Thursday, 10 September 2015

Tilt table test

Another one of the tests I've had recently was the tilt table test (what a tongue twister!). This is primarily used to diagnose a condition called POTS (Postural Orthostatic Tachycardia Syndrome). This is an interesting disorder which I have written about before. It is characterised by a sharp rise in heart rate (often accompanied by a drop in blood pressure) upon sitting or standing up, causing dizziness, blacking out, nausea/vomiting, paraesthesias and fainting. It can affect you even when you're not moving around as you just end up feeling really tired all the time. When you are moving, you don't have to move dramatically (e.g. standing up) to have symptoms - it could be a much smaller movement.
One of the first signs that I had trouble with these symptoms was when I suddenly fainted whilst doing burpees in the gym - in the days when I was much more mobile! I actually did that several times before deciding that maybe burpees weren't a good idea for me...

I'll give you one for a potsie - you're treated like a celebrity at the gym ever after, especially if you can faint more than once.
POTS is usually described as a type of autonomic dysfunction. At its purest, this means 'problems with the nerves which control automatic processes in the body.' However, a whole host of other problems can also cause symptoms in patients, such as:
  • Hypovolemia (low blood volume) and conditions which cause this, e.g. dehydration
  • Problems with levels of norepinephrine (a hormone/neurotransmitter)
  • Viral disease
  • Deconditioning and/or chronic fatigue
  • Genetic tendency
  • Weak blood vessels (a BIG problem in EDS!), because if the walls of your blood vessels aren't strong enough to cope with blood pressure then your heart has to work harder (faster) to compensate.
Courtesy of Stickman Communications.
Anyway, my cardiologist wanted to see where we were at with my POTS and so he got me to do a tilt table test, which is pretty much the 'gold standard' in diagnosis and management of POTS. As with so many of the tests I have to have, this one involved fasting the night before and in the morning. John had to drive me into the hospital (Papworth this time, so a bit further from home than Addenbrooke's) as I wasn't allowed to drive myself there or back, and then I was admitted to the Cardiac Day Ward.
Something I have in common with royalty - I, too, have left Papworth Hospital.
After a fairly long wait (in which I was both starving and dying for a drink - neither food nor water being allowed) I was called through to the testing room. By turning up in a wheelchair I immediately posed a problem for them, as in the test you have to stand up for quite a while, and although you are strapped to a bed at the same time the straps are not really strong enough to take all your weight. It would be really great if there could be some system in the NHS whereby a patient who sees a consultant in a wheelchair is also expected to go to their tests in a wheelchair. Just saying!
"Hello? Yep, I've got a patient in a wheelchair...no, not a wheely office chair..."
Anyway, we went through all the standard bits of explaining what the test was about and how it would work. Soon I was lying on the bed and they were attaching me to bits of equipment. I had a blood pressure cuff on my finger, another round my arm, and pads on my chest connected to an ECG machine. The start of the test was delayed by about 15 minutes whilst the two nurses tried to detect my blood pressure and heart rate through my finger. It turns out my circulation to all my fingers is pretty poor, and they had to go through several machines and lots of jiggling before they found one that worked!
Once I was fully attached, they strapped me onto the bed, and then it was time to start the recording. The machines recorded electrical activity in my heart alongside blood pressure and heart rate. We had about five minutes of me just lying down quietly and not moving (so that the machines could record a supine position) and then the bed was tilted electronically so that my head came up and my feet came down. This was my body's cue to start freaking out and, sure enough, I felt the stronger palpitations kick in and could feel my heart racing. I tried to stay calm and keep looking through that bit of tunnel vision which remained!
This is perfect! Credit to Stickman Communications (again).

After things had settled down, I was still standing, and they hadn't let me down. My feet were beginning to hurt. I was putting far more weight down through my legs than I had anticipated, and they whispered that I needed to stay there for another thirty minutes or so. THIRTY! I did my best but well before thirty minutes were up I needed to stop the test. I was just in too much pain and I knew that it was beginning to affect my heart rate because I was blacking out and feeling sick. They told me that unfortunately the results wouldn't be valid ('we couldn't find anything') as we hadn't waited the whole time, but I'm not sure this is true. They gave me a copy of the results, which of course I looked through, and I saw quite a lot going on in the old ticker. I suppose I shall have to wait and see what my consultant says.
Some of the fun in my results.
After lying down a little longer in the test room I was allowed back onto the ward - but not to go home yet! I had to eat some toast and marmalade (I even had the option of jam or marmalade, which puts it one up above Addies) and have plenty to drink (almost a litre - reeeeeefluxxxxxx...). Fortunately there was a good supply of papers so I sat and had a nice little breakfast all to myself before John drove me home.
This one's described as 'Nurse Holding Breakfast Tray With Patient Lying On Royalty Free Stock Images' - which doesn't sound very comfortable...
Later that day I had another trip to the Citizens' Advice Bureau, which was long and a bit tedious and depressing, but the lovely people at the Cambridge branch have made the whole process of applying for benefits so much less confusing and I am so grateful to them for all their help.
I felt fine immediately after the test but I did get a bit of a killer headache in the afternoon. I took a whole load of codeine, filled up on salt and water, and had a nap - which took the edge off it - then went for a very gentle scull in my boat in the evening which made me feel much better. Fresh air and exercise can work wonders sometimes!
This came up when I searched for fresh air, and who doesn't love Happy Feet?
If anyone is going for a tilt table test then the main thing I would say is that if you're not very good on your feet then be prepared for it to hurt - or ask them when you can stop the test. Other than that it's all quite straightforward and you don't really have to do anything. It's mostly things you mustn't do - eat, drink, move, talk, breathe...! Oh, and when they bring you a pot of tea afterwards, DON'T DRINK IT ALL - they also brought me a jug of lemon squash and made me drink half the jug, AND this was after I'd already had three cups of water. I simply cannot contain that much liquid!
Not me.

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