Refusing Test

My new cardiologist is wanting me to have a nuclear stress test with the drug Lexiscan.  I had a treadmill test in 2016 that revealed no blockages or profusion.  I am a healthnut, a long time vegan, with rediculously low cholesterol, and am 80 years old now.  The reason I don't want the test besides it being brutal for many people, is that it's very unlikely I would have CAD.  I don't want drugs either.  I am willing to take whatever risk I might have for the 5 years remaining on my generator.  There are people who want longevity no matter the quality of life.  I have a good quality of life now but can see the slippery slope ahead.  I am dreading this conversation with my very nice doctor..   


8 Comments

Refusing Test

by DMJ - 2022-08-27 01:49:45

Are you not able to do the stress test yourself?  I would also not do it with Lexiscan.  Seems like many side effects.  I have great insurance with Medicare and Athem and I see all the charges that come through for tests that I really didn't need.  It is like getting your oil changed and having to say  "no" to all the cross sale services.  If you aren't having any heart issues and it's just routine I say to them, "I got to die of something".  I wish you continued good health.

Investigation to rule out CAD

by Gemita - 2022-08-27 02:48:40

Swangirl, Firstly I have just seen your update to your previous post about atrial supression and increased AF burden.  

Regarding the Lexiscan, it is important that you do whatever you feel is best for you but if you can keep your EP on your side, it will be better all round.  

Just a few observations.  A treadmill or a Lexiscan cannot conclusively rule out any significant CAD. I know this only too well from my husband's investigations.  Only the gold standard Angiogram can do that and that would be even more invasive.   If you are not concerned (and it seems this is the case), then do nothing further and get on with your life and enjoy it.  But if you or your EP are concerned about any increased symptoms you are getting, then it might be prudent to rule out CAD for once and for all, but it is ultimately your decision not your EP's.  

Have a respectful chat with your EP, explaining that it is quality of life not quantity you are seeking and unless he is concerned for your immediate safety, you would prefer not to have the Lexiscan at this time.  Unfortunately AF can cause many of the symptoms you are getting, so perhaps you could work with your EP in this area first to see whether you could better control this little pest.

I wish you well Swangirl 

I agree with Swangirl

by Good Dog - 2022-08-27 07:53:57

I have to tell you that I agree completely with your feelings! As Genita said, as long as you are not in immediate danger. It is your life and your decision. As long as your decision is an educated one.

My attitude is; I may not be 100%, but I am not symptomatic to the extent that my quality of life is negatively impacted to any significant degree. Essentially, I have a decent quality of life for an older person. So if I am not in immanent danger, just leave me alone. I lost two friends and an uncle recently that died before their time due to unexpected complications from relatively minor issues and what are considered routine procedures. Two blood clots and one sepsis. 

Now, if it is something that is urgently necessary to prolong my life, that is an entirely different story. Knowing the risks, it is your life and it should be your decision!

I wish you the best!

Sincerely,

Dave

 

stress test

by new to pace.... - 2022-08-27 09:13:30

i had the stress test done 3 different times 2016, 2019 just before getting the pacemaker, 2022 with the Lexiscan.  Even though i do not like to take drugs.  The treadmill was out as my knees would not be able to take the stress .

Was told it was to see how my heart would bear the stress and blood flowing through.  Had no problems.

Not sure would do it again if asked.  Have 10 years left on my battery, which would make me 91.  That is another question for me then. 

new to pace

Stressing

by Lavender - 2022-08-27 09:38:21

I have had the Lexiscan twice, years prior to my pacemaker. I'm not sure why they didn't just let me walk the stress treadmill myself.  The injection just made my heart pound and I got a bit nauseous and sweaty but it quickly subsided.

I had a stress test this year, a bit over a year since my pacemaker. This time the same cardiologist who used lexiscan last time, had me do the treadmill by walking it myself. I had results better than my age group. My heart was pounding by the end, and it took about 10-15 minutes to settle but it wasn't traumatic. I only quit because my ankle, which has a split tendon, was acting up in spite of wearing an ankle brace while doing the treadmill.

The first time with lexiscan was in 2010 when I was hospitalized for chest pain that turned out to be a pulled muscle. The second time with lexiscan, it was after recovery from pericarditis. 

I think that I would refuse Lexiscan as long as I could walk. In all three times of stress tests, I wasn't given a choice. After reading this about Lexiscan, I would question using it:

You should not be treated with Lexiscan if you are allergic to regadenoson, or if you have a serious heart condition such as:

2nd or 3rd degree AV block; or

"sick sinus syndrome" (unless you have a pacemaker).

Receiving Lexiscan may increase your risk of having abnormal heartbeats, breathing problems, heart attack, stroke, or cardiac arrest.

I am so sorry you're having this worry. An honest talk with your dr may allay your fears and make them understand your viewpoint.

There are other alternatives to stress tests. I read this online:

The results of numerous studies comparing the accuracy of nuclear stress testing with stress echocardiography show that they are reasonably close. However, stress echocardiography is probably a bit less sensitive and more dependent on the expertise of the physician interpreting the test. Also, left bundle branch block can reduce the accuracy of either test.

Which test to select depends on an individual's situation and the expertise of the available doctors. Even more options than these are available at major centers, including CT angiography, coronary MRI angiography, single-photon emission computed tomography (SPECT) myocardial perfusion imaging, and cardiac positron emission tomography (PET). Some of these deliver radiation; some don't.
 

Here is the article to copy and paste:

https://www.sun-sentinel.com/health/fl-xpm-2010-11-22-fl-jjps-nuclear-1124-20101122-story.html

 

Quality of life

by AgentX86 - 2022-08-27 18:32:34

I don't see how a stress test is going to change your QOL, unless you're afraid of what they'll find and the possible treatment necessary to keep you alive and return your QOL. Sorry,  I don't get it.

The radiation involved in these tests is trivial compared to background radiation. Some foods, particularly bananas, have a high level of radiation. It's everywhere.

I just had a PET scan. It wasn't a big deal at all. I felt a cold sensation in my arm but he hadn't introduced the radio isotope yet. It was get from clearing the IV. I did feel SOB for a few seconds but nothing nearly like the "elevator test" during an interrogation. Though, this time she just turned my PM off for two cycles of two seconds each, just to confirm that there was still nothing there.

Unnecessary Tests, Treatments, and Medicine

by Swangirl - 2022-08-28 15:12:34

I have no symptoms of CAD.  I am in a U.S. Medical System where "more is more".  Routine testing without compelling symptoms is how they make money.  My doctor does not get the concept of "shared decision making" and isn't interested in my viewpoint.  I like to listen to Dr. John Mandrola on a podcast or Youtube.  He espouses "less is more" and trys to do the minimum necessary.  

I appreciate all of your excellant comments and always learn a lot from your experiences.  

John Mandrola

by AgentX86 - 2022-08-28 17:39:58

He has a pretty poor reputation among other surgical EPs. Be careful to corroborate anything from him with other practicing surgical EPs. Trust(?) but verify.

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