Hi, hilltop.

I was waiting for people who know more than I to respond, but since no one has, I will share my experience which may not be relevant. My dad had a triple by-pass and valve replacement when he was in his early 80s. It really didn't seem to make a difference in his day-to-day life. It fixed his heart, but everything else continued to go downhill. It broke my heart. He struggled for about three more years. He, however, was someone who fought for every minute of life and had no intention of going gentle into that good night. He was mentally sharp as a tack until the day he died. I am so glad for those extra years, but they were not easy ones for him. His experience made me hope that I will be able to say no to such measures when I get to that point unless the doctor can guarantee me a hugely improved quality of life.

One thing about the pacemaker surgery, though, that is very different is that it is done, I believe, with only local anesthesia and is not really considered invasive surgery. I would ask all the tough questions of the doctors (get several opinions)-expected outcome, chance of improved mental acuity, appetite, strength, etc. I would push a little if they hesitate to give you any real answers.

These situations are so difficult. I am not sure that we ever know we are making the right decisions. I am sorry you and your DH are having to deal with this.

Thanks for your comments cyn427.
The pacemaker has merit if it improves overall quality of life; however we're concerned it may simply keep his heart beating when it no longer should.

The uncle would not follow the doctor's recommendation for physical therapy, dietary supplements, etc. and he is hoping the pacemaker will be his ticket to bring back the strength in his legs, mental acuity and independence. He's grasping on to life as it rapidly slips away. I can see where the pacemaker could be either a medical miracle or a medical mistake.

Hi hilltop. I too am not an expert, but can only pass along my experiences with my DH who is in his early 60s. 11 years ago he had a pacer installed after 8 months of experiencing episodes of syncope (passing out) due to his heart rate dropping suddenly. The surgery was done under a general anesthesia. There are different types of pacers, the type DH has that is set to kick in when the heart rate drops below a certain number, and a defibrillator pacer that will kick in when the heart is out of rhythm. I honestly cannot say if a pacer will resolve the issues your DHs uncle is experiencing. I would encourage a family member to accompany the uncle to the appointment with the cardiologist. Four ears are better than two.

Good luck and keep us updated.

"The uncle would not follow the doctor's recommendation for physical therapy, dietary supplements, etc. and he is hoping the pacemaker will be his ticket to bring back the strength in his legs, mental acuity and independence"

It's not a magic bean that will restore him to his 70s.

Unless he's willing to do the rehab work to regain the strength he's lost from the years or more of declining heart function, it's not going to give him the independence.

He'll get some mental clarity from the increased blood flow, but still be unable to get around like he's hoping to. And that might be worse for him than quietly declining and dying with his heart.

Rehab in your 80s is quite possible ... it only takes consistent moderate effort with weights and elliptical machines and walking. But you have to want to do it, and you have to stick to it for as long as it takes.

Yes, my husband and possibly another nephew will accompany Uncle to the doctor appointment. Uncle will listen and ultimately ask the "boys" to tell him what to do.

Lazygardens expressed the concern: "He'll get some mental clarity from the increased blood flow, but still be unable to get around like he's hoping to. And that might be worse for him than quietly declining and dying with his heart."

Mental clarity without regaining physical stamina will likely mean a future move to the nursing home since he can no longer use the restroom or transport himself from wheelchair to bed or chair by himself. And a move to the nursing home is exactly what he does not want. He doesn't even want the physical therapy because it means a 3 block ride and stepping foot in the nursing home where the therapist facility is located. He's fallen enough times trying to move around without assistance that he's lucky he hasn't broken a hip.

A couple months ago my husband took him to a VA doctor due to anemia and she suggested 3 things: iron pills, physical therapy and another dietary supplement-like Ensure or other nutritional shake to ward off the weight loss. His response was no, no and no. The doctor joked, "I didn't bring my magic wand to work today - guess that's 3 strikes and I'm out." Ultimately Uncle did agree to the iron pill.

He's nearing 87. There are some at that age that still seem so young and agile; however he has reached the tipping point of being so fragile. Uncle hasn't accepted the fact he's dependent upon care and must both ask for it and pay for it, which he can afford but doesn't want to do. He thinks he can figure it out for himself. For example he stopped taking one pill without letting the nurses know (kept it hidden under tongue and later spit it out). Ultimately we found out. And the only reason he talked about it was because we were reviewing the pharmacy pill costs and it was one of the more expensive pills and he mentioned it was silly to be paying for the pills when he wasn't taking them anyway. Oh my.

I know one man that had a pacemaker implant in his 90's. He was certainly more comfortable for a few years and got around better with a walker.

Unfortunately, the cardiologist is unlikely to make a recommendation to him based on a holistic picture of your uncle. Instead, he is likely to determine whether he is able to undergo surgery and whether the pacemaker will function and improve heart function. Period.

You might want to consider writing to the cardiologist in advance, letting him know about your uncle's non-compliance with medical followup and physical therapy, and his fear of ending up in a nursing home. Then get your husband to engage the doctor in a series of what-if questions: what if the pacemaker works and the body doesn't get stronger? And certainly someone needs to ask whether he will need to be in a nursing home immediately after the surgery. And what does the recovery routine consist of? I would ask whether there are other, non-surgical options to make your uncle stronger.

My advice is to have them walk in the door of the doctors office with written questions. It will help focus the discussion.

My mother began having atrial fibrillation at age 67, due to undiagnosed hyperthyroidism. By the time it was diagnosed, the untreated hyperthyroidism had caused congestive heart failure (get your thyroid checked if you start getting tired/winded/rapid heartbeat doing things that normally don't cause that). Just treating her thyroid did not help with the atrial fibrillation, so she received a pacemaker to regulate her heart rhythm.

She handled the pacemaker procedure well, and it did keep her heart out of fibrillation. However, we didn't really notice any huge improvement of energy or capabilities. My mother's heart had already been damaged from the congestive heart failure, which was not reversible by having the pacemaker. She never suffered near fainting again since it kept her out of fibrillation, but she still died of congestive heart failure 3 years later. So, she may have gained 3 extra years of life, but it was basically at the same level of energy/capability she had prior to the pacemaker.

I think people with only rhythm problems and no heart failure or only maybe a mild degree may notice much more benefit from a pacemaker. But the Uncle already sounds quite compromised, so he shouldn't expect any miraculous level of improvement in his quality of life. I guess as long as a doctor explains all the pros and cons, it's up to him to decide if he wants to proceed or not.

My Mom suffered from A Fib. At the age of 75, received a pacemaker and was put on many heart medications. The medications made her very ill and sluggish until they were properly regulated. She was very reliant on her doctors and listened. She also became educated on the side effects of all her medications.

Cumadin was one of the medications. She needed to have blood work every 10 days and sometimes needed the dose changed. Coumadin makes your blood thinner and controls clotting. If they fall or cut themselves, it can be life threatening. My Mom died from complications of a fall.

It did not improve her quality of life. It did extend it for 8 years. She was a fighter.

My suggestion would be to ask what medications he would be required to take and how frequently since he doesn't adhere to what he should be taking now.

hilltop - you are receiving wonderful words of wisdom here. I would echo those who suggest getting the most holistic view of your loved one's situation as possible. Health, risks, financial, quality of life - for loved one and family. There is a wonderful book by Atul Gawande called "Being Mortal" that I highly recommend.

Our family's mantra in caring for our 85 year old loved one with dementia is "peace and dignity". I wish for your loved one the same. Best wishes -

Hi all, just an update regarding uncle and pacemaker surgery. The day before the cardiologist appointment the assisted living called to say uncle needed to move to the nursing home immediately--he'd fallen too many times over that past few days/weeks and they were concerned for his safety.

Uncle was extremely angry, especially since the NH hooked him up to a buzzer if he tried to get out of his wheelchair or bed. Plus he had to have a roommate which he did not want. Hubby said they needed to figure out a way to "bottle up the spunk" because it was the most alert uncle had been in a long time. That night he called begging us to take him home with us or back to his house or to Phoenix (where he lived years ago).

The following day the 2 nephews (my hubby & a BIL) took him to the cardiologist. Uncle was sent home to wear a heart monitor for 48 hours. Once back at the NH he refused to wear the monitor.
The nephews and cardiologist determined a case could be made both for and against a pacemaker, but that "peace and dignity" (thanks rubyclaire) were in his best interest. He's so weak that the surgery would be difficult on him. So, the surgery won't happen. He goes from having mild to moderate mental clarity to living in the past, back in his earlier working years. I had lunch with him yesterday and he asked what his brother was doing; however, the brother has been gone for 19 years. He'd been having mild dementia issues for almost a year, but as his body physically weakens his mind goes as well.

He's where he needs to be and is well cared for. We'll visit him or call him daily; although it's difficult to hold a conversation with him on the phone since he's so weak. Those final months and years can be hard on everyone.

Thank you for the update, hilltop. It is not an easy situation, but at least he is in a safe place. Thinking of you.

hilltop, I echo what Cyn wrote.