@diab
Hello diab
I felt compelled to answer your post because as someone who has had a 3 wire (biventricular) pacemaker with a defibrillator - also known as a CRT-D - implanted fairly recently, I can confirm that the pain and discomfort you are experiencing are real and not as minor as "striking your thumb with a good sized hammer." I remember the procedure and its aftermath quite well.
When one looks at the procedural notes, as I have done, you come to understand that there is, among other things, a fair amount of cutting, yes, but also a lot of stitching done. Once the leads are in place (for example, the right ventricular ICD lead is navigated to the mid right septum) and have been tested, then they are stitched to your pectoralis fascia. The same applies for the right atrial lead.
The left lead, in my case a quadripolar lead, was then guided using various wires and occlusive venography, to a favourable vein within the chamber in the vicinity of the coronary sinus, attached, tested, and secured by stitching to the pectoralis muscle.
All of the leads, after placement, are secured into your heart muscle by "screwing" them into it. This method has made them much more secure. Once upon a time, the leads were secured by "hooking" (think of something like a gaff hook) them into the muscle but that method resulted in more frequent episodes of the leads becoming detached. And because the leads are attached to very specific locations within your heart muscle, they are always attached and never static.
The wires are then attached to the generator, which in my case was enclosed in an antibiotic Tyrx pouch, then secured to prevent migration by stitching the generator to the pectoralis muscle. Indeed, mine is is installed in a little pocket the electrophysiologist created in my pectoral muscle. (I suspect he was not particularly gentle when he created this pocket. It certainly did not feel like he was afterwards. But he had a job to do and I do not have any complaints.) Needless to say, your pectoralis muscle takes a fair amount of "abuse", for the lack of a better word. And, yes, it is indeed, very sore and stiff for about a month, maybe more, after the surgery. If you have ever pulled a muscle, be it a sprained ankle or muscle in your back, you know that recovery takes some time. And the pectoral muscle in your left upper quadrant has been poked and pulled and generally treated like a pincushion so it will take time to heal. But gradually, the discomfort will ease.
If your electrophysiologist prescribed any pain medications, please take them as advised. I was prescribed Tylenol 3 and took 3 or 4 of them. After that, I could use regular Tylenol.
One thing that helped tremendously was a cool gel pack placed over the incision area. As with any muscle inflammation, a cold compress helps with swelling. I would recommend you wrap the gel pack in a towel so it does not come into contact with your skin, and place it lightly on the site for 10, 15 or 20 minutes . In addition, gentle heat helped me, as well. I use a reheatable cloth bag filled with wheat, of all things. I reheat in the microwave. I bought it on Amazon. It is called a Magic Bag. The good thing about it is: a) the heat dissipates slowly so you don't have to worry about burning yourself and b) the wheat in the bag absorbs a little moisture while in the microwave. Moist heat penetrates better than dry heat. Again, use a cloth between the bag and your skin. Especially in your early days of recovery.
I would stress you follow the instructions you received about activity restrictions for 6 weeks. Experiencing a displacement of any of the leads is something you want to avoid. But do move your shoulder gently to avoid a "frozen" shoulder situation but always with your restrictions in mind. I suspect during your follow up appointment, your clinician will review some gentle arm and shoulder exercise with you. If they don't, ask for some suggestions.
Also try not to touch the area of the incision after the protective bandaging is removed. I know of a couple of people who, absentmindedly , did that and the incision became infected. You really don't want that. You have had enough pain.
You are in early days of your recovery but barring any complications, you should feel better in a week or so and much better by Christmas. I sincerely hope so. Please keep us informed of your progress. We are all here to help one another on this journey by sharing our experiences.
Best Wishes for the Festive Season.