Volunteer Firefighter

Welcome to the club!

by CyborgMike - 2020-06-15 01:53:38

Hi Blair,

Welcome to the club. You get to be both unlucky and lucky at the same time. At 30 bpm that is about as close to death as you want to be. Consider that every day is now borrowed time. These little machines are amazing. 

On the BA, I think you'll be fine. I do a lot of backpacking with my son. I let the EP know before surgery and he placed my PM under my pec muscle, but I think it would have been fine without being under the pec. My backpack can get up to 50-60 lbs (25+ Kg) on a given trip for 3-4 days of hiking. I was really worried about it the first time I put it on, but the straps sit well to the outside of my PM and the waistbelt takes 60% of the pack weight. There is a company that advertises on this site (forgot the name) that sells a shield (like a sports cup) that fits in a special shirt pocket to protect the PM, but I never ended up wearing it. The PMs are nearly indestructable, but the leads are more sensitive. 12.5Kg is not very heavy. A lot of students wear packs full of books that are heavier.  

Thanks ar_vin and CyborgMike

by Blairhm - 2020-06-15 03:33:28

Thanks for your welcomes and thoughts. 
I wasn't expecting my pacemaker op, so I had never had any discussion about positioning options, or anything else. The placement choices I was given were left or right. So it is not under the pectoral.
I already asked my tech about a weird thing I noticed when I was on a cycle the other day. My BPM was up a bit over 130 and I felt ok but knew I was working hard, next thing I looked at the heart rate meter and it had dropped to 70BPM. I didn't feel too bad but wondered if I had overdone things so I only kept going another 5 minutes or so.
I emailed the tech and she said "If the Upper Tracking rate of the pacemaker is not quite high enough then the rate can drop to half the upper tracking rate, which may have been what you observed."
I have an appointment with techs in mid-July and she said she'd get the "upper tracking rate" slightly increased then. So that soaunds in one with what you were advising.
Other than when I am on a machine at the gym, I don't count my heart rate, so it's the only time I would pay attention to anything more than how I feel.

padding

by dwelch - 2020-06-15 06:58:47

Mine is not under the pec muscle either.  And sorry I dont do a lot of carrying of backpacks, have had a few very hard hits on that side with no issues and have had pacers for 33 years.

You might try adding some padding or maybe padding plus some armor, essentially distribute the force over a wider area and/or move/isolate it away from the device.  If being under a pec muscle is good enough then there should be a way simulate something similar or better, under a muscle it still experiences force

There are folks here that play hockey (or at least desire to return to that) and other activities that can result in a hit to the device, understanding that a pack is not a hit it is mroe of a heavy weight that can/does move around while pushing on the body.  so padding with something slick (plastic) so that the pack/jacket/etc slide over the device and dont grab the clothes which grab the skin like it normally would.

Hmm football shoulder pads have a vest like body portion, dont need the shoulder parts themselves and maybe remove padding right above with some margin over the device and bridge over it with the hard plastic.

Just some thoughts, thinking out loud.  Not a doctor, use at your own risk, standard disclaimer.

This one is hard to contemplate, but perhaps on your first replacement have it moved under the pec.  At least ask so doc what if you had had it placed differently could I wear a pack.  This doc/practice may for many reasons may say sorry no to any question in part because of legal fear.  Or might say yes we could have done that.

Give it more time I expect there will be more answers to come to your question.  You are by far not the first person to want to wear a pack fo some sort with a pacemaker...

5kg

by AgentX86 - 2020-06-15 09:12:04

The 5kg (10lbs) limit is usually for the first 4-6 weeks, as the leads settle into the vein walls.  After the initial period there shouldn't be any restrictions on weight at all.  Some doctors want more time for extreme arm extensions, like golf or tennis (if placed on dominant side).  You might find it quite uncomfortable with the straps on your PM but there should be some remedy for that too.  There could be other reasons for your limitation so ask for clarification but I think there is a misunderstanding here.

long term restrictions

by Tracey_E - 2020-06-15 10:36:50

Most weight restrictions are until we heal, not forever. Carrying weight, as long as the doctor clears you for full activity, won't hurt the pacer. Many of us hike with a heavy pack, lift weights, kayak, do whatever we want to stay active. The only thing to keep watch for is direct heavy pressure on the leads themselves. That's how you can cause damage. I have no idea how a BA fits, but if it's similar to a backpack, it's unlikely to be an issue but you should be able to tell pretty quickly when you put it on. When in doubt, skip the nurses and ask the doctor. 

It most definitely sounds like your upper tracking rate isn't enough. With heart block, our atria beats normally but the signal doesn't get to the ventricles. The pacer keeps the ventricles in sync, but it can only go as high as it's programmed to go (130, in your case). That's a normal place to start it, but anyone young and active will need it raised. Don't push it until you can get it raised, it's hard on the body when either the atria is going faster than the ventricles or you are working out and your rate suddenly tanks. Can you get in sooner? 

Update - tech visit

by Blairhm - 2020-07-14 07:53:48

Thanks again to those who have so kindly read and shared advice.
I had my first pacemaker tech visit today. Anything requiring a hospital visit has been reduced to a minimum to reduce risks of any unnecessary exposure to Covid19.
I am in New Zealand where our only active cases are now recent arrivals within quarantine facilities. I feel very sorry for those of you still facing high rates of infection and disruptions to normal life.
As for my pacemaker - it was a very reassuring visit for me. The tech increased my upper limit to 180. I can't see a time where I will push myself to that, but it means I will be able to get reliable pacing to the ventricles during exertion and no more signal skipping and mismatched upper/lower rhythm. 
I asked the tech his view on wearing a pack or firefighting BA and he was again reassuring. His experience was that packs were not a problem. Leads were very unlikely to be placed under strain by pack straps, and if the pacemaker was pressured, I could see if padding was any help. I don't see a BA being a problem. The harness just does not load the pectoral that way and a structural firefighting jacket is bulky enough to be called padding already.
I still have to get a medical assessment/sign-off from my doctor and then probably another one from a fire service doctor, and my chief would need to endorse my fitness, but I am feeling pretty positive about this working out.
Thanks for being there with advice and support everyone.