Ask Dr. Keith Roach M.D Adk IDte IKdlfln Itaodn MUD)
Electronic pacemaker won’t keep heart beating forever
DEAR DR. ROACH: How does a person with a pacemaker die? Won't the pacemaker keep the heart beating? My husband is 87 and on his seventh pacemaker. Please advise so that I know what to expect. – G.D.
ANSWER: An electronic pacemaker is implanted for a variety of electrical problems with the heart when a person's natural pacemaker, located high in the right atrium, fails to do its job of stimulating the heartbeat.
When someone dies, the heartbeat irreversibly stops. That's part of the legal definition the physician uses most commonly when declaring someone deceased. Patients also may be declared dead with irreversible cessation of brain function, which is the case for most organ donors. In that case, machines, including mechanical ventilators, keep the body alive.
The electronic pacemaker will keep sending electrical signals until its battery runs out, but the heart cannot respond mechanically. The electrical signal is imperceptible.
Let us hope your husband wears out several more pacemakers.
DEAR DR. ROACH: I'm 67 and overweight, and I understand I have spinal stenosis. Overall, I feel pretty good, and my back feels just great, except that I have pain in the back of my thighs, with the worst being at the joint where my thighs connect to my hips.
But it's not just the joint, it's also all of the muscles in the backs of my thighs. I cannot sit on a hard chair for very long, and therefore I sit on very soft chairs with extra cushioning in order to be semi-comfortable. No matter what I sit on, when I get up I don't have a lot of strength in my legs. It is quite painful, the process of going from sitting to standing. It takes me a few seconds to get to where I finally can start walking, which of course is still painful, but not as painful as the standing-up process. I have only limited pain when sitting on something very soft, and even less pain lying down, but I am in some pain all the time. I am writing because this whole situation has gotten much worse lately and is becoming a problem. — H.K.
ANSWER: I am quite concerned. If your problem is due solely to spinal stenosis, it's time to get re-evaluated.
Spinal stenosis is when arthritis and abnormal bone growth in the spinal canal compress the spinal cord and its nerve endings. This can cause the pain you describe. On a careful physical examination, the clinician can find numbness and decreased reflexes. However, weakness in spinal stenosis is a big red flag, since it means the compression is very severe, and weakness often is irreversible even with surgical treatment.
It is possible that there is another problem going on. There are many conditions that can cause muscle weakness and diffuse pain, from very serious (degenerative nerve and muscle diseases) to more easily treatable (including vitamin D deficiency). Pain with sitting may be a separate issue or could be related to the spinal stenosis.
Either you have worsening spinal stenosis that needs urgent re-evaluation or you have an undiagnosed condition. The bottom line is that it's time to get back to your doctor. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.