Wednesday, April 05, 2006

The Sausage Maker's MRI Survival Guide...

OK, I’ve never actually made sausage myself, but I know some people who know some people who HAVE.

I just returned from my umpteenth MRI scan today and had an epiphany (remember I’m still on steroids, so all thoughts feel larger than life in my mind!)…I thought perhaps I should share a bit of my personal MRI experience/wisdom with you in hopes it might ease your experiences with “The Tube”. I’ll even throw in a bit of my home grown scientific knowledge blended with black magic wisdom to try to lessen your anxieties, should you be facing your very first roll in the tube soon.

If you’ve already been diagnosed with Multiple Sclerosis, more than likely you’ve experienced The Tube first hand. MRI is one of the primary diagnostic tools in use that can visualize the brain and spinal cord with accurate clarity.

The acronym MRI stands for Magnetic Resonance Imaging. It’s a diagnostic tool that’s been around since the 1970’s, but used with much frequency now for assisting with the diagnosis of MS and other neurological disorders. It can pin point and identify down to fractions of millimeters exactly what type of tissue is scanned by building little 2-D and 3-D maps or x-rays, if you will. I won’t bore you here with a long lecture on atoms and hydrogen protons, but suffice it to say, our bodies are built out of these components (along with other important crap) and these little buggers are constantly spinning around inside us at high rates of speed…tis the stuff that keeps us alive. And this “stuff” that’s spinning around is susceptible to magnetic pull, thus the “M” in MRI.

The MRI tube is composed of some hella big magnets that spin and apply a radio frequency pulse that specifically causes your own hydrogen protons to spin and in a different direction. This is the “R” in MRI.

When the radio frequency pulse is turned off, the little bugger hydrogen protons slow down and go back to what they were doing before…having their normal spinning class in your gym. But before they return to normal, they give off energy in the form of a signal that’s picked up by that humongous coil the technician puts on you and the signal is sent to a computer to convert the information into pictures. The “I” in MRI.

Now, don’t you already feel better reading that simplified science lecture?
If you’ve never had an MRI before, there are a few little pointers you might need to know BEFORE you get sausaged into the tube. First, the tube is as I said a big magnet. That means anything magnetic is a no-no in its chamber. Your radiologist or MRI technologist will go over in exhausting detail what you can and can’t wear in the tube, but I recommend just leaving the family jewels and jewelry at home. This saves a headache at the last minute having to remove the earrings, nose rings, wedding rings, and any other ring you might be wearing. Plus you’ll know where your prized possessions are…safely tucked at HOME.

Second, always wear comfortable clothing no matter how unstylish you may appear. You’re most likely going to be taking the majority of it off and donning a pair of hospital scrubs or, God forbid, the open back gown dress. You might as well be comfy just in case you’re having some nervous energy and, the technicians like to move you as quickly in and out as possible. They have a schedule to keep or at least a lunch break on their mind. If you are having to spend a lot of time unbuckling a 10th strap on your army issued boots while unsnapping and unzipping your evening gown, the techs are just not going to appreciate your wardrobe.

Most of the MRI scanners today have a great feature to help drown out the roaring sound of the magnets spinning circles around your head. They’re called headphones and the technician can play just about any type of sound or music they have available for you. I recommend taking in your own favorite CD, but not something that will lull you to sleep. Because if you DO fall asleep in the tube and start to jerk about, those headphones will contain the voice of an irate technician trying to wake you up! And keep in mind, there may be that one Nazi technician who refuses to let you listen to your homemade CD of Johnny Cash because they just need to feel in control of your destiny.

Now, on to the parts of the scan that you might find unpleasant. YOU ARE GOING TO BE HORIZONTALLY SHOVED IN A TUBE WITH VERY LITTLE ROOM AROUND YOUR BODY OR ABOVE YOUR HEAD. It’s just going to happen that way. So if you’re claustrophobic, this can be a major problem.

My very first MRI in 1998 did not go well for this very reason. About 8 minutes from being finished with the scan, I began to hyperventilate and begged to be shot out of the tube. The technician calmly told me if he were to remove me at this juncture, they would have to repeat the entire test and couldn’t I “just hang on a few more minutes?” Those last 8 minutes felt like 8 days! I had poo pooed the offer of IV Valium at the time just prior to the test because I didn’t want to seem like a light weight…looking back, I think I would have let them jam a needle full of the tranquilizer in my jugular to have avoided that claustrophobic feeling.

So if you have issues with being in tight places (and you will be in one!), talk with your doctor or radiologist about what they can offer you to get you through it BEFORE the scan. I personally have found it helpful NOT to open my eyes once I’m in the tube. If I can’t see how close my nose is to rubbing the top of the tube, I can fake myself out and think I’m on a beach somewhere…or at least a beach that has a jackhammer pounding up the sand. You’ll thank me for this tip, I’m sure.

And speaking of tips, let’s just get the needle issue out in the open now, too. If your doctor orders your MRI “with contrast”, you’re gonna get poked. And more likely than not, your doctor WILL order contrast so they can check to see if you have enhancing lesion activity, which indicates inflammation.

How the needle issue comes into play is this: To check a certain type of MRI picture, dye is needed to see it. The dye is called gadolinium and it crosses the blood brain barrier effectively and mixes in with the fluid in the brain, “enhancing” areas of inflammation and the like. That’s a pretty simplistic explanation, but suffice it to say, it is necessary sometimes to have this dye to get the best look inside your noggin.

Now, you are probably wondering, “Why can’t I just drink the gadolinium?” Just accept it. You can’t. It’s going to go into a vein and the only way to get it there is with a needle. Chant your mantra, pray, deep breathe…do whatever you need to do to get through your needle phobia on this one. It can be an important part of your scan.

And finally…make sure whatever itches, burns, needs adjusting or touching is done prior to your being stuffed in the sausage tube. You won’t be allowed to move once the test begins. I always have the technician “line me up” and wait a minute before telling me he is starting my scan, just so I can make sure I will tolerate the positioning of my arms and legs I have pre-chosen. I simply don’t like to be uncomfortable if I don’t have to be. It’s my nature.

Depending on what type of MRI scan your doctor has ordered will determine just how long you're going to be in thetube. If the doc orders a full brain and spine, with and without contrast, pack a lunch! There's a whole lotta looking to do on that one. I've had one of these and it took about an hour and 45 minutes. The typical brain MRI with or without contrast will be less than an hour. Remember to use the "facilities" (ie., bathroom) before hopping gleefully on the rack and rolling in the're bladder will thank you for this tip. I will close this entry now and return to whatever it was I was doing earlier today before I started writing this…I wish I could at least recall what that was! Oh well, it couldn’t have been that important.

**Note to self: Always turn off the stove top before sitting down to blog…you’re running out of good pans!**

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