Would you "shop" for a cardiologist to do what you wanted?

[tiered007]

6 months ago I realized I was having episodes of rapid heat beat, had event monitor for 30 days, it showed one episode do atrial tachicardia , which I was told could lead to atrial fib.  I was started on 320 aspirin.  End of November to January my thumbs and part of hands turned blue (almost purple), cleared up, turned blue again. I went to several doctors, when blue felt hot, and hurt (unable to touch)..in the end I was told either it was a small clot, or from my neck ( have had cervical surgery), I dosed myself with high amounts of aspirin, never turned blue again.  Three weeks ago went to the ER thinking I had food poisoning, it turned out to be ischemic colitis, which is caused from low blood flow to vessels leading to colon, cause can be a clot.  My GI doctor wanted cardiologist to start me on blood thinner, even though I was bleeding he would not take me off the aspirin, was in for 8 days.  I'm again wearing a 30 day event monitor, cardiologist is reluctant to put me on a blood thinner without proof of atrial fib, spoke already if event monitor shows nothing about inserting a cardiac loop (over night in hospital).  Went to hematologist today, results will be back next week, he looked at pictures of blue hands, he's not sure if clot, will wait for event monitor is finished, if shows nothing agrees with loop, but thinks starting a blood thinner is appropriate, he will want cardiologist to monitor, since they do this more then him. Ischemic colitis can be same as stroke, only clot went down instead of up to the brain.  I'm very frightened, and would prefer being on a blood thinner, even though cardiologist I'm seeing specializes in rhythm disorders and I like and respect him, I'm not sure if I'm comfortable not being on blood thinner. I'm seeing a neurologist next week, I'm having a problem remembering some things ?blackouts?  Do I go to other cardiologists till one does what I want?  I don't want to live in fear of a stroke.  Statistically cardiologist said I have a 20% greater chance of having a stroke???I'm really scared.  What would you do, I'm 59, under a lot of stress, structure of heart is normal, but I have other health problems.  

[tiered007]

Thanks for replying,  the need for an anticoagulant is there is a chance that I'm having some afib, enough that I passed a clot to vessels leading to colon.  Clots can go up (brain) or down(vessels leading to colon), which is thought to be a cause of my colitis...low flow.  I was frightened when I got out of hospital after 8 days that this can happen again and go up to brain.  EP is looming for atrial fib, wearing 30 day monitor, talking about implanting loop, old 39 monitor superb what could be a pre strip for afib.

[tiered007]

Thank you for your response, sorry I didn't write sooner.  I'm going to ask the EP all my questions when I go back on the 26.  If I'm not happy with answers will go for another opinion.

[Bromley]

I am not there, but on the surface, it sounds like this. The suggestion to put you on thinner came from the GI doc, based on testing that they did. The cardio may not have the ability to validate the testing (perhaps from a different office that does not have any implicit trust in the testers) and may be uncomfortable recommending thinner suitable to counter the affects of afib, espcially without any evidence of afib, or test results he can validate for the collitis. If he did, he could be held accountable for the risks of giving you a thinner. If you get the documentation, can you get him to prescribe the drug you need? If so, I know what I would do....

However, if you asked questions about his reluctace to give you a thinner, and the answers dont make sense, I think you have to consider a second opinion. If the doctor cut you short , I think you have to get more time from the doc to go over your questions again, or get a second person to explain the reasoning and/or give a second opinion. Your questions, all of them, should be answered. This is a separate issue.

You dont sound like you are afraid of getting an opinion that doesn't line up with the original opinion. As you know, differences of opinion provide you with an opportunity to understand differences in assumptions, as well as differences in reasoning. For instance, perhaps doctor 1 was able to validate some testing that doctor 2 could not. Given some documentation which validates the testing in a way satisfactory to doctor 2, will doctor 2 change his opinion? If so, the original conclusion can be validated.

Would you want a doctor that did not need to validate that information? This isn't the same thing as shopping. You are free to choose. It may actually make sense, if you need a faster decision to reduce what you perceive as a risk. However, my personal suggestion has to be to follow the advice of a doctor.

[tiered007]

I understand what you are saying, as much as I trust and respect the cardiologist (EP) I'm seeing, I don't 100% trust any doctor.  I've worked in cardiology,(I'm echo and vascular technologist, have worked in cath lab, and taught ultrasound both to students, residents and fellows (including my cardiologist).  Cardiologist I'm seeing is in charge of arrhythmia center at hospital know  for "heart", I knew him as a resident and fellow.   My husband has atrial fib, he is the one I chose to do my husbands 2 ablations, second one took with aid of medication husband is out of atrial fib, but continues to take Warfarin.  Yes, I trust him as much as I can  trust any doctor.  When he told me statistically I have a 17% greater chance of having a stroke after having single episode of ischemic colitis I was not happy, I feel even if atrial fib does not show.  I said this to both him and hematologist who agreed with me.  I know and understand ramifications of either choice, but feel choice should be mine as much as doctors.  Cardiologist (always a bit pompous) doesn't agree, I realize most people including doctors don't question him.  I know my GI doctor wanted him to start me on thinner while in hospital, but he wanted documentation first.

[tom_h]

I would want a cardiologist that I could put my faith in that whatever he chooses would be in my best interest, and would help me.  If you don't feel that with your current provider, regardless of his expertise and credentials, then yes, I'd shop for a new one.  You don't want to be second-guessing your physician.

[Jerry_NJ]

I don't understand the "need" for Afib to be put on an anticoagulant.   I do understand the need if suffering form Afib, as I do.

I have very good results taking Warfarin, some people have a lot of problems, and it has to be monitored closely until a performance is established.  I get a blood test once a month.

I forget, which doctor suspects a clot?  That doctor may be willing to address the blood "thinner" issue, it is a broader subject than just the heart.  I believe clots have to be cleared and I believe are sometimes done in the hospital using heparin (sp?).