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When “Doing Fine” Is Relative

It was 11:00 pm when the pager vibrated, then beeped: it was the ER, Hospital #3.

“This is Dr. Fisher returning your page?”

“Thank you Dr. Fisher, just a moment for Dr. Frigamafratz.”

A brief pause, then:

“Wes, I think we’ll need your services. Old guy, found down at the nursing home, brought in unconscious, pulse 25 – hooked him up to an external pacer, he’s back with us now.”

“I’m on my way.”

When I arrived, there was the usual cacophony of activity in the Emergency Room. Someone screaming in one corner. Intercom sounding. Ambulance en route to our location. Breathing treatments underway in Bay 5. Room 10 headed to the CT scanner. Has room 12 got a bed? By comparison my patient was easy: his disposition in the eyes of the ER staff had been made: he was on the Express Track to the EP lab.

There he was, chest twitching. Big forceful jerking. He was a big guy, uttering something with purpose but impossible to understand. Next to him, his wife, just arriving and removing her coat. “Is he going to be okay?”

My head scrambled for an answer. “He’s okay for now,” I think I replied. Read more »

*This blog post was originally published at Dr. Wes*

Can A Bra Interact With A Pacemaker Or Defibrillator?

This comment [with a specific photo] was posted on my blog earlier:

“I was reading one of your old posts about magnets and I was wondering if a magnetic front closure on a bra would be a problem? There’s a warning on the label but I know part of that is just due to liability. What about this bra that has a magnet clasp on the front? If the magnet hits right in between the breasts would it be close enough to the device that it could interfere? Also does having a magnet that close change the settings or turn off a defibrillator/pacemaker early? I’m sure most doctors would say just wear another bra but this bra in particular is very comfy! I’ve tried it on but not worn it for extended periods of time. Luckily this is one of the only major complaints I’ve had about having heart disease and a [medical] device at such a young age.”

First, let me say thank you for asking this question. Who knew research could be so, er, entertaining! Second, this question reinforces why medical blogging is so great: You learn something new every day.

Now, as I slap myself back to a bit more professional stance, I’ll summarize by saying I think you’ll be okay to use such a bra with some precautions. Given the picture and the clasp’s location, this bra is more likely to interfere with the pacemaker of the partner you hug rather than yourself, provided your pacemaker was implanted over three centimeters from the magnetic clasp. Since most pacemakers and defibrillators are implanted just below the collar bone, the chance of the magenetic clasp to interfere with your device is remote. Read more »

*This blog post was originally published at Dr. Wes*

Dr. Insurance Broker

Call it sweet, delicious vindication. It was clinic day yesterday. No longer had I completed my rant in this blog about UnitedHealthcare’s program to require all cardiac elecrophysiologists to obtain a “notification number” before performing any pacemaker or defibrillator procedure, I discovered my letter from them dated June 3, 2010, on my desk stating that this requirement will begin September 1, 2010, for all Illinois electrophysiologists for “all electrophysiology procedures.”

Not longer than an hour later I was seeing a 67-year-old patient in the clinic who asked me: “I just got my Medicare (Part A) card and must decide about which insurer I should use for Part B, C, D, E, and F,” he said jokingly. “Since I have the medical problem and might need some care in the future, is there a company you would recommend?” Read more »

*This blog post was originally published at Dr. Wes*

The Mysteriously “Alarming” Pacemaker Case

I received this email from a dear friend of mine recently:

So,  for the last 2 1/2 weeks my husband and I have been seranaded with alarm tones every day.  We thought it was the new alarm system we had installed (it does a lot of automatic things we have since disabled), then we thought it was the smoke detectors…a new ringtone on our iPhone?… the battery charger on his new bike…his computer when his e-mail was hijacked?…the battery on my bike mileage computer?…my new alarm clock?…the refrigerator ice maker?…the clothes dryer? …everyday we checked everything, and everyday we thought we had found and fixed the culprit, until the next morning when we would hear it again!

It was not until yesterday morning when we figured it out… can you guess?

It was coming from my husband’s chest!  The battery on his pacemaker/AICD was alarming to let us know that he was just about out of juice!  Four years ago they told us we would hear that when the battery got low, but that was a very long time ago…and it just didn’t sound like it was coming from him!  We sent a modem transmission, and the doctor called back to say, “come on in!”

After talking with my friend later, I found out that her husband had his pacemaker replaced and all is well.  It took about 2 weeks to figure out where the alarm was coming from, since it only sounded once a day and only for about 20 seconds at that.  My friend expressed disbelief that it was so hard to determine that it was coming from her husband but surmised that going through body tissues helped the sound disperse enough to make it a mystery!

This left me wondering if any of Dr. Wes’ patients have had similar trouble with figuring out that their chests were alarming!

*This blog post was originally published at code blog - tales of a nurse*

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