Shoulder Replacement Part 4
Written on September 26, 2011 by Daniel P. Malito
Last time, I was about to get my cardiac stress test for the upcoming shoulder replacement surgery. Well, I am now a mere day away from my trip to the operating room, and the positive stress test results allowed that to happen. It seems my heart is A-OK, barring a bit of muscle thickening due to my high-blood pressure, and my circulatory system should have no problem dealing with the rigors of joint replacement surgery. Unfortunately, making it through that stress test was a six-hour ordeal that took me completely by surprise.
During the last checkup with my Rheumatologist, he expressed concern that my heart may not be what it once was, i.e., up to a major surgical procedure. Because of that, and because he likes to be thorough, I agreed to go for a cardiac stress test. When I asked exactly what that entailed, I was told that I would have to run on a treadmill or ride an exercise bike for a few minutes while wearing a heart monitor. Well, it ended up being just a bit more than a “few minutes on a treadmill.”
When I arrived at the cardiac specialist’s office to begin the stress test, I was told that I’d first have to have a consult with the doctor before I began any test. So, I waited until this new doctor was available to see me, which took forty-five minutes. When I eventually did get to see the specialist, I was told that I would not only be subjected to a cardiac stress test, but I also needed an EKG and an echocardiogram. Great, I thought, even more time spent getting tested.
If any of you have ever gotten an echocardiogram, you know that it can be more of a pain in the butt than it’s worth. The test is basically a sonogram of the heart, and as with any sonogram, gel is needed to help the sonic conductivity. The gel is blue, gooey, and cold. Not only that, but when the 20 minute test is finally over, you get a measly paper towel to clean yourself up. It’s as if an elephant has just licked you and you have a small napkin to deal with it.
Once that thoroughly unpleasant test was finished, it was on to the last step — the actual stress test. (The EKG was a simple five-minute endeavor.) As I walked into the test area, I was immediately fitted with an IV catheter. “That’s odd,” I said to the technician, “I thought I was just getting a cardiac stress test.” The technician told me that yes, I was getting a cardiac stress test, and it involved a few more steps than just the actual heart test itself. The first of these extra steps was to be injected with radioactive thallium dye and then lie still in an MRI-like machine for fifteen minutes. “What??” I said to the tech, “no one told me anything about a fifteen-minute scan. I am unable to remain still for very long as it hurts my R.A., and I certainly can’t lay on my stomach as you have asked.” Well, the techs put their heads together and decided that after the first fifteen-minute scan taken while I tried to lie still on my belly came out unusable that I would have to get scanned again. “Gee,” I thought, “it’s so unfortunate that no one told the technicians that I wouldn’t be able to lie still on my stomach for fifteen minutes. Fantastic.” This time, in order to help make the test results usable, I would be allowed to lie on my back. Why I wasn’t allowed to do this the first time is a question that I never got an answer to. So, I flipped over and repeated the fifteen-minute scan, all the time in a bit less excruciating pain.
Once the scan was finished I began the actual stress test part of the ordeal. The object of the test is to get the pulse racing and the heart pumping real fast. That way, any flaw or issue with the circulatory system will be much more visible. What they did not tell me is that since I was unable to partake in any physical activity, I was going to get the “chemical stress test.” This meant that instead of running on a treadmill or riding a bike, I’d be injected with a chemical that set my heart aflutter.
Since I was still fitted with the IV, it was easy to push the drugs that caused my heart to race. The only problem is that I went from resting to racing in less than fifteen seconds. As you can imagine, this was not only disconcerting, but it made me physically ill to the point of almost vomiting. I was told that the chemicals would cause some discomfort, but this was well beyond “discomfort.”
After ten minutes or so, I was soaked in sweat, dizzy, and nauseous, and I hadn’t moved a muscle. The technician told me the test was completed, and I was directed to the waiting room and told to have a snack and a drink. I did so, but could not shake the throbbing headache that had developed since the tress test had ended. I ate some stale crackers and drank a cup of hot decaf tea – the only drink available after ten minutes of strenuous exercise. It was refreshing, as you can imagine. As I finally prepared to depart after five hours of testing, I was stopped at the door. “Oh no Mr. Malito, you still have one more scan to do.” Ugh, were they serious? I had to lie in that horrible MRI machine for another fifteen minutes with my head pounding? Unbelievable. At this point I had passed annoyed and was swiftly approaching angry. It seemed like I was being taken advantage of, with tests being performed on me without any concern whatsoever for my discomfort or wellbeing. I was so aggravated that I told the technician exactly that.
Eventually, after several talks with the doctor, I was convinced to suffer through one more fifteen-minute scan. It seems the medical clearance I needed for surgery would not be given without my completion of the test routine. Medical blackmail? You decide. Unhappy, I climbed into the machine and sucked up my tremendous discomfort until the test was finally finished. Listening to my headphones inside that metal torture chamber made it a bit easier to take, and after six songs I was finally told I could go. On the way out, I was told the doctor had looked at my test results and saw nothing to be concerned about. Funny how that was the exact result I would have predicted had anyone listened to me beforehand. I angrily made my way to my car and went home.
So, here I am, waiting for the clock to strike twelve to begin my fast for surgery. I can only eat for a few more hours, so I’m stuffing myself. Since my surgery is not scheduled until three o’clock in the afternoon, I won’t be able to chow down until at least dinnertime. That’s if the doctors let me eat anything besides ice chips after surgery. Many times, the anesthesiologist does not want the patient to eat until they are regularly going to the bathroom again. This is done to prevent a septic intestinal backup. Prudent, yes, but extremely annoying when your stomach is growling for a big fat pastrami sandwich on rye and you have to settle for frozen water.
For any of you waiting for shoulder replacement surgery of your own, all I can say is that I will do my best to provide as much information on the actual procedure as I can. My quest is to spread information about Rheumatoid Arthritis and all of its symptoms and long-terms results as best as I possibly can. To this end, as soon as I am recovered enough from the procedure to author a new entry, I will add one. So, when you read this, keep your fingers crossed for me, and I will see you on the other side. Assuming all goes well, I’ll be worth over 100,000 dollars in parts when it’s done!