Lots of questions

Got a St. Jude dual-chamber PM on July 30. Immediately after surgery I was in horrible pain in my shoulder, neck and left arm and numb in my lower left arm. Tylenol 3, morphine and Norco finally helped, and I spent the night in the hospital taking drugs for pain. They checked my lungs and heart to be sure I was OK. I had two babies naturally, so I'm not a baby about pain. This had me crying and shaking totally out of my control. Never experienced anything like it. Startled all the nurses obviously.

Seemed to be doing better, but about two weeks ago my left arm started going numb and warm and tingly with pain in the shoulder and inner upper arm and elbow. Checked out twice by the nurse to be sure it wasn't a clot. I have an appointment with EP on Sept. 5 (she's been on vacation).

Took Motrin for a week, but with the coumadin I can't continue that (on coumadin due to a-fib which hopefully is cured since I had sinus node dysfunction leading to PM. EP thought that lead to a-fib).

Besides the arm/shoulder symptoms, I can't lay on either side at all without a lot of discomfort. Can't reach across my body to put on deodorant. General tightness and discomfort at PM site. Just sitting here typing this my arm/wrist/elbow feel warm and tingly. The incision healed fine. I have been really careful not to move my left arm above my shoulder but have also made sure to use it and avoid a frozen shoulder (been there, done that).

I'm guessing I will need a repositioning? Seems to be nerve involvement of some sort.

Traveling out of the country for nearly a month soon, so will have to delay any solution until I get back--I can live with this for a little while.

Any ideas on what might be going on?

8 Comments

So sorry about this

by janetinak - 2012-08-25 01:08:39

I think I'd see a Neurologist as I wonder if the PM may be resting on or near/on a nerve.Certainly no where near normal, I have had 3 replaced in last 12 yrs so have experience.
Hope you get some answers.

Janet

Having trouble too

by ILoominatedEKG - 2012-08-25 01:08:49

I went into the emergency room with level 5 pain several times after implantatin. I was watching a perect EKG during a treadmill test while experiencing classic pain symptoms of a heart attack (no weakness, syncope, or brething probs). THEY TOLD ME EVERYTHING WAS FINE.

They really started looking when I threatened to take the damned thing out with a box knife. They found (with a CAT scan) that a lead had punctured my heart and is now perfectly pacing my diaphragm.

As I understand it, a PM should not cause pain that was not already there past the first couple weeks. Certainly, a worsening heart may cause increased pain, but that usually doesn't happen suddenly except in myocrdial infarction. If they tell you you're not having a heart attack but the pain is still extreme, then give 'em heck Nancy. It's your life and your pain. Don't take no for an answer. There are plenty of cardiologists out there ready and willing to take the money from the one you have now. Find one that's interested in helping you too.

Best wishes, Dave

Hi Nancy!!

by donb - 2012-08-25 05:08:31

This sounds awful as I've been very lucky with 4 PMs over the last 20 years including having my last Implant on my right chest. As you're practically a neighbor from me here in Bay City, MI I just want to also recomend getting a Neurologist as wifey works Cardiac floor here many years.
I read your posting to her & she works with our Dr. Joseph & Dr Mohan. So, this was her diagnosis as nerve damage.
Also happy to have you aboard !!

donb

Correction Nancy

by donb - 2012-08-25 05:08:31

Wife Sharon just hollered at me, says she needs a good EP & naturally wonders if a cardiologist did the implant or an EP?

I agree

by NancyinMichigan - 2012-08-25 06:08:17

I had already looked at the wikipedia info-saw your post elsewhere. Brachial nerve seems right.

Any thoughts on the repositioning?

And yes, I'm next door to Bay City!

We've had a lot of this today!

by donr - 2012-08-25 06:08:22

Nancy - try some nerve damage or impingement on a nerve.

I want you to SEE this so you can appreciate what could have happened during surgery. Google on "Subclavian vein." When it opens go to the top entry - should be the Wikipedia entry. Open that up & youll see a couple rows of photos/drawings. Open the left photo in the bottom row - it's a photo of an opened RIGHT chest, but the left side is close enough that you'll see what I want you to.

Notice that the vein they need is buried beneath a potfull of nerves. To get to that vein, they have to MISS all those nerves. Depending on the skill of the surgeon, the size of his/her fingers (How did he put himself through college? As a football lineman weighing 300 lbs? Or as a woman gymnast weighing 125 lb?) A lot of the work in getting into this vein is done blind, w/ the possibility of some fingers & a scalpel or two going into the area. The Subclavian vein is also beneath the collar bone (hence its name) & takes a lot of skill to get at. There is a fair chance that one of those nerves was affected.

There are 4 nerves that route themselves through this area.
1) Radial - serves feeling in thumb, index, first & INSIDE of ring fingers.

2) Median - serves the palm side of hand & is the victim of whatever causes carpal tunnel syndrome.

3) Ulnar - serves the feeling in OUTSIDE of ring finger & pinky.

4) Brachial nerve - serves the back of the arm & other parts down the arm.

Google on each of those nerves & read for yourself which one you think it may be, based on what hurts.

Nerve pain can be very severe & should not be ignored. If it goes on too long, due to being pinched, it could become permanent. If your surgeon cannot or will not listen to you, get to a neurologist! ASAP. You should not come out of this procedure w/ any nerve pain like you describe. If I were to guess, I'd start w/ the Brachial nerve.

Don

@donb

by NancyinMichigan - 2012-08-25 06:08:44

Implant done by electrophysiologist/cardiologist (she is both). Pain level was past 10 right after surgery. Now it is about a 2-3. Numbness/tingling in arm and wrist comes and goes. Discomfort and tightness at implant site is constant. I am physically fit-usually ride a road bike about 24 miles five times a week, light weight work and zumba. Now walk about an hour daily. Pain and discomfort then. Just seems the PM is on a nerve and too close to my armpit. I am a side sleeper, so am trying to get back to that. Even lying on my right side is impossible. The PM feels heavy when I do that. Don't know how else to describe if. On my left side it feels like I am squeezing the PM.

I will be sure to write a follow up after appointment on September 5. Can't come soon enough!

Repositioning?

by donr - 2012-08-25 10:08:23

Who knows - only the surgeon or a neurologist knows for sure.

BTW: If it is a nerve, you don't want to wait a month to get it fixed.

Don

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