Annual Pacemaker Check

It seems amazing that it's been a whole year since I was last in the Cardio-respiratory department at our local hospital, but this afternoon I was back for my annual check-up.

Last February, they re-calibrated my unit to 60 bpm, my normal resting heart rate is 72bpm, so even allowing for a reduction in rate while I am sleeping, my heart has to slow below 60 beats per minute before my pacemaker works. 

I was interested to find out how frequently the unit was working as that has a direct impact on the length of time before the battery will need replacing. 

Today's reading shows that 53% of the time the electrical impulses in my heart works correctly, without any need for pacing. That figure surprised me as I expected it to be higher. The remainder of the time the pacemaker is split between working in the upper chamber and lower chamber quite evenly. 

On this level of work the battery life is showing as 10-15 years, so I have plenty of time before they'll be booking me in for a replacement.

One question that has been running through my mind recently is what happens when the condition gets to the point where there are no electrical impulses being sent by my body, the condition is degenerative so at some point the electrical impulses will stop. I have AV block Type 2, when it becomes a total block, as in no impulses, it will be Type 3.

I wasn't sure whether a pacemaker can work 100% of the time without any problem, so I discussed this with the technician while she was doing the readings. Well, the short answer is yes. They already have about 15 patients whose pacemakers work 100% of the time, and this isn't an issue. So, another question answered and something else I don't need to worry about anymore. 

One other bit of positive information from the check up was that all my readings are in the low range, which is good. So, everything seems to be working well and I am now free to get on with the next year before visiting them again. 

Cholesterol Control

When I was told my cholesterol was too high last year, and the doctor wanted to put me on statins, I was determined to get it under control through changes to my eating habits. I ate too much saturated fat, my daily menu included too much dairy and refined flours and starches. 

The recommended daily intake of saturated fat for a woman is 20gms, for a man it's 30gms. As I started to check the fat content of my various foods I was horrified to see the amount I was getting through in a day and along with a fairly sedentary lifestyle, I could see I was not doing myself any good. I needed a complete change to my eating habits and overnight we changed everything in our cupboards. We swapped white bread for brown, white normal pasta for wholemeal, bacon rashers for turkey rashers etc. Cheese was cut out completely and even eggs were restricted to 3 per week.

My target was to reduce my daily intake of saturated fat to less than 10 gms. Some days it was easier than others, weekends were worst and eating out was a nightmare but gradually I found places I could eat and keep to my limits. Eventually, the swapped foods became second nature and I felt able to plan menus without constant reference to my sheet of good and bad foods. I became an expert at reading food content labels and shopping no longer took twice as long to do.

It was tough at first and meals had to be planned well in advance to avoid lapses but over the first 6 months my weight fell by 20lbs and my cholesterol check showed my levels were normal again.

It's been 12 months since that blood test and during the last year I have allowed my daily intake to increase to around 10-12 grams, I have allowed bacon back into my weekend treat and I even enjoy the occasional cream bun so it was quite stressful as time progressed to my annual cholesterol check. Coming so soon after Christmas, it felt as if I was sure to fail and I prepared myself for a difficult discussion with the doctor, who I felt sure would be back on the statin's route.

They decided to do a full set of bloods and test me for diabetes, thyroid and cholesterol problems. I fasted for 12 hours before the blood test and waited for my results to come back. 3 days later I rang for my results. It reminded me of the day I went in to find the outcome of my school exams all those years ago as the nerves kicked in.

"They're all normal, doctor says no further action necessary." The receptionist seemed too casual about something so significant to me.

"All normal? Even my cholesterol?"

"Yes, all normal," she confirmed.

As I put the phone down I felt as if I'd passed an important milestone. Not only had I got my cholesterol under control through changes to my eating habits, I had maintained it for a whole year. My heart health is continuing to be good.

In a couple of weeks I have my appointment for my annual pacemaker check. This is the first check since I had the pacemaker fine tuned to my demands, so it will be interesting to find out how frequently it is working. It will give me the first real indication how bad the condition is and how long the battery is likely to last before being changed. Obviously I will need a further year to get any idea how quickly the condition is deteriorating, so there are still questions to be answered.

Still, for now I feel content that my cholesterol is behaving itself, and as a reward a feel a large slice a cheesecake heading my way.

Tackling the Airport Scanners

As the holiday approached the apprehension about travelling increased. I have never had any problems with flying but suddenly I was faced with having to deal with airport security and a pacemaker. I kept telling myself that it must be simple, many people travel with pacemakers fitted but it didn't make any difference, when travelling day arrived I could feel the tension building.

We were flying from East Midlands Airport, a small airport about an hour from home. We set off in plenty of time and I knew I had my pacemaker card (well A4 sheet of paper printed and folded into a little plastic wallet) in with my passport. This, I was told, would be all I needed.

I don't suppose it helped that we didn't check out journey to the airport before we set off as we had both flown from there many times and believed we knew how to get there. It didn't help that we both thought we came off at Junction 28 and only when we had travelled some 15 minutes along the road with no airport symbols showing on the road signs that we accepted we were on the wrong road and would need to retrace ours steps back to the motorway and carry on. Having lost half an hour of our journey time, we were now going to be close to check in time instead of having time to spare so we could arrive relaxed for the new challenge ahead.

Finally we realised our mistake in thinking we needed the Derby exit when it was actually the Leicester one and we began to see the signs for the airport. We parked up without any problems and arrived the departures section of the airport with a couple of hours to spare. The check-in desks were really quiet and in minutes our case was on its way and we had our boarding cards.

"What do I need to do about going through security with a pacemaker?" I asked. "Just speak to the security officer and they'll tell you what to do," came the answer.

On reaching security we asked the question again and was advised to tell the member of staff where we put our personal possession in the trays to go through the scanner.

I started to fill a tray with my bits and pieces and when the chap came over I showed him my pacemaker card and asked what I needed to do. He called across to one of the security officers and told me to go around the large walk through scanner to the farside and the officer would let me through the perspex gate and frisk search me.

On the other side of the gate I was asked for my card and passport to make sure the name matched on both pieces of identification and happy that they did, they frisked me and told me I could go and collect my personal belongings. 

And it was as simple as that. 

The return journey was no different even with an officer who spoke little English. I showed my pacemaker card, the called an officer over and they took me through the same procedure.

So, travelling is really no more complicated with a pacemaker than travelling before the implant. It's just important to make sure you show your pacemaker card before you reach any body scanner.

One Year on from the Implant

I vividly remember the feelings I had when I was told that I had a degenerative heart condition and needed an implant. I vividly remember the weeks of worry about the implant in the run up to the procedure (even I have stopped calling it an operation 12 months on) and I vividly remember the biggest concern I had in those weeks before the procedure...

How would I do my hair?

As many women will understand, if my hair isn't right I can't settle to going out, whether to work, shopping or simply walking the dogs.

I discussed options with my hairdresser on how Neil would best be able to help me. My work colleagues even offered to do whatever was necessary when I got to work to make my hair as I would want it.

Looking back 12 months later, I smile when I think of this. After the procedure, doing my hair was well down my list of concerns. 

In the first few days all I could think about was not moving my arm too much so I didn't dislodge my pacing wire, on managing the pain and in working out how to get dressed. My hair really had become a low priority.

Over the first few weeks I was focused on getting my routine back to normal and watching the progress of my wound healing.

3 months on and I was pretty much back to normal.

6 months on and I was no longer checking out my scar every time I got dressed, it wasn't that obvious.

12 months on, it all seems a long time ago. 

I have a lump to remind me it's there, but I often forget about it. I have times when I think I can feel it working , but generally when I am in bed at night and everything around me is calm and quiet. I get an odd sensation and a whooshing feeling, but it may be the night time playing tricks on me because I know that the problem occurs at night time.

12 months on and I am exactly where I was told i would be, but at the time found it difficult to believe. I consider myself fortunate that they found the problem early, I consider myself fortunate that what they found could be treated and then I could get on with my life.

I do take the health warning seriously and have started to get on with plans I had previously only thought about. It has made me realise that I shouldn't put things off until tomorrow,  need to get on with them today.

For anyone just at the beginning of this process it can be a very frightening thing so hopefully you can take my story as a positive. In the meantime I await my check up in February 2014 which will give me an idea of the amount of work the unit is having to do which will give me an idea of how many years I have to go before I need the unit changing.

Playing Golf with a Pacemaker

Having played golf for a number of years, and while in Spain I was on the course 3 times a week, I had already stopped playing on a regular basis due to painful arthritic joints in my feet that objected to 4 hours walking, but I always knew I could play if I wanted to. I had been out on the Par 3 course a few times last summer before being told I needed a pacemaker fitting, and as golf was no longer a major interest to me (much to the disappointment of my husband) it wasn't high on my list of priorities to get back to after my implant.

However, I know that for many people it is a key concern: can they play after having an implant and how soon.

Today, I have swung a club for the first time since my operation. A friend has just started having lessons and we went out on the Par 3 course with her.

Before going onto the course, I went onto the driving range, just to make sure I could still hit the ball. I started off with a gentle swing to see what I could or couldn't feel. My pacemaker unit sits quite high in my shoulder, according to my consultant, a result of my youthful age meaning my muscle is still quite firm and therefore the pocket is not as deep as some. It has caused a few problems previously and it didn't surprise me that at the top of my back swing I could feel it pressing in to my clavicle. I'm right handed and my unit is in my left shoulder. After hitting a practice few balls I could tell that it was going to get painful after a while if I wasn't too careful and that I needed to restrict my back swing. 

Onto the first tee and I suddenly felt very unsure on how to hit the ball, as now I was going to have to re-learn how to swing a club. Over 9 holes I had a variety of successes, but overall enjoyed it. 

I realised I could now let other pacemaker wearers know about golfing after an implant.

The main question is normally how soon after the implant can someone resume playing golf. In all honesty I don't think I would have been able to swing a club for a couple of months even if I'd wanted to, as my muscle was very tender and the wound was not healing as well as I would have liked. The biggest risk is dislodging the pacing wires and, as my procedure had not been straight forward, I was definitely in no mood to being opened up again to have them re-sited. 

Until your doctor or clinical technician says it's okay to start raising your arm above your head golf is a definite no-no, this is normally 4-6 weeks. There is plenty of cable inside you to allow the movement necessary for a full golf swing, (I was told there's about half a metre coiled up behind the unit) but it is important that the pacing wires have had time to gain a permanent hold to the inside of your heart. The leads have little hooks on them and are hooked into the ridges on the inside of your heart. Heart tissue then grows around them and forms a good hold. Those that are chomping at the bit to get back on the golf course could probably get back after about 6 weeks, with doctors agreement,  but depending on the healing process, your wound or muscle damage may mean you need to wait a little longer as the stretching and pressure may be too uncomfortable. For me, if I had been keen to get out there I think it would have been nearer 3 months for my wound and muscle to allow me to play. 

After the first couple of weeks from the implant you feel quite well in yourself and keen golfers will start to want to get their clubs out, especially if the weather is decent, and the next few weeks will be frustrating, but it's only a few weeks out of the rest of your life, so it's worth being sensible and waiting until your doctor says you can play again.

As far as actually playing, for many people a pacemaker will make very little difference to their game. Some, like me, may need to adapt their swing a little but as I found today, everything else works as it did before. In the first 6 months after my implant I was very aware of my unit all the time, I still had some tenderness in the muscle and the skin over the top of it felt tight at times, but gradually I found I noticed it less and less, so the earlier you start to play golf again, the more aware you will be of your unit. Over time I think it will become less apparent while golfing, as it becomes in other aspects of your life. 

It's surprising when you talk to people on the course, the number of other people you come across that have a pacemaker, so for the majority of golfers an implant will mean a few weeks away from the course and then carry on as before. And a few weeks to recover and make sure the pacing leads have a good hold is worth waiting for, for the sake of your health.

Happy golfing.

A year on from the accident that started the path to the pacemaker.

When I first got my calendar for 2013 and marked off Saturday 8th June as a day I would be leaving the car on the drive. This was the anniversary of the accident last year where I crashed my car into a wall. An odd accident that I couldn't explain & that led to a series of tests that resulted in the doctors diagnosing my heart condition.

I know deep down that if my condition was the cause of the accident it couldn't happen again as my pacemaker would prevent any possible loss of consciousness, but I really didn't want to take any chances.

It's remarkable to think how much the whole incident shook me up; how difficult I found it to accept that I had this problem when I felt so well.

Now, one year on I feel incredibly fortunate that I had the accident. After all, no-one (including myself) was injured, all the damage has been put right both to my car and the office block where I work and the condition that will continue to get worse and would start to make me feel unwell, if not by now certainly in the future, will continue to worsen without affecting my health and lifestyle.

My biggest issue this summer is not exposing my scar to direct sunshine, with the recent British summers that's not such a massive problem. Fortunately I do not wear tops and dresses with very strappy straps and the majority of vest tops I do wear, when the sun is out, cover the scar quite nicely.

Several people told me how I would feel like a new woman after having my pacemaker implant, but in actual fact I don't feel any different. I have more energy this year than I did last, but I think that has more to do with the weight I have lost while getting my cholesterol under control rather than any effect from my pacemaker.

You may notice I now refer to it as 'my pacemaker' not 'the' pacemaker or 'a' pacemaker. This is a deliberate decision I have taken. It helps me accept it as part of me rather than an alien object.  One year on, I can look back on the whole experience and accept the highs and lows it brought with it. I realise it put our lives on hold for a good 6 months, that it put both physical and emotional stress on me, my family and friends and their support was crucial in dealing with the whole situation.

One year on I can look back and be grateful that the accident highlighted a problem before it became a problem, that the condition is controlled and I have regular medical checks. One year on there is relief that the outcome of the tests didn't result in anything worse. One year on I am probably healthier than I have been for several years.

It's a shock to anyone when they are diagnosed with a condition or illness that requires surgery, a life change or some major shift to the normal life style, but I am now able to take the positives from the last 12 months. 

A lot can happen in a year, now I'm looking forward to a year where not a lot happens. 

Does a mammogram hurt with a pacemaker?

Due to work colleagues being on holiday and work changes I deferred my hospital appointment until last week. It wasn't through any concerns, it just wasn't convenient. I have had a mammogram within the last 3 years which was clear so I didn't feel delaying this check for a few weeks would cause any issues.

As suggested, I told the technician that I'd had a pacemaker fitted last September and that while it had healed well, it was still tender when I pressed on the area and so it may be that the scanner machine may be uncomfortable. She said she would be guided by me and if it got too uncomfortable she would stop. We decided to start with the right breast as this would give me an indication of the pressure that would be felt and where the potential problems may be.

The process is not particularly painfully, more uncomfortable but as the plate presses down it pulls the skin from the shoulder downwards and the edge of the machine presses into the shoulder. The right hand side was done quite quickly and I explained where the discomfort had been relative to where the pacemaker is. We swapped sides and she was very careful as she fitted me into the machine, making sure I was in the correct place to get the best image. I managed to get comfortable and she said I was to tell her when it got too uncomfortable or if there was too much pain and that as soon as she took the image the machine would release the pressure.

I tried to keep as still as possible and let the pressure build but it did become too painful to continue and I asked her to stop, she took the image at that point and immediately released the pressure. The relief on the skin over the pacemaker was instantaneous and, I stood back while she checked the images.

She said she thought the image, while not as clear as the right side, was perfectly good for the check they needed to do, and so I got dressed.

It was uncomfortable at the time, but left no lasting pain or discomfort and has certainly not given me any concerns about having to go through it again.

All I have to do now is wait for the results and hope,as they were last time, they come back clear.