Pacemaker discussion with Dr. Kubac (Fri, May 28, 2:30pm)

This has been a very interesting morning. Mom was obviously feeling better. She hasn't had any syncope episodes in at least 24 hours.

We were a little late leaving for town because Jana decided to go exploring. In spite of mom blowing her dog whistle at an ear-splitting volume (at 8:30am), Jana took her own sweet time about returning, then stood at the top of the steps looking like she was maybe considering going back into the bushes because she knew she was in trouble anyway. Mom finally got her inside and we took off for town.

The phlebotomist was a new girl, and as she typed mom's info into the computer, she said, "Last name?"

"Nelson," mom said.

"With an L?" the girl asked. (What else would it be, I wondered, and mom confirmed for the girl that it was Nelson with an L.)

"First Name?" the girl asked.

"Florence," mom replied.

"With an F?" the girl asked. She then proceeded to explain, "I have PH on my mind." (!!! HAHAHAHAHA A phlebotomist with PH on her mind...)

After that exchange, the girl was actually very competent with a needle, and she got the blood first try and even called someone at the hospital to meet her halfway so they could get the blood analyzed and the report to Dr. Kubac in 30 minutes.

The visit with Kubac was really interesting. It started with his assistant Shonna taking Phlorence's blood pressure (130/64, better than two days ago), and pulse (only 48). Shonna said that the printout from the Holter monitor was really alarming, which was why Kubac had wanted mom to go into the hospital when he called yesterday. I asked if they had been able to correlate the spells with anything, and she said definitely yes. She said that there were periods where mom's heart actually stopped for NINE seconds at a time. Shonna said, "It was scary. In a couple places you were in cardiac arrest."

Then Kubac came in and showed us the printout. It was really shocking. It showed a nice series of regular beats, then suddenly literally a flat line for a number of seconds before the beats would pick up again. Over the 24 hours there were a bunch of those flat lines ranging from about five seconds up to nine seconds. No wonder she was losing consciousness. Kubac also said that one of the dangers of these episodes in someone who is on Coumadin is that they can easily injure themselves and bleed internally simply from the fall. I think the huge bruise that mom has on her arm from her fall behind the couch is proof of that.

Kubac said that mom was actually on a very small dose of Toprol to slow her heart rate because previously it had been racing. He said that the small dose that she was on was not enough to result in the very slow and erratic beat that we saw on the monitor. But he stopped the Toprol anyway, and he wants to wait a couple days for it to completely leave her system, then he wants another 24 hour test with the Holter monitor. He said he thinks the problem is a "degenerating electrical node" which controls the heartbeat, and the reason for the degeneration is basically that mom's heart is worn out. She said that she knows that and accepts it. Kubac wants to see how mom's heart acts when there is no Toprol in her system. That will be the test that will give him the remaining info to determine how to proceed (i.e., whether to put in a pacemaker).

The discussion of the pacemaker was quite interesting as well. We won't know till after the next Holter monitor test whether Kubac will recommend the pacemaker, but I asked him for the details anyway (especially since it sounds like he is leaning that way). Pacemakers are designed to keep track of beats, and you can set the pacemaker to whatever heart rate you want. Kubac said he usually uses somewhere between 50 and 60 beats per minute. The pacemaker detects a beat, and it expects another beat within a certain interval of time, and if it doesn't detect one, it jolts the heart muscle to make it beat. This results in a steady and predictable heart rate. But if the heart is racing, a pacemaker cannot slow it down...that has to be done with drugs. And if the rate gets too slow, the pacemaker kicks it into gear again. A pacemaker does nothing for fibrillation, either. All it does is stop the pulse from falling below a pre-set threshold.

Since mom is on Coumadin to thin her blood because of her artificial valve, she would have to make a five-day transition off Coumadin and onto a different blood thinner named something like Lomanox(?). She would stop the Coumadin, wait 24 hours, then she would have to give herself an injection of the Lomanox every day for the next four days. The pacemaker operation is done under local anaesthetic (not general) and she would only stay in the hospital overnight. The pacemaker goes right under the skin, just below the collarbone. Then there is a wire that goes from the pacemaker through a vein and the corkscrew end of it screws into the heart muscle itself. The recovery period is apparently not a big deal...no heavy lifting for a few days. She would only have to come in every 3 months to check it, but they can even download data from it over the phone. Pretty cool. The only restrictions are that she cannot work in an electrical generating plant because of magnetic radiation, and she cannot weld, and she cannot have an MRI.

So Kubac told mom to come back next Tuesday and get hooked up to the Holter monitor again, and then on Wednesday (24 hours) we'll figure out how to proceed. He is a bit concerned that her heart will start racing again without the Toprol because that has been her pattern in the past. Then he said that the two options were pacemaker or just let it race, which has it own complications.

On the way back home, mom said again that she thinks that that the only reason she has been so opposed to pacemakers is because of her sister having one that "was not done right." I asked her how she knew it was not done right, and she said that her brother told her. Then she recollected that it wasn't that it wasn't installed right, but that it wasn't monitored right. But then we talked about how Aunt Dorothy had died. She was in her recliner watching some comedy show on TV and laughing, and the next second she died from cardiac arrest. I said wow, that's exactly how I want to go, and mom agreed that was a good way to do it. (Although I think I prefer Survivor to a comedy show...)