Under skin or Under muscle?

It seems the EP is going to give me a choice do I want my pacemaker implanted under my skin or muscle?

I am not vain. I don't care if it shows even thru my clothes, I think so anyway......

So please help me with some stories to back up whatever decision I make.

1. I feel it will be a longer recovery if I have it under muscle. Am I correct?

2. Changing the battery in 10 years (I am 62) may be more difficult if the pacemaker is under muscle? Am I correct?

Anything else I should ask? Please tell me your experiences.

I appreciate any responses. This is my first pacemaker.

Peg

13 Comments

Location

by ElectricFrank - 2012-01-20 09:01:32

Peg,
If you aren't concerned about the cosmetics it's a no-brainer. Put it under the skin. Much less invasive surgery and faster healing. I can't think of any reason other than cosmetic for putting it under a muscle. (Maybe one other..a very few people who have developed an untreatable infection in the pocket needed to have there's moved. The under the skin location was the next best spot.).

Mine is under my skin and in the 7 or so years I've had it there have been zero problems. That includes a replacement as well. Healing has been fast.

Have it done with the minimum anesthesia you are comfortable with and you can likely walk out of the hospital the same day. Both my original and replacement were done with just a local pain shot and no sedatives. I realize that everyone isn't up to that approach though. I've been more uncomfortable in the dentists office. In both cases the anesthesiologist had me prepped for whatever I needed or wanted, and he jus t waited for me to complain. He is still waiting.

best wishes and enjoy your new sparky friend,

frank

location

by Tracey_E - 2012-01-20 11:01:15

Mine is under muscle.
1. Yes recovery is a bit longer but it's not bad. I only took tylenol to sleep at night after the first few days, nothing by the end of a week.
2. Yes and no. I was probably more sore than Frank, who has his under skin, but it was not bad at all. Scar tissue builds up around the device so replacements are easy wherever they are. I'm on my 4th. It's so numb now that I didn't even feel the incision get itchy when it healed last time.

One thing that was more complicated due to my placement, I needed a new lead last time. It wasn't a big deal, but because of how mine was placed the first time, they put the new lead in an auxiliary vein rather than in at the same place as the others so that was another incision. Again, a bit more complicated than the standard placement but not a big deal. By the time I was cleared to do whatever I wanted (6 weeks post new lead), I was back to my full routine at the gym including push ups.

I'm not vain either and didn't really care about a visible lump or scar, but the dr thought I'd be more comfortable with it buried so I went with his advice. I have to say, I didn't really care about the scar, but there have been times I've been glad it's not visible.

Some women, esp ones who are thin have problems with the bra strap or seat belt rubbing when it's shallow. Some have problems carrying a backpack. That's not a problem for many but I love to hike. I am very active and rarely even notice it's there. Frank could probably run circles around me so his doesn't slow him down either (tho I'm fairly certain he doesn't wear a bra so he can't chime in on that one :oP) so these are minor considerations.

It's up to you! If in doubt, go with the easy way. When the teenage girls post, or women who are worried about how it looks ask, I generally say to at least ask their dr about burying it. When mine was done that way (1993) it was virtually unheard of but now it's fairly common. I've never regretted it.

Thank you

by Peg541 - 2012-01-20 11:01:48

This is all very very helpful. Maybe I'll let the EP go by his judgment.

Seatbelts and back packs worry me. I don't back pack per se but I do carry one occasionally. Seatbelts are mandatory and that will be a problem since I would never consider driving with one even put on differently.

My job is pretty easy. I am a receptionist for Weight Watchers so it might not interfere after my three weeks off, two after the procedure. That is IF I went with the longer recovery.

I lost a lot of weight 4 years ago and honestly the thinnest place on my body is my upper chest (sadly too!)

OK I guess I can take a longer recovery if it's easier in the long run. We'll see what the EP says. I won't see him again until the day of the procedure and I know how hectic those minutes on the way into the OR usually are. Or cath lab or wherever they do it.

Isn't' the Internet the greatest? Where would we get all of this anecdotal information otherwise?

Thank you all so much.
Peg

?mammogram

by Peg541 - 2012-01-21 01:01:14

How do you get a mammogram with the pacemaker under the pectoral or breast tissue?

Could you manage alone at home soon after the implantation. My kids work as does my husband.

How long before you could drive.

Was it tough to cough and deep breathe?

Was it hard to get out of bed or a chair?

I have to make an informed decision and appreciate any help.
Thanks again.
Peggy

Easy

by ElectricFrank - 2012-01-21 04:01:56

I had no problem with mammograms or daddygrams LOL

Absolutely no problem being alone or getting out of bed. Same with caughing or deep breathing. I had a bit of soreness for a day or so, but really nothing limiting. I walked a mile or so the first day and was doing my usual 3 a day later.

The driving thing depends totally on your doctor and state law if any. There would have been nothing limiting physically in this regard. It partly depends on the reason for the pacer. If you have had any episodes of passing out they want to give it time to be sure the problem is solved.

I wouldn't leave it to the EP as far as placement especially since he gave you a choice. If it was a medical decision it might be different, but he has no way of knowing your preferences otherwise. Isn't it better to make the decision and take responsibility? It's a good way to get used to handling some of the future decisions which most of us seem to encounter. Nothing sinister, just an attitude of taking charge.

frank

Now I'm really worried!

by ElectricFrank - 2012-01-21 08:01:17

Peg,
OMG, a nurse and a doctor! Two strikes against you. LOL's

Seriously, glad you have it under control. Thanks for the update.

best wishes on an easy implant where ever you decide,

frank

sure

by Peg541 - 2012-01-21 08:01:46

Sure Frank makes sense. I was really referring to once the EP gets a good look at my chest he can say No you don't have enough skin there or you'll be fine either way.

That's this week and the pacer is next week on the 31st.

I am a nurse and my husband a physician so we are pretty savvy about medical stuff and decisions but I am a Googler and want as much anecdotal experience as I can get.

This is all good folks. Thanks so much. Frank I walk three miles three days a week also and ride my recumbent stationary bike at least 30 mins every day. Soon to be an hour, new bike takes getting used to. I'll want to get back to my routine as fast as possible.

Thanks so much.
Peg

placement and mammograms

by kathyfletchall - 2012-01-21 09:01:57

Hi Peg,
I've had my pm for 2 1/2 years and have mine just under the skin. My physician thought I had enough tissue there that it wouldn't be a problem for me and I trusted him. After having lost 20 lbs recently, I have noticed it bulging alittle more, but quite frankly no one has ever asked me about it. Fortunately my tops usually cover it, even tank tops. I did and still occasionally do, have problems with seat belt rubbing, but you can buy the seat belt cover at any walmart/target to soften the belt. The one thing my cardio said was to never play with the area and the scar because it will soften the tissue and make it bulge even more. I did find myself touching it alot, especially when it was still healing cause it itched a bit. He saw me doing it when I was there for a checkup and told me about not doing that. I'm glad he did, cause I find it was a strange habit I developed. Also, I have had 2 mammograms since implanting and I have never had any problems. The technician asked when she saw the scar, and I was really scared it would hurt, or hurt the leads, but never a problem. Good luck with your surgery and I hope you have a speedy recovery. And welcome to our wonderful group of battery operated people!
Kathy

I had mine moved from under the skin to under the muscle

by kathykat11 - 2012-01-21 12:01:07

due to pain, I had pain bad enough to cause me to vomit with just under the skin, Having it placed under the muscle made such a difference to me. When it was under the skin, a nerve was being pinched between the pacer and my shoulder. My recovery was faster with the under muscle placemnt than under the skin. but then I was not in any pain except from the incision. I got the added bonus of not even being able to tell I have a pacer in there. The initial placement looked like I had a stack of quartersunder my skin. I am totally pleased under muscle.
best always,
kathykat11

questions

by Tracey_E - 2012-01-22 02:01:09

Hey Peg,
mine is very deep, under the breast rather than pectoral. It was put in from the side. The scar is about where the underwire of my bra hits (yes, the surgeon was a man, a woman would have scooted it over a bit!).

Mammo- I go to the same place every time. They use digital imaging so they can pull it up right away and see where the pm is. The first time I went, they did one very gentle image to get an idea what they were dealing with re:wires and the device itself.

Home alone- yep, no problem! Lifting and twisting are a problem but just being home alone, or even doing your job won't be a problem. I was cleared to do whatever I wanted after 6 weeks. It was 8-10 weeks before I was able to lift/bend/twist any direction without feeling a twinge.

I was never told not to drive, but I think that's rare

No problem breathing deep or coughing.

No problem getting out of bed or chair

a few pieces of advice I like to pass on...
wear a button up top to the hospital and for the first couple of weeks. You won't want to be pulling anything over your head or raising your arms for a while.

I like to sleep on my side, which doesn't work for a while after surgery. I slept on my back and hugged a small pillow with my left arm. This kept me off the incision and kept me from rolling onto my sore side

If you decide to bury it, getting a bra on will be a challenge for a few weeks. I stocked up on the tank tops with the built in shelf bra, wore loose blouses over it.

Just what I needed

by Peg541 - 2012-01-22 03:01:33

Thank you Tracey and all for this information. I like to go into things having an idea what others experienced.

I am looking around and do not own ONE button down thing except pajamas. I found one old soft sweater that is too big so that will do for a while.

I hope to get active right away. I will play it by ear. I like the under the muscle idea. Have had a lot of surgery I bounced back from so this sounds like a cake walk compared to knee replacement.

Thank you for all the help.
Peg

healing

by Tracey_E - 2012-01-22 10:01:05

This IS a cake walk compared to a knee replacement ;o) I got my first one before the internet so I had no way to research and ask questions. I had it built up in my head to be something awful but it ended up being very simple. It sounds a lot worse than it is. You are going into it with the right attitude, you'll bounce right back.

I was out walking the day I got out of the hospital. Other than babying the sore area until the lead could heal, it didn't slow me down at all. I didn't own any button downs either! I hit the clearance rack at Marshalls and picked up a few. They're still in my closet, haven't worn them since.

btw, I got my first one in 1993 and am on #4 now. I feel fantastic, night and day from before. I've never regretted burying it. A little additional discomfort the first few weeks is a small price to pay to have it comfortable and out of the way.

Great stuff

by Peg541 - 2012-01-22 11:01:06

Really isn't the net just a miracle how we get & give so much help? Thanks so much. I'll let you all know how it goes.
Peg

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A pacemaker completely solved my problem. In fact, it was implanted just 7 weeks ago and I ran a race today, placed first in my age group.