00 their losses to zero, she says. Although the program costs about $30 for each participating server, Mr. Waxer says there can be financial rewards for estab- lishments considering TIPS: Some insurance companies will give a rate break to participating businesses. Reaching as large a population as possible with the TIPS mes- sage provides a personal reward, too. "Knowing that I have very like- ly saved at least one life with this program," he says, "makes me feel it's worth it." MARSHALL FRANKLIN SPECIAL TO THE JEWISH NEWS -_.. -,= / N, ht The ❑ A Pacemaker Can Save Your Life I lica1th fair he heart has its own elec- when his heartbeat returned. He trical system. One part of was not aware of the episode the system is a cluster of when questioned afterward. We hospitalized Jack immedi- special cells called the sinus node. This is the heart's natural ately. Jack had not been taking drugs pacemaker. A chemical reaction within that might cause CHB. He had these cells generates a recurring not had a heart attack, nor did he electrical signal that is transmit- appear to have some other struc- ted over fleshy wires called the tural heart disease known to Purkinje System. These signals cause CHB. He had a condition stimulate heart muscles to con- most probably due to the deterio- tract in the proper sequence for ration of the heart's electrical sys- blood propulsion. tern with age. Jack needed a reliable stimu- The sinus node responds to messages the body sends it. That later to make the heart beat fast is why the heart beats more slow- enough to keep a good blood sup- ly when we are calm or sleeping ply pumping to his brain and oth- and faster when we exercise, be- er vital organs. That is what an come excited or have a fever. The artificial pacemaker does. An artificial pacemaker has two heart stops if something corn- pletely blocks the sinus node's sig- components — the battery pack nal from the Purkinje System. and the lead. The battery pack This is called complete heart block acts like the sinus node and the Sometimes a secondary pace- lead like the Purkinje System. The maker, other than the sinus node, battery pack's circuitry delivers will take control of the heartbeat repetitive small electric shocks when CHB occurs. In this case the that are transmitted to the heart pace is much slower — usually muscle via a thin insulated wire fewer than 50 beats per minute called the lead. The frequency of the shocks can and sometimes in the low to mid- 30s. This is too slow to maintain be changed electronically or by vital body functions adequately. sensing circuits in the battery An example: Jack Wilson is an pack programmed to respond to active 78-year-old man who re- various signals from the body. cently fainted. He had been feel- A permanent pacemaker is fin- ing well prior to that time, but his planted in the operating room. family felt he was no longer as The patient is sedated but not sharp mentally. On occasion he placed under general anesthesia. would seem to fall asleep in the The surgeon injects local anes- middle of a conversation. thetic into the skin of the left up- One day Jack woke up on the per chest, just inside the left floor and didn't know how he got shoulder. Through a small incision the there. A few days later, while walking with a friend, he fainted, physician finds a vein and inserts the lead into it. The lead is thread- fell and bruised his forehead. In the doctor's office an electro- ed through the vein, into the chest, cardiogram indicated complete and put in contact with the wall heart block. Although the ECG of the heart by means of the flu- showed the sinus node was firing oroscope. A sequence of tests makes cer- at 85 beats per minute, the heart was only beating at 36. In addi- taro there is secure lead contact tion, from time to time the heart- with the heart wall and good elec- beat would pause for a few trical capture of the heartbeat. seconds. The doctor then connects the lead On one occasion the ECG and battery pack. The whole sys- showed a six-second pause. At the tern is retested to make certain it same time Jack's eyes began to is working properly Finally, the roll. He looked as if he were about lead and battery pack are packed to faint. He promptly awakened under the skin and the incision is closed. Jack later got a special trans- Dr. Marshall Franklin is a San mission unit that can check his Diego-based cardiologist who pacemaker from any telephone. ❑ writes for Copley News Service. 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