Cardiac rehabilitation for Pacemaker Implantation

Posted by dianegracie1 @dianegracie1, Jul 13 11:24am

I am a 74-year-old woman, and I received a pacemaker 20 days ago. I asked my new cardiology nurse for a referral to cardiac rehabilitation, and she said that unless there was a heart attack, they don't refer to rehab for just a pacemaker implant. I also have a calcium score of 111, so I do have heart disease. I checked with Medicare and they will cover it if it is referred by the cardiologist. Has anyone else faced this? I am so certain that I could benefit both physically and emotionally from that type of support.

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Dana, Volunteer Mentor | @danab | Jul 21 10:37pm

In reply to @dianegracie1 "Thank you, Jackie. I will give that a try." + (show)

Actually @jackiet is got a great idea. As I remember I also had my first pacemaker put in as a precaution and I never saw that surgeon again. But as i developed more symptoms I also started seeing a EP Cardiologist besides my regular Cardiologist. It was after an ablation that I first went to Cardiac Rehab.

dianegracie1 | @dianegracie1 | Jul 30 6:27pm

Thank you, Dana. I still think I could benefit from cardiac rehab. The surgeon that did my implant said I just need to go to a general cardiologist, so I do have an appointment, but I do not agree. How was cardiac rehab? I need it for the emotional piece as well as the physical piece.

dianegracie1 | @dianegracie1 | Jul 30 6:35pm

In reply to @jackiet "Maybe I should explain a little more why I suggested seeing an electrophysiologist (ep) might help..." + (show)

@jackiet

Maybe I should explain a little more why I suggested seeing an electrophysiologist (ep) might help with your problem. I don't know if an ep installed your pm; I understand that sometimes an ordinary cardiologist does the surgery. So I would ask you if a cardiologist or a cardiac electrophysiologist performed your surgery.

I'm not sure what kind of rehab you are requesting after a pm implant. Or exactly why you think "rehab" is necessary. But I can tell you about my experience, which may or may not be helpful.

I had a pm installed four years ago for bradycardia (low heart rate, dizziness, chest tightness, one fainting episode), much like what you say you experienced. Two months after the pm went in I continued having some of the same symptoms--trouble breathing (getting exhausted after a short walk) and chest tightness. The ep (a cardiologist who specializes in the electrical (f) of the heart) who did the surgery refused to give me a follow-up appointment. Instead, the device technician checking to see if the pm was performing as expected said everything was fine when I went in for a checkup. I later saw another cardiologist (not an ep) who looked at how the pm was working and could see nothing wrong.

Only four years later did I discover that pacemakers have hundreds of features that have to be "set" when the pm is implanted. There's something they call the fitness level (of which there are four), there's a breathing sensor, a motion sensor, and many other features that get set by the ep who installs it. There are also different names given to these features, which may differ according to the manufacturer of the device.

In my case, the way my pm was set up was wrong for me. I got help from Boston Scientific, the manufacturer of my pm (they will often give help over the phone), and from another ep (not the guy who installed it) who was willing to work with me to change some of the settings. There are hundreds of combinations and ways to "set" the pm. The device is very complicated.

The health profession is in a state of chaos. There are many inattentive providers out there. You have to hunt for the good ones.

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Thank you, Jackie. The health profession is in a state of chaos. After taking several years to diagnose this and finally get the implant, I am skeptical. You asked who did the implant and it was an electrophysiologist. Dr. Adler, who has a great reputation, did the implant. I called their office 2 times, and they would not set up an appointment with me. They tried to assure me that a general cardiologist should be able to take care of me. It has now been 5 1/2 weeks, and I have seen no one. I have an appointment with a general cardiologist next week. I am so frustrated with this whole process. I appreciate you sharing your experience because it is similar to mine. Is this because I am on Medicare and a BCBS advantage plan?

dianegracie1 | @dianegracie1 | Jul 30 6:38pm

In reply to @deniseheart "Hi, I have a pacemaker /defibrillator (ICD) implant. I was eligible for cardiac rehab because my..." + (show)

Hi Denise. I am so glad you were able to get rehab. I did call my insurance carrier and they initially told me I qualified. I called rehabilitation and they said I did not qualify and to check back with my insurer. I called Medicare again and spoke with a supervisor. She apologized and said the intake person was new, but I do not qualify because I did not have an "event". All those passing out episodes (8 in the past year), plus stitches in the back of my head, chest pains, etc. did not qualify. This is really frustrating. I am so glad you got the care you deserve. Take care. Diane

jackiet | @jackiet | Jul 30 8:41pm

In reply to @dianegracie1 "Thank you, Jackie. The health profession is in a state of chaos. After taking several years..." + (show)

Medicare is my primary insurer and I have a second that is linked to United Healthcare. I can’t imagine your insurers have anything to do with the problem you’re having.

What brand is your pm? Mine is Boston Scientific. It’s possible the kind of pm you have might be programmed differently than older models (I had mine implanted 4 1/2 years ago.). Which may (or may not) have something to do with the resistance you’re experiencing.

You need to see another ep. A cardiologist is not going to be able to determine if your device is programmed for your needs. I don’t know where you live, but there must be other electrophysiologists you can call on. You have a right to a second opinion!

I realize you feel you need cardiac rehab, of which I am ignorant. It is not something I needed. However, getting a second opinion from a different ep about whether your pm is working well for you may convince someone you could benefit from cardiac rehab.

You have a right to a second opinion from an electrocardiologist, not a cardiologist.

dianegracie1 | @dianegracie1 | Aug 1 11:50am

In reply to @indy1 "Please make an appointment with your Cardiac Electrophysiologist. Their team should be following you." + (show)

Thank you. I have tried to get an appointment with an Electrophysiologist, and they said I just need to see a cardiologist. The reasoning is the same as not being able to get cardiac rehab. I am frustrated. Thanks for your input.

jackiet | @jackiet | Aug 2 8:36am

In reply to @dianegracie1 "Thank you. I have tried to get an appointment with an Electrophysiologist, and they said I..." + (show)

Here’s another idea: Can you ask your PCP to refer you to a different Electrophysiologist for a second opinion? It sounds like the cardiologists are calling the shots. Can you get your PCP involved?

dianegracie1 | @dianegracie1 | Aug 2 7:01pm

In reply to @ted3 "Have you checked YouTube? There are many videos on the topic of Cardiac Rehab. Not the..." + (show)

Thank you, Ted. I have been looking at videos on U-tube, and they are helpful. I did start hot yoga a few days ago (105-110 degrees), and I have had no adverse side effects. It feels cleansing and healing. I have done hot yoga for years, so my body is acclimated. Does anyone else do hot yoga with a pacemaker?

dianegracie1 | @dianegracie1 | Aug 2 7:03pm

In reply to @jackiet "Medicare is my primary insurer and I have a second that is linked to United Healthcare...." + (show)

Thank you, Jackie. I am going to try to schedule an appointment with a different EF. I appreciate your support and prodding. I will do so on Monday.

jackiet | @jackiet | Aug 3 7:07pm

I am going to shut up now, dianegracie1. I’m afraid my own experience with the ep who implanted my pm has infuriated me. You do what you feel is best for you and good luck.

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