Juvenile Diabetic with active lifestlye

I’m 28 years old and have a VERY active lifestyle. I am also a Juvenile Diabetic (26yrs) and have an insulin pump. I have been diagnosed with sick sinus syndrome and have bradycardia mostly at night when I sleep. My cardiologist recommends that I get a pacemaker. I am pretty much ok with the idea. I already have the pump so I’m not really phased by having another electronic device hooked to me. I came on this site when I first found out that I needed a PM and was relived to see so many active, and young, people here. I have been told by my Cardiologist that the PM is just going to watch my heart and when the rate drops below a certain level then it will kick in. Am I going to feel this?
I’m scheduled for implantation on January 19th and now I’m getting a little nervous about the recovery period. I assumed it was a 2 week minimum from other things I have read online but I came here and people have years of not feeling right. Now I’m really scared of getting the PM and then having 6 months or so of feeling like shit. I don’t know what people’s activity level and symptoms are before they get their PM. I personally don’t have a whole lot of symptoms right now maybe Once or twice a month I get dizzy and almost every night I have bradycardia so I’m tired in the day time and occasionally I’ll have a heart flutter or some pain in my chest but I’m not sure if its related to my heart.
As for my activity level....well I’m an underwater videographer so I chase people around in the ocean and swim with wild life and film it. I was also training for an olympic distance triathlon but I have stopped training because I had running induced lightheadedness/dizzyness.
I’m just wondering if anyone in a slightly similar situation can tell how their recovery time was. I have read that seat belts will be a bitch along with bathing suite tops and bra straps. Some people talk about panic attacks, what's that about? I know that there are some scuba divers on the site I’m getting a St. Jude device but I don’t know what model, are most of them depth rated? I couldn’t find any info on the st. jude pacemaker site but maybe I wasn’t looking in the right place.
Sorry this is a lot of info and a lot of questions but I’ll take all the information I can get right now.
Thanks,
ERL

7 Comments

An Article That I Found...

by Pookie - 2010-01-08 02:01:51

this article is probably from WebMD: (hope it helps answer some of your questions)

Managing Your Pacemaker

Do your part in managing your pacemaker. You may have to have someone help you, but there are certain things you'll need to do to manage your pacemaker successfully. These include:

Understand your acceptable heart rate. Before you leave the hospital, discuss with your doctor the specific maximum heart rate above your pacemaker rate that's acceptable. Discuss the programmed lower and upper rate for your pacemaker, too. Talking about this with your doctor early in your treatment will keep you from worrying unnecessarily.

Take your pulse and keep a record for your doctor. Counting your pulse is a good way to check that your heart is pumping correctly. Every time your heart beats, it pumps blood through your blood vessels. By putting your fingertips on a point on the inside of your wrist or over an artery in your neck , you can feel this beat (pulse). The number of pulse beats per minute is the same as the number of heartbeats. Count your pulse for one full minute, note the number of beats and see if it's in the range that your doctor told you was acceptable for your pacemaker. If your pulse is very slow or very fast, call your doctor. Use these guidelines for pacemakers and pulse counts:

If your pacemaker is beating regularly and at or above its proper rate, it's OK.

If your heart is beating close to or within the accepted rate but has an occasional irregularity, don't worry.

Every now and then your own heart's natural pacemaker competes with the man-made one. Some extra beats that the pacemaker can sense electrically won't result in a pulse that you can feel.

If your pulse rate suddenly drops below the accepted rate or increases dramatically, call your doctor immediately. Your doctor will tell you what to do. It may be possible to program your pacemaker so it resumes working normally, or there may be some other problem.

If your pacemaker is installed for a fast-slow type of heartbeat and your pulse is rapid and irregular (above 120 beats per minute), call your doctor for more instructions.

If your pulse is beating faster than you've noticed before — but below 100 beats per minute — don't be alarmed.

Take prescribed medications. It's important to follow instructions and take prescribed medicine by following directions precisely. The reason is that the medicine works with the pacemaker and helps your heart pump regularly. Your doctor may ask you to keep a record of when you take your medication by marking a calendar.

Follow all instructions regarding diet and physical activity. Allow about eight weeks for your pacemaker to settle firmly in place. During this time, avoid sudden, jerky or violent actions that will cause your arm to pull away from your body.

Other warnings and information

Avoid causing pressure over the area of your chest where your pacemaker was put in. Women may find it more comfortable to wear a small pad over the incision as protection from their bra strap.

Feel free to take baths and showers. Your pacemaker is completely protected against contact with water.

Follow the program of activity outlined by your doctor.

Car, train or airplane trips pose no danger.

People with pacemakers can continue their usual sexual activity.

Perform some kind of physical activity every day, whatever kind you enjoy. You might try taking a short walk, or moving your arms and legs to help your circulation. If you're not sure about exercising, ask your doctor for advice. You may be able to perform all normal activities for a person of your age.

Don't overdo it — quit before you get tired. The proper amount of activity should make you feel better, not worse.

Report to your doctor if:
You have difficulty breathing.

You begin to gain weight and your legs and ankles swell.

You faint or have dizzy spells.

Tell physicians, dentists and other health professionals that you have a pacemaker. Physicians or dentists need to know that you have a pacemaker. Tell them about it before you have any work done. Notify the doctor or nurse where you work. Modern pacemakers have built-in features to protect them from most types of interference produced by other electrical devices you might encounter in your daily routine. Household appliances such as microwave ovens, televisions, radios, stereos, vacuum cleaners, electric brooms, electric blankets, electric knives, hair dryers, shavers, gardening machinery, toasters, food processors and can openers won't affect your pacemaker. Most office and light shop equipment such as computers, typewriters, copy machines, woodworking shop tools and metalworking tools also pose no risk to your pacemaker.

If you suspect interference with your pacemaker, simply move away or turn off the equipment. Your pacemaker won't be permanently damaged and will resume its normal activity. Consult your doctor about special situations (such as working with high-current industrial equipment and powerful magnets). Surgical procedures also count as special situations. Certain types of medical equipment, such as magnetic resonance imaging (MRI) equipment, can also affect how a pacemaker works.

Always carry your identification card. In any kind of accident, your I.D. card will tell the people helping you that you have a pacemaker. Your card can be particularly handy if you travel by air. The metal-detection devices in airports may detect the metal in your pacemaker, although they won't damage it. Showing your card may save you some inconvenience.

Keep all medical appointments. To work properly, your pacemaker should be checked periodically to find out how the leads are working and how the battery is doing. Today many thousands of people have pacemakers and lead full, productive lives. Pacemakers are usually safe and reliable, but they do need to be checked regularly. The easiest way to check your pacemaker is to take your pulse. Taking medicine as prescribed and seeing your doctor regularly will also help. Your doctor can explain things you don't understand.


Pookie

AHA Guidelines

by golden_snitch - 2010-01-08 03:01:15

ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices

D. Pacing in Sinus Node Dysfunction

Sinus node dysfunction (sick sinus syndrome) constitutes a spectrum of cardiac arrhythmias, including sinus bradycardia, sinus arrest, sinoatrial block, and paroxysmal supraventricular tachyarrhythmias alternating with periods of bradycardia or even asystole. Patients with this condition may be symptomatic from paroxysmal tachycardia or bradycardia or both. Correlation of symptoms with the above arrhythmias by use of an ECG, ambulatory ECG monitoring, or an event recorder is essential. This correlation may be difficult because of the intermittent nature of the episodes. In the electrophysiology laboratory, abnormal sinus node function may be confirmed by demonstration of prolonged corrected sinus node recovery times or prolonged sinoatrial conduction times. However, utility of electrophysiologic studies for sinus node dysfunction is limited by issues of sensitivity and specificity.

Sinus node dysfunction may express itself as chronotropic incompetence in which there is an inadequate sinus response to exercise or stress. Rate-responsive pacemakers have clinically benefited patients by restoring physiologic heart rate during physical activity 73-75.

Sinus bradycardia is accepted as a physiologic finding in trained athletes, who not uncommonly have a heart rate of 40 to 50 bpm while at rest and awake and may have a sleeping rate as slow as 30 bpm, with sinus pauses or type I seconddegree AV block producing asystolic intervals as long as 2.8 seconds 76-78. These findings are due to increased vagal tone.

Although sinus node dysfunction is frequently the primary indication for implantation of permanent pacemakers 73, permanent pacing in patients with sinus node dysfunction may not necessarily result in improved survival time 26,79, although symptoms related to bradycardia may be relieved 27,80 (see Section I, Selection of Pacemaker Devices). During monitoring, pauses are sometimes observed during sleep. Duration of sinus pauses and their clinical significance is uncertain. If due to sleep apnea, apnea should be treated. A small retrospective trial of atrial overdrive pacing in the treatment of sleep apnea demonstrated a decrease “in episodes of central or obstructive sleep apnea without reducing the total sleep time” 447). Although this initial trial is encouraging, it is premature to propose pacing guidelines until a larger body of data is available. Otherwise, there is not sufficient evidence to distinguish physiologic from pathologic nocturnal bradycardia.

Recommendations for Permanent Pacing in Sinus Node Dysfunction

Class I

1. Sinus node dysfunction with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. In some patients, bradycardia is iatrogenic and will occur as a consequence of essential long-term drug therapy of a type and dose for which there are no acceptable alternatives. (Level of Evidence: C) 27,73,79
2. Symptomatic chronotropic incompetence. (Level of Evidence: C) 27,73-75,79

Class IIa

1. Sinus node dysfunction occurring spontaneously or as a result of necessary drug therapy, with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. (Level of Evidence: C) 26,27,73,78-80
2. Syncope of unexplained origin when major abnormalities of sinus node function are discovered or provoked in electrophysiologic studies. (Level of Evidence: C) 351,352

Class IIb

In minimally symptomatic patients, chronic heart rate less than 40 bpm while awake. (Level of Evidence: C) 26,27,73,78-80

Class III

1. Sinus node dysfunction in asymptomatic patients, including those in whom substantial sinus bradycardia (heart rate less than 40 bpm) is a consequence of long-term drug treatment.
2. Sinus node dysfunction in patients with symptoms suggestive of bradycardia that are clearly documented as not associated with a slow heart rate.
3. Sinus node dysfunction with symptomatic bradycardia due to nonessential drug therapy.

http://www.acc.org/qualityandscience/clinical/guidelines/pacemaker/incorporated/I_indications.htm

Why the pacer?

by golden_snitch - 2010-01-08 03:01:31

Hey there!

From what you have posted here, the question I would ask is: do you really need the pacer? I mean why have another device implanted when the indication is not given?
You say you live a very active lifestyle, and you have bradycardia mostly while sleeping. So, unless you aren't symptomatic with bradycardia or pauses or chronotopic incompetence, the pacer is not a must have for sick sinus syndrome patients. Of course, if your rate drops very low at night, for example below 35 or 30 (very well trained people can have a rate as low as 40bpm at night, and it's perfectly normal because their heart muscle is so strong) or you have pauses at night that are longer than 4.5 seconds, then you should get a pacer even though you might not be symptomatic. You can read the guidelines for pacer implants by the American Heart Association, European Society for Cardiology etc., and you'll see what I mean.
http://www.hrsonline.org/Policy/ClinicalGuidelines/upload/Pacemaker%20Guide%202002-2.pdf

I'm not saying don't trust your cardio. It's just that from you are telling us, neither the indication is clear, nor the advantage of having a pacer.

I can tell you that in Germany some doctors are not following the guidelines, that's what the national pacer registry says, and the result is not that patients who need a pacer don't get one, but rather that people without a clear indication get a pacer, and the number of these patients is increasing.

Best wishes
Inga

If you do end up getting a pacemaker...

by sln - 2010-01-08 08:01:15

I'm not anywhere near as athletic, or young, as you, but I like being active and have a thin frame, so the EP put my pacemaker under the muscle. They can tell you if that's an option for you. I do find shoulder belts in the car irritating sometimes, but don't have a problem with bra straps or most bathing suits. My PM is not noticeable at all under clothing and the scar is covered by most of my bathing suits and not bad when part of it is showing, just a thin white line (living in Southern California, bathing suits are a fact of life). I've worn a wetsuit with no problem also - I was initially worried about the pressure but it didn't end up bothering me. I've snorkeled and kayaked and gone white-water rafting etc. with it, not until about 6 months after the implant but only because that was when my son got out of school for the summer and we started doing that stuff, not because I didn't feel up to it. I don't scuba (because of asthma history), so maybe others can address the depth issues. But I can tell you, I'd sure rather deal with a PM than with fainting if I were scuba diving!

The recovery is different for everyone. I'm guessing that someone as fit as you might be more resilient than many people! I do notice the PM working sometimes, which I was told can happen in people who are sensitive to bodily sensations, but it doesn't bother me anymore. I sometimes find myself thinking, especially if I'm driving when that happens, "Boy, I'm sure glad I'm not passing out about now!"

Wow

by Angelie - 2010-01-08 12:01:14

Ya know, there's no real answer for you I'm afraid....
I was younger than you when I developed symptoms from my heart arrhythmia. Have you received a second opinion?
People respond to pacemaker implant differently, as no two people are alike. The procedure itself was not a big deal to me, where others describe a horrendous experience with a lot of pain.
My first single chamber pacer was much smaller than the one I have right now. I'm a petite 34 year old and right now am still waiting to see if I can tolerate my new pacer, just implanted 9/09, in it's location. It gets in my way ALL the time. Pinches, moves around every time I move my left arm. It's a pain in the "A".
4 months after my first pacemaker implant, I ran my first 5k, but sadly my arrhythmia symptoms continued and I found that I couldn't exercise as well. People get devices for many things. I had a gamut of problems- like I said no one is exactly the same.
I'm 100% atrial paced. My sinus node doesn't work anymore and every electrical impulse comes from the pacemaker for my heart to initiate a beat. I've had a really hard time getting my pacer set correctly for my activity level. (that's with both my single chamber, and now my dual pacemaker). My first implant was in 8/08. Just one month over my first pacer anniversary, I was back in the OR getting another pacermaker.
It's no cakewalk, let me tell you that. There are many adjustments, but after you heal and get settled you should be able to do most anything that you did before the implant. Pacemakers are not designed to disable you, but enable you to continue living.
Sounds like your artificial pacemaker would only be there to check for missed beats, but your own heart's electrical impulses would be the dominate pacemaker for you. It's so right to allow your body to do as much as it possibly can for as long it possibly can.
Although I don't know your complete history, I do get afraid that some doctors suggest pacemakers too frequently.
I had to struggle through close to ten years feeling like crap to finally get my pacemaker. They always thought that I was too young for pacemaker implantation. For me and my doctors, the pacemaker was the absolute last resort. (but I had fast rhythms as well- totally different scenario for you)

I would suggest that you get a second opinion with a doctor that is not at all affliated with the one that you're currently seeing. Regardless of what people say, implanted heart devices ARE a big deal. My EP who suggested, when we were at our wits end, a pacemaker for me told me that he refused to implant a pacer in me without getting a second opinion from another doctor besides him. He wanted to make sure that there wasn't another option, and to hear the pros and cons from someone other than him. He mainly just wanted to make sure that I understood what I was about to endure.

Best of luck with your decision and pacer implant,
Welcome to the club. I always wanted to be in a club when I was younger. I thought it was cool. I never dreamed I'd ever be in a club like this, though.

-Angelie

Welcome

by ela-girl - 2010-01-08 12:01:31

Hey, ERL.

As far as the pacer kicking in and your feeling it...if your pacer is set correctly and working correctly, you shouldn't be feeling it at all. With that said, a lot of new pacers are hyper-aware or sensitive to having a pacemaker for the first few weeks. If you are going to feel anything, it is usually the ventricular beat since it is the strongest beat.

As far as reading "horror" stories here and getting nervous...remember that this is a support site. People come here looking for help or experience or reassurance that other people have gone through the same "bad" time they might be dealing with. Not all of us here have those kinds of feelings or problems. I have had my pacer for over 3 years (got it for NCS and bradycardia when I was 29) and I have been great ever since! Do you see what I'm saying? When things are going well, a lot of people don't seek out groups. :)

I'm sure some swimmers/divers will be along to share their experiences with getting back in the water...I can't help you there. All of us gals can give you great and practical advice on how to deal with your bra or doing your hair etc.

You can always call your pacer brand's 800 number and ask some of your questions to them about the pacer's depth rating or whatever else.

Hang in there! And ask as many questions as you need to because there are no dumb questions here.

ela-girl

Active

by ronyelon - 2010-02-20 10:02:45

I got my pm when i was 29 years old. Prior to I was very active, played basketball 2x week in the winter and fall. During spring and summer I do triathlons, and long endurance events (centuries, half marathon/marathon). I had to cool it for 8 weeks however slowly eased my way back into it. It has been a year for me and I am in the same shape I was in before. My pm also kicks in when the hr dips below 35 beats. I can notice an increase in the heartbeat but thats about it. It doesnt wake me if it occurs in the middle of the nite.

You know you're wired when...

Your old device becomes a paper weight for your desk.

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