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Does it make sense to change a pacemaker battery for a 90 yr old dement...
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Does it make sense to change a pacemaker battery for a 90 yr old dementia patient?

Mom is 90 yrs old and has severe dementia. She is need of a new pacemaker battery. Cardiologist said they don't change batteries - the whole pacemaker is changed. She is using her pacemaker 95% of the day. Is is a good idea to change this?  Can you still die with a pacemaker? I know if she could make the decision herself she would tell me to not change it and leave well enough alone. I don't know what to do.
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657231_tn?1390151580
I found this:
"The purpose of a pacemaker is simple: it prevents your heart beat from going too slow.  The device is attached to the heart via wires called leads and spends its life looking for native impulses arising from the cardiac muscle.  If your natural pulse rate drops below 60 (or whatever our programmed number is) the pacemaker will begin stimulating the heart with an imperceptible electrical shock once every second.  The current passes through the tip of the lead into the adjacent heart muscle, and then spreads to the entire ventricle by flowing from cell to cell at lightning speed.  The stimulus triggers a brief restructuring of proteins and results in contraction of the muscle fibers.  Within a fraction of a second the entire ventricle wrings out somewhere around a hundred milliliters of blood into the aorta.

To summarize this series of events:
Step 1. Pacer sends electricity to lead tip.
Step 2. Electrical impulse conducts to tissue at the point of contact and spreads throughout the heart.
Step 3. The electrical impulse causes the heart to contract.

Now let’s talk about what happens to the heart at the moment of imminent demise.  One thing that a healthy body does really well is eliminate waste products (and, no, I am not complimenting you on your talents in the bathroom): the lungs eliminate carbon dioxide and the kidneys and liver break down and eliminate unwanted metabolic byproducts.  As these important organs deteriorate your blood becomes saturated with metabolic detritus and becomes an inhospitable milieu for normal cellular function.  Most notably, the pH of the blood drops and the normally neutral serum slowly turns into a weak acid.  Once the pH falls more than a fraction of a point the heart muscle becomes incapable of propagating an electrical stimulus or mounting an effective ventricular contraction."

A regular pacemaker thus will not keep her alive just keep her comfortable. If she had one with a defibrillator than that would be a different matter as that shocks the heart into working. That feature would have to be considered to be turned off at some point if the patient and family desires.

Does she have written wishes or did she express wishes? Is she healthy enough for the surgery? Patients with dementia are not always healthy in the end. Either way, the pacemaker is not going to extend her life.
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Avatar_m_tn
Thank you for the information.  Yes she did sign a DNR years ago - but my 2 sisters feel it is not the same and that they want to replace the battery. I guess will see what mother nature has in store as I don't think a heart can take constant pulsing if it is 90 yrs old, had bypass 15 years ago, and now has dementia/alzheimers. Eventually the brain is going to stop working and the pacemaker will not be able to keep her alive. Just wondering how much longer you do stay alive with the pacemaker?? It has to extend your life. As I see it, what are we extending??
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657231_tn?1390151580
Have you spoken to her doctor about your concerns? That should be considered as he/she would be able to tell you about the pacemake vs DNR vs dementia and what should be the overriding consideration. Are your sisters close by and involved in her care? Are you? Those involved more should know more?

Depending on how her POA is written - do all three have to agree, or is it just one of you making decisions?

It can be very complex. Went through this recently with my aunt - the decisions made though I must say were a squabble among sons and my aunt died a very painful death due to one (who was not involved in her care at all) wanting to withhold morphine, not turn off the pacemaker/defibrillator when they could tell it was only extending, and she was brain dead - it was rather awful. So I do hope that you can work it out peacefully for your mom's sake.
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212161_tn?1391090750
goodmorning 4skippy, i am so sorry your going threw this, but if i had a choice i would talk to her dr and go by whatever they want to do. you do not need the stress of this on you. if its her time no matter about the pacemaker it wont keep her here, but this way you dont have this laid on your heart and others cannot blame you. i understand where your coming from, why put her threw this but i say let GOD do what he needs to do and you just be there for her. Blessings to you and her
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1530171_tn?1362547225
4skippy, why was this question even raised?

When euthanasia is obviously NOT an option and  DNR is NOT applicable here at all!!! (the sisters are right), why would anyone question the replacement of a pacemaker, a rather simple procedure involving a minimally invasive surgery?
It is implanted under the skin, it takes less than an hour and only requires a local anaesthetic. All she needs is clearance from the cardiologist.

Her Dementia, unfortunately, does not allow her to express verbally her possible symptoms WITHOUT a new pacemaker:
Palpitations, pounding in her chest, dizziness or feeling light-headed, fainting, shortness of breath, chest discomfort, weakness or fatigue.
This is not a choice of extending her life or letting her go, it is about giving her the opportunity to live with less pain and suffering.

We have no idea how people in her situation really feel, but we can only try to imagine.
My mom was in a similar predicament, paraplegic,with TBI (following an accident involving an intoxicated driver, dementia, and in need  to have her
pacemaker replaced.
It was really an easy decision, as I had witnessed her almost daily scary and very painful"episodes", well before her paroxysmal tachycardia dx, that led to the implantation of her first pacemaker.  
I would not have considered an extra day of her being without a new one.

She passed on last May at he age of 78 a couple years after the new pacemaker was installed, and I'm at peace with her passing and knowing that her life was just a little more comfortable.

I'm hoping that my reply helps bring some clarity in this matter.
Blessings to all!
Niko




  



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