Suggest Remedies For Persistent Hematuria Post A Partial Hysterectomy
She had a uterine cancer 22 years back.
Was treated with partial hysterectomy and followed by radiation therapy.
Recently she has been having occasional symptoms of gross hematuria for past 3 months.
She has been ordered a bladder biopsy for the second time in three months and doctor needs a cardiologist clearance before the surgery.
The cardiologist has recommended a Lexiscan stress test.
She has never had a stress test in her lifetime.
BTW, she has a AFib, high BP and high cholesterol and these conditions are in control with medications.
I would like to know - are there any risks or concerns about the Lexiscan stress test?
Is there any preparations required before the test?
Thanks for your time and expert advice!
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding Lexiscan stress test, I would explain that this is a diagnostic procedure in which cardiovascular stress induced by pharmacologic agents is demonstrated in patients with decreased functional capacity or in patients who cannot exercise. The procedure consists in the fact that patient reclines while the pharmacologic agent is injected through an IV line. A nuclear tracer is injected through the IV. Blood pressure, heart rate, and ECG are monitored before, during, and after the test, and imaging is obtained at specified times.
So, there is some risk of possible allergic reaction and a little radiation.
Has she suffered from asthma or any allergic reaction before? You should discuss about this with her doctor before the test. Breathing problems can occur during the procedure.
She may feel a shortness of breath, headache, flushing, chest discomfort or chest pain, dizziness, or nausea. She may also experience abdominal discomfort, a metallic taste in the mouth, or a hot feeling during the test.
An increased risk for heart attack (acute coronary events) is also associated to the procedure. You should talk about this with her doctor.
Before the test, I would recommend some tips:
1- Do not eat, drink anything other than water, or smoke for 3 hours prior to the test.
2-Do not consume anything with caffeine, including products that say “decaffeinated or “caffeine free,” after midnight the night before the test.
3-Wear comfortable clothing.
4-Bring a list of all current medications, along with times and dosages. You should ask her doctor if she should stop them the day before the test.
5-Avoid strenuous activities (eg, jogging, running) before the appointment.
6-Do not apply powder or lotion on the chest that day.
You should discuss with her attending physician on the above issues.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Thank you very much for your response.
I have few follow-up questions:
1) Is the pharmacologic agent used to achieve the targeted heart-rate like the regular stress test? If so, what should be the targeted heart rate for a 77 year old woman (186 pounds weight)?
2) What are the possible reactions of lexiscan?
3) If the lexiscan reaction happens, what is the treatment?
4) Is there any antidote for lexiscan?
5) She has AFib and on medication. Is this a concern?
Will greatly appreciate your quick response as my Mom have the test schedule for tomorrow afternoon.
Thank you very much for your expert advice!
I would explain as follows:
Detailed Answer:
Hello again!
Regarding your concern, I would explain that it not a matter of achieving a certain heart rate. The aim of this exam is to increase the coronary artery blood flow and examine if there is any presence of coronary artery disease.
There is no need of any antidote as the substitance is cleared naturally by her body in some minutes in the urine.
Contraindications to this procedure are atrio-ventricular block grade II and III and sick sinus syndrome.
So there is nothing to worry regarding your mother case. Atrial fibrillation is not a contraindication.
It may cause possible allergic reactions, but as it will be performed under medical supervision, there is nothing to worry about, as the staff is usually prepared to such possible complications.
Hope you will find this answer helpful!
Best wishes,
Dr. Iliri