PCP or cardiologist

[Deb]

This question is for Dr. Fett and you ladies,
If you're on sleep meds or anti depressants, since diagnosis, who prescribes your medication?

When I was first diagnosed and in the hospital, my ob prescribed my anti-depressant. Obviously I'm no longer under the care of my ob and when it came time for a refill, I asked my cardio about a refill - he referred me to my PCP, who then, contacts my cardio again, to make sure it's okay. When I got my ICD and couldn't sleep afterwards due to the pacing waking me up constantly, my nurse suggested ambien. However, I had to contact my PCP, who then contacted my cardio again...etc.

The point of this question is that, I'm having real difficulty with my coreg. I'm talking psycho crazy woman. I discussed it with my cardio - he blew me off and told me to discuss it with my PCP and let him look at the "whole picture" and see what he thinks. I went to my PCP, discussed it with him, and he agreed that my emotional and psychological problems were not acceptable and that some type of medicine change was needed. That was 2 1/2 weeks ago!! He won't make any change (i.e. add'l anti-depressant medicine to offset some of the coreg side effects or a new BB) without discussing it with my cardio...

I feel like I'm being totally blown off here. It seems like a lot of you ladies have your cardios prescribe add'l meds as needed, am I right? CM affects us physically, mentally and emotionally. I feel like if I commit a murder/suicide here my cardio will say "at least, her heart was improving." Forget the fact that I ended up dead anyway!

Do any of you feel the same way or have you dealt with this issue at all? I live in such a small community and there is only 1 HF specialist in this area - other than traveling to Boston, I can't burn bridges here in case I'm ever in an emergency situation. Who do I turn to?

[julianameng]

Do you like your PCP? If so i would explain the problem to him and see if he can call your cardio and get him to speed up this process. This is frustrating and i am sorry you are going through this. Sometimes we have to be our own advocate.

[JAMESFETT]

For long-term care the input of the cardiologist (and obstetritian, if pregnant) are necessary, but generally the PCP is the coordinator and prescribing doctor who should be able to do all the renewing or changing with appropriate consultation and advice. Perhaps you and your team would want to change the carvedilol to metoprolol long-acting as a reasonable step to see how much benefit to your psyche ensues?

JD

[julianameng]

just read Dr. Fett post and wanted to say that cahnging me from coreg to toporol helped alot i was not so psycho anymore:) my hubby is the one that noticed and commented LOL

[Deb]

I LOVE my PCP. He was totally understanding when I discussed this with him. But, after a week, and I hadn't heard from him, I called his office and the nurse called back and said they hadn't heard from my cardio yet. Okay, so I waited another week. I called back. No return call.

Friday afternoon, I called again. My PCP wasn't in for the day, but I asked for the doctor in the office to return my call. He called back around 5:15 and basically said that there was nothing that could be done for me. When my PCP hears from my cardio, then he'll let me know. I tried to explain that this is getting to be a rather serious situation emotionally for me. He said "I'm not going to tell you to stop taking your meds and there is nothing that can be done today. Don't you realize it's after hours?" I thanked him for the call and hung up. Then, I sat and cried!

So, y'know when you reach a point when you just can't keep fighting? I'm at that point.

Thanks Dr. Fett, I thought this was a simple process of maybe switching me over to the Toprol XL. I was on that initially and have some left over. I'm thinking about just switching over to it on my own. I've got 50 mg twice daily.

[JAMESFETT]

Yes, I agree with you: work it out with your PCP. Let them know that your well-being depends upon the change from carvedilol to metoprolol long acting and ask them to help you know just how to do that. I'm confident your PCP will help you with this. When it comes to your personal welfare there are no "after hours."

JD

[sethsmom2000]

That absolutely blows my mind. My OB/GYN is considered my PCP, but my cardiologist does all my medication prescriptions. Of course, I haven't had to ask for anything not for the PPCM (other than antibiotics for dental work), so I'm not sure how complicated it would get. I do know that my OB defers to my cardiologist, but I assume they would work together if there were other medications I might need.

I'm sorry you're going through all this. It's ridiculous. My only suggestion is to get the Toporal XL prescription from your cardio and your Ambien and anti-depressants from your PCP and let the pharmacist figure out if there are any drug interaction problems.