Transplant evaluation day 1: The air I breathe

This is the air I breathe,

This is the air I breathe,

Your holy presence living in me

~from "Breathe" by John and Maria Barnett

Day 1, up at 5 am (wasn't sleeping anyway), dressed and ready to go.  Someone on the Vanderbilt Transplant Buddies Facebook site recommended that I take snacks.  I forgot the gummy bears, Laffy Taffy, and jelly beans, but I thought these would do.

 We arrived at the Vanderbilt Pulmonology Clinic at 7:20, before the receptionists were even there.  This is the place where I have been going every six months to have tests and see the pre-transplant doctor.  I signed in and received my updated transplant schedule along with other documents.

I did not wait long for them to call my name.  The first thing on the list was the arterial blood gas draw.  Those of you who have had this done know that it is more than a tiny bit painful.  The last time I came they could not get blood, so I was praying that would not be the case today.  After three attempts- success!  (Warning- if you are squeamish scroll through this next picture)

Liquid gold!

 On to pulmonary function tests.  This set of tests reveals so much about the function of lungs.  You are required to hold your breath, breathe fast, breathe slowly, breathe deeply, and pant like a dog.  This happens in various sequences, and some are repeated.  Oh yes, you get to wear a lovely nose clip during the entire process. It is harder than it sounds.  I often see stars and feel like I am going to pass out before it is okay to take a breath.  If you are doing the full set of tests, they close the door on the "glass box" and have you do more tests.  Whew, I'm worn out just writing about it!

The last part of this test is a 6 minute walk, which is just what it sounds like.  You walk up and down the hall at your own pace and they check your oxygen saturation.  You have to walk at least 750 feet to be listed for a transplant.  I walked 1135 feet today!  I can usually walk for about that long on flat ground without oxygen, as long as I walk slowly and am not carrying anything.

From there I went to the lab.

I never tell anyone ahead of time, but I am usually a difficult stick.  I have been stuck multiple times on many occasions in an attempt to draw blood or start an IV.  My veins are very small and scarred.  Today was a great day, because the phlebotomist got 18 (gulp) tubes of blood on the first attempt!

Are all of those for me?

Happy patient!  But seriously, do I have any blood left?  I need chocolate!

Okay, onward and forward to radiology- clinic radiology, that is.

This visit was for a DEXA scan, which measures bone density.  I have had many scans in the past, because I do have osteoporosis.  After a transplant you have to take very large doses of steroids, which can thin the bones.  This test is painless and takes only a few minutes.  No IVs and you do not even need to put on a gown!

My next appointment was with the transplant psychiatrist.  The transplant team wants to make sure you have good coping skills and they also want to let you know that the medications you take post transplant can cause depression, anxiety, and irritability.  For some reason, my secondary caregiver had to be present for this appointment, so our daughter Christy drove up.  The office is across the street from Vanderbilt, and it was cold and raining.  Did I mention I hate rain and cannot tolerate cold?  Satan knows how to push my buttons.  The visit consisted of questions.  At one point the doctor asked me if I felt hopeless. I replied that I am a Christian, so I always have hope.  She did not respond and just continued to the next question.  It was awkward.  I felt a little strange taking pictures there, so this is the only one I took.

We ate a quick lunch at a pizza place that was close by and it was good.  When we got back to the clinic building, I was tired from all the walking and back to back visits, but we kept going!

The next challenge was finding the Heart and Vascular Institute (in another building- we had to walk through a parking garage to get there).

First I had an echocardiogram, which is an ultrasound of the heart.  For this test, I got to put on a designer hospital gown.  As the ultrasound tech began the test, I watched my heart beat on the monitor- amazed at how the valves opened and closed over and over again, to pump blood to my lungs and to my body. I mentioned something to the tech about how miraculously God created us, but she did not comment back. I was in a dark room on a bed, and they covered me with a blanket.  I'm pretty sure I fell asleep at some point.  However, at the end of the test they told me they had to start an IV to give me saline that is shaken up with air.  It is called a "bubble echo."  They watch for the bubbles to move from one side of your heart to the other, to be sure everything is moving in the right direction.  Two sticks later, the IV was partially in, but far enough to administer the saline.  The nurse taped it securely in hopes that radiology could use it for my upcoming tests.  After the echo I had a EKG.  

On the way back to the main building, we saw this.  You know I had to get a picture!  Yay for nurses!

 By this time I was getting really tired.  We made our way to hospital radiology (in a different place from the radiology department we visited this morning.)

 I was scheduled for two CTs- one of my abdomen and pelvis, and one of my chest.  The one for my chest required an infusion of contrast dye.  Remember the IV from the echocardiogram?  It was in my left arm.  It seems that it has to be in the right arm for this test.  So, after one unsuccessful stick, she sent me to the PICC line nurse, who used ultrasound to find a vein.  The first one went through the vein.  She found a vein in the underside of my upper arm, and victory was mine!  The CT itself is painless and quick.  

 If you enlarge the picture, you can see the IV.  This fancy CT machine is one of only three in the country, and one of the other two is in the ER at Vandy.  It is faster and takes better pictures.  This means you are exposed to less radiation, and it takes less time.

It was 5:00 and I was finally finished.   Actually,  I was "stick a fork in me" done.  I was not expecting it, but I broke down into tears as I was leaving CT.  I was losing my sunny disposition  The tests were uncomfortable, but  but not terrible.  I guess it was the combination of the weather, the walking, and the multiple needle sticks.  I felt exhausted.  My husband picked up on this and took me to The Grilled Cheeserie for tomato soup and a grilled cheese sandwich.  Comfort food was just what I needed-  no fancy food tonight.  (If you have never been there, it is across the street from the Pancake Pantry two blocks from Vandy- it is amazing!)  I wanted to bring Christy here for lunch, but it was too far for me to walk and I only had 30 minutes before my next appointment. 

Michael chose roasted red pepper soup with a grilled mac (yes, macaroni) and pimento cheese sandwich.

Here is my choice -plain old tomato soup and grilled cheese -just what I needed!

We came back and I did one of my favorite things- put on my pjs!  There is a Hallmark Christmas movie on TV as I type this blog post.  I feel better now.

As I reflected on the day, I recalled how often the people taking care of me remarked about how well I appear, and how they were surprised that I had done so well over the years.  To God be the glory!  The Michael Smith song "Breathe" came to mind.  The air in my lungs is not what is keeping me alive, it is the presence of God living in me.  He truly is the air I breathe!