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08/04/2014
Surgeries and Pacemaking
CHAPTER 47 Medical Stuff
I'm late in posting this column, which will be relatively short for reasons that will be apparent. A year ago last month, Dr. Paul Lombardi replaced my left hip. I was home two days later and was driving in two weeks. It was a snap. Last week, Dr. Lombardi replaced my wife's right knee, which was 88 years old. Although Lombardi described the surgery as having been "routine", replacing a knee is a more serious operation than a hip replacement and my wife is now in a rehabilitation center for what I suspect will be a number of weeks of physical therapy. Needless to say, for the past few weeks I have been busy taking my wife to various medical facilities for the necessary pre-op testing and to physical therapy to help strengthen her for the demanding post-op physical therapy required after the surgery.
Aside from the surgery, consider what happened on the day last week when my wife was scheduled to transfer from the hospital to the rehab center. I was driving to the hospital when an emergency light came on telling me that my brake pads needed "immediate attention"! Our car dealer happened to be in Morristown, NJ, where the hospital is located. With two hours before her scheduled transfer, I decided to drive to the dealer to assess the situation. The result was that I got a loaner car, an up-to-date BMW with all kinds of dials and switches and a GPS display. Our car (actually, my wife's) is a 2005 BMW, the most sophisticated feature of which is that I press the key to open the door. It took a while for the garage people to teach me how to drive the rented vehicle and off I went back to the hospital. It was there I realized that the service people had not put the luggage containing my wife's rehab clothing in the loaner trunk. I also found that the time of her transfer had been changed from 1 PM to 3 PM. So, it was back to the dealer to retrieve the luggage and then back to the hospital again.
It was there, while talking to the nurse, that I learned that they had assumed I was going to transport my wife to the rehab center. This was a shock to me in that the numerous times she's been transferred from hospital to rehab it's always been by ambulance. And with a car that I barely knew how to drive, the nurse concurred that it would be much safer to arrange for an ambulance. I went home after asking the nurse to call when the ambulance left so when she arrived I could be at the rehab center, a half-hour drive from our house. At about 3 PM I get the call but the nurse tells me the transfer has been rescheduled for 6:30 PM. Whoa! That meant I would be driving home in the dark in the loaner car and I don't even know how to turn on the lights! Did I mention that I'd never been to this rehab facility and was unfamiliar with the route? At any rate, I called the rehab place and was assured that everything would be OK and that my wife would not need anything other than her clothes that she wore to the hospital. The transfer went smoothly and I picked up our car the next day - the bill was $1,600!
Today, I learned that our next door neighbor had a harrowing medical experience three weeks ago. His wife told me that they were up on Cape Cod. They were out on a boat and had put out a buoy of some sort, I guess to anchor the boat. My neighbor jumped into the water to swim ashore. When he jumped in, he realized he was short of breath and couldn't make it to shore. He clung to the buoy until an emergency team arrived to get him to shore and to a hospital. He had had a heart attack and ended up with a bypass. In retrospect, his wife said they were probably lucky that he had jumped into the water, precipitating the attack and the finding that one artery was a hundred percent blocked! I shudder to think that, just this past winter over my protests, he insisted on shoveling our long driveway after a snowstorm that wasn't deep enough to qualify for our contracted snowplow guys to clear.
I was going to beg off writing anything more this month but I just read this morning a heart-related article titled "Improving cardiac rhythm with a biological pacemaker" by Nikhil Munshi and Eric Olson in the July 18 issue of Science. When I transferred from working on light-emitting diodes to the battery development area back in the early 1970s, one of my first tasks was to look into the maintenance of semiconductor memory in telephones. We were considering using lithium-iodine batteries of the type then being introduced into the cardiac pacemaker world. In fact, I have just this minute reached over to the horrendous disorganized pile of "stuff" on the bed in my so-called office and picked up an actual live lithium-iodine pacemaker battery at least 40 years old manufactured by the Catalyst Research Corporation (CRC) in Baltimore, Maryland. In my column of January 1, 2012 I mention a trip to CRC in the 1970s that I'll never forget. On my return on the Metroliner, the train ran over a person who I later found was known to my brother, who was then a professor at the University of Delaware. The train tracks ran near my brother's house. It was apparently a suicide.
But I digress. I've known a number of people with cardiac pacemakers, including my wife's brother, with whom I talked yesterday. The implantable pacemaker and implantable defibrillator have revolutionized the treatment of heart problems. But what happens if there's an infection due to the pacemaker and/or the leads associated with the pacemaker? It seems that in such a case the pacemaker and leads have to be removed and a temporary pacemaker brought into play until the infection is taken care of with antibiotics. The Science article deals with another possible approach that shows promise - the reprogramming of heart muscle cells to restore heart rate and function. This approach, developed by Y. F. Hu and coworkers, involves injecting some sort of human encoding virus into pigs that in the pigs restores heart rate function in the pigs, at least for a period of time. I won't attempt to describe the process - it's beyond my comprehension at this point. The main thing is that there is hope that eventually the general approach can translate to humans and at least for a useful length of time allow a biological pacemaker to fill the gap of a missing electrical pacemaker while an infection is cured. Of course, I would assume the Holy Grail would be to find an approach that would form the needed cells to regenerate a long lasting biological pacemaker.
Well, it's time to make the trip to visit my wife, driving a vehicle that I have some proficiency in operating.
Next column will be posted, hopefully, on or about September 1, 2014.
Allen F. Bortrum
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