by Nancy Conn-Levin, M.A.
Editors note: The following article originally appeared in Heads Up, the newsletter of The Brain Tumor Society, and is reprinted here by permission of TBTS and the author, Nancy Conn-Levin. A health educator and brain tumor survivor from Monmouth County, NJ, Conn-Levin is a specialist in stress management and coping techniques.
In the next two weeks, I will be going for my annual MRI scan. Like most other brain tumor survivors, regular follow-up scans are a permanent part of my health care. I am thankful for the benefits of this technology which allows early diagnosis of new or recurrent tumors. However, I dislike the actual procedure. Even under the best conditions, few people enjoy the confinement, noise, uncomfortable position, or immobility associated with MRI scans. What follows are some suggestions for coping techniques to make this test and similar procedures as comfortable as possible.
A support person can be enormously helpful during an MRI. Unlike CT scans and other tests which use radiation, MRI scans do not present any known risks to those in the room with the machine. Therefore, a spouse, friend, or significant other can stay with you during the procedure. My own first experiences with MRI scans were in this supporting role, initially for a close friend with metastatic brain tumors, and then for my husband after he had a cerebral hemorrhage. With both of them, I found that gentle foot and leg massages reassured them that they were not alone. Several years later, when it was my turn to have the MRI and my husband was outside, I fully appreciated how comforting this simple touch could be.
Since MRI scans of the brain involve lying flat on a hard surface with your head immobilized, any personal choices which increase comfort levels (and do not interfere with the actual scan) can make this experience more pleasant. Dressing in loose, comfortable clothes is a good place to start. The temperature in most facilities tends to be on the cool side, so lightweight layers are especially practical. Some people like to wear socks, and others prefer bare feet so that some part of their body is open to the air. Both you and your support person should avoid clothing with metal buttons or accessories, since they will have to be removed (along with watches, most jewelry, belts with metal buckles, etc.). A visit to the restroom before the test begins is always a good idea.
Even people who are not usually claustrophobic can become anxious inside an MRI machine. If this might be an issue for you, speak to your physician and your radiologist before the test and ask about appropriate medication that can be administered by the radiology staff prior to the study. More than a few people (even those who have previously experienced MRI scans) have had sudden anxiety attacks in the middle of a scan, and have needed to reschedule for another day.
Similarly, some people with a history of back or neck problems may experience painful muscle spasms from the immobility or body position used for the scan. If this could be a problem, your radiology staff can administer medications prescribed by your physician that can minimize muscle spasms or cramps during the test.
Using your sensory input
Psychological coping techniques, or those which combine mental and physical factors, are especially valuable during long, stressful procedures. Holding or squeezing something, or passing an object from hand to hand, can be distracting and reassuring. Itís important to be aware of sensory factors and their role in promoting relaxation; a pleasant texture (like the velour fabric on a bean bag animal, or the softness of a silk scarf) adds to the benefit of holding something in your hands. Some people react positively to fragrances; in addition to the possibilities of using a small amount of your favorite cologne, consider moistening a cotton handkerchief with a mild scent like vanilla extract (or one of the many aroma-therapy oils which are widely available) and tuck this in your shirt pocket, or near your neckline.
The power of imagination
One of the most powerful coping techniques during any stressful medical procedure is the use of visualization and positive self talk. Visualization involves actively remembering a pleasant scene, either real or fictional. Some people are comforted by the idea of being inside a protective cocoon, or by thinking of the machine as a special barrier which will keep danger away. Others imagine themselves floating on a raft in warm water, or lying in a comfortable, safe place. Choose whatever image appeals to you, and concentrate on the colors, textures, smells, sounds, and any other details you can imagine.
Sound is a typical and often challenging part of the MRI experience. Facilities at Duke offer systems which allow you to listen to music during the scan. However, in many places, the loud and rhythmic sounds of the machine are the only background noise. Some patients cope by picturing a dance or other scene. They include the drum-like sounds of the MRI into their visualization. Disposable earplugs may be provided as an alternative. If there is a choice regarding light and/or a ventilation fan, be sure to let the MRI technician know how you will be most comfortable.
Positive self talk involves making encouraging statements with your inner voice as a way to promote relaxation and confidence. Some useful phrases to consider during an MRI would be "Iím fine, Iíve done this before," or "I am surrounded by positive, healing energy." Silently counting or repeating the words to a favorite song or prayer can also help.
After the test is completed, ask when you will learn the results, and how you or your doctor will be notified. If possible, plan something pleasant to do immediately after your appointment. Each follow-up scan reminds us of the possibilities of tumor growth, and that often evokes anxiety and fear. Itís important to ask for help and encouragement from those who are close to you, and to utilize brain tumor support groups, online message boards, and other coping resources as needed. Each yearóeven each dayóof being tumor free is a milestone, and that is one of the encouraging messages an MRI scan can bring.