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Dear Dr. Roach: How does a person with a pacemaker die? Won’t the pacemaker keep the heart beating? My husband is 87 and on his seventh pacemaker. Please advise so that I know what to expect.

G.D.

Dear G.D.: An electronic pacemaker is implanted for a variety of electrical problems with the heart when a person’s natural pacemaker, located high in the right atrium, fails to do its job of stimulating the heartbeat.

When someone dies, the heartbeat irreversibly stops. That’s part of the legal definition the physician uses most commonly when declaring someone deceased. Patients also may be declared dead with irreversible cessation of brain function, which is the case for most organ donors. In that case, machines, including mechanical ventilators, keep the body alive.

The electronic pacemaker will keep sending electrical signals until its battery runs out, but the heart cannot respond mechanically. The electrical signal is imperceptible.

Let us hope your husband wears out several more pacemakers.

Dear Dr. Roach: Should an otherwise healthy 63-year-old female who has had genital herpes for 28 years still get the shingles vaccine?

Wouldn’t there be some immunity built up in her system, as she has regular occurring outbreaks, six times or more annually?

C.S.

Dear C.S.: Genital herpes usually is caused by herpes simplex virus 2 (it can rarely be caused by HSV-1), which is related to the virus that causes shingles, varicella-zoster.

Unfortunately, the two viruses are different enough that a history of genital herpes doesn’t protect you from developing shingles. So, the vaccine is recommended for all adults over 60, unless there is a reason not to get it, such as a deficiency in the immune system due to recent chemotherapy.

Herpes viruses (there are eight in total) are very good at evading the immune system, and the vaccines for herpes viruses have so far been disappointing; only the shingles and chickenpox vaccines are effective (and even they are not as effective as we’d like).

There are new vaccines in development that hopefully will give more complete and longer-lasting protection.

Email questions to ToYourGoodHealth@med.cornell.edu.

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