End of life (IPG)

Hello,
Just thought I would pass on my experience of End Of Life (EOL) symptoms.
I had a dual chamber IPG for Mobitz type 2.
After nearly ten years it was close to replacement time and was being monitored at 12-week intervals which were to go to 8-week.
I had been starting to get tell-tale missing beats etc., but on 6th Jan 2016, sitting quietly at the computer, my pectoral muscle and left arm went into spasm, in synchronisation with the heartbeat. This was strong and did not stop after two minutes, so I called the emergency ambulance (I was on my own at the time and very nervous of what might happen next).
During the 8-hour wait in the UK A&E (ER) the IPG was diagnosed as having failed due to low battery voltage, reset itself and changed mode from bipolar to unipolar. The technician made some adjustments and altered the threshold voltage(s) and the spasms stopped.
I was put on an overnight monitor and next day went the PM operating list. The device (IPG) only was removed in what I can only describe as a gruelling procedure (well imbedded after nearly 11-years, low blood pressure and much tugging and diathermy). I now have a new Medtronics SureScan device that can be remotely interrogated and is MRI-proof.
While I am immensely grateful for the technology and the skill of the surgeons and technicians, I am less than happy that what should have been a planned, scheduled replacement, turned into an emergency, scary admission that could have been avoided had it not been for squeezing the last few millivolts out of a nearly dead battery.
The only consolation was the fact that there was no time to contemplate the replacement procedure.
For those interested, I have a large bruised area below the left collarbone, a tender area immediately over the incision, but four days later, am almost back to normal.
The A&E system in UK is almost on its knees and a dumping ground for drunks and drug-takers. 8-hours in a cubical and very little attention before ward admission at 03:00 AM.
Not a nice way to celebrate 10-years on the pacemaker.

5 Comments

Hi piglet!!

by Bionic Beat - 2016-01-11 05:01:45

Very glad to hear you have a new pm but sorry about the circumstances.
As scary as it was, it might have been better than an elective wait time and it's over, you are well etc.

I had hoped to switch out my nearly 8 yrs old Medtronic as my life was deteriorating. I don't think it was working well but was told 'these are very expensive and you have two years of battery life left, as well as risks of surgery.'
That was a year ago. This November, it was recalled for sudden battery depletion, so I have a brand new Boston Vitalio and am much better. It was also a rush job, urgent not emergent.

Good to see you back!

All the best!

Bionic Beat

Hi piglet

by IAN MC - 2016-01-11 09:01:53

Glad to read that there was a happy ending to your story and that you are almost back to normal.

A pity though that your last experience in one UK hospital has made you conclude that " The A & E system in the UK is almost on its knees and is a dumping ground etc ". I think that is an unfair generalisation.

I say this because I have been to my local A & E twice in the last 4 weeks, once for myself when I received brilliant rapid treatment , also Saturday when I took a neighbour who had fainted. She was so impressed by the quick service and the number of tests she was given in A & E that she has written a letter of thanks to the hospital management.

Don't you agree that any emergency department , anywhere in the world , on a bad day, would make you have a long wait. The demand in emergency services is totally unpredictable !

But glad you came out the other end OK

Ian

Interesting

by Good Dog - 2016-01-11 12:01:46

Glad to hear that you are now well after that experience. I will be sure to have my PM changed when the interrogation says it has 4 months remaining on the battery. As you found -out, it just isn't wise to wait. The shame is that I know insurance companies (here in the U.S.) don't want to pay if we don't wait until it is in elective replacement mode (3 months remaining). Trouble is; I feel like crap and can hardly function when it gets to that point. I am not doing that again. I think it is cruel.
I am confident that my doctor will find an excuse to justify changing it before that final 3 months. Though it is a shame we need an excuse.

Best Wishes,

David

What a tale of woe !

by IAN MC - 2016-01-12 05:01:46

Piglet : It sounds as though it is not only your A & E dept which is crap where you live , your cardiac/ medical records team seem pretty incompetent too.

My only tale of woe and dissatisfaction with the NHS leads to my advice to you :-

" Never, ever, be admitted as an emergency for a PM implant on a Bank Holiday , on a Good Friday to be precise. " I was . A & E again were fine as it happens and after a couple of hours i found myself in the cardiology ward. The only trouble was that all the cardiologists were on holiday till the following Tuesday.

But, like you, there was a happy ending - eventually !

Next time you need a PM replacement why not go in blind-drunk. Where you live, that may get you to the front of the queue.

Cheers

Ian

Thanks for comments

by piglet22 - 2016-01-12 10:01:14

A couple of points to expand on ref the UK A&E.

I've no doubt there are very good departments, but also some bad ones. I live on the South coast close to one particular city with many night clubs, alcoholics, drug-takers, homeless etc., etc. - this is also the main cardiac centre.

I also have a lovely local cottage-style hospital that USED to do the cardiac clinics, has a small injuries unit, is well loved locally and is somewhere you want to go to.

The local shut down a couple of years ago forcing the mainly older patients to get to the city hospital. This was done on the flimsy excuse that the check-ups were "challenging" and the local hospital was possibly not suitable - this is hogwash. They have all the facilities to take care of anyone who felt "challenged" - this is money talking. The politicians drone on about local services for local people, the reality is different and in any case, they will be on BUPA.

The main hospital is not fit for purpose, on an unsuitable site, old, falling apart in places, a nightmare to get to for patients and relatives - it is also conveniently close to the main police department. It is now too late to relocate the hospital.

Both my A&E admissions have been grim. The one before last for a broken pelvis involved a long painful wait in A&E, moved between three different wards in 5 days, ending up in an old ladies long term stay ward with no male facilities.

The latest was no better. 10 ambulance crews with patients just waiting to get into A&E, while staff floated about on the other side. Police there, chaotic.
In my cubical wing, there were two drug or alcohol fuelled women and a third ejected by security. A much older lady opposite screamed, shouted used language that might upset many, ignored by staff. 8-hours to watch all this going on

What I am getting at is that the A&E entrance is not the preferred route to PM replacement. With over ten years of PM data, 20 check-ups, the end of life was getting very predictable and I was already getting the old original symptoms back months ago. Squeezing the last millivolts out of a device might save a few quid, but the patient ends up paying.

Yes I'm hugely grateful for all the research, the incredible surgical skills, Medtronics etc., etc. Life now without the PM would be a poor experience.

The A&E route could be acceptable if it wasn't for the folk who shouldn't be there. If you've drunk yourself to oblivion, get picked up by the police who are almost duty bound (compensation claims fear) to take them to A&E, homeless ditto - go to the back of the queue.

I'm only grateful that on short unplanned notice, the cardiac department had the right PM on the shelf and found an operating slot.

To cap it all, my medical record is now full of errors - PM card with the wrong date year, a duodenal ulcer, news to me and untrue, wrong medication, but worst of all, and a matter I am going to take up, the notes written by the implant team an hour previously, scrubbed out by a ward nurse with the comment "you've had a battery change, you don't need this" - including the note not to drive for 7 days.

I'm afraid, Ian, when I see a nice, quick A&E around here, I'll let you know. I base my comments on what I experience. You are very lucky to be so well served.

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