Letter to the Editor: Regarding the Back Pain in the Cath/EP Lab article from August 2006

Jose D. Flores, RT Mission Regional Medical Center / St.Joseph Health System

Jose D. Flores, RT Mission Regional Medical Center / St.Joseph Health System

In the August 2006 issue of EP Lab Digest, Mr. Daniel Dindy, RCIS discusses his experiences in the cath lab and EP lab with back pain and other maladies. I personally relate to just about everything that Mr. Dindy brings up, especially with the long hours and heavy aprons we used to wear. I have been a radiologic tech since 1973. I begin my career as a special procedures tech in a small community hospital. All of our cases were done with the Puck film changer; later on, while at another hospital, I used another version of film changer, the Schonander. These were film magazines that held 2 - 30 films (14 x 14) and had to be hand-carried to a dark room for developing. Each magazine weighed at least 15 pounds when fully loaded. During these cases, I also wore an apron that was at least twice the weight of my current one, perhaps three times heavier. We wore aprons during barium studies, myelography, biopsies, etc. Back strain was not unusual for all of us, either. However, I do remember that I would take off the apron at every first chance I had and would stretch for at least a few minutes. Over the years, I was fortunate to have only one episode of severe lower back strain, which was coincidentally not related to work but to lifting a pet dog at home. This was treated with Darvon, Parafon Forte, and moist heat for one week, after which I returned to work with directions to avoid heavy lifting, etc. for at least two weeks. In 1985, I begin working in the cath lab where we performed routine pulling of sheaths and transporting our own patients, which meant pulling and pushing hour after hour. At that time, we did not have the electric motor beds that we are fortunate enough to have now. Our gurneys were also not the Cadillac version that we now use. As Mr. Dindy relates, the cases were somewhat shorter if they were normal heart caths. However, since we were a combined lab, we still performed special procedures, which meant that the radiologists would sometimes do cases (i.e., cerebral AV malformation occlusive procedures) that would sometimes take four to five hours. Again, these were in the days before digital radiography, using the above-mentioned film changers.  At a later position I held, I was the supervising tech in an EP lab where I shifted to even longer cases. We also had a C-arm and had to be in three places at once: placing catheters, connecting cables, etc. When not busy in the EP lab, which was seldom, I had to transfer to the cath lab to either scrub or monitor. During this time, I begin experiencing more and more lower back pain. I remember at least three, maybe four times, of having to wear a lumbar support. I even had a running pharmacy tab on skeletal muscle relaxants! I did not really have any physical activity at that time per se to try to minimize the strain. Mental stress was also quite extreme back then. In addition, for years I had routinely worn a single, front-sided apron; however, for the first time, I begin wearing the SuperLite apron (made by Burlington Medical Supplies, Inc.) that I still currently have. It is pathetic that it took me almost 20 years before the light bulb went on.  I shifted gears approximately three years ago, leaving the above job to the current job I hold. In this job, we have more radiologic techs, which alleviates the wear and tear. Our cases are shared with terrific nurses and one CV tech. I only assist in an occasional EP procedure, and our cases are only occasionally longer two than hours. The only procedure that is routinely time-consuming is lead extractions. The SuperLite apron is still functioning properly; I check its integrity every six months. I would certainly purchase another of this type. It is the wrap-around style, not the vest and skirt, so I can still have my back to the x-ray source and not be as concerned with exposure.  We still have to occasionally hold sheaths, but we use Perclose or Angio-Seal in our cases now. We use D-Stat to minimize oozing, and on procedures where the bleeding is troublesome around the site, we use FemoStop Plus.  With all of these factors set in place, the hand strain is minimal, and the back strain is not really a problem anymore. However, I must mention that last year, in 2005, I was diagnosed with Type 2 diabetes. At the beginning of last year, I had weighed nearly 200 lbs., which had bothered me and also added to the occasional back strain. Then, between January and July 2005, I lost 30 lbs., first of fat and then muscle, accompanied with constant urination. This was the first sign that I had diabetes. I mention this because I had to shift from the bad diet to measured carbohydrates (no desserts, candy, fruit drinks, etc.). I also had to begin an exercise program to try to rebuild my muscles and drop my blood glucose (440 at the highest) to a more manageable level. Coincidentally, my exercise program consisted of stretch exercises, Pilates and yoga, combined with at least 30 minutes of walking each day. This not only rebuilt my leg muscles and abdomen, but has really strengthened my lower and upper back musculature. I begin each day with what is called an AM stretch, and end each day with a PM stretch. If I can't walk my 30 minutes each day, I try to walk at least 10 minutes, three times a day. I try to come as close to 10,000 steps per day as I can. Basically, I went from a couch potato to a fairly active walker and exercise aficionado. The 10,000 steps a day was made popular by a Japanese physician in 1965; in addition, the Cooper Institute for Aerobics Research in Dallas, Texas conducted a physical fitness and health study, with over 30,000 men and women involved. They found that a change in fitness, from unfit (overweight, sedentary) to moderately fit, reduced the risks of death more than a change of any other risk factor. So, fit persons with any combination of risk factors (smoking, high blood pressure, abnormal cholesterol, obesity) have a lower mortality rate than low-fit persons with one of these risk factors. Both of these are quotes from the Cooper Institute wellness study. This, in combination with the aforementioned stretch exercises, have revolutionized my health. At age 59, I feel better than I did when I was 39. So in summary, I am truly fortunate that I have not had the problems mentioned by Mr. Dindy, and that I have not had to have surgery for any kind of back problem or associated joint problem. I would recommend a stretch program, especially Pilates, which truly works, and some kind of walk or jog (I don't jog). Taking off the apron after each case is essential. With the complex cases we perform, the electric motor beds I mentioned before have made it superbly easy to transport multiple drips as well as a balloon pump with ease. A team effort to pull patients on and off the table and gurney is also a must. One last thought: we must not try to be supermen or superwomen we are only mortal with moving parts that degenerate with time. We must listen to our bodies and take care of them. We can only benefit from this.  Currently I am at Mission Regional Medical Center in Mission Viejo, California. We are a trauma and stroke center. Our CV Lab has two operating CV Labs, 1 backup CV Lab, and 1 EP Lab. We have five rad techs, including myself. The hospital is part of the St. Joseph Health System.