Acronyms can be confusing... especially in the medical community
Last week as I was leaving my doctors office I was going over in my head what he had said and what he wanted me to do to help him solve a new problem my body recently came up with. I use to think the white coated men and women that had; MD, DO, PhD, etc. behind their names could look at me, feel around a bit then listen to my bodily sounds with that thing they all hang around their necks, give me an aspirin and I would be fine.
That’s not quite true . Actually not even close.
Last week I saw a neurologist for the first time. I figured anyone that could stick me with that many needles and say, “Uh-huh” and “Hummmm” so many times certainly had me figured out. Maybe not. He wanted a test first so he had me report to the hospital for an MRI.
Everyone knows what an MRI is, right?
In our world of acronyms we smile at the right times and nod our heads when we should be thinking as we just plod along in our own little world. “You need an MRI. I will schedule it for you.” OK. Three months ago another doctor said, “You should have that checked by a CAT scan. My secretary will schedule it for you”. OK. Many of us have heard those words from our doctors. Some of you even know what they meant and what was involved while the rest of us just figure the MDs know their business and we will report to whatever appointment is made.
I discovered this morning there is a big difference between MRI and CAT.
A pretty young lady named Kelly called me from the waiting room and my adventure began. “Good morning Mr. Hester, have you had an MRI here before?”
“Yes.” I said. “In the last three years I have had several.” That was a mistake but I didn’t realize it until I had to take my pants off.
“I have just a few questions and we can get started.” Kelly was saying as she handing me neatly folded off-color faded orange cotton something. “Please strip and put on these one-size-fits-all cotton hospital utility pants. If they are a bit loose the draw-string rope should hold them up. You may keep your socks on if you wish.” Kelly was being the true professional. She was a petit young lady, short chopped blondish hair, dancing dark eyes, all smiles with a bubble personality that put me immediately at ease. She was good. I was to find out later she had a behind-the scene partner named Daphnia that was equally as professional (she punched the keys and monitored the screens). They made an excellent team.
Kelly bounced to my side with clipboard in hand as she chatted and positioned my half naked body with that wrap-around all-purpose tent onto what looked to be a steel-like gurney. A first impression was the same as seeing the table convicted criminals are strapped just before they receive that lethal injection. My mind was wandering and conjuring all kinds of visions and scenarios as I took in my new surroundings. The room was not ‘star-wars’ but in the dim lighting, could have been. One door that had my attention had yellow and black diagonal 2” tape indicating – ‘special’. My gurney looked to be targeted into a long metal-like mechanical contraption. The forward torpedo department in the movie “Das Boat” flashed behind my eyes.
“This isn’t a CAT scan machine” my brain whispered as my eyes watered and my tongue dried.
“Are you claustrophobic?” Kelly began. No. Looking at the hole where my gurney was aimed the question made sense and was not comforting. A picture from my youth flashed between my ears as I looked at that hole and remembered two of my favorite uncles tying a rope around my ankles and lowering me into abandoned water well. They were my “favorite” kin and I just knew they would hot hurt me – intentionally. I had the same feeling about Kelly. Why would she try to hurt me? I was her patient. Besides a pretty sweet young thing like her was not old enough to have formed that many bad habits, so I trusted her. I convinced myself I could handle being a little “close” for awhile. The one problem I didn’t know just how long “awhile” was going to be and my tongue was too dry to ask.
“Are you wearing a pace-maker?” No. I know I look ancient to a twenty-something year-old but other then being bald, overweight, paunchy and knobby-keeled I could still walk upright and could still chew my food with my own teeth. Heart is still active just the body around it was losing steam.
“Have you ever had eye-surgery?” No.
Kelly must have sensed my winkled brow was silently querying her questions as she said, “I just have a few questions I have to ask for your own safety. They are all metal related and will not take but a few more seconds.” I blinked, she smiled and I nodded thought the other questions.
Then she was ready. I was becoming more apprehensive but with the clipboard finished and my pants in a locker, the procedure was at the-point-of-no-return so I just hoped she would not drop me into any wells.
“Good.” Kelly said basically to herself. She had done this many times in her young life but she apparently didn’t recognize a chicken-heart in a grown man. Kelly was still grinning and happy. “Would you like a blanket? You will be in there for awhile?” No. I have a hairy chest but that macho response would shortly prove to be a very wrong answer. There was that “awhile” again. I should ask but I couldn’t.
“Eye plugs. Did I give you your ear protection?” Kelly asked. No. I had told her I had other MRIs so she knew that I knew the procedure was going to be a bit noisy and didn’t explain further. I accepted the small sponges and buried one in each ear. Kelly said something to me but all I could do was nod and grin as I was now in my own muted little world.
Kelly helped position my head into a padded vise after placing a rolled cushion under the knees. Even on the cold metal gurney Kelly was making me comfortable. The vice was secure but to make it really secure she placed a couple wedges next to my temples to make sure my head didn’t wander. It’s not called a vice for nothing. Just as I was thinking the only direction my head could move was up Kelly placed a clamp over my forehead and secured it. I now knew how the eighteen century colonials felt in those punishment chocks and Napoleons political prisoners in France moments before the guillotine blade fell.
When Kelly left to join Daphnia my mind said, “OK…now just take it easy for ‘awhile’ and relax”. I tried. As I was going over that ‘awhile’ word again Daphnia pushed a button and it was like the crew on Das Boat loading a torpedo for firing. Motors whirled, gears turned and my gurney moved into the abyss. I wear glasses now but even in my 20-20 perfect vision years I could never focus on anything two inches from my nose so once inside the tube I immediately gave up looking around and closed my eyes to nap. I listened to the blood running in my veins for a few minutes before Daphnia apparently pushed a few more buttons. That is when the banging started and I was glad of the sponges in my ears. The banging was not one sound but three. Each just different enough for you to know there were three muscular guys on the outside and just over your head, with mallets. I was trying to put the differing sounds into some kind of musical theme just as a cold breeze picked up across my bare chest that changed my mind about music. Damn being macho. My brain reminded me however it was glad I had stopped into the men’s room shortly before Kelly first called my name. This isn’t going to be that bad.
I still had no idea how long ‘awhile’ was going to be.
On July 3, 1977, an event took place that would forever alter the landscape of modern medicine. Outside the medical research community, this event made scarcely a ripple at first. This event was the first MRI exam ever performed on a human being.
It took almost five hours to produce one image. The images were, by today's standards, quite ugly. Dr. Raymond Damadian, a physician and scientist, along with colleagues Dr. Larry Minkoff and Dr. Michael Goldsmith, labored tirelessly for seven long years to reach this point. They named their original machine "Indomitable" to capture the spirit of their struggle to do what many said could not be done.
This machine is now in the Smithsonian Institution. As late as 1982, there were but a handful of MRI scanners in the entire United States. Today there are thousands. Medicine can now image in seconds what used to take hours.
MRI or magnetic resonance imaging is a very complicated technology not well understood by many. The machine is still a huge, noisy contraption that actually works.
MRI provides an unparalleled view inside the human body. The level of detail that can be seen is extraordinary compared with any other imaging modality. MRI is the method of choice for the diagnosis of many types of injuries and conditions because of the incredible ability to tailor the exam to the particular medical question being asked. By changing exam parameters, the MRI system can cause tissues in the body to take on different appearances. Some circles would call that “cool”.
To understand how MRI works, you must first focus on the word "magnetic" in MRI. The biggest and most important component in an MRI system is the magnet. Magnets are a lot like water. Unless you understand the power of each, they can do you bodily harm as well as good. Until you have turned on a spigot in your front yard or seen a swollen river wipe away whole towns or seen a metal object magnetically pulled across a room and deeply imbedded in a wall the word ‘magnet’ probable means only something kids play with and it’s just part of the motor that drives your ceiling fan. If not careful an MRI magnet can suck a metal watch right off your arm and eat it before you can blink. Knowing the power of a magnet made the metal questions from Kelly - personal.
For example: People with pacemakers cannot be scanned or even go near the scanner because the magnet can cause the pacemaker to malfunction. Aneurysm clips in the brain can be very dangerous as the magnet can move them, causing them to tear the very artery they were placed on to repair. Some dental implants are magnetic. Most orthopedic implants, even though they may be ferromagnetic, are fine because they are firmly embe dded in bone. Even metal staples in most parts of the body are fine -- once they have been in a patient for a few weeks (usually six weeks), enough scar tissue has formed to hold them in place.
Kelly and Daphnia are not just two very pretty young ladies but intelligent, dedicated and exceptional professionals.
There are three basic magnets in the standard MRI machine but the superconducting magnets are by far the most commonly used. A superconducting magnet is somewhat similar to a resistive magnet -- coils or windings of wire through which a current of electricity is passed create the magnetic field. The important difference is that the wire is continually bathed in liquid helium at 452.4 degrees below zero. Yes, when you are inside the MRI machine, you are surrounded by a substance that is that cold! But don't worry; it is very well insulated by a vacuum in a manner identical to that used in a vacuum flask. This almost unimaginable cold causes the resistance in the wire to drop to zero, reducing the electrical requirement for the system dramatically and making it much more economical to operate. If that is not impressive enough, the next time you view your medical bills, without superconductivity try imagining total cost with three more zeros (000).
Remember when I mentioned wishing I had a blanket – superconductivity was the reason.
While in the torpedo tube I did learn a valuable lesson about myself. I learned that every itch did not have to be immediately scratched.
Daphnia had perfectly positioned me within the torpedo tube three different times as hammers banged, the cold winds blew, my facial itches moved from left eye to cheek to right eye to forehead to the tip of my nose then finally to an elbow until finally ‘awhile’ arrived. This time my gurney did not stop inside but moved to open air. I was free.
As I was re-focusing Kelly bounced next to my gurney and gave me a hand to sit. “That wasn’t too bad, now was it?” She tried.
“No… not really. It wasn’t bad at all.” After answering her I couldn’t wait and ask my question. “How long was I in there?” I had to know how long ‘awhile’ had been.
“An hour and ten minutes” she responded. The number surprised me a little as it had seemed a long time but not that long. “You had three procedures and each takes about twenty minutes.” I grinned as I was thinking; maybe I had napped while my nose was itching.
After I had my street clothes on I cornered Kelly and Daphnia to fess-up my confusion between MRI and CAT Scan. Even though they were busy with my report they took time for me and explained in terms so I could understand the differences. They did it together and separately as they began: “Compared to most CAT Scan images, those made by MRI tend to be more detailed and often have more contrast.
Kelly covered the advantages: why would your doctor order an MRI? Because the only way to see inside your body any better is to cut you open.
MRI is ideal for:
Diagnosing multiple sclerosis (MS), Diagnosing tumors of the pituitary gland and brain, Diagnosing infections in the brain, spine or joints, Visualizing torn ligaments in the wrist, knee and ankle, Visualizing shoulder injuries, Diagnosing tendonitis, Evaluating masses in the soft tissues of the body, Evaluating bone tumors, cysts and bulging or herniated discs in the spine, Diagnosing strokes in their earliest stages.
Daphnia picked up on the few Disadvantages:
Although MRI scans are ideal for diagnosing and evaluating a number of conditions, it does have drawbacks. For example: There are many people who cannot safely be scanned with MRI (for example, because they have pacemakers), and also people who are too big to be scanned.” Neither lady responded to my comment as I said, “That must have been the size pants I had to wear. If they fit, then you were too large to fit into that torpedo tube.” Daphnia grinned and Kelly just shook her head.
“MRI systems are very, very expensive to purchase, and therefore the exams are also very expensive. Thinking back on that superconductivity temperature gadget made a lot of sense by putting a dollar sign to something needed to maintain a minus 400+ degrees reading. With all the disadvantages the almost limitless benefits of MRI for most patients far outweigh the few drawbacks.”
Now that the ladies had me up to speed on MRIs they looked to each other, grinned and continued with: “CAT scans take the idea of conventional X-ray imaging to a new level. Instead of finding the outline of bones and organs, a CAT scan machine forms a full three-dimensional computer model of a patient's insides. Doctors can even examine the body one narrow slice at a time to pinpoint specific areas.
The Basic Idea of the computerized axial tomography (CAT) scan machines produce X-rays, a powerful form of electromagnetic energy. X-ray photons are basically the same thing as visible light photons, but they have much more energy. This higher energy level allows X-ray beams to pass straight through most of the soft material in the human body. A conventional X-ray image is basically a shadow: You shine a ‘light’ on one side of the body, and a piece of film on the other side registers the silhouette of the bones.
In the scanning procedure the CAT machine looks not like a torpedo tube but more like a giant donut tipped on its side. The patient lies down on a platform, which slowly moves through the hole in the machine. The X-ray tube is mounted on a movable ring around the edges of the hole. The ring also supports an array of X-ray detectors directly opposite the X-ray tube.
A motor turns the ring so that the X-ray tube and the X-ray detectors revolve around the body (in an alternative design, the tube remains stationary and the X-ray beam is bounced off a revolving reflector). Each full revolution scans a narrow, horizontal ‘slice’ of the body. The control system moves the platform farther into the hole so the tube and detectors can scan the next slice.
In this way, the machine records X-ray slices across the body in a spiral motion. The computer varies the intensity of the X-rays in order to scan each type of tissue with the optimum power. After the patient passes through the machine, the computer combines all the information from each scan to form a detailed image of the body. It's not usually necessary to scan the entire body, of course. More often, doctors will scan only a small section.”
The ladies had been sharing dialog until Daphnia stopped, leaned back into her chair and let Kelly finish. It was dark in the monitor room where the girls were talking to me but even in the darkness I could see Kelly’s eyes light up as she said, “Since they examine the body slice by slice, from all angles, CAT scans are much more comprehensive than conventional X-rays. Today, doctors use CAT scans to diagnose and treat a wide variety of ailments, including head trauma, cancer and osteoporosis. They are an invaluable tool in modern medicine.”
I told you these ladies were smart.
PROLOG:
We only see ‘hospital people’ when we are sick and that is a shame. They come in all shapes, colors and nationalities. They wear white coats, candy-strips, flowery prints, pin adorned smocks colored from white to children designs. They wear tennis shoes made by Keds to Air-Jordan and always have that listening tube around their necks. Hospital people have their own language only understood by those in white. Hospital people are nice folks that only see us at our worse but they always have a spring in their step and happy words for us even after they have been on their feet for twelve to sixteen hours.
I have a saying: Ya know WHY they call it medical PRACTICE? They ain't PERFECTED it yet. Spot on truth: they want their patients to be dumb, they are the smart DOCTORS, THEY have the schooling and the degree that SAYS they are. We're just stupid people who pay their greens fees/million dollar mortgages/brand new HUMMER payments.
'Bout time we wise UP.
Think it ought to be required of ANYONE in the medical field to be admitted into the hospital for a week or two, just to see what the PATIENTS go through. That'll change their tune...
"I have whatawhatawhat of the secondary what?????????????" Need a damn translator when they tell ya what ya got (or not)
"This won't hurt a bit" YEAH RIGHT!!!!!!!!!!!!
Grrrrrrrrrrrrrrrrrr
Your writing gets me stirred UP-keep stirring things up.
Just sorry I didn't read you until tonight: make it this morning LOL
Tracking you, so don't miss another WORD: very important!
Working in a hospital setting as a registered nurse I know all about those strange machines...I know them even better since I myself have had to experience them. They can be scary to many...I am there to comfort others. Great piece you have written.
Wow, what an experience. It sounds silly, but I only figured out what one of these contraptions were off a Sci-Fi movie. It was the only way to get the 'aliens' out when they turned the machine on. I've heard they can feel like a coffin...
Reviewed by Missy Cross
3/19/2006
Very informative and educational story. I have an MRI lurking in my future - thanks for the preview!
Reviewed by Jerry Bolton
3/18/2006
Well, now I know a little more about MRI's than before. Actually, like you, I had no idea. Now that I know this little bit more I am so intimidated I can't think of muuch else to say, except you wrote this quite well. I'll save it, I may need to refer to it in the future, but I hope not.
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A wicked Cajun Fairy named Robes Pierre entered the impenetrable Magical doll land of Sha Bebe. Queen Faustina, the ruler of the doll land, thought she had destroyed him, but he's back! Will the doll land survive his evil ways?
