Thursday, August 29, 2013

Cerebral Blood Flow Study by Ultrasound

by Dr. Margaret Aranda

For various reasons, I don't know why entirely, I ended up with quite an experience yesterday. I found myself like this:

The item that looks like an inhaler is actually producing a CO2 (carbon dioxide) curve with each exhalation. With each inhalation, the technician (who was very sweet indeed) slowly tortured me by first dilating my cerebral arteries by dialing in more CO2, then having me hyperventilate to get my CO2 down. This made my cerebral arteries constrict. As you can imagine, this mimicked the vascular vasospasm of a migraine headache. So of course that left me feeling like I just got a migraine headache.

After the CO2 portion, to test the vasoreactivity of the cerebral blood vessels, then the fun began all over again. But this time it was in a different way. We removed the inhaler circuit, I drank some mineral water because my entire mouth and throat were parched dry, and we kept the 'halo' on my head. It is actually an ultrasound, that can pick up pulsations from the Circle of Willis in the brain. 

So they laid me flat. Then I sat up. Felt the world sway as the blood left my head and went down my body to my legs. Then I stood up. I balanced on the bed (and my Caregiver held me up), and I kept my eyes opened for fear that I would fall. I turned green, they said. I felt like vomiting but I didn't say anything. My Caregiver could sense it, though, and tried to joke about it, saying, "Now, you don't go throwing up on me." I was afraid to talk, too sick to answer. She was straight in the line of my projectory, sure to be hit with my vomit if I did vomit. As a trained anesthesiologist, no one understands the value of an empty stomach more than me. I never eat before any study that has any remote chance of making me vomit. Vomit in the lungs can lead to aspiration pneumonia and death, and that's not what any anesthesiologist wants to die from. Ever.

But you know me better than that by now, right? No one told me to be npo (nothing per os; or no breakfast), but I did it anyway. Because I knew this study would make me want to throw up and I wanted to have an empty stomach. And I didn't take my midodrine. Nor did I wear my Jobst stockings, nor my Spanx. I was raw. I gave them pure dysautonomia with my untouched brainstem disorder, my uncorrected vertebral artery disorder, so it would show up on their tests.

So no one can say I'm pretending. 

But now I'm thinking (now that it's all over): maybe this is a good test, the cerebral ultrasound, to test for dysautonomia along with the Tilt Table Test that has been the gold standard for so long. Maybe this test would be good for those who do not get a positive Tilt, or for everyone who has dysautonomia and needs more documentation of the abnormality.

After all, who ever heard of any body being allergic to gravity? 
Because we are. We are basically allergic to gravity. We are fine and we look so good in bed. It's just that getting out of bed and standing and walking are so hard. There's no blood in our heads, so we faint!

Maybe the scientific community would do more for us if they could actually find more that is wrong with us ~ in the sense that it shows up on their tests. This cerebral ultrasound, put together with the three orthostatic positions, amounts to a dynamic test, with the pathophysiology in action. What a perfect test to show what happens to the blood flow in our heads when we stand up!

The test was ordered by a stroke neurologist at a large university hospital. So maybe my having this 'event' in January can be turned around to do some good for us all. I'll keep you updated on the official reading when it's in. 

Bet they think I'm an "interesting case" now, eh? 
There were no doctors around for the test. I didn't see a crash cart anywhere nearby.
The tech was safe, and talked to me, but I think I could tell you one thing. 

They are not used to testing people who pass out when they stand up.

Maybe they should be.

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