Have pacemaker, pain and getting worse

[Dodiad71]

Hello,
I am a 36 year old female. I wear a pacemaker; my previous two tried to come out of me (pre-erosion). No infection could ever be found. In May 2006 I received a new pacer put under the muscle. Since then, I have been plagued with problems with my shoulder and arm--tingling and numbness in the fingers, chronic dull pain. With physical therapy the tingling and numbness pretty much disappeared. But the pain never left.
The pain over time has worsened and the more I use the arm the worse it gets. 9 months after my surgery in Feb 2007 my pain went through the roof for several days in a different way and then suddenly disappeared. I felt like I had been stabbed, shot and poked with hot pokers at the same time in my armpit. Since then, however, my pain continues as a chronic dull ache that goes the entire length of my arm to the fingers. I've noticed some swelling in the left arm (pacer side). Recently I also began to notice sharp pains in the chest on that left side with deeper breathing.
I recently saw my internist; she ordered a D-Dimer and it came back at 4,000. I know this test helps rule out thrombosis, but with 4,000 does it become more likely I could have a clot? Is this something that could have happened with my prior pacer woes or with the current machine being in the muscle?

Thanks!

[fred23394]

A related discussion, pain developing in muscle with pacemaker was started.

[Dodiad71]

Actually, doctor, my pain tolerance is extremely high. The docs who know me well enough know that when I start complaining, something serious may be happening--and it usually does.

As for the infection part, my pacer doc has ordered a gallium scan to try to check on an infection as you describe. I hope this is going to be accurate enough as this whole pacer pre-erosion phenomena started 2 years ago and I still have no outward signs of infection--pus, redness, warmness, etc.

Thanks for your response.

[Forum-M.D.-MJM]

Hello,
Sorry to hear your story.  these can be frustrating problems.

I know this test helps rule out thrombosis, but with 4,000 does it become more likely I could have a clot?

D dimer is very helpful if it is negative. A positive results like yours could be from so many different causes that it is not helpful.


Is this something that could have happened with my prior pacer woes or with the current machine being in the muscle?

Pacer related pain issues truly require someone with expertise dealing with this issue.  Bruce Wilkoff is my mentor at the Cleveland Clinic and this is his expertise.  There is no one better.  Two issues come to mind with chronic pacer pain syndromes: 1. you worry about infections.  2. you worry about people with pain syndromes, more sensitive than most others related to pacemakers.  This later  cause does not mean you are making it up or that you have no pain tolerance.  We do not understand why some people have chronic pain in the absence of infection, erosions, etc.  If your two previous pacemakers did not bother you like this one, I would want to rule out a slow indulent infection.  This requires an expert face to face evaluation to make sure the right thing is done.  Many other centers have experience with these issues, I just happend to know Dr. Wilkoff and of his expertise.

I hope this helps, thanks for posting.