[Sheltiemom18]

Hi,

On Friday, have a check-up with my cardiologist. Until this neuropathy began a year ago, used to have annual cardio check-ups that included treadmill stress echocardiograms every other year. Was still able to perform very well even at the then age of 72. Last year was skipped because when I showed up for my appointment burning like a firecracker, the cardio didn't want to put me through having the stickies for the EKG, let alone going on a treadmill.

Never had an adenosine (chemical) stress test and am concerned that if it's suggested, that test might start up the burning all over again. This has improved so much in recent months and don't want to trigger it. However, doubt I'm able to do the treadmill anymore up to adequate heart rate level, and if I can't the test would be useless.

The question is this: Would an adenosine/thallium stress-test be a no-no?

Sheltiemom

[mrsD]

I have no idea.... but you know, Thallium is a cause of neuropathy!

That is alot of stress testing...

http://emedicine.medscape.com/article/821465-overview

another example:
http://www.ncbi.nlm.nih.gov/pubmed/17224548

You know, I'd ask if this is really necessary... and skip it if not.

[nide44]

I had both types, a chemical 3 yrs ago and a treadmill last year.
I don't think that the treadmill is advisable for my emphysema and PN again.
I had no adverse reaction to the chemical stress test, at all.

[kwinkler]

Chemical stress tests can be done with adenosine, Regadenoson, dipyradimole, or dobutamine. Of course, its always better if you can walk. Adenosine will be an infusion, but if you have symptoms, it has about a 15 seconds half life. So, when the drip stops, the symptoms don't last much longer. Regadenoson and dipyradimole work within the body to directly increase your own adenosine. If you have symptoms they can be reversed with aminophylline. These 3 dilate the coronaries to assess differential perfusion. Dobutamine acts directly on the heart making it contract more, similar to exercise.

As for the radiopharmaceutical, most places will generically have the order listed as thallium. These are 2 phase studies, with one done at rest and the other after stress. Some places will use thallium at rest and technetium (sestamibi or tetrofosmin) at stress, although many are transitioning to technetium agents for both phases. This use to entail a 2 day study, but can easily be done using a low dose for the first part and a higher dose for the second.

[Sheltiemom18]

Thanks for the post, kwinkler. In my other life (before retirement) I was a medical transcriptionist in Biometrics for a cardiology practice that performed this test among others.

I'm just concerned about what effects if any there might be on the sensory small fiber neuropathy.

Sheltiemom

[nide44]

Its different with everyone, as far as PN reactions go- so its a crap shoot, even if you do get info from others. You may be the special case, or you may not be affected at all.
Best just to weigh the different chemicals used, and opt for the least objectionable.

[mrsD]

I get the feeling that subconsciously SheltieMom is remembering what happened after the repeat tests last time?

The medical establishment, just does not vet its own testing.
The CAT scanners can be found to be putting out too much radiation..and have been found to do so.
http://www.cat-scan-radiation-overexposure.com/

Injection of foreign chemicals and heavy metals to facilitate visualization is not really vetted for repeat use.

Using radioactive substances? Repeat use? It is all foreign to the body.

I recall BPA was called safe at one time. So were Phthalates from IV bags. My son had IVs when he was a preemie for over a week. When he went thru puberty, his chest and beard hair was spotty and still is at 29.

http://en.wikipedia.org/wiki/Phthalate

a 3 lb infant exposed to phthalates that are supposedly safe for adults?

So while the test itself one time may be okay and safe for most, having this test over and over? it that really necessary without symptoms to suggest its need?

I do think we need to pay attention to medically invasive procedures. Consider your benefit vs risk for them.

I have put my own neck CAT scan on hold... going to see if it is really necessary, and perhaps get a second opinion from an oncologist to alternate ways to evaluate this issue.

[kwinkler]

Another option would be a dobutamine stress echo. It uses the dobutamine instead of exercise and sonography, so no ionizing radiation.

[buca16]

Mrs D I have a nuclear stress test every year for 8 years for my heart. Is this stuff bad? Thanks buca

[kwinkler]

The amount of radiation from the study is low. The question you need to ask, do you need an annual stress exam. These studies should not be done routinely just to make sure everything is alright. In fact many insurance companies are now requiring pre-certification for this exam. You know what the ordering doctors are doings. They're doing conventional treadmill stress tests or stress echos, since they know that they do not need to do the nuclear stress exam. Many nuc med departments are only doing about 25% of the cardiac studies that they were doing when compared to a couple of years ago. Don't get me wrong. These exams have their place, just not routine screening.