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Another very interesting article there in this issue is titled : 'Exploring the Potential Role of Catheter Ablation in Patients with Asymptomatic Atrial Fibrillation: Should we Move away from Symptom Relief?" It is a very thorough look at this key issue and makes a compelling case for not just ignoring asymptomatic patients when it comes to offering ablation for them when appropby Shannon - AFIBBERS FORUM
Hi Karen, Happy thanksgiving to you as well! And no worries at all Karen, I didn't feel in any way that you were being offensive whatsoever to either me or Dr N. ... Far from it. Please understand, when I write these replies to given threads, I take whatever points, comments or questions from any of these posts that make for a good discussion and try to respond while always being awarby Shannon - AFIBBERS FORUM
Karen, First of all, while Dr N, is obviously a very busy ablation EP, he doesn't exclusively do ablations. He does full consults with ever patient and if he feels you are better off not doing an ablation now he will advise that and prescribe drugs or whatever is appropriate for the situation. He also does Lariats and Watchman installations as well, and if you live near him or are willingby Shannon - AFIBBERS FORUM
Thats a good plan Allan, But if you have a Cauliflower or even Cactus shape LAA, you might want to consider going with a Lariat procedure .. or if you might not quality for Lariat then Watchman as second tier option. It also all depends on the emptying velocity from your LAA. While an LAA isolation can certainly make for a too low velocity to avoid blood thinners, it is very possible to havby Shannon - AFIBBERS FORUM
Thanks for sharing this Dennis, as we discussed on the phone this past week too, it really does seem AFIB was your canary in the coal mine in this instance and as sorry as I am to have learned you have to go through this operation and recovery, it's a blessing they found it now and that you had time to get that index ablation with Dr N under your belt 5 months ago! That should make the whby Shannon - AFIBBERS FORUM
Lake, If you are looking for the best option in the Bay Area for ablation skilled EP you already know where to go it sounds like. Don't make the mistake of choosing an ablation EP because he or she seems like the best one who can see you the soonest! Please don't do that, you can get lucky that way but its a major role of the dice. Any active ablation EP with an established practiceby Shannon - AFIBBERS FORUM
Thanks Researcher, As usual, this issue of JAFIB has a number of interesting articles. This one is a good overview of LAA sealing systems, though it's a little light on the Lariat coverage and more focused on the various LAA occluding devices like Watchman, St Jude's Cardisc Plug, Amplatzer plug etc. Its certainly a growing area of interest and development with more options cominby Shannon - AFIBBERS FORUM
Yes Jackie, Coumadin with its slow ramp up time is completely incompatible with a short term and more or less very fast anti-coagulation protocol. Shannonby Shannon - AFIBBERS FORUM
Karen, Regarding Combining Nattokinase with Xeralto, while there is probably a workable combination with low dose Nattokinase and Xeralto we just don't know what that safe dose is at this point. With Coumadin it was much easier by using weekly at home INR testing one could safely titrate their Coumadin dose to be able to maintain a solid in-range INR while accommodating a safe daily Nby Shannon - AFIBBERS FORUM
The key thing to remember Paul, is that when it comes to nutrient therapy you want to get your advice from a highly skilled Functional/Integrative medicine MD who is board certified in this area. Just as much as in seeking out a highly skilled EP for ablation work you would dream of relying on the advice of a functional med ZmD for ablation guidance and to do your ablation and the same holds justby Shannon - AFIBBERS FORUM
Hi Barb, Good to hear things are going so well. And I agree, a case like yours was tailor-made for Natale and you are lucky to have had him in your own backyard for that first index, and possibly only, procedure. You're in good hands with Dr Barrett too and who will be in direct contact with Dr Natale as well so all is good. I suspect he will have some new set up in the area before tooby Shannon - AFIBBERS FORUM
Hi George and Chris, Thanks for your report Chris, generally Dr Natale prefers most patients who require anti-coagulation to be on continuous therapy. However, the new recommendation from Dr N which we discussed here several weeks ago is mostly for only some of his patients to adopt and is similar to a PIP-like protocol with Xeralto. The group of patients who he is most likely to recommend thby Shannon - AFIBBERS FORUM
Iatrogenia, FIsh oil and anticoagulation is very dose dependent. The typical doses used in most Omega 3 studies are far too low for a significant AC effect. Just look at anecdotal long term Eskimo histories among those tribes that often get excessive doses ( in the ten grams plus range) of Omega 3s from the fatty seals. whales and other cold water fish that is their staple diet. In addition tby Shannon - AFIBBERS FORUM
If you want a second opinion on the Lariat in your case, I would definitely discuss it with Natale. Your Cardio may well not be the gy to listen too on this matter. A local Cardio, I had to see a few times in a country hospital here in northern Arizona, tried to warn me away from first my follow up ablation with Natale and then later when I first brought up the Lariat to him. He was dead wrongby Shannon - AFIBBERS FORUM
Sounds great Lon, But why did your cardio not suggest you have a follow up ablation if you are still having AFIB issues?? Did he give any specific reason even if you have a preablation TEE to confirm no LAA or left atrial clots our SEC?! In any event, Id get a consult with a true expert like Natale in the US or at Bordeaux if you are in Europe and make sure they agree ... Chances are they mayby Shannon - AFIBBERS FORUM
Iatrogenia, The bulk of my information and experience with Nattokinase comes from quite a few in depth conversation with top functional medicine MDs, not only those I work with as a consultant for some of their patients, but also those well known MDs Ive had the opportunity to meet and get to know at the over 15 large medical conferences Ive attended to date in which these subjects are highligby Shannon - AFIBBERS FORUM
Hi McHale and Liz McHale, You never know, that could be a good fit as it sounds like a solid organization, time will tell which way the wind blows. And Liz, the issue with leaving St Luke's has nothing to do with Natale not being able to get along with others as you assume might be the case. Far from it, one of his most recognizable traits that almost everyone who has seen him and workby Shannon - AFIBBERS FORUM
JOey, As Jackie advised, start low at 500mg and gradually increase. Night time is most important and can help sleep too as it tends to be a calming amino acid ... though some can have a paradoxical effect on too large a dose for them as noted above, but that is much less common on doses of 3grams or under per day than it is to have the supportive and heart calming, intracellular ionic balancinby Shannon - AFIBBERS FORUM
Stephen. Andexanet Alpha is a promising potential reversal agent for all Factor Xa anti-coagulants such as Xeralto and Eliquis. Hopefully it will continue one with good results and, importantly, so far very little reports of any side effects through the approval process and get out into the field to all ERs and ambulances around the world. Then taking those NOACs will be much more acceptabby Shannon - AFIBBERS FORUM
Randy, Both St Davids in Austin, Natale's home base, and CPMC are excellent. I have had procedures and TEEs at both and wouldn't hesitate to recommend either one. Let you location be your guide. It might be a little quicker to see him in Austin simply because he is there at least 2 weeks per month. Shannonby Shannon - AFIBBERS FORUM
Hi Hans and afhound, For those Canadians not able to come to US or Bordeaux, I know Dr Natale thinks very highly of Dr Verma and recommends him. Shannonby Shannon - GENERAL HEALTH FORUM
Hi Barb, Keep your regular appointment and ask to see only Dr Barrett as you are familiar with him and get an EKG and ask him to communciate all that to Dr Natale who will be in touch with Dr Barrett in any event, and you can then arrange to speak with Dr N on the phone too after your Barrett meeting about your next 6 month follow up and TEE. Cheers! Shannonby Shannon - AFIBBERS FORUM
Hi Afhound, Yes it is my understanding that Dr Barrett and Dr Danik are still there at Al Sabah at this time, and both are trusted colleagues of Dr Natale who he will ask to work with the existing patient NYC base, as needed, on his behalf as well so that a smooth communication between the patients and Dr Natale will continue. And yes, its unfortunate that big hospital politics and businesby Shannon - AFIBBERS FORUM
A message for patients of Dr Natale in NYC, There have been some recent developments regarding Dr Natale’s association with the Al Sabah Arrhythmia Institute at St Luke’s Hospital in New York City that will be of interest to those patients who have seen Dr. Natale at St. Luke’s, or that are planning too in the near future. Some of you are aware that in April of this year Dr Natale accepted anby Shannon - AFIBBERS FORUM
So basically they are saying, in translation, that despite the fact that large double-blind clinical trials have yet to be done, the small amount of human trial evidence on Nattokinase does, in fact, indicate a noticeable blood thinner effect. However, we are not 100% sure of all the mechanisms for that effect ... but that is less of a negative than it might seem at first blush in comparison to mby Shannon - AFIBBERS FORUM
Hi Liz, It doesn't appear you got my drift from my reply above. In no way did I imply or suggest that learning how to eat properly and take care of oneself was the role of government, beyond perhaps encouraging, to some small degree, that folks take more personal responsibility for educating themselves and their families about making better choices in their life styles, diet how better tby Shannon - GENERAL HEALTH FORUM
Gay there are good and bad examples of medical insurance systems all over the world, Switzerland has a superb model, UK not so good and Canada works well is you have a true emergency but is challenging for more 'elective' procedures and can take a long time to get it done. The current US system before the Affordable Care Act has been a train wreck heading into a dark tunnel for someby Shannon - GENERAL HEALTH FORUM
Cost for self pay ablation with Dr Natale in Austin is approx $40,000 which includes pick up and delivery to Austin airport and 5 night hotel cost near St David's Zmed Crnter which is also very near University of Texas campus and not far at all from downtown Austin and the riverfront area. Shannonby Shannon - GENERAL HEALTH FORUM
Hi Liz, I avoid all supplements sourced from China, unless they have full cGMP certification and are backed by US companies the use pharmacuetical quality control methods in their production process. The one small cost in the form of requiring the buyer to educate themselves a bit and learn which of the many supplement companies are consistently reliable and trustworthy from the much smallby Shannon - GENERAL HEALTH FORUM
Hi Joey, as George noted, go ahead and start with 200mg dosing at first with the mag with your low levels then gradually increase every 4to 5 days slowly to bowel tolerance, if you are having no loose stool at all after 5 days at 200mg mag, then you could venture adding another 200mg increment, but from then on try titrating up in 100mg stages until you get up to mild to moderate loose bowels andby Shannon - AFIBBERS FORUM