PATIENT’S NAME: _______________________________________________________

APPOINTMENT DATE AND TIME: __________________________________________

PLACE: The Guild Building, 825 Washington Street, Suite #290, Norwood

INFORMATION FOR THALLIUM TREADMILL PATIENTS

A thallium treadmill test (stress test) has been ordered for you by your physician, ____________________. This is a simple walking exercise test. Ten (10) small electrodes are attached to your chest and then attached to a monitor via a long cable. You will then be asked to walk on a treadmill machine. This is used to produce the effects of walking at different speeds and at different inclines. At no time will a patient be asked to exert themselves beyond their capabilities.

The following instructions should be followed prior to your stress test:

1. DIET: Do NOT eat or drink anything (except water) for four hours prior to the exam. Please do not have any caffeine or caffeine containing products 24 hours prior to the stress portion of the test.

2. CLOTHING: Wear comfortable clothing (shirt and slacks, no dresses or one-piece suits for ladies). Shoes should be comfortable with non-slip soles. Sneakers or rubber sole shoes without heels are preferable.

3. MEDICATIONS: Take all of your medicines with a little water, as directed, unless otherwise specified by your physician. Please bring a list of your medications with you.

ALWAYS INFORM YOUR PHYSICIAN IF YOU ARE HOLDING YOUR MEDICATIONS. If you an Insulin dependent diabetic please take half of your Insulin dose. Bring the rest of your Insulin, plus a snack, with you to your appointment. If you take a beta blocker (Atenolol, Metoprolol, Tenormin, Toprol, Inderal), please do NOT take your morning dose but bring it with you.

4. Above, all try not to be apprehensive or worry about this test. Relaxation is best for you and for the accuracy of the test.

5. A tracing agent will be administered via IV during the exercise portion of the test. Imaging will be done immediately after exercise and again two to four (2-4) hours later.

6. You should plan to be at the office one and one half (1 ½) hours for the first part of the test. You may leave the office for two to four (2-4) hours and return for 30 minutes. You will be able to eat after the stress portion of the test.

Medication and dosage: ___________________________________________________

_______________________________________________________________________

IF YOU ARE UNABLE TO KEEP THIS APPOINTMENT, 24 HOUR NOTICE MUST BE GIVEN. PLEASE CALL 781-255-0561 or 508-384-2500.

Rev: 2/02 Appr: WDD