Archive for March, 2006

Ok, I said I would come back to this, because I ran short on time last treatment.
There’s nothing worse than getting to the good part of the story, only to have your dialysis machine start beeping with the display “UF GOAL REACHED”.

I’m sure you can all empathize

So where was I?
If I remember correctly I was talking about a nuclear stress test on my heart that didn’t go too well (the one two years ago, not the recent one).
As I said in the last installment, after the echocardiogram, everything turned out ok.
Flashing back, I’d like to talk just a bit about the procedure itself. Typically with such a test there are sort of two sets of images taken, and then the results are compared. They want to see blood flow to the heart at rest, and then after stress. Comparing the two results gives a good idea of how blood is flowing through the heart.

First, an IV is placed into the arm, and the nuclear isotopes are placed gently into the body via a giant syringe.. You’re then ushered to a nice table to lay on, which slides into something looking like a giant doughnut. The tech positions the imaging portions of the machine properly, having you rest your arms behind (above) your head. They then ask you not to move for 22 minutes, and begin collecting images.
After a break for some food, you’re usually brought back in for the stress portion of the test. I believe for most people this involves some activity on a treadmill. Unfortunately due to my medications, I always seem to get option b, which consists of jump-starting the heart pharmaceutically. I’m on an ACE Inhibitor called Atenolol, which slows my heart rate. This makes it difficult (even with running on a treadmill) to get my heart rate up where they’d like to see it. To get it where they wanted it took a couple of different drugs – the first one didn’t seem to do the trick. Eventually I was given atropine to “juice” me up a bit.
While the whole ordeal was painless (IV’s are now considered “painless” after almost 4 years of dialysis), it was extremely odd to be laying on a table, and to suddenly have my heart rate accelerate like a Ferrari. I could feel my heart bouncing around in my rib cage for several minutes, and sort of just wanted the whole thing to be done. Eventually it was, and as I said earlier, the results weren’t favorable. After some quick research and an echocardiogram however, I was let loose.

So fast forward to the present (sorry for all of this jumping around – I’m a piano rebuilder, not a writer).
I get the call for the nuclear stress test, and am told I have to have it by a certain date to remain “active” on the list. Unfortunately at the time there’s a nationwide shortage of this isotope, and people aren’t able to get the test done. Finally after several phone calls the test was scheduled and my lovely wife accompanied me to my date with the nuclear medicine techs.
Again, due to my use of Atenolol, I was informed that I wouldn’t be walking on the treadmill. Instead of jump starting my heart though, they had a new process of inducing stress-like conditions in the heart. I was given a vasodilator, which is a drug designed to cause your veins and arteries to dilate. Of course there are multiple people monitoring you the entire time, as well as a half dozen leads glued to your skin around the heart. So there’s no need to fear the weird feelings that kind of ‘ooze’ over your body as your entire vascular structure expands. A flushed face is normal, as is some stomach cramping (very mild), and general discomfort from sitting half naked in a hospital around strangers. This portion of the test lasts 6 minutes or so – and amazingly the side effects of the drug halt immediately when the dosage is stopped.

Then it’s back over to the imaging machine for another ~22 minutes of imaging. Laying there the second time (that day), I was much more relaxed, and almost fell asleep. Then it was out with the IV, and off to work.

I was very nervous afterwards, as I had been watching the monitor during the test, and thought that what I was seeing on the “stress” portion of the test was different from the “rest” portion. Thank God I don’t know a thing about what I was looking at – another several days of my life thrown away due to anxiety. The results came back, and everything is great. Not only is my heart working, but appears to be able to do so for some time.
I am also currently active on the list again, pushing on into the next year of waiting.

**don’t hesitate to send O blood types this way for donation**

Ok.

Wonderful in fact.

I think I forgot to mention it, but I had a stress test last week – well the results are in, and I seem to have a working heart.

So why a stress test you ask?

Well part of being listed with UNOS is keeping up to date with a bunch of stuff. Essentially, in order to keep you “active” on the list, they want to make sure you’re in relatively decent health. So every once in awhile the wonderful folks down at University Hospital call me up (or send a letter) and let me know I have to do this or that test.
The last time I did this test was a couple of weeks before my wedding.
So I go and do this nuclear stress test. Yes, nuclear isotopes are injected into the blood stream to do God knows what (I think they drink margaritas).
A few days later I received the unsettling news that the test results showed significant blockage in my heart.
Great
Every person dealing with Chronic Illness is familiar with these calls from nonchalant doctors which end with you having a panic attack thinking of what torturous concoction of further testing you are going to be subjected to. In this case the doctor wanted me in the “cath-lab” ASAP. He wanted to (not personally) thread a catheter through the femoral artery (conveniently located near my groin), aaaaaaall the way up to my heart.
“Then and only then can we figure out what’s really going on up there” he told me.
So I went into research mode.
“How can a 27 year old man have significant heart blockage and not have noticed it until now?” I wondered.
Some patients get that call, and go straight to the Hospital to figure it out. I went straight to google, and in five minutes learned that there was an alarming rate of false positive results with this particular test.
Rather than feel that hose dance its way up to my heart, I simply asked if we could do something else (anything else!) first.
So I went in again and did an “echo” to check it out. The “echo” is just a fancy ultrasound of the heart.
While I was told it would not tell us conclusively if there was blockage, they said it would certainly show blockage at the level indicated by the first test.
Now … before I go any further, I need to point out something that to this day really bugs me.
This first test I speak of came back indicating that there was “significant” blockage causing lower blood flow in one area – but then showed increased flow further down the same “line”. Ok, so as kids did any of you kink a hose during a water fight and have the person manning the front of the hose turn around and drench you?
No, you didn’t, and I’ll tell you why.
If you block a line, and decrease it’s flow, that flow remains decreased all the way “down stream”
So how then, do I have a blockage in my heart diminishing flow in one area, while I have great blood flow a little further along?
And why was having me sent to the cath lab the answer to this question rather than the echo?
I still don’t know…
It turns out there was no blockage, and no need for all that anxiety a week before my wedding. I was taking valium to quell the anxiety attacks.

So when I got the call this time around telling me to head down for another nuclear stress test, I was a little apprehensive.
My machine is beeping … I’m done.
Awe man … and I was just getting to the good stuff!
Tune in Wednesday (or possibly sooner) for the next installment:

Having Your Heart Jump Out of Your Chest When They Juice it up With Atripene