Quality of Life issue

quality of life

by new to pace.... - 2022-08-27 09:47:44

Pacemaker August 2019 have not taken any prescribed medications. 

Do use Tumeric supplement for blood thining,pain and allergy, seems to work for me.

Reduced my sugar intake which has lowered my A1c. Taking Red Yeast, Rice  supplement and it has lowered Cholestral.

Now trying to stay away from the trigger foods for Afib.  Since they are some of my favorite foods having a hard time.

Will try substituting Carob for Chocolate to see if that satisfies my craving.

Now have found a Gluten Enzyme took it before eating rye bread for the first time in a long time. With other trigger foods saukaurt , thousand island dressing.  Did not feel any high rates last night.  Will try pizza next week. 

Will of course check after my next  remote on Sept 20 to see if there was any problems with afib.

new to pace

Red Yeast Rice warning

by Lavender - 2022-08-27 11:51:24

Just a caution in one supplement that newtopace mentioned-red yeast rice. I had severe reactions to it after only taking it for a few days- after my former pcp suggested it. I had stomach pain and bloating and couldn't digest anything without discomfort for a long time. The problem with taking supplements that aren't regulated or approved by the FDA, is not knowing what's in it. It can have varying levels of product as well as added unknowns. 
Good article on red yeast rice:

https://universityhealthnews.com/daily/heart-health/what-you-should-know-about-red-yeast-rice-side-effects/
 

It took a year for me to get back my stomach back on track. Amazingly, my sister in law takes it daily with no ill effects. 
 

There are cautions when taking some supplements with others as well. Research with a natural products expert is best before buying and injesting any nonregulated substance. 
 

I have successfully gotten my stomach issues under control by what I put into it. I manage all pain with ice or heat or alternating those as well as by meditation and seeing a licensed massage therapist. I take no meds except vitamin d3. If a doctor prescribed needed meds for me and there was no way around it, of course I would listen to my medical professionals first. My blood pressure runs low. 
 

End of life is different. I know a 91 year old diagnosed with leukemia who has chosen not to have bone marrow biopsy or any treatment. For him it would be very challenging to go through extra measures. 

My own mom is 97 and under hospice care in a facility. She's off meds except for anxiety. She's dealing with dementia but is not in pain, is pleasant and happy. They even stopped medicine that was to stave off spread of breast cancer. Her life is peaceful. Her heart is better than her childrens' and she's not on oxygen. 

Stubborn high blood pressure

by Gemita - 2022-08-27 12:09:33

Hello new to pace,

I truly respect your beliefs that your lifestyle is the right one for you and it has certainly kept you well all these years.  I also look daily for natural ways of controlling my AF, since I have a number of known triggers which unfortunately intermittently include swallowing and eating which are difficult to avoid.

But anything we can do to try to help ourselves can only be a good thing.  I am less brave however when it comes to AF control and do rely on my anticoagulant to keep me safe from an AF related stroke and on my beta blocker to control my heart rate.  

We are having a hard time with hubby’s medication which seems to be increasing daily and he is beginning to refuse treatment because of difficult symptoms that are developing.  I know his cardiologist is now of the opinion that fewer meds might be the way to go and that we may never succeed in getting his blood pressure to the desired level.  He is certainly much happier on fewer meds and that has to be important too.

Have you ever had high blood pressure new to pace and if so how did you manage it?

supplements and no high blood pressure

by new to pace.... - 2022-08-27 12:40:41

Yes Lavender, am aware that  supplements can cause reactions to them was on 2  different ones for Osteroporis.  Caused edema badly in my ankles, bloated and the occasionally Afibs.  Now off and doing so much better.

Gemita thank goodness Blood Pressure is under contral am aware too much salt can cause high blood pressure.  The only salt i eat is now in the occasional Pizza, sauerkraut, salad dressings and rye bread when i cheat. Now will eat a side of asparagus after indulging, as it is a diuretic. and many chasers of water to flush the forbidden salt out.

 Know how i care to address my problem is not for everyone.  I respect everyone choices.

new to pace 

Weight?

by Lavender - 2022-08-27 13:05:00

Assuming your hubby's weight is within limits -too much can attribute as I'm sure you're aware. 

I share your concerns Gemita

by IAN MC - 2022-08-27 13:38:50

As our life-spans increase so does our exposure to "polypharmacy".

Apparently, in the last  10 yrs there has been a massive increase in the number of people taking more than 5 different drugs daily . This is understandable as the longer we live, the more different illnesses we develop , BUT no clinical trials are done on the potential downsides of polypharmacy !

- what drug interactions are there ?

- where is the data on the LONG TERM safety and efficacy ?

- where is the data on the all-important " Quality of Life " ?

There is a "gap in knowledge" ( to put it mildly )  between the evidence for the short and long-term effects of these drugs. We haven't a clue whether or not their benefits last for decades.

Perhaps, instead of the act of faith " drugs for life" policy, we should be looking at " discontinuation trials " where outcomes are compared for people who stop taking some  of the drugs in their mix to those who carry on taking the lot.

I believe  the results may be surprising ..particularly if quality of life is taken into account.

Ian

Weight yes has increased

by Gemita - 2022-08-27 13:39:09

Lavender before I take a supplement, I do my research and also involve my doctors to make sure that any supplements I take do not adversely interact with any of my meds.   I am a great believer in Vitamin C for me personally (non acidic form taken as magnesium ascorbate powder).  I prefer to get most of my vitamins and minerals from my food alone though, more enjoyable and safer.  I was also advised to take Vitamin D3 and Vitamin K2 (MK7 form) for bone health.  Both these were recommended by my GP.

Yes hubby's weight is creeping up because of poor quality sleep and getting up to eat a bowl of cereal at around 3 am every night.  It is almost a habit now.  Not sure that he really needs it.  His weight has also increased due to insulin for type 2 diabetes.  Am sure poor quality sleep is the number one cause of his stubborn high blood pressure and weight gain but many of his meds seem to cause sleep disturbances and nightmares which we are trying to address 

Ian

by Gemita - 2022-08-27 14:03:26

Ian, yes I know all about an ever increasing number of meds.  Hubby came home with a shopping trolley full of new ones again yesterday and I felt like handing them back to our chemist. 

Clinical trials looking into the potential downside of poly pharmacy and the long term safety and efficacy of some of our meds is well overdue.  I agree we should be looking into “discontinuation trials” and comparing these with trials of patients who remain on meds for the rest of their lives. I wonder what the results would reveal.  

Quality of Life

by Julros - 2022-08-27 14:59:46

My doctors practice a shared-decision model of care. They explain their reccomendations with the benefits and drawbacks, and I make choices based on that. In the past I have been advised to take metformin, and I stopped due to side effects, and my A1C is stable. I was also on thyroid supplement, but after reading an article that many people do fine without it, I stopped that too. I was able to halve my lisinopril after weight loss and mindfullness practice. 

If a lexiscan test was as advised to offer a solution to afib, as I did not mind the last one. But with my pacer, I would be able to do a treadmill. 

Yes, we all make choices, but we should certainly get expert opinions before doing so. A competent provider should feel comfortable having this discussion. On the other hand, I understand if they feel unable to treat a patient who refuses all advice. 

his cardiologist is now of the opinion that fewer meds might be the way to go

by Persephone - 2022-08-27 18:37:57

I know this is very difficult, but I am so appreciative of you putting this concept out there, Gemita. There are many, many sides to this story, but the "resistance is futile" road to mandatory medication is probably not the one many of us would want to go down.

Julros and Persephone

by Gemita - 2022-08-28 01:14:27

Julros, well done with the weight loss and coming off Metformin.  We have never refused advice.  In fact the opposite is true;  we always hoped that a new treatment might just help.  Your comment about Lexiscan therefore might belong on Swangirl’s thread "Refusing Test"? 

Hubby initially had a chemically induced stress test which led to an angiogram and then to two stents in his almost totally blocked LAD artery.  After his stress test before the extent of his disease was known, we were initially given several choices.  One of the choices was to be entered into a medical trial comparing treatments of medication alone to a surgical fix.  We asked for the angiogram and surgery (which was risky at the time) but I believe it was the only choice, even though hubby had to be on triple therapy for stent/AF stroke protection initially - Clopidogrel, Aspirin and Apixaban - which caused urinary bleeding.

It is not easy being a carer wanting to follow doctors’ instructions while being aware of the patient’s discomfort and needs too. There are times when I have to make decisions about my husband’s care swiftly without the guidance of doctors, especially with our hard pressed NHS service.  I have mostly got it right but balancing his medication can be a lottery.

Persephone thank you.  I also believe fewer meds is now the only way to go. It will keep his blood pressure at least partially “controlled” and out of the danger zone without causing distressing, destabilising symptoms, which in themselves can be dangerous too in the elderly.  

Polypharmacy

by AgentX86 - 2022-08-28 02:35:25

I'm currently on seven prescription drugs, for hypertension, heart rate (and hypertension), a statin, and an anticoagulant for heart disease, one for gout, glaucoma, and seizures. I also take a bunch of supplements but all prescribed by a doctor somewhere along the line. I don't see ever reducing that number[*]

BTW, the assumption is that the seizure was caused by a micro-stroke (two, actually) before I was anticoagulation seven years ago. I'm lucky. Don't mess with anticoagulation. "Natural" means nothing to a stroke.

* add morphine to the list right now :-/. I kinda forgot how to count ladder rungs.

A Massive Benefit of Polypharmacy !

by IAN MC - 2022-08-28 07:12:33

Agent .... I think I owe you a big THANK YOU.

I spent most of my working life in the Pharmaceutical Industry ...... polypharmacy doesn't half help my pension !

Ian

High Blood Pressure - none medication treatment.

by Selwyn - 2022-08-28 08:12:37

Weight control, alcohol restriction, and sodium restriction are the only study proven ways to control raised blood pressure. 

Experience shows anxiety is a major factor in raised pressure.  Blood pressure should be checked outside of the doctor's/nurse's consulting room. 

Caffeine increases heart rate and is likely to raise blood pressure.  

Medications shoud be checked as some may actually raise blood pressure. 

What is hypertension ( raised blood pressure)? Blood pressure increases with age. A raised blood pressure should be considered along side the normal for age. 

See https://www.nhs.uk/conditions/high-blood-pressure-hypertension/treatment/

for general advice about how to deal with raised blood pressure.

As blood pressure depends on cardiac output, peripheral resistance, and  the blood viscosity, sometimes a raised blood pressure can be very resistant to treatment. Sometimes lowering the blood pressure reduces the blood flow to the brain and this can cause loss of brain function ( memory, dizziness etc). There may have to be a balance struck between kidney function ( very sensitive to blood pressure) and quality of life.  This is the art of medicine, rather than the science. 

Raised blood pressure can cause strokes, heart failure, and kidney failure.

This is an important topic!

by Good Dog - 2022-08-28 09:06:14

Gemita: to the point of your question, "living with a condition that is "only" partially treated".

I am faced with that dilemma today. Most of the discussion here has been related to drugs/polypharmacy and that is certainly understandable. However, in my case I am faced with a decision to undergo a procedure that has significant risks attached. I can continue living with an EF of only 40% (PM induced HF, paced DDD) OR have 35 year old leads extracted to facilitate a CRT. It is not possible to simply add a lead at this point. Some here have said; "oh, just get them extracted". "You'll be better-off and you have the best care you can get (Cleveland Clinic)." While certainly true, it does not change the fact that risks remain. They are increased due to the age of the leads. My Doc has made those risks very clear to me.

My HF is not symptomatic to any significant degree and it seems currently to be stable. I can physically do anything today that I have always done. I may not have the stamina that I once did, but I am fully functional. My current leads while very old are still fully functional and the battery life currently at about 8 years; is good. There is little doubt in my mind that a CRT would improve my EF and provide for a brighter future, but at 74 years of age, who is to say how much longer that will be. I also realize that putting-off extraction until a later date, should it be necessary, will result in increased risks.

So given a choice, my decision is to retain my old leads and move forward without any changes. That decision is based on the simple fact that however minimal the risks may be, why should I take a risk that I do not need to take. Of course, if my condition worsens, then that will change the calculation. Others may differ or take issue with my decision, but it is my life and my decision to make.

Good Dog

by Gemita - 2022-08-28 09:51:35

I would support your decision whole heartedly. If you are stable why change anything.  Why risk surgery for an upgrade that may or may not immediately improve your EF.  There are no guarantees in life and the risk for an infection or other difficulties are always there, particularly with an upgrade to something that is more complex than your present system and with the lead extractions.  In the event of a change in your circumstances, then of course the path will be clearer.  

Your statement tells me everything I would want to know. “My HF is not symptomatic to any significant degree and it seems currently to be stable. I can physically do anything today that I have always done. I may not have the stamina that I once did, but I am fully functional”. 

My EP would probably not be recommending an upgrade if I presented with such a statement and with a battery of 8 years remaining.  He would just advise to watch, have regular echocardiograms and act if my condition changed for the worse.

In any event, Good Dog, for those who are telling you to proceed with haste to a change in device, I would gently like to remind them that the indication for a CRT device is usually 35% EF or lower. 

EF can be subject to change for many reasons and some meds can help to support EF in any event.  My sister who was in heart failure at the end of last year, with an apparent EF of only 16% has had a remarkable recovery with meds alone.  It has increased to around 45% without any device intervention whatsoever.  Frankly I am amazed.

So move forward with confidence Good Dog.  It is all about making a decision and believing in it. 

Gemita - Thank you!

by Good Dog - 2022-08-28 10:22:50

Gemita, thanks for the vote of confidence in my decision.

LATE EDIT: Just to be clear; My reference to my battery life is based upon its depletion to-date (8 yrs). The reason I am faced with this choice is, because it is nearing elective replacement and so the need for the decision is imminent. Any changes/upgrade would be made at the time when the generator will need to be replaced. I wasn't sure that was clear in my post!

I have to tell you that I too am amazed at the benefit your sister is receiving from her medication. That is pretty incredible! I currently do not take any medication regularly. However, it is good to know that it is out there if I ever need it.

Sincerely,

Dave

I had misunderstood about the battery life but it doesn't change my opinion

by Gemita - 2022-08-28 12:48:34

Dave,

A device change will be quick and easy, just a disconnect and a reconnect and your done.  My opinion hasn't changed mainly because as I read your comment "I currently do not take any medication regularly" I am thinking well he doesn't have any symptoms, other than just not having the level of stamina he once had.  Now who can say that at 74?  

CRT in my opinion would be overkill in such circumstances.  I have read that CRT works best when we are truly in heart failure and symptomatic and with an EF below 35%.  You are not showing signs of needing CRT at all, you have no symptoms, you do not need medication and your quality of life is good.  I realise though that you have pacemaker induced HF, but you say your EF is stable.  

Just a few questions for your EP:-  

is your EP recommending a device upgrade because of your 40% EF or because he is concerned about your ageing leads and sees an opportunity to upgrade your system at the same time as lead replacements?  

Are your old leads showing any clear signs of failing?  If not, would they, at 35 years, be able to pace a modern, new device satisfactorily in the future?  

Would there be room in your present veins housing the old leads, to accommodate two new leads beside them, if your two old ones were to fail?  In other words, are your veins housing the old leads still looking healthy and capable of accommodating two new leads?

Selwyn, Ian and AgentX86

by Gemita - 2022-08-28 14:09:10

Selwyn, thank you for the excellent NHS advice on blood pressure.  I can see that the target figure for the over-80s is below 150/90 when measured in clinic or surgery and below 145/85 for home readings.  It would appear our doctors have been rather severe in trying to get those numbers lower. 

Hubby most definitely has nocturnal/early morning blood pressure spikes because his blood pressure is always higher when I first take it, dangerously so sometimes.  This morning it was high again 194/98 but it is usually more in the range 170/90.  During the day however it falls nicely after his beta blocker, calcium channel blocker and prolonged release Isosorbide Mononitrate.  He does have diabetes, thyroid and kidney problems which are conditions I believe that can trigger a spike in nocturnal blood pressure.  I will definitely get a complete review of all his meds to make sure that they are not making matters worse.

Yes his weight is creeping up and becoming a problem, so we can do more there.  He doesn’t drink alcohol, tea or coffee.  He just likes his food.  We avoid adding extra salt.  Stress is a real problem and he doesn't handle it well and poor quality sleep and nightmares won't be helping.

AgentX86, I can see you are on quite a cocktail of meds too.  We have tried many BP meds including Ace Inhibitors (caused worsening cough and all over rash, especially Ramipril and did nothing for his blood pressure), ARBs, Calcium Channel Blockers, Beta Blockers, Alpha Blockers, Ranexa, Statins.  Hubby also takes Gout meds, Thyroid meds, Pain Relief (oral, patches and liquid-Oxycodone), GTN spray for angina, Anticoagulant, not to mention the boxes of COPD antibiotics we have in store and inhalers, his insulin and other medical supplies.  Between us we can keep Ian in comfort for a while longer. 

Good questions - Gemita, Thanks

by Good Dog - 2022-08-28 14:32:55

Those are all very relevant and important questions and the timing could not be better. My Doc has not yet made a recommendation, but I am meeting with him this Thursday. We have already discussed my potential options pending results of a recent veinogram and another echo. Although his nurse already indicated to me that the vein is occluded. I am also anticipating a more detailed discussion with regard to the condition of my leads as well. So all of this before determining the way forward. 

Thank you for all the helpful info. 

Sincerely,

Dave

A Massive Benefit of Polypharmacy

by AgentX86 - 2022-08-28 17:01:30

Yeah, my Medicare Part-D insurance and I can just say,  "you're welcome".

polypharmacy and discontinuation of drugs

by AgentX86 - 2022-08-28 17:14:18

I don't see how any of the drugs can be eliminated. In my case, except for the two hypertension drugs, one being Metoprolol, there isn't any overlap between diseases/symptoms. Unless the underlying disease and damage that it's already caused can be reversed the need for these drugs will remain. For life.

quality of Life

by Gotrhythm - 2022-08-29 13:22:05

Thanks for raising this topic, Gemita. I find the subject of quality of life looks easy from a distance, when you're already sitting in a good place. Working up close, trying to sort through details, compare drug and therapy regimens, to be hospitalized or not, where to live, how much to pay someone else to do what you've always done for yourself---quality of life seems a much less solid concept, much more ephemeral, like fog, vanishing whenever you get right up close to it.

Quality of life is particalarly germane to a discussion of pacemakers, since, with a few exceptions, pacemakers aren't really making a black and white, life and death difference. They are not keeping us alive. Most of us would not keel over dead instantly if the pacemaker lost function. What the pacemaker does is allow us to have a (much) better quality of life with the heart condition we have.

Gotrhythm

by Gemita - 2022-08-29 16:57:20

Gotrhythm it is so nice to hear from you and to receive your thoughts.  Even though our QOL from a health perspective is not always the best, we still both appreciate “what we do have”.  As you say, QOL can vanish so quickly just when we think all is well.

Our pacemakers have allowed us to have a much better QOL and we can really measure the advantages in terms of improved exercise and feeling more confident that our heart rates will not plummet and cause collapse when we are out in public places.  What is not so good is the increasing medication we have to take to control heart rate and blood pressure.  While some meds may successfully treat one problem they often create another that needs treating.  It is easy to see how quickly our meds can increase over the years.

I have received so many helpful responses to this post and I am confident that I am on the way to finding a way to safely reduce the medication that we have to take and hopefully with the blessing of our health professionals.

QOL vs. life sustaining

by AgentX86 - 2022-08-29 19:55:01

The attempt to surpress atrial arrithmias is a QOL matter but I don't agree with you regarding pacemakers.  Most are life-sustaining.  SSS is usually degenerative and will often lead to asystoles.  VT and Vfib are quite common drivers of ICDs (I'll lump them under the "pacemaker" category).  Even heart block can result in a non-life sustaining ventricular heart rate.  While this probably doesn't add up to 50% of the PM use, I'd think that it's not an insignificant portion.

AgentX86

by Gemita - 2022-08-30 06:31:43

You make a very good point, pacemakers more than improve quality of life for so many of us today.  They can and do prevent sudden cardiac arrest from a dangerously low heart rate and an ICD can certainly stop a malignant arrhythmia.  I know with my own natural heart rate being so low now, I would really struggle to stay alive without the backing of my pacemaker.  I hope though that in the unlikely event of my pacemaker ever stopping, I personally would still have time to seek help and not "keel" over

Keel over

by AgentX86 - 2022-08-30 15:03:14

Sorry, I didn't mean to imply that the response to a failure isn't an ambulance, rather a hearse. There are other natural pacemakers in the heart that will sustain life for some time, if not indefinitely. It might get ugly but it's unlikely to be like a LAD blockage,  where you're dead before you hit the ground.

This al academic, though. Pacemakers are so reliable that the odds of winning the Mega-millions lottery and get struck by lightning in the same week, are higher. Stay out of the rain, don't pay the stupid tax, and you'll be fine. The pacemaker will take care of itself.

Paliative care

by Gotrhythm - 2022-08-30 15:11:34

I had to leave the discusion before I had quite finished all I had to say. AgentX brings up points I was going to make about the distinctions between life-saving and life extending.

I am just getting over an asthma flare that landed me in the hospital. The drugs I was given required 24 hour cardiac monitoring, since in those doses they were likely to send my already wonky heart into arrythmias--hence, the need for in-patient treatment. I am slowly improving, and we are lightening up on the dosages, but quality of life has been a forefront issue for the last three weeks, since the drugs make me feel extremely weak, so shaky I can't even text, and give palpitations that can cause collapse. And always in the background, I'm aware of my pacemaker, not keeping me alive, making me able to walk across I room, which is a good thing. But also being the safety net so that cardiac arrest doesn't happen.

Everybody has a "good death" fantasy in which someday when they are not horribly sick and frail, but ready. While they are still in their rigth mind, all the good, good-byes said, they will simply lie down, go to sleep, and simply not wake up again. A pacemaker makes that less likely to just happen.

There is a new/old concept in medicine that's gaing traction called paliative care. It's about finding the levels of care that promote the greatest possible sense of well-being and comfort as we deal with chronic conditions. Our local non-profit Hospice now has a paliative care division which I am going to ask for a referral to. One does not need a terminal diagnosis--I do not have one. But as Gemita is saying, the challenge of what to treat, when to treat, how agressively to to treat, and how to preserve enough QOL that I don't regret having a pacemaker, is becoming overwhelming.

I need help. And please God, I'll do a lot to never wind up in an ED again. I'll let y'all know how a paliative care referral works out.

Paliative Care

by Gemita - 2022-08-30 16:22:47

Gotrhythm, I was saddened to read your message and to know that you have been suffering.  I am so sorry we didn’t know and weren’t able to support you.  ED is really no place for patients like us and we also will do everything in our power to stay away from emergency departments. 

I was sent to A&E last week too for urgent assessment and some checks and the concern I had about leaving my husband alone at home was very difficult to cope with, particularly since he is unable to manage his own medication and insulin injections, or to “safely” care for himself.  We too are beginning to think the unthinkable that it will soon be time to go into care, to be free from the burden of worrying about managing a home.  

We are here for you Gotrhythm, please never forget that.  You have done so much to help others on their pacemaker journey and now it is time to support you. 

Gotrhythm

by Gemita - 2022-08-30 17:23:05

I don't agree with your statement below about the pacemaker making a natural death less likely.  Perhaps an ICD would continue to shock the heart unless it is turned off, but a simple pacemaker will not stop a heart from failing.  Once we stop breathing the heart muscle will die and stop beating even with a pacemaker.  The pacemaker will hopefully give you a better quality of life until that time comes:

"Everybody has a "good death" fantasy in which someday when they are not horribly sick and frail, but ready, while they are still in their right mind, all the good, good-byes said, they will simply lie down, go to sleep, and simply not wake up again. A pacemaker makes that less likely to just happen".

For a very helpful pdf, type into your main general browser:

Heart Rhythm Society End of Life and Heart Rhythm Devices

Also disagree, Gotrhythm

by Lavender - 2022-08-30 21:46:30

wowsers! This thread is so long👀
 

I enjoy your posts, Gotrhythm, and I did notice one where your texting wasn't your usual top "writer quality", so now I understand why. May your quality and quantity of life improve!
 

Two things:

 Yes- I would most likely keel over without my pacemaker. The cardiologist told me before I had my implant that I wouldn't make it to the parking lot when I teasingly suggested that maybe I could go without it after a 33 second pause put me in the emergency room. 
 

Also, my younger brother had a pacemaker for several years but was still on his first one when he had to have surgery to replace a valve. The surgery was successful but other health issues caused by years of alcohol abuse led to multiple complications. He was in the ICU for four months. He died in his sleep there one night. The pacemaker did not keep him going when his heart stopped beating. He died peacefully. 
 

I read this online:

Patients and their families often make assumptions that pacemakers prolong the dying process and thus prolong suffering.   However, a pacemaker is not a resuscitative device.  In general, pacemakers do not keep dying patients alive, as terminal events are often due to sepsis, hemorrhage, pulmonary emboli, or arrhythmias from metabolic abnormalities associated with end-stage cancer, liver, or renal failure.  At the time of death, the myocardium is usually too sick to respond to the pacemaker generated signals.

and this:

 Pacemakers are not resuscitative devices, and they will not keep a dying patient alive. Most dying patients become acidotic before cardiac arrest, which effectively renders a pacemaker nonfunctional, as under such conditions, the myocardium does not respond to the pacemaker's discharges.

World Hospice and Palliative Care Day 2022

by Good Dog - 2022-08-31 07:26:20

Saturday, October 8 2022

For anyone that has a need or an interest:

https://www.thewhpca.org/world-hospice-and-palliative-care-day/about

https://proyectohuci.com/en/home/

What are the 3 main goals of palliative care?

The goals are:

Relieve pain and other symptoms.

Address your emotional and spiritual concerns, and those of your caregivers.

Coordinate your care.

Improve your quality of life during your illness.