attention donr

I am heading for a big toe surgery in 2 weeks and just read your comments in a 2012 post about knee surgery. You also advised me on a surgery last summer in which they used electrocautery very successfully with a ground plate on my opposite thigh and did not put a magnet over my pacemaker. I was not 100% dependent and my 31 beats per minute during the small zaps of their instruments ( and 60 beats at the rest of the time) was a heck of a lot better for me than 3 1/2 hour under the knife at 100 beats a minute.

In two week I have a big toe issue to address --extra calcification on top of the first joint. My Podiatrist intends to use NO electrocautery at all even though my pacemaker EP says that it wouldn't hurt me at all just not to make an issue of the pacemaker at all - just ignore it. My silly question is how much more bleeding would then happen without cautery at all?

Since this is being done at an outpatient surgical center, and not the U. of Chicago hospitals with all their bells and whistles like at my last summer's surgery, I think my podiatrist knows that he can handle it the old fashioned way because it supposedly it very simple and just involves shaving away that lump of extra bone that keeps my big toe from full movement.

I have also read that there is a sound based cautery system.

5 Comments

Watch out for that BIG Toe!!!!

by donr - 2015-07-07 06:07:11

For some of us, this is a dangerous place to go. In winter, my lonely 12 red corpuscles huddle together there for warmth., leaving the rest of me to shiver while they are toasty & warm.

So much for the lousy attempt at humor.

First off, I am surprised that when they did your knee w/ the ground plane on the other leg that your PM ever sensed anything going on.

However, in retrospect, when considering the way electric fields act, I would suggest that on the buttock of the same leg would have been much better a location for the ground.

Sounds like they are going to do this job w/ conscious sedation & a local as opposed to general anesthesia.

When I had my first Big Toe's bunion done that is the way he handled it. In & out in a couple hours at an outpatient clinic. I THINK that they used Versed on me along w/ a local. No Electrocautery.

Second Big toe was done in a hosp OR w/ a spinal block, no EC, but they did put a tourniquet on the leg above the foot because he went in & did more than just scrape Calcium. He also did not use EC.

Ask him outright if he plans to use a tourniquet on it. If so, there should not be much more bleeding. The toes are not noted for a lot of blood, especially where he will be working, which is not far below the surface. Sometimes they control bleeding w/ a local containing epinephrine that constricts the blood vessels locally, preventing a lot of bleeding. ASK about what he plans to do. If he would use EC as a last resort, tell him you would prefer the ground on the lower thigh OF THE SAME LEG. That should preclude your HR even being affected.

Have fun!

Donr

I have a general surgeon who uses ultrasonic energy to cauterize while mucking around in your belly w/ a laparascope. He did that on me while fixing an incisional hernia. Dunno if that works on big toes.

Big smile for Donr

by flutetooter - 2015-07-07 11:07:56

Thank you, thank you, thank you! Now I can enjoy the rest of this week and a family vacation for 20 on Sandbridge Beach, VA next week. ECG, chest Xray and blood work follow on the day we return for toe surgery on July 23. Doc promises he will have me driving in 2 weeks, as hubby still can't drive following a fall on the ice in Jan.

I was not the person with the Knee surgery in your 2012 reply - it just popped up on Google searching for info on "toe surgery with pacemaker". My surgery last summer was for a major rec room redecoration (hysterectomy, hernia, and 3 prolapses) hence the ground plate on my thigh opposite the groin hernia side. They did not put my pacemaker on "operating mode" at that time because they agreed that 100 beats per minute for 3 1/2 hours surgery would be too stressful for me. I did fine on my own bradycardia beat.

Now I know that what the podiatrist and I had agreed upon for this time with no electrocautery, sedative if needed, and MAC will be quite sufficient. A tourniquet will be used on the ankle. Thanks again.

Thanks again.

by flutetooter - 2015-07-08 10:07:00

I had read your long article (you included a link) about surgeries and electrocautery last summer and all went very well. I have opted against an additional repair on a hammertoe pinkie because it does not cause pain, and from viewing toe surgeries on You Tube (doctors hate it when patients do that), the surgery on the top side of my big toe was much simpler and that toe was causing trouble with my gait. You are right about the sharks. My whole family is planning to stay out of the water except for the pool. Too bad! Here in Indiana I can hardly go out of the house without getting lyme causing ticks on my because of all the deer. Where is it safe?

I had forgotrten about the ...

by donr - 2015-07-08 12:07:28

...3 hr wallow in your nether regions last year. I also don't recall the knee surgery that I wrote about, either. Must be be getting old!

THere are two kinds of EC device - mono & bi polar. They are called "Bovies." The mono-polar has a single conductor - sort of like a sharp point on a pencil. The electric current jumps from that sharp point to your body, which returns the current to the Ground Plane. Then there's the Bi-Polar sorta like a spark plug in your car, where the current jumps from one point on the device to another point on it. In the jump, it creates an arc that gets hot enough to sear the tissue & stop the bleeding. This one needs no ground plane.

Stay away from the shark feeding grounds.

Donr

Treadmill test with a pacemaker?

by flutetooter - 2016-07-26 00:50:32

Hi everybody, especially Donr. Saw that you were on.  Very busy with family and care for hubby after  head bash on winter ice Jan. 2015.  Not used to this strange site.  Hubby O.K. in activities of daily living, but I do all the finances, driving, house repairs, etc. Trying to stay healthy.  I have an actual cardiologist now - did his Internship and Residency at U. of Chicago hospitals where they put in my pacemaker, but has an office much closer.  He would like me to have an actual treadmill stress test rather than the chemical stress to see about some  tachy stuff on the pacemaker printouts.   The pacemaker team assured me that it was self limiting and triggered by the atrium (I thought) and not to worry.  I will call my pacemaker team and find out more.  My Boston Scientific is set for  60 beats per minute and provides boosts up to 120.  My heart can go higher on its own, but I seldom  exercise above that. I do mostly strength and balance and water stuff.  (77 yrs. old and not an athlete). Any comments?

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