Tuesday, 13 March 2012

Upgrading Your Pacemaker; Sliced n Diced; or, The Adventures of Zappy the Second

As I mentioned recently, following my little ride in a helicopter and subsequent hospitalisation over New Years, I was brought under the care of a new electrophysiologist. He decided that, although his battery had not yet depleted, it was time to replace Zappy with a newer model that had an enhanced ability to pace my heart and therefore, hopefully, reduce the number of cardiac episodes. As luck would have it, I landed in the care of the doctor that my specialist in Adelaide had recommended (and who had also trained my Adelaide doctor, so I was off to a good start).

On Wednesday last week I was admitted to Melbourne Private Hospital. I opted to go in as a private patient because you have a little more control over when your surgery is, and plus I have private cover, so why not use it? I was out of pocket by $250 which I will only have to pay once this year, which I don't think is too bad for 5 nights plus surgery. I also did the maths and determined that in the last ten weeks, my health insurance has covered approximately ten years' worth of premiums in benefits, if not more. How's that for value for money!

Mum and Dad and Rex Wombat, Defender of the Infirm, came along for the ride.

There's a bit of a story to Rexie, but the people involved may be embarassed for it to be shared with all of the interwebs, so we'll just leave it as saying that Rexie was there to look after his girl.

"You lookin' at me?? I'll take ya!"

He sure looks tough... I wouldn't take him on...

Anyway, admission went swimmingly, besides a little freak-out when I met my nurse who was perfectly sweet but also quite green (she was about 2 weeks into her graduate rotation). I know I taught her a couple of things, which scared me at first, but after a couple of days I realised that she does listen, and takes things on board, and isn't afraid to ask questions. All of these are good things!

Once mum and dad left me at the lift, though, I started to get a teensy, tiny bit terrified. There may have been a wobbly lip and a crack in my otherwise calm facade that lasted about twenty seconds before I talked myself out of making an ass of myself.

I met the surgeon - this time around, because they were implanting the new Zappy more deeply than they had the old one, they called in the services of a cardiothoracic surgeon in addition to my normal doctor (another perk of being in a private hospital is the ability for your doctor to request assistance from whichever medical professionals he chooses). He was quite lovely and straightfoward and between him, my specialist and the anaesthetist, they had me settled down in no time at all. They even agreed to my somewhat whacky request to take photos of the operation!

I'm serious.

(Nobody is particularly surprised by that, are they...)

Unfortunately, I had a crack at dying on the table as they put me under, so they opted to restart my heart instead of taking photos, dangit. Oh well, fair call I guess! So I have no photos of the operation to share with you. Better luck next time.

I actually walked into the operating theatre and climbed onto the table myself. I suppose they eyed me up and decided they didn't much fancy lifting someone nearly 6'2" onto the table themselves! In memory it's sort of like a surreal dream sequence, and it will be interesting to see whether it ever pops up in my dreams/nightmares. I remember commenting on how narrow the operating table is (and yet, how long - I swear you could fit nearly 2 (short) people on it), and asking how on earth they got seriously overweight people to stay on the table - didn't they sort of, like, hang off the edges and overbalance?? They just laughed but I was serious!!! I'm not overweight anymore, but I didn't have much room to spare. I have the same question in regards to fitting people in to MRI chambers but I don't suppose anyone will ever answer that one for me, either :(

When I came to, things looked a bit like this (although it was more like the upper right hand corner of this picture):

The anaesthetist was basically a bright blue blob with no distinct edges who sounded a lot further away than just standing by my feet (although, to be fair, that is further away from my head than it is on most people...). I heard him say something about me going into VF (ventricular fibrillation, aka Dancing with Death), and I'm not sure whether he said it to me or to someone else in the room, but when I asked the Purple Recovery Nurse about it she denied it. Then again, my question probably sounded like "mmnmfgoiumdpolfg?" so it's entirely possible she had no idea what I was asking. My parents later told me that the surgeon had told them that what the anaesthetist had said was true.

Besides that whole nearly dying thing, which, let's face it, is a bit old hat for me, the operation went quite well.

Not too much later I was wheeled back to my room where Rex Wombat and my parents awaited me. The next thing I looked at was the television screen, and I was deeply struck by the irony of the brand of television considering I could barely see the label!

I didn't laugh on the outside, but inside it was hiLARious! It was so funny I kept repeating it to myself and thinking I had to tell the bloggy world about it (which I have now done... it was way funnier in my drugged-up head... sorry!)

After my vision had cleared and I had vomited up a whole lot of nothing (tasted like saline, not like spew, which I presume is what it was), my dad had to feed me my dinner, one tiny spoonfull at a time, because I was to groggy to do it myself, and I couldn't move my right arm anyway (it's still not really up to snuff). I made it through half a bowl of soup and a quarter of sandwich before calling it quits.

That first night I remembered how hard it is to get comfortable following surgery. This is the most invasive surgey I have had by a country mile. It not only involved removing the original device, but also replacing it - much deeper - with a new one. This meant teasing out layers of pectoral muscle to slide the sucker into place. It was my choice to have it implanted more deeply, mainly because I'm incredibly vain and because I don't want it to physically effect me in terms of carrying packs etc, but boy oh boy will I be rethinking the deep implant option next time. I guess I'll have more of an idea if it's worth the extra pain once I'm all healed up and fully functional again.

The first night is also the night where I came to realise that nurses in private hospitals are much more generous with time and resources than those in public ones - they'll stay for a chat, and pat you reassuringly on the back of the hand, and are more free (possibly as they have more time?) with helping you to the toilet and/or shower, and they'll fetch you sandwiches or icecream or cheese and biscuits (or painkillers and ice packs!) or whatever your defective heart desires in the night.

Thursday, I settled into my rhythm of eat-drugs-sleep-eat-drugs-sleep. Dad came and sat with me for a few hours and I don't remember much else about the day. I don't think I ate a great deal.

Friday I spewed up my lunch and only ate part of my dinner as I feared a repeat of lunchtime. There aren't many more painful things than vomiting with a swollen chest wound. You also wouldn't believe how intricately the muscles in your torso are connected with one another, or what colour lettuce is when it comes up again.

Nice :)

Thursday night (or was it Friday? Can't remember) was just awful. I have never been in pain like that, ever. And that includes the time I broke my right arm into an S-bend sort of shape. I think part of it was that I was more or less neglected for 2 or so hours as the shift changed over, so the ice pack I had asked for never showed up, and the pain killers hadn't shown up, and I was lonely and sore and so when I woke with a start from a wee snooze I was having and jerked the wound, it felt like the world was ending. Pain (and pain killers, for that matter) does funny things to your brain. I cried, partly from the pain and partly because I was scared it wouldn't stop.

I had plenty of visitors on Friday, including my brother. I was so stoked to see him cos I know how much he hates hospitals! I had visitors over the weekend, too, so my routine changed a little to sleep-eat-visitors-eat-drugs-sleep-visitors-eat-drugs-sleep. I didn't have a great deal of time to watch TV and I didn't read anything I brought with me - that's how much sleeping I did!

Shortly I will share with you my X-Rays and a couple of pictures of my wound, but before that I will share some pics of both the Royal Melbourne Hospital (where I stayed at Christmas) and Melbourne Private (which is next door) so you can see the difference.

The view from my first room at the RMH was pretty awesome. It was the best room in the ward because I was the sickest patient there, which meant that I got this view but with THREE LOTS OF FIREWORKS on New Year's Eve - one just this side of the city, one to the right over near the Bolte Bridge, and some way down between the buildings. It was very pretty.

But then they moved me to a submarine, occupied by a snorer, which I wasn't terribly happy about. I suppose that was their way of moving me along. Note also that this was the only window, and it was beside my bed, so I had to actually sit backwards on the foot of my bed to see out the window. But at least there was a tree!

Conversely, this was the view from my room at Melbourne Private. I would say it's an equally good view, or perhaps a little better on account of there being a sportsground down there, so at certain times of day I could hop out of bed and ogle watch the college boys training and playing soccer.

It had the added bonus of some local impromptu street art/sculpture thoughtfully added by - one assumes - school children, but given the aerial perspective it could also have been constructed by friends of a patient, or perhaps nurses (who are well known for having a filthy sense of humour):

Having trouble spotting it? Perhaps you need to look a bit harder *giggles*

Then of course there are the inevitable menu errors. The one at the RMH was all the more amusing because I'm not **really** supposed to drink coffee (the form requests tea. It also requests low fat, and I'm not sure whether I ought to be offended by that...)

but the one from MPH is definitely not fruit toast, which is what the form requests (not that you'd know it, cos my phone's camera won't focus on anything closer than about 3' from it).

Ahh, first world problems!

We're in the home straight now, and the next few photos may gross you out so if you're squeamish, best you look away.

First up, meet Zappy the Second. And also the ribs on the right hand side of my body.

He's about the size of a Zippo lighter, perhaps a little larger. I estimate that I could lie two of him, side by side, along my palm from its heel to the base of my fingers. I have quite small hands. And yep, that big bundle of wires and metal is inside me. The fatter wire that crosses down to the left of the picture is not - that's just the lead from the telemetry they had me on - but the two finer wires are still there. The model sounds very futuristic - the St Jude Medical Pacemaker 7000.

Second, this is what my surgical site looks like. I won't give you the close-up right away so you don't get too grossed out too soon. It's stuck together with Contact!

Thirdly, here is my whole chest X-Ray. You can see the two little leads that terminate in my heart (which is on the right side of the picture, and therefore the left side of my body). The lead that ends to the left is in my atrium and is the new one; the one to the right is in my ventricle and is the one that has been there since last time. I didn't realise how far the (or, my!) heart sits on its side until I saw this X-Ray and realised that, although your atria are above your ventricles in all the diagrams, in reality mine are kind of angular. I have no idea whether that's normal. Or whether I'm interpreting the X-Ray correctly. You know, with my non-existent medical science degree and all ;)

Okay, I just realised that it's not particularly obvious what I meant by the above, so at some point when my head is less foggy I'll play with the contrast on the picture and draw some lines to explain what I mean.

Fourth is a bit of perspective on the location of the incision. Once it's healed I'll find an old photo and do a before-and-after. As you may be able to imagine, it's kind of a big deal for a young woman to have such an ugly wound on her chest, which is why my incision is vertical - to make it easier to hide. As I said - vanity. The bulge will also be far less prevalent now as it is tucked under my pectoral muscle and not just under the skin (you could see pretty much the shape of the whole unit before, and could feel the lead terminals at the top. Gross, hey?).

And lastly is the gross one, taken 6 days after surgery, that reminds me of the plastic wrapper around corned beef, and all the goop that it contains. Plus some bruising. Plus some pink antiseptic stuff (which looks suspciously like the stuff they mark lamb with). Plus the more I look at it the more I wonder whether there are actually two incisions, side by side. I guess it would make sense, given that they had to take old Zappy out and put new Zappy in, in a slightly different spot. Oh well, I'll find out in a few days when I peel the dressing off. Not looking forward to it. I'm not geneally squeamish - opting instead for a certain level of fascination about the human body - but I suspect that if it does actually resemble that corned beef wrapper, that I will in fact gag a little. As long as it doesn't scar as badly this time I'll be happy. And the new surgeon explained what the old dropkick at the Austin didn't - that it scarred because my skin stretched, and the scar added fibres to itself to compensate. But if I keep it taped for 3-6 months, which the old surgeon never told me, I should get quite a fine scar out of it instead of something 5mm across like last time! Grr to incompetence, and may I never again encounter it...

So... I hope you weren't about to eat...

My experience at Melbourne Private was altogether a positive one, with staff who listened, and who I felt gave me a certain degree of control over the treatment of my pain and over my comfort in general, which is always good.

I'm not used to the different sensations in my chest just yet, but that will change soon, I guess. I still don't know what the new normal is. Hopefully my new normal involves the words AWESOME, and, as a good friend suggested, INVINCIBLE :)

Oh, but one awesome final note - the new model has this kickass function whereby it vibrates to warn you when it's running out of juice, or that it has detected that a lead is faulty, or that it needs attention in general. It feels like a mobile phone going off, only pressed really hard against your chest. How cool is that! (And yet, I'll probably positively sh!t myself if and when it ever goes off!).

Well that's it from me. In case you couldn't tell by my ramblings I'm well overdue for my afternoon nap, and even more overdue for painkillers. Sweet dreams to me, and thanks to everyone who called/dropped by/wished me well in general!


  1. That's just fascinating! I'm amazed at how large Zappy is - I'm not sure what I imagined when you were talking about it earlier, but clearly I was envisaging something entirely different.

    It sounds like it all went very well and you were in the hands of incredibly competent people who coped quite well with your attempt to stop existing in the middle of the surgery. I hope your recovery is speedy and that you're feeling much better in no time at all. :)

    1. I'm feeling much better already, as far as my heart goes, anyhow :) I've spent the last two weeks having to do everything with my left hand and not being able to roll over at night, but it's slowly coming good now. I'm looking forward to being physically recovered so I can get fit again - it's amazing how badly two weeks on your arse affects your fitness.

      Normal pacemakers that only pace are more like the size of a 50c piece, but because mine also defibrillates it needs a bit more guts and therefore a bigger battery. Once upon a time they were so big that they would be implanted in your abdominal cavity! Which, eeuw...

  2. I'm glad you gave the Zippo analogy because in the x-rays he kind of looks like an upside down laser mouse... ;)

    Glad that all went well (despite the hurling and the extra days in hospital) and that Rex was there to keep an eye on you. And that there were menus with tick box options - I know how much you like those!!

    1. Yeah, I tried to convince mum to provide me with menu options in tickbox form once I was home but she didn't seem to keen for some reason ;)

  3. Awesome stuff Ness. Its great to be able to share a story and photos too. My surgeon took photos during my last op to prove that my tumour was finally gone and showed them to me when I'd woken up BEST FEELING EVER!

    So because of what you've done I'm seriously considering blogging my next medical journey too :)

    1. There's quite a few people out there who do it Deano (I assume this is Dean...). You will probably find groups of people online who have been through the same process so it's a good way of getting support.

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