Check-ups/Pacemaker etc

<[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Few questions. . I have a mechanical MV and a dual chamber pacemaker.
I have to take warfarin which I understand the reasons for but I also
still take Digoxin and Verapamil. As far as I recall, digoxin
strengthens the heart but with a pacemaker I am surprised that
Verapamil is still necessary. I really need my pain meds now and
would therefore really like to get off Verapamil because of the
constipation problem. Also, has anyone who takes Verapamil noticed a
worsening of joint pain?.

Also, I am not being checked on as often since the pacemaker was
inserted. It will have been 4 months next time I go to the clinic and
after that I'm told its routinely 6 months for checkups. I can
understand this for someone with a pacemaker who has not had heart
surgery but thought it would be more often for someone like me with a
leaking aortic valve and heart block etc. Appreciate any comments.
Diana

A friend who had a pacemaker fitted last November (NHS, no sedation:-)) was
told on his first check up that if he has any problems or worries just to
phone the clinic and they will see him. He has had the device adjusted
several times and now goes hill walking again.
Derek.

Quoted message said:

Few questions. . I have a mechanical MV and a dual chamber pacemaker.
I have to take warfarin which I understand the reasons for but I also
still take Digoxin and Verapamil. As far as I recall, digoxin
strengthens the heart but with a pacemaker I am surprised that
Verapamil is still necessary. I really need my pain meds now and
would therefore really like to get off Verapamil because of the
constipation problem. Also, has anyone who takes Verapamil noticed a
worsening of joint pain?.

You should inform your doctor about the increasing joint pain.

Quoted message said:

Also, I am not being checked on as often since the pacemaker was
inserted. It will have been 4 months next time I go to the clinic and
after that I'm told its routinely 6 months for checkups. I can
understand this for someone with a pacemaker who has not had heart
surgery but thought it would be more often for someone like me with a
leaking aortic valve and heart block etc. Appreciate any comments.
Diana

Sounds like you should call for a sooner appointment since the increasing
joint pain and the constipation are active issues.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

As far as verapamil and the pacer, it depends on what kind of pacer you
have. It sounds like a run of the mill variety which first stimulates your
SA node (causes the atria to contract) and then the AV (the ventricular
counterpart). What these pacers generally do is prevent your heart rate
from dropping below a certain point which is set by the doc. For instance,
if your pacer is set at 72 beats a minute and your own heart rate falls to
65, the pacer will recognize this and kick in to bring your heart rate back
up to 72.

What pacers do not do that verapimil does is prevent your heart rate from
going to high. Even when pacers have a ramping feature which overrides the
intrinsic rhythm or a defibrillator implanted with them, it is often
unpleasant, although life saving, when they kick in. Therefore, it could be
that your doc wants to protect you from both a low heart rate and a high
heart rate. Neither are very good.

You say that you really need your pain meds now. Why is that? There is
nothing intrinsically painful about a rhythm problem.

I have not heard of verapamil causing joint pain but most of my experience
is in CCU. If you have long term chronic joint pain, regardless of the
cause, it should be addressed by an ortho doc or a rheumotologist (if it is
related to arthritis).

Without reading too much into your post, I guess I am disturbed by all the
attention to your pacer and the heart drugs, while you clearly state you
'need' your pain meds. It is not unusual for patients with legitimate pain
to develop a dependency on pain meds. Please forgive if I read too much
into your post. There are chronic pain clinics that can offer you relief of
joint pain. I have seen wonders worked with physical therapy. How much do
you weigh? I lost twenty something pounds a few years ago because of my
knees. Nothing else would motivate me. I still need to lose 20 or so
pounds but damn if the joint pain isn't resolved!

You need to be able to trust your doc. I know many cardiologists and heart
surgeons. When I am called for advice, I always take into consideration the
personality of the patient. I know a couple of docs that I don't
particularly care for but if I code, I want them there. There are docs who
really respect the patient's right to make an informed decision and go to
great lengths to carefully lay out all their options and they don't fit well
with patients who really don't want to know! So, without saying that your
doc is bad, you may want to shop for another.

Constipation is a minor problem unless you are the one suffering🙂 There
are other remedies other than stopping meds. The best one I can think of
eating well and exercising. The addition of fruits and veggies to your diet
and walking would be good for anyone. If you change the amount of green
leafy veggies you eat, you should call your doc and have your PT/INR
checked. It is erroneous info that coumadin patients shouldn't eat green
leafy veggies. Rather, the dosage should be adjusted to the patient's diet.
For you, that means eating whatever quantity you desire on a regular basis
and informing the doc if that changes. Yogurt keeps your gut healthy and
there are some pharmaceutical remedies that help. Again, I worry that if
you are taking pain medication with a sedative effect on a regular basis,
your drive to exercise might be diminished.

I wish you well. Please check back in. I apologize if I read too much into
your post concerning your need for pain meds. It has never been and will
never be my desire to have a patient hurting. Rather, for long term chronic
pain, there are other answers besides pain meds.

j

<[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Few questions. . I have a mechanical MV and a dual chamber pacemaker.
I have to take warfarin which I understand the reasons for but I also
still take Digoxin and Verapamil. As far as I recall, digoxin
strengthens the heart but with a pacemaker I am surprised that
Verapamil is still necessary. I really need my pain meds now and
would therefore really like to get off Verapamil because of the
constipation problem. Also, has anyone who takes Verapamil noticed a
worsening of joint pain?.

Also, I am not being checked on as often since the pacemaker was
inserted. It will have been 4 months next time I go to the clinic and
after that I'm told its routinely 6 months for checkups. I can
understand this for someone with a pacemaker who has not had heart
surgery but thought it would be more often for someone like me with a
leaking aortic valve and heart block etc. Appreciate any comments.
Diana

I'd like to try to help. When you speak about your valve you are talking about
the plumbing of your heart. When you talk about your pacer you are talking
about the electrical system. True, your valve problems may have something to
do with your supraventricular rhythms, however the pacemaker only responds to
the brady rates, that is unless you have something like a Medtronic AT 500 that
will treat high atrial rates.The verapamil deals with these high atrial rates
and the digoxin makes your heart more effective as a muscle. The pacemaker
both protects you from having a slow heart rate which can come as a result of
your medications and/or sick sinus syndrome. The pacemaker stimulates your
heart to beat, the digoxin makes each contraction stronger and the verapamil
keeps the upper chambers of the heart from having high rates as in atrial
fibrillation, atrial flutter and SVT.

As for regular visits. Pacemakers should be checked every six months in the
clinic. A full interogation should be done at that time. Your pacemaker
outputs should be optimized at that time to extend battery like. While most of
the insurance HMO's will not pay for more frequent checks, if you should have a
problem,have any cardiac symptoms, always call your cardiologist and have him
see you. As your pacemaker gets older and the battery voltage declines the
checks will become more frequent so that the battery status can be monitored.

As your cardiologist questions when you have one. Do not be afraid. There
is nothing wrong with wanting to know what is happening and being done to your
body. Patients go to MD's with all levels of medical knowledge and sometimes
the DR overestimates the patients understanding, so speak up if you have a
question.
As for the joint pain....I am not a physician. I would check with your
primary care MD and let him look for the cause. He would be the right person
to see for your issue.

If I can add anything else feel free to ask.

I will try to give you and 'Complex' more info,as, in my first
message, I was trying to be brief in case I repeat the stuff people
have heard before. The last diagnosis I was given was paroxysmal AF
and flutter and 2:1 AV block. The pacer is set to prevent my heart
beat going below 60 or above 130. I need my pain meds for widespread
osteoarthritis; neck, shoulders, spine, hands etc and the danger of
dependency is something I am aware of. I take 4 painkillers each day,
one co-codamol and one tramadol when I wake up and 2 co-codamol in the
afternoon. I had three major procedures in a 15 month period ending
last November. The first procedure was to remove a Duke's A tumour
from my colon (outlook very good). It is now two years since that one
and there have been no worrying symptoms. But, because my colon has
had a large section section removed I tend to worry about using
laxatives but I do use them as I am too uncomfortable otherwise.

About two months ago I saw a rheumatologist and will be having a
steroid injection in my shoulder - but, the appnt is not until Dec.
This is the down side of our free National Health Service. My GP has
given me amitriptyline (25mg) but it seems to interact with the
verapamil i.e. I feel zombie like the following day so I stopped
taking it.

I do have good cardiologists. The 'chief' is a Professor who is said
to be an authority on pacing. Unfortunately, there has been a big
upset in our relationship. All his registrars are great but he seems
to have a very high opinion of himself and I . As a result I am
reluctant to ask for earlier appointments or leave messages with his
secretary. (I suspect the Prof. resents the fact that my surgery was
done at a different hospital..even though the new procedure I had for
AF did not go well for me)
It is possible I will be seen by a different consultant in future.

Thank you both for your responses.
Diana

On Wed, 1 Oct 2003 21:01:07 -0500, "Julianne" <[email hidden]>

Quoted message said:

As far as verapamil and the pacer, it depends on what kind of pacer you
have. It sounds like a run of the mill variety which first stimulates your
SA node (causes the atria to contract) and then the AV (the ventricular
counterpart). What these pacers generally do is prevent your heart rate
from dropping below a certain point which is set by the doc. For instance,
if your pacer is set at 72 beats a minute and your own heart rate falls to
65, the pacer will recognize this and kick in to bring your heart rate back
up to 72.

What pacers do not do that verapimil does is prevent your heart rate from
going to high. Even when pacers have a ramping feature which overrides the
intrinsic rhythm or a defibrillator implanted with them, it is often
unpleasant, although life saving, when they kick in. Therefore, it could be
that your doc wants to protect you from both a low heart rate and a high
heart rate. Neither are very good.

You say that you really need your pain meds now. Why is that? There is
nothing intrinsically painful about a rhythm problem.

I have not heard of verapamil causing joint pain but most of my experience
is in CCU. If you have long term chronic joint pain, regardless of the
cause, it should be addressed by an ortho doc or a rheumotologist (if it is
related to arthritis).

Without reading too much into your post, I guess I am disturbed by all the
attention to your pacer and the heart drugs, while you clearly state you
'need' your pain meds. It is not unusual for patients with legitimate pain
to develop a dependency on pain meds. Please forgive if I read too much
into your post. There are chronic pain clinics that can offer you relief of
joint pain. I have seen wonders worked with physical therapy. How much do
you weigh? I lost twenty something pounds a few years ago because of my
knees. Nothing else would motivate me. I still need to lose 20 or so
pounds but damn if the joint pain isn't resolved!

You need to be able to trust your doc. I know many cardiologists and heart
surgeons. When I am called for advice, I always take into consideration the
personality of the patient. I know a couple of docs that I don't
particularly care for but if I code, I want them there. There are docs who
really respect the patient's right to make an informed decision and go to
great lengths to carefully lay out all their options and they don't fit well
with patients who really don't want to know! So, without saying that your
doc is bad, you may want to shop for another.

Constipation is a minor problem unless you are the one suffering🙂 There
are other remedies other than stopping meds. The best one I can think of
eating well and exercising. The addition of fruits and veggies to your diet
and walking would be good for anyone. If you change the amount of green
leafy veggies you eat, you should call your doc and have your PT/INR
checked. It is erroneous info that coumadin patients shouldn't eat green
leafy veggies. Rather, the dosage should be adjusted to the patient's diet.
For you, that means eating whatever quantity you desire on a regular basis
and informing the doc if that changes. Yogurt keeps your gut healthy and
there are some pharmaceutical remedies that help. Again, I worry that if
you are taking pain medication with a sedative effect on a regular basis,
your drive to exercise might be diminished.

I wish you well. Please check back in. I apologize if I read too much into
your post concerning your need for pain meds. It has never been and will
never be my desire to have a patient hurting. Rather, for long term chronic
pain, there are other answers besides pain meds.

j

<[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Few questions. . I have a mechanical MV and a dual chamber pacemaker.
I have to take warfarin which I understand the reasons for but I also
still take Digoxin and Verapamil. As far as I recall, digoxin
strengthens the heart but with a pacemaker I am surprised that
Verapamil is still necessary. I really need my pain meds now and
would therefore really like to get off Verapamil because of the
constipation problem. Also, has anyone who takes Verapamil noticed a
worsening of joint pain?.

Also, I am not being checked on as often since the pacemaker was
inserted. It will have been 4 months next time I go to the clinic and
after that I'm told its routinely 6 months for checkups. I can
understand this for someone with a pacemaker who has not had heart
surgery but thought it would be more often for someone like me with a
leaking aortic valve and heart block etc. Appreciate any comments.
Diana

Wow, what a difference an ocean makes. I had never heard of co-codamol and
was excited to see that there was a new pain relief med for arthritis.
Alas, it is just run of the mill Tylenol No. 3 which is codeine and tylenol.
And the biggest side effect of codeine is constipation. The doc who follows
you for your gut should be aware of both the constipation and your use of
laxatives. There are varying types of laxatives ranging from industrial
strength to milder stool softeners. It is easy to imagine that your
stomach doc might prefer some over others and it is also easy to imagine
that constipation might be equally as alarming.

Your GP has given you amitriptyline for an 'off label' use. It is approved
for depression but has been shown to help to with chronic pain, as well. In
the states, it is seldom given for depression anymore because there are so
many other antidepressants with fewer side effects but those haven't helped
with long term pain. Frequently, it takes a couple of weeks to adjust to
the older antidepressants and most patients do fine after a stuttering
start. But, you can't take them for one day and determine your eventual
tolerance of the medication.

Here, many docs are using cox II inhibitors for arthritis with great
success. I have no earthly idea what you might call them. You call
acetaminophen 'paracetamol' and Tylenol No. 3 'co-codomol' and cookies
'biscuits'. For that matter, you call elevators 'lifts' and pencil erasers
'rubbers' (which got me into severe trouble when I moved back to the states
after living in Australia where they have adopted your linguistic
idiosyncrasies). Because they get at the cause of the pain, they are
generally more useful. Also codeine is a mild opiate and people do tend to
build up tolerance to it's pain relieving effect.

If your heart rate is fine, I would blow off looking for answers from your
cardiologist and go straight to the GP and rhumatologist. I would bring
every single pill you take with you along with contact names and numbers of
the docs who prescribed them so that drug interactions could be fully
explored. Also, I have had some very dear patients who keep brief accounts
of their medical history with their meds. This is invaluable when you only
get a few minutes with a doc and you are nervous and in pain and likely to
overlook something or not consider something to be important.

It never hurts to eat well and exercise within your ability. It probably
not cure your constipation but it may make it better.

Chronic pain is serious. Many health care providers, including nurses, docs
and therapists are quite capable of dealing with it. Others are not. Even
in my own colleagues I see nurses look with disdain on someone who always
'whines' about pain. And then I see them reassigned to a nurse who is very
good with chronic pain and the patient does well. I have no idea how easy
it is to change practitioners but I suspect there is greater relief for you
available than you are currently receiving. Alas, I know regulatory matters
like the back of my hand here in the states but couldn't begin to tell you
how to navigate a system overseas. Good luck. Be aggressive. Deal with
the pain and everything else will be much easier.

j

<[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

I will try to give you and 'Complex' more info,as, in my first
message, I was trying to be brief in case I repeat the stuff people
have heard before. The last diagnosis I was given was paroxysmal AF
and flutter and 2:1 AV block. The pacer is set to prevent my heart
beat going below 60 or above 130. I need my pain meds for widespread
osteoarthritis; neck, shoulders, spine, hands etc and the danger of
dependency is something I am aware of. I take 4 painkillers each day,
one co-codamol and one tramadol when I wake up and 2 co-codamol in the
afternoon. I had three major procedures in a 15 month period ending
last November. The first procedure was to remove a Duke's A tumour
from my colon (outlook very good). It is now two years since that one
and there have been no worrying symptoms. But, because my colon has
had a large section section removed I tend to worry about using
laxatives but I do use them as I am too uncomfortable otherwise.

About two months ago I saw a rheumatologist and will be having a
steroid injection in my shoulder - but, the appnt is not until Dec.
This is the down side of our free National Health Service. My GP has
given me amitriptyline (25mg) but it seems to interact with the
verapamil i.e. I feel zombie like the following day so I stopped
taking it.

I do have good cardiologists. The 'chief' is a Professor who is said
to be an authority on pacing. Unfortunately, there has been a big
upset in our relationship. All his registrars are great but he seems
to have a very high opinion of himself and I . As a result I am
reluctant to ask for earlier appointments or leave messages with his
secretary. (I suspect the Prof. resents the fact that my surgery was
done at a different hospital..even though the new procedure I had for
AF did not go well for me)
It is possible I will be seen by a different consultant in future.

Thank you both for your responses.
Diana

On Wed, 1 Oct 2003 21:01:07 -0500, "Julianne" <[email hidden]>

Quoted message said:

As far as verapamil and the pacer, it depends on what kind of pacer you
have. It sounds like a run of the mill variety which first stimulates

your

Quoted message said:

Quoted message said:

SA node (causes the atria to contract) and then the AV (the ventricular
counterpart). What these pacers generally do is prevent your heart rate
from dropping below a certain point which is set by the doc. For

instance,

Quoted message said:

Quoted message said:

if your pacer is set at 72 beats a minute and your own heart rate falls

to

Quoted message said:

Quoted message said:

65, the pacer will recognize this and kick in to bring your heart rate

back

Quoted message said:

Quoted message said:

up to 72.

What pacers do not do that verapimil does is prevent your heart rate from
going to high. Even when pacers have a ramping feature which overrides

the

Quoted message said:

Quoted message said:

intrinsic rhythm or a defibrillator implanted with them, it is often
unpleasant, although life saving, when they kick in. Therefore, it could

be

Quoted message said:

Quoted message said:

that your doc wants to protect you from both a low heart rate and a high
heart rate. Neither are very good.

You say that you really need your pain meds now. Why is that? There is
nothing intrinsically painful about a rhythm problem.

I have not heard of verapamil causing joint pain but most of my

experience

Quoted message said:

Quoted message said:

is in CCU. If you have long term chronic joint pain, regardless of the
cause, it should be addressed by an ortho doc or a rheumotologist (if it

is

Quoted message said:

Quoted message said:

related to arthritis).

Without reading too much into your post, I guess I am disturbed by all

the

Quoted message said:

Quoted message said:

attention to your pacer and the heart drugs, while you clearly state you
'need' your pain meds. It is not unusual for patients with legitimate

pain

Quoted message said:

Quoted message said:

to develop a dependency on pain meds. Please forgive if I read too much
into your post. There are chronic pain clinics that can offer you relief

of

Quoted message said:

Quoted message said:

joint pain. I have seen wonders worked with physical therapy. How much

do

Quoted message said:

Quoted message said:

you weigh? I lost twenty something pounds a few years ago because of my
knees. Nothing else would motivate me. I still need to lose 20 or so
pounds but damn if the joint pain isn't resolved!

You need to be able to trust your doc. I know many cardiologists and

heart

Quoted message said:

Quoted message said:

surgeons. When I am called for advice, I always take into consideration

the

Quoted message said:

Quoted message said:

personality of the patient. I know a couple of docs that I don't
particularly care for but if I code, I want them there. There are docs

who

Quoted message said:

Quoted message said:

really respect the patient's right to make an informed decision and go to
great lengths to carefully lay out all their options and they don't fit

well

Quoted message said:

Quoted message said:

with patients who really don't want to know! So, without saying that

your

Quoted message said:

Quoted message said:

doc is bad, you may want to shop for another.

Constipation is a minor problem unless you are the one suffering🙂 There
are other remedies other than stopping meds. The best one I can think of
eating well and exercising. The addition of fruits and veggies to your

diet

Quoted message said:

Quoted message said:

and walking would be good for anyone. If you change the amount of green
leafy veggies you eat, you should call your doc and have your PT/INR
checked. It is erroneous info that coumadin patients shouldn't eat green
leafy veggies. Rather, the dosage should be adjusted to the patient's

diet.

Quoted message said:

Quoted message said:

For you, that means eating whatever quantity you desire on a regular

basis

Quoted message said:

Quoted message said:

and informing the doc if that changes. Yogurt keeps your gut healthy and
there are some pharmaceutical remedies that help. Again, I worry that if
you are taking pain medication with a sedative effect on a regular basis,
your drive to exercise might be diminished.

I wish you well. Please check back in. I apologize if I read too much

into

Quoted message said:

Quoted message said:

your post concerning your need for pain meds. It has never been and will
never be my desire to have a patient hurting. Rather, for long term

chronic

Quoted message said:

Quoted message said:

pain, there are other answers besides pain meds.

j

<[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Few questions. . I have a mechanical MV and a dual chamber pacemaker.
I have to take warfarin which I understand the reasons for but I also
still take Digoxin and Verapamil. As far as I recall, digoxin
strengthens the heart but with a pacemaker I am surprised that
Verapamil is still necessary. I really need my pain meds now and
would therefore really like to get off Verapamil because of the
constipation problem. Also, has anyone who takes Verapamil noticed a
worsening of joint pain?.

Also, I am not being checked on as often since the pacemaker was
inserted. It will have been 4 months next time I go to the clinic and
after that I'm told its routinely 6 months for checkups. I can
understand this for someone with a pacemaker who has not had heart
surgery but thought it would be more often for someone like me with a
leaking aortic valve and heart block etc. Appreciate any comments.
Diana

But, you can't take them for one day and determine your eventual

Quoted message said:

tolerance of the medication.

I did take them again when I knew I didn't have to go anywhere the
next day. Maybe I will try them again because the better sleep was
great.

Quoted message said:

Here, many docs are using cox II inhibitors for arthritis with great
success.

Tried those (known as Cox 11s here as well) and stomach was affected
so they are a no as far as the GP is concerned. I am on Warfarin and
she is worried about bleeding.

Quoted message said:

Good luck. Be aggressive. Deal with

Quoted message said:

the pain and everything else will be much easier.

You are so right with this, I just know it. But it is taking me a
while to get there. Thank you for your good wishes.

Bye the way, Tramadol may be called Ultram where you are. It gives a
bit of a 'high' so is not much use before bedtime which is a good time
to take pain reducing meds for arthritis.

Diana

Quoted message said: