Saturday, April 30, 2016

It's Day 3 of Pacemaker Life

My hands are warm! I know, you are thinking, this is a revelation why? Because they are always cold. Hopefully now it will be "were always cold."

If you ask my husband, for at least 21 years I've had ice-cold hands and feet, and would be under 3 blankets in the middle of summer. It was just the way I was - maybe thyroid was too low, or poor circulation, or just vasoconstricted, who knew.

When I woke up in my hospital bed the morning after having a pacemaker put in, I realized two things: I had warm hands, and I could not tell when the device was working. I was surprised when the nurse pointed out on the monitor that I was being paced - the monitor being on the left side where it wasn't easy for me to see - and that it was pacing while I was in bed doing nothing. And I wasn't cold... I was comfortable under the sheet and one blanket. 

No one ever told me that one of the benefits of having a pacer was warm hands! This is BIG. All the pacer was supposed to do for me was to be an "insurance policy" to keep my heart rate over 50 bpm so I would be less likely to faint without warning - the reason the device was put in.

My story (short version): two significant syncopal events with bradycardia in two years, on top of blood pressure that has always been on the low end of normal and slowly dropping over the past few years. I had fainted several times before this, going back as far as 8th grade, and it had been attributed to things like fasting, sitting still for too long, getting up too quickly, etc.

I also had an ablation for an SVT in 2011- my introduction to emergency departments, advanced cardiac care, electrophysiology, and the other side of medicine. I'm a healthcare professional and have always been on the provider side, as a clinical pharmacist, and not on the receiving end. My appreciation is very high for those who have cared for me and the insights are invaluable to me in my current role.

Back to getting a pacer. April 27, 2016 at a world-famous hospital in Boston (one of the few times I've been in the right place at the right time) and I get to the EP area and it is crowded. Very crowded. So crowded people are standing around waiting to be checked in - or by the wheelchairs their family members are in. My husband almost left me at the door, but he quickly came to his senses and mellowed out. It became clear pretty quickly that my case was not going to be on time, which I expected, as I got a call the day before to let me know my 7 am case had been pushed back to 10 am, and once there it became 12:45 pm. I finally got called around 1:15 pm, said bye to the husband (who immediately left for lunch at MickeyDs) and got prepped and into the procedure room by 2 pm. 

Stop reading here if you are squeamish.

Pacemakers are put in while you are under conscious sedation (unless you are having an abdominal placement - rare in adults). CONSCIOUS sedation, meaning you are awake and supposedly not feeling a thing or not caring if you do because of the drugs used. Ha. I was curious to follow along and I saw a lot more than I ever expected. In contrast, I remember almost nothing about my ablation, other than looking at all the monitors and equipment in the room and thinking it looked a lot like mission control for the space program before they put me out. This time was much different. Yes, I received midazolam and fentanyl. And lidocaine at the site. But I did have to ask a few times for more of each - it hurt when they were cutting into the skin of my chest to make the pocket for the generator. Especially when my EP directed the fellow to make the incision deeper! Ouch. Can't wait til this dressing comes off so I can see the scar. 

Once that was done, the fun started with lead wire insertion. Apparently, my heart is small (I can hear my husband laughing now) and one of the leads was difficult to place - it kept bumping up against a valve. Yes I heard you guys talking!!! And I felt the pushing, almost like pounding. But maybe that was just the leads being torqued into place. The only thing I don't remember much of was going from the EP lab to the cardiac step down unit, other than the transfer device, a very cool net that got me from the stretcher to the bed.

I received a dual chamber pacemaker with a closed loop sensing system that automatically registers when SVR is too low and kicks heart rate up to compensate. A very smart device, and customized to my situation. The overnight stay was fine, the care was great on the unit, pain or discomfort was non-existent until the buvipicaine wore off (thank you for adding this to the site!) but manageable with acetaminophen and ibuprofen. I found out that the pacer was used 31% of the time since placement when it was interrogated (yes, really) the next morning. Which was a lot more than I was expecting. 

Since then, my rate has been kept in the 70s or 80s - way higher than what I was running before placement. I have a fitness tracker that showed my rates dropping to the low 50s at night and 65-70 during the day. With the occasional excursion into the 40s (with symptoms so I could get flat and avoid fainting) or spikes to the 130-140s with exercise.

My follow up is in a couple weeks and I will get the home monitoring system. So far, it's all good. I just get reminded every so often when I move exactly how much my left arm and pec gets used during normal activities - it is more than what you think. 

So, what is your experience with being paced? 

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