How happy patients become unhappy

I'm in the EP clinic having a micro-adjustment to my PM's settings - one of which excites some interest from the EP tech (boring electro-physiology stuff).   My box does a fantastic job for me, and I'm very happy with it.

'Oh,' says the EP tech, 'you have Minute Ventilation enabled.  We normally turn that off,' he continues in a nonchalant way.  And this in a centre where I had thought that they use a lot of BostonSci PMs.

Oh, good grief! (expletive abbreviation deleted)

I recognise that I didn't handle this comment very well, but managed to convince the tech not to fiddle with this setting - I was only in to have a tiny tweak to my MSR.

All ended well, my settings report shows that nothing else was changed, and the reports confirm what I had been expecting.

But very odd.  If the EP tech hadn't been the sort to at least check with the patient, I might have had the most important feature of my box disabled.

3 Comments

NOW PLEASE

by Gemita - 2019-12-17 12:28:31

don't use that language Crustyg, you disappoint me !!

You were lucky you were in control and could convince the EP tech you knew a thing or two.  Imagine someone unfamiliar with all this, they would have come away worse off.  But please explain what is Minute Ventilation ?

Glad you got a clean bill of health.

Pardon my frustration

by crustyg - 2019-12-17 13:07:03

There's actually a Hollywood film with that as a title (starring Tina Fey - well worth watching).  But I've changed it, as I know you are right.

Minute Ventilation measures both the respiration rate *and* depth of each breath and multiplies the two together to derive Ventilatory effort per minute.  It's another way of detecting significant exertion, and for activities like road cycling where there's not a lot of upper body movement (which can be detected by the accelerometer that most of us have in our PMs) it's essential to drive the rate response software algorithm to increase HR.

It's technically quite difficult for the vendors to make it work reliably (BostonSci had to disable it worldwide last year), as there are a *lot* of possible interferences, the PM is working with tiny signals, and it can easily drive up HR much more than it should if there are interferences.  There are, I believe, only two vendors who offer it in their PMs.  For those who use it, it's brilliant, but it seems that there is quite a bit of education required.  For someone like me, it's similar to collecting the car after a service and they happen to mention 'Oh, we turned off the anti-lock brake feature as we find sensible drivers like you (==old) don't need it.'

Thanks for the kind words.  Actually I had hoped to find a couple of events in my arrhythmia log - but nothing.  But my PM is set slightly unusually (as I found out) - apart from wanting to use MV.

Always learning.

Been there

by Gotrhythm - 2019-12-19 14:35:15

It happened to me, but I didn't know to say anything. Although I thought they were wrong. I didn't advocate for myself because I didn't feel capable of arguing with them.

Your experience is just one more example of why it behooves all of us to know what our settings are and why our settings are as they are.

And to recognize that at any moment, we may need to advocate for ourselves. It's highly possible that anytime we see some medical person for the first time, we know more about why our device is programmed as it is than they do.

You know you're wired when...

Your signature looks like an EKG.

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