85 year old husband with Vascular Dementia had cardiac arrest in Church. CPR, 911. Short term memory non existent.
Not supposed to raise his left arm above his head for 4 weeks. Yeah.
The sling does not work. Securing his sleeve to his shirt and his belt does not work. He breaks all connective devices when he impulsively raises his arm.
Please help.
Please help with suggestions on how to keep his arm down.
This is what I am currently doing:
At night, in bed, a t shirt pulled down OVER his left arm. This works f a i r l y
well. In the daytime, I tie a shoelace through his belt loop and the other end through a watch. This works as long as he keeps the watch ON.
Quite a sight to see a wrist watch dangling at his side.
He is physically fit for 85 years old. He walks at least 2 miles a day, up and down hills. He was diagnosed with Vascular Dementia May 2015. He is kind and loving. I know some people will criticize me for wanting him to have the pacemaker.
He no longer has a driver's license, and the guns are gone.
Thank you.
Thank you.
Whereas, if I felt something pulling my arm in towards my body, like a sling, or my t-shirt being caught awkwardly, I'm sure I would exert myself to get rid of it.
Look for the trigger, for whatever is making your husband lift his arm in the first place, and try to get rid of that.
And if he *doesn't* habitually raise his arms, and this is a purely preventive measure, then it seems counterproductive and it might be better not to do it. You do have to wriggle quite hard to dislodge a well-sited pacemaker lead, especially after a couple of days post-op.
And next time a doctor or surgeon gives you instructions for patient care that you know are going to be a challenge, ask them how they suggest you do it.
You might also like this article from Baylor University in Texas
(to see the whole article Google NIH reference Proc (Bayl Univ Med Cent)v.22(1); 2009 JanPMC2626349):
Appropriateness of sling immobilization to prevent lead displacement after pacemaker/implantable cardioverter-defibrillator implantation
Aster Naffe, RN, CCRN, Mini Iype, RN, Mini Easo, RN, Sandra DeJong McLeroy, RN, Kelli Pinaga, RN, Nancy Vish, RN, PhD, Kevin Wheelan, MD, Jay Franklin, MD, and Jenny Adams, PhDcorresponding author
Author information ► Copyright and License information ►
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Abstract
After pacemaker/implantable cardioverter-defibrillator (pacemaker/ICD) implantation, patients are often required to immobilize the affected arm with a sling to minimize the risk of lead displacement. We examined whether performing a resistive range-of-motion exercise protocol after pacemaker/ICD surgery would result in lead displacement and, therefore, whether sling immobilization and activity restrictions are justified. Ten subjects who had undergone pacemaker/ICD surgery performed four individual resistive range-of-motion exercises (three sets of 10 repetitions for each: one warm-up set without weight and two sets with a 1- or 2-pound hand weight) with the affected arm prior to hospital discharge. For each subject, an electrophysiology nurse specialist used a noninvasive device programmer to evaluate surgical lead placement before and after the exercises. As an adjunct to the study, we queried clinicians at 48 US hospitals about sling immobilization and activity restrictions after pacemaker/ICD implantation at their institutions. No lead displacement occurred after the weightlifting exercises were performed. Based on these results in a small group of patients, it appears that requiring the use of a joint immobilization sling is overly restrictive, promotes fear, and hinders recovery. We encourage the development of consistent discharge instructions that will promote early mobility and a safe and rapid return to normal activities.
He is short. Just to get a coffee cup out of the cupboard gets his arm above his head. Getting in and out of the car, he reaches for the handle near the roof of the car .
The childproof locks on the exit doors in our house are above his head.
To put on or take off a shirt. (I tried getting him to wear a button up shirt. He took it off 4 times and put a sweater on 4 times .)
It angers him every time I remind him to keep his arm down. Then I have the ill will episode. He does not know why he is angry (short term memory loss), but the anger remains for quite some time. My husband has always been loving and kind.
To take a shower. Oh my. So we have been showering together.
It is very difficult to constantly observe and prevent these actions, but I believe the word these days is "proactive". I will not use the childproof locks anymore.
He ignores the coffee cup I have taken down for him.
I do not have eyes in the back of my head.
braces" that will be hart to get out of and accomplish that. Try Amazon even it has an abundance of options. I'm trying to remember id a figure 8 brace prevent's raising the arm or the injury did that...then are used for broken collarbones. Worth looking into, it should say if they restrict some movement, because if it does it would be perfect.
The other thing I was going to suggest and CM sort of did is give the doctors and or surgeons office a call, explain the issue and maybe they have suggestions. It's very possible they have run into patients with this problem before given the number of pacemakers they put in. By the way it sounds like your husband while he may have this terrible disease (VD) still has a full and happy life and that he contributes to his families full and happy life so please don't second guess yourself for doing the medical things that extend that. It sure doesn't sound like he's close to the end and who can say how long it will be before he isn't living in and enjoying his life and yours. Good luck on curtailing that arm lifting, think about it this way this new need for you to come up with ideas to troubleshoot his short term memory issues is exercising your brain the way they say helps keep our minds sharp!
It worked.
There are doctors who specialize in dementia care, of course. I hope your husband has one! That is the office I'd call for advice. This behavior is not a cardiac problem, it is a dementia problem.
In the future, if you foresee an obstacle to directions you are being given, explain that obstacle immediately and ask for advice, as CM suggests. You may still have to call the dementia doc (and post here!) but by explaining and asking you are contributing to the education of that clinic.
I loved seeing the article CM found. That was a small test and not all doctors would be willing to change their practices until further testing is done, but at least it should be reassuring to you to know the restraints may not even be helpful. We know that restraints on a person with dementia are definitely not helpful for his behavior and peace of mind. I suggest discussing that article with the surgeon.
The staff at the TCU complained that our mother would not keep her arm in the sling. (Not a pacemaker issue.) Sure enough when I walked into her room she had both arms free and was sitting up doing crossword puzzles. By coincidence the doctor came in. I mentioned the dementia and the difficulty of keeping Mom's arm in the sling. His reply? "Don't worry about it. The sling is just to improve the comfort level while she is healing. If she is comfortable without it, that's fine." !!! Of course the staff has to follow the orders they are given. The orders just say, "Sling," they don't say, "Sling as needed for patient's comfort."
As to the issue of whether you should have decided to have the pacemaker at all, as I understand it keeping the heartbeat steady contributes to the patient's comfort. It does not extend the patient's life. My husband was adamant that no measures be used to extend his life. He had his heart surgeon take out the defibrillator but continued using the pacemaker. He had a DNR order and as far as he was concerned the defibrillator violated that. But he was not at all opposed to being comfortable.
I spent several days in the hospital after being diagnosed with diabetes. Each day I got two very big bottles of diet coke. I don't like any pop, so I offered it to the next aide who came into the room. (I never got turned down.) When I got one with my breakfast the third day, I asked the nurse why I kept getting them. She had never seen that before so she looked at the orders. The doctor had written "2 liters diet coke/day" when what he meant was "up to 2 liters of diet coke if patient asks for pop."
When I remind him to keep his arm down, his pat answer is that his arm does not hurt. He does not remember that he has a pacemaker, even when I show him the fresh incision in his upper left chest.
I have contacted the cardiology department at our VA, and they said to not restrain him. So. I will not restrain his arm anymore.
That makes sense to me, because to gracefully raise his arm for whatever reason he has is much less traumatic to his pacer wires than him straining against a restrained arm, and in the process, breaking the restraint and forcefully overshooting his arm.
Also, he was told not to arc weld again. I called the manufacturer, he suggested my husband keep the welder away from himself by pulling the welding cables out straight and working as far away from the machine as possible. The Manufacturer also said, "Use common sense, if you feel funny, stop welding".
A lot of time I think Doctors are just covering themselves with instructions and have no thought for the patient's quality of life.
My decision is this:
Current therapy is not working. I was in a state of total anxiety which spilled all over my totally innocent husband and lover.
I have done a complete turn around.
However, as long as he will tolerate it, for the next six weeks, we will continue the t shirt at night with his left arm tucked inside.
The rest of the time, I will simply be proactive (good word, there) and prevent the need for him to raise him arm as much as possible.
No more shouting or crying. All that does is create angst.
No more daytime physical restraints of any kind.
It was driving me nuts and as a result keeping us both in a state of turmoil.
The past 18 hours has been peaceful. Want to keep it that way.
He is 85, right handed, in good physical shape for his age. We walk at least 2 miles a day up and down hills.
Thank God for this forum.
Thank God.