Catheter ablation for PSTV on public funding?

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Sticker

6 posts

Wannabe Geek

# 209018 9-Mar-2017 13:17

Hi there. I'm completely new - this is my first post :)

I'm 44, female, and recently was diagnosed with PSVT (paroxysmal supraventricular tachycardia).

I've had this for at least 25 years, had it quite severely escalate for some months around age 30 and despite seeing several doctors over the years (plus a cardiologist at a time when I was asymptomatic), have only just had a diagnosis (to my immense relief). I am very confident (based on Googling symptoms and on trusting my GP) that the diagnosis is correct.

My GP recommended lifestyle management to avoid triggers, which I already do, but I don't think it's controlling it enough.

We discussed beta blockers and decided against them for now, as I don't want the side-effect of fatigue.

She told me to Google the condition, and I learned that catheter ablation is a procedure which many people with this condition find life-changing (in a good way).

My question is, can anyone advise how I would go about obtaining a referral to have a catheter ablation in NZ on the public health system?

What key phrases would I need to say to the GP (who may or may not be in favour of this); what (if any) tests would I need to ask to have; and what would I have to say to justify asking for those tests?

My GP said that if I have a severe episode, I should go to ED and ask for an ECG. Do I need to wait for this, or is there something I can do to get the ball rolling sooner?

Thanks!

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timmmay

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# 1733642 9-Mar-2017 13:20

Welcome to Geekzone :) Sorry to hear about your troubles.

I really think you need to get specialist advice here. Your GP is your entry point to the health system. If you're not happy with your GP you're always free to change to a different GP. I did that a few years back to get access to medication my first GP didn't want to provide.

Zeon

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# 1733643 9-Mar-2017 13:20

Do you know how much the operation may cost if you just pay for it? There is quite a bit of medical tourism these days - may also pay to check of the procedure price in other countries like Thailand?

Sticker

6 posts

Wannabe Geek

# 1733669 9-Mar-2017 13:27

Thanks!

I asked my GP whether there was a case for me to see a cardiologist again, and that is when she reviewed my history and diagnosed me. I guess I could go back and say that lifestyle isn't doing it and ask for a referral (and try a different GP if there is no luck there)?

I gather it costs about $30k to pay for. I've never bothered with health insurance because I thought that I wouldn't be eligible with a pre-existing condition (even though it was a 'mystery' condition until now). Medical tourism may be a good option, though, thanks (but I'd rather get it done in NZ on public!)

afe66

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# 1733674 9-Mar-2017 13:32

Just see your GP and ask for a cardiologist opinion at your local hospital.

The referral will be triaged at the hospital and an appointment made depending on the clinical urgency. Some of this may include how often symptoms occurring and proven recent ED ecg would probably get you more points.

Not all palpitations are svt. Also they would be interested in the actual pattern of svt as there are a number of different types.

If you don't want to wait you can pay to see cardiologist privately.

If the diagnosis was made overseas, you should contact that hospital and ask for copies of your old notes and particularly the egg which showed the diagnosis.

Ablutions are not done in all parts of the country either.

A.

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6 posts

Wannabe Geek

# 1733681 9-Mar-2017 13:45

Thanks for that info! I will duly do so (and I guess I can see a cardiologist privately but still go on the public list for any procedure)?

Some of my medical history occurred overseas, so I will set about making that contact ASAP

Thanks again!

itxtme

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# 1733746 9-Mar-2017 14:56

Hi Sticker,

Ablations are publicly funded, however as above not all patients are candidates for the procedure. Equally there are effective medications that help stop the triggers for many people, and in the first instance I would expect that to occur. When you say you are diagnosed what has formed this diagnosis? I would expect for the GP to have come to this conclusion that they have an ECG confirming the arrhythmia.

I think it would be unlikely you would be put forward for ablation publicly if the occurrences are not often and if you have not/do not require cardioversion (chemical or electrical). Ablation is not without risks, after all it is necrosing cardiac tissue.

EDIT: I see you have decided against Betablockers, these could be very effective and you can always stop taking them if the side effects are too unpleasent

Sticker

6 posts

Wannabe Geek

# 1733767 9-Mar-2017 15:33

Thanks! My GP didn't suggest betablockers at first (only confirmed they were an option when I asked about them). I said the main problem I had with the SVT (if it is that) was the fatigue, and she said I was having palpitations because of being fatigued rather than fatigued because of SVT. So that along with her reluctance to suggest them made me opt against them.

However, I'm finding the dizzy spells a problem too.

So on balance, I think I will follow your suggestion and go back and ask to try some betablockers.

The diagnosis wasn't based on an ECG, but my GP said the palpitations are hard to catch so I should go straight to ED when I'm having an episode where they're very frequent and ask to have an ECG when that happens.

I appreciate all the advice here - I really have had no idea what to do or how to advocate for myself!

itxtme

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# 1733815 9-Mar-2017 16:16

When you have the palpitations how long do the episodes last? Also are you able to take your own pulse? If you can wait until you are having an episode and take your pulse. If it is paroxysmal SVT then that rate will be 160+

I would be reluctant to try betablockers until the arrythmia is confirmed, as if it is something more common like vasovagal triggers then betablockers will worsen your symptoms. Other options if these are happening often is to get a holter monitor to record what your heart is doing over a 24 hour period. Again this would require a specialist appointment, and they dont give these devices out for long periods of time.

Sticker

6 posts

Wannabe Geek

# 1733825 9-Mar-2017 16:36

It varies from just very short episodes (I notice a couple of seconds) to maybe half an hour. I hadn't thought to take my pulse.

I did have a holter monitor 15 years ago, when I had weeks/months of more severe symptoms. My GP at the time found I had a very fast pulse and sent me to a cardiologist (this was overseas), but despite his best efforts to get me an appointment ASAP, it was weeks before I was seen and I wasn't having symptoms while wearing the monitor.

Perhaps I need to try to take my pulse and then go back to my GP and discuss either taking beta blockers or being referred directly to a cardiologist (who could prescribe beta blockers)? Thanks again!

afe66

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# 1734076 9-Mar-2017 23:25

Ultimately, while there are medical posters on GZ, you should talk to your GP and if needed ask to be referred to hospital or private cardiologist.

Be careful about paying too much attention to posters and (professional) posters should also be careful too of giving specific advice.

Sticker

6 posts

Wannabe Geek

# 1734575 10-Mar-2017 22:19

Thanks, all good advice! :)

Personally I would draw a distinction between medical information, medical advice, and what perhaps could be called process advice.

I wouldn't count anything in this thread as medical advice ('here is the treatment you need'), only as medical information ('this may help, this symptom is actually worth mentioning even if a previous GP didn't think it relevant, your mystery symptoms sound a little like this condition, do go back to your GP and ask again, do ask point-blank if anything more can be done because many GPs won't offer unless asked, do ask for a referral even if you previously drew a blank').

I think that medical information and process advice can help a patient to make their case to their GP (who otherwise might not be forthcoming), or show them how to access a specialist if they want to.

But I also agree that actual treatment (advice) should come only from people who have seen me. The answers on this thread should help me to make my case and access that help.

Thanks again to everyone who has replied to me!