Recently I was on the bus when my implantable cardioverter defibrillator (ICD) kicked in and saved my life.
But afterwards I was told the battery had less than a month of power left. I’ve since heard that pacemakers can deteriorate near their battery renewal date but improve once a new battery is fitted. Can this happen?
Name and address supplied.
This must be a great worry for you. For the benefit of other readers, let me first explain the reasons for having an ICD and the way it functions.
It is a small device placed in the chest to detect and correct abnormal heart rhythms. It is similar to a pacemaker but contains additional technology and can deliver a larger electrical shock to reboot the heart.
An ICD is typically given to patients at risk of an unusually rapid heart rhythm, such as ventricular tachycardia. This can lead to ventricular fibrillation, the most common cause of sudden cardiac death.
It requires an electric shock to restore the normal heart rhythm, which feels like a thump on the chest. The device should usually be carefully reviewed every six to 12 months at your local cardiology unit by an electrophysiologist, a highly trained technician who checks, for example, the leads that connect the device to the heart, the software, and how much battery life remains.
The device should usually be carefully reviewed every six to 12 months at your local cardiology unit by an electrophysiologist
The battery life of an ICD is usually five to six years, but this can depend on how often the device gives off shocks, which require more energy than its more passive monitoring function. This may explain the anecdotal stories of batteries running lower after cardiac problems in patients.
Since the Covid-19 pandemic, many patients with an ICD have been given an ICD monitoring device to use at home. It should be placed next to their bed, where it will remotely monitor ICD functions at night, sending data to their electrophysiologist.
This represents a major advance in care for those with heart problems, but it does require a wifi connection.
From what you say, it appears that you may not have been given this device or had a recent check-up. I would recommend that you speak to your cardiologist to see if this home monitoring service might be available to you, as this should ease any concerns with regards to a low battery.
My wife has a pessary for pelvic organ prolapse. Last weekend, it fell out and the organs it was supporting slipped down. We called NHS 111 and 999 but were told that nothing could be done. She is 82 and does not want an operation. Are there any other treatments?
Peter Berriman, Angmering, W. Sussex.
Pelvic organ prolapse — where the uterus, bowel or bladder slip down into the vagina — is very common. It occurs when the muscles and tissues that support the organs weaken as a result of age, obesity or childbirth.
Indeed, around 50 per cent of women who have given birth naturally have some degree of prolapse of the womb — 10 to 20 per cent will have symptoms such as incontinence as a result. Treatment options depend on the severity of the symptoms and their impact on quality of life.
The most common non-surgical treatment — the route your wife is following — is a vaginal pessary. The silicone device is placed in the vagina to painlessly support the pelvic organs.
The pessary is fitted by a gynaecologist. Factors such as ageing and weight change can affect the fit, so a follow-up appointment is needed every six to 12 months to check this.
Without these essential reviews, patients can find themselves in a situation like your wife’s.
Pelvic floor exercises to strengthen the muscle holding the organs in place are the second key strand of non-surgical manage-ment. Taught by a specialised physiotherapist and subsequently practised at home, they can lead to a substantial improvement.
It is never too late to start these, and your wife’s gynaecologist can arrange a referral.
When pessaries and pelvic floor exercises don’t work or a prolapse is severe, there are a number of surgical options.
You say your wife is reluctant to pursue these and I fully understand why — the operation has been associated with a recurrence rate of up to 30 per cent, and between 13 and 65 per cent of continent women develop stress urinary incontinence after the surgery.
With this in mind, I urge your wife to ask her GP for a referral to a gynaecologist for a reassessment and placement of a new pessary. She should also enquire about pelvic floor exercise sessions.
She has been poorly served by the health service thus far, likely due to the pressures placed on general practice and the NHS by the pandemic.
But, be reassured, help is available, and her predicament is remediable.