pacemaker for my father who is 87 years old

morning all, this is a cry for help really my father is 87 years old and has suffered a heart attack, an atrial flutter and now has been informed he has bradycardia his most recent ecg shows his heart pauses 23 times during an hour. so we are waiting on a date in december for a dual chamber pacemaker to be fitted. it has troubled him greatly that he will be awake during surgery and the fact that he has been told he will be unable to use his left arm for 4-6 weeks after surgery. i am looking for some experience of this and how you all managed. he is right handed and is worried about what if anything will he be able to do with the left arm. will it be placed in a sling for example. he is concerned about the most basic of tasks of course,  toileting, dressing, washing, eating everything basically. i have searched for advice on this and all i can find is dont raise the arm above the head or stretch it behind your back for example.  i have also read sleeping becomes a challenge as well as getting out of bed. i am his carer along with my mums carer as she has dementia and i have a 6 year old son. i can see the next few weeks and months being very challenging the consultant has said i will need to give him round the clock care. so please any advice, tips, guidance would be greatly received by me so i can put his mind at rest (perhaps) and make my life a little easier (if thats at all possible) many thanks 


10 Comments

Challenging times ?

by IAN MC - 2022-11-16 09:38:00

Hello GEMINI

Three things occur to me  ;-

i )   With  23 cardiac pauses per hour , your father definitely does need a pacemaker ! There is absolutely no alternative

ii)  He could ask to have the PM installed under a general anaesthetic. It doesn't have to be done under a local.  Having said that , I had both of mine installed while awake and it really wasn't too bad.

iii) Everyday activities like brushing hair/teeth ,going to the toilet etc are absolutely no problem in the weeks immediately after getting a PM. BUT he will need to avoid heavy lifting and reaching high above his head on the pacemaker side.

Hope all goes well

Ian

 

Round the clock care?

by Gemita - 2022-11-16 09:43:55

Gemini,

Firstly I am sorry about your father’s heart attack and atrial flutter but reassured to hear that he will be getting a dual chamber pacemaker for his pauses and bradycardia.  A pacemaker should improve his quality of life and help him to become more independent, so this should benefit you too.  

As regards your father’s fear about being awake during implant surgery, please ask your medical team whether he could have a level of “sedation” that would help him to stay asleep during the procedure.  There are different levels of sedation if a full general anaesthetic is unsuitable for him. I attach a link on different levels of sedation which you need to copy and paste into your general browser to open:-

https://rcoa.ac.uk/sites/default/files/documents/2022-06/12-SedationExp2021web.pdf

With regards the use of his left arm, I see your father is right handed so he should still be able in the first few weeks to do most activities and in any event his left arm will still need to be moved and can be safely moved to prevent shoulder stiffness/frozen shoulder.  I didn’t use a sling and my team wouldn’t recommend this anyway. 

I was sore for the first six weeks and found it difficult to get into a comfortable position to sleep, but I used more pillows and a pillow wedge to sleep in a more upright position.   Before leaving hospital, make sure you are given wound care and other instructions and a return date for follow up and a number to ring in case of need.

To prevent the leads from moving out of position, it is important not to carry anything too heavy like shopping with the pacemaker side arm or to raise it above shoulder level for up to 6 weeks.  You will need to keep a close eye on his wound and watch for any unusual signs of swelling, redness, oozing, but some bruising and swelling is normal.  

Your father will still be able to attend to most of his needs, if he is able to do this now?   He may benefit from a bit of help dressing or washing his hair for example for a few weeks.  In my opinion, he will certainly not need round the clock care because of his pacemaker.  On the contrary, he will be in a much better place without the pausing and slow heart rates.  Have faith and confidence that all be well.  I hope for the very best for all of you. 

No worries please

by Lavender - 2022-11-16 09:47:34

When my boyfriend's dad was 89-two years ago-he got a pacemaker. He already had a quadruple bypass years ago and is on several heart meds. He did fine. I was feeling sad that he had to get a pacemaker-and-to my surprise-3 months later-I ended up with one!! Gosh did I feel old thinking this older guy got one and here now am I with one🙃

It is not really as restrictive a healing as you imagine. The sling was only for one day for me. Any longer wearing can cause frozen shoulder -which is a problem. He can't raise the elbow above the shoulder for a short while too. The wound must be kept dry. 
 

He will quickly forget that the pacemaker is there. My bf's dad said his never bothered him. We recently took him out to lunch for veterans day. 


I have brady and pauses. I have a dual chamber CRT-P. I'm right handed and it's on my left side. I'm back to my normal lifestyle. The first days after the surgery were challenging in bathing and there was discomfort but Tylenol took it away. I also learned to alternate ice and heat packs on the shoulder and back area which felt strained. Everything else was easy because you can use the other arm all you want.  
 

I wasn't awake for surgery but I am certain that your dad will be made comfortable and have pain meds. 
 

Sleeping was a challenge but I quickly learned to prop pillows around me and a small pillow right over the device-which I leaned into it to protect it. The first nights, I slept on my back with a pillow under the knees in back. 

Seriously, it won't be as bad as you imagine! Some folks worked within days. Many live alone and managed fine.  I still cooked but didn't carry the laundry.  I think there was a restriction like lifting nothing heavier than a gallon of milk. Again-it all heals fast and life goes on!

May God richly bless you as you spend your life caring for others. May your worries subside and peace reign in your family. 

Probably A Dumb Question on My Part

by Marybird - 2022-11-16 12:36:44

But I will ask anyway. Is "conscious sedation" used in the UK as widely as it is here in the US for medical procedures or minor surgeries? Or is it not routinely used there?. Conscious sedation meaning the use of Versed, propofol ( maybe other agents, but I don't know what they are)  to sedate the patient, ranging from an extreme relaxed don't give a doodlie but,awake state to unconsciousness ( ie, sleeping, with no awareness of what's going on). Conscious sedation differs from regular anesthesia in that in conscious sedation, the patient maintains control of his breathing so no intubation is needed. Also the drugs used for conscious sedation are short-lived, so once they aren't administered anymore the patient usually is quick to recover and hopefully has no lasting side effects. At least that has been my experience.

I've had several procedures where conscious sedation was used, and I slept like a baby through the entire procedure. This included my pacemaker implant 3.5 years ago, as the EP who implanted it wanted his patients sleeping during the procedure. Although it seems many surgeons/cardiologists have the patient semi-aware and awake-ish for pacemaker implants, their aim is to make the patient comfortable during the implant, using not only the conscious sedation but a local anesthesia injected into the surgical area so the patient doesn't feel anything during the surgery. 

Gemini, I'd suggest if possible your father might be able to receive conscious sedation with enough of the medication used so that he goes to sleep and stays asleep till they wake him up after surgery. He'd still be under the watchful eye of an anesthesiologist, or a nurse anesthetist who'd make sure he was comfortable and safe during the surgery. 

I wish you both the best.

Mary

Conscious sedation

by Gemita - 2022-11-16 14:14:20

Hi Mary, hope you are doing well.  Yes conscious sedation is used here in the UK often too, for example for an EP study and angiogram, I asked for lots of sedation and slept through it all.  But it is important to remember to tell our doctors that we want to sleep throughout a procedure, otherwise we may find the sedation falls short.  During my EP Study and angiogram I received Midazolam and Fentanyl.  For my pacemaker implant, my EP wanted me soundly asleep so I had a general anaesthetic but of course it takes longer to recover and I was kept in hospital overnight.  I also ask for strong sedation during endoscopies since I am unable to tolerate the scope down my throat and would fight them all the way.

pacemaker for my father who is 87 years old

by Gemini - 2022-11-16 14:17:20

Thank you all for your messages this has really helped me and i will read them to my father and should any more questions arise i shall be in touch. This is such a great forum real people dealing with real life issues. You have all made such a difference to my day thank you so much.

Just one other thing, Gemini

by IAN MC - 2022-11-16 14:48:56

When it  comes to anaesthesia it is important to remember , depending on the procedure, that often the patient is given a CHOICE of the level of sedation he wants...... it is usually the simple question "Do you want to be awake or asleep ? "

The time  for your father to make his wishes known is at the "" Pre-operative assessment "  when the anaesthetist introduces himself / herself just prior to the op.  They also ask you about allergies, drugs taken etc.. The type of anaesthetic given will be discussed.

If your father does opt for general anaesthesia for this simple procedue ,the anaesthetist will be the last person he sees !  ( until he wakes up that is )

Ian

a couple more things

by Prof P - 2022-11-16 18:26:55

Everything reported here corresponds to my experience.  Gemini, you haven't said how your father is doing otherwise.  By that I mean if he has been able to do normal tasks, he will still be able to do many of those after the pacemake.  

I found that the sling was unnecessary after a day or two, but I also found that sleeping with it on for a few days helped me heal up.  Most of the restrictions after the procedure are to help healing.  The incision will take a couple of weeks to heal.  Not lifting with the left arm and not placing it over one's head helps in healing up where the leads are inserted.  It's pretty easy to put on a shirt without lifting the left arm, so most daily tasks are managable.

Elsewhere on this site there are dozens of posts about those first few days an weeks.  They helped my navigate this time where sleeping is hard (and then gets easier) as one heals.

Try not to worry

by Flamingo - 2022-11-16 19:38:27

I had my pacemaker fitted in July this year with a local anaesthetic and was absolutely fine. It sounds awful, but believe me I've had much worse. I came  out of theatre into the recovery room and I can honestly say I felt 100 percent better and I was home the next day. If your father cannot have anaesthetic because of his low heartbeat (like mine) then a local is very bearable. Plus you get to see your heart being 'mended'. 

Afterwards he will have to take things easy, no wild parties please, just be sensible. Do as has been suggested, take care. Yes, there might be a bit of discomfort, but it's a small price to pay for getting your life back. It will be the best Christmas present he'll ever have. 

awake or not

by new to pace.... - 2022-11-19 17:29:25

I recall i must have been a little when they threaded the wire down from the pacemaker to my heart as i flinched a little,  But the rest of the time i was out like a light.

  Did come home that afternoon and slept on my lift recliner.

Now if i found out that was having 23 pauses in an hour would certainly ask for a sooner appointment to get  a pacemaker implanted.

I was told on a Friday that i needed a pacemaker, did ask for the hosiptal that was closer to me.  Could not get in to the middle of Sept.  Doctor said if i went to the other hosiptal could have it on Wed.  So that is what i did , my sister was able to come on short notice. Stayed the night , after was ok, just make sure not to leave my left arm above my shoulder.  Did get a neighbor to drive me to the first appointment.  mostly to hear what the doctor said.  Did have a reaction to the glue that was used to close the incision. 

new to pace

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So, my advice is to go about your daily routine and forget that you have a pacemaker implanted in your body.