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Pacemaker candidate?
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Pacemaker candidate?

My mother-in-law will be 90 in April.  Her doctor wants to put in a pacemaker to stabilize her heart.  She has lung cancer, quite a large mass but apparently not very fast-growing.  She has diabetes, which might mean amputation in her future, and she has Alzheimers that is no long mild but not very advanced.  She often recognizes my husband.  Some days she seems to really enjoy life.

I cannot understand the doctor's recommendation.  It seems as if she will be prevented from having a relatively good death.  

Any thoughts or advice?  My husband and his sister are the only family left.  A living will means that the decision is really theirs, but they don't want to kill their mother.
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187666_tn?1331176945
A pacemaker won't save her life either. It's just an item on her list of health problems that can be managed for her comfort. At her age the cancer and Alzheimers are not manageable. And keeping her heart beating at a decent rate will improve her circulation and cognitive abilities. That means more lucid moments to share with the family.

By not putting in a pacemaker, that doesn't mean they're "killing" her. It just means her heart will not function as well as it could. The cancer is a much bigger threat. (I know this because my Dad had a bad heart and had an ICD. But the lung cancer is what finally took him at the end.)

I would trust your husband and SIL's choice on this. They know her the best and what she would choose if she could.
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Avatar_f_tn
CS, I agree with the above poster, as I have an ICD implanted, which also has a built in pacemaker.  I'm only 46, but I've had two heart attacks.  Anyway, one of the first things I asked my doctor, since if I "drop dead" from sudden cardiac death, the defibrillator will go off, and restart my heart.  But I asked him, ok, so what happens when I'm 85 or 90, and it is "my time to go", but the damn ICD will keep kicking in.  He told me no, if it came to that, they would just shut the unit off, which can be done by simply placing a magnet of some kind (medical device) over the unit, and it will simply shut it off.  

But the above poster is correct, the pacemaker will make her heart function as best it can, which in turn could lead to more lucid moments. If the heart is not functioning at it's best, then other problems crop up, leading to other issues.  I say, regardless of her age or other medical issues, go for it.  It's not a difficult surgery, and recovery time is not excessive either. I was 43 when they put my unit in, I was off work for 5 days, and the only restriction I had was not lifting my right arm (it was put in on my right side) above my shoulder level for six weeks to prevent the leads from pulling out.  It takes about six weeks for the leads to "scar in" the heart muscle.  After that, no problems. I ride a bicycle 25 miles on Saturdays and Sundays, work full time, went to school full time...and ride every roller coaster I can find.  Best wishes to your MIL.
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Avatar_n_tn
Thanks for your replies.  I am wondering if we shouldn't get a second opinion on the lung cancer part.  The doc originally told us - six months ago - that she had a year to live, but now he says 3-5 years.  I wonder about that.  One of the nurses at the assisted living place said not to put in the pacemaker, that Jim's mom is having trouble swallowing and isn't eating well.

The thing that scares me more than anything is the amputation possibility.  As she is more and more bedridden her chances of poor circulation and then amputation increase, but I don't know how much they increase.
Maybe I am too phobic and am not a good judge here.
I am a founder of what was once called The Hemlock Society after I watched both my parents die fairly gruesome cancer deaths.  I want a good death.  My mother-in-law was hard to rouse last week, but assisted living got her to the hospital.  I would have liked to have the kind of death where I wouldn't be roused.  It is hard to know what she wants except, as I say, she does seem to enjoy some of her days.      
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Avatar_f_tn
CS, only you/family can decide what is best, it's hard over the internet to express actual feelings, but I wonder if the pacemaker were inserted, and her circulation increased, if that would decrease the chances of any type of amputation. Do they have her on any type of meds that assist the heart in it's function?  I know that along with the ICD, I also take 3 heart meds, one of which is specific to heart failure, and assists the heart in pumping as efficiently as it can.  Best wishes to you, your family, but most of all, your MIL.
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475570_tn?1280944963
When we think about situtations like this at her age what is the quality of life. I would do everything to keep her confortable and happy. If she has a peasefull end why have a defrib unit bring her back. I guess that is what I would want if it was me.  Warm regards to you and her.
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Avatar_n_tn
Thanks very much for your good wishes.  Yes, she is on tons of meds, I think including ones that might help her heart function.  I personally am definitely in agreement with alleycat2.  That is what I would want.  Being unable to be roused seems the best possible ending.  The problem is that we are not she, and we have to speak for her, act on her behalf.  

I would like to know the answer to the amputation question , and maybe we can get an answer.  Even if the docs say it might help, though, to have the pacemaker, I am not sure it would make the decision that much easier.
A doc insisted that a brain operation would give my mother extra months at the end of her life when she had a tumor, and the operation paralyzed her.
It seems to me that docs sometimes get on a treadmill, often don't think about these end-of-life issues the way I would want them to.  I teach people English from all over the world, and yesterday we were discussing my MIL.  The Russian students tell me that it a person is 80 and goes in for medical help, s/he is told to go home, that s/he has had a happy life.
I don't like that, but I wonder if we haven't flipped the coin in this country.  
TR Reid wrote a book called The Healing of America in which he took his bum shoulder around the world and presented to the docs in various countries.  Germany said let's operate, Japan said maybe but let's do some accupuncture first.  Canada said he could have the appointment with the orthopedist in 9 months.  England said, "Look.  We can't afford to improve your golf swing.  Your shoulder isn't bad enough.  We are providing health care for everyone and must consider costs."
The way we do health care seems unsustainable in the US.  Over 50% of a person's costs are incurred in the last 6 months.  And why?  Maybe we have a hard time accepting death.

Sorry.  I seem to have broadened out the discussion.  I cannot help thinking of my MIL in a broader context though, watch docs order expensive MRIs on her brain - and for what reason?  
I know if may sound crazy but I wouldn't mind if people thought about the costs I might incur to all of you in the last 6 months of my life.  I think I like the way England thinks.

The important thing, I agree, is her comfort and happiness in this last period of her life.

Thank you for your kind wishes.
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