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Fear of isuprel during TTT


melly4
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Hi, everyone. I am supposed to have the tilt table test in about 4-6 weeks. I was reading on this site about how the test was administered, and noticed that isuprel was given IV during the second part of the test. I'm terrified of going through that. I absolutely cannot have epinephrine or any substance that mimics it given to me. I faint. I know that sounds stupid, because that is what they are looking for, but I had a really bad episode in the dentist's office related to epi in the novacaine, where I fainted in the chair. What was so bad was that I was left alone in the room while they were working on another patient, and I have never gotten over it. I have gone through great lengths to make sure any procedure that I have had requiring a numbing agent being given is free of epi. Like I said, I know I'm being silly, because the whole point of this test is to see if mild stressors to my nervous system will make me have syncope, but I can tell them ahead of time that I definitely will faint when given the isuprel.

Sorry, I just needed to vent my fears. My heart rate is going up just thinking about it!!

Melly

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Melly -

Call the center doing the testing. Make sure you ask about YOUR test specifically, not "generally, how do you do it" I was given the test without the injection. It was already known I would show symptoms - as my higher heartrate was obvious to everyone.

By calling the center, you could relieve your mind if they aren't using epi, and if they are, you could talk to your doctor about it. Given the amount of time before the test, you should have plenty of opportunity to resolve it. ;)

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Hi,

I don't know where you're going for your TTT, but both of my kids had theirs done at University Hospitals in Cleveland and neither had any type of IV. My daughter also had another one done at the Cleveland Clinic, no IV. So, I agree, call the testing center where you're going to see how they plan to do the procedure on you

Take care, Patti

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As a rule you only get the isuprel if you are non symptomatic during the first part of the test.

When I had mine, I requested that they not give me the full dose, so I only got half and it worked fine. At tilt table tests you are monitored and never left alone. And the isuprel onmly stays in your system a few minutes after they stop it. Unlike novacaine with epi. As soon as they stop it, it starts to wear off and they won't let you leave till you are back to baseline with everything. Just talk to the place doing it and tell your doctor about your concerns. morgan

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Thank you all for your replies. I feel a little calmer. I will be having the test done here in Macon, GA. I will have an opportunity to speak to my doctor before the test, as I have a follow-up with him prior to the test. I'll address my concerns then.

I did the "poor man's TTT" on myself and my 13-yr-old yesterday and today. My heart rate went up over 30 bpm at 10 min. of being upright. My son's went up over 30 bpm at 45 min. of being upright. So, I'm hoping that isuprel won't be needed for the test?!

Thanks again for sharing your knowledge on this test and for the advice. I'll quit being a baby about this. ;)

Melly

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Many times they don't give the drug to you if they see the symptoms during testing but you can confirm with your Dr.

Also, sometimes they want to give you just a small amount of it to get the "on paper" documentation of how your body responds. This can help them determine if you have the hyperandrengic form of POTS or some other form. So, you could ask if they give it to you to give you like 1mg which is a tiny amount and most likely if you are hyperadrengic 1mg will be enough and it does quickly get out of your system (it can leave you with a "hangover" effect though).

You'll do fine! I understand it's scary though

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Guest Finrussak

I agree that its not always mandatory BUT its not like epi...it is a VERY short acting heart rate drug...it causes a faster (and sometimes stronger) beat.

It is opposite to a beta blocker and can rarely cause PVC's so if u r prone to these tell the people doing it.

Once stopped it leaves the body in a few scant minutes ( in seconds the rate lowers). It feels only a very little more uncomfortable than a usual tachy episode...and if you already have symptoms like high heart rate they often skip this OR do less....but again they MAY have to in order to see blood pressure changes...like how bad it can get...in order to fully evaluate you and even to see which meds will be most helpful.

My first 2 TTT were w/o drugs ( I was too afraid and pulled panic PLUS dysauto episodes on first and when I said NO at second they said Ok) and it showed a lesser BP response...so at third one ( a few yrs later) I relented and tHATS when they found the weird BP reactions as the heart rate climbed...fisrt high then plummeted...and then they needed an "extended" TTT (longer than the usual 30-40 minutes) to see what really happens...so the 4th was this spring and took over 60 minutes total!!! UGH apparently my body has gotten TOO good at compensation so they had to really stress it past a point to get a reaction.

definitely ask but also ask IF you may need it...ask what IF you dont get the drug...and IF they cant see exaclty whats going on can they still inject so u wont need another one??...in other words can it be ONLY if needed??y go thru this more than once out of fear???

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I find it interesting what everyone's been saying. I had a TTT here in Hawaii and they administered isuprel despite the fact that I was already symptomatic. I was strapped in, and they stood me up, within five minutes my heart rate went from 54 lying, to 130's, I began to feel dizzy and my pressure began to drop and that's when the doc said "Ok, we're going to begin the isuprel".

The experience was horrific, once they injected it, I felt like my heart was going to beat out of my head, and my chest began to hurt. They stopped the test when I went brady (beat went from 150's to 60's while standing). But is this abnormal protocol? It sounds like from what everyone's been saying that my TTT wasn't performed properly.

-Lauren

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I discussed with my cardiologist in advance. Told him in no uncertain terms that I would not permit the injection. I knew well, that there was no need. I'd be symptomatic without it. And I was.

Remember YOU are in control. Even when it feels like every system in your body is out of control. They can suggest, recommend and encourage but you get to research, contemplate and make the best decision for you. And if your "doctor" isn't ok with that kind of partnership then find another one because that's a big red flag.

Good luck on your healing journey.

EM

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Lauren,

To answer your question, it doesn't sound like you had the "wrong" protocol.

Obviously, it appears they were able to answer your heart rate questions prior to administering the drug. Sounds like they maybe administered the drug to see what your BP and heart rate would do.

It all depends on what your body does during the test and even if you are symptomatic prior to the drugs they still sometimes need the drug administered to find out more. As Finrussak mentioned, sometimes it's the best thing to do to avoid further ttt's and to start out with the drugs that are most likely to help you. The drug will help determine not just if you have POTS but what FORM of Pots you may have.

Melly, I think if I were in your shoes I would ask if they need to use the drug that they only use a tiny amount and verify with them how much they gave you in the end. Two reasons for this #1 if you are hyperadrengic a tiny amount will do the job #2 it's been proven that the average person will pass out if given enough

Isoprel so it's best to only use a tiny amount so there aren't questions later by other Dr's about the accuracy of the test.

I'll also reiterate that while it is not a fun experience, like others have mentioned, it does leave the body very fast. You won't necessarily feel good but it's usually a much shorter spell than my own body has.

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Yikes!!I'm back to being nervous again. My husband, a cardiovascular ICU nurse, told me they used to use isuprel in his unit several years ago, but quit due to patients having really bad tachy and even fibrillation episodes from the drug. Of course, the patients he cares for are the worst of the worse, as far as heart conditions go, but I know how I respond to epi, which is what they use in his unit now. Oh, brother!! I understand that from eveyone's replies here and some POTS research on my own why this might be necessary during the course of the test, like Pooh suggested. My son and I both have a lot of premature beats, and I am so med senstitive. I can't tolerate stimulants of any kind.

Thanks again for the advice. I'll certainly ask my doctor if the isuprel is necessary and try not to be a baby about it if they do decide to administer it. But I'll probably panic when I know it's coming!! :lol:

You guys and gals are great. Thanks so much for the support.

Melly

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On my first TTT, they had set up an IV line to give me isuprel, but within 10 min my HR went to 150 and I threw up. So they never had the chance to give me the isuprel. I guess that I'm lucky that I avoided the 30-40 min TTT that everyone talks about! It has really been helpful in my treatment to have a positive tilt test and an official diagnosis of POTS. The doctors I have seen don't always know how to treat me, but at least they believe I actually have POTS. So I agree with Poohbear - I would opt for getting the isuprel if it helps to get the diagnosis.

I was pretty sick after that TTT and they kept me in the hospital for the afternoon and gave me IV saline. The IV really helped, so maybe that's something you can talk about with your doctor.

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The last TTT I had, I just refused to have the injection. They got enough data from the test. Don't be afraid to say "no." I had never met his doctor before but he said "OK." and that was that. It's not worth the stress thinking about it. Just make your decision and stick with it. I have had the same experience at the dentist. They use carbacaine now and I have not had problem.

Good Luck.

Dawn

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IThomas,

Poor thing. You went through it twice?! I will take your advice and bring along my RN husband (yes, he's a male nurse, for those of you who are "Meet the Parents" fans!!) But if he's not available, I'll consider bringing along my very big and protective dog, Toby!! :lol:

But seriously, I'll take it into consideration that there's a reason for administering the isuprel, like Poohbear suggested, and it may be essential as to an accurate diagnosis and treatment.

Dawn,

I,too, insist on carbacaine when I've had moles removed and my recent hand surgery. No more epi for me, unless it's absolutely necessary. The slightest amount makes me see stars and then black out!! Tachy is no fun. Severe tachy is a nightmare.

Standupsitdown,

As a lab tech, I know that docs are sometimes ignorant to how tests are run, etc. I will be seeing my GP prior to the test, so I will ask him what he has specifically ordered with the TTT, what the facility's protocol is, and quiz him in a non-threatening way about dysautonomia in general. Pick his brain, so to speak. See if he has one!! :) He's been great so far, and acted like he disagreed with the panic/anxiety disorder crud that's been thrown at me. Of course, as most of us know, that can change at a given moment.

Melly

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I never had any IV during tilt 8 years ago.

My HR raised 55 beats in about 65 seconds. It showed definite ANS to my cardio at the follow up visit. But his idiot assitant who was PRESENT for my TTT claimed my test was not conclusive so I went home depressed out of my mind. Then I saw my cardiom 2 weeks later, who said the test confirmed my endocrinologists suspicious of ANS problems.

The "doogie howser" doc present during my TTT spoke to the techs that he didn't believe in giving meds as they gave false positives for results. So it depends on what the doctor orders for the patients and probably the pts history. I am symptomatic daily, hourly...all the time. As others said, simply call your doc and see what his protocol is.

Also, when I got a copy of the print out of the test, it really helped to see I had POTS. My BP didn't drop much but the tachycardia is what keeps many of us exhausted...though I can't do beta blockers except in baby doses on really bad days. Just remember, the worse you feel DURING the tilt, the more answers the doctors should get from your reaction. I felt kind of crummy during mine (hot flashes, anxiety sensations, terribly lightheadedness, and sweats--back when I still perspired normally. Some people feel fine during the tests. So just remember, the worse you feel, the better to prove ANS problems. :ph34r:

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