Are you willing to take a cardiac road trip with me?

I know you’re wondering what I mean by a cardiac road trip.  Is it a vacation where everyone wears heart rate monitors, eats food very low in fat and sodium and visits rest stops frequently to check their blood pressure?  Well of course not, because that would not be a fun vacation.

Actually it’s not even a vacation at all.  Instead, I am asking you to be with me, at least in spirit, as I submit to yet another cardiac test to determine what is going on with my heart failure.
​

​Earlier this year, my heart failure doctor told me that he wanted me to do another right heart catheterization.  I panicked initially because I always assume that the need for more tests means that I am not doing well.  I cannot seem to get it through my thick head that if I’m still exercising and only having dizzy spells occasionally, I am doing well and there is no need to push the panic button.

Indeed, from what my heart failure doctor said, it appears that this is just one of several routine tests that they can perform in order to assess the levels of pressure within my heart and between my heart and lungs.  I actually have had this test several times:  Once when I initially blacked out while on a treadmill in 2012, and again in 2014 when the doctors wanted to see if I was a candidate for a heart transplant.

Because the test evaluates pressure in the heart and lungs, it is sometimes referred to as a pulmonary artery catheterization.  According to the Johns Hopkins Medical website, the procedure requires the doctor to guide a special catheter (a small, hollow tube) to the right side of the heart. The tube is then passed into your pulmonary artery. This is the main artery that carries blood to your lungs. The doctor will observe blood flow through the heart and measure the pressures inside the heart and lungs.

So can you see the analogy here?  The folks at Johns Hopkins may refer to it as a pulmonary artery catheterization.  But I call things the way I see them, even when they have a medical purpose.  So in my mind, I’m viewing this as a road trip through Melanie, with a catheter as the mode of transportation.  The trip can start through one of a number of boarding sites – the neck, the arm, the groin, etc.  It makes me wonder if the doctors can use Google map to see if there are any traffic tie ups as they travel the chosen route to the final destination of my heart/lungs.

Now back to the more boring medical explanation provided by Johns Hopkins.  As the catheter advances toward the pulmonary artery, the doctor will measure pressures along the way, inside the chambers on the right side of the heart. This includes the right atrium and right ventricle. The doctor can also take indirect measurements of pressures on the left side of the heart. The cardiac output—the amount of blood the heart pumps per minute—is also determined during a right-heart catheterization.  All of these measurements are used to diagnose heart conditions and to determine an appropriate course of treatment. 

So back again to the trip/vehicle analogy.  It looks like the doctor stops for a brief respite along the way to check the air in the tires.  Hey doc – can you tell me how many psi (pounds per square inch) are needed for the tires in my lungs and my heart?  And is this the medical method to figure out how many miles per gallon might heart can achieve?  

What do I need to do to prepare for this road trip?  I will have to fast for about 6 or 8 hours before the procedure is performed.  I will be given a sedative, but supposedly will be awake throughout the procedure.  I am emphasizing the word “supposedly” due to my previous experience with cardiac catheterizations in 2012 and in 2014.  I may have been awake during the procedure, but they must have given me something to erase my memory because I do not remember anything.  We’ll see if there is anything that I can remember for the third time around – it might make a great blog post!

Having been through a number of procedures like this in the last few years, I doubt that the doctor needs to give me post-procedure instructions.  I think I have them memorized.  And once again, it’s kind of like recovering from a road trip where there was a lot of activity, and maybe even a change in time zones.  You just are weary and need to catch up on your rest.  So I will not be allowed to drive myself back home because I was under sedation and will be too wiped out to be trusted behind the wheel. 

I found my discharge instructions from the test in 2014.  (I am a pack rat and keep almost everything the doctors and hospitals give me).  Here is the first instruction – the advice that always bums me out:  No strenuous exercise or lifting greater than 10 pounds for 3 to 5 days. 

Hopefully I will be able to at least walk at a moderate pace outside to get fresh air and space, or maybe even on a treadmill at a moderate pace and no incline should the weather be bad.  I suspect that planking, another one of my favorite activities, might not be wise.  This is because planking involves lifting my body up off the floor in a push up position.  Not the type of weight-lifting that you see the body builders doing at the gym.  But it does involve maintaining a push up position that supports my body weight and all the water my body is retaining!   

No tub baths or swimming for 10 to 14 days.  This one is no big deal.  I take showers and am not a swimmer.  Another one that I can handle easily: Minimize stair climbing for 3 to 5 days.  As long as the elevator works in my condo building, I will be able to avoid stairs. 

Of course, if the site starts to bleed, the instructions say to apply firm pressure, call 911 and lie down. 
Believe it or not, this might be the hardest thing for me to do.  You see, my blood flows like a geyser, especially now that I take a low dose aspirin each day.  And I hate the sight of blood.  Fortunately, I’ll have my iPhone with me at all times.  So in the unlikely event that bleeding occurs, I’ll just hit the emergency call command, scream “help” and try to stay conscious while the 911 team gets on the line.  If I should pass out, I figure the emergency authorities can then locate me through my iPhone coordinates.  Isn’t technology wonderful?

Here is an instruction that is a little tricky.  The 2014 instructions said:  “When coughing, sneezing, or laughing, support the site with your hand.”  My first question is what do they mean by “the site”?  The site where the probe was initially inserted (the arm, the neck or the groin), or the site where the probe ended up?  They probably mean where the probe was inserted.  Seriously?  If the entry site is in the groin, well I think Emily Post would tell us that it is quite unrefined to put one’s hands on that area when laughing, coughing or sneezing.  Even if I have the probe inserted into my arm or neck, the last thing it would ever dawn on me to do is to put my hand on on my arm or neck.   I’ll just do my best to refrain from laughing, sneezing or coughing.  Maybe I’ll just sleep.

I also remember that when I had the procedure in 2014, I was given a patient information card.  I was told that I would have to keep this card with me, like in my wallet, or in a pocket, or wherever medical personnel could find it.  The card explained that a special new type of closure had been used to close up the wound where the catheter had been inserted.   I was supposed to keep this card with  me for the 90 day period after I the catheterization was performed.

I guess this means that if I ever do black out and an ambulance is summoned, the EMTs will know to look through the wallet, etc. to find any health information.  I’ll try to remember to make it easier for them by cleaning out the plethora of customer loyalty cards I have in my wallet.  I suspect that a lot of people forget about the card within the first day, or it gets tossed out when they get home.  But to me it’s like being on a trip and making sure you have your passport with you at all times.  So if I am provided with a similar card going forward, I will keep it in my wallet.  If someone is going to have to respond to my medical emergency, I want them to be as informed as possible.  

In my medical folders, I also found the report from the 2014 procedure.  It listed a lot of figures regarding pressure readings, etc.  that are totally Greek to me.  It appears that there is a schematic of the heart and the lungs, or going to back to the road trip analogy – it looks like a map.   I see that the doctor wrote the word “normal” on the roads surrounding the heart.  I assume this is a good thing.  From what my sister reported from the chat with my doctor, there was nothing of concern found in my heart or lungs (other than congestive heart failure which we already knew).  In fact, it was this test, along with the blood tests and treadmill stress test that convinced the doctors that I was not in need of a heart transplant.
​
So while I would like to be using an upcoming fall day for more fulfilling endeavors, like shopping or having lunch with a friend, or working on this blog, I do understand the need for the right cardiac catheterization.  I just hope I remember more of the procedure this time, as what I had to rely on a website to describe the test.  I’d like to be able to describe to you what really happens on a cardiac road trip!