More risk to PM Dependent patients.....

Did anyone know that there is more risks to surgery if you're PM dependent?

The surgeon says I'm at higher risk of stroke, heart attack and general heart damage!!!

I have a cyst in my Common Bile Duct, seems to be benign but will cause malignancy if left....so no real choices.

Apparently, it's harder to monitor us under anaesthesia, we do NOT respond to "stressors" such as infection or internal bleeding, post-op.....our heart rates do not increase, their first sign of trouble.

Also, we're at greater risk of pneumonia and thrombosis.

Have to come off ALL blood thinners for a number of days before and after surgery (I didn't ask how many days) d/t risks of bleeding causing complications.

Apparently, they usually give patients an epidural at the end of the surgery, to help with the first 12 hours of pain BUT having been on blood thinners, I might not be eligible.

The incision will be about 12 inches or "as big as necessary", on the right side near the ribs and I'm wondering if that'll endanger my pacemaker on the left side.

Would you ask them to be very careful with your pacemaker?

Would you delay the surgery? or just get it over with?

I'm a wreck over this.....just a wreck.

Thanks


Bionic Beat


5 Comments

GEE THANKS

by pete - 2008-09-01 03:09:16

Gee wizz thanks for cheering me up !! Im only joking.
On a more serious note I dont think you need to tell the Surgeon to be carefull. They certainly will be, its their job and duty as a doctor to do all they can to look after you. They seem to dislike being told their job. It would not be amiss to word it in a different way so that its not so direct. For instance you could say "Its amazing how you surgeons can operate on someone like me without disturbing my pacemaker". It would be interesting to see if something like that would provoke a comment.
Dont delay just get on with it. The risks of not having treatment when you need it are far greater. This is not major major surgery. Ask if they can use keyhole surgery as the recovery is much quicker.Good luck. Cheers pete

You and your PM

by maryanne - 2008-09-01 03:09:20

PM's do make things more challenging for surgeon's but not impossible. I have had surgeries with my PM....anytime they have to use a cautery I had to have my PM deprogrammed as the cautery machine interferes with the PM....now I am not 100% PM dependant...damn close though....anyhow after the surgery they come and reprogram my PM.....as for chances of strokes etc. You have been on a blood thinner because of your atrial fib....if you weren't on that then that is where you run into the possibility of a stroke....but with that being said..whenever anyone is on a blood thinner (asprin, plavix,heparin or coumadin)it must be stopped pre op or you run an extremely high risk of a bleed....once they are assured you are not going to bleed they start you back on your blood thinners.

As far as the epidural verses General there are reason why they choose one over the other and it has nothing to do with convenience for the doctor but rather safety and comfort for the patient. I have had a block, a general and then even an epidural for post op pain. There are many reasons why the anesthetist choose the route for sedation that they do, but primarily it's what the patients underlying condition which often dictates how they will sedate the patient.

Best of luck....

Depends

by ElectricFrank - 2008-09-01 06:09:41

The relative risk of surgery depends on the reason you have the pacer.
With something simple like AV block it should be no problem. In this case the heart rate is still determined by the persons intrinsic pacemaker so responds to stress. Also, there is normally no reason to be taking blood thinners. The only potential problems are that we can't have an MRI, some surgical instruments like cauterizers can interfere with the pacer.
I may be looking at some back surgery and the surgeon isn't concerned at all. He mentioned that in some cases he asks to have an EP or pacer rep present in case there is a need to make some change in the pacer program.
If you are taking thinners for something like afib then that is another issue, but not related to the pacemaker.

frank

frank

Hi BionicBeat,

by Gellia2 - 2008-09-01 08:09:59

I think with a pacemaker or ICD, we're at a higher risk for nearly everything that can go wrong, but the happenstance is rare.
I agree with Pete. Is there anyway that they can do the surgery laparoscopically? The incision is much smaller - recovery much quicker.

I had abdominal surgery years ago for a tumor. Hip bone to hip bone incision. The anesthesiologist came in and told me they would do an epi. I didn't want that. At all. He told me it would be "safer" for me. I told him it was just easier for him! I didn't want to be awake. So I wasn't, and everything went fine. YOUR comfort should come first. They get well paid to know how to monitor people with pacemakers and ICD's. Just make sure you are happy with the decision as to what you get. It's up to them to make sure you are safe and comfortable, not do what is easier for them.

My surgery went fine with regular general anesthesia.

I'm sure you will do fine.
Best to you,
Gellia

My response

by janetinak - 2008-09-02 02:09:13

Hi,

I have told my story before but will say again. Those who heard it before can skip this, hah. I am 100% PM dependent due to Afib & a Ablation. Yes, I know better things now but in 2000 that was best choice & I was a mess. Well anyhow, about 6 yrs ago I had both knees replaced in two different surgeries with general anesthesia. They wanted to do epidural but as I stopped Coumadin 4 days before as requested my INR was still too high. So I went with general & all went well, twice! I was put back on Coumadin & my Ortho & Cardio slowly increased it & no problems. Just to let you that it can be done & I also ended up with a very long scar on each knee, about 16 staples on each. Hope my experience helps.

Good luck, Janet

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