Newbie with a question

Pulled lead

by AgentX86 - 2020-03-28 22:50:12

First, the chances that you did this yourself are very small, though sh*t happens.  It's recommended that you, not raise your hand above your shoulder but also behind your back or a full extension of your arm forward for four to six weeks.  There is little chance of any of these things causing problems but it's better safe than sorry.  Also lifting more than five (or ten) pounds is also normally proscribed for this period.

Normally leads pull out in the first few days because there was a problem with the anchoring.  Either it wasn't put in right (probably not common) or the site they used wasn't good.

Pulled Lead

by RickP - 2020-03-29 00:05:46

Thanks for the reply.

The doc that did the first proceedure felt that the problem was not caused by me but was an anchoring problem.  The 2nd proceedure went well and, so far, I have had no other problems.

I appreciate your guidance.  Four to six weeks it will be, I really don't want to do that again.

6 weeks

by JaeJae - 2020-03-29 08:51:04

I had mine put in a few days after you.

They told me 6 weeks with any big movements, stretching or lifting. They were pretty strict on making sure to be careful for 6 weeks. I'm still using my arm for every day stuff and sometimes wake up with it above my head and think 'that's not good' but just being cautious for 6 weeks.

Its hard though as I feel hardly any pain and kind of forget about it when I'm walking the dog or buy groceries until I go to use it.

My theory is 6weeks in the big scheme of things is nothing to not have to have them go back in!

Disconnected lead had nothing to do with you!

by crustyg - 2020-03-29 11:33:13

Hi RickP: there's an international standard for pacing lead attachments to the PM box itself and when properly used it's impossible for the lead(s) to come off the PM.  Whoever did your implant just forgot to use the locking screw to actually *fix* the lead, rather than just simply *connect* the lead.  It's a two step process: connect then fix.

Have a look at http://www.howtopace.com/attachment-of-device/ if you're interested.  Notice the little tool that the manufacturer provides to tighten the locking screw - it's *really* important that they don't overtighten this as someone will need to undo that screw in 7-15years time without damaging the lead.

Make a note of the name of whoever did your first implantation and avoid them like the plague from now on (pun intended) for actual device/lead manipulation in your body.  They *might* be the world's best EP doc, but they don't have the diligence for patient surgery that you are entitled to expect.

Thanks for your response

by RickP - 2020-03-29 14:50:05

Hi CrustyG,

You may be right - the doc who did the first procedure said it was not anything I did, it just happens sometimes. Anyway, the second procedure worked, I just really don't want to do that again, especially since we have a growing number of Covid-19 cases.

Thanks again, and stay safe.....

Arm position and lead displacement

by Selwyn - 2020-03-29 15:53:48

This old chestnut keeps coming up on this site.

There is no correlation between arm position and lead displacement ( merely comfort). Do what is comfortable for you. 

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

 "We encourage the development of consistent discharge instructions that will promote early mobility and a safe and rapid return to normal activities. " I could not agree more!

2 random controlled trials have shown that early mobilization is safe and feasible, and some physicians encourage a full range of movement on the affected arm. Moreover, patients could self-restrict the arm movements and arm-related daily activities to a further degree or for a longer duration to avoid the risk of device malfunction or to decrease pain.  However, prolonged immobilization or restriction of the arm movements have been associated with the development of shoulder problems such as adhesive capsulitis etc.

Arm position and lead displacement

by RickP - 2020-03-29 17:51:11

Hi Selwyn:

Thanks for your comments. This was the only area of post op instructions that were fuzzy. I was told everything from 5 days to 5 months so I agree consistency here is probably as important as the number.

Thanks for the paper reference, I'll take a look. Got lots of time while shut down.

Insight

by nhorner10 - 2020-03-30 19:23:29

After being on here for a few months you start to see that every doctor gives different recommendations. It makes you realize that medicine isn't necessarily as clear cut and standardized as we like to think - it's science, not math! My doc recommended 4-6 weeks of taking it easy, but emphasized that I should just do what I felt comfortable with. In general, if it hurts don't do it, if it doesn't go for it. In the first few weeks everyone accidentally lifts their arm over their head a time or two - might be a bit uncomfortable but probably not a big deal.

My EP told me the only time he's seen a patient pull their leads from over-exertion was a guy hauling around hay bales 2 days after his surgery. Doesn't hurt to be catious, but common sense covers most of the bases.