Pacemaker Do's and Don'ts!

STAY AWAY FROM THE MICROWAVE!!

JUST KIDDING! That’s a hoax. The microwave is fine. Most little magnets are fine…I have this eyeglass holder magnet that is really quite strong, and I attach it to my left chest area on my jacket or polo shirt when I’m working or going somewhere that I need my readers. Even though it’s basically right on top of the device, the pacemaker tech said it’s fine. She had us hold a magnet that WOULD make a difference, and it was really quite heavy.

Remember, I’m not a doctor, so my advice is just from my experience and exploration. Please don’t take my words as gospel on this. And don’t sue me; this is just my take.

Turtle from Canyon Ranch, Tucson.
Rose Quartz, Moss Agate, and Fluorite.
Taken just a few minutes ago! :)

Airport security: I can go through the airport security thing where you hold your hands over your head, but the tech suggested they don’t do more than one pass over the device with the handheld metal detector when they pull me over after the big one. They should be trained to avoid running the handheld over it altogether. Gotta carry that pacemaker card or they’ll be quite suspicious. Which is fine—they’re doing their job!

Cellphones: I have trouble hearing through my phone when I hold it to my right ear, so I was very curious about that. My surgeon said it’s fine to hold it on my left ear, but the tech said I shouldn’t. I think it’ll be very tough not to hold it left, so I’ll have to see if it makes a difference at my 6-week visit. I’ll let you know!!

Although I don’t use one, they say that Bluetooth headsets are fine. But keep headphones away from your device—don’t drape them around your neck or put them in your chest pocket. Word is most MP3 headphones have a magnetic material in them that may interfere with your device. The players themselves that emit radio waves, such as iPods, Garmins, and Fitbits, do not affect your PM.

MRIs: Can’t have ‘em. That’s kind of a bummer, particularly when my knee gives out some time in the future. But that’s okay; I’d rather have my heart working. Always tell your doctor about your PM if you are going to have any procedure to make sure they are aware. According to Heart.org, several procedures should likely be avoided: ESWL to dissolve kidney stones, TENS therapy devices, among others, and be really mindful when considering CT or CAT scans, Electrocauterization to avoid bleeding during surgeries, and Electrolysis for hair removal (a concept difficult to comprehend for balding men).

Shopping: You can scurry through those anti-theft structures at many shops, but don’t linger in them.

Are you an arc welder? You may have to quit your day job. If you are an arc welder or know what they do, tell me! I’m curious.

Ab stimulators: Here’s a picture of me just a few weeks ago using my favorite ab stimulator. If you are gullible enough to believe that ab stimulators are useful (sorry Denise Richards--I still love Starship Troopers!), you should probably stop using one if you have a pacemaker. They will interfere.

Remember, pacemakers and ICDs (defibrillators) can be slightly different. When in doubt, do some research and ask your doc.

Below are a few websites that I’ve visited that seem quite useful. I’ve pulled a lot of the info above from them, as well as from my talk with the PM tech at the Cleveland Clinic.

Next entry I’ll talk about my upcoming schedule…do I really have to drive up there every three months?!! Also, I got a NEW TOY!!! I’ll also try to infuse more jokes so this doesn’t become dry and boring like most of the websites I’m visiting.

Here are some resources I found to be helpful:

I keep going back to the British Heart Foundation’s website, as they have a lot of positive stories and good information. Here’s one such story: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/my-story/30-years-with-a-pacemaker

The Mayo Clinic also has a good overview, especially if you’re bored with my writing and want a quick and dirty, non-personal look at the process: https://www.mayoclinic.org/tests-procedures/pacemaker/about/pac-20384689

Sweet website with real questions and answers about do’s and don’ts from My Heart Sisters. It’s focus is women, but it’s great for everybody! Thank you Heart Sisters! https://myheartsisters.org/2018/01/28/pacemakers/

Sixth Post: The Machine is In

What a striking difference.

For all readers who have been in AFib, atrial flutter, had partial heart block, or even PACs/PVCs, you know how awesome and alive you feel after you have been cardioverted OUT of those, or been ablated, or have naturally returned to your innocent heart rhythm, etc. Point is, you feel totally alive again! No doom and gloom of being able to feel your heart beat while just sitting there. You’ve shed that dejected and despondent feeling and you can take on anything the world has to dish out once again!

I’m totally there. It’s a brand new day.

Simple incision, already feeling just fine!

The surgery was really easy (from my perspective). Lots of prepping—they had to shave my entire chest and belly. And I’m not that hairy. They also shaved the sides of the groin just in case they had to go in there for some reason. It’s nothing to have a hairball about; it’s not a big deal. Then one of the nurses (the one who would be at my head, administering sedation) talked to me for 15 minutes about what was happening. He stayed with me until one of the other nurses came by. I met her and they wheeled me to the O.R.

When I got to the operating room, there were all these cool machines in there. The nurses were super nice and professional, keeping the moment light but serious. Plenty of smiles, and I’m typically one to make light of situations, so they were quick to pick up on that.

They basically had to cover my head and right shoulder so I had no view of what was going on down there. I could however always see the nurse above my head who was administering the versed and fentanyl. Those were sweet! And being a bit claustrophobic (nightmare = getting rolled up in a carpet and left alone forever), I had no problems with the ‘tarp’ that was semi-covering my head and shoulder, thanks to the fine administration of appropriate sedation.

Right before the surgery, they did gently strap down my legs and arms with soft and loose wrist- and ankle-restraints. This is done so you don’t at any point snap out of a benzo-induced calm and decide to suddenly take a swipe at the air or scratch your nose with your left arm while the surgeon is threading wires through your veins. You know.

When the surgeon entered, all ears were trained on him. (There were 3 nurses present, which makes 6 ears. Plus mine.) He gently barked out instructions of what he was going to do and what everybody’s role was. This made me feel like everybody was working together and on all cylinders. I was feeling super mellow, but was able to follow along nicely. Why aren’t more surgeries performed with this simpler type of sedation?

During the surgery, which lasted about 3 hours, I clearly was comatose some of the time. The physician mentioned later that I did a little snoring for about 5 minutes. Hey, put me on my back, all flat and whatnot, and I’m gonna snore. Sorry. Flip me over and I’ll stop. Most of the time.

Also, apparently a Fellow was there for some of the surgery. She came in the next day to check on me and acted as though I should know her from the surgery. No recollection. Must’ve been in the middle of it all when I was zoning. Thankfully, she was super nice and smart, so I know I was always in good hands.

I remember at one point the surgeon kept pushing and pushing on the area where they placed the pacemaker. I think he was either

1. Squishing it around to make sure it was placed properly, or
2. More likely he was actually testing it to see if it was working.

I thought it was (1) while I was in the OR, but the next day he did the same thing to me to make a point. Apparently these devices function based on vibration, which is amazingly cool.

View from my room whilst standing up.

I was sitting in my bed with a resting heart rate (HR) of 60. He started brusquely tapping on it for about a VERY long and rather uncomfortable 10-15 seconds, and then had me look at the HR monitor. The device, having noticed the vibration of the tapping, automatically took my HR up to 80-90 bpm! So when I walked around the hallways as a demo, the pacemaker noticed the vibrations and when I returned to my room I saw that my heart was pumping close to 100 bpm.

And the COOLEST part of that is that they can adjust those rates/numbers! Another thing I had to do the day after surgery (yesterday) was to meet the nurse who specializes in making those adjustments.

So for example, since my max HR during my last good stress test in January was about 145 bpm, they set that as the top tier. So if my heart rate goes ABOVE 145, the pacemaker will max it out there so as to not overtax my heart. And they want to keep me at no less than 60 bpm, so that is my bottom number. (I was in the low 50s before surgery, occasionally dipping into the 30s.)

Then if I’m exercising, the pacemaker goes into a sliding scale mode as to how quickly my HR goes up and down based on my level of exercise (the vibrations it senses). When I meet with the specialist in 6 weeks, she can adjust that scale of how quickly my HR changes, and she can adjust that max or min HR as well.

For me, I have a feeling that my HR is increasing too quickly. It’s not used to that, based on the amount of beta-blockers I’ve been on for the last decade+. But I’m more than willing to give it a go if they think I can handle that. I will be journaling any issues I have this next 6 weeks. That way, if there’s a day that I think I’m going to quickly in there, they will be able to look at the data from that day to evaluate whether it was too stressful or not. SO COOL! This is the ultimate FitBit!

That’s a ton of info. I’ll dispel some rumors about what you can and cannot do with a pacemaker tomorrow and perhaps go into more detail about what this little machine can do for me.

The Day After the Procedure

I’m Alive!!!!!!

Of course I am. My biggest fear going in was that he wouldn’t be able to connect the third line in the left ventricle. Of course he did! He’s the master. I’m so grateful for ALL my caregivers. 

So much to say about the experience. But I need to do it tomorrow—I’m kinda pooped! Here are some sweet, enticing pictures to hold you over. Tomorrow though, I can’t wait to tell you all the details! It’s so exciting!!!!

Room with a view! I had to stay overnight, which makes sense.

All patched up! And shaved.  :(

Awesome card from a little friend!
(Nice hair.)

The Day Before the Procedure

It's Monday. Tomorrow is the day!

Had to call the Clinic at 3pm today to find out what time I go in tomorrow. But then I got a message on my MyChart page with the Clinic that said I had to be there at 6am?!! I called at 1 (instead of 3), and found out that that message is just a page-holder. I’m scheduled to arrive at 11am, with the surgery around 1 or 2, depending on how long his early surgeries go.

I’m sending out positive energies for those early procedures! If they go long, I’ll be quite hungry.

No food after midnight tonight. Grr.

And no coffee. Double grr.

I’ve been doing everything I can to prepare mentally for tomorrow, and I’m quite relaxed. Did some things on the computer to tie up some loose ends for work. Cleaned the parts of the house that Karen didn’t clean yesterday. Meditated. Sent positive thoughts out for other folks I know who are in much worse shape than me. Played a little Super Mario. Walked the dog; it was beautiful today—low 70s and sunny! Allowed me to be grateful for the opportunity to be on this planet! I’ve also been carrying around three stones—moss agate, aventurine, and rose quartz, all of which work on the heart chakra or have healing energies for the heart.

So I’m ready! Bring it on!

Early pacemakers

I’m hearing more stories as people I know come out of the pacemaker closet. A friend about my age I used to play volleyball with has had one for a couple years now—and he’s starting to play tennis! My cousin (cousin’s wife…is she also my cousin?) has had several, starting when she was 33 (she’s a wee bit older than me). We have some commonalities, although she was in worse shape early on. Her ejection fraction was 15!!! Mine was 20-25 at its nadir.

The first story I read last week when I searched the internet regarding life after pacemakers was

written by a guy who got one in when he was in his 20s in the 1970s. It weighed THREE POUNDS!!! The ENIAC of pacemakers! He’s still chugging along in his 70s.

So I stopped reading stuff. Why would you want to know failure stories? My goal is to live into my 80s. That goal is attainable. If I start thinking about anything less, how can I possibly manifest my original goal of 80s? Can’t. So my goal remains the same, and remains plenty attainable!

Feel free to write about YOUR success story…I want to hear it! The more we read/hear/talk about those successes, the more that energy will carry through to all of us.

So let’s look briefly past tomorrow, and the recovery phase. After surgery, they’ll want me to hang out with them overnight, make sure it’s pumping on all cylinders.

I have multiple questions to ask the EP before or after surgery.

1. What have they put together with regard to rehab for me? Do I do some stretching exercises, light walking, jump on the bike? I mean, if it’s all working fine, why wouldn’t I start to get back in shape?
2. When can I drive?
3. When should I restart my eliquis (blood thinner)?
4. What about the glasses magnet I wear on my left chest area? If I can’t wear it, how will I be able to find my glasses?
5. Who invented liquid soap, and why? 
6. Do I have to stand back from the microwave oven? And what about airports?
7. What would you rather do, slide down a 10-foot razor, or suck the snot out of a dog’s nose until its head caves in?

Driving back home from last week's visit:
Chester and 55th, about a half mile from
Cleveland East Side Turners

Sounds like six weeks is the time for heavy activity, like golf or tennis. Probably won’t play volleyball with the big boys on 55^th St. at the Cleveland East Side Turners. Don’t want to take a 90 mph hit down the line, straight to my collarbone.

I’ve looked at a few websites to see what I can and can’t do, but I really want to ask the professionals, the ones doing the surgery, right here at the Cleveland Clinic.

Tomorrow, mid-day.

Let’s git ‘er done!

(So I can go eat.)

By the way, I decided to eat too much tonight. Probably a bad idea. Huge dinner. Then I decided to have a milkshake. I love milkshakes, but I haven’t had one in years, as they’re not the healthiest buggers out there. I’ll let you know if it was good to gorge the night before, or if you should just eat normal. But it was yummy! Grommit wanted some, too.

Credit #5 in above list: John Cusack in Say Anything
Credit #7 in above list: Matt Groenig, Life in Hell
(Both of those from the 80s, of course.)

Third Post: The Waiting Game

As I slog through this weekend, I’ll reflect briefly on what I’m feeling like (so you can compare it to what YOU are feeling like), and give you a glimpse of the super-cool device that is going to be implanted under my skin below my collarbone for the rest of my life. (I make it sound so appealing!)

Grommit

In reality, I’m super grateful for this incoming electrical apparatus. Without it, I would continue to feel as crappy as I do now, and eventually my energies would cease to exist in this human world. In the words of Ben Folds in relation to this world in which our human bodies live, “I really like it here; I’m quite attached to it.” Not sure where else, celestially, one can get coffee that tastes so good.

“Could you please define ‘crappy’?” As I walked our awesome dog, Grommit, this morning, I was thinking about how my 36” inseam legs were aching to stretch and pivot, spin and twist, run and jump. Yet everything from waist up was saying, hey, this .5 mph pace is really starting to drain my energies.

First thing that I feel is that ‘pressure’ we talked about yesterday, the inflating-balloon-heart effect. Then my brain automatically kicks in and thinks about bad things that are unlikely to occur at .5 mph, then my whole body decides that as soon as Grommit poops, we’re bee-lining it back to the house to go sit down.

The mind absolutely plays a role in all this. I should feel comforted that although my heart isn’t acting correctly now, it’ll hang in there fine for a few more days until this man-made object that has actually withstood the test of time to a large degree gets buried in my flesh. But the mind wanders. I’ve been able to meditate when I wake up at night, focusing on my breathing, in order to keep my brain in check and get back to sleep, which is vital.

Writing about it has been cathartic as well. It helps to put things into perspective. I’m so lucky that this is something that

1. Was predicted, and
2. Can be rectified.

Consider my friends who have a child with cancer, or who have a loved one that just passed away tragically, or who have weathered other traumas to themselves or in life. I have a good prognosis, a means of getting there, and an amazing support system of family and physicians. Being grateful for what you have can bring about a positive attitude. And being empathic toward others in way worse situations also helps with perspective.

SO…what is this thing they are putting into my body? My electrophysiologist (EP) gave me this great visual aid yesterday that the Cleveland Clinic puts out. Below is a website that discusses it more.

Thank you Cleveland Clinic for this sweet visual aid!

Lucky me, I get a Biventricular Pacemaker (see diagram)! When I asked how long the surgery takes, my EP said that feeding the first 2 lines to the right atrium and right ventricle will take a mere ½ hour. Easy peasy. He was a little concerned about the lead heading over to the left ventricle. I had open heart surgery in 1971 when I was 5 to repair an ASD (atrial septal defect), and he is not sure what it will look like in there to be able to get that lead through to where it needs to be.  He suggested they could feed it through in five minutes, or it could take a couple hours working out what to do.

For the medical folks reading, I also have a left bundle branch block happening in there, so my left ventricle contracts a little bit later than the right. That third lead will really help correct the issues in that left ventricle, so it would be nice to get that properly situated. The EP was great, saying that he’s not sure what to expect until he gets in there. He then added that he has about a 90% success rate for the third lead. I’m confident the light will be shining on his skills next Tuesday!

Interestingly, they don’t put you out on the table! He said I’ll have some nice relaxing drugs sent through so I don’t feel anything, but I don’t have to be out cold. That’s pretty cool! I asked him if there was a giant mirror over the operating table so I could watch, but he said no. L

https://my.clevelandclinic.org/health/treatments/16784-biventricular-pacemaker

How big is it? My understanding from the Boston Scientific spec sheet is that it’s about the size of a match box, but thinner, and weighs just over an ounce. Now if you need a defibrillator, it’ll be a bit larger.

How long will it last? My batteries are projected to last 7-11 years. Considering that mine will be working feverishly as I re-introduce higher levels of coreg into my system, I expect a battery life in the 6-7 year range. A defibrillator projects a 5-8 year battery life.

What can go wrong? Not much. You can find a bunch of possible problems, but they occur so rarely, so why worry about them? It’s not something you can control. If you all of a sudden feel like crap a couple years down the line, go get it checked and think about it then. Do not let tomorrow take up too much of your today!

Still so much running through my head! Tomorrow I’ll talk about a cool success story, and projections about what activity levels I can expect to be able to achieve soon after surgery.

And who doesn't want a couple more Grommit pictures? (Top one taken by Karen.)

The Electrophysiologist Visit

Willamette Valley, Oregon

I’m not getting paid to say this. But those people and facilities at the Cleveland Clinic (CC) are phenomenal.

My beautiful, talented, and ridiculously smart wife Karen and I took the 50 minute drive to the Clinic this morning and had a great talk with the electrophysiologist. What impressed me the most about him was the fact that he wanted to understand the Why of what was happening more than anything. He knew that the solution was a pacemaker. But the circumstances were puzzling to him.

I envision him waking up at 2am this weekend and calling his colleague and friend, my CC cardiologist, and saying, hey, maybe it was THIS that caused the rapid onset of the second degree AV block.

He just cares that much, you know?

It’s refreshing.

I’ve never really had any “symptoms” of heart issues, even though I was diagnosed with non-ischemic cardiomyopathy in 2007. My local cardiologist—remember, I have two…one nearby, and the other at the Clinic. They actually trained together and talk frequently, which is yet another reason why I feel so fortunate to be getting such great care.

What was I saying? Oh, my local cardiologist mapped out my life for me about 10 years ago. He said the following things are in my future, in this order:

1.       I will experience PACs and PVCs. That’s when you feel your heart fluttering a bit. If feels weird, and for me they would last anywhere from a couple days to a month. Then I wouldn’t notice them. They’re harmless, but any time you can sit there and notice your heart beating, it causes a wee bit of anxiety. So, those came first.

2.       Then he said at some point I would go into AFib (Atrial Fibrillation). That’s a total irregular heartbeat where electrical impulses fire abnormally, causing the atria to quiver. This started about 3 years ago. I’ve been in AFib three times, and was successfully cardioverted out of it each time.
When I went into AFib, I felt my heart go out of rhythm. Not completely different from the PACs, but different enough that I know the difference, so I address them with deference. I would also get sweaty, feel like I have heartburn, and just feel yucky all over.

3.       Then, eventually, I’ll need a pacemaker. They could’ve slapped one in in 2007, but they decided to try some drugs that I am very fond of because of the wonderful work they have done for me. Coreg (Carvedilol) has reshaped and retooled my heart. It was a MESS, but now it’s rollin’! Losartan is also my buddy, as it lowered my blood pressure (which wasn’t super high in the first place) which helps reduce the workload of my heart.

4.       I’ll eventually need a mitral valve replacement. Let’s wait another 15 years or so for that menu item, please!

5.       I’ll live at least til my mid-80s, start my own blog, shoot photos for National Geographic, win a gold medal in the senior Olympics as the starting middle hitter, and hike every trail in the Willamette Valley with Karen.

Actually, I added that fifth one; my cardiologist failed to fill in those blanks when I asked him. They don’t know EVERYTHING, you know.

So that’s all mapped out. But what about experiencing actual ‘symptoms’? Until last week, I never had any! I was a walking time bomb in 2007 until Karen, who would not be my wifey until 2013, suggested I get a complete check up by a cardiologist. I had an ASD repair in 1971 when I was 5, had annual checkups until I went to college, then nothing until 2007 (thank you Karen).

That’s when they discovered all these issues in there.

My impression of “chest pain” is one of a shooting pain coursing through my heart. When I described a chest “pressure” to my cardiologist last week during the stress test, here’s what I felt: It was as though my heart was actually a balloon, and somebody was in there inflating it, putting pressure on everything in there—my chest wall, my lungs, even my upper belly and ribs.

When my cardiologist was dictating stuff and talking about it, he used the term 'chest pain.'

LESSON LEARNED! So if YOU are feeling chest “pressure,” it is actually chest “pain.” GO TO THE EMERGENCY DEPARTMENT. Don’t mess around with that stuff. Don’t be a hero. Go check it out.

The consensus for today is that I need a pacemaker, as expected. Should I get one today? Prob. But the EP is comfortable waiting ‘Til Tuesday (Voices Carry). So I’ll be good and wait!

More info this weekend about what the pacemaker looks like and what it does. (I got a cool diagram from the EP.)

First Post: Setting the Stage

Let’s clarify. I’m 53 not 50 (still young-ish!). “On Pace at 53” just isn’t as intriguing as 50.

Male.

Back on the volleyball courts a couple years ago!

6’5”, 195 lbs. “Athletic build” (I like that moniker!).

Active in volleyball (played at Villanova in the 80s), and just picked up a tennis racquet recently and found I could play reasonably well. Like to lift weights twice a week to ‘maintain,’ not to get huge (gotta look good for Wifey!).

And now they tell me I need a stinking pacemaker! Ugh.

This blog will track the process—looks like I’m going to get it in next Tuesday, April 23, 2019.

Where to start a blog on it all is the tough part. When I was told last week that I needed one, I of course searched around to see what the process has been like for other folks like me. And of COURSE I peeked to see how it might affect my longevity! Gotta keep my goal of mid-80s intact!

My search for a personal look at the process came up pretty empty, so I thought I’d document the path before, during, and after, in case other folks find themselves in a similar predicament.

The Acute Reason as to Why I Need a Pacemaker at 53 (explained two ways: Medical vs Layman)

I’ve had a first degree AV block for a really long time. I’ll give you more history another day. Average Joe wants a PR interval of 120-200 milliseconds (the time between the P wave and QRS). Mine for the past dozen years has hovered around 240, which wasn’t a huge problem for me, considering all the other things going on in there.

Acutely, which my electrophysiologist finds odd, I jumped from a first degree AV block to a second degree AV block (Mobitz I). My PR interval has jumped to 390! Yikes! This second degree heart block, Mobitz type I, is referred to as the Wenckebach phenomenon, which I find to be a delightful name. My cardiologist, when discovering this in me during a stress test last week, kept saying this term (pronounced Winky-bok), and it helped lighten the mood for me. 

Put a white doctor-coat on and a stethoscope around your neck, look in a full length mirror, and say Winky-bok a bunch of times in various sentences with a stern face. You can’t feel terrible about it! We need more Dutch anatomists to give their names to various phenomena.

Scoot over to this website—Life in the Fast Lane (litfl)—to get a better understanding of these two (first degree heart block vs second degree (Mobitz I):
https://litfl.com/pr-interval-ecg-library/

 

This is all pretty confusing for the layman, like me, so here’s how I describe it to other lay persons:

The upper chamber primes the heart with a squeeze, and then the lower chamber pushes all that blood through the arteries to the veins and whatnot. The interval between those two squeezes should be less than 200 milliseconds. Mine jumped last week to 390 ms. That’s too long an interval!

When that long PR interval happens, eventually there is a P wave conduction WITHOUT the subsequent QRS, so you’re kinda missing a beat (as shown in that second ECG reading in that link above, or in the picture below).

To continue, when you exercise, the heart rate will increase and you can bump out of that second degree AV block (Mobitz I). If you don’t bump out of it, then your heart rate can stay super low EVEN WHEN you are exercising or doing some strenuous activity, like hauling mulch bags, or hiking up tall mountains and finding waterfalls in nature. That’s not really a good thing!

When I did that stress test with my cardiologist last Friday, I didn’t bump out of it. After seven minutes on the treadmill with a gradually steeper grade and faster speed to walk, my heart rate didn’t go above 50 bpm. Should’ve been hitting triple figs at that point. Looks like my activities will be bird watching. Or frog watching. No hiking for awhile. Boooo. No mulch carrying. Yay!

What can correct this?

Pretty much only a pacemaker.

What's next? What will the morrow bring? A trip to the electrophysiologist! After a week of trying to get in, the time has arrived. Update on that coming tomorrow, as well as perhaps some discussion of symptoms, and understanding the difference between chest "pressure" and chest "pain."

Comments are welcome. What else would you like to hear?