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Friday, September 11, 2009


Well, it took me a bit longer than I had anticipated, but I'm finally here to bring you guys up to speed on what's happening with my cardiologist.

Recap: about a month ago I went to my new cardiologist, Dr. Dhillon, after asking my pcp to refer me to a cardiologist because I had read about some heart/blood pressure conditions that I thought I might have. I went to Dr. Dhillon hoping to be set up with a table tilt test to test for neurally mediated hypotension, which is a type of orthostatic intolerance which causes blood pressure to drop significantly during standing, resulting in light-headedness and other symptoms.

So I went to Dr. Dhillon. Being 22 in a cardiologist's office is kind of...embarrassing? Or I just felt kind of silly. Every other patient was at least 50. When the physician's assistant was taking my bp and EKG (you know you're at a heart doctor's when instead of taking your temp they do an EKG), she was like, "How old are you!? You look like a baby!"; I think people my age are pretty rare in their office. I think because of my age, Dr. Dhillon was slightly skeptical of me, not to mention that I came in knowing pretty much everything he ended up telling me, but he was decently nice and was fine about setting up tests and things for me. He agreed that I likely have some sort of syncope/neosyncope (which means fainting/near-fainting), but we are still in the process of trying to determine exactly which condition I have under that umbrella. There are several conditions that create the same symptoms but have different causes. For example: neurally mediated hypotension (NMH) and postural tachycardic syndrome (POTS) are both types of orthostatic intolerance (which is a type of syncope in which symptoms are aggravated when standing). They both cause light-headedness, dizziness because they both result in getting too little blood to your brain after standing (your body can't properly respond to the change in gravity when you stand up). Both are the result of abnormal regulation, but NMH is the abnormal regulation of blood pressure while POTS is the abnormal regulation of heart rate. So table tilt test will help us figure out which thing is happening abnormally (more explanation to follow : p).

At my first appt with Dr. Dhillon, he scheduled me for an echocardiogram, which is an ultrasound of the heart. This just checks to make sure that the actual heart is functioning properly, to make sure that it is a problem with the regulation and not the mechanism. I think we also had to do it before a table tilt test to make sure that a table tilt wasn't going to kill me or something. So I had my echocardiogram a week after my first appt with Dr. Dhillon, and then had a follow-up with him a week after that. My echo was normal, as expected, so now I have been scheduled for a table tilt test next Wednesday.

Ok, so what is this table tilt test thing? Basically, here's what I think is going to happen: I'm going to lay on a table for 15-20 mins to establish a resting heart rate/blood pressure, and then they're going to strap me to the table, and raise it up to a 70 ° angle (so it's slightly less extreme than actual standing up), leave me like that for 30 mins and see what happens with my blood pressure and heart rate. POTS is diagnosed with an increase in heart rate of 30 beats per minute within the first ten minutes of being put upright, while NMH is defined as a drop in blood pressure of 25 mmHG within 30-40 mins, so this will be able to determine which of those things are happening. It is highly likely that I will pass out during this test (a lot of people have their first actual fainting episode during the test) because I can't go lie down. Normally, when I start feeling symptoms I go lie down so that I don't pass out. This test makes it so that you can't counteract what's happening with your circulatory so that they can actually see what it is. Make sense?

I'm actually pretty nervous about this. From what I've read, I'm supposed to feel like absolute death for 2-3 days afterwards, which believe it or not, I'm not really looking forward to. Also, the test isn't super reliable, and can result in false positives or false negatives, but it's the only way to be able to see what's happening (it's basically like triggering a seizure so you can brain map it, you know?). We have a family friend who's a nurse, and she said that the first table tilt test she was ever at, the girl flatlined for 13 seconds...good to know. She said that that's super uncommon, but still, it's not very comforting.

But, good news: after this test, regardless of what the results are (like, even if it doesn't show stuff) Dr. Dhillon is going to start me on medication for hypotension to see if it helps. I'm pretty excited about that because I think it's going to make a big difference, but I'm trying not to get too excited, just in case it doesn't.

Oh, and other good news, I was able to get health insurance, and in time that I didn't have to push these tests back or anything. Very exciting.

So be thinking of me on Wednesday the 16th between the hours of 12 and 2pm (my table tilt test) and I'll let you guys know how it goes!

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