This was pretty much the last day of testing for me. I still have a few more appointments but all of the actual testing ended today. I must say they saved the "best" for last.
7:00am Pre-Admissions Appointment:
This was just to get me checked in and registered in the hospital's system for the procedure.
8:00am - TC (Transplant Center) Pulmonary Medicine Exercise Swan VO2 Study:
They got me in the room and my parents were able to WAIT with me. The nurse came in and started getting everything set up. They ended up using my port for this test as they were in need of an IV for sedation. My parents stayed with me until the nurse had gathered everything she needed and was ready to access the port. When she said she was ready to access the port my parents left and went to the waiting room.
The set up involves not only the IV, but also placing a pulseoximeter (device to measure a person’s oxygen saturation) on your finger, getting the heart monitor set up for the nurses and another one for the respiratory techs, and a blood pressure cuff placed on your arm.
It was actually one of the doctors on the transplant team that did the procedure. It was nice to meet one of them - other than the doctor I saw on my first visit this is the only transplant doctor I have met. He asked me general questions - like if anything in my health had changed since I saw the doc for the first time in Dec. I said yes I am on O2 now and he just nodded and patted me on the shoulder and said - it is good you are here to do this now since you have started on the O2, and we will take care of you.
He explained the procedure pretty well. They started start by giving a small dose of versed to help with the anxiety and nervousness of the whole thing. Then they numbed my neck with lidocaine and took and inserted a line in a vein in my neck just above my clavicle. Once they gained access in my neck they feed a line through the vein, through the heart and into the Pulmonary Artery. He said the line has a small balloon type thing on the end of it that can measure the pressures within the pulmonary artery once it is properly placed.
Also to Note: As the line is being fed through you can get a fluttering in your heart it is relatively easily dealt with - the line is simply advanced through the heart and the fluttering will stop.
Then once the line is placed in the neck the Swan is attached and the site is covered with tegaderm or some type of dressing cover. From there they moved to my wrist – again numbing with lidocaine - to start an arterial line. They end up taking several blood gases throughout the testing and rather than stick you repeatedly they just get an arterial line so they can continue using it throughout the test.
They take several measurements while you are at rest, flat on your back. For this portion of the test I was on 5 liters of Oxygen. I am not really sure why my oxygen saturation was so low, but they were at 91-92% on 3-4 liters at the beginning of the test. By the end of the test they were up to 97% on 2 liters - go figure.
Once they get all of the measurements they need from you laying flat they will sit you up. You sit up straight for several minutes, and they take the same measurements they took while you were laying flat while you are sitting up straight.
After sitting up straight for several minutes I was helped up out of the chair to a standing position and placed onto a stationary bike. I had to ride the stationary bike for a time to be determined by them. They have you place a mouth piece in your mouth, and they remove your nasal cannula (if you are on Oxygen). You then begin getting O2 through the mouth piece. They have you use the mouth piece so that they can measure the way that you absorb gases while you exercise. They then start you off riding the bike. They tell you to go faster and faster until you are at the pace they want you to be at and then you have to maintain that speed until they tell you to stop basically.You have to signal if you think you will need to stop soon, you can not just stop - if you just stop they have to start the bike portion of the test all over again. I signaled and they started taking their measurements but they would not let me stop. They told me to keep going and keep going because my saturation was doing well and my other readings were apparently stable at the time. At that point I told them that my legs were hurting and that is why I wanted to stop. They kept me going until I was shaking - then I heard the doctor say get what you need she is done. Then they took their measurements all over again and I was able to slow down. This test was pretty much as hard as I expected.
They took about 4-5 blood gases throughout the testing. They also read other things - blood pressure, pressure within the pulmonary artery, respirations, O2 saturation, and some others. I was told that I had some pulmonary hypertension - which would go away with transplant. Otherwise I think everything else was normal with my heart.
This test is done to show the docs whether or not my lung problems are caused by heart problems or if there are heart problems caused by my lung problems. It can give them an idea of what meds I need to take before, during or after transplant. He said that if I had heart irregularities I may need to take meds now or after transplant for that - or there may be certain meds they need on hand to help me through surgery when I am actually getting transplanted.
Once all of the testing was done and the doc gave the okay - the nurse pulled the line from my neck. For this the worst part is really the pressure on the insert site because it is tender. She also had me take a deep breath and hold it as she removed the actual catheter because she said there is a risk of pulmonary embolism if you breathe while the catheter is being removed.The arterial line was also tender on removal - it was not a sharp piercing pain so much as a prolonged throbbing nagging pain. Initially my hand was numb into my thumb, pointer and middle fingers.
They said that the reason I do not have to have a left heart catheterization is due to my age. With the left heart catheterization you remain laying the entire time and the catheter is placed in your groin. If I was older and heart disease was more of a concern then they would most likely have ordered a left heart catheterization as well.
Sorry if I scared any of you with the write up of this test - but I didn't want to lie - it was hard - it was NOT horrendous. I CAN imagine worse things, but it is not an easy test to get through that is for sure.
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