Functional MRI- fascinating! (just don't think about the tumor part...)

Wednesday, August 13, 2008
Subject: For Dr. Maurer (and Marsha, of course :)

Good morning, sir. I know how busy you must be today, but I thought you might like to hear a bit about my functional MRI.

I arrived at 8:30 and was taken immediately back to change (no metal was allowed anywhere on my body) and an IV was put into my arm. After the technician finished with me, the doctor arrived in my "changing room" with his laptop computer and spent an hour describing the test to me. Yes, an hour. He also pulled up the test on his computer to show me what I would be doing and have me practice. Now, it is worth mentioning that this guy is "the guy" for neuro-radiology. He said that there are only 4 centers like this in the country, and he is the head of the standard-setting body for the protocol and use of functional MRI. He, needless to say, was very excited about the whole thing. He was also on the "tumor board" that reviewed my case last week. He used the terms "left temporal lobe lesion" and "tumor" interchangeably and without reserve, which is also news, in a way.

I was put on a sliding bed and given headphones, a "panic ball" in my left hand, and a box with buttons in my right hand. They packed foam in around my head to keep it as still as possible (the doctor explained that stillness was extremely important, as even a millimeter would throw off the results- honestly, he said "millimeter"). Then they put a cage with bars I could see through around my head and a small TV screen about 6 inches in front of my face. At this point they slid me into the tube.

The tasks were designed to test my speech/language region, as that (and memory, which is harder to test for) is where my lesion is. I did tests for 30 seconds and "control" for 30 seconds for all of the tests. The idea being to watch the blood flow to the working region while I was engaged in the task they designed, then have a similar comparison when I wasn't actively engaged in the test. For example: they showed me words—two at a time—and I was to think to myself whether or not they rhymed. If they did, I was to push the button on my box. After thirty seconds, a line drawing (of nothing) came on the screen and I was to simply stare at it and keep my mind free. Another test was showing me pictures—clip art pictures of things like lighting bolts, a church, a horse—and I was to simply think to myself what the picture was of. Another was showing me a letter— "c" —and I was to think to myself all of the words I could that began with "c" for several seconds before the next letter came up. The control for that one was a kind of matching test where I was to think about whether two rows of lines, drawn in a pattern, matched each other.

There was an audio test which involved my listening to a story for 30 seconds and trying to visualize the story as I heard it, interspersed with 30 seconds of garbled sound (speech played backwards, they told me).

At the end they did two other tests—one to simply map my motor function region for reference, which involved tapping my fingers to my thumbs, and a long scan of my whole brain while I did nothing—which I barely remember because they suddenly pumped a lot of contrast solution into me through my IV, I felt it "hit me" all over, and was promptly knocked out until they came in to take me out of the tube. I was actually in the tube for 2 hours.

The doctor came to see me again (he was present for the administration of the whole test) and told me that he believed that they got several very good tests out of the lot. Of course they still need to read them, but it is a relief to hear that this test is probably a success. I haven't heard otherwise yet, so I believe this one is done.

He mentioned that this test will help my surgeon decide how to proceed with the treatment of the tumor (his words). Depending on the location, the risk of surgery is significantly greater. They will have a meeting together to discuss the results, and I will meet with Dr. Lim next Thursday to find out what they think we should do. The great thing about being with Johns Hopkins Neurology is that I don't need to second-guess their decision. I already know I am in the absolute best hands, and I will do whatever they recommend without hesitation. That is a great relief—to know that you are getting the best care. Now I just have to cool my heels for ANOTHER week and try to stay positive. There are times when it distinctly does not sound good, but I have to keep reminding myself that we simply do not know yet what it is, and borrowing trouble never helped anyone.

I realize this is terribly long-winded, but I thought you would be interested. I intend to write a shorter thank-you letter/update to the staff to thank you all for the wonderful collection gift you gave me. And thank you (and Mrs. Jernigan) again for the nice visit and cake- it was delicious & we really appreciate the support. Here's hoping next year's birthday doesn't involve an MRI :)

-Kristina