Monday, September 27, 2010

Sleeping Beauty

Ashley had yet another MRI under anesthesia last Friday. She was already having them twice a year to check the status of the three brain tumors she has, but this time, her neurosurgeon ordered an MRI of her spine to make sure no tumors were present on the brain stem or the cervical spine. Ashley has been experiencing some slight right-side weakness, and the neurosurgeon said he would rather be proactive about checking.

I agree with that approach, but still don't like it. The MRIs under anesthesia are incredibly difficult for her.

She knows what is going to happen as soon as we pull into the hospital parking lot. She tries really hard to be brave, but her anxiety kicks in after just a few minutes. It doesn't help that the MRI staff seem to move in super slow motion. The longer she sits, the worse the anxiety gets. But the time the staff is ready for her to get on the stretcher, she is in all out refusal mode.

We've tried a couple of things to try to make the process easier. One thing we have tried is giving her Versed via her G-tube. According to the manufacturer, "Midazolam is given to children before medical procedures or before anesthesia for surgery to cause drowsiness, relieve anxiety, and prevent any memory of the event. Midazolam is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow relaxation and sleep."

Sounds good, doesn't it? Well, it doesn't work all that well for Ashley. If it reduces her anxiety, I'm not seeing it. She still fights for all she is worth when it's time to move to the stretcher. Friday, it took two strong men and a nurse to get her in what appears to be a great wrestling hold, and then move her to the stretcher. Another nurse had the mask for anethesia on the ready, but Ashley still ripped it off her face and broke it. In addition, whenever we use the Versed, she is slow - really, really slow - to wake up after the procedure. And that scares me beyond words.

The other thing we have tried is Ketamine. According to Wikipedia, "Ketamine has a wide range of effects in humans, including analgesia, anesthesia, hallucinations, elevated blood pressure, and bronchodilation. Ketamine is primarily used for the induction and maintenance of general anesthesia, usually in combination with some sedative drug. Other uses include sedation in intensive care, analgesia (particularly in emergency medicine), and treatment of bronchospasm. It has been shown to be effective in treating depression in patients with bipolar disorder who have not responded to other anti-depressants."

Ketamine knocks Ashley out in less than 30 seconds, but the side effects frighten me.

I want there to be another solution...

Here are some photos from Friday (sorry for the poor quality. I was using my cell phone):

Ashley is waiting in a small room adjacent to the MRI room and watching TV while we wait...and wait...and wait. This is early on so she is not too upset yet.

Ashley is in the recovery room. This is exactly how she looked for 4 straight hours. See why I am so scared?

Even on the trip home, she is still half asleep. And, she stayed 'out of it' for the rest of the day and night.

Now we have to wait until Tuesday to see if the MRI revealed anything :(


Dalya said...

If it helps I take a long time to come out of ansteshia too, and often go to bed for several hours once I am home.

What about Ativan? I don't know if you have it in the US but it's a really good anti-anxiety med, it's quick acting to help relax, calm, and often make people feel sleepy. I used it in bad bad depression and it helped alot. Hope this helps :)


Ashley's Mom said...

Dayla, Ativan is next on my list to try. I may ask the docs if we can get it to take at home just before leaving for the hospital.

Michelle Morgan-Coole said...

Knocking kids out for EEGs and MRIs, trying to keep them still (as in not move a muscle) for bone density scans ... it all sucks.

Sorry, I don't have any answers but there is one drug I am thinking of whose name escapes me - it was next on our list to try to stop status seizures in the Blue Jay. Propofol? Not quite, but something like that. Then again, if you read up on them, they all have scary side effects. Heck, most seizure meds list seizures as a possible side effect!

Hope you get only good news from the MRI.

Ashley's Mom said...

MMC, I believe propofol (or however it is spelled!) is the drug alleged to have killed Michael Jackson. Of course he was taking massive quantities of it.

All the drugs scare me, and like you said, the side effects are horrible.

I really think in Ashley's case if the staff took her immediately back when we arrived, we wouldn't have such a tough time. It's the hour long waits that allow the anxiety to build and build.

I know she has to be sedated for the actual MRI, but I sure would like to avoid the drugs given before.

I've always used the same hospital for the MRIs for her, but I am thinking about switching to our big teaching medical center next time to see if they can do things a little easier on Ash.

Dalya said...

That does tend to be what you do, you take it about half an hour before, or thats what I've always been told to do, other wise its the kind of thing you take asap if you have an anxiety attack :)