I failed at being an MRI patient. What now?

November 2, 2015 2:35 PM

This afternoon I was scheduled to have an MRI on a knee that I injured a couple weeks ago. Although mentally I felt a little nervous, I was not freaking out. Unfortunately, my body disagreed. My heart was pounding and my leg would not stop twitching and shaking, so much so that they couldn't get a good image. Looking for stories if any others have had this problem and advice as to next steps.

To be clear, as far as my conscious brain was concerned the ordeal was a little scary but mostly because I didn't know what to expect. But whoa man, as soon as it was time to hold my leg still, little muscles started twitching. I could feel the impulse to shake/twitch like electrical impulses coursing through my body, and whether I tried to consciously relax or resist the twitching it happened anyway. And it got worse and worse as the MRI went on.

I seem to have this issue with holding a body part super still for any reason (I once had a tattooer complain when she was trying to take a picture of her work afterwards that my whole body was swaying.) It's like the minute you tell me I can't move, my body freaks out and overcompensate and tenses up. In the MRI today it turned into really, really bad twitching and shakes that I could not control and that ruined any chance at a good image. Even now sitting at home on the couch if I try to keep my leg perfectly still I can feel the weird tensing muscles and impulse to twitch.

I don't think I was claustrophobic because although it was a closed MRI, I was only in the machine up to my waist.

I'm so mad at myself and embarrassed and I have no idea what to do next. I'm going to call my doctor tomorrow morning and see what he suggests, but I would love to hear from others who have had this kind of physical anxiety manifest during an MRI, and what you did about it. The tech mentioned a sedative but I've never taken any kind of sedative before so I'm not sure what that feels like or if it will help (and it complicates rescheduling if it's going to mean that I need someone to drive me to/from the appointment.)

posted by misskaz to Health & Fitness (26 answers total)

Best answer: IANAD but Xanax has helped me in times where extreme stress was making me shake uncontrollably and you only need to take it right before your procedure and then never again.
posted by raw sugar at 2:40 PM on November 2, 2015 [4 favorites]

Best answer: N'thing Xanax. I have been proscribed it for dental procedures where my anxiety was to the point I could not hold still for them to do the work. It didn't make me feel 100% calm, but helped enough that I could stay still. I would not plan drive with it, but I was ok to take public transit on my own getting home afterward if that is an option for you. Uber/Lyft could also be an option if you have that in your area?
posted by rainbowbrite at 2:43 PM on November 2, 2015

I feel your pain. I had an MRI once on my shoulder and was completely panicking, so the images came out blurry. Luckily, I was able to have different tests later instead. My thought is that a sedative might help, but it also might just make you slightly relaxed (you still might move a little). Nuclear option: Ambien. Your doctor should have a good recommendation. I had a huge co-pay for my MRI, so it might be good if you don't have to re-attempt it more than once.
posted by three_red_balloons at 2:43 PM on November 2, 2015

Best answer: Seconding Xanax, which I've used for this situation, and have recommended to many who needed it for just that situation. Sometimes I'm surprised that doctor's don't suggest this immediately.
posted by MCMikeNamara at 2:45 PM on November 2, 2015 [1 favorite]

Best answer: I have a few OCD related tics that force me to take Xanax or Valium for MRIs. My first MRI experience was much like yours, only without the shame and embarrassment.

It's a common thing and totally not a big deal.
posted by builderofscience at 2:55 PM on November 2, 2015

Best answer: Definitely Xanax, and don't be embarrassed. I mean, I know it's embarrassing, but I really think that patients suffering from anxiety are more common than not and nobody's thinking anything bad about you. MRIs don't bother me, but I recently went in for dental work and as soon as they gave me the numbing shot, for some reason I felt completely overwhelmed with anxiety. The assistant was so kind and said when she went in to have her wisdom teeth pulled, as soon as they numbed her up she started bawling. It's very common. So they sent me home and I came back a couple of days later, this time with a Xanax in me, and it was smooth sailing.

Since you mention you don't know what a sedative (I assume the tech was referring to a benzodiazapene, which is the most common approach to situations like this) feels like: For me, it feels like nothing. No unusual sensations at all, just like the anxiety almost imperceptibly floats away. And then a couple of hours later I get really sleepy. After a total of about four hours I'm back to normal.
posted by HotToddy at 3:03 PM on November 2, 2015 [1 favorite]

prev thread that might help
posted by andrewcooke at 3:03 PM on November 2, 2015

Propranolol or other beta blockers might work for you and may be what a GP prescribes to you instead of Xanax.
posted by theraflu at 3:05 PM on November 2, 2015 [1 favorite]

[actually maybe not, sorry, didn't read in enough detail]
posted by andrewcooke at 3:06 PM on November 2, 2015

Best answer: Yup to Xanax. That being said, do they offer sedation? Prior to my MRIs they asked if I would need sedation at the appointment. Therefore you won't need to go pick up an Rx or anything. If you are sedated or take a sedative, you will want someone to drive you.

I had to get two brain MRIs, which is super claustrophobia-ville for me. The second time I closed my eyes before going in and that was much better. I also focused on my breathing. Knowing what would happen since I already had one made the second one way easier.

I also started making up little songs in my head or trying to find words in the sounds the machine makes. I swear one of the thumping noises sounded like it was saying "butts, butts, butts" and that made me relax because it was goofy. You can also imagine you're at a weird disco nightclub with the thumping sounds.

Also, my second one they had to insert contrast while taking an image, which meant they did it remotely and didn't pull me out of the machine. Since you can react to contrast, they gave me a little emergency bulb (similar to a bulb on a blood pressure cuff) to hold. I could squeeze it in an emergency and it was so calming just to hold onto something. If I ever need another one I may ask for the bulb to hold onto.
posted by Crystalinne at 3:07 PM on November 2, 2015 [4 favorites]

I've always been given the bulb to hold onto, and never had contrast. I thought that was normal. Definitely ask for that if you think it would help, it should be no problem at all and might give you something to focus on.
posted by HotToddy at 3:19 PM on November 2, 2015 [1 favorite]

Best answer: xanax is the way people i know have solved this. you will need someone to drive you home if you've never taken xanax before.
posted by nadawi at 3:23 PM on November 2, 2015

Best answer: I had one on my foot and could not stop shaking it. The more I tried the more I failed. They managed to get decent images in the end but I was in there twice as long as expected.

My doc prescribed me diazapam for the next one but luckily it got cancelled.
posted by kitten magic at 3:38 PM on November 2, 2015

Best answer: I take Xanax (alprazolam) when I'm going in for a blood draw (I'm kind of phobic about it) and it's very mild, doesn't make me sleepy or groggy, just makes the anxiety float away and everything is just kind of fine (and it's a low enough dose that I can drive myself). When I had a contrast MRI, my doctor gave me something stronger (I think it was Ativan/lorazepam), which did make me groggy so my spouse had to drive me to the procedure and he said I was getting kind of loopy, but it meant that the giant contrast needle didn't bother me at all.

In short, you can see from all the responses above that there's no shame in getting a relax pill when getting an MRI. You can mention to your primary care doctor (or whoever was the specialist that sent you for the test) that you had this reaction, and they will prescribe something that is appropriate for your history and your needs. In fact, they can probably prescribe a course of just one or two pills so you don't even have to worry about the risk of having them lying around your house afterwards and who might get into them.
posted by matildaben at 3:51 PM on November 2, 2015 [1 favorite]

I am a little claustrophobic and have had a couple of in the tube MRIs. I use a mantra the whole time, and only minimally reply to staff. It takes me a full few rounds, silently, to catch a full breath, but the mantra works. It can be any of the sanskrit 4-8 word chants. I am never more focused in my practice than when in imaging.
posted by Oyéah at 5:35 PM on November 2, 2015 [1 favorite]

I had an outpatient procedure recently where the doctor gave me a Xanax prescription for just this sort of thing, but I didn't get it. What I did do was barely get any sleep the night before, so I was totally nodding off throughout the procedure.

I don't recommend it, but if you can't get the Xanax for some reason...
posted by Etrigan at 6:05 PM on November 2, 2015

Best answer: In short, you can see from all the responses above that there's no shame in getting a relax pill when getting an MRI.

I wanted to highlight this because yes, absolutely, there is no shame at all with either taking something or not knowing that you should take something (and therefore not being calm). It is SO totally normal to have a weird reaction to being enclosed in a thumping loud narrow tube (even if you aren't all the way in which I wasn't either).

Don't feel bad about what happened today, just work with your GP about a way to make it easier on you next time. My GP recommended I prepare by taking a dose of diazepam on a day I was home alone to make sure that I didn't have a bad reaction as I'd never taken it before.
posted by kitten magic at 8:04 PM on November 2, 2015

If you can find one of these, they show entertaining videos with headphones or subtitles to distract the patient during the MRI and have a very high success rate with claustrophobes and others.

http://www.standupmrilocations.com
posted by claptrap at 3:43 AM on November 3, 2015

Response by poster: Thanks everyone so, so much for the advice and words of encouragement. The tech seemed frustrated and annoyed and I was feeling very much like a failure. While I'm not happy others have had bad experiences, it's nice to know I'm not alone.

I called my doctor's office and he called in a prescription for valium so I guess I'm going to be trying this again in a day or two. Wish me luck.

It's funny that now I'm getting nervous and a little shaky just thinking about going back -- so I guess the valium will be needed.
posted by misskaz at 8:39 AM on November 3, 2015

I work with MRIs, and I would be interested to know if you feel that the shaking leg could be in anyway emeriolated by the use of better padding or cushioning. There often are many sizes of foam padding around to more or less lock the knee, wrist, head etc in place, or just to make you more comfortable. Did you recieve any of that, and do you feel it might have helpt in this case?
I appreciate that this will not help anything on the psychological side of the examination, and indeed a mild sedative or valium is often used to help with anxiety related issues.

Alternatively, there are systems that support visual distractions by use of a beamer + mirror setup, primarily used for functional studies, but also increasingly used to simply make the patients, if not completely at ease, at least a bit calmer (example) .

With regards to the signalling balloon: you should - always - get it, contrast agent or not. In fact, it is your only means of communication once a scan has started.

So if there is a next time, explain your issues with the technician and:
1. Ask for the baloon if the tech forgets
2. Ask for an fMRI screen setup with some cartoons/documentaries on, if possible.
3. Ask for some drugging, they often can arrange it rather quickly.

Good luck, and Remember: failed exams are rather costly, so its worth the effort to get them right first time!
posted by Zigurana at 10:52 AM on November 3, 2015 [3 favorites]

Best answer: Zigurana, in my foot MRI they did use padding but it was just placed next to my foot and I was told to hold still. I would have done much better if they had totally wrapped me up tightly so I couldn't move even if I want to. I am actually really good at keeping still (I can zone out very successfully at the dentist) but telling me to 'keep still' is as effective as saying 'don't think about pink elephants', especially when it's for unspecified periods of time.

I've had a bone scan too and while I was generally supposed to be still the technican would specify which body part I had to hold absolutely still and for how long ("keep your right hand still for another 20 seconds, 19, 18...") and that helped so much.
posted by kitten magic at 2:17 PM on November 3, 2015

Response by poster: Zigurana, my knee was in a foam cutout thing, but my leg from the hip to the knee was relatively unsupported and that definitely made things harder. During the second attempt, I asked for more support under my thigh and they put some rolled up towels under it but it wasn't enough. They also added like a beanbag weight thing on top of my lower leg and I would have loved that across my whole leg.

I did have the balloon and that was how I stopped the second attempt once it was clear my shaking wasn't better.

What kitten magic describes in terms of "don't think about pink elephants" was definitely at play. I couldn't keep from shaking due to the anxiety, and knowing it was ruining the effort was ramping up the anxiety and making it worse. Like I knew I should completely relax my muscles and not think about it but instead it was all I could think about.
posted by misskaz at 2:38 PM on November 3, 2015 [1 favorite]

Another tip: If you've never taken those pills before, try them with a good meal. I find that it starts to hit me slower when I eat while taking a Xanax. (Though I'm sensitive to medications and I don't take them often.)
posted by Crystalinne at 12:21 PM on November 4, 2015

Response by poster: Thank you all so much for your advice and compassion. I just got back from a successful attempt #2, with the help of a bunch of Valium. I was still twitchy now and then, but not enough to ruin the images. It also helped that the tech this time was nicer and locked my leg in tighter. She also put a cloth over my eyes so it was less bright and forced me to keep my eyes closed. I chose talk radio (NPR) over music so I had something to focus on. And (thanks Crystalinne!) I pretended some of the thumping noises were saying "butts butts butts" which made me smile.
posted by misskaz at 12:30 PM on November 5, 2015 [6 favorites]

Response by poster: Oh, and this tech talked to me a lot more, telling me "ok this round is going to be 8 minutes" or "this next part is about 5 minutes" and that helped a lot.
posted by misskaz at 12:31 PM on November 5, 2015 [2 favorites]

Great to hear it went better, thanks for the update!
posted by Zigurana at 10:58 PM on November 5, 2015