Keeping up with pacemakers

In Episode 11 of the Healthy Matters Podcast, I enjoy an electrifying conversation with electrophysiologist Dr. Rehan Karim about pacemakers. He’s a cardiologist who specializes in the electrical systems of your heart. Why do some people need pacemakers? What exactly do they do?

“In simplistic terms, the only job of a pacemaker is to prevent the heart from going too slow,” explained Dr. Karim. “If someone’s heart rate is very slow, they are going to have symptoms like feeling dizzy or lightheaded. The pacemaker’s main task is to make sure that it’s providing a minimum heart rate.”

So it sets the pace. That’s where we get the term, “pacemaker.” In addition to feeling dizzy, Dr. Karim said that people can pass out and injure themselves if their heart decides to slow down and not beat – even for a few seconds.

“Sometimes when there’s an electrical problem, the heart rate doesn’t increase appropriately in scenarios when it should increase with exertion,” he said. “This can also make people feel very fatigued.”

Dr. Karim mentioned how in adults aged seventy-five or older, more than 2,500 out of one hundred thousand may end up needing pacemakers. “You can think of it this way: as time passes by, the electrical wiring tends to get worn out and may need some extra support.”

The same-day procedure for pacemaker placement is not extremely complicated, and usually takes about an hour.

“For comfort, patients are given a mild to moderate degree of sedative drugs to make sure they’re not having too much pain,” said Dr. Karim. “So, we give local anesthesia, and the incision may be about two to three finger breadths. Patients may feel a slight pushing and tugging kind of sensation on the skin. And you know how they say all roads lead to Rome? Well all veins go to the heart. So basically, you get access to a large vein under the collarbone, thread a couple of wires into the heart, and those wires have a little screw at the tip. The screw is then secured into the heart muscle.”

Dr. Karim wants patients to take away three important messages about pacemakers from this podcast:

  1. Pacemakers are there to treat your symptoms, not to “set” a specific number for your heart rate, for example.
  2. Pacemakers can make a big difference in someone’s life and people can lead as normal of a life as possible with them.
  3. There are a lot of resources available if you have any questions. He recommends the Heart Rhythm Society. They have a website for patients called which has a lot of information about heart rhythm disorders in general.

More about what to expect during and post-procedure, the future of pacemakers, and great questions and answers about microwaving oatmeal and airport security are discussed in Episode 11 of the Healthy Matters Podcast.




Pediatrics! Where it all begins…

Kids don’t come with a guidebook? In Episode One of Season 2 of the Healthy Matters Podcast we have the next best thing – Dr. Krishnan Subrahmanian, pediatrician at Hennepin Healthcare! We talk about RSV and other viral illnesses, early childhood development, reading and language development, and how to access your child’s pediatrician. (Warning: This is snot an episode for those who get queasy hearing the word “booger.”)

Dr. Krish – as he often is called – was a high school special education teacher before he became a pediatrician.

“The kids were incredible. They were amazing. They inspired me. They made me think, they challenged me. And I honestly loved my job as a special education teacher. My hats and heart go off to all the special education teachers out there. They do incredible work.”

This love of learning spills over into his work as a pediatrician, and Dr. Krish’s interest in brain development – especially at an early age.

“Actually 90 to 95% of brain development – neuronal connections – has happened by the age of five,” he explains. “And it leads us to think, ‘wait a minute, what are we doing in those early years to help support that brain development to get kids off to the best start?’ What this means is that even pre-birth in utero, brain development is starting, and neuronal connections in those first few months and years of life are growing every day.”

Dr. Krish explains how playing with children, talking to children, and singing with children helps form a brain that is more able to learn, more able to grow, and sets them up for success for the rest of their lives.

“There’s a type of interaction called serve and return learning,” he shared. “It’s the kind of thing that you see folks do all the time. ‘Hey, baby, how you doing? How’s it going?’ And then waiting for that little response, that smile or that cue back from the baby. That kind of communication pattern, giving a little bit to the baby, waiting for the return and, and ensuring that we do that repeatedly, really does help form brain connections and can begin right from the very moment that they join your family.”

While Dr. Krish and I talk about ways to relieve nasal congestion, reduce fever, and when to bring your child in to be seen by a physician he also gives this piece of advice for the well-being of children, which is very worthy of sharing:

“The greatest tool and gift we have for little babies and kids is an adult who loves them, is an adult who cares for them, is an adult who’s investing their time and energy. If you can spend yourself, your time, your energy, that will make the biggest difference.”

Wise words indeed. Thanks for listening to Episode One of Season 2 of the Healthy Matters Podcast!


The fentanyl addiction experience

Fentanyl has been plaguing our society for quite some time now. In Episode 4 of Season 3, addiction medicine specialist Dr. Lauren Graber sheds some light on the substance.  She starts with an alarming number:

  • In 2022, fentanyl claimed the lives of more than 73,000 people. This is more than a year’s worth of car accidents in the United States – and traumatic in so many different ways.

“Fentanyl is a high potency synthetic opioid – it is 50 times stronger than heroin,” she explains. “In general, opioids are medications that hit that opioid pain receptor and help with pain. The opioids that come naturally are from the poppy plant, like morphine and heroin. Fentanyl is synthetic – meaning it is made by humans from other different substances.”

These substances come from a number of places around the globe and then arrive in the U.S. in various ways. Because fentanyl is such a strong medication, a little bit can have a huge impact.

“And that makes it a lot easier to get into the country, because whether it’s coming by mail, land or water, it can come in small batches and it’s harder to detect. It’s also much cheaper and stronger than other opioids,” said Dr. Graber, who also talked about the many legitimate, effective uses to manage pain. It’s used often in surgery for anesthesia. It’s fast-acting and can be carefully monitored and safely administered to patients who need relief from pain that cannot be achieved from other medications – but it’s rarely sent home with patients.

Outside of a medical setting is where it becomes a concern, she explains. “I think it’s used in a lot of different ways and for a lot of different reasons. Our patients come from every background, every neighborhood of the city and really have a lot of reasons about what things started them off in using fentanyl. I think there’s a very close association with pain, and a very close association with going through hard times, whatever that is for a person. It’s a really personal reason why people start using.”

Dr. Graber talked about the many ways people use fentanyl, its addictive properties, and that sometimes people may not even realize what they’re using contains fentanyl – a trend she’s become more aware of in the past year or two.

“People think they’re getting one thing and then actually it’s mixed with something else. I think the most common contaminants are stimulants like cocaine, crack, and meth. These are sometimes mixed with fentanyl – especially the powder forms. Because fentanyl is so powerful, it’s really easy to cut in or mix it in with some of those other substances in a way that could be surprising – and devastating.”

We talked about the larger scope of opioid addiction, its stigma, and its societal impact, as well as withdrawal symptoms (remember the worst flu you’ve ever had?) and the hope for recovery. Listen to this important conversation about fentanyl on Episode 4 of Season 3 of the Healthy Matters Podcast.