Category: Medical Procedures

The first MRI (magnetic resonance imaging) I ever had was a cerebral MRI in a foreign country.  I hadn’t been in the country very long, and didn’t speak much of the language.  I also didn’t know much about the procedure.  All I knew is these people with whom I could barely communicate were going to look inside my head.

The MRI was state-of-the-art – a small, donut-shaped open MRI machine:

The nurse, however, was another story.  She had no bedside manner, or rather, her bedside manner was very stern and unyielding.

My referring physician had requested an MRI with contrast, which means “dye” was injected into my veins through an IV.  The dye helps the radiologist see certain areas more clearly.

After the nurse inserted the IV and began administering the contrast, I felt a burning sensation in the arm in which she had placed the IV.  I was concerned that I might be having an allergic reaction to the dye, because I had read that was possible.  I asked the nurse if the burning sensation was normal (I rather doubted that it was).  Once she understood my question (it took several attempts, due to the language barrier), her response was “That is not possible.”

It has been over 15 years since this experience, and I still remember it vividly.  I am in a hospital gown in a cold room in a foreign country, and I am having what seems to me to be an abnormal response to this medical procedure, and all the nurse will say is “That is not possible.”  I asked again.  Again she responded “That is not possible.”  I started to get excited:  “It must be possible, because it is currently happening TO ME!”  

I could not believe that I might die of a routine medical procedure because the nurse refused to acknowledge my reality.  I had driven myself to the procedure, and I wondered how long it would take before anyone figured out what had happened to me.

I continued to express to the nurse that I thought I might have a problem and I was not satisfied with her answer.  Finally she snapped, “The only way that would be possible is if I had missed the vein, and I did not miss the vein!”  Case closed, as far as she was concerned.

I finally decided I would either die or I wouldn’t, but I didn’t seem to have any control over the outcome.  So I made my peace with it, and continued on with the procedure.

I was given ear plugs, because the machine can be loud.  After I inserted the ear plugs, I laid back on the patient table, someone tucked a foam wedge under my knees for comfort and placed a thin blanket over me for warmth, fastened a basket-type device around my head (see image at beginning of post), and I was eased into the MRI “donut.”

I don’t remember much from that first MRI, except that it didn’t seem that bad, and it was over fairly quickly.

I didn’t die from an allergic reaction to the dye, obviously.  But I was correct that the burning sensation was not normal.  Miss “That is not possible” was wrong.  As it turned out, she had not missed the vein – she had gone completely through it.  I figured this out the next day, when I woke up with a huge black & green bruise on the inside of my elbow, surrounding the IV site.

Presumably enough dye reached my brain for the radiologist to get adequate images, since my doctor was given results, and I didn’t have to re-do the procedure.

Since then, I have had several more MRIs – a few more looking at my brain, and ones looking at my hand/wrist, elbow, and shoulder.

Here’s what I’ve learned about MRIs:

There is a wide variety of condition of equipment and pleasantness of experience.  The “donut” open MRI was the nicest equipment I have experienced.  Many facilities do not have them, or only use them for certain patients (obese, claustrophobic, etc.).

The nicest facilities now have headsets for the patients to wear during the procedure, and will play your choice of local radio stations or even subscription radio (Sirius XM, etc.).  Time passes more quickly when you are listening to your favorite jam.

The worst experience I have had was at a military facility.  The MRI was in a trailer in the parking lot – it was on loan from the VA.  Yes, I had to walk across the parking lot in my hospital gown to get to the trailer.  The machine was small, so the table that I laid on was narrow, and the machine opening was tight too.  That’s the closest I’ve come to feeling claustrophobic in an MRI machine.  The machine was old and VERY LOUD.  There was no music.  No headsets.  Only ear plugs and disappointment.  And a lot of vibration.

The MRI machine cycles through various “runs.”  In most facilities, the technician will talk you through the procedure while it is happening, informing you when the next run is starting, and how long it will last.

You have two-way communication with the technician at all times.  You also have a “panic button” in your hand that you can press at any time if you want to disrupt the procedure and get immediate assistance.

The machine makes noises at different frequencies and volumes during the different runs.  Some runs are quieter and less noticeable.  Other runs are loud, and you can feel the vibration in your body.  Some feel like thuds.  It doesn’t hurt, but some runs are louder and less pleasant than others.

The contrast agent (“dye”) does not normally burn.  You usually can’t feel it at all.  Sometimes it might feel a little cold initially.  Sometimes you might get an odd taste in your mouth (kind-of metallic).  Side effects are rare, but can happen.

In my opinion, cerebral MRIs are the easiest, because all you have to do is lie on your back and not fall asleep.  (Some people might not agree, as a cerebral MRI guarantees that your head must be inside the machine, whereas if they are imaging your arm or leg your head might not have to be inside the MRI machine, which is less claustrophobic of an experience.)

NOTE: It is very important that you not move while the MRI is being conducted.  Moving can blur the images, and the procedure or portions of the procedure would then need to be repeated to get clear, accurate images.  This is also the reason that the body part to be imaged is typically placed in a surrounding device to help stabilize it.  This is also the reason you cannot fall asleep, as you might move in your sleep.

For me, the MRI of my shoulder was no big deal.  The wrist and elbow were more memorable.

In order to get the images they needed of my elbow and wrist, I was required to lie in less comfortable positions.  Although the techs propped me on various pillows and foam wedges to hold my body in the position they needed, my muscles started to fatigue during both of these MRIs.  I was trying to prevent my wrist and arm from shaking, but the muscles became so fatigued that I was unable to prevent the muscle tremors by the end of the procedures.

In particular, for the elbow MRI, I was positioned with the injured arm straight out above my head, in front of me, like Superman’s flying position.  For this procedure, I laid on my belly, rather than my back.  Despite my best efforts, I could not keep my arm from shaking by the end of that procedure, although the tech said the images came out ok.

The procedure typically takes about 45 minutes.  Afterward, the tech will typically check the images to see if any runs need to be redone.

Bottom line:  MRIs are loud, but the procedure isn’t a bad experience.  They are not painful.  I have never felt claustrophobic, although I came close in the tiny, old military MRI machine.  If you are claustrophobic, make sure you are referred to a facility that has an open MRI machine and has experience with claustrophobic patients.  Also, you can get a mild sedative if you need one to help you get through the procedure.

[If you think you will need a sedative, make sure you bring a wingman/battle buddy to drive you home.]

It is very rare to have an allergic reaction to the contrast agent.  The pre-procedure paperwork will explain the type of agent used and possible side effects.  If you have any concerns, discuss them with your referring physician or with the MRI facility staff.

You can resume your regular activities upon completion of the MRI – it’s not a procedure that requires recovery time afterward.

Don’t worry that you will get a nurse like I had for my first MRI – “That is not possible.” 🙂  Every tech I have had in the US has been very helpful, very knowledgeable, and most of them have been very reassuring.  They know the procedure can be a bit intimidating for many people, and they typically go out of their way to make it as pleasant as possible for you.

Approximately six weeks after hand and wrist surgery, I developed “trigger finger” in the pinky finger of my surgery hand.  After the splints were removed and I started using my fingers again, I noticed my pinky finger “clunked” when I curled it, and it “clunked” upon full extension too.

Trigger finger (medical name: stenosing tenosynovitis) happens when inflammation occurs in the sheath surrounding a finger’s tendon, narrowing the space through which the tendon moves and impinging its movement.

After two weeks of occupational therapy and treatment for the swelling in my hand and wrist (eight weeks post-surgery), the clunking in my finger had gotten worse.  So the therapist informed the surgeon, and he decided to treat the trigger finger with a steroid injection.  This was not fun.

My orthopedic surgeon cleaned the injection site thoroughly with an alcohol wipe and then he sprayed an icy numbing spray on the area.  I felt the needle go in.  But the discomfort started as he began to inject the steroid solution.  It felt very similar to an arthrogram injection – there is increasing discomfort as the space begins to fill.  In the case of an arthrogram contrasting solution injection, your joint fills with fluid.  In the case of this steroid injection, my tendon sheath filled with fluid.

As the discomfort increased, I once again found breathing exercises very helpful for controlling the discomfort (for more on breathing exercises, see this previous post).  Additionally, my surgeon was applying pressure to the tip of my finger which helped focus my attention away from the discomfort at the injection site near the base of my finger.

About halfway through the process of filling the tendon sheath with the steroid solution there was a noticeable “clunk”.  Both the surgeon and I could feel it.  He asked me if I felt it, then grinned and said “That’s a good sign.  We’re getting the solution where we want it.”

Toward the end of the injection there was a second “clunk”.  My surgeon was very pleased.  As he continued the injection, he asked if it felt to me like the area was getting too full.  When I said no, he finished emptying the syringe, removed the needle, and placed a band-aid over the injection site.

My surgeon warned me that it would probably hurt the next day – possibly a great deal.  He mentioned that I might find myself saying very uncomplimentary things about him.

[As it turned out, I had no pain or discomfort the next day.  I don’t know if it made a difference that I was wearing a compression glove, a compression stocking, and a brace on that hand.]

My occupational therapist cautioned me not to do my therapeutic exercises for the remainder of the day, as that could cause the steroid solution to work its way out of the target area.  She also told me not to apply heat to the area for the remainder of the day, but said that I could ice it as desired.

For several days following the injection, I am supposed to modify my therapeutic exercises to exclude my pinky finger as much as possible.  My surgeon said it can take up to five days to achieve the full effect.  The steroid injection should reduce the inflammation and allow the affected tendon to move freely again.

I did notice the temporary side effect of facial flushing, but it didn’t last very long (maybe 20-30 minutes).  My finger was also swollen and numb after the injection.  I’m not sure how long that lasted, because I went home immediately and applied a cold pack to the area.  By the time I removed the cold pack, the numbness was gone and most of the swelling was too.

In theory, the steroid injection will relieve the inflammation and cure the trigger finger.  Meanwhile, the rest of the post-surgery swelling of the hand and wrist should gradually abate and hopefully the trigger finger condition will not return.  In other words, hopefully this one treatment will fix it and I shouldn’t need another steroid injection.

Bottom Line: It was pretty uncomfortable during the injection, but I didn’t experience any after-effects.  If this cures my trigger finger in one treatment, it will have been totally worth the temporary discomfort.  As far as medical procedures go, for me, this one was no big deal.

In my experience, this was one procedure it was best not to think too much about ahead of time: having a 30 gauge needle stuck repeatedly into your head in order to inject multiple doses of neurotoxin.

Most people think of Botox as a cosmetic procedure that reduces wrinkles.  But Botox is used medically to treat several conditions, such as repetitive neck spasms (cervical dystonia) and chronic migraines.  Botox injections work by weakening or paralyzing targeted muscles or by blocking specific nerves.  Although scientists still don’t know exactly how Botox works for chronic migraines, according to The Migraine Trust:

A recent US study by Rami Burstein et al using animal models suggested that botulinum toxin inhibits pain in chronic migraine by reducing the expression of certain pain pathways involving nerve cells in the trigeminovascular system…

Unlike many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscles.

In my case, the Botox injections were prescribed to treat chronic migraines (more than 15 headache days per month) which had not responded to any prescribed medications.

Since I was a bit apprehensive, I did research prior to the procedure, and watched several YouTube videos about the procedure, which made me think a little too much about needles going into my scalp and face.

I couldn’t find a good video that demonstrated the procedure for patients – most of the videos are either commercials for the product, technical demonstrations for healthcare professionals, or patients talking about their experiences.  This video is a technical video produced for healthcare professionals, but it gives you a good idea of the procedure:

My treatment began with me lying on my back on the examination table, and receiving injections in my forehead, temples, and scalp.  After that portion of the treatment was done, I was asked to sit in a chair and put my head on a pillow on the exam table.  (My arms were crossed, and my head was resting on them, like in the elementary school game of  Thumbs up, 7-up.)

While I was sitting in the chair, injections were administered to my scalp and trapezius muscles.

Unlike in the video, my provider did not use ice packs to numb the injection sites.  Some of the injections stung a bit as the Botox went in, but they didn’t hurt as much as some of the patients on YouTube had said they would.  Also, some of the injections were more painful than others.  For me, the injections in my left temple and behind my left ear were the most painful.  That’s the side on which I get most of my migraines, so the nurse practitioner figured those nerves were hyper-sensitive.

One of the injection sites on my face bled onto the pillow a little bit when I was getting the injections to the back of my scalp, and the injection sites were a little bit red and swollen for about an hour after the injections, so I kind-of looked like I had hives (or bee stings?).

But the staff was very careful to follow sanitary procedures, including cleaning the sites with antiseptic and treating the site that bled with clean gauze.

Also, I had no negative reactions to the Botox, so it turned out to not really be a big deal at all, and my apprehension was for nothing.

The entire procedure took about 20 minutes, and the effects should last for about 3 months.  Botox injections are not a cure for migraines – they are a treatment, meaning that they don’t fix what’s wrong; they only treat the symptoms.  If the injections work to lessen my migraines, I will have to continue getting injections once every three months for the rest of my life.

After injections, results are typically felt within 3-4 days.  However, studies show that most people do not experience the full effect until 6 months of treatment, which would be after the second or third series of injections.

If individuals have not responded by two to three treatment sessions it is generally considered that the individual is a non-responder.

(In other words, like other treatments, Botox for chronic migraines doesn’t work for everyone.)

Potential Side Effects of Botox treatment: Pain, swelling, or bruising at the injection sites.  If the person administering the shots isn’t careful to avoid certain muscles, you could have a drooping eyelid – or be unable to hold your head up – until the Botox wears off.

NOTE: Even though the injection sites might feel a little weird (slightly swollen, numb), it is very important not to rub the injection sites, as this can cause the toxin to spread outside of the designated areas.

[For more information on Botox, see this 2009 New York Times article.  Note that Botox has been approved for chronic migraine treatment subsequent to this article.]

Have you had medical Botox injections?  What was your experience with them?  Please comment below.

Update: One week after Botox

Still having debilitating migraines, but I’ve started to feel a little bit better.  Still very light-sensitive.  Less motion in my forehead muscles – can still make a Spock eyebrow, but the eyebrow doesn’t go as high.  Slight furrow when I frown.  Shoulder tension noticeably reduced; able to activate shoulder muscles that had been constantly tense.  Puffy eyes.

Update: Two weeks after Botox

Still having debilitating migraines, but also a few productive days.  Still very light-sensitive.  Very little motion in forehead muscles – can’t make a Spock eyebrow anymore.  Almost no motion when I frown or try to look surprised.  Shoulder tension noticeably reduced, with better range of motion of shoulder muscles.  Eyes still very puffy – but not drooping.

Update: ~ Nine weeks after Botox

My provider had informed me that, for some people, the effects do not last the full 12 weeks.  For these people, he said, Botox wears off a week or two before the next treatment.  For me, the Botox wore off 2 1/2 to 3 weeks before my next treatment.  My migraines returned with a vengeance, like they were making up for lost time.  While I appreciated the reduction in migraine symptoms and migraine frequency for nine weeks, having them return and knowing there’s nothing I can do about it for nearly three weeks until the next scheduled treatment sucks.

[The FDA approved Botox for migraine treatment at a 12 week interval, so even if it doesn’t last the full duration, the provider cannot shorten the interval.]

Some things are scary.  Like when your healthcare provider refers you for a procedure that involves bubbles injected into your veins and flowing through your heart.

I told my PCM the thought of it kind of freaked me out.  She said it was perfectly safe.  Just a routine procedure.  No big deal.

So I went home and researched the procedure.  I found an article from a reliable source that explained the procedure simply and thoroughly and assured patients that “The bubble study is extremely safe.”

And the rational part of my mind believed them.  But some other, irrational, part of my mind kept thinking of all the TV shows in which the villain kills someone by injecting an air bubble into their IV.  (Medical personnel hate Hollywood for this, by the way.)

I’m not the type to worry about things and get anxious, so I didn’t spend the days between the doctor’s visit and the bubble study obsessing about it.  But I didn’t sleep very well the night before, and I was pretty anxious on the ride to the hospital.  I did breathing exercises to try to relax, and, of course, cracked dark jokes about things Spousal Unit needed to know in case I didn’t survive.  (Not sure Spousal Unit appreciated that.)

What ultimately helped me relax was talking to the tech who performed the bubble injection part of the procedure.  She told me three reasons not to worry:

1) The saline solution is being injected into a vein, not an artery, and therefore there is less risk;

2) The bubbles are very small, and could not block a vein;

3) The bubbles go through your heart to your lungs, and your lungs handle them just like they handle every other gaseous fluid (bubble).  That’s what lungs are made for.

In other words, your body knows what to do with the bubbles, and it’s no big deal.

That’s when the rational part of my mind won, the irrational part of my mind stopped freaking out, and I relaxed.  More breathing exercises helped me release the tension as well.

So, what exactly *is* an echocardiogram?  It’s basically just an ultrasound of your heart.

Most of us have seen an obstetric ultrasound on TV, where the technician looks at a pregnant woman’s fetus in the womb.  The technique for an echocardiogram is pretty much the same – sound waves are used to get images of your heart.

But unlike an obstetric ultrasound, where the woman lies on her back, for a cardiac ultrasound you lie on your left side.  This helps the technician get a better image of your heart.

My technician explained to me that the ultrasound cannot get images through your bones, so they have to manipulate the wand around all the bones in your chest, like your sternum (breastbone) and ribs.  The ultrasound also cannot get images through air, so they have to avoid your lungs as well.

Since your heart is already off-set to the left of your chest, lying on your left side allows the heart to fall a bit further left, away from your sternum.

So, you take off your shirt and put on a hospital gown (open to the front), and the technician attaches some electrodes to your chest with sticky patches so they can monitor the electrical currents of your heart.  (For a good overview of the entire procedure, see this Mayo Clinic article.)  Then you lie down on your left side, and move your left arm up near your head.

The technician lubes up the wand (a.k.a. probe or transducer) and moves it around on your skin until they can get clear images of your heart.  (The gel helps improve the conduction of the sound waves, and makes sure there’s no air between the wand and your skin.)

Since they are dodging your bones and your lungs, the wand can wind up feeling like it’s trying to dig under your ribs as the technician attempts to get the clearest image, which can be a bit uncomfortable.  It’s not really painful, just a bit…insistent.  This is another time when the breathing exercises can come in handy.  Although it was rather uncomfortable a few times, I didn’t have any bruising afterward.

The technician takes a series of images from multiple angles, so they move the wand around and dig it in to new uncomfortable places to get the various images.  This may cause them to re-apply more gel as well.  My technician also asked me to take a deep breath, hold it, and exhale at various points in the procedure.  (She only forgot to tell me to resume breathing once.)

I appreciated that the technician explained to me what she was doing as she was doing it, and didn’t mind me watching the monitor as she was working.  An echocardiogram allows you to see the heart beating, and the heart valves opening and closing, and it’s fascinating to watch.

I particularly enjoyed watching the Doppler portion of the procedure:

The first part of the procedure took about 20-25 minutes, and then it was time for the Bubble Study (a.k.a. saline contrast study).  My PCM ordered a bubble study because she wanted to determine if there was a hole in my heart.

In a normal heart, the bubbles that are injected for the test enter the right side of the heart through the vein and then go through to the lungs and are removed from the bloodstream before the blood circulates to the left side of the heart.  If there is a hole between the right and left sides of the heart, the technician can see the bubbles flow through the hole to the left side, where they don’t belong.

Don’t Panic!  The bubble study is less freaky than it sounds.  Nothing is injected directly into your heart.  (Also, if you do have a hole in your heart, and the bubbles leak though to the left side, it’s ok.  Your body will still process the bubbles safely.)

A second technician came into the room, we had the conversation about bubbles and why they aren’t dangerous, and she inserted an IV line into my right arm (since I still needed to lie on my left side for the procedure). The IV line had a valve, so that the tech could start and stop the flow of the saline contrast solution.

The second tech told me that at several points during the bubble study, I would need to do a valsalva maneuver, but she described it as “the way you would bear down during a bowel movement”.  Well, that’s not the way I learned to do a valsalva maneuver during aerospace physiology, so we had a conversation until I figured out that what they *really* wanted was an anti-G straining maneuver (except they wanted me to hold my breath during the maneuver, and not exhale in a big gust when they told me I could exhale).

With that cleared up, we proceeded with the bubble study.  The first technician would signal that she was ready, the second technician would release a stream of bubbles into the vein near my elbow, and they would tell me when they wanted me to do the straining maneuver.

Then we would watch the stream of bubbles rush into my heart.  The bubbles appear white on the monitor, and they are very obvious.  Sometimes the second tech would massage my arm a bit to help the bubbles flow faster or something.

The saline bubble solution felt a little bit weird when it first went into my arm, but then I didn’t feel it anymore.  The first batch of bubbles felt weird when it entered my heart – my heart seemed to flutter a little bit.  But it didn’t hurt, and I didn’t feel it with the subsequent bubble batches.

We repeated the sequence four or five times, until there was no more saline solution, and the first tech was satisfied that she had all the images she needed.  They were both very impressed with my straining technique. 🙂

Then the second tech removed the IV line, the first tech removed the electrode sticky pads, and they left me to wipe the gel off my chest and get dressed.

The whole procedure took about an hour, and I had no residual effects.  Turns out, the bubble study really *was* no big deal.

Also, since having a hole between the two sides is congenital (something you’re born with), I’ll never have to have this procedure again.  Once they’ve determined whether the hole is there or not, that doesn’t change and you never need to check again.

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