Now that I am a heart failure patient I must have a treadmill stress test each year. The name is appropriate because for some reason, this test always causes me a significant amount of anxiety.
I know you think I’m exaggerating. How bad can the test be? Well, since you’ve asked, my results have seemed to decline each year. So despite my commitment to exercise and a healthy diet, I seem to be taking a step backwards at least in the aspects measured by the test.
After I scheduled the upcoming test, I reverted to my normal behavior when I need to solve a problem. I researched the topic of treadmill stress tests hoping that I would learn something that would ease my anxiety. Did that happen? Well, the jury is still out – but the research provided information I can convey to you regarding another pesky heart test. As always, I hope this account is informative, yet a bit tongue in cheek.
I found that the American Heart Association (AHA) has a good description of how the treadmill stress test is performed. Below are excerpts from the AHA description, along with my commentary.
The AHA says that the patient will be hooked up to equipment to monitor the heart. Yes, this is accurate. The medical technicians put those little sticky circular electrodes on you that are also used for a routine electrocardiogram during your annual physical. I know they perform a necessary function, but the sticky electrodes are a pain in the neck. It never fails that I find 3 or 4 stragglers left on me when I return home. While I don’t have any arts and craft talent, I am thinking about collecting the wayward electrode patches and converting them into a necklace or coasters.
The other piece of equipment that allows a medical team to monitor you is a mask. The combined use of the mask and electrodes enables the doctor to gauge how your heart is performing. But it also makes the patient look like a cast member in an alien invader movie. A patient on the website CHFPatient advised that his technicians put a padded clothespin-like device on his nose. The reason I guess is to make the patient breathe through his mouth. I don’t recall this device being used during my treadmill stress tests. Maybe there was such a device but it wasn’t as obnoxious/memorable as a clothespin. But frankly, it sounds like CHF patient’s preferred provider may be the Marquis De Sade Clinic of Cardiology.
The AHA tells us that “you will walk slowly in place on a treadmill. Then the speed is increased for a faster pace and the treadmill is tilted to produce the effect of going up a small hill.” Their underplayed description makes it sounds so serene - almost like you are going for a walk with your dog in the park. But that would be pleasant and for someone who is equipped with a mask and electrodes, it is not pleasant and you are not dressed to take a leisurely stroll with Spot. While the treadmill starts out with a relatively slow speed and incline, it will eventually crank up to where you’re really pumping those legs and trying to catch your breath. No time or energy to walk and take care of Spot. Plus Spot doesn’t want to be seen with you because you look kind of creepy. (See Spot run from the alien invader!)
The AHA website then tells us that “you may be asked to breathe into a tube for a couple of minutes”. I’m not sure why they put this step here. In my experience, the test where you breathe into a tube is actually performed before you step on the treadmill and before you are dressed in alien gear. The CHF patient says that you will have to perform one of these two pulmonary tests: (1) blow once into the tube completely expelling all of your breath out till you have no breath left, or (2) or blow fast and hard 5 or 6 times with all your lung power into the tube without any rest in between each breath. My experience differs in that I do not have the luxury of performing just one of the pulmonary tests. I have to perform both, and I have to perform them multiple times.
The first time I did the test with the one big breath, I ended with a loud, prolonged coughing spell. When you have allergies and sinus drainage, it is difficult to perform this test without causing a coughing fit. Have you ever seen the classic movie “Camille” with Greta Garbo? The main character Camille was dying of “consumption” (now known as tuberculosis). I remember she would recline on the sofa and very weakly yet gracefully and beautifully cough into her handkerchief as she was slowly slipping away from the world. Well, I ain’t Greta Garbo! Instead, I sound like I’m coughing my lungs up. If my life is going to slip away, it won't be a quiet departure. It's going to exit this planet with a lot of noise and saliva.
The second test is similar to making yourself hyperventilate because you are told to breathe in and out really fast. I have never figured out why it is a prudent medical test to simulate a condition that some people take anti-anxiety drugs to treat. I guess it is just another one of those medical mysteries that I will never understand.
The AHA indicates that your heart rate and rhythm, breathing and blood pressure will be monitored while you are on the treadmill. This is correct. It is noteworthy that some technicians tend to freak out when they initially take my blood pressure. The pulmonary tests are always performed at the same hopsital. I wonder if the hospital can have some sort of alert system when I come in for my annual test. Like a pop-up wanted poster on the computer screen with my picture that says: “Do not be alarmed. This woman has extremely low blood pressures but has proven that she has the ability to function adequately during pulmonary and treadmill stress tests.” This would help me tremendously because the freak outs over my blood pressure definitely inhibit my ability to relax as much as I can during the test.
In terms of the test itself, I found that there is a protocol that dictates the rate of the change in incline and speed. In fact, there is not just one protocol. I found that there are at least 22 protocols. Most appear to be named after people (maybe the doctors who developed the protocols). A few have acronyms. I am especially fearful of the STEEP protocol. I don’t know what STEEP actually stands for, but if it has anything to do with running up a mountain, well please do not sign me up for that test.
I also found this description of the stress part of the test on a website for a sports cardiology clinic: “Because the stress test starts off nice and easy, it provides a good opportunity to chat, exchange jokes, and get to know one another!” Having participated in this test 3 times in the past, I’m having a hard time with this advice. It’s not like we’re having a cocktail party in the pulmonary lab of the hospital. Maybe the medical personnel in the room can laugh, chat and mingle, but I am so focused on just getting through the test that coming up with witty remarks is at the bottom of my to do list.
So just what is it about this test that is so stressful. As I continued my research of the term “treadmill stress test” on the web, I saw the following explanation for why people are scared: Most patients who experience anxiety about a stress test are usually more afraid of what the test may reveal rather than the test itself. So is that what is happening to me? I would say yes but for one important distinction. My very first test produced a really fantastic result. So in theory, this should have quelled any anxiety I had. Additionally, since that first test, I have kept in what I believe is excellent shape for a congestive heart failure patient. So what is the reason that the second and third tests reflect scores that have dropped?
I think it boils down to an issue that continues to recur for – and it is the issue that probably makes me a Type A. I find it challenging to relax. It isn't in my DNA. But it is in my DNA (thanks Mom!) to panic when I am in the midst of the test and feel like something bad is about to happen. I feel like I must stop the test. I never really take the time to consider if it is my brain that is telling me to stop because of my anxiety, or my heart that is telling me to stop. The anxiety just sets in and I can’t remember that the calmer I am, the more energy I will have and the better the test results will be.
So this year, I have decided to try a different approach. The SOS in the title of this post is not the traditional distress signal asking others for help. Instead, it is a mnemonic devices or a technique to help my brain recall important information. It is a shortcut that will help me associate achieving a successful test result with an acronyn/image.
I have decided that for purposes of the treadmill stress test, SOS should mean “stomp out stress”. As I think of SOS, I will picture me on the treadmill stepping with strength, deliberation and certainty. With each step, I will try to stay on the treadmill longer and log in a good result. I’ll let you know if it works!
Melanie discovered that she had heart failure in 2013. Since that time, she has been learning how to live with the condition, and how to achieve balance and personal growth.