Doctor Won't Approve Box

Doctor won't approve my medtronic box?. Do I need to get another doctor or insist on the box? Jude Tech had the box for me during a check up at Doctors office but doctor said I did not need it and kept Jude Tech from giving it to me as he had planned? Doctor said see you next year, if I had any problems to got to ER!
Like I can afford the ER costs for a problem that might not be a problem! Isn‘t that the point of the Box to save Doctor Office and ER costs!

New to this all - not sure what to do?
PM placement was a month and a half ago.

13 Comments

Thanks Everyone for all the replies

by BatteryPwrd - 2011-05-13 01:05:26

Thanks Everyone - for the replies.
I am now within several months of signing up for Medicare (do it six months before turning 65 I am told). I have been exploring the different supplemental plans before this happened. Never had a need for ER services Hospitalization or used a Doctor, GP or otherwise for anything. Getting my head around this all is very difficult.

Getting this Heart Doctor to understand is useless. He dose not seem to care that my physical work (self employed 30-years) puts the PM at risk of sudden impact. He just won’t listen! Getting him to understand the heart block is more than likely related to my work working with animals doesn’t seem to matter to him. I have the PM now so it does not matter. Since I don’t have insurance the implant is all he seemed to care about.
I have learned and been told that proving the block was caused by a past work related tick bite exposing me to lymes disease is very difficult. Once the initial tick infection leaves the blood stream and enters body organs it’s hard to test for or detect, except for symptoms that come and go and get worse over time and with age. Some of the symptoms I suspected was lymes disease have appeared as I have gotten older. But been so mild I took little notice until this happened. None until now have stopped me from working. I did not learn until just recently (through my own research on the Internet) that lymes disease could cause a sever heart block is some people. One Hospital doctor me to “stay the hell off the Internet” when I tried to share that research with him.

Anyhow, I have been attempting to design a shield of some sort to offer the PM some degree of impact protection. Difficult because any shield that offers impact protection reduces my shoulder and arm mobility. I will solve the problem as I anxious to get back to work (I am feeling great) but must feel the PM is protected. But now I read somewhere, that repetitive actions of the arm - shoulder are not good for the device or the leads? I have always been a independent self-sufficient problem solving kind of person. The PM has solved the heart-block problem but solving all the related problems is going to be challenge. Disabled I cannot do the work I love nor will disability pay the Bills, so not an option! As the shock about all that has happened dissipates and knowledge reduces my fears I will get more of my head around this! Sorry about rambling.

No need for "normal" pacer patients

by golden_snitch - 2011-05-13 03:05:35

Hi!

Recently heard an expert talk about carelink etc. home monitoring. Doctors agreed that it was good for heart failure and ICD patients, but that there was definitely no need to do it for regular pacer patients (for example with a heart block). Sounds like you are such a "regular" patient when the doctor told you, he'd see you next year.

I mean, what can they actually do by home monitoring? They can't run a normal pacer test, like threshold testing etc. And most importantly, they can't change any settings. Home monitoring is not for free, either, and when they'd find something that needs to be checked, you would end up paying for telephone check AND going to the doctor.

The majority of pacer, ICD and CRT patients here in Germany still hasn't got a monitor, but I can't see that they are worse off because of that. I think it makes most sense for heart failure patients. As a normal pacer patient I don't need these telephone checks, and I would not ask for them. Don't see any benefits from it.

Best wishes
Inga

I've got one, but don't use it

by turboz24 - 2011-05-13 05:05:47

I received my Guidant device on my 2 week checkup after my ICD implantation. I used it for a good while, but then I moved, which meant no more analog phone line. At the same time, my insurance company had changed policies and the 'free" phone checkup suddenly cost what an office visit cost, so I decided it would be in my best interest to simply drive in for device checks. Why do it through a computer when I could do it in person for the same $$$.

Merlin box

by fishfighter - 2011-05-13 07:05:44

I have one and come to find out it didn't do me any good. I'm on week 3 with a CRT-D. Been feeling very bad even after the implant. Twice they ran the home check fallowing the next day with a doctors office vist. The doctor and the St Jude tech told me that the PM was doing fine.

Well yesterday after a return to do a optimizer/ ultra sound test, the St Jude tech told me know he seen that I was having big problems that the Merlin at home box wasn't picking up.

Due to go back into the hospital for a few days for new meds!

Can you get another doc?

by Zia - 2011-05-13 10:05:50

Quite aside from the question of the box, your doc sounds like a jerk if he won't listen to you and/or discuss the situation in a civilized manner. If he thinks you don't need it, he should have the decency to explain why not. After all, he supposedly works for you.

Phone PM Check

by donb - 2011-05-13 11:05:00

Just want to support snitch feelings on phone checks. It will be 19 years of phone checks in a couple months. I have had checks every other month on each of my 4 PMs' in the1st year of each in use. There after in the 2nd year I would have a phone check every month.

Now with all the insurance fraud my hospital phone checks are every 3 months. I had 1 battery failure where the call in didn't even show low battery the month prior. Also, I did not have any noticeable ill effects as my PM would keep me at the low HR setting. So, all these checks (in my case) have only benefitted $$ the hospital.

As snitch pointed out, many phone checks are not needed. Patients with other related heart problems would have benefit with regular checks. Also as many have posted that when they have ill feelings it's time to get medical help. donb

The real issue

by ElectricFrank - 2011-05-13 12:05:22

Sounds like your doc is a "implant pacer, collect $, and get rid of you as quickly as possible" type. I wouldn't have much confidence in him looking at the data from the phone check even if you were able to force him to give it to you. No doc should just tell ou t go to ER. They are responsible for handling any problems that might come up.

I would check around for a more interested doc. You might contact St Jude and ask for for the names of local docs who use their tech services.

It's possible you don't need more frequent checkups

frank

Box

by Cheryl B - 2011-05-13 12:05:42

I got my ICD last November 2010, and got the box in January, St. Jude model. No one even suggested I not get it. they actually said it was a good idea. It saves a trip to the hospital. they can monitor me if they need to, et cetera. I'm sorry, but after what your doctor said about if you have any problems, go to the ER, I'd get another opinion or call your doc and make him listen. Like I can afford ER costs, especially after what I'm paying for a two-week hospital stay!!! Besides, I don't like the ER. It scares me. I'd really push to have my doctor listen, or if he has a nurse practitioner, call them. Most cardiac docs have an assistant. They are too busy to deal with us heart patients I guess. I love my nurse practitioner. She expects me to come in with a list of questions, and I don't disappoint her. Good luck. Remember, you're paying the bill so get what you pay for.

Sorry!!

by donb - 2011-05-13 12:05:51

I forgot to mention!!! AT&T disconnected my phone service to my 2nd garage (workshop) as I had 2 services (lines) and paid for 1 service as it was installed many years ago. Sooo, I have 2 PM phone monitors, I called to have my line restored as I needed it for my PM monitor when I spend many hours in my 2nd garage. No Problem!! They came out & restored my 2nd service pronto at no cost. Now there's a plus!! donb

Stupid box

by wenditt - 2011-05-14 01:05:35

I bring my box on vacation but other than that I leave it in the closet. I go to the clinic every 3 months and get my PM checked. I have a better piece of mind with the check they give me in the office anyway.

But I do bring the box on vaca just in case LOL

Carelink phone check misconception

by ElectricFrank - 2011-05-14 02:05:22

Somehow, wrong idea has started going around. I'm looking at my last Carelink phone checkup and here are some of the things it transmits:

Lead Impedances: These give advanced warning if a lead is going bad.

Voltage Thresholds: This is part of the self tests we feel if we are awake. An increasing voltage can also indicate a lead problem, or a change in the hearts sensitivity to pacing. If the threshold goes too high it can lead to lack of capture, which I had a couple of years ago.

Event Counters: These show the number of afib, vtach, PVC's with obvious reasons for watching.

Battery Condition: Batteries do fail prematurely and a year is a long time without checking them.

I wouldn't want to go a year without at least having a quick look at all of these. There is also a good reason for taking the unit on trips. If symptoms of a pacemaker problem happens on a trip it could be very helpful to be able to send a test to someone familiar with your settings. In my case the data is sent to Medtronic and the rep has told me that I can just send a test anytime and follow it up with a phone call to them. Much better than going into ER and seeing someone who doesn't have the ability to test the pacer.

frank

Interesting, but...

by golden_snitch - 2011-05-14 04:05:04

Hi!

It probably helps when you are getting closer to replacement but I still don't see any other benefit from it.

The arrhythmia counters in pacemakers often record artefacts, every doctor knows that. Unless the pacer records an EKG, I would not believe those counters. You will always have to do a holter when you've got the feeling that you have arrhythmia.

Batteries fail prematurely? Well, yes, in some cases they do, but I do not no a single patient in whom a battery in a simple pacer has failed for example after three or four years. I know some who were told that theirs lasts another one or two years, and who ended up needing a new one just after a couple of months.

Voltage threshold and lead impedance: For me that's important to keep an eye on the first months of pacer implant, and when the leads get older. In Germany, you usually go for a check-up 6 weeks after pacer implant, then again after three months, then after six (so three months later), and then you settle for every 6-12 months; I go at least every six. ICD patients in Germany go every 3 months. That's what our guidelines say. Does the monitor transmit only the latest measured impedance and threshold? When my lead broke, I had impedance peaks, one needed to see the curve, not only the latest measurement.

I prefer personal consultation, and from what I have heard here so far, the monitor does not really safe any costs. I'd rather pay for a doctor looking at and talking to me, then for a phone check. I don't generally believe in the need to keep checking a pacer when the patient is doing perfectly fine. But this is exactly what the monitor does.

So, for you it's a good thing, for others it's not. I think what we tried to explain here is that this monitor is nothing you definitely need. Can be helpful, but you won't die without one, if you can say so.

Very interesting discussion. I wonder if before carelink etc. was started, patients had been asked whether they would like to have such a monitor or not. Most patients I know don't want one and think that it's just a way for the doctor to avoid personal contact with the patient.

Best wishes
Inga


A few more thoughts

by ElectricFrank - 2011-05-16 02:05:03

Inga,
It seems there is quite a difference in what the various make pacers record or present in the data. You mention that one needs to see a curve of impedance and/or threshold trends. That is exactly what my Medtronics ADAPTA does. I don't know whether it is stored in the pacemaker , in the programmer, or in the data base at Medtronic.

You also mention you won't die without one. The intermittent loss of capture was caused by a slowly increasing V threshold. With my complete AV Block I would have dropped back to my escape rate of around 30 bpm if the threshold had increased much more. For some it could be deadly. I just felt lousy and picked I up on my BP monitor.

The thing that stands out in this whole discussion is the cavalier attitude about situations that could be serious. It's not a matter of phone or office check, but rather the frequency of checkups. A doc will scare the daylights out of a patient based on a single measurement of BP or lipids, but isn't at all concerned about a pacing failure.

Kind of reminds me of the Columbia Space Shuttle where NASA could see no reason to check the tiles before re-entry because they never did serious damage in the past.

frank

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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.