Sunday, February 24, 2013

Cardiac MRI & Ferriscan for Dummies

Yay!  E had her first MRI to look at the iron in her liver and heart and it went quite smoothly.  While it's still fresh in my mind, I thought I'd write an "educational" post detailing our experience in case any newbies out there want to learn more about it.  I'll make a disclaimer that this is just how it was done at my hospital, and that I know it is not done this way everywhere.

Day 1--Pre-Op
The day before E's MRI, we had to go in to the hospital for a pre-op visit.  This is only required because she was receiving general anesthesia for the test.  It's a long and somewhat miserable visit for what seems like very trivial things.  I've heard this part is not a requirement at other hospitals, or perhaps it is done on the day of the scan.  I can understand why parents get bent out of shape for having to drag themselves in to Boston for this visit, but I also understand why it could be important.  I think some parents have complained about this visit and gotten out of it, but for E's first time under general anesthesia I was OK with it.  It was a lot of waiting to answer a few questions and to have height/weight/vital signs.  That's it.  I guess from the hospital's perspective, if they let you do it day of and you get bumped out for some reason, then they've got a much-coveted MRI spot that is left unused.  And, I also feel that given how serious general anesthesia is, it's nice that the anesthesiologist has SOME idea about E before we get there.  In the future, it would be nice if they would do the questions over the phone and do vitals upon arrival for the scan.  Wishful thinking.

Day 2--MRI
To me, the MRI itself is no big deal at all.  I've had several myself (without anesthesia or even anything for that matter) and it's just laying there perfectly still in the tiniest space ever, stuffed in with some water bags, with a lot of loud noise.  When you are awake for the scan, it's quite "interactive" in that you are really sort of running the scan yourself.  The tech tells you "OK, T, you are going to do 5 breath holds now.  Do them at your own pace.  Squeeze the buzzer at each breath hold and I'll tell you when you can breathe again."  Or, "OK, T, you are going to hold your breath now for 12 seconds.  Go ahead when you are ready."  In between you get to listen to Rascal Flatts or if you have the goggles you can watch a Dora video (it's a children's hospital).  Inevitably your nose gets itchy and you can't scratch it so you are wiggling it with all of your might to no avail.  This goes on for an hour and then you get up-albeit a little woozy-and you are free to go.  I always treat myself to a post-MRI coffee.

E's MRI was a whole different ball of wax.  Injecting (literally) the anesthesia piece into the whole thing really ratchets up the drama, if you ask me.  So, as a parent, E's experience was much more about the general anesthesia than anything else.  We arrived at 9:30am and left the hospital after 3pm.  The time you get called back for the scan depends on how the case before you is going.  We were called back to a somewhat scary room a little after 10.  I say scary because it's full of machines and tubes and syringes and stuff that I know is to make you go to sleep.  It also has a TV, so E was glued to that it didn't notice any of the stuff around her, which was great.  The rather gruff anesthesiologists came in to chat with me and had me sign some consent forms.  They gave me two choices for E going to sleep.  (1) Put a mask over her face, she takes a few deep breaths of yummy tasting air and goes limp in my arms.  (2) Give her a drink of terrible tasting Versed, she gets really woozy, then the mask goes on and she doesn't care.  The anesthesiologist told me that if it was his kid, she gets the mask and that's it because the Versed takes longer to wear off, so if she wants to be out playing in the afternoon, go with the mask only.  I asked him what if she pushes off the mask and he said, "I don't mean to sound cruel, but the mask always wins."  OK, so I went with the Versed first.  They gave me the honors of squirting the Versed into her mouth and to this moment that's all she talks about or remembers about the day.  That Mama stuffed that horrible tasting poison into her mouth.  She sat on my lap and within ten minutes was like a drunk little puddle, her eyes all far away and talking a little funny.  At that point, the nurse came in and said, "OK, it's taken effect.  Give her a kiss and it's time to go."  Basically the moment I dreaded all day.  So I kissed her, the nurse took her, E was barely with it at all but she blew me a kiss with a very noodle-y arm, and I walked away miserable.

After all of that heart-wrenching drama, I'm told what goes on is that she gets the anesthetic gas (anyways), the nurse changes her into a johnny and takes the bow out of her hair, she gets two IVs, she gets the breathing tube, they suck the extra air and Versed out of her stomach, they tape her eyes shut, and off she goes for the scan.  The nicer of the two gruff anesthesiologists controls her breathing and yes-you guessed it-"pauses" the breathing machine for the breath holds.  It's one thing to hold your own breath, totally another to think of a machine stopping your kid's breath.  The anesthesiologist even agreed with me that it's scary when you really stop and think about it.  So don't.  But of course I did.

The prep before and after is about an hour and the scan is about 45 minutes--part of the time to look at the heart, and part to look at the liver.  It was our luck that the machine was running slowly so it took an hour.  In fact, the two scans after us had to be cancelled.  So she was away from me for 2 hours total (AGONY).  I paced, drank coffee, and peed 25 times.  The nurse calls when there's about 15 minutes left so you are there and ready to leap to action when they say she's done.  (I was ready to leap the entire 2 hours).  They called me back and she was with a nurse in a dim room kinda out of it but awake, holding a heart-shaped balloon.  When she first tried to talk her voice was scratchy.  She seemed pretty happy but a little confused about where the IVs came from.  Then she remembered that the nurse promised her some Dora later so she started asking for that and all was good with the world.  She refused a purple popsicle but quickly drank 2 apple juice boxes, water, ate a bag of oyster crackers and a graham.  Then she asked for Goldfish crackers in my bag.  No nausea, no issues at all, really.  The anesthesiologist came back to give a quick look and said, "if she's scarfing all of that down with no problems, she's good to go."  E was happy to get the IVs out, but a little sad that leaving meant goodbye to the Dora video.  That was the biggest trauma for the day for her (besides the Versed).  For the rest of the day she was totally fine.  ie, chatting the entire ride home, back to dancing in her princess dress, eating snacks, and generally causing trouble.

The next day we got a nice call from the staff to check in on E and to answer questions.  E was feeling absolutely normal, and the only lasting issue was that under one of her eyes was a tiny bit red from the tape.  I had noticed this yesterday a little bit and thought it might be from rubbing her eye, but I can tell today it's from the tape.  If that's all I've got to complain about, we're all good.

So, that was our experience with MRI under general anesthesia.  To me, any experience where your child goes under general anesthesia is going to be the pits, but I felt like the whole thing went as well as it possibly could.  I can say with certainty that the experience was actually more traumatic for me than for her.  At 3, she really didn't know what to be afraid of, whereas I was a wreck.  I'll definitely take it a little calmer next time.  Maybe....

Post-MRI.  I got that bow back in her hair right quick.

Watching Dora and having snacks.


Wendy Wardell said...

Hi T
I'm from Resonance Health, the company that provides the FerriScan analysis. It was really interesting to read your post on the experience of a pediatric patient having a GA for the MRI. Very scary for the parents. I just thought I should let you know that the normal time for a FerriScan MRI is only ten minutes. I assume the radiologist was doing additional tests for the rest of the hour it actually took. I'd be happy to give you any further info if you want to email me at
Your gorgeous daughter is getting great care - I hope she recovered quickly from the GA.
Kindest regards
Wendy Wardell

Fannie said...

I am SOOOOO thankful to you for posting this! We are waiting on LOA for our son with beta thal major and we were wondering what goes into this part of his
treatment. Thank you so much!!

:) Fannie