So... that was a day.
I was scheduled today for an EMG (Electromyography) and a tilt table test.As always, these tests were schedules many, many weeks ago but it takes time to actually get in to have them done. I'd read up on both tests extensively and was prepared for the worst possible variations of each (every site or practitioner has slightly different protocols that they follow). I was pleasantly surprised to recieve much milder versions of the tests. Even so, I am freaking wiped out by the experience. I don't have any reports, but just the basics that the doctor told me, but I shall relate the experience here.
EMG
What was scheduled as an EMG turned out to have been ordered as an autonomic system test. It makes sense given my symptoms, and the test wasn't that bad. They did three separate tests, apparently aimed at measuring my system's response to various stressors. The first two were breathing tests, and they time and measure my heart-rate, blood pressure, and EKG readings as I took slow, deep breaths at the guidance of a computer display. The second measured the same responses to being asked to sustain a forceful exhalation for twenty seconds. Apparently on one o these tests, my body's response was slow enough to be out of the correct range, indicating some autonomic issues. The second test came back as normal. It's best if these two tests are consistent with one another - the contradictory results aren't particularly helpful, apparently.
The third test was the only real EMG they did on me. It was what they call a "surface EMG," meaning that they did not stick electrode needles into my body, but rather used pads similar to what you might see on a TENS unit or one of those goofy electronic ab machines that force you to flex.There were other sensors stuck to the same muscles and as I understand it, they measured my muscles response to a light electrical current - a good indicator as to the speed of signals along my nerves - as well as my sweat response to the stimulation. They used some liquid-filled suction cup like things to measure my sweat and I have no earthly idea how the science behind this one works and I'm too worn out to look it up right now. That test, I believe, bore little in the way of immediately visible results, but all three tests will be analyzed further both mechanically and by the doctor before the final report is generated.
Tilt Table Test:
I really wish we'd scheduled this test the first time it came up with one of my doctors. Or the second. Or the third. I am fast closing on one year since my first hospitalization and today we did what I believe will be the most conclusive test I've had in all of that time. Tilt tables are weird. It's a flat table that you lay on and the doctor then straps you down using thick velcro straps across your thighs and chest. They measure all of the same things as above while you lie there in a prone position on your back. After a few minutes of baseline readings, they tilt the whole table up to nearly 90 degrees upright. Because the straps are holding you to the table, you need to support very little of your weight on your legs and this really exaggerates your physiological response to the change in position. In my case, the light headedness that I experience when standing up was amplified to the point that I got some tunnel vision and my tachycardia kicked in with a steady heartrate up in the high 140s from a prone rate in the 70s. It was, in my opinion, a singularly unpleasant experience. They leave you hanging off of this table for a long time - 30 minutes is what I was supposed to do, but my BP was being a little bit scary today and the doc lowered me down after 20 minutes. Even so, he seemed to feel pretty confident that I DO INDEED have POTS.
Thoughts:
My autonomic doc needs to see the report before I will get a firm diagnosis, but based on my conversation with the testing doctor, POTS is a go. This is good news and bad news and bad news. Good: A solid diagnosis might finally be within reach. Bad: POTS is not a fun syndrome and it is not cureable. Bad: If I do indeed have POTS, it's unlikely to be all that I have. My rheumatologist is still chasing down this lupus-like thing that's going on and it's far enough outside of the standard POTS spectrum as to indicate multiple conditions. Co-occuring conditions are not unusual with POTS, so it's very possible.
You are informed. I am tired.
EMG
What was scheduled as an EMG turned out to have been ordered as an autonomic system test. It makes sense given my symptoms, and the test wasn't that bad. They did three separate tests, apparently aimed at measuring my system's response to various stressors. The first two were breathing tests, and they time and measure my heart-rate, blood pressure, and EKG readings as I took slow, deep breaths at the guidance of a computer display. The second measured the same responses to being asked to sustain a forceful exhalation for twenty seconds. Apparently on one o these tests, my body's response was slow enough to be out of the correct range, indicating some autonomic issues. The second test came back as normal. It's best if these two tests are consistent with one another - the contradictory results aren't particularly helpful, apparently.
The third test was the only real EMG they did on me. It was what they call a "surface EMG," meaning that they did not stick electrode needles into my body, but rather used pads similar to what you might see on a TENS unit or one of those goofy electronic ab machines that force you to flex.There were other sensors stuck to the same muscles and as I understand it, they measured my muscles response to a light electrical current - a good indicator as to the speed of signals along my nerves - as well as my sweat response to the stimulation. They used some liquid-filled suction cup like things to measure my sweat and I have no earthly idea how the science behind this one works and I'm too worn out to look it up right now. That test, I believe, bore little in the way of immediately visible results, but all three tests will be analyzed further both mechanically and by the doctor before the final report is generated.
Tilt Table Test:
I really wish we'd scheduled this test the first time it came up with one of my doctors. Or the second. Or the third. I am fast closing on one year since my first hospitalization and today we did what I believe will be the most conclusive test I've had in all of that time. Tilt tables are weird. It's a flat table that you lay on and the doctor then straps you down using thick velcro straps across your thighs and chest. They measure all of the same things as above while you lie there in a prone position on your back. After a few minutes of baseline readings, they tilt the whole table up to nearly 90 degrees upright. Because the straps are holding you to the table, you need to support very little of your weight on your legs and this really exaggerates your physiological response to the change in position. In my case, the light headedness that I experience when standing up was amplified to the point that I got some tunnel vision and my tachycardia kicked in with a steady heartrate up in the high 140s from a prone rate in the 70s. It was, in my opinion, a singularly unpleasant experience. They leave you hanging off of this table for a long time - 30 minutes is what I was supposed to do, but my BP was being a little bit scary today and the doc lowered me down after 20 minutes. Even so, he seemed to feel pretty confident that I DO INDEED have POTS.
Thoughts:
My autonomic doc needs to see the report before I will get a firm diagnosis, but based on my conversation with the testing doctor, POTS is a go. This is good news and bad news and bad news. Good: A solid diagnosis might finally be within reach. Bad: POTS is not a fun syndrome and it is not cureable. Bad: If I do indeed have POTS, it's unlikely to be all that I have. My rheumatologist is still chasing down this lupus-like thing that's going on and it's far enough outside of the standard POTS spectrum as to indicate multiple conditions. Co-occuring conditions are not unusual with POTS, so it's very possible.
You are informed. I am tired.