Monday, July 3, 2017

What To Expect During A Gastric Emptying Scan

Pain contorted the face of a young girl as she entered the radiology room for her Gastric Emptying Scan. Fear and uncertainty swirled in the pit of her stomach, along with last night's dinner. The nurse stated that the test would take the length of one movie, at the least. The table was prepped for a Thanksgiving feast complete with scrambled eggs laced with radioactive material.

That description was me on the day I was diagnosed with Gastroparesis several years ago via a Gastric Emptying Scan. The test was completed towards the beginning of my health journey. Due to fear of the unknown, I was scared. I had not known what to expect. Had I had someone preparing me for such a test, I would have come to the realization that those feelings were so unnecessary! 

"What is a Gastric Emptying Scan?"

A Gastric Emptying Scan (GES) is a medical test that calculates the length of time it takes of the stomach to empty its contents into the small intestine. It uses radioactive dye that the patient consumes in a meal and an x-ray camera. It differs from a standard x-ray in the fact that it tracks and measures the radioactive material as it is digested. 

"What symptoms are indicative of the need for a Gastric Emptying Scan (GES)?"

  • Nausea 
  • Vomiting
  • Bloating 
  • GERD - Reflux, Heartburn
  • Constipation 
  • Diarrhea 

"How does it work?" 

Step 1: Eat a meal with radioactive dye
Radioactive material is easily visible to the scanner. The substance is introduced into a meal provided by the hospital for the Gastric Emptying Scan. The patient is expected to eat the meal within five to ten minutes.
"What meal contains the radioactive dye?"
  • Eggs 
  • Eggs with toast 
  •  Oatmeal
The bulk of the eggs with the toast is ideal for the test, as it closely depicts a typical full meal. The dye does not alter the taste of the meal. Water is allowed. 

Step 2: Scan 
Once the meal is ingested, the patient is directed to lay under an x-ray scanner. The patient lays on a hard, metal table with the scanners above and/or below it. The scanner is not noisy, nor is it enclosed. It is totally silent and the square contraption is moved over the stomach area.
"How long does is the scan?"
The Gastric Emptying Scan can taker place a variety of ways. The average Gastric Emptying Scan is 3 to 4 hours, consisting of a series of images every half an hour to an hour. Depending on the facility, patients can remain under the scanner the entire duration of the test or they may leave the radiology room and come back long enough to snap another image.
Other scans take a total of 8 hours. In my experiences, the lengthier scans like that have been done at larger hospitals, like the Mayo Clinic where the technology is updated. For those, I was not required to lay for hours on end. Once I ate their meal with the radioactive dye, I was able to leave after receiving a schedule of the times to return for the images. Each image was a quick, standing scan that took all of 5 minutes. At the halfway point of the test, I was advised to leave to eat another meal without the radioactive dye. My family and I went to McDonalds. How healthy. 
Example of Scanner
Step 3: Results 
The scanner follows the food laced with dye to calculate stomach motility. It is visible on a computer. 
My first Gastric Emptying Scan showed severe Gastroparesis with a halftime of over 6 hours. The results will be given to the prescribing doctor and discussed at a later appointment. 

Computer Calculating Digestion

"Do you have any tips?"

  • Wear comfortable clothes that have little to no metal. 
Dress as if you are going to bed, like in yoga or sweat pants and a t-shirt. Also, dress to accommodate symptoms (i.e. bloating) that can be provoked from eating the meal.

  • Bring a cozy blanket or pillow. 
Like other radiology scans, they are lengthy. You may be in a dark room on a hard, metal table for a few hours. The hospital provides both, but their blankets are generally scratchy and pillows flat. Having your own from home is always superior! 

  • Bring a neck brace for cervical-cranio instability. 
If you have cervical-cranio instability as a result of Ehlers Danlos Syndrome, considering bringing a neck brace for extra support in case the metal table provokes issues. 

  • Ask about television/movie options. 
A GES is rarely less than 2 hours. Laying still under the scanner is incredibly boring if you are not doing the scan where you can leave and return intermittently just for the picture. Watching a movie for the duration of the test makes the time pass more quickly. Inquire beforehand about the DVD and television options. 

  • Review your medication list. 
Certain medications do effect stomach motility, which can lead to inaccurate results. Consult with your medical team about the medications that need to be discontinued and resumed after the scan. 

  • Apply anti-nausea techniques. 
A meal with radioactive dye is consumed for the GES. Eating alone can cause symptoms. There is a chance that the addition of the dye can compound those symptoms. Do what you can to combat symptoms, as the test can only be completed if that meal stays down. Take permitted anti-emetics, use SeaBands, or mediate! The test is unpleasant enough without having to repeat it. 

  • Be prepared with rescue medications for Mast Cell Disease. 
Mast cells are finicky little suckers. Eating, the process of digestion, and the radioactive dye can be triggers. It is wise to ensure rescue medications are available to treat reactions if they do come (i.e. Epinephrine, steroid, H1 and H2 blockers). I did not experience significant exacerbation of my symptoms in comparison to a regular meal, but I had never had a severe Mast Cell Disease reaction at the time of my scans.

  • Remain calm. 
There is no reason not to be calm. I have had about 5 Gastric Emptying Scans and it is an overall easy test.