Friday, March 27, 2009

The Heart, The Brain, The Mystery Continues

Whew -- I survived the cardiac testing.

I did not faint on the tilt-table test, which was not exactly what I expected but was fine. They left me upright for 30 minutes, and although I was dizzy and got hot and sweaty (apparently the only one in the room who thought the room got really hot), my blood pressure stayed pretty steady and my pulse didn't jump as much as it sometimes does when I go from prone to upright.

Then I did the stress test on the treadmill. Man, when I used to go to the gym and walk on a treadmill, I don't think I ever did an incline higher than 5 percent, and usually stuck closer to 3 percent. I'm from the Midwest and grew up in the flatlands. I don't do hills! And I didn't realize that they would have treadmills that didn't show any info or controls. It was all done by their computer. So they started me off at a reasonable pace but at 12 percent incline. I literally held on to the bar at the front of it because I felt like I'd go sliding off the back if I didn't!

My heart rate was at 100 bpm when I was lying down. Upright, it was about 120 or so as long as I didn't talk, which made it go higher. Once I started on the treadmill, I jumped immediately to about 140 and it climbed from there. When it hit 183, I said I'd had enough. Somewhere in the last couple minutes I was on it, they raised the incline to 14 percent. I didn't even know that was possible! And apparently it can go steeper than that too.

So, Dr. McAnulty concluded that my heart is healthy in that I'm unlikely to have a heart attack although it clearly gets going pretty quickly. I eavesdropped as he dictated to his medical student what to type in the computer for the summary/notes, and he said I appeared to have mild dysautonomia and "inappropriate sinus tachycardia." (I was like, "Inappropriate?!" Funny way to describe it.)

I'm supposed to go back to see him in six months, sooner if my internist needs his input on my evolving symptoms.

Meanwhile, I got the radiologist's report on my brain MRI from earlier this week. I'm just going to type it in verbatim because I haven't had enough time/energy to analyze and completely figure it out.

Findings: The ventricles appear to be within normal lijmits in size and configuration. No abnormal extra-axial fluid collection is observed. No significant mass effect or significant midline shift is noted.

In image 12 of the FSEIR axial sequence, two punctate foci of increased signal are observed adjacent to one another in the white matter of the right frontal lobe. These may be the result of volume averaging. They may also be associated with chronic small vessel ischemic disease or, perhaps, vasculitis. The larger of the two may be present, in retrospect, in the comparison examination from 10-4-2007. It has not clearly changed significantly in size. Plaques of multiple sclerosis cannot definitely be excluded but would appear to be less likiely. These foci do not enhance following the administration of intravenous contrast.

No findings are observed that would suggest the presence of an acute or subacute infarction. Very mild to mild mucosal thickening is identified in the left maxillary sinus. Very mild mucosal thickening is noted in the right maxillary sinus, and in the frontal sinuses, ethmoid air cells, and sphenoid sinuses, bilaterally. This mucosal thickening is new or has progressed since the earlier study. Increased signal is also identified in the mastoids, bilaterally, in the T2-weighted sequences. There may be small air-fluid levels within multiple mastoid air cells on the right. These findings are new since the earlier examination.

Impressions:
1. Two, punctate foci of increased signal are observed in the white matter of the right frontal lobe in the FSEIR axial sequence. Please see discussion above.
2. Mucosal thickening is observed in the paranasal sinuses, bilaterally, as described above. Ther are also findings suggesting the presence of bilateral mastoiditis.

Ok, I have to say, that now that I've looked up mastoiditis, I'm wishing I'd called the ENT this week. Apparently, there's some really bad stuff that can happen if it's left untreated, and it used to be the leading cause of death in children before the advent of antibiotics. It's apparently very rare in the U.S., so I guess I'm just lucky once again. :)

I'll be calling the ENT on Monday to make an appointment. I wonder if the mastoiditis is the cause of the severe vertigo that I was having last week. And actually, come to think of it, I did have a fever and ear pain as well last week. I did not have a middle ear infection, though, when I was checked twice last week.

[Update: Here's a better article on mastoiditis. Potentially scary stuff. How funny that I could possibly get something that has a 0.004 percent rate in the U.S. and developed countries. I'm thinking of calling my immunologist, who griped about my getting put on antibiotics for a double ear infection not long ago. He thought it was unnecessary. Hmmph!]

And I still need to get that neti-pot to see if that will help my sinuses. I'm definitely uninterested in sinus surgery at this point, although I am prone to getting frequent sinus infections.

6 comments:

Laurie said...

Well, good to hear the heart is healthy and the MS lesions less likely!! If it makes you less weird, I had mastoiditis when I was really young. None of the antibiotics worked. Spent 3 weeks in isolation on IV vanco and then had to have surgery b/c it was spreading to my brain. The upside was, I got a lot of good toys and books when I came home :) And I was fine in the long run.

But, certainly not what you need right now! I hope things calm down and that you get closer and closer to concrete answers.

PDXBarb said...

I am holding out that you're not ill with what they think. "Findings suggest" is not a given. But with the heart, it's good that you're in better health than you think (thought). Want to see my acupuncturist for the sinuses? Way more pleasant than a neti-pot.

Aviva said...

Laurie -- I should have known that if 0.004 percent of people get mastoiditis, you'd be one of them. :) Good to know that IF I have it, I'm in good company. :) How old were you? Scary that you needed the surgery, which I read is a last resort when nothing else works. Clearly, you recovered and your brain is outstanding, though, and that's what counts.

Barb: Thanks for that reminder that "suggests" doesn't mean HAS. And thanks -- I've got a great acupuncturist that I've been seeing for 18 months now. I will definitely be bringing in this MRI report to her to see how else she might want to treat me. I know, though, that when she's tried to do sinus points on me before, I've been unable to tolerate the needles for it. :( Maybe I just need to toughen up even though they're so ouchy ... At any rate, I figure a neti-pot has to be more pleasant than sinus surgery. :) And I know people who swear by them, so it can't be *that* bad, can it? Have you done it?

PDXBarb said...

Neti-pot. Done it once. It works...just messy. :)

Laurie said...

Well complicating matters was that I developed staph in there, and when nothing responded to meds, even the vanco, that's when they needed to do the surgery. I was five. I believe they did what was called an external mastoid...lost a lot of hair and had a lot of stitches, but I was still able to start kindergarten a few months later :)

I do hope you get some more concrete answers soon, Aviva. This must be so incredibly frustrating.

Elite Health said...

Good to know that you are somehow out of danger. I am also suffering from Sinus tachycardia. My story goes up something like this. I was having some palpitations since my childhood, but was considering it as normal. It never came to my mind that anything that is going on is only happening to me. As time passed, the severity of the palpitations and its frequency increased noticeably. At some points, it went to my extremes. I then searched over the internet sharing my experience, and at that point of time, I was surprised to know that this was something that I shouldn’t be ignoring. Then I came across a medical provider company providing eConsultation. I consulted their experts regarding my situation and I was suggested to have my cardio scans done. On my first ECG test, it came to me as a surprise that I was not having a proper heart beat rhythm. It was arrhythmic, and non sinusoidal. I was doubted to be having sinus tachycardia. Then on my further advance diagnosis, like CT scan, MRI, Echo test and stress test, it was found that one of my left valve was deformed, and was not closing completely while beating. But still, it was not to the extent that I require a valve replacement. I then was warned regarding the degradation in accordance with time, so I joined their wellness program where I am in their constant contact with the experts. I have to have all my basic tests monthly, and then quarterly. I am right now having a deformed valve, but still leading a quite healthy life. I just need to take care is to have immediate medications whenever I am facing any heart problem, which I am able to do because of elite health’s e consultation facility. I would like to thank my heart for relentlessly working so hard and faithfully even though having a deformation. This seems to be odd for someone to understand, but one with such a heart can better understand the value of heart.unde