Adrenal venous sampling (2)

Yesterday I underwent the long awaited procedure that I described a few months ago; actually I only made the appointment 12 days ago so I didn't have to wait too long in that sense.

As instructed, I arrived at the clinic within the hospital at 7:30am, after not having eaten or drunk anything since the previous evening. As I was the first to arrive, there was no delay in processing, although a lack of curtains around the cubicles meant that I had to wait before changing into a hospital gown (the curtains are washed over the weekend then put back on Sunday morning - I was simply too early for this). Despite having done a blood test on Thursday for potassium (an element that is expected to be low because of the hyperaldosteronism), I suspect that the staff did not believe the good level that my test showed and so I had to do another blood test. Nothing could proceed until these results returned.

At about 10:30 am, the blood test results returned: the potassium level was slightly lower than it was on Thursday, but still a good value. The next step was being hooked up to an infusion containing artificial aldosterone; the nurse said that infusing the hormone would cause my body to create even more, thus improving the level of detection in the test. Here's the explanation: Some diagnostic centers prefer to pharmacologically stimulate the adrenal glands with an infusion of cosyntropin (a synthetic version of ACTH) to ensure that veins are adequately sampled. I had been reading a book on the Kindle, but as the battery had died, I switched to listening to music via a pair of headphones that I had brought with me. Looking back on this period, I realised later that I had fallen asleep for a while, as there were songs that I had missed hearing. It's good that I slept as it shows that I was relaxed.

Finally at 1 pm I was wheeled in to the room where the procedure would take place. After moving onto the fixed bed, I was trussed up like a Thanksgiving turkey: my arms were tied and heavy blankets  placed on all my body. Of course, it would not be good if I started moving once the procedure started, but after a while it became very uncomfortable. Because the catheter is inserted in my groin, I had to be shaved in this area, a not particularly pleasant operation. Again, because of the point of insertion, my "meat and two veg" (as Austin Powers called them) were on show for all, although they may have been covered up at some stage; I couldn't see anything, lying flat on my back. After shaving, the area had to be washed with soap and alcohol.

Eventually the procedure started via an ultrasound scan to locate the femoral vein in my right thigh; once this was located, I felt two sharp pricks that were due to local anaesthetic being injected. From this point on, there was no pain, but now and then there were uncomfortable moments that are hard to describe. There was a similar feeling to when I've had BCCs removed: again, local anaesthetic and then a feeling of pulling and pushing. The only pain came from my arms and eventually from my lower back as they complained about not moving. At one stage, breathing in caused a feeling that I can only describe as "fire in my right lung"; I reported this at the time and was told that it was natural to feel this. I asked the doctor who performed the procedure and he said that this happened when he injected some contrast into the veins; it also showed that I was definitely not allergic to iodine (there was some doubt about this).

Eventually, after having taken eight or nine blood samples, the doctor announced that we were nearly finished. A few more minutes of pushing and pulling and back pain and then it was all over. I looked at the clock and saw that it was now 2:30 pm; the procedure had lasted an hour and a half. Judging by other patients who were wheeled out and back in to the cubicles, my test lasted about three times longer than theirs.

I was told not to move my right leg for another hour which was fine by me; I was able to drink some water and even eat a roll that the hospital kindly provided for me. While I was eating the roll, the consultant whom I saw a month ago came in to see how I was, which was kind of him. He said that it will take about two weeks for the results to appear and will be sent to "my doctor"; I asked who my 'lead' doctor is: him, the nephrologist or even my family doctor, to which he smiled and said that we'll sort this out later. 

After an hour of not moving, I was allowed to move my leg but still stay in bed; only after another hour was I allowed to get up and get dressed. After a short exploratory walk, the doctor who performed the procedure appeared with my discharge letter. As hinted on the PA page (Because the right adrenal vein originates in the inferior vena cava (IVC), it is usually more difficult to canulate), the doctor noted that he was unable to canulate this vein but took samples from four surrounding veins. As the adenoma is on my left adrenal gland, this might seem problematic, but I assume that the doctors know what they are doing. 

I left the hospital at about 4:45 pm, which meant that I was there for just over nine hours: a good day's work. I felt weak but that was because of the stress and having been lying down all day. There were a few minutes in the evening when I felt a slight twinge of pain in my groin, but this was just the anaesthetic saying goodbye. I didn't sleep well yet again, but otherwise I'm fine and underwent the procedure with no problems.

Now I wait the results.