Dobutamine stress test question

[Laoshur]

Hi, all,

Greetings from Virginia for another week! I came back the middle of January from Beijing for a month and plan to return Saturday. While here I have had lots of med tests and doc visits including spending the month on an event monitor and taking a dobutamine stress test. Before I took the test Dr. Gilligan said that if my BP dropped, we should relook at the ICD. An associate of his did the test. I had a small gradient registered from last time and an increased gradient while on the test. My heart rate went to 111 and then dropped as my BP dropped from 129/49 to 80/56 (I think they said. I was a little distracted by trying not to vomit or pass out.) The doc was concerned about the drop and said I needed a pacemaker or additional medication. The nurse, however, said that she thought that I just had a bad reaction to the dobutamine. My question is is it common for BP to drop when on dobutamine as opposed to a treadmill stress test? I have tried to call the office to ask, but have not heard. (This was less than a week ago, so I am not too concerned about not hearing.)

I have also been having a problem with walking, leg numbness, and falling and found that I have severe (doctor's word) spinal disk degeneration and some spinal stenosis. I also learned that there is a possibility I have glaucoma. I guess going back to Beijing with all this hanging over sounds crazy, but actually, nothing has changed - just the names - so I guess everything can wait until we get back this summer.

Any answers on the dobutamine thing?

Also, one other thing: Does anyone else have a terrible rash from the glue from the event monitor? I am allergic and using antihistimine and cortisone ointment twice daily, but still have a bad rash - sort of like poison ivy. Suggestions?

Thanks!
Rhoda

[Linda]

Rhoda, Good to hear from you again, been thinking about you. As for the skin rash, see someone about it now. You'd have more time to think about it if you weren't leaving the country so soon, but till you get an appt and then do what you need to do, travel time will be upon you. We had one experience where the irritation persisted for 6 months, with cardiologist and pediatrician both telling us to be patient, it would go away. I finally lost patience and made an appt with a dermatologist, who immediately recognized an infection. Thirty days of low dose erythromycin cleared it up. The cortisone cream was keeping things at a low level and not quite getting better, yet not bad enough to be recognized by the other docs. I certainly don't assume that's your problem, but if something isn't getting better with the usual treatments, you have to look for another problem.

As for the results of the stress test, a low BP can cause the severe nausea. Call tomorrow am for your results. If they haven't looked at the results yet, a reminder won't hurt. You're on a tight schedule. It's my understanding that the dobutamine stress test should mimic the results of the treadmill stress test. Otherwise, it would be back to comparing apples to oranges. Let's see what info others can offer on that thought. Someone will know. Best wishes, keep us posted. Linda

[Toogoofy317]

Was the stress test done by echo or did they do it by taking x-rays to determine your gradient and thickness?

I had a dobutamine/ nuclear stress test done and got devestating results that turned out to be inaccurate.

As far as the difference I did have a drop with dobutamine but when I had a traditional stress test I was flat on the response. Doesn't help much but thought I'd give my two cents.

Mary S.

[Laoshur]

The test was done with echos. I am not sure what you are referring to about the xrays as I cannot see how a gradient could possibly be measured by xrays. I can imagine an xray being used for measuring thickness, but not very accurately, I would think. Is this done? If so, how and is it supposed to be more or less accurate?

When I last had a treadmill test done last spring, they did not know, or at that time diagnose the HCM. However, the doctor (a different practice) did make some passing comment about my blood pressure not responding as expected, so the two may or may not be different.

Rhoda

[Laoshur]

Hi, everyone, me again!

I talked tonight with Dr. Gilligan. He has had laryngitis, so could not call apparently. It was a pretty big dose of info, but not too many things that were very unexpected. He recommends a pacemaker and possibly an ICD. He seemed more certain of the need for the pacemaker referring several times that this was also important for monitoring my arrhythmias. He mentioned Norpace, but said he would only do it with 2-3 days hospitalization, but since I leave Saturday, there is no time. He also mentioned myectomy and ablation as possibilities. These were unexpected as was the Norpace, which I know nothing about. He said that for now I was on the best possible drugs. He told me to do nothing to stress my heart over the next 5 months and see him when I get back. He also said that he did not see a problem with any painkillers that the orthopedic doc might prescribe, but that he would not favor any surgery because of severe arrhythmias possibly developing. I did not think when talking with him about the fact that I had gone to a dental practice in Beijing. They are highly recommended and used by the American embassy. A large filling had broken off and they found that a cavity had developed under the old filling. They said they will try to fill it when I get back, but it may be impossible to do so without entering the pulp. If they enter the pulp, they will have to do a root canal and a crown. I am scheduled to do this next week. Now, here's the problem. I don't think I can wait 5 months, but I don't know whether I should allow them to drill given the possibility of being forced to have the root canal. I had a problem with anesthesia last summer and also did one time long ago.

Any suggestions? Maybe I could use a little hand holding here as well. I am pretty calm but somehow this month home I have learned that my spinal deterioration is severe, causes me to fall frequently, and may eventually immobolize me; my HCM is more obstructed than anyone previously realized; I may have glaucoma, but have to wait until I get back to find out; and (I am not sure exactly why) but clearly Dr. Gilligan is concerned about arrhythmia. I know I am basically calm because I know that my destiny is not in my hands or anyone else's but God's, but I certainly do not want to hold it together here and then get back to China and fall apart.

As I wrote a friend, I feel OLD at 56. (Yeah, I know that is OLD to some of you, but I expected to get old at 95 like my dad did.) BTW: My dad at 101 has had pneumonia, has a huge hiatal hernia, had an extremely low blood count, and is RECOVERING!

Thanks for listening! I'll write next from Beijing. Y'all come visit me now!

Rhoda

[Burton Borrok]

Rhoda,
Is it possible somehow to just clean out the cavity and put in a temporary, leaving the heavy work until you get back and have your heart taken care of?

Also, before I have any dental work done – including just a cleaning – I take 2,000 mg of Amoxicillin one hour prior to getting in the chair. This is to protect myself against having an infection carry down to my heart in the bloodstream. Should you be protecting yourself this way too?

By the way, I’m seventy-one, and my health insurance will have to keep me alive for at least another hundred years just to get their money back from the expenses I ran up in 2003. - Now that’s a life insurance program.

Good luck in China, and come back safely,
Burt

[Lisa Salberg]

Please take care of yourself and delay your return to China if your health is "calling you" to tend to it.
Dr. Gilligan is looking out for your best interst - please listen carefully.

Be well,
Lisa

[Laoshur]

Greetings from Beijing!

We made it back here last night at midnight, later than expected, but tolerable. I had chest pain from time to time, but not much more than usual, so the flight seemed to be OK.

Thanks, Lisa, for the encouragement to do what is best for my health. I really am not trying to be bad. I just have a contract here and obviously made it last semester and last year without the pacemaker or ICD, so I hate to break the contract.

Dr. Gilligan did not recommend that I stay in the US, but got his nurse to schedule an appointment for me as soon as I return early in July. He said I need to know what I want to do when I come back. I have some questions about at least a couple of things he seemed to say. He seemed to be saying that I need the pacemaker for two reasons - the obvious one for pacing but also for continual monitoring, which he said the pacemaker would supply. Can anyone explain what he meant? Or has anyone had that given as a reason for a pacemaker? I am not sure I understood this correctly. Also, he seemed to imply that I needed time to think about all this. I think he said something like this changing my life from here on. I wonder if he meant that they would not be able to set the maximum heart rate as high as usual since I had problems at 111 bps. Has anyone had trouble with their pacemaker preventing them from getting things done because it would not allow their heart rate to increase? Is this a good guess of what he meant?

Thanks!
Rhoda

[Lisa Salberg]

Pacemakers allow your heart to beat as fast as your body needs, the also 'keep it up' to a minimum heart rate (it paces you faster should your rate drop too low). I have had a pacer since 1992 - ICD since 1997...in short it aint stopped me yet!
Please take care of yourself.

Best wishes,
Lisa