What were they doing?

During my recent pacemaker implant, I was of course heavily sedated but woke up during the procedure to a lot of pain - it felt like something was being jammed into my chest (above my left breast). When I started talking (hello that hurts!) the doctor said that I shouldn't talk because it could collapse my lung. What I'm wondering is...what was he doing? I thought the leads were fed in through veins, so what could collapse a lung?

I read in someone else's post here about the surgery itself (the subject was "it's not just "minor" surgery") and they referred to the fact that an incision is made into a major muscle. I know that the muscles in my upper left chest were extremely sore, but I didn't know they have to make an incision in one.

I haven't seen my doctor yet for my follow-up and so haven't had a chance to ask him. Can anyone here tell me in more than the general non-scary terms we all have read what they really do during an implant?

By the way, my doc did a great job and I'm doing lots better.

7 Comments

just quick....

by sweetkozy - 2008-04-01 01:04:14

My implant was placed under my muscle....so yes they did have to make an incision into the muscle. It was quite painful afterwards. I think it makes a difference where they place your PM. I was slightly awake for my first ablation, in and out and throwing up over the side of table. When I went in to receive my PM, I asked them to make sure I was out for the whole thing and give me medicine to help with the nausea. I do not remember a thing and they respected my wishes about being out for the entire procedure and they even knocked me out good for my second ablation.

Cheers :)
Jenny

Making a pocket

by ElectricFrank - 2008-04-01 01:04:46

I was totally awake during mine with local anesthetic by my own choice. The pressure you feel is when they make a pocket for the pacer under your skin. Visualize an uncooked turkey sitting in a pan with the breast up. Now cut a slit in the skin and start pushing something under the skin to separate it from the underlying tissue and make a pocket large enough to hold the pacer. It takes some force to separate the skin from the fascia and it would be painful without either being out or have a local.
As for puncturing the lung some of the work inserting the leads through the vein is tricky and close to the lungs. If the person is moving a lot it could conceivably cause a problem. Keep in mind too that what you remember may be cloudy if you were coming out of being sedated.
By the way I recently saw an article about side effects of the anesthetics that are supposed to keep you from remembering the pain etc. It seems they have been implicated in continued memory problems for a while after use. Having been married to a therapist for 48 years I know how much time she spent with clients in regaining lost memories of traumatic events that were causing all sorts of emotional problems. That's why I made it very clear that I was not to be given that kind of drug.
I'm glad to hear you are doing well. It is great when you have that feeling that your doc did a good job. I have the same feeling about the cardiologist that did my implant. Being awake I really know how competent he was. Now his knowledge of programming the pacer is another story, but fortunately I have the Medronics rep doing that.

frank

PAINFUL

by peter - 2008-04-01 03:04:22

I remember the local anaesthetic to stop any pain as I was awake during the proceedure. As soon as the knife started cutting my flesh I felt quite a bit of pain. I was given mere anaesthetic after I mentioned the pain from the knife. After that no more pain until the anaesthetic wore off. The site was so painful I had trouble getting out of bed for a week afterwards.

It can be painful

by kimm102576 - 2008-04-01 10:04:18

my last PM replacement was painfull...I was wake the hold time and it hurt...it felt like tearing...she had a hard time get my last PM out becasue of all the scare tissue...but all in all I was glad I did not have to be put under...next time I will ask for more meds!

It is a funny feeling................

by NH - 2008-04-01 12:04:02

During my first PM implantation in 2002, I was sedated with what is called "twilight sleep". My eyes were closed but I knew what they were doing. I felt no pain, but felt some pressure.

At one point, the Dr. was pushing something into my left shoulder, below the collarbone and above the breast. Again, no pain, but I thought to myself, WOW he must have been an NFL linebacker the way he was tackling my chest.

I guess this is just standard procedure to get the PM situated in our chests. When my replacement PM was implanted last fall, I was completely out cold.

My shoulder was not all that sore afterwards and so I have done well with the implantation site both times. My problem has been regaining my strength and stamina.

Hope this helps at least to hear another experience.

Take care,
NH

They were "implanting..."

by Swedeheart - 2008-04-01 12:04:28

Hello,

I am surprised you felt any pain... many patients are lightly sedated and sometimes fall asleep during the procedure, but some are awake. They should have given you significant drugs to numb the area. I know during my implant about 5 weeks ago, I was fairly "out"... I told them I didn't want to see, hear, or feel anything! I did sort of wake up momentarily a few times ~ one of the times was when they were making the "pocket" for the actual pacemaker. It didn't hurt but NH's description of a NFL linebacker is right on the money! A big amount of pressure!

I don't know that the pocket where the implant actually is located is in a major muscle. Mine is right under my collarbone area, under a layer of tissue... but I don't think mine is located within a muscle, because I can easily palpate the area and find the edges of my pacemaker.

Here is a link to the general procedure, it isn't too scary to look at... a few diagrams, but nothing gruesome, from the Cleveland heart clinic webpage.

http://www.clevelandclinic.org/heartcenter/pub/guide/tests/procedures/pacemaker.htm

It might explain everything for you.

The whole lung collapse thing is something I never heard. When I woke up during the procedure the few times, I was talking to the people around me... doubt if I made any sense, but I attempted conversation.

Compared to other surgeries I have had... I think this is just about as major, if not more so in some ways. The only thing that isn't "major" in my opinion is they use the local anesthetic approach rather than completely putting you out and have to have an anestheologist. (Which adds several thousand $$ to the procedure...)

I am sure you had post op directions... how long since your implant?

Glad to hear you are doing better! That is always great news.

Swedeheart

Thanks!

by Beth28585 - 2008-04-06 12:04:07

Thank you everyone for the responses. I was kind of wondering if the pain I felt was from the injections of local anesthesia - perhaps they have to make some injections fairly deep into the chest, maybe putting the syringe between ribs? That's what it felt like. It could be that they gave me more valium after that because I don't remember anything right after that pain to when they told me that I was all finished.

I did consider the possibility that my memory was altered due to the IV valium, but it was such a clear memory.

The PM was implanted about 1-1/2 " below my left collarbone - the pain I felt wasn't in that area, so I don't think it was the pocket being made.

I'm almost 3-weeks post implant and still having a lot of muscle pain in and around my left shoulder and am hoping that will improve when the day comes I can start lifting that arm higher and start going to the gym again.

Thanks again for all the responses!

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