This message is from: "plumg...@pon.net" <plumg...@pon.net>
Hi all, Well, Jim just got a pacemaker for bradycardia. (Slow heart rate). The good news is that his skin color is about four shades pinker (red, really). He appears to be getting a LOT more oxygen to his tissues. Even his demeanor and personality are pretty clearly different (improved...I think...but wait for the final report after I live with him for a while.) The bad news is that the cardiologist (who had been told that we ride horses) informed him AFTERWARDS that he can never again ride a horse! It has to do with the step-up pacing that is delivered during walking or running that is built into this pacemaker. Turns out that the pacemaker (A Zephyr XL DR 5826 made by St Jude Medical)has an accelerometer sensor that picks up up and down movement when you walk and jog, and increases the pacing during that time. THis is fine when you are walking or running, because the heart needs to speed up (to 120 beats per minute as set right now)because you need more oxygen to your tissues. The problem is that, even on a walking horse, the doctor believes he will not be using enough oxygen via exertion to compensate for the increase in pacing induced by the up and down motion of a horse. I suppose each foot fall of the horse might be seen as on human step by the pacemaker. (Jim's heart problem was a Type I Mobitz (Wenckebach) Second Degree Atrial Ventricle block. HOwever, his resting heart rate had gotten routinely to be as low as 34, with it going up to 45 beats after we took the dog for a long walk (and when he was definitely breathing faster). That was more or less OK, but the doctor did not like that his treadmill test showed he could not get his heart rate above 109 beats of minute on a treadmill..even though he was clearly getting winded. This condition has obviously been progressing. The list may remember when he and I got trapped in a Vienna hospital with them wanting to put in a pacemaker, and me scanning the Internet, posting SOS's to the FJord list (one of the view e-mail addresses I could remember) and reading cardiology stuff on the Web so we could feel safe signing him out against medical advice. At that time, his resting rate was 45 beats a minute, and he could get his heart rate to a least 117 beats per minute.) The good news is that the guy who will program his pacemaker in 3 months said, "oh, we'll get you back on a horse" ...so at least he thinks it is possible, though I suspect they will have to downgrade the sensitivity of the sensors to the point where his heart may not accelerate enough when he IS walking. And the guy was young, so I am not positive he knows what he is talking about. Part of the reason I asked for help is that I want to set things up so the person who programs the pacemaker has the best possible information. We have a POlar heart rate monitor that will allow us to create a graph of heart activity on a computer. If I can superimpose that over a schedule of MY riding Jim's horse at the walk, that should give some idea of how much riding a horse at a walk actually DOES naturally raise a heart rate. (I suspect that it takes much more energy than the doctor thinks...especially if you focus on not slouching...or riding as I understand one is supposed to...where you are sort of "walking" in the stirrups.) After Jim is allowed to do things, we can also put HIM on a horse at a walk for a short period and see what his heart rate really goes up to with the pacemaker set as it is. Currently the pacemaker is doing ALL the work, and beating at 52 beats a minute...something like that. Right now, Jim's heart will naturally go up a bit with exercise on its own, but that may ultimately not be the case. They put this pacer in because it looked like he was sliding toward chronic ventricular incompetence. Our hospital does not have one of those telemetry systems for setting pacemakers (apparently the old phone ones are not being used, and they have not converted to the computer ones). So......Suggestions appreciated. Ways to give the docs the best background info (are my ideas above worthwhile)? Ways to manage the docs? What is possible? If necessary (and possible), we might pay extra so he can have his pacemaker custom set on a regular basis...as in....we are going hiking to eleven thousand feet...so up the accelerometer sensitivity...or...we are going riding lots, so slow things down. If we had been told, we would have had a different pacemaker put in. We are not too happy about this. Gail Important FjordHorse List Links: Subscription Management: http://tinyurl.com/5msa7e FH-L Archives: http://tinyurl.com/rcepw Classified Ads: http://tinyurl.com/5b5g2f
