Wednesday, May 25, 2011

Pacemaker Issues

I added this addendum to this blog to complete the medical history of my hip surgery.

I uncovered the fact that my pacemaker was not returned to its original settings following my hip surgery at Cleveland Clinic. While the change might appear to be trivial, particularly for a 72  year old person, I found it to be life-changing the farther my recovery progressed. I suspect it was a major factor in my recovery process.

First a disclaimer. I find the medical field strongly adheres to the mantra "one size fits all.' Secondly, in the field of heart surgery, the person who does the surgery is not the contact person  for any followup, as it is in the orthopedic field.

The facts are: on Nov 23, 2010, just prior to my hip surgery at Cleveland Clinic, a device nurse turned off the breathing response to my pacemaker. The next day this response was turned  back on; the device nurse was Janet. (When I asked why this was necessary, the answer was they didn't want my heart to speed up for any reason during surgery.) On May 16, 2011, when I  met with a tech rep from Boston Scientific, along with my regular device nurse, Peggy, it was discovered that, while the breathing response factor was on, it had been set to 2 instead of the  original 4. Also the 'auto-lifestyle' setting was ON--which puts the pacemaker in the 'one-size-fits-all' mode. Finally, the reason for a shift in resting pulse from 60 to 70 was never satisifactorily  explained, but it may have something to do with another setting that kicks in when AF is detected. The first two of these changes were not detected by Peggy on her device check in April  20, 2011, nor the Tele-Trace check on April 25, 2011. The third change in resting pulse from 60 to 70 was actually changed by Peggy in her April 20 checkup. So we agreed to reset the  breathing response back up to 4 and turn off the auto-lifestyle. I wanted a higher response setting (the range is from 1 to 16), but we agreed to get together again in two weeks to evaluate  the results. A second response factor for heel strike was reduced from 11 to 8.

I keep a daily log/diary of both my vitals and exercise efforts. This log was telling me that my maximum HB was only 75 to 80 after a strenous mile swim, hence my call for help from Boston  Scientific. For the record thirty minutes after the May 16 changes, I swam my daily mile. My time was two minutes faster than normal and my maximum HB was 112. The next day the max HB  was at 126--which is tough to measure. So I knew the new settings were making a big difference. I had been seeing similar low maximum HB results when doing a Modified Bruce Protocol  on the treadmill; after the May 16 adjustments, I would max out my HB at 131, sometimes in as little as 4 minutes when doing the regular Bruce Protocol.

My original pacemaker settings DID NOT have the breathing response turned on. I got this corrected on August 5, 2010. Some discrete inquiries while at Cleveland Clinic brought comments that it is not unusual to not have the breathing response turned on, particularly for older people. Terrific!

The bottom line is that, looking back on how much I struggled those first few weeks following hip surgery to merely walk around, I must conclude that my heart's inability to speed up with  increased effort on my part was a significant factor in my recovery progress. This lack of breathing response was, of course, limiting my efforts to maximize my cardio-pulmonary output in the pool or on  the treadmill.

If you are reading this blog and wish further details, I can be reached at would remind the reader that I have written detailed accounts of all my surgeries, so I have voluminous records.

Larry Piper

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