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um... ok...??? aka, why i'm really starting to believe in multiple universes. aka, blerg. :S

Posted Feb 25 2011 9:51am
so, it was cardio yesterday. and i have to admit, it left me with more questions, confusion, a little bit of freaxia, and a touch of "WTF?!" (for lack of a better term).

but for anything here to make sense to you (haha), you're gonna need some background information
  • asher's pacemaker is set at 80. this means that his heart rate is never supposed to go below 80 beats per minute.
  • when the pacer was checked in august, it was firing approximately 80% of the time and had 6 years left in the battery.
  • when the pacer was checked in october, it was firing approximately 80% of the time and had 5.5 years left in the battery.
  • between april (when he got the pacer) and november, asher's heart rate was always in the 80 to 86 range. never higher. which means that he was basically just riding the pacer.
  • over the last couple of months, asher's heart rate has been in the 100 to 108 range. it has never been lower whenever it was checked (other than tuesday, when it was 74).
so, we went to clinic today for our pacemaker check.

so dr w checked the pacemaker.

and according to the computer,
  • the pacemaker is firing 88% of the time. you'll note, that is 10% higher than in october.
  • the pacemaker battery has 8.5 years of juice left.
um... wha-?!?!

ok, so i'll readily admit that i am not the most tech savvy person out there. yes, i'm pretty handy when it comes to knowing how to use a computer, but i know virtually nothing about how the computer actually works. and i'm not electrician, but i think i've got a pretty decent handle on batteries.

meaning, i know that they don't recharge themselves. on their own. without help. 

and they certainly don't gain half again as much power. on their own. without help.

and they most definitely do not gain half again as much power by working harder than ever.

and why, if it's working so much, is his heart rate so often in the low 100s? i mean, if it's firing that often, shouldn't his heart rate be in the low 80s most of the time? again, i'm no electophysiologist, but it seems to me that if his heart rate is consistently in the low 100s, that would mean that his pacemaker is firing less often, not more. but apparently it's firing more often.

oh. yeah. some of you reading might not realize this: the pacemaker is designed to keep the heart rate above 80. after a few minutes of shocking the heart, it will pause, to see if the heart can sustain its own rate. if it does, the pacer stops firing and goes into "sensing" mode. the pacemaker will not prompt every single heart beat. so it is asher's own heart that is beating 100 times a minute. the pacer has nothing to do with that.

and in addition to not being an EP, i am also not a statistician. so can someone please tell me the odds of asher's pulse being checked only during the few minutes that the pacer isn't firing? that those rare moments of non-pacing are the times when his pulse is checked? every. single. time? what is the probability that his pacer is firing all the time except when his pulse is counted and those moments just happen to be the only times he's not paced? 

you can see why i'm so confused.

dr w did offer one possible explanation, though: growing pains. makes a bit of sense, when you think about it... he's a growing boy and he has a lot of things in there that don't grow, so there can be some pulling and straining and so forth. but...

i don't understand where the jaw and left arm come into play with this theory. i mean, i remember having growing pains when i was growing painfully back in the day, and i don't remember having pain in my jaw. as for the left arm...

other than the pacemaker, which is on the left side, below his ribs and squished against his stomach... everything non-grow-able is on his right side. glenn? right side. fontan? right side. pacer leads? right side. stent in the aortic arch? center. MPA patches? center. RPV patches? just right of center.

ok, i know there's the possibility of pulling and such and that pain could radiate... but...

riddle me this...

when you have a patient present in emerg with an extensive history of severe heart disease, symptomatic bradycardia and Sick Sinus Syndrome with a pacemaker, and his heart rate is decreased (below his normal and pacer settings), and he is grey and very flushed and complaining about chest pain radiating down his left arm, are you going to think... growing pains??

i don't know...

i just don't know...

you see why i have so many questions now. i don't get it. the growing pains theory makes sense if you eliminate tuesday. the pacemaker report makes sense if you disregard everything you've observed and reported before yesterday's appointment, as well as all laws governing batteries and technology.

and this is why i'm starting to believe that, sometime in the last couple months, we slipped into a parallel universe. one where dryers don't blow fuses with every load (been having some electrical issues at home), stove burners actually heat up (the burner that hadn't worked in 3 years decided to work the other week and i almost burned the house down), blithe wants to clean her room and do as she's told the first time, and batteries recharge themselves by working harder and longer than ever.
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