Usually they are done with local anesthesia at the insertion site, combined with sedation. How did you do the first time? Do you ever have airway or breathing difficulties when at your weakest? That could pose difficulty since you will have to lie flat for a long time. Perhaps you could ask your cardiologist and neurologist to have a planning conversation.

Hi Erica,
Actually, this will be my fifth time, but like I said the first since my MG diagnosis. The last time, however, I remember having to stay the night, as I was feeling extremely weak and demanded staying overnight, which was no problem. My regular Cardiologist has talked with the Doctor who will be performing said Angiogram, and I will also be providing them the contact information of my Neurologist, who is 100 miles south. I know that it's more of a 'twilight' sort of drug, but yes have had some slight breathing problems at my weakest part of the day.

Hi - all your preps sound very solid.

I was only a step or two recovered, from the throes of severe MG symptoms, when I had my angiogram.

I had no apparent problem with the contrast dye, the angiogram, or any anesthesia.

(However, after the angiogram, I was shuttled between two hospitals, for weeks and weeks of opinions, because no two cardiologists could agree on what was wrong with me. As a result, I am being treated ''medically'' - with cardiac medicines.)

A strong sidenote:
If possible - do not let the catheterization team allow a resident ''student'' to perform: either the catheterization, or the angiogram.

Tell them to save the ''student'' for someone - who does not have MG.
My catheterization was performed by a greenhorn resident, who made typical greenhorn goofs, at the incision site for the insertion of the catheter. This resulted in excessive bleeding and bruising, and a wound that easily took 3-times the normal healing rate (2 weeks or more, as I remember).

Tell them to save the student - for an otherwise healthy 45-year-old!

Bottomline: my angiogram did not seem to exacerbate my MG, even though I was so weak, I could not transfer myself, from gurney to exam table, and vice-versa.
- Ross

It's crucial that they have a good, long talk with your neurologist. Make sure thy set you up for inpatient status again, too. If a patient is to undergo a "Monitored Anesthesia Care" case (also called MAC or twilight sleep) procedure, if they are known to not be able to maintain their airway, I will choose general anesthesia instead. General anesthesia does not always necessitate the use of paralyzing agents (even if a breathing tube is used). If a person has airway compromise, it can be an "all or nothing" decision at times. Propofol is a wonderful and safe drug, when used properly. Obviously with angiography (especially if stenting) it isn't safe for a person to move during the procedure. There are times when we start out doing MAC and need to convert to general anesthesia mid-procedure. Do you have a BIPAP machine? It may be a viable option for during the procedure. You could inquire. I definitely don't want to scare you! As you said, you've been through this many times before. It just sounds like it got pretty hairy last time, so planning is critical. Sorry if I'm rambling and unclear.

Snowbelt, I am fine with them not having an inexperienced person on me, as as matter of fact I personally know this particular doctor, and his is top rated in his field. So, I'm comfortable there.

Erica, I do not have a BIPAP machine, though my wife a CPAP. I have already alerted them to possible breathing issues, and that I will be also bringing my Mestinon with me, as I'm on 180mg every three hours. The actual procedure won't last long, the entire process of arriving, preparation, procedure, and final release certain will span that time.

Wonder if they would let out stay overnight just to be safe?
Good luck Bill and will be thinking of you. Please let us know how things turn out.
-sherry

Hi Sherry,

That's certainly an option that the same doctor offered to me last time, and I did stay. Not sure what time I started last time, but this time check in time is 8:00 a.m., but still I'm sure it'll be after lunch by the time they'd be ready to let me go. But, it still sounds like you and Snowbelt recommend the staying.......

I think you should definitely stay the night, too.

Wow Ross, what a complete post. Good info.

I was supposed to get a blood draw for a test at my last doctor visit. They had a student and I got nervous so the pro stepped in and it was sooo smooth. I don't think anyone pulled blood so easy from me.

Today is Bill's procedure.
Holding you in the light, Bill, waiting for word, b.

Completed my Angiogram yesterday as scheduled. It went well, I suppose, as the chest tightness, pain, and shortness of breathe is not stemming from my heart. I decided to go home around 4:00 p.m., after being cleared by the medical staff. In retrospect, I suppose I should have stayed, as I am super weak ever since, but am following doctors orders and literally doing nothing today. But, then, that's really not too different from every other day:)

I was pleased that I had taken literature for them to read about MG, and medications I could not take, as it really gave them insight into the disease and what my special needs are. Also, having discussed my need for taking my Mestinon every three hours helped too, as I did to take my 10, 1, and 4 p.m. doses there.

So, while I still have the same symptoms leaving the hospital as when I went in, after their not finding any more problems with my heart, I will seek out a Pulminary Doctor. Cathi has been encouraging me to do so, but now Dr. Weiss (my MG doctor), as well as my cardiologist.

Thankful there are no problems with your heart Bill! How are you feeling now? More weakness or have you recovered.
Now to add on a pulmonary Dr....our list of doctors seems to grow:-(
-sherry

Today being Thursday, I'm just starting to feel a little stronger. Actually left the house today, as I generally try doing a short morning walk, while it's still cool enough to consider. But, still feeling weak, and eyes are funny.

Yup, adding another doctor! That's what my reaction, when Cathi had originally mentioned it to me several months ago. 'Heck NO', I don't want another doctor, but with the growing chest pain, tightness, etc, I guess it's time to consider it, now that my heart isn't the issue this time.

Bill, I am so relieved to hear your angio went well. You were super prepared and a great inspiration to all of us. Thank you for sharing all of this helpful information! Xoxo