Second MRI

As my days in the hospital pass, my daily routine of doing therapies and getting injections became mundane and disengaging. I was doing the same things again and again. It felt like I was trapped inside a time loop, just like in the movie groundhog day where Bill Murray had to relive the same day again and again until he got some of his life mistakes right. my feelings of being in the neuro ward were somewhat equivalent to what Bill Murray was experiencing in the movie. I was bored beyond description. Every time I wake up I would often look out the window to the left side of me, thinking when will I be able to get out of the prison that is the hospital. Though I was bored to the core, it wasn't always bad, some of the nurses were fun to talk to. Needless to say, I was lucky to have ended up at Sir Charles Gairdner for my surgery and recovery since most of the nurses who were stationed there are pretty good looking, especially my day nurse, Andrea, and my night nurse, Lindsey. both of them are stunningly gorgeous i'm absolutely happy to see them everytime they come in to do my observation. Unfortunately that all changed one morning when I was expecting Andrea to come into my room to take a reading of my blood pressure. but instead of the beautiful nurse, I was hoping for it was a dorky looking student doctor that went inside my room.

I was downright disappointed that my favorite day nurse was replaced by a not so good looking student doctor. I made a complaint to him and asked what happened. The student replied that my day nurse Andrea was currently stationed at another section of the ward to look after those who are currently still under induced coma in the ICU and the student doctor was sent to my room to get me ready for my MRA (Magnetic Resonance Angiography). It seems the team of neurosurgeons under Professor Knuckey wanted a second evaluation of the inside of my cerebral structure to see if there was still any remnants of the AVM left. At around 11 am the student doctor got the canular ready to be injected through my right hand. Before the injection took place. I was somewhat anxious as he was still a novice and didn't have much practical experience doing his medical course and having him insert the canular through my hand would be his first medical practice. so there will be mistakes on his first try. The moment he inserted the canular needle on my hand. he placed it too close to the bone of my middle finger and it hurts. I responded with a quick "ouch!" the student doctor apologized for his mistake and attempted to make his second try. I told him that he better get his next try right. he then inserts the canular on my hand and what do you know? the damn fool injected it on the same spot again. I responded with another "ouch!" I asked him, " what the hell are you doing?" to which he responded, " sorry sir just trying to get you ready for the MRI," I told him that his third try had to be right otherwise I'd report him for patient abuse. I was sure that by threatening him with the patient abuse he would feel the pressure to get things right this time. Sadly I was wrong yet again. he injected the needle on the bone of my ring finger. that last injection hurt like hell, I shouted a big "ouch!"

Larisa my senior nurse heard me being in pain, she came into my room to see if I was alright. she asked the student Doctor what was going on and he explained to her that he was trying to get me ready for the next MRI scan and had to inject the canular on my hand to insert the angiogram fluid which will be used to take images of my brain. she then asked him why he had failed to get the canular ready. I immediately told Larisa that he was no good at injecting it. Larisa then took over and showed the moron how a real medical professional would do it. she grabbed a plastic strap and placed it on my wrist and fasten it tight to limit the blood flow going to my hand so I won't feel pain when it's injected. She then gently inserts the needle into the vein on the back of my hand and I didn't feel that much pain at all. After this, I was ready for the MRI scan. I waited in my room for the doctors from the radiology department to take me downstairs to the MRI room. Surely enough somebody from that department did come. His name was Doctor Evran Church and he came into my room with several of his colleagues from the radiology department. Before I was transported to the MRI room, they did a briefing with me on the MRI procedure and what they are willing to achieve. It turns out they were ordered by Professor Knuckey to conduct a second examination of the Interior of my brain to see if the AVM was still present after my craniotomy.

While the briefing on my procedure was taking place in my room. The nurses outside had prepared a mobile stretcher to take me to the MRI room. a few minutes later, they rolled in that stretcher into my room. Roger the nurse said to me, " alright Sam you know the drill" I then shuffled my bum to the side of my bed while the nurses aligned my mobile stretcher to the right side of my bed so i could roll over onto it and transport me to the radiology department where my MRI will take place. Once the stretcher was next to me. I immediately rolled to my right and landed safely on it. Having done bed changes over the course of my stay at the hospital, i became very good at it. the first time that i had to do it i wasn't very able to do it myself and the nurses would use a slide sheet to shuffle me from bed to bed.

Having secured my landing on my stretcher, Dr. Evran church approached me and gave me a brief description of the MRI procedure just so i know what to expect so it doesn't scare me when they're doing the examination. he told me i had to wear a plastic face frame that will keep my head still so that the MRI machine could take a clear and detailed image of my cerebral interior. the canular needle that was previously placed on the back of my hand will be injected with fluoroscopic dye that will act as a contrast  for the MRI so that all of my blood vessels will be visible in the brain. This method is otherwise known as an MRA( magnetic resonance angiography ) and not an MRI. The difference between the two is that an MRA gives a clear picture of the network of blood vessels while a normal MRI would give an overall image of the human brain or body but the vascular formations would at times be invisible as they are small to detect even with standardized MRI or CT scan. so if anyone out there wishes to know wether or not they have an AVM present in their brain then i would highly recommend getting an MRA or CTA ( computerized tomogram angiography) done.

As i arrived at the radiology department at Sir Charles gardener, i was asked by the nurses and doctors to fill up a consent form of the procedure that was about to take place and this form lists ou all possible risk that could take place while the procedure takes place which includes allergies and irritation from the fluorescent dye that will be injected. I read the form carefully and filled out questions regarding my potential allergies and if i have any metal inside of me. if i did have some sort of metal in me it would get ripped out of my body during the examination. so its absolutely necessary that no metal is present. once the forms have been filled up i was then  placed on the MRI table with the help of a patient slide to help me maneuver myself easier into the MRI machine. Then the doctors and nurses pushed further inwards into the MRI machine and turned it on. i could hear the sound of the magnets pulsating their electrical fields, it sounds a lot like an alien contraption and hearing it for me was a bit strange, so it made me a bit anxious and i was also claustrophobic. Five and half minutes into my scan i felt uneasy from the noise and had an urge to pee as the cold temperature in the room made my bladder full.

Shortly after, they stopped the MRI for a while to let me use the bathroom. however due to my paralysis on the left. I wasn't able to stand up and walk to the lavatory, so i had to use a urinal bottle where i had to hold it and pee in it. thankfully i was already used to it as i had to pee this way every night while i'm in bed. They gave me the urinal and I immediately emptied the contents of my bladder in to that urinal, it gave me a relief. the only downside of peeing this way is that my john Thomas was always often exposed and having female nurses nearby just made it uneasy as if i was peeing to be watched. Once my peeing was done i gave the filled urinal to one of my nurses to dispose it. After this i slide myself back into the MRI machine to continue my scan. thirty minutes into the scan the angiogram fluid is inserted inside my body and i could see flashes in my eye and the lower extremities of my body felt warm as if i was soaked in warm water. This sensation wasn't unusual. Dr. Evran church had already told me of the sensations that i could experience when the angiogram fluid enters my bloodstream. So this was no surprise to me and i was pretty much okay seeing rainbow flashes inside my eyes for the next few minutes of my scan. The last thirty minutes of my scan got a little bit uncomfortable. Dr. Church, who was outside operating the MRI told me that he was going to ramp up the magnets to get a clearer image of my brain. The humming sound from the electromagnets got louder. it sounds as if somebody was putting a megaphone next to both of my ears. Thankfully, i had already worn my earplugs before the start of my procedure to prevent myself from going deaf. After a total of an hour inside the MRI, my doctors turned off the machine and told me that i was free to go back to my room and spend the rest of my day inside my room as a crippled.
i was asked to move to the side of the MRI bed and shuffle myself back on the mobile stretcher to be transported back into my room. I got on the stretcher and Larissa and the other doctors pushed me all the way through the corridors of the hospital and into my room.    

     
                  

                                    

Reducing spastic muscles

The most common aftereffects of having a stroke from an AVM is always the development of spastic flexion within the muscles that have been affected by the stroke. Though the muscles experience spasticism after the initial stroke, during the moment that the stroke happens the muscles experience a short-term lazy flexion and becomes weak with paralysis. When this happens, one side of the face that is affected by the stroke will droop, the arm will droop as well and would look like rubber, because of this most stroke patients will have difficulty communicating as their facial paralysis would cause them to slur their speech, making pronunciations harder to produce or comprehend. The paralysis will also affect the arms and legs where it is affected by the stroke, as a result, mobility is drastically reduced to almost zero. The hemorrhage in the brain will put pressure on the surrounding brain tissue and depletes them of oxygenated blood. When this happens, our neurons begin dying and the neural receptors aren't able to carry out messages to one another, which causes our muscles to tense up beyond control. To release or reduce the tensions, most doctors would often resort to medication that eases up muscle activity. An example of such medication would be Baclofen, which consists of aminobutyric acid that helps ease up the tension.

However, the use of medications to reduce spastic muscles also has some drawbacks one of which is that it may potentially affect the liver in the long-term as a side effect from prolonged use. So other effective alternatives have to be considered to get rid of the tension. Here are some ways to reduce spastic muscles:

1. Transcutaneous Electrical nerve stimulus: Otherwise known as a TENSE device, this type of equipment is usually used for pain management or reduction and it's no different than the electrical stimulus that's used for acupuncture. To use this device you have to know a bit about the human anatomy, particularly the nerves that control certain movements of the joints. For example, if you want to move your thumb, you have to place it on the radial nerve, located on the back of your hand nearing the thumb and index finger. this controls your thumb and index finger movements. The receptors should also be placed near the elbow as the radial nerve runs all the way from the brain stem, down your spine across the shoulder, through the elbow, and down the forearm before reaching your hand to the index and thumb.
2. Constant use of affected limbs: There's a saying that if you keep working on certain things you'll eventually get better at it and make improvements along the way. The same goes for a weak arm after a stroke. the movements may not be perfect but it's still movable to a functional degree if we keep on using the affected arm for daily activities. Neuroplasticity also plays a role in this. As we constantly use our affected limbs for daily usage, our neurons will get acquainted with the movements and eventually create new connections to the affected side.
3. Visualizing full recovery of the limbs: At times what we believe or perceive about our conditions is what causes or recovery to be stalled or become limited. Sometimes believing that our affected side is healed can help us regain lost connections within the brain. It has already been proven by numerous scientific findings that though the brain may be damaged in certain parts, there are still numerous neurons that can replace these damaged cells and they can actually be motivated by our own thoughts if we focus hard enough. 
4. Being aware of emotions: The way we feel can actually have an effect on our muscles after suffering a stroke. Not many people are aware of this as this is often overlooked by most doctors and physiotherapists. You'll notice that if you get angry or anxious about something, your muscles will tend to tense up. This is because the parts of our brain that control our motor skills are located near to the part that controls emotion. 
5. Infra-red therapy: Surrounding temperature has an effect on our muscle contraction. you'll notice that when it's cold, our muscles will tend to feel stiff as this is an involuntary response that our body has to prevent heat loss. An infra-red therapy helps loosen up the muscles by using heat to turn off this involuntary response. However, using this therapy should be done with caution as prolonged use of infra-red therapy an cause minor burns on the surface of the skin

Though the list of methods above mention some of the potential ways that we could alleviate tensions within the muscles after a stroke. it doesn't mean that we should be solely focusing on them for a permanent solution. we should strive on making our progress in our physiotherapy better in each and every session as the improvements will help create better movements to compensate the ones that are lost after the initial stroke.