Friday, September 22, 2006
It itches while it's healing. To tone down the itching a bit, I've been putting some gel on it. There are a couple of kinds of gel that do a good job of muting the itching: antihistamine gel, such as CalaGel, and sunburn gel, such as Solarcaine with Aloe Vera, which has the topical anesthetic lidocaine in it. If you don't want that many ingredients, plain aloe vera gel is better than nothing, but a gel with a topical anesthetic works better. The gel, any gel, also serves as sufficient goo to get a 4"x4" gauze pad to stay in place, which keeps bra straps and other clothes from irritating the incision site. I am finding that my skin is so sensitive there that even a cotton sheet resting on the skin at night is annoying if I stir at all.
Speaking of sleeping, I prefer sleeping on my side. The new device is more or less in the top surface of my right breast, and if I try to sleep on my left side, the weight of it pulls down; probably not great for having the leads settle in properly, never mind it makes it ache somewhat. So I have been using stuffed animals to prop up the breast. Yes, I have a large collection of plush toy animals, or should I say, we have, because they're not all mine; some are my husband's. We are an egalitarian family: silly stuffed toys for all ages and genders. Our collection includes a ring-tailed lemur, a giant south american anteater (not life sized!), a manatee, several penguins, a platypus, a couple of manta rays, and quite a bit else. What I am finding the right size to sit propped under my breast while I lie on my side is a larger-than-life-size stuffed guinea pig - about twice as tall and twice as long as a real guinea pig. The manatee would probably work as well. If you don't have stuffed animals, then a small roll pillow (cylinder-shaped) would probably also work.
Speaking of sleeping, I prefer sleeping on my side. The new device is more or less in the top surface of my right breast, and if I try to sleep on my left side, the weight of it pulls down; probably not great for having the leads settle in properly, never mind it makes it ache somewhat. So I have been using stuffed animals to prop up the breast. Yes, I have a large collection of plush toy animals, or should I say, we have, because they're not all mine; some are my husband's. We are an egalitarian family: silly stuffed toys for all ages and genders. Our collection includes a ring-tailed lemur, a giant south american anteater (not life sized!), a manatee, several penguins, a platypus, a couple of manta rays, and quite a bit else. What I am finding the right size to sit propped under my breast while I lie on my side is a larger-than-life-size stuffed guinea pig - about twice as tall and twice as long as a real guinea pig. The manatee would probably work as well. If you don't have stuffed animals, then a small roll pillow (cylinder-shaped) would probably also work.
Thursday, September 14, 2006
Well, I have my new ICD/pacemaker, as of Monday, and as expected, they did NOT get the 3rd lead in this time either. The new device is on my right side, since the left side now has too much scar tissue; this means that the leads had to be placed across the chest, behind the sternum.
Things they don't tell you about placing leads across the chest: it winds up irritating and inflaming the tissue in there, especially the pericardium, which in turn means it HURTS every time you inhale more than the shallowest amount. It took about 2 days for it to stop being quite so painful, although I still had a short flare-up today for a while. And it is definitely still painful to sneeze, cough, or yawn. In hindsight, I'd say that one should avoid having this surgery during hay fever season when sneezing and coughing are likely...
Other side effects of doing the cross-chest lead placement: longer time period for restricting the range of motion and the amount of weight you can lift with the right arm and hand, since it's easier to dislodge the leads. So even though the visible bruising is already fading and the incision is starting to heal, I can't go back to normal activity completely as soon as the incision is healed, the way I did with the first pacemaker; instead I have to wait 6 full weeks before doing anything that involves lifting my arm above shoulder level or behind the plane of my body (putting it behind my back), or lifting more than 10 pounds with that arm. Annoying limitations.
On the good side, since I knew in advance this time that hospital food sucks, even at the great Johns Hopkins, I brought my own lunch and dinner in insulated bags, and ignored their food. I had low-fat yogurt, fresh fruit, low-fat pudding, reduced-sodium cheese, low-sodium crackers, and fresh-brewed iced tea, and completely ignored the stuff they brought on trays. Staff thought this was funny. My roommate thought I was wonderful, since she also was having a tough time with the bland hospital food; I gave her a nectarine and some of the cheese, and she was quite appreciative. Let's hear it for end-of-season nectarines and peaches!
Things they don't tell you about placing leads across the chest: it winds up irritating and inflaming the tissue in there, especially the pericardium, which in turn means it HURTS every time you inhale more than the shallowest amount. It took about 2 days for it to stop being quite so painful, although I still had a short flare-up today for a while. And it is definitely still painful to sneeze, cough, or yawn. In hindsight, I'd say that one should avoid having this surgery during hay fever season when sneezing and coughing are likely...
Other side effects of doing the cross-chest lead placement: longer time period for restricting the range of motion and the amount of weight you can lift with the right arm and hand, since it's easier to dislodge the leads. So even though the visible bruising is already fading and the incision is starting to heal, I can't go back to normal activity completely as soon as the incision is healed, the way I did with the first pacemaker; instead I have to wait 6 full weeks before doing anything that involves lifting my arm above shoulder level or behind the plane of my body (putting it behind my back), or lifting more than 10 pounds with that arm. Annoying limitations.
On the good side, since I knew in advance this time that hospital food sucks, even at the great Johns Hopkins, I brought my own lunch and dinner in insulated bags, and ignored their food. I had low-fat yogurt, fresh fruit, low-fat pudding, reduced-sodium cheese, low-sodium crackers, and fresh-brewed iced tea, and completely ignored the stuff they brought on trays. Staff thought this was funny. My roommate thought I was wonderful, since she also was having a tough time with the bland hospital food; I gave her a nectarine and some of the cheese, and she was quite appreciative. Let's hear it for end-of-season nectarines and peaches!
Wednesday, September 06, 2006
And another article:
Initiative helps minority heart failure patients
Aug 16 (Reuters Health) - A nurse-led program can improve functioning and reduce hospitalizations among African-American and other minority patients with heart failure, a study shows.
Despite the availability of effective therapies, heart failure "continues to cause substantial hospitalization, and death, especially among African-American and other nonwhite populations," note the study's authors in the Annals of Internal Medicine.
In their study, involving 406 mostly African-American and Hispanic heart failure patients, Dr. Jane E. Sisk of the National Center for Health Statistics at the Centers for Disease Control and Prevention in Hyattsville, Maryland and colleagues found that a year-long nurse-led effort focusing on specific problems was more effective than usual care
Half the participants in the study received standard care for heart failure. The other half were counseled by bilingual nurses about their diet, the importance of sticking to their medication, and self-management of symptoms through an initial visit and regularly scheduled follow-up telephone calls.
The nurse managers also talked with patients' doctors about medication changes that would be helpful.
After 12 months, the patients with nurse managers had had somewhat fewer hospitalizations than patients receiving usual care -- 143 vs 180. They also had better functioning, based on standard tests.
"These results have important clinical significance," Sisk's team says. "The average nurse management patient reported maintained functioning, with a slight limitation in physical activity, but the average usual care patient reported worse functioning and marked limitation in physical activity."
However, continued contact with the nurse manager may be needed for sustained improvement. The differences favoring nurse management did not continue after 12 months, when the counseling stopped.
SOURCE: Annals of Internal Medicine, August 15, 2006.
This week's article:
Surgery may help people with heart failure
Aug 31 (Reuters Health) - Quite often, people with heart failure have some degree of blockage of the coronary arteries. In such cases, those who undergo surgery to clear to arteries have markedly better survival than those treated with medication, researchers from Canada report.
"Our main finding," Dr. Ross Tsuyuki told Reuters Health, "was that those receiving revascularization procedures -- bypass surgery or percutaneous coronary intervention (angioplasty, for example) -- had half the risk of dying compared to those who did not."
Tsuyuki, at the University of Alberta Hospital in Edmonton, and colleagues used data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) study to review the survival rates of 1690 patients with heart failure who had coronary artery disease treated medically and 2538 who underwent coronary revascularization surgery.
According to the team's report in the Canadian Medical Association Journal, the crude 1-year death rate was 11.8 percent among patients who underwent revascularization compared with 21.6 percent among those who did not.
"We did a number of statistical adjustments to account for differences in patient characteristics and factors which might influence the decision to revascularize, but came up with the same conclusion," Tsuyuki explained.
"All patients with heart failure should be assessed for coronary artery disease blockages and, if feasible, be considered for revascularization," he concluded.
SOURCE: Canadian Medical Association Journal, August 15, 2006
