My Next Pacemaker Surgery

I found out a few weeks ago that something is wrong with my pacemaker, and it has to be replaced. At first I was really scared. I still am a little scared, but my Mom explained that they are just taking one out (both of my old ones) and putting a new one in.

I'll keep you updated on how things go.

Thinking about Other People

Because I have a pacemaker and my scars, I think that I am more kind to other people who are different. I don't think it is funny to make fun of other people if they have issues, because we all have them or we all will have them. I do not use words like "retard," even just being funny. I have met people with Down's Syndrome in my life, and they are probably some of the nicest people I will ever meet. When I think of someone like that, I am grateful to have my pacemaker--instead of something else. I think I have a good life. I love my life.

Pacemaker Checks

Pacemaker checks are really very simple. I do some checks over the phone where they just put stickers on my chest. Some of the checks I do in the doctor's office. I have to stay real still.

When they put the magnet over my pacemaker, I can feel my heart slow down. It does not hurt.

Life with a Pacemaker

Even though I have a pacemaker, I stay active. I play tennis, and I LOVE to swim. I go swimming a lot in the summer. I also want to be in the Drama Club next year. I stay very busy.

We have trees on the side of our house, and we also have some near a lake where we live. I love to climb them! I have gotten a lot of cuts before, but it doesn't slow me down.

Most of the time I don't even notice or remember I have a pacemaker. I move a lot, so I am always making new friends who don't know I have a pacemaker. One day in the fourth grade, I told my friend Ashlyn that I had a pacemaker, and about 10-20 people came up to me and asked if I seriously had a pacemaker. They thought it was so cool. A lot of times I am popular for a while when people first find out. Some of the boys don't care though. It is pretty funny.

I think I am like any other pre-teen. I enjoy hanging out with my friends, listening to music, and going to the movies. I go to the beach a lot with my friend, Morgan, and I love it there.

My doctor says the pacemaker is about the size of a Girl Scout Thin Mint Cookie (which I love--yummy, my mouth is watering just thinking about it). Sometimes I am surprised that something so small can last so long.

The Scars

I have several scars on me from my pacemaker surgeries. I have one down near my belly-button that is about 2 1/2 inches across. I have another scar that is about 3 inches that runs up and down (Mom says its called "vertical"). I have another one just beneath that one that looks like a star; it has five dots looking like the points of a star. I have one up near my shoulder that looks a little like a hill.

Sometimes I like to feel the wires connecting to the pacemaker. I can feel it just by touching the hill-like scar. It is pretty cool.

Sometimes my scars make me feel very different, but some days I think they are pretty cool. It just depends on what type of day I'm having.

Lamby

Before I was born, my Papa gave my mom a little, pink and white lamb (that is shaved) for me. The lamb went with my mom to the hospital, and they put it in my bed with me after I was born. It rode with me in the ambulance too.

When I was older, I named it "Lamby." Lamby went with me to my second pacemaker surgery too--even in the operating room. She is going with me to my third pacemaker surgery next month. Lamby is over 10 years old now. She is older than me!

I think it's helpful to have a special stuffed animal with you along the way. I used to talk to her and let my feelings out. I felt like she was listening, and I knew for a fact that she would not make any comments! In my mind, she would talk to me.

My First Surgery Thoughts

I do not remember my first pacemaker surgery, because I was only a few days old. I was almost three-years-old when I had my second surgery. I remember a few things about it. There was a room across the hall from me that had stuffed animals, games, other toys, and videos. I remember getting pulled around in a wagon that was made into a bed.

After my surgery, I remember the nurse asked me if I felt different. I told her "Up here it's itchy," pointing to where my new pacemaker was. She took off a bandage, which I thought was a sticker. There was my scar.

Lots of my family came from near and far to be with me. Someone brought me a Beany Baby Bear that was white with a blue heart on its chest and a blue, silk ribbon around its neck. Mommy told me its name was "Earl Bear." It was named after the man that made the first pacemaker. I still have it today.

Pacemaker "Recall"

The third week of May I received a message from Dr. Buck at UNC. He said that he had been contacted by Medtronic about issues with Grace’s pacemaker, and he would like to speak with me about our options. As it turns out, Grace’s current pacemaker, implanted in July 2002, is affected by Medtronic’s current advisory (http://www.medtees.com/blog/MedtronicKappaSigmaAdvisory.pdf). Essentially it is a“recall.” Even though the failure rate has only been .5% and for the life of her pacemaker it is 3.9%, we decided it is best to replace it. She is not pacemaker dependent; however, her underlying heart rate is quite low. Also, we have worked hard not to make her pacemaker an issue, I do not want us to become hypervigilant now.

Grace was noticeably shaken from the news of her surgery. Her Dad is in Afghanistan, which makes it tougher. She was initially quite frightened, but I have showed her diagrams and talked about the procedure. No leads need to be replaced, so it should be simple. The only unusual item will be the removal of pacemaker number one, which is still in her abdomen area. When she received pacemaker number two, pacemaker number one was left in since she was only a toddler. Grace seems emotionally better. I know we are in good hands at UNC. Dr. Mark Mill will be performing the surgery (http://findadoc.unchealthcare.org/directory/mill).

As a good side note: we switched pediatricians again. When we went in to get a referral, the new pediatrician was amazed at where Grace was on the growth chart. She is now in the 94th percentile for height (4'10") and 69th percentile for weight! So much for all the people telling me how small she was as an infant!

I will keep you updated on our surgery as we get closer...

Another Home, Cardiologist, and School...

The summer of 2007, we departed the rainy Pacific Northwest for sunny North Carolina. Grace was physically growing quickly becoming one of the tallest in her class, even though she is always one of the youngest (an August 17 birthday). She discovered a love for tennis, which she has been playing now for two years. We have a new cardiologist here as well, Dr. Scott Buck (http://findadoc.unchealthcare.org/directory/buck) at North Carolina Children’s Hospital, affiliated with UNC Chapel Hill. Dr. Buck has been following Grace for the past two years.

Within the last year, Grace has expressed some concerns about having her pacemaker and being different. I attribute it to her maturing and entering an age where it is most acceptable to be like others. I try hard to keep the lines of communication open, listen to her feelings, validate her feelings, and assure her that sometimes different is good. I tell her that her scars are the outward signs of strength and to be proud of them.

Breastfeeding Issues

I want to mention my experience with attempting to nurse both Josh and Grace. My intention with both pregnancies was to nurse. In addition to being a Labor and Delivery nurse, April, my mother-in-law, is also a certified lactation consultant. With Grace, I thought it was particularly important that she receive breastmilk. April set me up with all the tools I needed, to include the best pump available. After 2 ½ weeks of trying to pump, I gave up. My milk never came in, despite Herculean efforts by both myself and April. I desperately tried every trick available, but nothing worked. At any particular time, I might get an ounce. One day, I was at it again—crying, feeling inadequate and like I had let down Grace. My Mom was with me at this point and told me that it was more important that I hold Grace lovingly and relaxingly. I gave up and decided to move forward; however, I carried the guilt that I had not done the best for Grace. April found out years later that steroid use in pregnancy can potentially cause the problem I experienced.

With my pregnancy with Josh, I was more determined than ever to breastfeed. I got all the latest cool stuff, and I was ready to go. April was there to help again. Within a few days, Josh was screaming and hungry and getting very upset due to lack of food. I had to supplement with formula, but again, I kept trying—more tricks, pumping, and effort. My volume never increased, and within Josh’s first week I had stopped trying. This time I knew that it was not me. April could not explain it, except that perhaps it was related to Sjogren’s Syndrome. I refuse to own the guilt now. I know with both children I did all that I could. I would be interested in learning of other women with Sjogren’s breastfeeding experiences.

Finally Pregnant...Will it Happen Again?

The idea of having another child was the last thing on my mind for first few years after Grace's birth. Once I got my health back in check, I consulted both an Obstetrician and my Rheumatologist on the chances of having another child with heart block. They both gave me the green light to have another child. When Grace turned two, Bill and I started trying to have another child. While we were pregnant within a couple of months of trying with Grace, this was not the case this time Six months went by with no pregnancy. I was 35 years-old, so I consulted a specialist. We completed all of the standard tests, and were told there was no physical reason for our infertility; my diagnosis was “secondary unexplained infertility.” Bill and I discussed our options, and we decided not to pursue any fertility treatments.

While in Rhode Island, I joined the local YMCA and exercised daily. My body was well-conditioned, and I was able to cut back on my frequency of Salagen (http://fdb.rxlist.com/drugs/mono-237-PILOCARPINE+-+ORAL), which I had been taking for dry mouth symptoms associated with Sjogren’s Syndrome. Just weeks prior to my 38th birthday, I was more than surprised to find out I was pregnant; I had thought I was entering perimenopause. A side note here on my infertility: I still do not know what caused 2 ½ years of infertility. I suspect that part of the cause was age-related; however, a few years later I read that Salagen had some negative fertility outcomes in rats. According to Novartis, the manufacturer of Salagen, “the effects of pilocarpine on male and female fertility are not known.”

While I was elated, I was also terrified at the idea of having another child with heart block. I immediately began seeking the help of specialists. After weighing my options, I opted not to take the steroids as a preventative measure. I was concerned about the effects of the steroids on both the baby and myself, while administering prednisone preventatively had not been proven to be effective. I then began the long wait to the window where heart block develops (generally 18-24 weeks). Along the way, I found out I was expecting a son. While I was excited, the gender did not matter to me--I just wished for his good health.

As the pregnancy progressed, I felt pretty good. At 17 weeks gestation, I began weekly stress tests that continued until the end of my pregnancy. I remained anxious through the weeks, but I no heart block developed. I delivered Josh on November 27, 2004; he was a healthy baby boy. I was concerned that heart block might develop after delivery. I watched Josh closely, but thankfully all continued to be well.

Finding Normalcy

Grace continued to grow and thrive. She became a preschooler, and our family made the move to Newport, Rhode Island in the summer of 2003. We were lucky enough to be seen by Dr. Frank Cecchin again, who had moved to Boston Children’s Hospital. Overall everything looked good. Grace participated in weekly swim lessons and ballet. As parents, Bill and I began to relax with the understanding that Grace was living a good and normal life.

The challenge I found was mentioning “pacemaker” on any school, child care, or sports form. Organizations get nervous, and understandably are concerned about care and/or liability. Over time, I found it is best to always get and have on hand a letter from the cardiologist giving Grace a green light to participate in activities. As she has grown, the concerns have lessened.

In the summer of 2004 we journeyed back across the country to Fort Lewis, WA. We were grateful to have Dr. Puntel again at Madigan Army Medical Center as Grace's Cardiologist. He followed us for our next three years in Washington. We were also seen again for pacemaker checks at Seattle Children’s Hospital. Grace participated in cheerleading and gymnastics. She did well in school, both socially and academically. Her father deployed to Iraq and returned safely.

The Unexpected--Grace Gets a New Pacemaker

In July of 2002, Bill and I took Grace to Children’s Healthcare of Atlanta for a routine pacemaker check. While there, Grace experienced both a normal heart rate and a slow heart rate. Through some fantastic investigative work, Dr. Margaret Strieper (http://www.choa.org/strieper) determined that one of Grace’s leads had become dislodged. The pacemaker was working only when Grace was in certain positions. Grace needed a new pacemaker. This surgery was much easier. She received a new Medtronic pacemaker beneath her collarbone, and the leads were placed transvenously into her heart. Grace’s spirits were great throughout her time there. Recovery was easy, and we were home within a few days.

The most positive outcome of this incident was the knowledge that Grace can live without her pacemaker. While we had been told that Grace was not pacemaker dependent, we could not be certain; however, Grace spent a night in the hospital and a good portion of the day before her surgery being monitored. The night was a bit stressful, as our heart rate slows down while we sleep. Grace’s heart rate dipped into the high 40’s, but she made it. Typically her underlying rate remained what we had been told—in the low 50’s.

The First Two Years & My Diagnosis

The first year was full of typical life with a newborn--lack of sleep and round-the-clock feedings. Both sleep and feedings slowly transitioned to longer durations. In addition to the regular baby check-ups, we had pacemaker and cardiology appointments.

Due to the steroids circulating through my body and the placenta, Grace had to be weaned off the steroids after birth. She was also initially on Lasix (http://en.wikipedia.org/wiki/Furosemide) and Digoxin (http://en.wikipedia.org/wiki/Digoxin) for her heart, but within a short period, she was taken off of those too. Over time and positive feedback on her appointments, my outlook on her future became more positive. Grace was still quite thin. She did not have the stereotypical healthy baby look about her—no chubby cheeks or legs. Strangers often commented on how little she was. I did not admit it, but I was sensitive about it. I knew she did not look healthy.

The Army gave Bill an opportunity to move to Fort Benning, Georgia (we were living in Washington state), and I asked him to take the position. With family in North Carolina and Georgia, I knew I would not feel so alone. We made the move when Grace was ten-months-old. We had a huge first birthday party. Grace was walking, and life was much better.

Over the course of time, my exhaustion did not go away. I attributed it to a host of things: having an infant, the move, and a new job. When Grace was about eighteen-months-old, I started experiencing mild dizziness as well. I finally went to a physician. Two-months later I discovered I had developed Primary Sjogren’s Syndrome. This diagnosis was not a complete surprise, and now I knew the source of my symptoms. For more on Sjogren’s Syndrome, please read http://www.sjogrens.org/home/about-sjogrens-syndrome . With medical treatment and lifestyle management, I began to feel better over the next year. The road to some recovery contained a good deal of trial and error. I came to the realization I could not do some of the things I used to do; my stamina was not the same. Life had been altered, but over time we all adjusted.

Grace continued to grow and progress as a normal toddler. She brought much adventure and laughter into our lives.

Grace's First Surgery

Day three of Grace’s life, she had her surgery for her pacemaker. We have been working with Dr. Frank Cecchin for months also (Dr. Cecchin is now at Boston Children’s Hospital http://specialists.childrenshospital.org/directory/cecchin). I was unprepared for seeing her after the surgery. She was hooked up to all sorts of machines. She had no bandages on her incisions at first, so they look massive on her tiny body. There were three incisions: 1) one vertically down the front and middle of her torso about three inches long, 2) one much smaller incision beneath that one, and 3) a horizontal incision where her pacemaker was implanted in her abdomen. Due to her size, the pacemaker had to be inserted in the abdomen area rather than underneath the collarbone; this is termed an epicardial implant. The incision in the chest allowed the leads to be attached to the outer wall of the heart. This surgery was more serious than a normal pacemaker implantation, in which the leads are placed tranvenously (through the veins). The bulge from the pacemaker in her belly looked so large. The physicians reminded me that the scars will stay the same size throughout Grace’s life; however, her body would grow—making the scars much smaller proportionally.

Grace remains at Seattle Children’s Hospital for one week. It is a tough week for me. I have not healed or rested from the C-section. I am also weaning off of the steroids. Bill spent the nights with her, while I attempted sleep. A nurse commented to me about how wonderful my husband was to Grace; she says he talked or sang to her throughout the nights. He softly sang her Irish lullabies to calm her crying. I did not know this at first, but finding it out was one of those defining moments in life. I knew I had married the right man. Imagining this U.S. Army Special Forces/Green Beret singing to his tiny daughter in the stillness of the night still warms my heart.

Grace grew strong. She cried loudly, in a NICU where many babies were not healthy enough to cry. The nurses told me she is a fighter, and it was time for her to go. Grace was transferred back to Madigan Army Medical Center, where she spent another five days. We were then allowed to take her home. I felt a mixture of emotions—elation at us making it to this point and fear of being away from the monitors and medical staff.

The Delivery

From the time I arrived at the hospital, things progressed quickly. I was excited about Grace's pending arrival, but I was scared that her heart would be too fragile to sustain her. In the delivery room, the anesthetist was making sure I was numb. The staff were busy setting up their stations. I was impressed by their efficiency and sense of purpose. The team was in place, and the surgery began. Bill was at my side. I knew he was scared too; I saw it in his eyes. I then heard the sweetest sound in the world—Grace’s cry! I knew it was a good sign. Grace was shown to me briefly and then whisked off to the Neonatal Intensive Care Unit (NICU).

The next few hours for me seemed like eternity. I had not been prepared for the separation from Grace. I needed to finish the C-section surgery, and then I was off to recovery. This was in the days before digital cameras, but someone was kind enough to take a Polaroid shot of her and attach it to my bed. Looking at it made me sad—I had waited so long for her to be here, and yet I could not hold her or look at her. Finally I was able to get into a wheelchair and go to the NICU. My first glimpse of her was a bit overwhelming; she looked so vulnerable. She weighed only 5 pounds, 12 ounces. There was a large plastic "hood" over her head providing oxygen. The nurse put Grace in my arms. Holding her was awkward. Wires were everywhere, and I had to hold a hose with oxygen up to her nose. It was surreal to hold her in my arms.

Dr. Robert Puntel, Grace’s Pediatric Cardiologist at Madigan Army Medical Center was wonderful. His plan was to first access how well Grace’s heart functioned on its own. In doing so, he allowed me time to recover so I could join her at Seattle Children’s Hospital, which is 40 miles away. I spent as much time as I could with her in the NICU. When I was not there, Bill or some of our family was with Grace.

By day two, her heart was not responding to the medication; she needed the pacemaker surgery. She was transported by ambulance up to Seattle. Bill followed in the car. The physicians allowed me to be discharged early since April is a Labor and Delivery RN. She drove me up to Seattle. The pain from my C-section was greater than I anticipated, and I got around at Seattle Children’s in a wheelchair. The NICU there was much different than the Madigan Army Medical Center NICU. There were some seriously ill and premature babies. It was company I was reluctant to keep--the gravity of Grace's condition descended upon me.

The Pregnancy

The tests came back, and I indeed had the SSA/Ro antibodies. I was instructed to follow-up with a Rheumatologist, as I was likely to develop Sjogren’s Syndrome or Lupus—more great news, which I did not have the time for right now; I had enough worries with the pregnancy and Grace.

I was immediately prescribed Dexamethasone, a steroid (http://en.wikipedia.org/wiki/Dexamethasone). They specialists thought it might keep Grace’s heart block from worsening. In addition, I was put on Terbutaline (http://en.wikipedia.org/wiki/Terbutaline), which is often given for pre-term labor. In my case, it was an effort to speed up Grace’s heart rate. It did slightly, and it sped up my heart rate as well. Within a week or two on these medications, I developed medically-induced gestational diabetes. I added insulin twice a day to my list of medications.

I felt awful—physically and mentally. Each day I prayed to simply allow Grace to grow inside of me. Twice each week I went in for ultrasounds to take a look at Grace’s heart function. We were looking for signs of congestive heart failure (http://www.americanheart.org/presenter.jhtml?identifier=4585). For me, the days and weeks passed slowly. Finally Grace was scheduled for a cesarean section (C-section) at exactly 37 weeks on August 18. The physicians did not think her heart could withstand the stress of delivery. The evening of August 16, my in-laws arrived. My mother-in-law, April, is a Labor and Delivery nurse, and I was grateful to have her with me. The next morning, August 17, I woke up at 6:00am feeling a bit different. Due to April’s professional experience, I found out I was in labor. We were off to the hospital! It did not go unnoticed to me or others that Grace had decided to enter this world on her own terms.

Learning About Congenital Heart Block

So there we were with a diagnosis—third degree congenital heart block or third degree congenital atrioventricular block or congenital complete heart block—long, technical names for the same frightening condition. The counseling began with our team of physicians – Perinatologists, Pediatric Cardiologists, Neonatologists, Electrophysiologists. The education began on the heart and congenital heart block. What is congenital heart block? According to Web MD (http://www.webmd.com/heart-disease/heart-block-congenital):

Within the right atrium of a normal heart is a natural pacemaker that initiates and controls the heartbeat. The electrical stimulus travels from the pacemaker (SA node) to the ventricles along a very specific path consisting of conducting tissue and known as the AV (atrioventricular) node. As long as the electrical impulse is transmitted normally, the heart behaves normally.

If the transmission of the signal is impeded, the blocked transmission is known as a heart block or an AV block. If the heart block occurs in the fetus or newborn, the condition is known as congenital heart block. This condition has nothing at all to do with the flow of blood or with the blockage of a major or minor coronary artery. It is an electrical problem rather than a hydraulic one.

Heart blocks are categorized according to the degree of impairment of the patient. The categories are first, second and third degree heart block.

In summary, Grace's heart did not get the signal to pump blood from one chamber to the other. There was nothing structurally wrong with the heart. Her heart rate in utero was between 50-55 beats per minute. The normal fetal heart rate is between 120 and 160 beats per minute.
Congenital heart block mysteriously develops around the 18-24 week period in pregnancy.

How Our Story Began

My introduction to the world of congenital heart block, pacemakers, and Sjogren’s Syndrome began in April 19, 1999, my 2nd wedding anniversary. I was pregnant with my first child, and I went in for a routine 20-week ultrasound with my husband. We were excited first-time parents and were hoping to find out the sex our baby that day. We had agreed that if our child was a girl, her name would be Grace. I did now know how appropriate that name would actually be.

We found out the baby was a girl, and we also found out she had something seriously wrong with her heart. The ultrasound tech looked worried. A parade of physicians began—moving up various levels until we got to the Pediatric Cardiologist. The diagnosis was congenital heart block. We were told that she may not make it to term. Congestive heart failure was a possibility.

In the haze of that day, I was also told that usually this occurred when a mother has certain antibodies, SSA/Ro and/or SSB/La. These antibodies occur in people that have the conditions of Sjogren's Syndrome and/or Lupus. I was perfectly healthy, with no family history of either. I needed blood tests. Our story began...

Resource List for Parents

1. http://www.childrenshospital.org/az/Site567/mainpageS567P0.html
Source: Children’s Hospital Boston
“Heart’s Electrical System” provides an overview of how the heart pumps/beats. The site achieves credibility by its status as a world-leader in research and treatment, as well as its affiliation with Harvard Medical School. A parent of a child with heart block or an arrhythmia would benefit by learning how the electrical impulses of the heart move through the heart’s conduction system.

2. http://www.childrenshospital.org/az/Site473/mainpageS473P0.html
Source: Children’s Hospital Boston
“Arrhythmia” details extensive information on heart arrhythmias. The author is a world-renowned children’s hospital. The site achieves credibility by its status as a world-leader in research and treatment, as well as its affiliation with Harvard Medical School.
A parent of a child with heart block or an arrhythmia would benefit by learning about the different types of arrhythmias, how arrhythmias are diagnosed, treatments for arrhythmias, and the latest research on arrhythmias.

3. http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/cardiac/pacemkr.html
Source: Lucile Packard Children’s Hospital at Stanford
“Overview of Pacemakers” gives a summary of pacemakers and their components, along with some wonderful illustrations of pacemakers inside the body. The author is a major, well-respected children’s hospital. The site achieves credibility by its reputation as a research children’s hospital and its affiliation with Stanford University. A parent of a child needing a pacemaker or pacemaker replacement would benefit by learning information on pacemaker components, the heart’s electrical system, and pacemaker implantation.

4. http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/cardiac/lwp.html
Source: Lucile Packard Children’s Hospital at Stanford
“Living With a Pacemaker or Implantable Cardioverter Defibrillator (ICD)” provides basic pediatric pacemaker information. The author is a major, well-respected children’s hospital. The site achieves credibility by its reputation as a research children’s hospital and its affiliation with Stanford University. A parent of a child needing a pacemaker or pacemaker replacement would benefit by learning pacemaker precautions, sports participation guidelines, and pulse information.

5. http://www.childrenshospital.org/newsroom/Site1339/printerfriendlypageS1339P1sublevel406.html
Source: Children’s Hospital Boston
“iPods and similar devices found not to affect pacemaker function” reports Boston Children’s own 2007 study on the effect of four digital music players, including the iPod, with pacemakers. The site achieves credibility by its status as a world-leader in research and treatment, as well as its affiliation with Harvard Medical School. A parent of a child with pacemaker would benefit by learning reliable information on whether their child could use a digital music player as well as how it should be used.

6. http://health.groups.yahoo.com/group/heartblockkids/
Source: Yahoo Groups
This online group provides a forum for parents of children with congenital heart block to virtually gather. The “author” is a community of parents sharing the experience of parenting children with congenital heart block. The site achieves credibility by its members’ experiences. A parent of a child with heart block would benefit by learning about other families’ experience with a child with congenital heart block.

7. http://www.bostonscientific.com/procedure/ProcedureLanding.bsci/,,/navRelId/1000.1002/method/Procedure/id/10001001/seo.serve
Source: Guidant/ Boston Scientific
“Pacemaker Implantation” explains the pacemaker implantation procedure, accompanied by an excellent illustration of the procedure image. The author is a one of the largest manufacturers of pacemakers in the world. The site achieves credibility by its status as a pacemaker researcher and manufacturer. A parent of a child with a pacemaker would benefit by 1) viewing the high-quality illustration of a pacemaker implanted within the body, and 2) reading the information on pacemaker implantation.

8. http://www.medtronic.com/rhythms/downloads/UC200602918EN.pdf
Source: Medtronic
The “Electromagnetic Compatibility Guide” lists electronic devices that may interfere with a pacemaker’s performance. The author is a one of the largest manufacturers of pacemakers in the world. The site achieves credibility by its status as a pacemaker researcher and manufacturer. A parent of a child with a pacemaker would benefit by learning what devices are safe to use with a pacemaker as well as restrictions and guidelines on other devices.

9. http://www.medtronic.com/your-health/bradycardia/BRADYCARDIA-BROCHURES.htm
Source: Medtronic
“Printable Brochures” lists a large number of helpful brochures for people living with pacemakers. The author is a one of the largest manufacturers of pacemakers in the world. The site achieves credibility by its status as a pacemaker researcher and manufacturer. A parent of a child with a pacemaker would benefit by reading specific brochures about pacemakers as they relate to dental and medical procedures, and cell phones, as well as brochures on the heart and circulatory system.

10. http://www.lifebeatonline.com/
Source: Guidant/ Boston Scientific
“Lifebeat Online,” an e-newsletter, provides pacemaker updates, cardiac news and health tips. The author is a one of the largest manufacturers of pacemakers in the world. The site achieves credibility by its status as a pacemaker researcher and manufacturer. A parent of a child with a pacemaker would benefit by subscribing to the newsletter and receiving updates and tips.

The Disclaimer

Every site now has to have its disclaimer, so here is ours:

Neither Grace nor Cheryl claim to be any medical expert, nor do we have any medical training. This is simply a journal of our individual experiences, which is not to be taken as medical advice. Please consult your physician to see what is right for you/your child.