basic activities

Hi...

I am presently in cardio rehab... about 4 weeks after pm corrective surgery. Rehab is going great...but I'm still very reluctant to do anything using that using that left arm. I was told 4 to 6 weeks to not lift the arm overhead...I have been overly protective, but am concerned about dislodging the pm leads. I guess I'm looking for how to determine when I can resume "normal" activities...I do well on the bike and treadmill exercises, and walking is fine. I am monitored during these exercises, and I am gaining strength and confidence with each session. But, I'm ready to step out and play frisbee golf once again..do stretching execises which involve lifting and stretching using both arms...yoga stretches... so I guess I'm looking for that point where its ok to do these things and not be worried about pulling the pacemaker leads from there attached positions in the heart muscles. Guess I'm anxious to become a "normal" exerciser once again. I haven't played regular golf in years, but can I eventually do that again? Can a golf swing dislodge the leads? I'm not into any contact sports, but am wondering just what I can or can't do now... I'm hoping there are some members here who are going thru or who have gone thru this sort of worrisome challange to become more active. I would like to know if I will eventually be able to do things like swim...snorkel...play golf...do vigorous physical exercises...do yoga or other "stretching" type exercises again...I feel so out of shape at this point...does the fear of dislodging those leads ever go away ? I've read that after time, one can resume "normal activities"... I'm just not sure when and what I will be able to resume doing...
any feedeback would be greatly appreciated...
thanks...

Lou

4 Comments

Not sure about golf yet but..

by ma_ku - 2013-03-14 01:03:15

There was a similar topic yesterday

http://www.pacemakerclub.com/public/jpage/1/p/story/a/storypage/sid/27086/content.do

Copied here: My first PM was implanted about 3 weeks ago. Similar concerns about using left arm but found this interesting article that basically concludes that the going home restrictions on arm movements could be overly restrictive, potentially causing more problems than it allegedly prevents.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626349/

I personally wouldn't try golf cos that is a pretty extreme arm movement, but it should be possible to do some lightweight exercises as discussed in the article. I hung a shelf (at chest height on a step ladder) yesterday without any apparent problems. I guess I will find out at my checkup next month if I have been overdoing it but I don't have any symptoms that suggest I have been.

I have been back to running for a week and did 5 mile run in the sun today. Feeling good. Want to do some press ups but will hold fire until I get the ok. I am using my arms for most daily tasks though. Just avoiding big stretches and big weight stuff.


Mark

just do it!

by Tracey_E - 2013-03-14 01:03:23

If you are too conservative now while healing, your shoulder can freeze. Be sure to use the arm.

As long as you take it easy, you can start to do more now. It's great that you're back on the bike and treadmill, it's a good start. My dr says ease back into regular activity at 4-6 weeks, but hold off on a full golf swing for 3 months, anything else is ok at 6 weeks. So for now, if your arm goes up when you stretch or if you want to wash your hair, go for it, just be gentle about it. After another 2 weeks, do whatever you want! Swim, snorkel, yoga, even golf if you're careful.

Yes, the fear does go away for most of us. As we feel better and are busy again, get back into shape, we think about it less and less until one day you realize it's been a few weeks and you never thought about it.

Dislodging leads

by donr - 2013-03-14 01:03:53

Lou: below is a copy & paste of a comment I wrote just last night. About 75% of it approaches your questions.

Begin copy & Paste:
"Its tough to break a lead...
Comment posted by donr on 2013-03-14 01:01.
...I know - I did it!

Well, actually, I didn't do it but it happened to me.After about 4 yrs I had a lead break in two, somewhere down in the subclavian vein between the insertion point & the point where the subclavian joins another larger vein & plunges into the heart.

Absolutely no reason ever determined for its breaking.

Now - how hard is it to dislodge a lead from the heart? Try this tale for size. Happened to me, again:
Begin Copy & paste:
Comment posted by donr on 2013-02-25 19:52.
"Let's put inertial forces in proper perspective.

I took a Jeep Cherokee in the right shoulder through the door post on our Chrysler minivan. The Jeep was doing 35 mph when we collided.

9 weeks before, I had a new lead implanted. Here's what happened to me:
8-12 broken ribs
broken collarbone
collapsed lower right lobe of lungs
Lacerated liver
bruised kidney
Fluid around heart
created an aneurysm in the aorta, just above heart.

Cardio & ER Doc Daughter said the impact was great enough to have killed me by ripping my heart from its moorings.

Now for the important part - the NEW PM lead was not affected at all. The X-rays taken in the trauma hosp showed it was as good as new.

Now - does anyone out there think that the forces experienced on any coaster running will beat that?"
End Copy & Paste.

Let's talk about the majority of the leads that become un attached.
This happens when they are not properly implanted during the surgery. Making one of those leads take hold & be permanent is not as easy as it sounds. It's not exactly like Capt Ahab sinking a harpoon in Moby Dick's flank. First off, the surgeon works by what he/she sees in a fluoroscope image. second, the heart wall is constantly & suddenly moving - either toward or away from the surgeon's "harpoon." So, a significant number of the leads are not really implanted securely. The blood is turbulently flowing through the heart, tugging & pulling on the lead, 24/7 - so if it's not well embedded, there are a lot of forces trying to pull it from its moorings.

Further, if you look at an X-ray of a chest w/ a PM in it, there is a bunch of excess lead between the PM & the insertion point in the vein. The lead is sewn to the vein where it enters, thus anchoring the lead at that point. You are going to have one tough time moving an arm enough to pull out all the slack in the lead up to that point. Now look at the lead inside the vein. Again, a lot of loose lead flopping around inside the vein; ditto inside the heart chambers. In order to pull all that slack out of the lead, you'd have to really have to go through one heck of a lot of gyrations of the arm. You aren't going to pull that anchor point out w/o pulling all the slack out of the line first & you will have one hard job doing that.

Relax & be aware of what you are doing & follow the limitations & you will be fine. Pulling out a lead is pretty much a case of paranoia unless you do really violent acts w/ that arm. Look down at your wound - it's pretty much secure after a few days - otherwise it would be leaking blood the whole time. Well, the wound where the lead is attached is just as well healed.

You need not make yourself an invalid over this issue.

Just make sure that if anyone gives you a banana to eat that you do NOT grab the dining room chandelier w/ the hand on the new PM side & swing back & forth while eating that banana w/ the other hand.

The Dr. told you 6 weeks - you've gone 4 of them. Just be patient - you have the rest of your life to enjoy what you want to do.

YES!!!!! you can return to whatever you want to do. Just not right away. Golf is played by all who want it.

The only way to lose the fear of dislodging as lead is to understand the difficulty of doing that. Read what I wrote - do you plan on doing anything as violent as stopping a Jeep Cherokee w/ your shoulder? No? then don't worry about dislodgement.

We have golfers, marathon runners, campers, backpackers, hunters, swimmers, divers, climbers, ironmen competitors, bikers of both sorts, carpenters, electricians, probably even a wrestler or two. You name it, we've got it.

About the only thing that can restrain you is a turned on Rate Response function that activates too easily w/ activity.

So just wait out your sentence & work your way back into activity at a slow rate & build it up at a slow pace & you will be just fine.

Don

Don

activities

by lubro - 2013-03-15 01:03:01

First off...Thanks to everyone for the feedback. I know I need to stop worrying and get myself in gear. Need to work this left shoulder especially... been babying it too much I suppose. This club is a wonderful place not only for information, but those who post here are among the most caring and concerned people. I am proud to be among such prestigious posters. I hope as time goes by I'll be able to post helpful things as well. Still too early for me to be giving any advice...and Don, I will always eat bananas, but I promise, no swinging from the chandeliers...oh, and after reading your story, I'll never look at Jeep Cherokees again without thinking of how lucky we are to have you around. I know I'm a newbie here, but I've read other posts by you, and know that you are well respected here. Your posts are always so informative, educational, and your caring & concern, as well as your candor are greatly appreciated. I know I speak for many here when I say this.

ok this being said, I went to cardio rehab this morning and had a major a-fib episode. Don't know the cause (who does really?) the nurse calld my cardiologist, sent him several "paddle" readings, as well as a 12 pt EKG...Gonna see him real soon...This episode lasted for almost 15 or 20 minutes... I usually can't tell when I go into afib...but this time I surely felt something going on...Been in rehab 1 1/2 weeks...only other episode happened a few days ago.. when they hooked me up to the heart monitors, I was in afib...lasted 3 or 4 mins, then stopped...I did try to push myself this morning on the bicycle, but nothing drastic...just a little harder than the last time... problem is, I just don't know what does trigger the afib...I think I went into afib lsat night while watching a movie...pulse felt like it was racing ..
I guess that's why I have been worried about what to do or not do exercise wise...I want to get back to "normal" activities, but when things like this happen, I sorta lose that confidence level. The nurse at rehab called my cardio...he suggested taking me off digoxin and back to flecainide...called his nurse when I got home... waiting to hear back... I'm scheduled to see him in 1 week & 1/2...got some questions ready for that visit. This is all such new territory for me. I might just be one of those who just has to live with afib...hopefully, they can tweak the meds... maybe set levels on the pacemaker to help,
Too much too soon ... The first week of rehab went fine...no afib incidents. Today was a different story...
Guess that's why my confidence level has yoyo'd so much.. I never expected any easy answers, but I'm supposed to go back to work in 2 weeks, and I'm just not sure of what to expect. I work in an airline control tower...Gotta climb 90 steps to get up there. Concerned about the effects of this... Just a worrier by nature I suppose...but hey...I'm gonna try to be optimistic and hope we can tweak the meds and the pm and I'll get on with trying to be "normal" again.. at least physically that is lol...Thanks again for the comments and suggestions you've given me... Sorry if I sound needy, but I've always been very healthy and never had to deal with anything like ever before. I appreciate all the wonderful feedback. thanks to all...

Lou

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