Question re: first few months post op
- by Griddlebone
- 2014-11-07 11:11:16
- Checkups & Settings
- 1567 views
- 3 comments
I had my pacemaker implanted Sept. 18. I saw my regular doc for a wound check 5 days later, then the cardiologist at the end of September. He did an interrogation and said I had atrial sensing (yay) and ventricular pacing (ok, fine), with 96% pacemaker driven. Wow, I was surprised the number was so high. My voltage was 3 V. This was the first cardio I talked to in the hospital but he was not available for surgery so his colleague did the surgery.
I saw the second doctor, the one who did the surgery, a month later at the end of October. There was a minor wound care issue which was resolved. I talked to him about the strange burbly sensations under the sternum and he said he didn't feel they had anything to do with the PM. We talked about the wackadoodle gastroenterologist and formed a plan going forward for that. So the visit was more or less successful but he did not do an interrogation of my PM. I asked him and he said, "You're doing fine, we don't need that now." I had waited in the exam room about an hour and 15 minutes, so he was running quite late and I had a lot of other questions, and I am not sure if I had just run out of time for that visit - if so, that's unforgivable and I would have expected a follow up appointment to be set for the near future. But according to what he said, he felt it wasn't necessary. He set up a follow up for 6 months, at the end of April.
I had been somewhat distracted during the exam by the other issues and forgot that I had questions about the voltage. Our hospital system recently set up a computerized system and encourages patients to use it. I left a non-urgent e-mail asking about the voltage last Friday (i.e. a week ago) and have heard nothing back. I wouldn't be surprised if that office never checks the e-mail feature; it's the hospital system that's promoting it.
I plan to go old school and call the office on Monday, but knowledge is a good thing. Is it common to stay at 3 V for over 7 months following the implantation? The first doctor, the one who did the interrogation, said that they would reduce my voltage and I got the impression it would be in a 2 month time frame.
This office does not use St. Jude techs; they do the interrogations themselves. I talked to the tech in the hospital the morning after my surgery and he told me I might not see the techs again. He told me about Merlin@Home. I asked the first doc about it and he said, "Oh, you want that? We don't know who gets those reports. They go somewhere. We don't have many patients who want that." I called St. Jude on another matter (which numbers to give the GI doc) and asked them and they said it was up to the doctors whether they wanted to prescribe Merlin@Home. It was free to me if the doc wanted it but they had to initiate the request.
So, first, the 3 V thing - 7 months at 3 V? Really? And second, does all this sound pretty normal? I am more or less happy with both cardiologists but I think we have a communication problem. Thanks for input.
3 Comments
Voltage
by golden_snitch - 2014-11-08 08:11:01
Hi Griddlebone,
in Germany the standard proceeding after a pacemaker implant is to do the first pacemaker check when the patient is still in the hospital, then about 3-4 weeks later (a wound check and/or removing staples can of course be done earlier), then 3 months, 6 months, and after that every 6-12 months. The voltage (=amplitude) can usually be reduced after 3 months already, but I'm sure that there are doctors out there, who do it sooner or later than that. It all depends on the threshold (= minimal voltage needed to effectively stimulate the heart), the amplitude is often programmed threshold x 2, just to be on the safe side.
Also, not sure if this feature is already switched on in your device, but nowadays most pacemakers have an "automatic capture management". The threshold is being checked automatically for instance every 24h, and then the voltage is adjusted accordingly. My pacemaker does this. I got my latest pacemaker in January this year, and the amplitude (voltage) in the ventricle was 2.1V last time I got a report. But it can change as it's being checked every night at 2:30 a.m. I always get threshold + 1.0V = amplitude.
Best wishes
Inga
What is normal?
by Theknotguy - 2014-11-08 11:11:33
Artial sensing with 96% PM driven. Don't get wrapped up in the numbers. Just because you don't match a set of numbers doesn't mean you have problems. Or, if you do, be happy the PM is taking care of the problem(s). Just because you are 96% PM driven doesn't mean you would drop dead if the PM stopped working (which it won't). It just means the PM is supposed to wait a set period of time, and if your heart doesn't initiate a beat, the PM will step in and get a heartbeat going. I was accustomed to my heart doing anything it wanted so when the PM stepped in and kicked off a heartbeat I go on coughing jags. "Wow", I thought, "this is what it means to have a regular heartbeat!"
About the 3 volts... I was doing repair on a six volt piece of equipment, asked my wife to hold the wires. She had to drop them because the six volts was "biting" her. I didn't feel a thing. So while your 3V question is a good question and needs to be asked, you may require the 3V to keep things going. But I'd still ask. At my last PM check they tested my heart threshold response and left it at 1.8V. Right after I got the PM it was set to 3V.
Burbly sensations: Don't you just hate it when the EP / Cardiologist says, "That can't be it." Just that flat out statement. I told my EP the muscles in my neck cramp up. He said it had nothing to do with the PM. Strange, but I never had my neck muscles cramp up that way before they put the leads under my clavicle. I have my licensed massage therapist work on the neck muscles regularly. Always the same spot and I swear I can feel it all the way into where the leads go into the vein. So I understand your frustration when the doc says, "That can't be it." In the meantime I'm looking for the doc who just had his PM implanted and the dentist who just had the root canal. I feel they'd be a lot more empathetic. The good news is they don't feel you need a checkup for six months.
My best fantasy when I was in the hospital was for the - I only talk to God - doctor to end up in the hospital and go through what I had to go through. I feel they'd be a whole lot more empathetic if they got treated like patients. But, like I said, it was a fantasy.
Non-urgent e-mail. Yeah, that's frustrating too. You're getting into the "practicing medicine / legal liability" area. So it will probably be a long time (shorty before our sun becomes a red giant star) before you get an answer on that one. If you do get an answer it will probably be, "Check with your doctor." So don't hold your breath.
I plan to go old school and call the office on Monday: Probably your best bet. -- I'd be a squeaky wheel about the whole thing. I'm not sure about the time frame on the 3V issue but, like I said before, I'd check it out. For me, at the 3V level I was getting a real hard, "thump" with every beat and I could quite often feel the PM kick off. After they reduced the voltage I don't feel the PM as often and I don't get the "thump". Just because it isn't a big deal to your EP doesn't mean it's a no-never-mind for you.
This office does not use St. Jude techs: -- That's pretty normal. My EP office uses techs who are qualified on Medtronics, St. Judes, Boston Scientific, and a few others. They just pull out the fat laptop that matches your PM and read the reports. Be sure to insist on and receive your report each time it is read. I can't read everything that is on mine but they are a gold mine of information and are helpful when you see someone reference something about your PM on this forum. I've learned a lot. The more knowledge, the better you feel.
He told me about Merlin@Home: -- I've got the Merlin@Home but haven't used it. I'm well past the initial danger period so question if it is of any use, especially if you live in a large metropolitan area. I'm only five to ten minutes away from a major hospital so if I started having problems I'd punch the button, get the EMT's here, and head out to a hospital with a crash cart. I'd do that rather than messing around with the at-home system, waste time, and possibly kill myself.
So, first, the 3 V thing - 7 months at 3 V? Really? - - Yeah, I'd be a squeaky wheel about that situation.
Second, does all this sound pretty normal? -- Sorry, don't know if there is a "normal" for heart situations. But I'd still get it checked out.
I think we have a communication problem. -- And what makes you think you're so special that you won't have a communication problem??? Like I've said on this forum before, about 80% of the information I was given about PM's was wrong. And that was from the medical profession and people who should have known better. Sharing information with other PM people is one of the few things that has kept me from going off the deep end - although my wife would question about me going off the deep end.
Oh, one other thing. You keep being logical and trying to make sense. Doesn't work. I prefer Robert Heinlein's theory. Your life is controlled by two departments. 1) The Surprise Party and Practical Joke Department. 2) The Fairly Godmother Department. Guess which one is over staffed and works overtime?
Hang in there. Life gets better. You've got a lot of living to do. So go out and enjoy life.
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I'm 44, active and have had my device for two years. I love it as I can run again and enjoy working out without feeling like I'm an old man.
Oh... the diagnosis is heart block, no AFib or such.
by Griddlebone - 2014-11-07 11:11:32
I think I'm a fairly straightforward PM recipient.