AVS # 2 went much better than the first one but I left it feeling a little disappointed, I’ll get to why later. Firstly I’ll explain what happened on the day. Arrived at 7am, sat in the waiting room for about 2 hours. Name was called and I filled out some paper work and answered the registrar’s questions. Then the same old guy as last time collected a group of us and we walked to our various waiting areas. The first AVS I was led to a room with about 14 people in it waiting on chairs while they had bloods taken, signed consent forms, etc. This time I waited in a room with one other person and we had our own beds. My favourite nurse from the first AVS came and took my blood. She said she recognised my name on the chart and that they had all learnt a lot from my first AVS and had changed the procedures since then. Interesting…
A cleaner came into the room where my bed was and began dusting the medical equipment and TV above my bed, this triggered my allergies/asthma and I started to cough. I couldn’t stop coughing, nurse got me some ventolin and I stopped coughing – winning!
Before entering the operating room the nurse had trouble finding a vein in my my arm for an IV. She tried my left arm, then the other one and back to my left. She fiddled around for ages and she still couldn’t get it. Maybe I was dehydrated from fasting. She resorted to getting an ultrasound machine and used it to locate my vein (which hurt a bit – actually a lot) because it involved ultrasounding my arm on top of the needle inside my arm. What joy! I have a pretty strong stomach but I began to feel queasy at this point. Finally the IV was inserted and I asked for medication before my second AVS, using my panic attack during the first one as an excuse. 💁 Sometime before going into the OR Dr Jay, the biochemistry doctor, who would be analysing my blood (like he did the first AVS) came over and introduced himself. It was nice to put a face to the doctor I’d been emailing heaps before and after the last one.
After my IV line was in I was wheeled into the OR. I had drawn quite a crowd of medical professionals (around 12 of them) who wanted to observe my procedure as they were very interested in my complicated case. Lucky me, the human science project. I got a bit angry and lay there feeling sorry for myself because I felt stressed enough without a million people there for the show. Then I thought about it from their point of view and if I was a med or nursing student then I’d probably want to observe it too, because it is sort of interesting. They stayed in the room with the windows to my right and I couldn’t see them so it was like they weren’t even there. I was completely over the day already. Would they just hurry up and give me some meds and get this procedure over and done with?! A medical student came up to me and said ‘Hi Katie, I’m <such and such> do you understand the procedure you are having today or would you like me to explain it to you?’ I couldn’t help myself, I sarcastically replied a tad dramatically ‘Oh haven’t you heard?! I’m back! This AVS number 2. I’m quite familiar with the procedure, thank you.’ The whole OR erupted in laughter. I don’t know how he reacted and I hope he didn’t feel bad but it was pretty funny. Rule number 1 become familiar with the patient’s history before you speak to them. The nurse who did my IV came up to me and called me cheeky (fair call) then flushed my IV with saline solution. A male nurse was introduced to me and he prepared me for the procedure – disinfected the skin on both sides of my groin with swabs of blue liquid. Then they put the drape over my abdomen with two holes over my left and right sides of my groin. I started to freak out a little bit at this stage because I was anxious (the high aldosterone messes with my mind and causes extreme anxiety). I said to the nurse ‘Please don’t stick anything in there (groin) until I get some meds’ they assured me that they wouldn’t but they couldn’t administer any meds until Dr A arrived.
I lay there waiting for Dr A then I suddenly became super itchy. The disposable surgery underwear was driving me nuts. I was told not to move my arms (something about how there was expensive equipment on the table) when I tried to take them off myself. So I resorted to asking a nurse to take them off. I didn’t really care, I just wanted the itching to stop – I couldn’t be moving around during the procedure. I needed to be completely still to make sure none of my veins were damaged by the needle at the end of the wire. Plus I’ve had gynaecological surgery and procedures before, so whatevs! As long as they covered me up during and after the procedure, it was all good. The first nurse left the gigantic plastic undies half under my butt after asking if that was ok, which was fine until I started to itch again. I had to call a different nurse over and get her to pull them all the way out. Cringe but the relief from itching was worth it! 🤷🏼♀️
When Dr A arrived, they eventually gave me 2 different types of medications which made me feel super relaxed. I really liked Dr A he had a good sense of humour. This time when they inserted the catheter and moved it up my femoral vein it did not hurt. Bonus! 😛 There was no chest pain, hallelujah! Just like the first AVS a little pathology station was set up behind me, to the right (out of my field of vision) to analyse my blood on the spot. Again, it was the old routine of ‘Dr A taking blood out, giving it to nurse, nurse delivering it to blood station for analysis, nurse coming back and telling Dr A the result. I couldn’t feel any of this but I was listening to the Dr and the nurses. This went on and on (like the first one) and still no “Eureka we’ve got it moment’ after analysing each blood sample. I was so relaxed with the drugs (‘Magic Juice’) they gave me I barely registered this and I didn’t really care. Then they told me they were going to administer some Synacthen to activate my adrenal glands. They administered it and Dr A took a break while we waited 20 minutes for it to kick in. After 20 minutes Dr A came back and I was told to be careful not to sigh or yawn while he got the needle as close to my left adrenal cortex as he could. Finally he said ‘I’ve got the left’ (hell yeah!) and I said ‘yay!’ then had to pipe down and not speak as gently prompted to do so by Dr A. No moving, bad idea. The right was not as easy, I had to be careful not to breathe in too deeply, sigh or yawn, without asking, to avoid damaging my veins. I noticed how much I actually sigh and yawn during this time – heaps. There were a lot of samples taken but still there was no eureka moment. I felt upset because I really wanted both sides to be declared as successful on the day. I asked Dr A if we were back to square one again like last time and he said ‘No we will most likely get a much more meaningful result than the first AVS.’ I didn’t understand what had happened really because my cortisol was within normal range so why didn’t the on the spot test detect it?! So I emailed Dr Jay the biochemistry registrar, and asked questions.
He told me that because my cortisol was low side of normal sometimes it doesn’t get picked up by the instant test they do during the AVS, although it is quite possible they got it. The only thing left to do was wait for the results. They took 2 weeks to come back.
Well fast forward two weeks and I was told my AVS results by my endocrinologist, Dr E, last week. It was successful!! They successfully cannulated my left adrenal in 5 samples! Successfully cannulated my right in only 1 sample (after the synacthen was administered). The results showed it is my left one (with Edgar) causing all my issues! He said it was up there with the highest aldosterone levels he’d seen but not the highest he’s ever seen. Hooray! I was referred to an endocrine surgeon and got an appointment the following week.
Here’s my results. The left adrenal was successfully cannulated in attempt No. 1, 2, 3, 4 and 5. The right adrenal was only successfully cannulated in attempt 7 after synacthen was administered. There are two results per attempt – the peripheral result was from blood taken away from my adrenal glands, I think from my leg. Remember that in order to gauge whether or not the needle is in correct place (close enough to the adrenal cortex where aldosterone and cortisol is secreted) they compare the peripheral value of cortisol to the adrenal cortisol value. I think they use some sort of mathematical equation as well, but I don’t know how it’s calculated. Anyway as you can see there is a massive difference between what my left and my right adrenal are pumping out! 🤓
http://endocrinediseases.org/adrenal/hyperaldosteronism_treatment.shtml < img src=”https://thehyperaldosteronismblog.files.wordpress.com/2018/02/img_3106-1.jpg” class=”size-full wp-image-278″ height=”994″ width=”644″><