There’s no reason for a pacemaker or defibrillator to zap wanderlust
Less than a month after Charles “Chick” Woodfall, 78, got his defibrillator implanted in 2000, he and his wife, Nancy, 72, traveled in their nearly 27-foot motor home from the Palo Alto area to Morro Bay, about 200 miles south.
Three weeks after Jeyne Brown, 80, of Los Feliz, got her pacemaker implanted in the summer of 2000, she took off to sightsee in Eastern Europe.
And barely a day after my dad, now 86, was discharged from the hospital in Lafayette, Ind., last November with his new defibrillator, he was on the road with my mother and sister, heading for Thanksgiving dinner in Wichita, Kan. Had the doctor allowed it, he would have taken the wheel for the 715-mile trip. Instead he tried to be a patient passenger.
As this trio proves, having an implanted pacemaker or defibrillator to regulate heart rhythms is no reason to stay home -- at least not for long. Doctors who implant the devices say that as long as reasonable precautions are taken during the early healing period, most who are otherwise healthy can take to the road or the sky with no problems. Exactly how soon varies from patient to patient.
As manufacturers make it simpler to check on these devices remotely, it will soon be even easier to leave home knowing care will be thorough. And if travelers take the time to learn about their device and how to handle airport security, the road will be smoother still.
About 500,000 people in the United States have pacemakers, and 250,000 have implanted cardioverter defibrillators, or ICDs, according to the North American Society of Pacing and Electrophysiology, the association for cardiac arrhythmia professionals. Pacemakers and ICDs are about the size of a pager and are implanted under the skin near the collarbone. Electrodes connect the device to the heart so it can help monitor and correct its rhythm. Pacemakers stimulate the heart to beat at a rate that’s best for the individual patient. ICDs detect life-threatening heart rhythms and “reset” or shock the heart to correct them.
Resting a bit after the device is implanted is recommended, says Dr. Kalyanam Shivkumar, director of interventional cardiac electrophysiology at the David Geffen School of Medicine at UCLA. “Typically I ground patients for a week or so,” he says. But he makes the decision on a case-by-case basis.
Whether traveling or at home, patients should keep the area around the implant site clean, dry and covered, says Dr. Ravi Dave, an interventional cardiologist at Santa Monica-UCLA Medical Center and a UCLA assistant professor of medicine. Don’t raise the implant-side arm above the shoulder during the healing period, which lasts for about two weeks after implantation, advises Shivkumar. (And that means no stuffing bags into the overhead compartment on airplanes, he adds.) This allows the electrode leads to stabilize and helps the incision heal.
Dave suggests that once those with new pacemakers or defibrillators begin to travel by air, they should “wear clothing that will be easy to take off to show you have a pacemaker. I’ve had patients who have been asked to show security officials at airports [the devices].”
Taking along your implant ID card is a must, doctors say, to prove you do have the device, especially in this era of tightened airport security.
As for the security checkpoints, manufacturers say the airport security system and the hand-held metal detector, or wand, are typically safe for those with implanted devices. But passengers who are not comfortable with the idea should request hand security checks.
“If you walk normally through the airport security system, it will not reset a pacemaker or defibrillator,” says Scott Papillon of Medtronic, a manufacturer of the devices. Likewise, he says, the wand that is sometimes passed over a passenger’s body is OK as long as security personnel “don’t stop it at the site and hold it there.” Pacemaker and defibrillator wearers who request a hand search are typically accommodated, Papillon says.
Wands and airport security systems are generally safe for those with pacemakers or ICDs, agrees Peter Gove of St. Jude Medical Inc. But an implant may set off the alarm on the security system, he says.
If you’re traveling alone and are wary of leaving your bags on the X-ray belt while you go off for a private search, call the airline beforehand to explain the situation and ask if you can get a wheelchair when you arrive at the airport, suggests Ron Pelayo, assistant federal security director for the Department of Transportation at Los Angeles International Airport. “Then let the wheelchair person keep tabs on your bags,” he says.
Know your pace
Travelers with pacemakers or defibrillators should know basic information about the device, such as the setting, or heart rate. A setting of 72 is common, Dave says. If you know that, you can do a crude test by taking your pulse. If it is close to the heart rate setting, you can be fairly sure the implant is set properly.
“Patient education is critical,” Shivkumar agrees. “Know your device. Know the brand and the make. Rarely does travel affect a pacemaker or defibrillator. But if someone is going away for six months to a year, it is wise to have it checked out before leaving.”
Patients who travel can send data about their devices back to their doctor, just as some do from home. For years, patients with pacemakers have been able to send an electrocardiogram over phone lines using a trans- telephonic monitoring transmitter. This does, however, have limitations. “That only shows you what the electrocardiogram is at the moment they are hooked up,” says Dr. Kenneth Riff of Medtronic. And it is not useful for defibrillators, because physicians need to know if the device has shocked the heart back into a normal rhythm and what kinds of abnormal rhythms have occurred, he says.
A newer system can help those with defibrillators transmit information to their doctor over the Internet. Medtronic’s CareLink Monitor system was approved by the Food and Drug Administration earlier this year for defibrillator patients, Riff says. (The company also hopes to get approval for the monitor system for use with pacemakers.) Using this system, the patient holds a small antenna-like device over the implant, collecting information that the monitor then digitally transmits through a standard phone line. The information includes not just an electrocardiogram but also a history of abnormal rhythms and corrective actions taken. The data are stored on a secure server, and both doctor and patient can access them online.
Defibrillator cannot yet be programmed via the Internet, Riff says, so if corrective action is needed, the patient would be referred to a nearby doctor.
The system is expected to be a boon for patients who divide their time between two homes, Riff says. Generally, defibrillator patients are checked every three months, he says, and pacemaker patients every six or 12 months.
Some patients say they feel more able to travel after the device is implanted. “There’s a feeling of security that the thing is in there,” Woodfall says. He and his wife travel as frequently as they did before. So do my dad and my mom, who has a pacemaker.
A few days after Thanksgiving last year, they drove home. “The hardest part was waiting for the implant site to heal,” Dad says. Otherwise, “I was able to do everything I wanted.”
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Healthy Traveler appears twice a month. Kathleen Doheny can be reached at kathleendoheny@earthlink.net.
