1st check up 11/23

by breezy
2009-11-19 11:11:05
Checkups & Settings
1780 views
13 comments

Hi :) I am new here but have been reading since I got my PM which was 10/19/09 now with my 1st check up coming I wondered what they will do..? I feel better then I did before.. but still have little weird things going on...and wondered ihow they check the PM for the right settings.. I am anxious about this so wondered if you might help me.
Thank you

13 Comments

First checkup

by ElectricFrank - 2009-11-19 11:11:50

The basic procedure is to hang a device over your pacemaker (through your clothes) which connects wirelessly to the pacemaker. It connects to a computer that first reads information that your pacer has been collecting since implant and then runs several tests. The tests give information on how your heart and the pacemaker interact. This is often referred to as interrogating the pacemaker. During the test the pacemaker will make temporary changes in your heart activity that may feel strange, like skipping a few beats, speeding up, and slowing down your heart rate. None of these present any risk so just relax and breath. This part only takes a few minutes. Then using the information from the tests the doc will decide on what changes need to be made in the programming and these will be transmitted to the pacer.

Generally, the new settings will result in a noticeable improvement in how you feel. Until the first checkup the pace is usually running on the way it came from the factory. After the checkup it will be tailored more to your individual condition.

One thing we usually suggest is that you ask the doctor for a copy of the Pre and Post Programming Report. This gives the details of your pacemakers settings and how your heart is responding. If you have any strange things going on several of us here may be able to make suggestions or explain them, especially if you have the report.

hope this helps,

frank

Fast pulse on stairs.

by ElectricFrank - 2009-11-20 05:11:06

Breezy,
With AV block you do not need Rate Response turned on. This is a feature where the pacemaker senses your body movements and uses it to set pacing rate. With AV block rate response just ends up competing with your natural pacemaker and makes for an uncomfortable situation. The way to tell whether you are using rate response is to look at the Mode the pacemaker is set for. With AV Block the commonly used Mode is DDD. If it is set for DDDR then the rate response is on. Another way to tell is to sit still for several minutes until you HR slows down. Then use your thumb and forefinger to jiggle the pacer fairly rapidy. If your HR rapidly increases Rate Response is ON. This is what happens when you climb the stairs.

I had a problem with this after my implant. I happen to be to be an engineer with biomedical background so I built myself an ECG that would let me see my heart together with the pacemakers action. I insisted on a checkup session only 10 days or so after the implant to have rate response turned off. I also insisted that they increase the upper pacing limit from 120 to 140. It made a big difference in my ability to exercise.

frank

Fast pulse

by breezy - 2009-11-20 06:11:33

oh boy I have a lot to learn about this PM stuff and I thank you so much for your information and everyone else too:).. so the fast pulse would that be why it seems to race after getting out of the shower? and doing things like my hair seems to bring this on?
then it calms down? some days are worse then others
sorry for all these questions.. but when I go in Monday 11/23 for my 1st check I want to know what to ask the Dr.. about whats normal and not normal....so much to learn...
so increasing the upper limit will help for walking and such? and what should the bottom be? I don't feel so good when the bottom drops to the 60's... of course if was only in the upper 30's before when this all started... I feel better what it is around 70 or so.. we walk alot and also walk on the beach alot.. I don't know what my settings are? and guess I won't know until Monday.
Thank you again:)

Piece of Cake

by Bionic Man - 2009-11-20 06:11:48

Frank is right. The first visit had me a little nervous at first also. I didn't know what to expect. I was also having strange feelings and beats after my pacer. The Dr will adjust the pacer as is necessary to make you feel better. One piece of advice when you see your Dr. Make a list of any questions you may have. The first time I saw my Dr he was very busy and I didn't get to ask him all the questions I wanted. If I had written them down ahead of time, I would have remembered what to ask.
Good Luck,
You'll be fine,
Bob

Feelin funny stuff

by wenditt - 2009-11-20 09:11:54

I am not as good as Frank with the setting etc...but I am REALLY good with the extra beats and anxiety! LOL...I am 12 weeks post implant and still have funny beats. Some feel harder than others, some feel like palpitations. I feel them during exercise or if I am trying to sleep or just sitting still. Basically I feel them when I am not distracted by the outside world. I am wearing a halter again just to make sure the beats/feelings are ok and not dangerous. So far...so good. I've had a really hard time adjusting to the pacemaker idea and have been dealing with a lot of anxiety etc... So far it sounds like all the extra beats and skips are anxiety and nothing dangerous.

It may just be that you are noticing them more now than you were before. People tend to be on HIGH ALERT when feeling and thinking about their beats after the pacemaker.

If it makes you feel better, ask for a halter. It can record your beats and you can write down when you feel something "unusual." Then they print out your readings and can tell you EXACTLY what it was. That is what I am in the process of doing.

Just remember to arm yourself with information and questions. You have to advocate for yourself as a patient because no one else will. If you are ever unsure, keep asking questions until you are sure. And keep pushing until you get all the answers you need so that you are confidant and comfortable. This is a difficult process but with information and understanding, you can make it through. :-)

Best of luck,
Wendy

feeling funny stuff

by breezy - 2009-11-20 10:11:14

thank you Wendy :) I have written down lots of questions for the Dr and will see what they say about the halter
I had one a couple of years ago and it turned out to be nothing... and as you say every little thing that goes on one really pays attention to...and when I am busy I may get one but I just don't pay much attention to it.. it is when it happens out of the blue....
thanks again for the advice... to all of you :) it so helps to read all the post and then write and get answers.. I am glad to have found this site :) Thanks again

First check up

by breezy - 2009-11-20 11:11:29

Thank you so much both of you for your information
I have been very anxious and it seems to make all these weird things worse... I seem to be always checking my pulse.. drives my hubby crazy...so I will try and not do that so much...
Do you know if the PM causes the paplitations? and does that go away when they check the PM settings?
it seems like I get alot of these things?
Thanks again

First check-up

by breezy - 2009-11-20 12:11:26

Thank you Frank :) for the information. It certainly does help... can I ask you.... I do the stairs just fine now
but sometimes after my shower I feel some papiltations and feel funny.. I feel my pulse and its going fast
ten it drops down to where it should be..I have AV/block
and have a Medtronic ADDRL1 if that helps
anyways, weird things seem to happen..so I guess that is related to the factory settings?
Thank you

PM rep

by ElectricFrank - 2009-11-21 11:11:49

You are fortunate if you have a Medtronic rep doing the checkup. My experience is that they are very competent. In my case the rep does the checkup and then talks with the doc. I had to get beyond medical politics with them. With my being an engineer with biomedical background I could talk the lingo with the Medtronics rep. I could sense an uneasiness in him about implementing my requests so I directly brought it up with him that I didn't want to put him in a bind. I ask that the doc come in and stated with both of them in the room that I didn't want any politics. That has seemed to solve the problem.

By the way, what I mean by medical politics is that "ethically" only the doc can make decisions. The rep, tech, or nurse in some cases can only provide information to the doc and make recommendations. All this is suppose to be done away from the patient. I simply let them know that I didn't care about the ethics and that I wanted to hear the direct recommendations each had. The I would make a decision.

The approach you need to take with your doctor will vary with your sense of his way of doing things and your feeling of comfort.

frank

rate response

by breezy - 2009-11-21 12:11:30

Thank you Frank - this makes sense to me..becuz the symptoms that you talk about happen and it does not make me feel to good..for example I went down the stairs to do the laundry this morning and felt okay but I got that "feeling" and by the time I got back upstairs to feed the dogs my pulse was at 100...then it came back down to 60 or so... I hate that feeling and I get to the point where I don't want to move....:( I don't have any problems sleeping... only if paplitations occur...
We live on the water so we walk the beach and walk other places.. I haven't been able to do this becuz of what sometimes happens....it really is a icky feeling and my anxiety kicks in..that doesn't help :( I will remember about the Dr's too......for the first check is the rep for the PM company with the Dr? when they reset the settings?
So thank you again for all your information - things are making some sense to me and I really appreicate your taking the time to help me :)
Sincerely
breezy

rate response

by breezy - 2009-11-21 12:11:31

Effects of rate response

by ElectricFrank - 2009-11-21 12:11:44

breezy,I

f rate response is ON anything that involves body movement will be senses and increase your HR to some extent. For people who need to have it ON its important for have it adjusted properly. But in your case it sounds like there is no reason to have rate response on.

You mentioned getting out of the shower and fixing your hair. The first thing that came to mind was getting out of the shower and toweling off with a rapid movement of your arms. The same with using a hair dryer and comb. For me the jets on my hot tub would send my HR to the upper limit.

The upper limit if set too low can cause a lot of problems. The way it works is to cause your heart to skip beats if you exceed it. My upper limit was set to 120 which wasn't too hard to reach. I started in with my usual 3 mile brisk walk the day after I got the pacer, and would feel great for the first few minutes. Then my HR would hit the limit and it didn't feel good. I actually asked them to set it to 150, but we compromised on 140 until the next checkup and then 150. I'm 79yrs so don't push myself up to 150, but I don't need to have the pacer telling me what to do.

My lower limit is set to 55 which is nice for sleeping. My guess is that the feelings you have when your HR drops to 60 are due to the rate response interactions. By the way I know what you mean about have a HR in the 30's. Mine was down to 26 the night before I had the implant. I could still stand up without passing out, but felt lousy. Sure felt good when they turned it on.

One thing to keep in mind when dealing with the docs. They are more accustomed to dealing with folks who are in poor shape and tend to base their settings on that. Your mentioning walking on the beach gives me the impression you are in good shape. It may pay to mention this to the doc if you haven't.

I had a funny experience with my cardiologist early on. He just couldn't get it that I was in good shape and very active. That was part of his reluctance to setting my upper limit to 150. We live in a small desert town and on one of the appointments I ran into him in the parking lot outside his office. He had seen me walking across the lot and asked me where I had parked. I told him it was such a nice day I walked from home. He blurted out "why that's 4 miles". I said yes, and unless you guys mess the settings up I plan on wlaking home. The whole experience was a reality check for him and I was treated quite differently after that.

best,

frank

PM rep

by breezy - 2009-11-22 10:11:53

thanks again Frank :) tomorrow I will find out what s going on and I can ask my questions and get things taken care of.....we live on the coast as I said before and we had a huge wind storm early this morning..all heck broke loose with the winds, down trees,power lines all over the place...we had to travel North for my appt early today..and so I had these blasted syptoms and didn't feel good thru all of this mess.... but now I am better.... its like a yo yo for me.....
I will be happy to get things taken care of
Thanks again for your help....I will let you know what happens after tomorrow.

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