Wednesday, July 13, 2011

rapunzel has a transesophageal echocardiogram

Well, NO, Rapunzel didn’t because the fancy doodad ultrasonic probe wasn’t in use for cardiac testing until the 1970s, and the Grimm’s brothers published their story in 1812.
At least being imprisoned in a tower kept Rapunzel isolated from germs. Smallpox. Leprosy. Typhus. Streptococcus.
If streptococcus isn’t treated with antibiotics, which hadn’t been discovered yet in once-upon-a-time, it develops into scarlet or rheumatic fever. (There were antibiotics when I was growing up, but that’s another story.)
Rheumatic fever scars the heart valves. And whereas some scars fade, rheumatic scars are aggressive. The valves get stiffer and thicker. They become stenotic—which is a great word: a narrowing constriction. I can think of relationships I’d call stenotic.
My understanding of the heart is very simple. I think of it as a pump that sends blood to the lungs to be oxygenated and then through the body. The valves are the tubes through which the blood flows. A damaged rheumatic valve isn’t as efficient as a healthy valve.
A cardiologist keeps track of how well the valve functions with an echocardiogram or ultrasound of the heart. This is a non-invasive procedure where a technician traces a probe across your chest. The probe picks up echoes of sound waves to form a picture. Sometimes the technician forgets that the object being examined is a human body and digs the probe into your ribs. That hurts. With all due respect for science, this test isn’t supposed to leave you with bruises.
A much better picture of the valves can be obtained with a transesophageal echocardiogram. That’s right, down the throat. The probe can get right behind the heart without any flesh, fat or ribs in the way.
Still. Down the throat. Ugh.
You lie on an examining table next to an expensive machine. For this test you need to sign a consent because it’s an invasive procedure (into your body) and something could go wrong. The most serious risk is a perforated esophagus, in which case you will need to be rushed to the operating room. When you sign, you acknowledge that you understand the risk—so, yeah, make sure someone explains it to you. Don’t worry though. The risk of perforation is minuscule—less than 0.05%. And hey, what choice do you have? Free will and self-determination won’t get you far if you don’t have a viable, functioning heart.
The technician will start an intravenous. If you’ve had tests or blood drawn before and know where you have a good vein, now is the time to share. You’ll save yourself a lot of painful poking. I’m not saying it won’t hurt anyhow, but one good stab as opposed to a dozen is eleven less stabs as I see it.
The intravenous allows immediate access to sedate you. I’ve had this test before. Twice awake, once completely knocked out. This time I thought I’d like to eavesdrop on what the docs were saying and so asked for a minimum of sedation. They thought that was weird, and in retrospect I agree. I couldn’t understand all the talk about gradients and they had to keep upping the dose because I was gagging on the probe. Sorry, if that’s TMI but this is a post about a TEE, not window-shopping on rue Ste-Catherine.
Next the technician gives you a thick fluorescent liquid in a cup to gargle with and swallow. I suspect it’s partly antiseptic (because hospitals like to use bright pink for antiseptic soaps) and partly numbs your throat. Though I didn’t ask. I was already in that Zen headspace I go into when I’m at the dentist’s. Do what you have to and let me get the fuck out of here.
Now that I’m prepped and lying on my side, the good doctor enters the room. I get a white plastic mouth guard shoved in my mouth—like hockey players wear to protect their teeth, though this one protects the probe. No one wants a patient chomping down.
A little sedation and the doctor begins to ease the probe down my throat. Two doctors and the technician discuss what they see on the screen, tap buttons, measure percentages, disagree on interpretation of the numbers, then decide to agree.
All very civilized over the prone misery of my body. The probe feels like the handle of a wooden cooking spoon stirring in my chest. A very weird sensation in a place where I don’t expect to feel movement. I’m not sure if being aware of it is worth being conscious. I distract myself trying to figure out how to describe how it feels.
Best, of course, would be not to have this test—or rheumatic valves—at all.


  1. My dear Alice,
    I send hugs from my part of this difficult old world.

  2. Hugs are very nice. They don't exist in Grimm's fairy tales.