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Left arm pain after pacemaker

Pacemaker Club: left arm pai

  1. I had a pacemaker installed in Sept of 2012. I have no complaints about the pacemaker itself, but have experienced left arm pain (sometimes severe) ever since the surgery. I thought perhaps having the arm immobilized for almost 6 weeks after implantation caused the problem. Now, I don't think so
  2. Pain in left arm after pacemaker surgery Pacemaker pain left arm Download Here Free HealthCareMagic App to Ask a Doctor. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice..
  3. pacemaker put in nov. 2011 from that time i have had a pain in my left arm from the shoulder to tips of my fingers in the last few months in has gotten much more painful. it is like the blood in not flowing well. i have ask my doctor that put it in from the first visit and even have moved and have a differtnt heart dr amd the people who come to test the pacemaker every six mo. no one has told me any thing
  4. Original Poster Update by rovercar - 2012-09-02 03:09:25 . Not quite two weeks since my pacemaker insertion. My left index finger definitely is numb and or pins and needles. Pain in my arm seems to be lessening, although it seems to bother me most when I am walking

This reports an arm edema that was initially treated as cellulitis and later diagnosed to be subclavian thrombosis due to pacemaker wire irritation. We present an 87-year-old Caucasian man with 5 weeks duration of left arm swelling and pain that was treated with two courses of antibiotics Pain in left arm after pacemaker surgery Pacemaker aftercare pain Pacemaker pain left arm Download Here Free HealthCareMagic App to Ask a Doctor. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice.. An overlooked complication of device implantation is shoulder pain and disability in the first year after implant, [ 5, 6] a condition that can be incapacitating to affected individuals

ANYONE who has red, purplish painful arm (hard/leathery arm) and/or spotty red palms should consider requiring their physician to perform an venous ultrasound to look for bloodclots. Again, immediately after my surgery (pain) and within 2 weeks was diagnosed as having 5 bloodclots in my upper chest, and left arm Swollen Arm by suzanne_1961 - 2011-04-02 05:04:36 My dad had surgery Mar4th and was discharged after one day. While he was well on day 2 & 3, by day 4 his left hand and arm began to swell.. He was in so much pain and could not sleep that we took him to the local hospital The pacemaker is positioned in my breast tissue because it protuded out of my skin when the pocket was up further under my clavical. Will this constant ache ever go away? It hurts to cross my arms to reach for something, to raise my arm to grab a can off a shelf -- any movements such as that What could lead to left arm pain after putting a pacemaker? 1 doctor answer • 3 doctors weighed in. Share. Dr. Charles Ruotolo answered. Orthopedic Surgery 26 years experience. Arm pain: This can be from your heart and referred to your arm or it can be a primary problem with your shoulder or arm of people with DVT-UE have a cardiac pacemaker or central venous catheter in the area of the clot. Up to one-fourth of people with a central venous catheter will develop a clot, according to a 2002..

Redness, swelling, heat or foul smelling drainage near the procedure site Discomfort that increases or if the discomfort extends to the arm on thesame side of the device Swelling increases or becomes painful, or if the hand or arm on the sameside as the device is swellin I recieved some nerve damage, probably to the left subclavian or in the area during my pacemaker insertion. Most of my left shoulder and upper arm were both numb to sensation, and incredibly painful. For weeks, I felt like someone had shot me. For months, it hurt, pretty badly

The pain lessens swiftly but laying down/sleeping remains an issue for up to 6 months. I still lie on my right side and lay my left arm along my body. Otherwise moving my left arm in other positions pushed the pacemaker into the muscle (pacemaker in left side). After 6 months even tat improved A 53-year-old woman reported burning pain, muscle weakness, and dysesthesia of the left arm 2 months after permanent pacemaker insertion in the ipsilateral side for the treatment of sick sinus syndrome. Complex regional pain syndrome (CRPS) induced by pacemaker implantation was diagnosed Arm pain after pacemaker implant. The procedure was far more brutal than I expected so no wonder we are all left with pain and awful bruises. Reply (0) Report. Bigdan in reply to bantam12. I'm on my second implant as the first was taken out after 6week due to infection concerns. I didn't have much pain with that one but just discomfort when.

Pain in left arm after pacemaker surgery - Doctor answers

Early and late complications after pacemaker implantation range from 3.2 to 7.5%. 6,7 Pericardial complications including pericardial effusions after pacemaker have been reported around 1-5%. 1,8,9 One of the first reports of PCIS after pacemaker implantation has been reported by Dressler in 1962 in two out of 11 patients. 10 In a CT-based. What could lead to left arm pain after putting a pacemaker? 1 doctor answer • 3 doctors weighed in. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Talk to a doctor now . 24/7 visits - just $39! 50% off with $15/month membership. Disclaimer 4 Responses. Forum-M.D.-MJM. Hello, It is not normal to have pain like that after a pacemaker implant. He should definitely communicate with his doctor about the problem and if they can't address the problem, find another doctor that will. I have put in many pacemakers and seen pacemaker follow up's and this is not a problem that I have seen Question: I am a 43 year old female and got a pacemaker 5 weeks ago. Yesterday I started having pretty severe left arm pain. It feels like it is deep inside the bone, as I can not seem to get to the pain by rubbing my arm. This pain goes from the my left arm up into my neck and shoulder. I called my cardiologist and I was told to monitor the. You will probably stay in the hospital for a day after having your new pacemaker is implanted. Sometimes, the procedure is so quick that people don't need to stay overnight. Your doctor will program the pacemaker to match your specific pacing needs before you go home. It can take a few days to a few months to fully recover from the procedure

Armpit and left arm pain after pacemaker Left arm pain after angioplasty Left arm pain epilepsy Left arm pain after mucinex Download Here Free HealthCareMagic App to Ask a Doctor. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical. Hi I had a pacemaker put in about three weeks ago. The past week and a half my left arm has been hurting real bad. The pain is from my shoulder to my wrist. Feels more like the muscle or nerve all the way down to my wrist. The inside edge of my wrist feels numb some of the time also. I had a iregular heart beat ,now i

Extreme weakness after pacemaker implant: Q: I only waited a few weeks. I did not use my left arm a lot for anything and followed the instructions about not raising my arm above my head. It was not a problem keeping my arm at the recommended height or below. I have pain in the middle of my chest that feels like muscle pain and I have a. Post pacemaker implant pain. I had my 3 wire pacemaker installed in January 2019 after being admitted as an emergency with total heart block in the New Year. The procedure was ok but I am still feeling discomfort after 4 months and can't sleep on my left side and still getting twinges of pain when I move my left arm However, now I only get the pain on the left arm. I mentioned this a couple of months back to the cardiothoracic surgeon who is reviewing my annual post-op CT scans, and he said it is relatively rare but not unheard of to get these neural pains after OHS, (and that when you do, it's often on the left, in fact)

Only remove the bandage when your doctor permits—typically two days to a week after the implantation. Do not move the arm on the pacemaker side above shoulder level for a few weeks. Take medication for pain as directed by your doctor, if necessary. Pain and tenderness should start to decrease over a few days But once it starts healing and the pain gets less, it takes conscious effort to look after the area. (Reader tip: If you keep waking up and finding yourself with your left arm stretched above your head - wear a bigger shirt, and sleep with your left arm tucked inside it, down by your side!) After the surgery, it hurt to raise my left arm and I wasn't allowed to carry anything heavy. About 8 weeks later I was back to my normal activities, including playing tennis. The pacemaker did. Pacemaker infections can occur in the generator pocket, along the lead wires, the heart valves, and the endocardium. 1 The incidence of infection can be as high as 5% of patients receiving a permanent pacemaker or generator replacement; three-quarters of infections occur within the first year after implantation. 1 Increased infection risk is.

A transthoracic echocardiogram showing a patent foramen

A 53‐year‐old woman reported burning pain, muscle weakness, and dysesthesia of the left arm 2 months after permanent pacemaker insertion in the ipsilateral side for the treatment of sick sinus syndrome. Complex regional pain syndrome (CRPS) induced by pacemaker implantation was diagnosed After the initial appointment you will have a important appointment in 3 months for pacemaker check when adjustments will made to the programming to increase device longevity. Please call our office and confirm your appointment. The pacemaker check is performed at the Device Clinic and takes about 15 to 30 minutes

Pacemaker surgery affects more than just your heart. After this procedure, your doctor will likely limit what you can do with your arm for the first couple of months. Movement is restricted to allow your body to heal with the pacemaker in the correct position If after reading it, you require further explanation please discuss this with a member of the healthcare team. Wound care. There may be some discomfort at first, near where the pacemaker box has been fitted. You are advised to take pain relief medication such as paracetamol to ease the discomfort You have pain that does not get better after you take pain medicine. You hear an alarm or feel a vibration from your pacemaker. You have loose stitches, or your incision comes open. Bright red blood has soaked through the bandage over your incision. You have signs of infection, such as: Increased pain, swelling, warmth, or redness I'm still waiting for my next cardiologist appointment hopefully in the next few weeks , pain has been increasing by my pm, it started as a very mild discomfort on the left edge , every day gets more painful especially after I've been reaching up or been more active at home , nothing too strenuous , it's been 6 months since it was fitted She had chronic nonvalvular atrial fibrillation, hypertension, systemic lupus erythematosus (in remission), and sick sinus syndrome for which a pacemaker had been implanted 2 years ago. She presented with acute onset of left arm swelling and pain after having taken a domestic airline flight and missing a single dose of her direct oral.

What can cause soreness and pain around vns pacemaker A 38-year-old female asked: I fainted at a club last night. had a few sips of a drink but im on amoxicillin for sore throat. i'm an svt heart patient with pacemaker A pacemaker is a life-saver, keeping your heart beating at a normal rhythm. But in rare cases, an infection related to your pacemaker can be life-threatening. Be on the lookout for signs and symptoms Left Arm Pain & Racing Heart after Pacemaker Implantation Feb 14, 2010 I had an ablation to resolve issues with tachycardia in 2005 and then a pacemaker put in 4 weeks ago.. Hi all can anyone please recommend cream for pain relief,i am getting a lot of pain from pacemaker surgery (left shoulder its been nearly 5 months since had pacemaker fitted been ok but now pain is really bad.doctor is saying it's muscle and nerve damge pain pain and swelling in the arm; If a person is in the hospital following pacemaker surgery or another procedure, the healthcare team will monitor the person for signs of a blood clot. They will.

As with any medical or surgical procedure, pacemaker implantation has risks as well as benefits. Blood clots. A blood clot can develop in one of the veins in the arm on the side of the body where the pacemaker was fitted. This may cause some swelling in the affected arm, but it usually settles in a few days and is rarely a serious problem Your pacemaker will be checked the day after the implantation and then at six weeks. After that it will be checked every year, and more often towards the end of the battery life. We also ask patients not to lift the left arm above the head in those six weeks. The reasons for that are firstly that it can be uncomfortable until it heals up. You may move your arm normally after getting your pacemaker. Do not lift objects that weigh more than 10 pounds. Do not hold your arms above shoulder level for 3 weeks An 80-year-old woman was referred to the cardiology department with a history of syncope. She had a background of left breast carcinoma with wide local excision and radiotherapy in 2007. Her 24 h electrocardiogram (ECG) showed sinus node disease with pauses of up to 5 s. A dual chamber permanent pacemaker was implanted via the

My 79 year old mother underwent pacemaker and cardioverter defibrillator surgery on Thursday of last week. On Saturday evening, she began to experience severe pain under her right arm and down the right side of her right arm. The pain subsided somewhat after taking an OTC aspirin. On Sunday morning, the same situation occurred Left arm pain or shoulder pain can be a common symptom of an impending heart attack.A heart attack occurs when the blood flow to the heart is blocked as a result of plaque buildup along the. Common Presentation: Tight, crushing, pressure type chest and left shoulder pain, dizziness, shortness of breath, nausea, tingling sensation Overview: A heart attack is typically caused by build-up of plaque in arteries which reduces blood flow to part of the heart muscle. Pain typically starts in the chest and then spreads to the shoulder/arm (most typically the left side) and jaw 12 weeks since surgery ICD terrific pain in left arm - Sudden cardiac arrest. Following my 2nd ablation I experienced prolonged QT's . The following day my doctor gave me an hour to decide if I should have an ICD implanted. To back up a bit. 1987 I suffered V-Fib, thank God it happened in a hospital. I had just given birth to my 5th and was. Usually pain aftetr chest lead implantation would suggest erosion or perforation ( on CT) of lead but these cases had none. Pain types: - constant sharp substernal, 3/10 severity, chest pain not aggravated by eating, breathing or position but exertional - initially low sternal but later higher in chest when moved

After getting a pacemaker, you will need to follow-up with the doctor and nurses in a pacemaker clinic and through phone check-ups. This will allow them to monitor your pacemaker's function and. After the initial appointment you will have a important appointment in 3 months for defibrillator check when adjustments will made to the programming to increase device longevity. Please call our office and confirm your appointment. The pacemaker check is performed at the Device Clinic and takes about 15 to 30 minutes March 31, 2015 at 4:32 pm. Report. I had my defib implanted in Nov 2014. Mine too sticks out when I move my left arm across my body and when I sleep on my left side - I find sleeping on the right is still a bit painful and cannot sleep on my back because it causes breathlessness due to my heart failure

For 4 weeks after the pacemaker implant you should not lift your upper arm (on the pacemaker side) above the horizontal or carry heavy objects with that arm. Most machines and devices will not interfere with a pacemaker (such as microwaves, computers, hairdryers, electric blankets and most power tools) Blood clot: A clot in one of the deep veins (deep vein thrombosis or DVT) of the arm can cause swelling, often accompanied by pain and redness. Arm clots are uncommon but can occur in the setting of vascular trauma, such as when a pacemaker or catheter is present. A clot may be complicated by chronic arm swelling A 73 year old man admitted to our hospital with pain and twitching on the pacemaker pocket.His past medical history included hypertension and right pneumonectomy due to lung cancer. The patient had a VDD pacemaker on the left side, which was implanted 9 years ago due to third degree atrioventricular block.The battery had replaced one year ago due to battery depletion

My wife had a pacemaker put in 6/9/07. From right after the surgery, her arm is in intese pain when she moves it certain ways or holds it in certain position. This has not left and seems to be worse. She is limited in what she can do as she cannot put much strain on the arm. It pains between the elbow and shoulder While the arm and hand can be used, we wish you to avoid raising the arm above the level of the shoulder. This is because large movements can displace the pacemaker leads. After 6 weeks, there is sufficient healing to allow much more normal movement and the risk of displacement drops significantly Question: Pacemaker pain shrtstuf121 - Tue Feb 10, 2004 1:43 pm: Share | I am 30 years old and recently had a pacemaker pocket revision for erosion. I have since had alot of pain in the armpit and left arm. The pacemaker itself is palpable in the armpit. I brought this to the surgeon's attention who told me it would be fine returning from the left arm was normal. After the implantation of the AV graft, the arterial FIGURE 1. Massive left arm edema following AV graft placement in a patient with pre-existing ipsilateral permanent pacemaker leads. FIGURE 2. High-resolution sonogram of left arm subcutaneous tis-sue shows large areas of interstitial edema (asterisk. The PCP said after 6 mos. I should not be having pain. I couldn't raise my arm very high w/out pain or feeling it just wouldn't go any further, I couldn't sleep on my left side at all, had trouble taking off a top over my head. The pain was a constant reminder of the foreign piece of machinery bulging under my shirt, reminding me of my.

What causes pain in the left arm after implantation of

I got a pacemaker June 20th on the left side. There has been swelling in my left shoulder and arm from almost the time I got the pacemaker. The left side of my neck is contantly stiff. A venogram showed no clots. The shoulder and are feel very tight and the left arm is obviously larger than the right arm to the naked eye A pacemaker gives a much smaller shock, just enough to trigger the heart to contract, either because the intrinsic pacemaker isn't working or because the structure (AV node and bundle of His) that carries the electrical signal to the bottom half of the heart isn't working After a pacemaker implantation, the patient may experience pain and swelling at the site where the pacemaker is implanted. These symptoms may last for several days and maybe weeks, as the recovery process may often take up to four weeks. The patient is also advised to avoid lifting any heavy weight objects for approximately 4 weeks after the. Posts: 2. Left Arm Pain & Racing Heart after Pacemaker Implantation. I had an ablation to resolve issues with tachycardia in 2005 and then a pacemaker put in 4 weeks ago. In the last week or so my left arm has started to hurt from my shoulder down to my elbow (occasionally into my forearm). The pain is a constant ache or throbbing and at times. A 40-year-old Puerto Rican-born female presented to the emergency department with a 2-day history of subjective low-grade fever and pleuriticleft-sided chest pain localized to the pacemaker site. She reported chills and rigors as well as swelling with redness at the pacemaker site associated with left arm pain

Indigestion Pain Under Left Arm If During Pregnancy Eat

Pacemaker Club: Nerve pain in left arm after new P

Post-Scoliosis Surgery Back Pain severe pain during mri scan which has left bruising Shooting Pain in fingernail! Painful Throbbing Pulsing Neck and Throat Randomly appearing raised bump on arm Post cervical spine surgery pain purple dot on left breast, no pain, not sure? Left abdominal pain, severe bloating, stabbing pains The right arm was the dominant arm for 50 patients (90.9%) in the IDH group and 46 patients (88.4%) in the CDH group. While the pacemaker was the dominant CIED type in the IDH group (83.7%), the ICD was dominant in the CDH group (78.8%) After Surgery - Pacemakers. Bradycardia (Slow Heart Rate) The surgery to implant pacemaker is usually quick, and most individuals can return to their everyday activities after a reasonable recovery time. However, each person's experience with a pacemaker is different. Allow yourself some time to adjust, and discuss your recovery goals with.

Arm edema, subclavian thrombosis, and pacemakers--a case

Her arm pain wasn't from skiing - it was a heart attack. Thinking she'd just dislocated her shoulder, Kelly Kleiner was in fact having a massive heart attack. (American Heart Association) Feeling hot, nauseous and in pain after snow skiing in Missouri with her family, 40-year-old Kelly Kleiner tried getting some relief in a restroom at the lodge Left arm pain is one of the most common symptoms of a heart attack. The nerves that branch from the heart and those coming from the arm send signals to the same brain cells. As a result, the brain. Pacemaker syndrome is a condition that represents the clinical consequences of suboptimal atrioventricular (AV) synchrony or AV dyssynchrony, regardless of the pacing mode, after pacemaker implantation. It is an iatrogenic disease—an adverse effect resulting from medical treatment—that is often underdiagnosed. In general, the symptoms of the syndrome are a combination of decreased cardiac. By themselves, any one sign of heart failure may not be cause for alarm. But if you have more than one of these symptoms, even if you haven't been diagnosed with any heart problems, report them to a healthcare professional and ask for an evaluation of your heart

Video: Left armpit pain and pacemaker - Doctor answers on

Preventing Shoulder Pain After Cardiac Device Implantatio

Fig. 2. Chest X-ray showing right pneumothorax (arrow) 8 h after placement of a left-sided permanent dual chamber pacemaker. Location of pneumothorax, i.e. ipsilateral or contralateral was reported. Contralateral pneumothorax to the site of the pacing syst em has been reported, which was secondary t MONDAY, Feb. 24, 2014 (HealthDay News) -- About one in 10 heart surgery patients has persistent pain for up to two years after the operation, a new study reveals. The study included more than 1,200 patients aged 18 and older who had heart procedures -- such as bypass or valve replacement -- at four cardiac surgery centers in Canada What can I expect after the procedure? Once the procedure is finished you will be taken back to the ward. You will need to rest in bed for a few hours. You must restrict you arm movements on the side that the pacemaker has been fitted. Your blood pressure, heart rate and wound site will be checked regularly

left arm purple and painful after defibrillator implant

Biventricular pacemaker. Biventricular pacing, also called cardiac resynchronization therapy, is for people with heart failure with abnormal electrical systems. This type of pacemaker stimulates the lower chambers of the heart (the right and left ventricles) to make the heart beat more efficiently A pacemaker implant can stabilize your heart rate, and improve your quality of life. Surgery . During the pacemaker implant surgery, your cardiologist will numb the incision area so that you do not feel pain or discomfort during the procedure. He/she may also give you antibiotics prior to the surgery to ward off potential infections

Pacemaker Club: arm pain after pacemaker surger

A 65-year-old male was admitted with a painful swollen left arm and shoulder. He denied trauma of the extremity, chest discomfort or dyspnoea. Eight months previously a permanent DDDR pacemaker had been implanted via the left subclavian vein due to syncope and high degree AV block. The procedure lasted 37 min and there were no complications Pacemaker implanted 1 monrh ago in partner. swollen left arm and hand, shortness in breathing dry mouth funny taste = - Answered by a verified Cardiologist Yes Ultrasound of arm and hand and site of pacemaker no sign of clots. Cardiologist: severe pain in arms across chest and upper back when coughing hard.

(PDF) Complex regional pain syndrome induced by pacemaker

After pacemaker surgery, patients should call their doctor if they experience any of the following issues: Breathlessness; Chest pain; Dizziness; Fainting; Fever lasting longer than 2-3 days; Pain, redness, or swelling at the site of the pacemaker; Prolonged hiccups; Prolonged weakness; Swollen arm on the side of the surger 1 North Texas Arrhythmia Associates, Dr. R. Haris Naseem and Dr. Andrew Owens ~ Office (940)-565-0800 POST-OP INSTRUCTIONS FOLLOWING IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) IMPLANTATION Care of Your Incision Site • You will be discharged with a dressing over the incision site. This dressing will be removed at the 1 week post op check If you have a heart problem, whether sudden or long-standing, working with a doctor is a must. But in the midst of the coronavirus pandemic, not everyone is getting medical help for heart issues — even potentially serious ones, such as heart attack, heart failure, arrhythmias (irregular heartbeats) and others.. Despite the focus on COVID-19, heart problems aren't taking a break during the. A very fast heart rate, called pacemaker-mediated tachycardia, can cause palpitations and dizziness 4. Likewise, a condition known as pacemaker syndrome can cause the top and bottom chambers of the heart to beat out of sync. Anyone can experience abnormal heart rhythms after pacemaker placement, but diagnosis may be delayed in the elderly when. Good question, this one. After my operation I suffered awful shoulder and back (between the shoulder blades) pains for months. It's still not completely right even 18 months after the op. Why? Don't really know technically, but here's how I ration..

Pain associated with Cardiac Pacemaker -- is this normal

If you are fitted with an arm sling, keep your arm in the sling for as long as your doctor tells you to. Most often, the sling will be removed the next day. But you may be told to sleep with it on for a period to prevent damage to the pacemaker while it's healing. Pain around your pacemaker; Fever above 100.4° F (38° C) or higher, or as. What happens after pacemaker insertion? In the hospital. After the procedure, you may be taken to the recovery room or returned to your hospital room. A nurse will watch your vital signs. Tell your nurse right away if you feel chest pain or tightness, trouble breathing, or pain at the insertion site. After a period of bed rest, you may get out. HAD a pacemaker put in almost 3 weeks ago, the site is still alittle sore but the problem is my left arm is so sore and pain ful for about the last 4 or 5 days, I have been moving my arm back and fort

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Except for perhaps just a few days after the pacemaker is implanted, there really is no restriction of the arm or shoulder necessary. The pacemaker could be implanted on her right side and would work just as well as on the left. There are no complications of pacemaker implantation that involve a frozen shoulder or immobility of the arm Pacemaker. This small, battery-operated device weighs about an ounce and sends a signal to your heart to correct a slow or irregular heartbeat. A pacemaker is implanted under the skin, usually on the left side of the chest below the collarbone. The procedure takes about an hour, and most patients go home within a day A few days after the surgery, the patient should expect some pain, swelling, or tenderness in the area where the incision was made and where the pacemaker has been placed. The doctor would give medicines to deal with the pain, and one should keep in mind to not take any more medicines without consulting the doctor The left or right side of your chest will be shaved; is the most common method. A local anesthetic (pain-relieving medication) is given to numb the area. An incision is made in the chest where the leads and pacemaker are inserted. A chest X-ray will be done after the pacemaker implant to check your lungs as well as the position of the. Tingling of the left arm along with pain in the shoulder or jaw could be symptoms of a heart attack. Stroke: Tingling in the left arm could be a sign of stroke, especially when accompanied by a. Keep at least 24 inches (60 cm) away from your pacemaker: However, when you are driving or riding you are at a safe distance. Can you take blood pressure on left arm with pacemaker? You will need to be careful not to put too much pressure on the arm nearest the pacemaker site (usually the left arm), or to lift that arm up too far