under skin vs. under muscle

Recently had pm put in. I am 44 years old and am an active person an am also a hairstylist. I had my pace maker put in under the skin because I was out of it and my fiance' told the Dr. to do it that way. I am very skinny and it looks hideous and is uncomfortable to sleep on my left side. and uncomfortable to have the seat belt rub against it. Also I am a runner and run the trails which I must admit fallen over roots before. Very scared of the is pm not being tucked under and more protected. My question is that I am seeing a surgeon to possibly have the pm put under the muscle. I am concerned about the pain and recovery as I lift my arms to do my job. Since I had this surgery just a month ago was wondering also how much of a surgery it will be because I am not moving leads or placing leads. Feedback would be greatly appreciated. D. Michele

12 Comments

Thin on top ...

by lahbigbro6 - 2012-07-03 03:07:59

I does settle in after time. My 2nd pacemaker seem to be located in a different area sightly. But, many months after its located where my old one was, but the pacemaker is smaller (which is great). I started pilates too soon after and had shooting pains, which scared me. Went to doctors, everything was ok, but was told give it a break for awhile. Doc told me not to do flys anymore with weights because of leads. So, some of my pilates moves are also similar cannot do. I did not start walking too soon, because I really swing arms and I am a fast walker. I am thin on top and PM has settled in and does even phase me now,

Biotronik PM fitted 2nd July

by normy - 2012-07-03 04:07:42

I had a Biotronik PM implanted yesterday, and am quite amazed that I am home today, and there has been no wound pain at all. It is fitted just under the skin, and I understand it is set to pace at 60 in the night, when I had the main problem of very low pulse rate and 3 second gaps. They have supplied a CardioMessenger for night monitoring as well, the data is sent to the doctor who is able to ask me to call him via a mobile network which causes a light to blink in the device.
Waiting to see how it all works out, impressive so far!

D. Michele

by walkerd - 2012-07-03 07:07:26

The cases of the pms are extremely resiliant to impacts there are a number of stories on here of individuals falling against objects right on pms no damage, hopefully Frank will answer and tell you of a few exapades he has had with his pm and falls on one of his many hikes in the mountains. Now pulling leads is another story this early in your post pm insertion, a fall while running (which you shouldnt be doing this quickly anyways) could pull out if not properly seated which takes a few weeks anyways. I guess its a personal choice on how it looks in your mind, I personally wouldnt go thru an unnessasary surgery just for that but that is me. Just my feedback on it.

good luck with your decision
Dave
oh welcome to the website

moving it

by Tracey_E - 2012-07-03 07:07:58

I would suggest waiting 6 months before having another surgery. After only 4 weeks, it's not as settled and pain free as it's going to get. As it heals more, scar tissue builds up around it forming a pocket that is more insulated and more numb. Another thing to consider, if it's more under the muscle, working with your arms up a lot of the day may aggravate it more than having it just under the skin.

Mine is buried under the breast. It took about three months until I was completely pain free and could move/sleep any way I wanted without feeling soreness. It was never awful, I never took more than Tylenol after the first day or two, but it lingered for quite a while. We all heal at different rates so it could be less for you. I've had 4 replacements and my recovery was longer for them, too, than if it had been just under the skin.

Drawback to having it buried more, when a lead went bad it was more complicated to replace it, and over time the scar tissue built up enough that it started to ache most of the time. Two years ago when I got the new lead, we had a plastic surgeon clean up all the scar tissue so now it feels great again. Again, it wasn't awful and I never filled the pain med prescrip, but it was 3 months until I was doing everything at the gym I wanted to do after that surgery.

If I had it to do all over again, I'd still choose to have it buried, the benefits far outweigh the cons imo, BUT mine was done this way the first time. I don't know that I'd have an extra surgery just to bury it.

There used to be a video on Heartbeat International's website about a boy who's life was saved when he got shot, the bullet hit his pm which prevented it from going into his chest and killing him, and the pm was not damaged. It's titanium, you're not going to damage it with a fall. You'll be bruised up, possibly, but you won't hurt the pm.

It's up to you ultimately what you want to do, but I would suggest talk to the plastic surgeon but then wait and see how you feel in 6 months before making a final decision.

PM Location

by donb - 2012-07-03 08:07:32

I've had 20 years of PM experience with 4 PMs'. My 1st 3 PMs' were just under my skin and each one developed lots of scar tissue. As I'm a skinny person my 3rd implant eroded and my left site was not suitable for another implant. It was decided that with my 4th implant it would have to go right chest and under muscle. I didn't find any differance in healing time or pain level. As I'm very active I am so much more satisfied with my new right chest under muscle implant. With my skinny build I'm so surprised why I had to wait 18 years of pain & disscomfort with the previous implants just under my skin. Hopefully when replacement time comes the healing & pain goes as well.
Ya, and I'm right handed & picking up any heavy article would always put the object against my left chest (ouch) which includes picking up balky grandkids. As we all just do our thing as far as picking up objects, but never stop to really analyze the differance between left or right handed anatomy.

donb

Swelling will diminish...

by jenny97 - 2012-07-03 09:07:30

One more thing to keep in mind is that the appearance will change over time. For me, it was about a year before the swelling went down all the way and I was able to see how it would look long term.

Let it Be

by bjean - 2012-07-03 09:07:39

Hi D. Michele,

I too am a hairdresser, 46 and active. I got my 1st pacemaker 8 yrs ago. (my 2nd one yesterday.) Give it a chance. After a few weeks I could sleep on the side with the device. ride roller coasters and parasail at Disney and do hair. After a few months run, snowboard, and wakeboard. The only thing I've had to opt out of was skeet shooting b/c the PM is on my right side and I'm righty.

Mine is under the skin and I think it's barely noticeable and I am a thin woman. Plus it sounds like your fiancee is OK with it since he made the decision.

Give it time and I'm sure you'll come to grips with it.

Barbara

Being small

by ldebaugh - 2012-07-03 11:07:17

HI D. Michele,
Also am very small and it bothered me at first. But with a regular tank top on, it's not visible. I got used to it. If you are very small, it's going to be a big deal to get it under muscle. I, myself would not do it. After grappling with the issues of mortality, this is so much less important. Also I would think that it will bother you less where it is while working than anywhere else.
Good luck!

Being small

by ldebaugh - 2012-07-03 11:07:48

HI D. Michele,
Also am very small and it bothered me at first. But with a regular tank top on, it's not visible. I got used to it. If you are very small, it's going to be a big deal to get it under muscle. I, myself would not do it. After grappling with the issues of mortality, this is so much less important. Also I would think that it will bother you less where it is while working than anywhere else.
Good luck!

Comments

by ElectricFrank - 2012-07-04 02:07:39

Falling on the pacer is not problem generally. I fell on mine with a large camera between it and the ground.

Something often missed about the under muscle location it that the muscle being what it is contracts to do its job. That muscle is going have to contract to move some part of your arm, chest, neck, or whatever. Especially for active folks this can irritate the area. Having said this there are a number hear on the site that do very well with this placement.

The under the skin placement is the easiest to access for replacement of pacer or leads. I've already been through my first replacement. The under skin location made it an "in and out" procedure.

This leaves the cosmetic aspects to consider. I can't comment on this other than think it would be smart to use a cosmetic surgeon to clean up the site after the implant.

best wishes,

frank

I had my pacer moved after 4months and change.

by kathykat11 - 2012-07-04 03:07:48

I was in constant pain from my initial placement. I talked to the people on here and they said so much pain was not normal for such a long time. The Doctor advised me he could move it, no guarantees that it would feel better but OMG I could tell the difference immediately. I am so glad I finally mentioned the pain I was in because over 4 months of being in pain and on pain meds was really taking a toll on me. My pain was getting worse not better, and cosmeticallyit was like night and day. I am over weight everywhere but on my chest, I didn't get it moved for appearances but that was a lovely bonus.
Good Luck,
Kathy

Give it Time

by Many Blessings - 2012-07-04 09:07:33

Hi Michele,

I too, am a very thin woman (and extremely active). I'm also very vain. LOL! Give it some more time before you make any decisions on moving it, just in case the swelling goes down more.

Before my surgery, I asked that mine be put under the muscle because I was concerned about it showing. Right before my surgery, one of my surgeons talked to me about placing it right under the skin instead because of bleeding risks from a high INR from taking Coumadin, and easier access in case something goes wrong. At the last minute I said, go ahead and put it right under the skin.

I chose the smallest PM available to me, which was a St. Jude (I have a CRT-P). For the first few weeks, my PM site was HUGE. Like the size of a baseball huge (we all called it my third boob). It got to the point where the hospital did an ultrasound after a couple of weeks to see what went wrong.

I used pure Arnica Gel from the health food store to reduce the swelling and get the blood out (I had a large hematoma). I think I only had to use it a couple of times, and you don't need much, just a little bit.

I couldn't believe how much the swelling went down within a couple of more weeks. You can hardly see it at all now. I'm at week 9 post PM surgery. It is still tender, especially when I bump it, but that will reduce with time too. The seatbelt hardly bothers it at all anymore either.

Give it some more time and if the swelling and bump doesn't improve, then go ahead with your decision to move it. But, do give it some time, just in case.

Good luck

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