Cardiologists - Heart 

Mayo Clinic has 216 cardiologists (Rochester, Phoenix and Jacksonville) 

Jacksonville Mayo Clinic has 28 cardiologists

Mayo Clinic has 72 doctors who are part of heart transplant teams (Rochester, Phoenix and Jacksonville) 

Jacksonville Mayo Clinic has 14 doctors who are part of heart transplant teams

 

What follows is my first experience at the Mayo Clinic. All the tests are done on campus with a short walk between buildings and even time to get a cup of coffee and sit outside between tests.  I did not wait any time beyond the scheduled time for my first meeting with Dr. Sher and for all the tests I took July 30 and July 31, 2018. All the results were on my Mayo Clinic portal within hours or, rarely, the next day and are still available.  My insurance information was recorded before I even arrived the first time at the Mayo and all the tests required me to go up to the reception desk where the test was to be conducted and give my name and date of birth. No forms, no insurance information has ever been requested since before my first visit July 30, 2018 to my last visit 9/21/2021. 

 

Monday, July 30, 2018 at 8:00 am first met with Dr. Sher, my main doctor at the Mayo Clinic then tests Monday and Tuesday. 

 

Thursday, August 23, 2018 got more lab work and bone marrow test at the Mayo Clinic.

 

Wednesday, August 29, 2018 met with Dr. Sher at the Mayo Clinic.

Thursday, August 30, 2018 met with cardiology consultant, Dr. Amanda Howard.  MRI and nuclear stress test conducted. 

 

I began chemo coordinated by Dr. Sher at the Mayo with Dr. Steven Newman at the Naples Florida Cancer Specialists on Monday, September 14, 2018 with a meeting with Dr. Steven Newman for the first time.

 

Monday, September 17, 2018 for the first time chemo treatment of dexamethasone (morning of Velcade shot) and acyclovir (everyday) and receive Velcade shot at the Naples Florida Cancer Specialists. 

 

Here is what the Mayo Clinic can do in two days. 

July 30, 2018 and July 31, 2018 were my first visit to the Jacksonville Mayo Clinic, 

 

July 30, 2018 test:

Blood Pressure

Pulse

Met with Dr. Sher for one hour 8:00 am See below for Dr. Sher’s notes 

Echocardiology image Exam

Echo Transthoracic (TTE)

Complete Blood Count

Monoclonal Protein Study

Liver function panel

Natriuretic Peptide Lever (Heart Failure)

Troponin T lever (heart damage test)

Immunoglobulin Light Chain Levels

Renal Function Panel

Beta 2 Microglobulin Serum

ECG

 

July 31, 2018 tests:

Monoclonal Protein, Urine 

 

NM Cardiac Perfusion Rest and Stress Spect imaging (Single Photon Emission Computed Tomography) (A nuclear medicine Myocardial Perfusion (MIBI) exam is used to study the structure and function of the heart. A small amount of radioactive tracer is injected into a vein in your arm and flows proportionally to the heart muscle, showing structure and function of the heart.)  done by Amanda Howard

 

NM Cardiac Perfusion Imaging 

 

Dr. Sher’s notes from 07/30/2018 - AZ/FL Conversion Encounter

H&P

Result Type:         Hematology Comprehensive H&P

Result Date:         30 July 2018 09:34 EDT

Result Status:       Auth (Verified)

Result Title:          Al amyloidosis

Performed By:      Sher MD, MBBS, Taimur on 30 July 2018 09:35 EDT

Verified By:           Sher MD, MBBS, Taimur on 30 July 2018 10:05 EDT

 

 

*Final*

Source of referral: Self.

Reason for the visit: Newly diagnosed AL amyloidosis (incidental finding)

History of present illness:  A very pleasant 75 y/o male visiting us today accompanied by his wife from Marco Island, FL.  I am summarizing relevant medical history in the following:

-Ever since childhood has had some GERD related symptoms and was having periodic endoscopies. A scope on 4/17/18 and  noted erythematous duodenopathy, non-erosive gastritis, small hiatus hernia, multiple gastric polyps.

 

-Underwent a repeat EGD for therapeutic resection of polyps on 5/22/2018. At this time one duodenal and multiple gastric polyps were resected.

The pathology evaluation of these specimens is summarized in the following:

Duodenal bulb polyps: Involved with amyloid. The gastric polyps were fundic polyp and not involved with amyloid. The amyloid type was determined to be lambda light chain AL.

Importantly, he is rather asymptomatic. In particular no symptoms of progressive shortness of breath, dizziness, syncope, altered bowel habits, neuropathy, bone pain, chest pain, difficulty swallowing, early satiety, unusual bleeding. He lost about 8 Ibs without much explanation but that has stabilized.

Overall has a good sense of wellbeing.

Review of systems: negative.

Allergies:

No known allergies.

Medications:

Aspirin, losartan, omeprazole, topical eye drops, vitamin B12 injections.

Past medical history: Hypertension well controlled with medications. Dyslipidemia.  Glaucoma- treated with medications. Nephrolithiasis.  Scarlet fever as a child.

Social history:

Lives with his wife.

Owns a school locally.

Stopped alcohol consumption a few years ago.

No smoking.

No other substance use.

No risk factors of HIV, Hep B or C.

Family history:

No cancers in family.

2 children in their 40's. Daughter has Crohn's disease.

Physical examination: A very pleasant white male in no acute distress he appears younger than the stated age. Awake, alert and oriented X 3.

 

Temp: 36.9 C

Height: 182.5 cm.

Weight: 76.9 kg.

Pulse: 84

BP: 125/80.

ECOG PS: 0.

HEENT: PERLA, EOMI. Oropharynx is clear no mucositis.

CHEST: Clear to auscultation bilaterally.

HEART:S1,S2 RRR

ABDOMEN: Soft, non tender, no organomegaly.

EXT: No cyanosis, clubbing or edema.

LYMPHATICS: No adenopathy.

NEUROMUSCULAR: No focal abnormalities. Normal gait. DTRs are symmetric in upper and lower extremities.

SKIN: No bruising or purpura.

AMYLOIDOSIS SPECIFIC SIGNS: No macroglosia, amyloid purpura.

 

Data review:

I reviewed outside pathology reports that he brought and included LCMS report of amyloid tissue indicating that this is lambda light chain AL.

 

Assessment and plan:

A very pleasant 75-year-old white male was otherwise very healthy is noted to have incidental finding of lambda light chain AL amyloidosis on duodenal polyp biopsy.

 

Over the course of today's evaluation we discussed the following:

 

The diagnosis of amyloidosis, its various subtypes, clinical presentation, overview of treatment.

 

In his case the most important aspect is to complete the workup for systemic disease in determine if we are dealing with systemic or localized form of AL amyloidosis.  I will start with complete blood count, renal, hepatic function, monoclonal protein studies in the serum, 24 hour urine studies, E electrocardiogram, echocardiogram, cardiac biomarkers.

 

After reviewing these we will determine the need for bone marrow aspiration and biopsy.

 

Clinically, I do not suspect we are dealing with advanced AL amyloidosis as he is rather asymptomatic without any clinical evidence of cardiac, renal, hepatic, extensive GI tract involvement.  However, it is crucial to complete the workup.  We will follow-up on the results and then plan next steps.

 

All of his and his wife's questions were answered to the best of their satisfaction.

 

Mr. Andrew Donaldson RN met with the patient and will help coordinate the plan of care.

Total time 60 minutes with 65% of time spent counseling and reviewing above findings and recommendations.

 

From this two day visit with all these tests, Dr.Sher began to plan my treatment for amyloidosis AL.