Nuclear Stress; or, Adventures in Cardiology

Faithful readers of this blog may recall my previous chronicle of Adventures In Radiology, the epic tale of my thyroid testing. I now bring you another exciting installment of my medical misadventures, this time in cardiology.

I recently switched primary care doctors, not that there was anything wrong with the previous one, except his location; a doctor in Norfolk was handy when I worked there, but once I was working in VB, trekking in to Norfolk for routine blood work got old real fast. So I finally found a new doctor less than 2 miles from my home, and recently had my first appointment with him.

After evaluating my current litany of prescriptions, ailments, and familial risk factors, he decided what I needed was a "nuclear stress test", for which he referred me to a local cardiology practice. Shortly, I was getting instructions for what I couldn't have after midnight the night before (i.e., anything except water and apple juice) and what time I should be there (8:15 for an 8:45 appointment), and, oh, by the way, it'll take "about two and a half to three hours."

Let's dispel that little myth right now; I didn't leave the place until 1 PM. I make that to be 4 hours and 45 minutes, or about 50% longer than even their most generous estimate.

So, you ask, what is a nuclear stress test? Well, in my admittedly limited experience, it consists of a nearly 5-hour period spent largely solving Sudoku in the waiting room, interspersed with two spells in that rig pictured above (no, it isn't a rack, though it wasn't the most comfortable piece of equipment I've been examined on) and several brief periods of torture (getting an IV inserted in the back of my hand, 10 minutes of what they called a "fast walk" on a treadmill and what I called "running uphill till I was ready to drop", and having ten electrode contact pads and the tape from the IV ripped unceremoniously off my skin).

I started off by filling out the inevitable ream of paperwork, including a paper they wanted me to sign acknowledging receipt of their privacy policy, which was fine except they hadn't given me one. The woman at the desk seemed a bit put out that she had dig a copy out for me. How unreasonable I can be. Once that was out of the way I settled down with my Sudoku until someone fetched me for "prep". This meant insertion of the aforementioned IV, administration of the first dose of thallium tracer, and getting those 10 electrode pads stuck onto various portions of my anatomy. Then it was back to the Sudoku while the tracer wended its way through my system.

Eventually I was escorted to the room containing the rack imaging rig and instructed to lie down on the table. Now, that table is at best, I would say, about 15 inches wide. Like the table on which I had my imaging for the thyroid tests, certainly not wide enough for my arms, but in this case I was told to put my arms up over my head. OK, but the part of the table above my head was not in any way designed for that purpose; it seemed to be more of a question of there being no place else for the patient's arms. So the curved edges of the table kept digging into my arms and cutting off the circulation. I wish the people who make such medical equipment would hire a designer who would actually lie down on the prototype for 20 minutes. I'll bet the result would be something actually designed for human anatomy.

Anyway, the skinny table moves the patient (me) into the ring, and the boxy things on the ring move around me, presumably taking pictures of the radioactive tracer in my heart. The "resting" run takes nearly 20 minutes, during which I try, without success, to get my arms into something approaching a comfortable position without moving the rest of my body. When that's done, I'm back to the waiting room for another thrilling Sudoku. Good thing I've got a whole book of 'em.

OK, that was the "nuclear" part of the test (well, part 1 anyway). Finally they come after me for the "stress" part. Remember those ten electrode contacts? This is when they hook 'em all up to the EKG machine and put me on the treadmill and start it rolling. Those of you who know me are probably aware that working out on a treadmill -- or, indeed, any other form of exercise -- is not exactly part of my normal routine. Suffice it to say that by the time I got my heart rate up to their target for the designated length of time, my legs were jelly and I was gasping for breath. At least I got to sit down for what they termed the "recovery" period. I asked for water and got apple juice (for some reason that was more readily available), and declined the offer of a package of peanut butter crackers despite having had nothing solid since 10 PM the night before. I hate peanut butter crackers.

The tech had already administered the second dose of thallium through my IV -- while I was still huffing and puffing on the treadmill! -- so after they yanked off most of the electrodes I got to hunker down with my Sudoku once more and wait for the final scan. And wait. And wait. Apparently they were having technical difficulties with one of their two scanners, so everyone (there seemed to be a lot of these stress tests scheduled) was being funneled through a single machine. I was beginning to fear that the thallium would decay too far or wash out of my system, and I'd have to repeat the whole bloody treadmill bit. But finally my turn came to get back on the instrument of torture imaging machine, fold my arms back up over my head, and try not to fidget for another 15 minutes.

And then I was free. I gathered up my jacket, my Sudoku, and my tote bag that I'd been lugging back and forth to the waiting room (they don't seem to believe in lockers for patient paraphenalia), and headed out to the desk, although no one gave me any paperwork or instructions to present myself there. When I asked if I was maybe supposed to pay my "encounter fee", the woman at the desk rummaged around in a file tray and finally decided yeah, probably I needed to pay $15. Then she had to go back to the examination area to locate my paperwork so I could get a copy.

In the end I finally got to work a good hour after I had expected to (having taken a half day of PTO in order to participate in these fun and games). My hand was sore from the IV, my legs ached from the treadmill, and other parts of me were stinging from the removal of various adhesive-backed things. And I was damned hungry.

But I'm getting pretty good at Sudoku.