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Old 11-29-2018, 05:40 AM
 
39 posts, read 10,790 times
Reputation: 44

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Quote:
Originally Posted by Travelassie View Post

In looking up information about use of flecainide as a "pill in the pocket" for paroxysmal atrial fibrillation, (as well as SVT, I see), there are many professional references quoting the success of stopping a-fib episodes in people who have them infrequently. So if that's you, it would seem that this approach by your cardiologist is entirely appropriate. And it seems one of the advantages of taking one dose of a drug infrequently is that you hopefully don't have many side effects, but the drug will be effective in stopping your arrhythmia.
I did some research on the drug. It was unsettling to learn that it apparently has a black box warning, one of the potential side effects being ďcardiac arrest.Ē However, I also looked at one of those sites where patients rate drugs and it has lots of reviews and terrific ratings ó 7.8/10, which is the highest rating Iíve ever seen for a drug. Apparently, it can be extremely effective with zero side effects. Also, all the relatively uncommon 1 ratings complained about severe side effects, not about the drug instantly sending a loved one into cardiac arrest.

I did read that one of the reasons that the drug is considered dangerous is that it could prolong the QT interval. However, in other explanations of how the drug works, I read that it doesnít really prolong the QT interval, but instead the QRS complex(?). Iím pretty sure that was it. In any case, it wasnít the QT interval per se. Also, metoprolol (which I already have and which is often prescribed in tandem with flecainide) works to normalize the QT interval, so if Iím really worried, i suppose I could take a low dose of metoprolol along with the Flecainide. Actually, if I ever feel I need the Flecainide as a ďpill in the pocket,Ē I think Iíll probably start with 1/2 the dose I was prescribed. My experience has been that I am almost always given too much medication. I am a rather petite female and it seems like I am always prescribed the standard ďadult doseĒ without consideration given to weight or metabolism.

Quote:
I guess what still makes me wonder a bit is that you don't mention the cardiologist attempting to get documentation of your arrhythmia, to see if it IS a-fib, or what else it may be. It is very difficult to catch it if it's infrequent, and if it's less than monthly even an event monitor might not do it.
I am supposed to be getting one of those watches which monitor and record your heart rhythm. I have to get on that.
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Old 11-29-2018, 06:04 AM
 
39 posts, read 10,790 times
Reputation: 44
Quote:
Originally Posted by tickyul View Post
Check for online-reviews.
Unfortunately, you just canít go with on-line reviews for doctors. (I am more comfortable with on-line reviews for medications.)

Do you remember the case of Dr. Farid Fata? (Look him up.) He was sentenced to years in prison for Medicare Fraud. But his worst sin in many peopleís eyes was that he actually told patients they had cancer when they did not just so he could pump them full expensive chemotherapy drugs! Well, he received many five star reviews on on-line reviewing sites and was considered a star oncologist in his community before he was unmasked. Scary.

An opposite example. About 3 years ago, I was diagnosed with a rare autoimmune condition (autoimmune inner ear disease) and needed to find a rheumatologist to prescribe the appropriate immunosuppressant and monitor my tolerance of the drug. I donít know how many rheumatologists I called. No one would take me on as a patient (ditto for the ENTs by the way).

Finally I tried this guy. I think he had a 2.5 star rating. I was leery, but I went with him. Well, he was great! His office was definitely eccentric ó only accepted cash, out-dated decor and Iím sure his receptionist had a personality disorderó but this guy (who seemed to be in his 60s or so) really seemed to know his stuff, always listened to me, and, when I finally did, after a year and a half, have a problem with the medication (which turned out to be amazingly effective), he called me at home as soon as he got the lab report to let me know I should stop taking the medication ASAP. A doctor calling me at home himself? What is this, the 50s? It was great ...

Anyway, all this to say that patients can be totally taken in by a doctorís self-promotion and flashy office or turned off by lack thereof.
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Old 11-29-2018, 06:08 AM
 
Location: The Driftless Area, WI
1,806 posts, read 673,338 times
Reputation: 3653
[quote=Jill_Schramm;53755244]... so if I’m really worried, i suppose I could take a low dose of metoprolol along with the Flecainide. Actually, if I ever feel I need the Flecainide as a “pill in the pocket,” I think I’ll probably start with 1/2 the dose I was prescribed. quote]


No. That's not the way things work. Don't treat yourself without a thorough knowledge of what's really going on.


"That does not compute." --- Robby the Robot


In regards your first visit impression: the guy was certainly distracted that day. If you really like him, give him another chance, but not two. If it happens again, it's his pattern and unacceptable.
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Old 11-29-2018, 10:26 AM
 
Location: SW Florida
9,247 posts, read 6,439,094 times
Reputation: 12941
Quote:
Originally Posted by Jill_Schramm View Post
Unfortunately, you just canít go with on-line reviews for doctors. (I am more comfortable with on-line reviews for medications.)

Do you remember the case of Dr. Farid Fata? (Look him up.) He was sentenced to years in prison for Medicare Fraud. But his worst sin in many peopleís eyes was that he actually told patients they had cancer when they did not just so he could pump them full expensive chemotherapy drugs! Well, he received many five star reviews on on-line reviewing sites and was considered a star oncologist in his community before he was unmasked. Scary.

An opposite example. About 3 years ago, I was diagnosed with a rare autoimmune condition (autoimmune inner ear disease) and needed to find a rheumatologist to prescribe the appropriate immunosuppressant and monitor my tolerance of the drug. I donít know how many rheumatologists I called. No one would take me on as a patient (ditto for the ENTs by the way).

Finally I tried this guy. I think he had a 2.5 star rating. I was leery, but I went with him. Well, he was great! His office was definitely eccentric ó only accepted cash, out-dated decor and Iím sure his receptionist had a personality disorderó but this guy (who seemed to be in his 60s or so) really seemed to know his stuff, always listened to me, and, when I finally did, after a year and a half, have a problem with the medication (which turned out to be amazingly effective), he called me at home as soon as he got the lab report to let me know I should stop taking the medication ASAP. A doctor calling me at home himself? What is this, the 50s? It was great ...

Anyway, all this to say that patients can be totally taken in by a doctorís self-promotion and flashy office or turned off by lack thereof.
I think from reading all those online reviews they tend to be more about personality than medical competence/expertise on the part of providers.

I've actually had a couple docs call me at home themselves this year. The first one was my primary doc calling to inform me of a positive stool occult blood result, telling me I needed a colonoscopy, and informing me of the name and contact info of the doc she was referring me to for this workup.

The second doc was a surgeon ( the same guy the primary referred me to), calling me with results of a gallbladder ultrasound and HIDA scan, explaining the results, and my options, including recommending surgery.

So I guess there are still some around.
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Old 11-29-2018, 11:04 AM
 
1,735 posts, read 2,807,988 times
Reputation: 1885
Quote:
Originally Posted by Jill_Schramm View Post
I had my first appointment with a cardiologist yesterday. There was a lot that I really liked about him and the way he related to me and yet I think there may be two red flags indicating that this is not the best, most careful, most professional cardiologist.

RF #1. During my consultation, he took a phone call from someone on the staff of another clinic and launched into a detailed discussion about the business end of his operation. He finally had the courtesy to finish the call outside the consultation room after I got my own phone out and started acting bored.

RF #2. I tried fulfilling a prescription he wrote me today and the pharmacist found three things wrong with it ó there was no quantity included, the dosage he prescribed was not a dosage this drug comes in and, finally, part of the script was illegible.


Obviously, neither of the above are great, but Iím wondering if they are enough to justify looking elsewhere.

Other red flags that you would like to share? I mean, besides overt problems like a bullying attitude and blatant incompetence?
Unacceptable, find another doctor right away.


I went to the doctor the other day as well, and this guy in overalls comes in a trades a pig for the doctor cutting off an ingrown toenail the week before.


A pig!


SS
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Old Today, 10:18 AM
 
12,555 posts, read 14,706,996 times
Reputation: 14363
Quote:
Originally Posted by oldgardener View Post
I can't believe he's still writing prescriptions by hand, haven't seen a doctor do that in years.
Every doctor I've seen still does it by hand. I'm always amazed that the pharmacist can read them.
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Old Today, 05:42 PM
 
Location: Foot of the Rockies
85,190 posts, read 99,420,985 times
Reputation: 31638
Quote:
Originally Posted by mapleguy View Post
Most MD's here in Canada don't "write " a prescription. They type it on their computer and then print it out and hand it to you or fax it direct to your pharmacy. Typing not writing, and in a clear easy to read format. Modern technology, right ?
It may come as some surprise to you, but many American MDs use EHR as well.
https://dashboard.healthit.gov/quick...quickstats.php
"As of 2015, nearly 9 in 10 (87%) of office-based physicians had adopted any EHR, over 3 in 4 (78%) had adopted a certified EHR and over half (54%) adopted a 'Basic EHR'. Since 2008, office-based physician adoption of any EHRs has more than doubled, from 42% to 87%, while adoption of Basic EHRs has more than tripled from 17% to 54%. Between 2014 and 2015, adoption of any EHR grew by 5%, adoption of certified EHRs grew by 5% and Basic EHR adoption grew by 7%."
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