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Hi. My dad is 87. He is on dialysis 3 days a week, which usually wipes him out. On top of that his heart dr wants to put a pacemaker in. Will it give him more energy? Will it make his heart stronger? The doctor says it will but that doesn't make sense to me. Is a pacemaker put in to help your heart pump or to help when your heart stops? I'm so confused. Any info would surely help. Thanks, Deb

Read the book, article, or watch the video by Dr Atul Gwande, "Being Mortal." This discusses end of life issues and the damage and suffering that occurs when we aggressively treat elders who are honestly on their way out.
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This is a good basic intro:

https://www.youtube.com/watch?v=sbHFDZxVrTw
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AlvaDeer Aug 7, 2019
You are so kind to look this up.
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Thanks for answering alva. I will google it.
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My father has the will to live but can his body keep up with his mind? Im afraid its not going to. His body seems to be failing pretty fast but his mind is pretty sharp. Except when hes in the hospital. He still takes care of all his finances. We still have the best family time when hes up to it. My heart hurts for him. He lives for his disabled grandson. He worries what will happen to us when hes gone. Even though we will be just fine. We always have been. But it is constant on his mind.
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AlvaDeer Aug 7, 2019
If HE isn't willing to give up, then don't you either. Just get all the info for him and let him make his decision. I had to learn that from a priest I cared for. He was so ill, and his care so devastating to nursing personnel that we were assigned to go in in pairs to spare us. One day I came out the door, collapsed on the wall and cried, saying "Why won't his God relieve his suffering". Next night, after our care, us all masked and gowned, he says to us "Girls, if I fall asleep could you wake me at 9 pm". Sure we could, but I couldn't help but ask why. "Quincy comes on at 9. I love that show about the coroner". I was ready for him to go. HE wasn't ready to go. Life was still worth it for him. I never again assumed that someone should go because I couldn't bear what was happening to him or her.
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Sure. They will do everything unless someone requests that they do NOT. Pacemakers are usually used for arrhythmias. That is to say the heart is too fast, or too slow, or too irratic in the electrical system. So the pacer is set to control rate, etc. The pacer is easy to understand if you google "how does a pacemaker work". The doctor will tell you why he thinks a pacemaker is appropriate for this patient and reasons vary. They do NOT help the heart pump. That is the mechanical and pacers regulate the electrical. It is all quite involved and there are many reasons for a pacemaker. My husband has one because he has chronic atrial fibrillation, and his medications for THIS can slow his already quite slow heart too much. So the pacer triggers beats when the heart slows below 60. All that said, and after you google and understand, and after you speak to the doctors there is THIS:
The pacemaker, yes, will likely prolong his life. Is that what he wants? Many people STOP dialysis because they do not wish to go on. Doctors will threaten you with "That is a very ugly death". On the contrary. It is not. It is in fact quite quick and easily medicated for comfort.
So your real question is : How much longer does he wish to fight to live. If the answer is that he wants to fight on and finds his life of value enough, then, yes, have the pacer. Today it is an in and out surgery in a day barring complications. I do not know his condition. If he wishes now to receive palliative care only, and to pass peacefully from life, it is time to say that he will have no more procedures and medications and treatments to prolong life.
So this, like most medical procedures is an individual decision. I worked cardiac all my life.
Do know that just occasionally pacers are placed that are automatic defibrillators, in that they give a bit of a shock if the deadly arrhythmia of ventricular fibrillation occurs. Ventricular Fib itself is a fast and merciful death; people who "go down" in the street from it don't have time to even whimper. This type of pacer can deliver a bit of a shock. Some get used to it. Others hate it. This is not the most common pacer.
So discuss this thoroughly with the doctor. If they have no time to discuss it with you then do not consider it. Also get out there on google. As I said, a pacemaker is pretty simple. You will easily understand how they work after they walk you through it on youtube or google. Good luck. Let us know what is decided.
And remember, if a doctor has no time to explain things to you then this is not the doctor nor the procedure for you.
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Just hearing that eases my mind. Our next appt is next monday. He sent us home to think about it. My dad is all for it but he doesnt do well in hospitals. He hallucinates so bad that we had to leave the last time because the nurses felt he might hurt them. He was hallucinating that they were taking his blood and selling it on the black market. He was in there for a dialysis treatment. He had skipped his regular appt so he had to go to the hospital for one. If it might help his kidney function im all for it. I need to ask the dr more questions. Thank you so much.
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AlvaDeer Aug 7, 2019
He may be in and out. It often is in in the morning and out in the evening. They seldom give a general. Just something to relax and on they go, so not as much danger of anesthesia problems. He up up to date.
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A pacemaker sends a current through the heart muscle to regulate its contractions. There are various types.

The "helping when your heart stops" bit is when the pacemaker includes a defibrillator. Then, when the muscle in the heart "flutters" instead of contracting properly, the defibrillator shocks it back into its proper rhythm.

This is all very roughly speaking!

But *in any case* your father's cardiologist MUST explain his plan to you properly, and not just send you off with a vague assurance that the pacemaker will make your father's heart stronger.

There is a saying "if you can't explain a thing to your grandmother, you haven't understood it fully." So based on that, your cardiologist can't expect you to trust his advice if he hasn't explained it. He can tell you how the pacemaker he is suggesting works, and how it will help your father's heart.

Assuming his reasons are good (and I do assume that, I don't suppose he'd recommend it otherwise), then improved heart function should also improve your father's kidney function, and your father will benefit. The process of implanting a pacemaker really isn't much to worry about, but ask the cardiologist to explain that to you as well.
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