This is Jim, the van driver who took us to Vanderbilt and in the red shirt is Chris, the restaurant manager.

Vanderbilt Day!

We ate breakfast in the hotel lobby then I was unable to eat or drink anything for 3 hours before my appointment. The hotel shuttle took us to the medical center which was only about 2 minutes away. What a nice and organized facility! They had signs up in the waiting area instructing the patients to notify the receptionist if they had been waiting longer than 10 minutes.

My first thing was to go through 4 different kinds of tests which were all done in the same room by the same medical technician, and of course Dan was there to help the tech :)

The first test I had been required to do three different times in Casper with the results submitted to Vanderbilt as a sort of pre-test to determine my priority status. So, I had done this test before and knew what to expect. It is called postural blood and heart rate.

The rest of the tests were performed hooked up to a heart monitor, blood pressure monitor and pulse monitor (it was a tight band wrapped around my wrist and felt like it was rolling back and forth over my wrist while it recorded my pulse-a truly creeping sensation).

Test number two involved deep breathing (no not heavy breathing!!) I was required to inhale deeply over 15 seconds hold it and exhale over 15 seconds. I had to keep repeating this without stopping for one minute and 30 seconds. This test is called a sinus arrhythmia test and it tests the vagal parasympathetic tone.

Test number three was actually kind of fun other than it made me turn beet red and I'm sure I looked like a tomato. It is called the valsalva maneuver. I had to exhale into a tube over a 15 second period while blowing against resistance.

Test number four. Hmmm. I'm not sure where to begin with test number four. When Dan asked the tech the purpose behind this test she replied (and I'm not making this up...) The alternative to this test is to beat the patient with a baseball bat to check their pain response. But this is easier on the patient. I was not at all prepared for this test. The cold pressor test measures your blood pressure and heart rate while holding one hand in ice water for one minute. Okay, I thought ice water no problem. I can handle cold hands...this had nothing to do with your hand being cold it was truly about pain and beyond. I have never experienced anything like it and I hope I never have to again.

After those tests I was exhausted. We had time to go eat lunch before my 2:30 doctor appt. They have a McDonald's in the hospital so that made it quick and easy.

We went back to the waiting room and they had already recognized us and checked us back in before Dan went to the desk. With 5 minutes we were called back to the room.

I was weighed first and then we had our own little exam room. Very, very shortly Dr. Biaggioni's Nurse was in the room reviewing my meds and asking questions. She already knew my full history when she walked in the room. Asked very pertinent questions related to my heart attack and the following years of my disability. From the questions that she asked I knew immediately that she knew about autonomic disorders. She was professional, helpful and made us feel comfortable.

She left the room and very soon Dr. B came in. He spent 40 unrushed minutes with us and we covered a wide variety of topics from the cause of my heart attack to the subsequent autonomic disorder. We discussed some management options and came up with this:

1. My tests showed that the area of my dysautonomia is the sympathetic nervous system (this we did not know). My sympathetic nervous system is hyperactive.

2. There is a drug that calms down the sympathetic nervous system and we will be trying that.

3. I am to manage this chronic syndrome using the following techniques: Avoid standing still, do not stand up to quickly, do not loose fluids.

4. New things for us to try: Muscle resistance training of my legs using weights and/or elastic bands. I am able to try gradual low impact aerobic exercise.

5. Try wearing an abdominal binder for walking.

6. Increase salt and water intake. Continue to monitor my blood pressure too make sure it is not increasing too much.

7. Drink 16oz of water quickly before performing any activities that might cause lightheadedness.

8. ****New thing*** My intense periods of flushing are extremely important to this diagnosing process and I have a special lab test to do if this happens again. So, this areas results are still pending.

So, the bottom line is that they confirmed my diagnosis and managed to further narrow down what part of the autonomic system was being aggravated and how it was being aggravated. With that we are able to try a new drug to calm the system down and with the other measures we are hoping that over time my quality of life will improve!

Thanks to all of you for your many prayers and support. The Lord has been so close to us this entire trip. We can feel His power and all of your love.