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New Directions - When Physician Collaboration Is the Key to a Better Outcome

New Directions Winter 2013

When Physician Collaboration Is the Key to a Better Outcome

Date: November 1, 2013


Dr. Joseph Marine and Dr. Alan Schneider with a patient
Dr. Joseph Marine, left, and Dr. Alan Schneider, right, collaborate on the treatment of patient Mark Olkon.

For more than two decades, Dr. Alan Schneider has been treating Wheaton resident Mark Olkon, 61, for hypertrophic cardiomyopathy. The condition, which results in an abnormally thickened heart muscle, causes shortness of breath and chest pain and may be associated with a variety of abnormal heart rhythms.

In spite of medical therapy, a pacemaker/defibrillator and an ablation for atrial flutter four years ago, his condition continued to deteriorate; by 2011 he had developed atrial fibrillation and congestive heart failure.

“I was retaining a lot of fluid,” says Olkon. “I was short of breath and very weak.”

“Mark’s heart was badly out of rhythm and we needed to find a way to fix that so he could be more comfortable and have a better quality of life,” explains Dr. Schneider, a cardiologist and heart rhythm specialist with Johns Hopkins Community Physicians Heart Care, who practices at Suburban Hospital and Holy Cross Hospital. “We do a lot of cardiac ablations at Suburban Hospital,” he notes, referring to a procedure that uses radio frequency energy to destroy tissue that causes abnormal heart rhythms. “But Mark’s case was extremely complicated; his heart muscle was already weakened and his left atrium was very enlarged. So we decided to refer him to our colleagues at The Johns Hopkins Hospital in East Baltimore, who are more experienced in performing ablations for patients with this type of chronic cardiac problem.

Dr. Schneider referred Olkon to Johns Hopkins heart rhythm specialist Joseph Marine, M.D., for consideration of a complex catheter ablation for atrial fibrillation. As more testing revealed that Olkon had developed anemia and kidney disease, his doctors began to reconsider whether the ablation was the right course of action.

“We thought there was less than a 50 percent chance that the ablation would be successful, and since Mark’s heart was so weak, we knew the procedure would present greater risk. So after thorough discussion, Dr. Schneider and I decided together that the ablation was no longer the best course of treatment,” says Dr. Marine.

The two physicians then considered another option—to upgrade Olson’s pacemaker/defibrillator to a biventricular pacemaker/defibrillator. The new device was expected to resynchronize the contraction of the left ventricle to improve its pumping capacity. Dr. Schneider performed that procedure at Suburban Hospital, and it proved to be a good decision.

“With cardiac resynchronization therapy, we were able to improve his blood flow and cardiac output,” says Schneider. “His atrial fibrillation is here to stay, but at least now his bottom chamber is pumping stronger and he is feeling better.”

“While I’m still limited in my activities,” Olkon says, “I no longer feel any chest discomfort or shortness of breath, and so it worked out well.”

Olkon says he is pleased with the coordinated care he received. “I have great respect and trust in Dr. Schneider,” he explains. He sent me to both Suburban Hospital and The Johns Hopkins Hospital, and I was happy to go to both and pleased with the outcome!”

For more information on the physicians in this article, click the links below.

Joseph Marine, M.D.
Alan I. Schneider, M.D.

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