Monday, May 02, 2011

The Gastric Emptying Scan

I took a reduced dose of Lantus last night (went down to 9 units from 10- but a single unit does a lot these day) and set the alarm for 3 AM. Woke up at 3 AM with an SG of 269 and bg of 298, feeling moderately dehydrated. Took 1 1/2 units of Novolog by syringe and drank some water, reset alarm for 6 AM, went back to sleep.
Got up at 6 AM, made a lunch, packed, had to think for a bit about what to wear because the nurse practitioner had asked me not to wear metal- no pants with zippers, no belt. So I found my sweatpants and then realized I'd look kind of silly with my usual dress shirts and sweatpants. Anyways.

Took a couple buses, arrived at the Nuclear Medicine Department at 7:40. Tried to use the bathroom, couldn't. Sat around being bouncy. Got called in at 8:05. Followed the nurse to a room with a lot of equiptment and a tray with a cup of water and a cup with about a half cup of oatmeal (labeled oatmeal with sulfer something), also a fork. The nurse was not happy when I asked for the carb count, but she got it (18 grams). I took a unit of Novolog by syringe (I hope- the syringe had a zero marking that didn't look like zero). Asked if it mattered whether I drank the water or ate the oatmeal first; she said no, but eat fast. My stomach started hurting a quarter way through the cup of water, which is unfortunately something I expect when I drink more than an ounce of water. I had trouble getting all of the oatmeal with the fork, so I scooped some with a finger. The nurse was not pleased with me when she saw that, on account of me having gotten radioactivity on my fingers. So I washed my hands.

I took off my sandals and laid down on the bed sort of thing. I had a pillow or two under my head and a pillow under my knees. The nurse asked if I wanted a blanket. I didn't. She said to lie still and not to put my hands over my stomach. I asked what we'd do if my blood sugar went low. She said it's never happened and she'd figure it out if it did. So the bed moved under (and apparently over) cameras, and I was in a tight space, two hours beginning to count down.

The cool part: I watched the screens for two hours. The first hour, nothing happened except for a count down. The white blob of pixels stayed at the top right and top left of the screens resepctively(one screen showed the picture taken from above me, one showed the picture taken from below me). There was a very faint outline of white elsewhere- on the back screen it looked sort of like a loop. In the first ten minutes of the second hour, the pictures changed dramatically. Blobs solidified lower on the screen, and over the second hour, the pictures took the shape of two fat bottles with the original blobs as stoppers and the lower blobs like liquid at the bottom of the bottles.
The scan ended after two hours- BEEP BEEP BEEP and the nurse came in and let me out which was good and bad- good because I needed to go pee and bad because the scan was supposed to go for longer. She said my doctor should have the results tomorrow.

The thing that made me most annoyed was that I had spoken on the phone with a nurse practitioner on Friday. She'd told me they were in the process of going from one protocol to another, and that we'd be doing the latter. I am very much in favor of the latter protocol. But the first protocol is what was used. The nurse said that firstly, an attending who was out of town would have to sign off for the second protocol to be used, and secondly, the second protocol had not yet been adapted for a diet like mine- it had eggs and, horror of horrors- strawberry jam! I refrained from mentioning that my diet does in fact include strawberry jam on occasion.

My blood sugar (or at least what Dexcom displayed) was excellent through the test. It showed 126 with a downward drift at the beginning, an initial "spike" to 135, a continued downward drift to 93, and then a very slow small rise in the second hour. My stomach hurt a lot and at some points I wanted to bolt up and rock, which is unfortunately fairly typical for me, both after meals and at some random times. I think my digestion was impaired both by the speed that I ate with, and by lying down. After big meals if I nap, I always wake up with vomit in my mouth.

I am curious about whether this scan will be read as being normal, and if not, abnormal in what ways. I'm not sure what part of the screen I was watching was showing my stomach- whether gastric emptying time is the time it takes to go from that blob in the top corner of the screens, or whether it's the time until all of the food is off screen or dispersed. If it's the first of the two, I think it was delayed because there was almost nothing doing the first hour, and still quite a large blob at the end of the second hour. If it's the latter, it was definitely delayed. So maybe I do have gastroparesis.
The diagnosis code the doctor used was GERD. I couldn't find an online reference about gastric emptying scans that confirmed the use of a gastric emptying scan in diagnosing GERD, but I would say that the scan showed that nothing was moving upwards, and that anyways my history should prove I don't have GERD- I've now been on three medications that treat GERD and none of them made me feel any better.

Tomorrow I should have a better idea.

Sorry I am late with that medical logic scenario I promised. I still don't have time as I am on a public computer- I just wanted to type up what happened with the scan while the memory is still really clear in my head.

1 comment:

Reyna said...

Wow...the nurse sounded a little "short" in her attitude. I hated working with gals like that ... know the "attitude" well.


Please let us know the results tomorrow Jonah.

Be well. I feel bad about the pain your abdomen causes you.