Mom and EOL

Hi everyone,
I was googling about pacemaker battery EOL when I found your club, so I joined. I saw a similar question to mine in recent postings, but not a lot of answers. My mom is 99 and her battery is scheduled to expire one month before her 100th birthday. She got the PM when she was blacking out, perhaps from low blood pressure. She says she is ready to go to God and won't re-up the battery. We have become at peace with this. But I'd like to know what will happen. What can we do for her comfort? How long might she last? When should we call in hospice? She has no serious illness that I know of. She says she won't go to doctors anymore. So I believe she will qualify for hospice. Can anyone help me with any similar eperiences with EOL?

4 Comments

EOL

by SMITTY - 2011-10-23 03:10:54

Hello PKB,

I can make a few comments about EOL, having been through that once.

First, don't let anyone kid you about being able to pick out an exact time the pacemaker will reach EOL. I had a PM checkup in July 2009 and the report showed I had at least 12 months battery life left. Well to my surprise the battery reached EOL 4 months later I to have a replacement.

If you can take a look the PM checkup report printed out at the end of each PM checkup. On that report will be "Estimated battery longevity is (some no. number of) years based on past history." Past history is determined by the percent pacing the PM has done and the power settings. Since those can be variable factors an exact time to EOL is at best a guess. Of course, it is also possible the Dr has a slot in his schedule and that is when he would like to do PM replacement for your Mom which of course is predictable. I mention this because you need to know what the basis for your Mom's PM EOL.

Now what will it be like when the PM reaches EOL. The PM does not quite working. It goes into a battery saving mode which they tell me will extend the battery life for at least three months. Ii can do this because in EOL mode the PM shifts from being an on demand (one that helps the heart only as needed) device to one that operates full time giving a fixed heart rate. That fixed heart rate will be from 55 to 70, depending on what is programmed into the PM.

Mine, as a fixed rate PM was very uncomfortable, to downright painful. My heart rate had been 80 BPM and all of a sudden it was now going 65 B PM. In addition, being a fixed rate PM, in place of an on demand unit, it did not defer to my hearts natural PM when it was trying to make my heart beat. This resulted in conflict in my heart beats and that was where my discomfort came in.

So, exactly when your Mom's PM will go into EOL, I do not think can be predicted. Just what she will feel is also unpredictable. They only thing that I think is predictable is your Mom will definitely know something has happened, but it may, or may not, be the disaster you think it could be.

Also, if she does not go for a replacement and they battery did reach the end of its life, the worst thing that would happen is that without benefit of the PM, her heart would probably revert back to doing what it was before she got the PM and in her case that could mean more blackouts.

The above is based on my experience and other may have differing opinions and I certainly do not think my experience is the last word.

I wish your Mom the best.

Smitty


eol

by Tracey_E - 2011-10-23 03:10:58

First of all, when the battery will go is just an estimate, and it's a range of time rather than a particular date. First it goes into ERI, elective replacement mode, which usually lasts about 3 months. During this time it's fully functional, think of it as the gas light on in your car. EOL also lasts about 3 months. During this time, it has limited function. It won't let the dr drop below a certain point, usually 60 bpm, but that's about it. Once you get to the end of EOL, it will be as she was before the pm.

I'm not a dr so I'm just guessing but if she only needs it for sudden drops she won 't feel a difference as long as it's in EOL so I wouldn't call hospice until it's no longer working. Even then it sounds like perhaps it's giving her quality of life rather than quantity of life so she may keep going just fine but with blackouts.

I would discuss hospice with her doctor. He will know when to make the referral and be the one to do it. If you've never dealt with them, they are completely amazing, a resource not just for the patient but for the whole family. They tell you what to expect every step of the way and make sure she's comfortable.

ERI vs EOL

by shockbox340 - 2011-10-24 09:10:48

pkb,

No one here can answer your question about how your mother will be affected when her device reaches ERI and EOL, because there are too many necessary details missing from your original post. ERI (Elective Replacement Indicator) is the "low battery" state when many extra features and algorithms are disabled to maximize the remaining battery life for basic pacing. This can last anywhere from three months to well over a year. Variables like how often your mother is paced, the outputs programmed, the current mode vs ERI mode, etc.

Your mother's doctor is the best person to give you an educated guess at what she will feel once her device reaches EOL (End Of Life), or quits functioning completely. I would guess that she would simply have a return of her blacking out episodes, and possibly even worse than before due to her heart potentially becoming "lazy" from the device controlling her rate for years. Best of luck!

Something to consider

by ElectricFrank - 2011-10-25 12:10:46

As several have mentioned letting the pacer die may not let your mother die. I many cases it is just improving our quality of life.

As an example back in 2004 when I developed AV block my HR dropped down around 30bpm. I didn't die nor even become non functional. I just felt lousy and could likely have survived for quite a while before some of my organs started failing due to low blood flow.

I have no problem with giving a person a choice about their own end of life, and I certainly want that choice for myself. I just wouldn't choose removing my pacer as the way to carry it out.

frank

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