Reality Rears its Ugly Head

Day 2 of the stress test was a walk in the park compared to the first day, but without the walk. In this type of stress test, on day 2 the technicians image your heart at rest as a comparison to the imaging that was done on day 1 when your heart was under load.

I showed up at the imaging department at 10:00 AM. The nurse injected me with the thallium, gave me a glass of milk, and told me to come back in an hour. I headed to the coffee shop in the hospital (giving the cafeteria in the place wide berth based on my experience from the day before), grabbed a cup of coffee and a glass of milk, and started killing time.

As an aside, Beth bought me an HP netbook with a solid-state drive for my fiftieth birthday. I love that thing! With public wi-fi in the coffee shop, the hour went quickly. I checked email, worked on the online class I was teaching, and did some more reading on angina. Then, I headed back to the imaging department.

Day 2 of the imaging was the same as the first day: You lie down on a table and hold your hands and arms above your head. The table has a strap to hang on to; keeping your arms out of the way gives the imaging head of the unit (which looks almost exactly like an open suitcase) a clear shot at your internal bits. If I had more sense (or been in less of a state of denial), I probably would have brooded. However, yours truly was fat and happy, so I dozed, did breathing exercises, and waited for the process to finish.

At the end of the 16 minutes, I headed out of the hospital. Since it was nearly 11:30, I decided to grab lunch so I headed to a hut that served pizza to eat a salad and a couple of slices. That done, I went back to the office. When the stress test was set up, I made an appointment with my personal physician for Friday morning to go over the stress test.

Several hours later, at work, the phone rang. You hear about times when everything changed? This was mine. The doctor who had ordered the stress test was on the line. She said, “The cardiologist is in the clinic. Could you please come in now?” I gathered myself together, called Beth, and we headed to the hospital. After that, things started happening fast.

Next up, the cardiologist and the vagaries of the healthcare insurance system.

The Active Stress Test

I’m an early riser: I’m usually awake by 5:00 AM and sometimes even earlier. On Tuesday morning I had to be at the hospital for the first part of my stress test at 7:00, and I was up quite early. My doctor scheduled me for a thallium stress test, which would take place over two days.

The first day of the test would take place under exercise; they essentially stand you on a treadmill and work your heart rate up, then inject a nuclear material into your bloodstream. Afterward, they take pictures of your heart to see where the material was taken up by the muscle. The second day was similar, without the exercise: An injection, a wait for the material to be taken up, and pictures at rest.

I showed up at the hospital at 7:00 AM. I had been on caffeine restriction for the previous 24 hours, to ensure that the test wasn’t influenced by that drug most of us crave and subsist on. I only fell off the wagon once; I brought in doughnuts for my staff and somehow a chocolate-covered cake doughnut leaped into my mouth of its own accord (healthy, eh?) but that was at 8:15 AM the day before so I figured I was safe.

They had me change into workout clothes, popped on a slew of electrocardiogram (ECG) leads (12, in fact), a blood-pressure cuff, and then we waited for the doctor. The ECG leads are a pain for me, as I’m a rather hirsute guy; the tech whipped out a set of electric clippers and made some dandy racing stripes for me. Classy. The respiratory technician said a 9-minute test would be a long one, so I set my sights on that.

The doctor showed up and we started the test. At first, walking was slow and easy, about 2.5 mph and a slight grade. Every three minutes, the treadmill sped up and the incline increased. At my weight (a bit more than an eighth of a ton… Do the math) and age, they were trying to get me to 150 beats per minute. At six minutes, the treadmill went to 3.4 mph and a 14.5 percent grade. Still, I kept working; my heart rate was 154. Then, near the end of the 9 minutes the nuclear medicine tech showed up, opened up his little lead-lined carrying case, and pulled out the syringe. A few seconds later, I had a glow about me. They kept me working hard for another minute, to get the tracer through my entire system. Then they moved the treadmill into a cool-down mode.

After the workout, they made me drink a couple of glasses of whole-fat milk (fat helps increase the uptake of the thallium), and scheduled me to report to the imaging department in an hour. In the meantime, they told me to go eat (the fattier, the better they told me: Something I don’t expect to hear any more any time soon!).

I went to the hospital cafeteria. Not being a big fan of cafeteria food, I can honestly say the experience didn’t change my opinion. My meal? An omelet, a bowl of oatmeal, and another glass of milk. The omelet was right up there with the worst I’ve had (and I’m a foodie, mind you); when I first saw it I thought it was a taco of some sort. I had that corn-meally look, and about the same size as an Ortega shell. The oatmeal approximated school paste from my elementary days, and wasn’t much better. But I ate it all, just to kill time.

I showed up to the imaging lab, and they laid me down on the table. The process took 16 minutes. The test works by looking for where the thallium was taken up by the heart muscle: No thallium means reduced blood flow to that part of the heart. From reduced blood flow, the doctors deduce that there is a blockage somewhere in the web of arteries that supply the heart. A good overview of the test and a picture can be found here: http://www.americanheart.org/presenter.jhtml?identifier=4743

After the test they sent me on my way. None of the technicians would tell me anything; since they’re not doctors they’re not qualified to perform diagnosis. So I went blithely back to work, thinking I was fine. The dialog went like this:

Me: Hey, that went ok. I mean, I’m fat and all, but I made 9 minutes.

Me2: Yeah, there’s that.

Me: And no chest pain. That’s got to be a good sign.

Me2: Yeah.

Me: So it’s got to be anxiety. See, I was worried about nothing.

In the next post, reality rears its ugly head. Plus, a healthy recipe that was really good.