Self-powered implanted programmable medication system and method

Claims

What is claimed is:

1. A self-powered programmable apparatus adapted to be totally received within a selected animal body, including human, for periodically dispensing selected medication therein according to a selected program coordinated with need while leaving the body ambulatory at all times, comprising:

(a) a storage member mounted within the body for storing selected medication to be dispensed therein;

(b) a micro size power source mounted within implanted housing means and having a useful working life in terms of at least several days;

(c) miniaturized dispensing means mounted within implanted housing means and adapted to be operated under programmed electrical control to cause selected said medication to be discharged from the implanted storage member into said body; and

(d) miniaturized programmable electrical control circuit means mounted within implanted housing means and connected to be energized by said power source, said electrical control means being adapted for performing control operations according to program instructions for actuation of said dispensing means, said control means embodying selectable and resettable plural program configurations, each program configuration providing a selection of logic stored digital control data corresponding to a set of predetermined body conditions and medical dispensation therefor, thereby providing in singular and plural programs assocated therewith a complex programming capability accommodating differential times and rates, means for extracting said data and means for applying said data to operate said dispensing means, said circuit means being set in a configuration corresponding to one of such programs and being adapted to actuate said dispensing means according to the selected program to dispense said medication within said body at times and rates determined by said program.

2. An apparatus as claimed in claim 1 wherein said circuit means further includes pacemaking circuit means operationally associated and functionally coordinated therewith.

3. An apparatus as claimed in claim 1 including means incorporating said logic stored control data arranged for being reprogrammed to selectively alter corresponding logic operating instructions and thereby provide the capability for simple to complex reprogramming.

4. An apparatus as claimed in claim 3 wherein said circuit means further includes pacemaking circuit means operationally associated and functionally coordinated therewith.

5. An apparatus as claimed in claim 3 wherein said evaluation, timing and associated circuit means include and operate with memory means to store selected said data from said sensing means and said memory in conjunction with said timing means provide the capability for evaluating said sensed body condition data selectively in real or historical or abstract time.

6. An apparatus as claimed in claim 1 including:

(a) sensing means selectively placed within said body for producing sensed signals convertible to electrical data corresponding to a sensed condition within said body;

(b) connector means within said body and connected to said sensing means for transferring such signals to said circuit means to be processed therein; and

(c) within said circuit means data evaluation means connected through said connector means to said sensing means and adapted to receive selected data from said sensing means and convert such data into an electrically processable form and adapted for electrically evaluating such sensed data at selected times wherein actuation of said dispensing means is coordinated with evaluations of said data by said circuit means and as regulated by the selected said program.

7. An apparatus as claimed in claim 6 wherein said sensing means is operative both for said medication dispensing and pacemaking.

8. An apparatus as claimed in claim 1 including extracorporeal operator means operationally associated with said circuit means and operable extracorporeally to selectively select and set within said circuit means a particular configuration corresponding to a selected said program.

9. An apparatus as claimed in claim 8 wherein said circuit means includes means adapted to store selected said information in electrically retrievable form and said operator circuit means includes means to readout selected said information stored in said circuit means.

10. An apparatus as claimed in claim 8 wherein said operator means and circuit means are operatively associated through a rotary needle connector means adapted to electrically mate with and provide rotatable electrical hardwire connection with said circuit means for plural functions therein.

11. A self-powered programmable apparatus adapted to be totally received within a selected animal body, including human, for periodically evaluating selected internal physiological states of such body and for periodically dispensing selected medication substance therein according to such states while leaving the body ambulatory at all times, comprising:

(a) a storage member mounted within the body for storing selected substance to be dispensed therein;

(b) a micro size power source mounted within implanted means and having a useful working life in terms of at least several days;

(c) miniaturized implanted dispensing means connected to receive said substance from said storage member and adapted to be operated at selected times and being adapted when so operated to cause selected said substance to be discharged from the storage member into said body;

(d) sensing means selectively placed within said body for providing sensed signals convertible to electrical data corresponding to a sensed condition within said body;

(e) connector means connected to said sensing means for transferring such signals for processing;

(f) miniaturized electrical data evaluation and timing means mounted within implanted housing means and connected to be energized by said power source and comprising:

(i) miniaturized electrical evaluation circuit means connected through said connector means to said sensing means and adapted to receive selected data from said sensing means and convert such data into an electrically processable form and adapted for electrically evaluating such sensed data;

(ii) timing means operatively connected to said circuit means and providing both long term and short term electrical time base information thereto whereby said dispensing means is operated in coordination with selected evaluations; and

(iii) associated circuit means responsive to external signal control enabling selected elements of said evaluation circuit and timing means to be selected and set in or to be reset to a selected operational program configuration selected from plural potential configurations therein, each program configuration providing a selection of logic stored digital control data accommodating for differential times and rates corresponding to a set of predetermined body conditions and needed substance dispensation therefor, thereby providing a complex programming capability determinative of the manner and mode of operation of said evaluation circuit and timing means; and

(g) control means located external of said body for producing said signal control to select said program or programs.

12. An apparatus as claimed in claim 11 wherein said evaluation, timing and associated circuit means include and operate with memory means to store selected said data from said sensing means and said memory in conjunction with said timing means provide the capability for evaluating said sensed body condition data selectively in real or historical or abstract time.

13. An apparatus as claimed in claim 11 wherein said associated circuit means includes switch contact means adapted to receive a needle connector for transmitting signal control through a hardwire connection and wherein said control means includes needle connector means enabling said signal control to pass therethrough to select a said program.

14. An apparatus as claimed in claim 1 wherein said storage member, dispensing means, sensing means and data evaluation and timing means are adapted for selectively dispensing plural sources of medication.

15. An apparatus as claimed in claim 11 wherein said storage member, sensing means, dispensing means and evaluation and timing means are adapted to storing, sensing the need for and dispensing doses of plural medications.

16. An apparatus as claimed in claim 15 wherein said dispensing means is adapted to dispensing said doses of plural medications to separate sites within said body.

17. An apparatus as claimed in claim 15 wherein said dispensing is according to plural sensing schedules.

18. An apparatus as claimed in claim 1 wherein said sensing means is adapted to sense and develop electrical signals corresponding to plural medical factors and said data evaluation and timing means is adapted to electrically evaluate said factors and dispense said substance medication according to such evaluation.

19. In an apparatus as claimed in claim 1 wherein said storage member stores a single medication, said dispensing member comprises plural dispensing means connected to a common said storage member and said data and evaluation timing means is adapted to evaluate the need for and to separately operate each such dispensing means to cause said medication to be dispensed independently through one or the other of said dispensing means.

20. In an apparatus as in claim 1 wherein said storage member, sensing means, dispensing means, data evaluation and housing means are adapted to sense the need for and to dispense a first medication on a regular timed basis and a second medication on a special basis.

21. An apparatus as claimed in claim 11 wherein said storage member, sensing means, dispensing means and evaluation and timing means are adapted to dispensing medication in a wide range of combinations of single and plural doses, medications, sensed conditions, sites, and timing schedules.

22. An apparatus as claimed in claim 11 adapted to dispense medication for prevention of recurrent tachycardias and arrhythmias and wherein said sensing means comprises a cardiac-type sensor and said data evaluation and timing means includes an amplifying circuit connected to said sensing means, a first QRS detector circuit connected to said amplifier, a second QRS period analysis and control value comparison circuit connected to said first QRS detector circuit, an R-R interval analysis and control value comparison circuit connected to said first QRS detector circuit and said QRS period analysis circuit, an evaluating logic circuitry connected to said second QRS period analysis and said R-R interval analysis circuit, a timing circuit connected to time said second QRS period circuit, said R-R interval analysis circuit and said logic evaluation circuit and wherein said dispensing means is controlled by said logic evaluation circuit.

23. A self-powered programmable apparatus adapted to be totally received within a selected animal body, including human, for periodically evaluating selected internal physiological states of such body and for periodically dispensing selected medication substance therein according to such states while leaving the body ambulatory at all times, comprising:

(a) a storage member mounted within the body for storing selected substance to be dispensed therein;

(b) a micro size power source mounted within implanted means and having a useful working life in terms of at least several days;

(c) miniaturized dispensing means connected to receive said substance from said storage member and adapted to be operated at selected times and being adapted when so operated to cause selected said substance to be discharged from the storage member into said body;

(d) sensing means selectively placed within said body for providing sensed signals convertible to electrical data corresponding to a sensed condition within said body;

(e) connector means connected to said sensing means for transferring such signals for processing;

(f) miniaturized electrical data evaluation and timing means and connected to be energized by said power source and comprising:

(i) miniaturized electrical evaluation circuit means connected through said connector means to said sensing means and adapted to receive selected data from said sensing means and convert such data into an electrically processable form and adapted for electrically evaluating such sensed data;

(ii) timing means operatively connected to said circuit means and providing electrical time base information thereto whereby said dispensing means is operated in coordination with selected evaluations; and

(iii) associated circuit means responsive to external signal control enabling selected elements of said evaluation circuit and timing means to be set in a selected operational program configuration selected from plural potential configurations therein, said associated circuit means including switch contact means adapted to receive a needle connector for transmitting signal control reprogramming data through a hardwire connection and wherein said control means includes needle connector means enabling said signal control to pass therethrough to reprogram; and

(g) control means located external of said body for producing said signal control to vary said program or programs.

24. The method for periodically evaluating selected internal physiological states of an animal body, including human, and for periodically dispensing selected medication substance therein according to such states while leaving the body ambulatory at all times, comprising:

(a) implanting a storage member within the body and storing therein a selected substance to be dispensed therefrom;

(b) implanting a micro size power source having a useful working life in terms of at least several days;

(c) implanting miniaturized dispensing means connected to receive said substance from said storage member and adapted to be operated at selected times to cause selected said substance to be discharged from the storage member into said body;

(d) implanting sensing means for providing sensed signals convertible to electrical data corresponding to a sensed condition within said body;

(e) implanting connector means connected to said sensing means for transferring such signals for processing;

(f) implanting miniaturized electrical data evaluation and timing means and connected to be energized by said power source and comprising:

(i) miniaturized electrical evaluation circuit means connected through said connector means to said sensing means and adapted to receive selected data from said sensing means and convert such data into an electrically processable form and adapted for electrically evaluating such sensed data;

(ii) timing means operatively connected to said circuit means and providing electrical time base information thereto whereby said dispensing means is operated in coordination with selected evaluations; and

(iii) associated circuit means responsive to external signal control enabling selected elements of said evaluation circuit and timing means to be set in a selected operational program configuration selected from plural potential configurations therein, each program configuration providing a selection of logic stored digital control data corresponding to a set of predetermined body conditions and needed substance dispensation therefor, thereby providing a complex programming capability determinative of the manner and mode of operation of said evaluation circuit and timing means; and

(g) positioning control means external of said body for producing said signal control to select said program or programs; and

(h) allowing said sensing means to operate, to produce signals corresponding to physiological states within the said body and allowing said substance to be dispensed to a selected site within the body on a schedule and program as determined by said data evaluation and timing means over a long period of time and by the program signal control established by said control means.

25. A self-powered programmable dispensing apparatus adapted to be totally received within a selected animal body, including human, for altering a selected internal state of such body and for periodically dispensing selected substance therein while leaving the body ambulatory at all times, comprising:

(a) storage means received within the body for storing selected substance to be dispensed therein;

(b) a micro size power source received within the body and having a useful working life in terms of at least several hours;

(c) miniaturized dispensing means received within the body and communicating with said storage means and being adapted when operated to discharge said substance from the storage means into said body; and

(d) miniaturized electrical control means received within the body and connected to be energized by said power source and comprising:

(i) miniaturized electrical circuit means adapted to be selectively set and reset to any of various operating modes for establishing a control program for operating said dispensing means, each of said operating modes providing a selection of logic stored digital control data corresponding to a set of predetermined body conditions and appropriate substance dispensation therefor, means for extracting said data and means for applying said data to operate said dispensing means thereby providing a complex program capability; and

(ii) timing means operatively connected to said circuit means and providing electrical time base information thereto.

26. A self-powered combined medicating and cardiac pacer apparatus adapted to be totally received within a selected animal body, including human, for periodically dispensing selected medication therein and pacing the heart thereof through electrodes connected thereto while leaving the body ambulatory at all times, comprising:

(a) a storage member received within the body and adapted to store selected medication to be dispensed therein;

(b) a micro size power source mounted within implanted housing means and having a useful working life in terms of at least several days;

(c) miniaturized electrical control means adapted to both provide controlled electrical impulses on electrode means for heart pacing purposes and electrical control for the operation of dispensing means, selectable and resettable circuit means within said control means providing a selection of logic stored digital control data corresponding to a set of predetermined body conditions and medication dispensation therefor, thereby providing in singular and plural programs associated therewith a complex programming capability, means for extracting said data and means for applying said data to operate said dispensing means and pace said heart according to the program mode in which said program circuit means has been set;

(d) miniaturized dispensing means connected to said storage member and adapted to be operated by said control means to cause said medication to be discharged from the storage member into said body;

(e) electrode means adapted to be connected to the heart of said body and having a connection to said control means for receiving electrical impulses for evaluation to pace said heart in coordination with dispensing of said medication; and

(f) selectable and resettable circuit means within said control means providing a selection of logic stored digital control data corresponding to a set of predetermined body conditions and medication dispensation therefor, thereby providing in singular and plural programs associated therewith a complex programming capability, means for extracting said data and means for applying said data to operate said dispensing means and heart pacing means according to the program mode in which said program circuit means has been set.

27. A self-powered combined medication dispensing and electrically stimulating apparatus adapted to be totally received within a selected animal body, including human, for periodically dispensing selected substance therein and electrically stimulating a selected organ thereof through electrodes connected thereto while leaving the body ambulatory at all times, comprising:

(a) storage means received within the body for storing selected substance to be dispensed therein for treating said body;

(b) a micro size power source mounted within implanted housing means and having a useful working life in terms of at least several days;

(c) miniaturized electrical control means adapted to both provide controlled electrical impulses on electrode means for organ electrical stimulating purposes and electrical control for the operation of dispensing means;

(d) miniaturized dispensing means connected to said storage means and adapted to be operated by said control means to cause said substance to be discharged from storage means into said body;

(e) electrode means adapted to be connected to a selected organ of said body and having a connection to said control means for receiving electrical impulses to electrically stimulate said organ in coordination with dispensing of said substance; and

(f) selectable and resettable program circuit means within said control means providing a selection of logic stored digital control data corresponding to a set of predetermined body conditions and substance dispensation therefor, thereby providing in singular and plural programs associated therewith a complex programming capability, means for extracting said data and means for applying said data to operate said dispensing means and stimulate said organ according to the program mode in which said program circuit means has been set.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates to implanted apparatus for dispensing medical or physiological substances. More specifically, the invention relates to a device and method principally concerned with using the control circuitry in an implanted medication system to provide medication programs responsive to the needs of the patient at particular times.

2. Description of the Prior Art

A review of prior art practices with regard to dispensing medical substances internally of the body has previously been given in my prior U.S. Pat. No. 3,692,027 to which reference is made. Also, a summary of such related prior art practices is given in my copending application, Ser. No. 463,262, now U.S. Pat. No. 3,923,060, to which reference is also made. The general background of the prior art is believed to have been also described or cited in my U.S. Pat. No. 3,923,060 and otherwise adequately explained in my prior patent and copending application and, therefore, will not be repeated here.

The present invention is primarily directed to devices and methods for dispensing substances internally of the body and which in some way utilize implanted components whose operational modes can be controlled externally of the body. So far as I am aware, my prior U.S. Pat. No. 3,692,027 provides the first teaching of a self-powered device which can be implanted and which is adapted to dispense medical substances in premeasured doses at specific intervals over a long period of time. The device and method of my prior U.S. Pat. No. 3,692,027 has been improved upon by the subject matter of my copending application, now U.S. Pat. No. 3,923,060, by providing means for sensing internal body conditions and for evaluating the sensed data in order to control both the conditions under which and the kind of dispensing which takes place.

In U.S. Pat. No. 3,923,060 there is described for one embodiment a logic flow chart for an implanted discrete electronic component medication dispensing system and an externally accessible switch which enables the implanted control circuit configuration to be changed by a needle-switch operator located externally of the body. Thus, there is provided a means for changing the implanted circuit configuration to vary the control system which controls the manner in which the stored substances are dispensed. Much of the referred to description of the copending application is later repeated in the specification of this application and is noted here primarily for the purpose of pointing out that the present invention is concerned with both the needle operator-rotary switch technique for extracorporeal circuit control as well as with a dramatically improved means and method for circuit modification of implanted dispensing control circuitry to provide a treatment more compatible with actual need.

The emphasis of the present invention is thus directed to providing implanted control circuitry for controlling the dispensing of medication and which circuitry can be modified by means located external of the body. In this regard, it may be noted that U.S. Pat. No. 3,527,220 has previously taught the practice of implanting a medication storage container, a pump connected to pump the medication from the container to a site within the body, and means by which the pump can be powered through an extracorporeal magnetic field. This patent reference also teaches the practice of having an implanted switch whose action can be controlled by an extracorporeal magnetic field. The system taught by U.S. Pat. No. 3,527,220, however, basically has only an on-off capability and no programming capability. That is, there is no choice of circuit configurations which can be modified by an extracorporeal control to provide a variety of programs for dispensing the medication. The system of U.S. Pat. No. 3,527,220 also noticeably lacks any means for sensing internal body conditions and using the sensed data as a means for controlling the dispensing of medication.

With respect to extracorporeal control of implanted programmable circuitry, U.S. Pat. No. 3,833,005 illustrates a cardiac "pacemaker" type device which uses an extracorporeal transmitter to provide control signals to the pacemaker receiver and from there to the control circuitry. The control circuitry includes memory, counting and logic circuitry which provides a simple programming capability for rate and amplitude control for pacemaking purposes but has no medication dispensing mechanism.

The prior art practices concerned with implanting artificial and replacement material organs should also be noted. Of particular interest to the present invention is the recent development in Canada of a non-implanted but computerized artificial pancreas in which blood sugar is monitored and insulin or dextrose is delivered according to need. This development is also reported in a Post Times Service news release of Apr. 18, 1974 and is described in the Medical Tribune and Medical News issue of Oct. 9, 1974, and the articles suggest the possibility of developing a miniaturized, implantable artificial pancreas.

Another prior art development related to the present invention concerns the availability of what are called microprocessors. In this regard, reference may be made to an article appearing in the Apr. 18, 1974 issue of Electronics Magazine. As explained in this article, the availability of a microprocessor drastically reduces the cost and also the size of the circuitry required to provide programming capability in miniaturized circuits. By adding appropriate memory devices to the microprocessor and applicable input and output circuits, there becomes available a micro-miniaturized programmable circuit with a versatile programming characteristic, highly adaptable input/output system capabilities, minimum parts count and easy expansion through modular architecture. The current Fairchild F-8 microprocessor series provides such a system. From the foregoing, it can be seen that while the implanted system and method for dispensing medical substances, as taught in U.S. Pat. No. 3,923,060, provides a unique system and a method for a limited programmable system for periodically evaluating selected states of the body and dispensing medical substances accordingly while leaving the patient ambulatory, the present invention recognizes that further improvements could be made by embodying a micro-miniaturized more adaptable programming capability and a system and method which would lend itself to extracorporeal control of such capability and to reprogramming.

SUMMARY OF THE INVENTION

The apparatus and method of the invention is based on storage, control and dispensing components of a unitary device being entirely implanted in the body but with selected control components being adapted to extracorporeal operator control. There is provided either one or a plurality of sensors, each of which is adapted to sense a particular body condition at a particular point in the body. There is also provided a self-powered medication dispensing apparatus whose operation is made dependent on evaluation of changes in the sensed data. The dispensing apparatus and method of the invention can be directed to one or a plurality of medical substances in powdered, liquid, suspension, or other dispensable form. The decision making capability of the invention, which functions on a basis of changes in the sensed data, controls when the dispensing apparatus operates and therefore controls the dispensing of medication according to the specific needs of the patient at specific times.

Of particular importance to the present invention is the capability of having the internal implanted circuitry modified by extracorporeal control means so as to provide a selectable, programming capability. Thus, for example, a variety of timing programs can be selected by extracorporeal control. Similarly, a variety of data evaluation programs or dispensing options can be selected by extracorporeal control with the employment of microprocessor techniques and similar micro-miniaturization circuit techniques. The choice of such circuit programs becomes essentially infinite. In one embodiment, extracorporeal control and internal circuit changes are obtained by an operatively associated externally inserted needle operator and needle-operated rotary switch. In another embodiment, the extracorporeal control is provided by a pulse transmitter adapted to provide coded pulses which can be interpreted by the implanted circuitry to achieve selected medication programs corresponding to particular codes.

As compared to the prior specification of copending application Ser. No. 463,262, the present specification repeats and supplements the prior specification by illustrating a system and method based on either direct replacement of the digital circuitry of the prior application or on replacement of the entire circuitry of the prior application with a microprocessor system having an appropriate interface for extracorporeal communication. Thus, the present invention provides a much improved method for an implanted medication system both because of the reprogrammable character as well as by reason of an improved interface through which extracorporeal communication with the implanted system may be obtained. More specifically, the interface portion of the circuitry of the present invention lends itself to use of a variety of peripheral devices such as memory latch controls, various types of remotely operable switches, R-F transmitters and receivers through which information may be sent to and from the implanted microprocessor circuitry in the form of programming changes, operation constraints, and the like. Information processed by the microprocessor system can also be transmitted to suitable peripheral devices of the kind indicated. As with the method and system described in the specification of U.S. Pat. No. 3,923,060, the system of the present invention which incorporates the improved micro-miniaturized microprocessor circuitry lends itself to being housed in a unitary housing having appropriate compartments for the medication storage, the micro-power source, the micro-miniaturized programmable control circuitry and the controlled dispensing means.

DESCRIPTIONS OF THE DRAWINGS

In respect to the following figure descriptions, it should be noted that FIGS. 1-17 and the descriptions thereof are used in both the present application and in U.S. Pat. No. 3,923,060, since such drawings apply to and help explain the separate subject matter being claimed in the present application as well as in U.S. Pat. No. 3,923,060.

FIG. 1 is a block diagram illustrating the basic components of an apparatus according to the invention.

FIG. 2 is a block diagram illustrating the application of the invention to cardiac monitoring and medication.

FIG. 3 is a block diagram illustrating the application of the invention to blood pressure monitoring and medication.

FIG. 4 is a block diagram illustrating application of the invention to body chemistry monitoring and medication.

FIG. 5 is a block diagram illustrating application of the invention to dispensing medication to the same site from multiple sources.

FIG. 6 is a block diagram illustrating application of the invention to dispensing different medications to different sites.

FIG. 7 is a somewhat schematic and enlarged diagram of a miniature bellows pumping device useful in the invention.

FIG. 8 is a somewhat schematic enlarged view of a multiple bellows-type pump for dispensing the same medication to the same site but in different quantities and under different conditions.

FIG. 9 is a somewhat schematic enlarged diagram of a multiple bellows-type pump for dispensing separate kinds of medication to separate sites in different quantities and under separate controls.

FIG. 10 is a somewhat schematic enlarged drawing of a bellows pump with multiple separated chambers for different chambers or sites having a common power source.

FIG. 11 is a somewhat schematic enlarged view of an implantable system according to the invention and adapted to dispense different medications from different sources under different controls.

FIG. 12 is a schematic diagram of the apparatus of the invention as it might be used with supraventricular tachycardias treated with quinidine.

FIG. 13 is a schematic sectional view through the apparatus of FIG. 12; FIGS. 13A, 13B showing alternate catheters.

FIGS. 14 and 14A schematically illustrate a portal arrangement for replenishing medication to the system.

FIG. 15 is a block diagram of the decision-making circuitry.

FIG. 16 is a more detailed circuit diagram corresponding to FIG. 15.

FIG. 17 is a representative timing diagram for dispensing plural doses of medication.

FIG. 18 is a schematic representation of a needle connector-rotary switch arrangement illustrated in FIGS. 12 and 13.

FIG. 19 is a block diagram illustrating how the needle-operated switch arrangement of FIG. 18 may be employed to modify the programmable characteristics of the control circuit.

FIG. 20 is a schematic illustration of an embodiment using a pulse transmitter as a program control device and an implanted device controllable by pulse transmission.

FIG. 21 is a block diagram illustrating use of pulse control for programming.

FIG. 22 is similar to FIG. 11 but illustrating use of pulse control.

FIG. 23 represents a circuit similar to FIG. 16 but with the digital electronics of that system replaced by a microprocessor-type circuitry.

FIG. 24 represents a circuit similar to FIG. 23 but in a more advanced state in which the entire discrete electronic control system of FIG. 16 is replaced by a microprocessor system arranged to receive information through an analog to digital converter.

FIG. 25 is a schematic block diagram illustrating various forms of communication through the needle switch arrangement of FIG. 18.

FIG. 26 is a schematic diagram of a system providing RF pulse code communication with both the implanted microprocessor control circuitry and an external receiver for monitoring the information transmitted.

FIG. 27 is a block diagram broadly illustrating the combining of pacemaking and medicating activities.

FIG. 28 is a more detailed block diagram illustrating a system having both pacemaking and medicating capability.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Substantial background information has been set forth in my prior U.S. Pat. No. 3,692,027 and also in my copending application Ser. No. 463,262, now U.S. Pat. No. 3,923,060, and to which reference should be made in understanding the present invention. Of particular interest to the present invention, such background information indicates the very substantial number of conditions in the patient which are subject to change and which control both the need for medication as well as the kind of medication. Such conditions also are shown in the mentioned background