Urgent Help Needed Complex Case
I am in need of some urgent advice regarding my Father, who has the following condition:
* serious congestive heart failure (20% of heart working)
* 20 yrs ago 4 bypass, with complication of staph infection in chest, loss of most of breast bone, and dorsal flat reconstruction
* coumadin use 5-7 mg per day for 20+ yrs.
* diabetes on insulin with 8-9 A1C
* blood clots in his heart currently and at least since 2006
* received 4th pacer 3 yrs ago which is a combo pacer/defib.
* having several events every month currently
* Dr.'s say he is 98% dependent on pacer/defib.
* current pacer/defib. almost dead - has 2.35 volts left, and will be not working at 2.15 volts (dr. said today he is 98% dependent on pacer/defib.)
* when he received current (above) pacer/defib. and old lead that is no longer working was severed and unable to be removed, and left inside. Therefore, a thorasic surgeon had to stitch a lead on the outside of his heart rather than through the vessels.
* all lines except the severed one are working fine, just running out of device life/battery
Plan of action:
* immedate replacement of the pacer/defib. by Venkata S. Sagi, M.D. (an elec (3 yrs ago 2 dr.'s tried unsuccessfully to do so)tro physiologist?) - scheduled for Friday, 4-11-08.
* Dr. wants to remove the severed lead because there are better tools now (3 yrs ago 2 dr.'s tried unsuccessfully to do so)
* If successful removing it, they want to put another lead in its place (it will use less juice) and have the one stitched on the outside of the heart left in place as a back-up source of juice.
I am concerned that something could go wrong in the removing of this inoperable lead - that something could break off in there (part of lead or a clot) and cause a problem. Dr. says in that event, they will go in through the groin and get whatever breaks off worst case.
My questions are:
* Are we working with the correct specialist?
* Should more than one specialist be involved?
* Is there someone in the country that specializes in these difficult cases I can consult with?
* Should we leave the broken lead alone since we know the man has blood clots in his heart already that coumadin doesn't disolve?
I don't have much time and am fearful that this event could take my father's life. Can you help me?
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