Non-Tilty Tilt and QSART

Non-Tilty Tilt and QSART

Today I had what is hopefully the last of my testing to determine which form of dysautonomia I have and what caused it. Combined with my testing from the other day, I’m hoping the diagnosis and cause should be fairly evident by the time all is said and done.

I could hardly sleep last night worrying about these tests. I literally slept from 4:30 am-6:30 am, so I definitely wasn’t feeling my best when we arrived at the hospital. This time my testing was at the autonomic lab in a different building than all the other testing had been.

When I was called back, the woman who was running my tests, Kim, led us to this tiny room that you could barely squeeze all the equipment into. I guess that’s what happens when you’re in the oldest building on campus.

img_0836First up was the QSART test, which involved running a current over parts of my skin to introduce a chemical to stimulate my sweat glands. Little capsules measured the amount of sweat produced. I had patches and capsules placed on the inside of my left wrist, the outside of my left calf, the top of my left foot, and the inside of my left ankle. It wasn’t the most comfortable test, because the current felt like a burning, itching, getting stung by bees kind of thing. But that part only lasted for five minutes. Then I just had to lay there for another ten minutes while the capsules collected their readings. She had to redo the one on my left wrist because it wasn’t reading correctly. But overall, that test wasn’t too bad.

The next tests were part of my “non-tilt tilt table.” Meaning, I didn’t have to do an actual tilt table test because of the risks involved due to the relatively new stent in my head. So I have no idea why they even call it a tilt table test. Oh well.

Courtesy University of Washington Regional Epilepsy Center

The first test was done with me laying down and is known as metronomic breathing. I was hooked up to all these sensors (including a nifty thing that measured my blood pressure continuously from my thumb). The jist of the test is I had to take deep breaths in and then let them out at a rate counted out by Kim. She would say, “And in, in, in, and out, out, out, out, out, again, in, in, in, and out, out, out, out, out” and so on for I think five times. This type of breathing causes blood pressure to fluctuate, decreasing with inhalation and increasing with exhalation. These changes in blood pressure cause fluctuations in heart rate due to the baroreceptor reflex. This variation in heart rate is measured and helps determine the presence of autonomic nervous system dysfunction.

The second test was the Valsalva maneuver. I was actually sitting up for this one. All I had to do was take a deep breath and blow as hard as I could into a little nearly occluded mouthpiece for 15 seconds and let me tell you, that is a really long time to be blowing that hard. The best thing I can compare it to is when you get those stupid balloons that will just not blow up for anything and you’re sitting there like an idiot, turning blue trying to force air into the thing. Anyway. I had to do it three times and almost blacked out near the end of the third one. There are a variety of complicated things that happen during a Valsalva maneuver,  including increases and decreases in blood pressure and heart rate, and at one point, a blood pressure overshoot which causes a reflex decrease in heart rate. In people with autonomic nervous system dysfunction, the blood pressure overshoot and decrease in heart rate are typically lost.img_0837

And after that, I was done. It only took an hour and 15 minutes from start to finish. Kim said the results usually take about three days to process, and then Dr. W (the neurologist in charge of all this autonomic stuff) would discuss with Dr. J. I figured I might give the office a call next Thursday to see if they can tell me anything yet.

So hopefully, my testing is pretty much done. I still have another week to hang out with Sherlock, but since Dr. J is getting the information daily, hopefully he’ll just be able to tell by the end of next week what’s going on.

I took a nap when I got home because I felt like I’d run a marathon. I’m still ridiculously exhausted, so I’m spending the day in bed with my head propped up instead of sitting up in a chair because I feel the best (which still isn’t very good) when I’m laying down. But I have lots of books to read and kitties to keep me company!


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