Left arm down?

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BKK
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Joined: September 5th, 2010, 5:36 pm

Left arm down?

Post by BKK » December 30th, 2012, 11:09 pm

This issue comes up time and again, and since my experience with it seems to be somewhat outside the norm, I was curious and did a search using Google Scholar. I found only one reference to a study touching on the subject. It is titled "Appropriateness of sling immobilization to prevent lead displacement after pacemaker/implantable cardioverter-defibrillator implantation". You can read the whole thing here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626349/

To cut to the chase, here is the Conclusion of the study, in full:

"Our study results show that patients can safely perform resistive range-of-motion exercises soon after pacemaker/ICD surgery, but our findings require validation by further research. Nevertheless, we believe strongly that the immobilization practiced at many institutions is overly restrictive, promotes fear, and hinders recovery. Instead of focusing on joint immobilization and activity restrictions, health care providers in cardiac electrophysiology should develop consistent guidelines that encourage patients to perform safe activities that promote healing and help them return quickly to normal daily life."

As I said, my post-op experience seems to be somewhat outside the norm: I continued to do shoulder stretches and range of motion exercises that I had been doing before my surgery as part of rehab for a shoulder injury. The only limit placed on me was that I wasn't to raise my elbow above shoulder level, but I could raise my hand as much as necessary. So doing most ordinary things, like eating, combing or washing my hair, were not an issue.

Exercise also was not an issue. Three days after surgery, I was at home taking it easy, and discovered that my blood pressure was higher than normal. So I called my cardiologist, thinking he might want to adjust my meds. Instead, he suggested I take a walk. Well, we were in the middle of a snowstorm, with a couple of feet of snow on the ground, I live out in the country, nothing has been plowed yet, and I wasn't supposed to be driving anywhere for a week. Then I mentioned that I had a set of snowshoes. So it was decided that I would go for a walk after all. :-)

The walk helped get my blood pressure back down, and, possibly more important at the time, it made me feel a lot better about my new situation.

At the end of that week I went back to work, which I wouldn't have been able to do if I had any restrictions. If there had been any restrictions on what I could lift I would have had to go on disability. I also went back to teaching martial arts, which was a good exercise in mindfulness, since there was a good bit of soreness and swelling, and I still had to keep from raising my left elbow too much.

But I did all of this with the docs blessing and no adverse effects on the leads.

I have often thought that the restrictions that some of us are put on are doing more harm than good. There is so much variability in what is recommended that it seems capricious and even a little like superstition on the part of the doctors. This study seems to support that belief. It would be nice if some more research could be done to determine what would really benefit us the most as far as post-op guidelines are concerned.

Brian

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freckles1880
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Re: Left arm down?

Post by freckles1880 » December 31st, 2012, 8:50 am

BKK wrote:"Appropriateness of sling immobilization to prevent lead displacement after pacemaker/implantable cardioverter-defibrillator implantation".

Brian
I think most of us will really agree that slings are not the best for recovery, except: I had just completed 8 weeks of keeping my arms down due to open heart surgery with complications. As I had been asleep for a couple of weeks and my arms tied down that was not an issue. Once recovering and able to start to use my arms again I got the ICD. The EP said NO sling and the nurse gave me one and suggested that I ONLY use it at night as that is when I would try to raise my arms. That's what I did. I was told to exercise my arm but not raise it above my head.

wavhi
Bob

Medtronic-Visia AF implanted 7-8-2016 stayed with the with 6947 Sprint Quattro Secure lead. Original ICD implant 2-4-2009. ICD turned off 10-6-17 as stage 4 lung cancer taking over.
Major heart attack, carcinogenic shock and quad bypass 10-13-08 post myocardial infarction, old inferior MI complicated by shock and CHF, combined, Atherosclerosis, abdominal aortic Aneurysm, Seroma 7 cm, left leg. Stent in the left main vein 10-7-2014

My "Wardens" are my bride of 54+ years and my daughters.

BKK
Posts: 241
Joined: September 5th, 2010, 5:36 pm

Re: Left arm down?

Post by BKK » December 31st, 2012, 3:35 pm

freckles1880 wrote:The EP said NO sling and the nurse gave me one and suggested that I ONLY use it at night as that is when I would try to raise my arms.
That brings up another issue, and that is contradictory instructions from the doctor and the discharge nurse. I have had that happen a lot.

Who do you follow?

Personally, I would go by the doctors instructions, but since the discharge nurse is the last one to talk to you, and they are usually the only one providing you with written instructions, it's easy to imagine that the doctor changed something after talking to you and that the nurse has the most up to date instructions from the doctor. OTOH, maybe the nurse is giving you the hospital's generic instructions rather than the doctor's individualized instructions.

I'm more inclined to go by the doctor's instructions if I felt I had understood them clearly. Or call him/her for clarification if I didn't.

Brian

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freckles1880
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Re: Left arm down?

Post by freckles1880 » December 31st, 2012, 4:19 pm

BKK wrote:
freckles1880 wrote:The EP said NO sling and the nurse gave me one and suggested that I ONLY use it at night as that is when I would try to raise my arms.
That brings up another issue, and that is contradictory instructions from the doctor and the discharge nurse. I have had that happen a lot.

Who do you follow?

Personally, I would go by the doctors instructions, but since the discharge nurse is the last one to talk to you, and they are usually the only one providing you with written instructions, it's easy to imagine that the doctor changed something after talking to you and that the nurse has the most up to date instructions from the doctor. OTOH, maybe the nurse is giving you the hospital's generic instructions rather than the doctor's individualized instructions.

I'm more inclined to go by the doctor's instructions if I felt I had understood them clearly. Or call him/her for clarification if I didn't.

Brian
Brian you are correct. We should follow the doctors advise over the nurse. But I did take the sling and used it for several nights. I was still trying to find out what they had now put into my body (my ICD) and how I was suppose to live with that electrical thing in there. The Nurse's comments made me feel a little better and I followed her advise.

Now for the other side. I have an EP/Cardiologist and his devise Nurse who prescribe most of my medicines, I have my Primary Doctor who does not fully understand ICD's. When ever my primary MD suggests a medicine change or anything to do with my heart or blood, I verify the information with my EP or his Nurse. I have more confidence in them. wavhi
Bob

Medtronic-Visia AF implanted 7-8-2016 stayed with the with 6947 Sprint Quattro Secure lead. Original ICD implant 2-4-2009. ICD turned off 10-6-17 as stage 4 lung cancer taking over.
Major heart attack, carcinogenic shock and quad bypass 10-13-08 post myocardial infarction, old inferior MI complicated by shock and CHF, combined, Atherosclerosis, abdominal aortic Aneurysm, Seroma 7 cm, left leg. Stent in the left main vein 10-7-2014

My "Wardens" are my bride of 54+ years and my daughters.

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