Author Topic: Just the Facts: Tilt Table  (Read 3813 times)

inga

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Just the Facts: Tilt Table
« on: October 23, 2010, 01:43:30 PM »
For any one interested in purely medical factual material regarding the tilt table test.

http://www.youtube.com/watch?v=5H5FZTAic7c&feature=related


Epson

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Re: Just the Facts: Tilt Table
« Reply #1 on: October 23, 2010, 03:55:37 PM »
Inga,

That was informative, but just like potato chips, I can't watch just one youtube clip, I think I am addicted, I have to go back.

inga

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Re: Just the Facts: Tilt Table
« Reply #2 on: October 23, 2010, 04:23:24 PM »
A few of them are pretty funny....if you want some really humor, try the banned european commercials.....laughed til I cried.

anita

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Re: Just the Facts: Tilt Table
« Reply #3 on: October 23, 2010, 06:11:27 PM »
The test is easy enough to repeat after medicines are prescribed to ensure they are working.  It's a good way to fine tune your treatment.

Same goes for the gastric empty test (another autonomic dysfunction--gastroparesis).  I had that one repeated while using the domperidone to make sure it was working.
« Last Edit: October 23, 2010, 06:51:12 PM by anita »
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

puccini914

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Re: Just the Facts: Tilt Table
« Reply #4 on: October 24, 2010, 02:27:09 PM »
I did notice that given testing time said about one hour.  If you start laying down and meds are given and then you're upright for 45mins and then back down for 15 min and then the test continues until you pass out or the doctor ends the test, it seems quite probable that this kind of test could last 2 hours, especially if they have to keep stopping the test.  Just my 2 cents.

anita

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Re: Just the Facts: Tilt Table
« Reply #5 on: October 24, 2010, 03:17:49 PM »
I don't think they give meds "while" doing the test.  The test is done, results given, medicine prescribed (if necessary).  Then at some point in the future (if they question the effectiveness of the treatment), then the same test protocol can be repeated while taking the prescribed meds to see if they are, in fact, working.

Same for the gastric empty test.  Do the test, get results, start meds...then LATER retake test while taking meds to see if empty time improves.

The same could even be applied for some arrhythmias.  Do holter or event recorder, identify problem with rate or rhythm, start prescribed meds.  These tests are simple and can be repeated (down the road) to ensure meds are working properly and heart function has improved.  

I have had this done myself with the gastric empty test and the holter.  I just thought it would be a good way to confirm the treatment is working.
« Last Edit: October 24, 2010, 03:25:58 PM by anita »
52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

puccini914

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Re: Just the Facts: Tilt Table
« Reply #6 on: October 24, 2010, 03:26:39 PM »
Sorry, my bad. I reviewed the video again and was confusing the part where they give meds to lower Bp if needed.  I was only refering to the time it took to complete the test.  Someone was recently told that it was a 20 minute test and could not have lasted 2 1/2 hours.  I was merely clarifying that according to this video, it would never be a 20 minute test.  Just playing devil's advocate for minute, standng up for someonelse's experience.  I have no idea about these test and I hope I never do.  My issues are mostly joint pain, sun sensitivity, fatigue and some neuro.  I hope I never know what it means to hav my heart involved in all this mess.  To those of you who do, my prayers are with you.     Jennifer

inga

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Re: Just the Facts: Tilt Table
« Reply #7 on: October 24, 2010, 06:06:08 PM »
I had the 'meds'.  It is isoproterenol provocation.  They want to get all this testing over with, it costs them a lot of money to run them and the faster the better.

I did have the isoproterenol provocation, it isn't pleasant, but it doesn't hurt.  You get sick pretty fast if you respond.  I was out in a few minutes after getting it.  53/38 and pulse of 42.  This was 6 ago.  They did other tilts on me, at least 4....without iso, and altho I didn't pass out, I 'flunked' them.   Lots of people get tachy.

I don't get POTS, I get brady. 

As far as EPS, I am really not looking forward to that and am trying really hard to avoid it, but, there may be no option.  I do need to say, like you Anita, I do go to an academic center.  I know you are at JH and I am at a major regional teaching hospital with an autonomic center too.

I had to have my Tilt in a hospital setting, as well.

Two hours is very unreasonable to be left on the table, and if some one left me in that position for 2 hours, I would be very peeved.  20 minutes is bad enough if you are hypotensive.  You just can't maintain consciousness.  They keep a very accurate record of your vital signs so they can assess what happens.  One can request the raw data from the test.

anita

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Re: Just the Facts: Tilt Table
« Reply #8 on: October 24, 2010, 07:02:55 PM »
What is...and the purpose of the isoproterenol provocation?  I would think they want to see how the BP & rate responds "naturally", for lack of a better word.  How do they know whether it was the meds or the autonomic dysfunction itself causing syncope?

52 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (CVID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Cardizem, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Fentanyl, Percocet, Zofran

inga

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Re: Just the Facts: Tilt Table
« Reply #9 on: October 24, 2010, 07:19:01 PM »
LOL, if you are taking too long passing out and it is getting to be lunch, they down you.

Seriously, they challenge your vascular system with iso, which represents stress.  This was done by an EP doc.

I was 28 minutes in....they wanted to finish me off. Now, I can't stand up without going gray....and I don't mean hair.

My neuro doesn't use iso.  My more recent TTT were without the iso.  No passing out, but bad hypo and brady.

voiceteacher

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Re: Just the Facts: Tilt Table
« Reply #10 on: October 25, 2010, 05:12:23 AM »
I had the tilt table test and flunked with flying colors in just a few minutes.  They kept me lying flat for 10 minutes to get some regular bp readings, then within 5 minutes of raising the table, my bp went nuts - but not enough for meds - my body finally regulated itself - after what seemed like forever.  I was then put on beta blockers and did great.  Then my cardiologist felt that the syncope was due to a virus so I was weaned off of the meds.  For several months I was fine.  Then in June I was in a hotel in Omaha and fainted again!!!  Now I'm on the meds and refuse to get off of them - - it's such a low dose of meds and if it keeps me from fainting, I'll stay on them :)  My diagnosis is just vaso vagal syncope - - not sure if that's related to sjogrens or not.  He's actually one of the drs that doesn't believe I have sjogrens because my bloodwork is seronegative.

Voiceteacher
ps - I'd like to let him see me try to lick an envelope!!!!

inga

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Re: Just the Facts: Tilt Table
« Reply #11 on: October 25, 2010, 06:29:39 AM »
I don't know why they used iso, I guess they wanted to see how low my BP would go.  When it dumped that bad, they were surprised.  The thing is cardios are very good at restarting things in general.

  The neuro did not use iso and my bp got very low,  not 50s/30s low, more like 70s/40s low, (no passing out) but it was the bradycardia that is different. Most people get POTS...the pulse goes up.  Things get even more complex when your kidneys start to dump on you, then you can get labile BP, high BP with over response to drugs that lower it.

I don't think they have sorted thru the Sjogren's stuff.

Seronegative, normal ANA is one entity. 
Seropositive, elevated ANA another.
Seropositive, elevated ANA, SSA/SSB yet another.

PN can occur with any of these and produce Sicca.  Sicca can happen in many diseases.  Honestly, I haven't jumped on the SjS bandwagon yet, since I am SSA/SSB negative.

I was started on a beta blocker recently, (I have been on them before) but my atrial arrhythmias (more than one) do not like it and are going full tilt right now.  They told me there are a few more drugs to try, maybe, then I need an EPS for ablation then if that doesn't work, pacemeaker.

I am just wondering why so many people seem to have Dysautonomia.  Seems to me, the incidence is climbing.

Also, I think there is a lot of familial dysautonomia of adult onset, that is not genetically mapped.