useful. I have to leverage the kindness of my colleagues, although I send them very nice interesting and grateful people.
My best friend 72 ,developed new onset severe depression that was debilitating. He was self referred for IV ketamine. No one bothered with an exam labs, etc.. I pushed him to go to internal medicine and even gave him a note saying please do a CT. He was given Zoloft. A week later, his wife took him to the ER and the golf ball size glioblastoma was found. It wouldn't have made a difference. He passed away nine months later.
It taught me we are all one ultrasound away from devastation. Be kind.
Every week I get a phone call from someone who cannot get in. They are clearly ill, but not emergently so they don't want to go to the ER. The other version is they've been in and essentially have been blown off. They are all older individuals with a high pretest likelihood of real illness.
There is another tier of health healthcare that I was not even aware existed.
When we were working with our weight loss program, we came upon a program for high net worth individuals. (These patients are not doctors :)) .
They essentially have access to a 24/7 Medical concierge that bypasses the system for them, no matter where they are in the world. They get instant access to medical care in whatever setting is most efficient. Insurance is irrelevant for these individuals.
In the TV show "blacklist." James Spaders character has medical teams on standby that can convert a warehouse into an OR in a moment's notice.
I just didn't realize this was true!
Merry Christmas and happy new year and thank you for educating all of us. (and Festivus for the rest of us)
The airing of grievances ceremony of Festivus should be a required meeting between doctors and hospital administrators every season!
Merry Christmas and thank you for all that you do!
Dr. Mandrola, Love your writing, thinking and so appreciate all you do for better medicine. I'm a lay person (former med device rep) that found you during my career trying to learn more on cardiology. I don't need your advice today, but I wish I knew for possible future use who are the EPs, cardiologists you would trust in my neighborhood (northern NJ). Cheers and happy Xmas!
John, when you say "Pulse field ablation is incredible", do you mean in terms of better safety or effectiveness outcomes?
Such a demanding field, EP, both intellectually and physically. Yet you find time to write with elegant clarity. Hats off to you!
I've had intermittent atrial fibrillation for decades with several failed ablations. I once took blood thinners, but for years, I have relied on high-dose omega-3 to prevent clots as outlined by my good friend Barry Sears:
https://drsears.com/do-omega-3-supplements-increase-the-risk-of-a-fib/
https://drsears.com/what-really-causes-afib/
I am a 77-year-old family physician, and so far, so good!
As a once busy surgeon, I am in awe of your ability to take such great care of your patients and contribute so meaningfully to those of us fortunate enough to have found you on Substack. I appreciate your honesty and intellectual curiosity. I hope your patients have some awareness and gratitude for the care you provide. I loved my patients and my craft and you clearly do as well. My very best holiday wishes to you and your family.
Foy’s addition a definite plus. More please
What method is the left atrial appendage to close it? A Watchman? A Clip? Curious.
Great update! - A greatful reader.
Merry Christmas and thanks for so many great articles this year. Re PFA, I had it done in August. About 2 months later, went back into AFib and returned to normal after cardioversion. I had understood that during the 3 month blanking period this wasn't unusual. Anyway, nothing is perfect!
Merry Christmas and happy new year John. You might add a summary point that if I recall correctly came from the house of God. The key to good healthcare is to quote " do as much nothing as possible" - that seems to be the mantra for a lot of these procedures and the layering of multiple drugs.
The one negative seems to me that our healthcare system either broke after Covid or it's one of those non-causal relationships.
In my retirement, I've almost become a full-time patient advocate. I don't know if it's because the physicians and team are so busy or I'm just getting selected people reaching out. It's kept me reading more than I did when I practiced and I can still feel useful. I have to leverage the kindness of my colleagues, although I send them very nice interesting and grateful people.
My best friend 72 ,developed new onset severe depression that was debilitating. He was self referred for IV ketamine. No one bothered with an exam labs, etc.. I pushed him to go to internal medicine and even gave him a note saying please do a CT. He was given Zoloft. A week later, his wife took him to the ER and the golf ball size glioblastoma was found. It wouldn't have made a difference. He passed away nine months later.
It taught me we are all one ultrasound away from devastation. Be kind.
Every week I get a phone call from someone who cannot get in. They are clearly ill, but not emergently so they don't want to go to the ER. The other version is they've been in and essentially have been blown off. They are all older individuals with a high pretest likelihood of real illness.
There is another tier of health healthcare that I was not even aware existed.
When we were working with our weight loss program, we came upon a program for high net worth individuals. (These patients are not doctors :)) .
They essentially have access to a 24/7 Medical concierge that bypasses the system for them, no matter where they are in the world. They get instant access to medical care in whatever setting is most efficient. Insurance is irrelevant for these individuals.
In the TV show "blacklist." James Spaders character has medical teams on standby that can convert a warehouse into an OR in a moment's notice.
I just didn't realize this was true!
Merry Christmas and happy new year and thank you for educating all of us. (and Festivus for the rest of us)
The airing of grievances ceremony of Festivus should be a required meeting between doctors and hospital administrators every season!