Wednesday, March 23, 2011

My Mayo Clinic Adventure - Autonomic Testing on Day 2

Mayo Clinic Arizona entrance
After meeting with Dr. Goodman on Monday and receiving my itinerary for the following three days, it was time to get down to the business of figuring out my diagnosis. Of course the only way to do that was to run some tests.

Day Two - Tuesday, March 15

8:00 am: Eight o'clock in the morning -- my autonomic testing was scheduled bright and early. Getting up that early in the morning is not something that is easy for me to do. Thank goodness for my wonderful husband Robert who handled the logistics of getting me back and forth from the hotel to the clinic.

The instructions attached to my itinerary said I should eat a light breakfast 3 hours before the test and the no food or drink after that. So I did the math, and decided I would go fasting because I wasn't getting up at 4:45 am to eat a light breakfast.

I was also instructed by Dr. Goodman to hold my sleep and allergy medications, which I thought would be no big deal, Well, that was until I couldn't fall asleep, tossed and turned when I finally did fall asleep and then woke up with a massive headache at 4:30 am. Since I needed to get up to take something for the headache and that medication needed to be taken with food, I wound up having a light breakfast after all!

Tests always make me anxious and I felt even more so when I read that Robert couldn't be in the autonomic testing lab with me. Luckily for me, the tech who conducted the test (boy I wish I could remember her name!) was warm, kind and sweet. We spend much of our time together talking about life in Arizona, gardening and her trips to California. She really made me feel relaxed; I knew I was in good hands.

Over the course of about an hour and a half, she conducted four different tests: 1) a resting sweat output test, 2) a deep breathing test, 3) a Valsalva test and 4) a tilt table test. With the exception of the tilt table test, all the other tests took place while I was laying down on an exam table. I suspect that during the moments of quiet before and between tests, the machines were recording my heart rate and blood pressure to establish some baseline and recovery measurements.

1. The resting sweat output test: For the first test, the tech applied one small circular capsule to my left arm and two to my left leg. Then she ran a small electrical current through the capsules to stimulate a sweat response. It felt like a buzzing or stinging and was a bit uncomfortable. My skin didn't feel sweaty, but that was because the capsules where actually drawing sweat into them to measure the amount I produced. This part of the test last about 5 or 10 minutes total.

2. The deep breathing test: This test was surprising similar to using my emWave PSR device. I was instructed to watch a breath pacer, which was a light bar that gradually lit up when I was to breath in and gradually went out when I was to exhale. Each breath occurred over about 20-30 seconds and I needed to complete eight deep breaths per session for a total of two sessions. Thank goodness there was a break between sessions, otherwise I might have gotten really lightheaded and passed out.

3. The Valsalva test: This was a different kind of breathing test. I was instructed to take a deep breath in through my nose and then blow it out through my mouth for about 20 seconds into a tube which was connected to the blood pressure meter. With my exhalation, I needed to maintain a constant pressure of 40 mm Hg. I got one practice run before completing two sessions that were recorded. Let me tell you, it was hard to hit and maintain that 40 mm Hg pressure mark, but I seem to have mastered it by my third attempt.

4. The tilt table test: So the table that I had been laying down on for the previous three tests actually moved from horizontal to vertical and back. Before any of the testing began, the tech actually had me step up against it while it was vertical and then lowered me down into a horizontal position. This time, big, wide pieces of velcro secured me to the table for my trip back upwards. The tech explained to me that she would only be raising me up 70 degrees, so in essence I was ever so slightly tilting backwards.

This part of the test was hard on me; I just don't do well standing up. For this test, I had to stand still for 10 minutes. Quite honestly, it was the longest 10 minutes of my life. At the 8 minute mark, I really wasn't feeling well at all: quite light-headed and woozy. The tech said we could stop, but I asked if she wanted me to tough out the last two minutes, which I did. I could see my blood pressure readings during this part of the test and my brain registered that my blood pressure was steadily dropping over time. 'That can't be good,' I thought to myself. At the end of the test, I was lowered back down into a horizontal position.

After all these tests, I needed to take some time to recover, first laying down, then sitting up. I eventually slid off the table and headed for the chair next to the tech's desk, where I spent a few more moments before heading out of the lab and back to Robert in the waiting room. I definitely felt a little wobbly on the walk out.

The only other thing I needed to do was check in with the Scheduling desk to see if any of my outstanding appointments had been scheduled yet. A friendly staff person checked and let me know they were still pending. She gave me a card with a number to call later in the day so I could check back on their status.

Thankfully that was the only test scheduled for Tuesday. I was glad when we finally made our way back to the hotel, eager to spend the remainder of the day resting and napping.

Tomorrow is my regularly scheduled Mission 2011 post, so I'll be back on Friday to share my day 3 at the Mayo Clinic with you.

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erinj0 said...

Interesting post..
How was day 3? Did you get a diagnoses. I hope all went okay and they were able to give you an answer! The hardest part is waiting and not knowing...

Do you know why they did the breathing tests on you or what they were looking for? My breathing is really bad with my POTS/Dys so I was just wondering.

Take care & keep us posted!

Felicia Fibro said...

That sweat output test sounds interesting, I'd never heard of one administered like that. What reason was the sweat output test done for?

I got a lil woozy feeling just reading about the tilt table test!

I'm enjoying reading about your experience at the Mayo Clinic and can't wait to hear their conclusions.

Selena said...

@Erin: The breathing tests actually looked at changes in heart rate and blood pressure. Those particular ways of breathing put stress on the body. When you have dysautonomia, your body doesn't respond to that stress in a right way because of autonomic nervous system dysfunction.

I know I get short of breath when my heart rate is elevated.

@Felicia Dysautonomia causes changes in sweating. In my case, my sweat response is reduced. That test stimulates the peripheral nerves, so it actually tests both sweat response and if there is peripheral nerve damage.

Thanks for your comments ladies.

Migrainista said...

I had that tilt table test a number of years ago. I don't generally have a tough time standing, even still like that so I wasn't really taking it very seriously. It was Christmas Eve and I was chatting with the technician about holiday stuff and 7 minutes in I passed out. They never really came up with a reason other than I'm tall and skinny (really skinny back then) and this kind of thing happens. Very interesting test.

Can't wait to hear your final impressions when they are all done with you.