Conquering claustrophobia during your MRI

Almost every week, readers ask us
about various aspects of medi-
cine and health. Most of the ques-
tions are quite interesting and we have used those topics in our columns. A few are personal – requesting our opinion on the readers’ own illnesses (we prefer not to respond to these consultations by mail as we usually do not have enough medical information and we have obviously not physically examined the persons concerned). Here are a few noteworthy questions that we have chosen from our mailbox recently.

MRI ANXIETY

My doctor has ordered an MRI for my lower back but I’m afraid to have it done. The closed space scares me since I’m quite claustrophobic. Is there anything that will help to make the experience more pleasant?

G.G., Pasig City

Magnetic resonance imaging (MRI) is one of the most informative imaging studies that your physician can order, and one of the easiest for you to undergo. In reality, however, anxiety is certainly not an unusual reason why many patients hesitate to proceed with the testing. Fortunately, anxious patients like you can take steps to ensure a reasonably relaxed experience.

MRI procedures may provoke anxiety and claustrophobia primarily because the patient is typically enveloped in the system, usually head first and lying on the back. In this position, the patient is unable to see the system opening and the face is usually no more than 3-5 inches away from the equipment. Such an environment is highly confining and may provoke feelings of claustrophobia and sensory deprivation. In addition, shifting magnetic gradients generate loud tapping, knocking, and chirping sounds that can be disturbing.

Familiarity is probably the best remedy. If you are nervous about having an MRI study; it may be helpful to see the system beforehand. Many facilities honor such requests. During the procedure, which ordinarily takes about 30 minutes, clinical staff will be nearby and able to speak with you through an intercom. Most facilities also permit a relative or friend to stay with the patient during the procedure. Some facilities use special lighting and music to produce a calm atmosphere. If noise is a problem, earplugs may be helpful. A mild sedation may also be used. In some cases, mirrors may be used to maintain the patient’s view of the room. It may also be possible to choose a less confining way to enter the system, such as face down or feet first.

A growing number of facilities offer a much less confining alternative known as open MRI. Such systems are unobstructed on three sides and the head is often positioned outside the system (though not for studies of the head, neck, or shoulder). The technology is ideal for patients who are highly anxious, elderly people who need help positioning themselves, and those who are too heavy to fit into a traditional closed system. However, because the magnetic field used in open systems is lower than those in closed ones, open MRI procedures take about 15 minutes longer and the quality may not be as good. An open MRI system is available at the Cardinal Santos Medical Center.

COENZYME Q10

Many of my friends have advised me to take CoQ10 for my heart. They all swear that it has significantly improved their activities. The TV ads on it also sound very convincing. Should I try it?

M.S. Malabon City

Indeed, a claim such as "Improves the heart and circulation" is hard to pass up. Maybe that’s why the magazine Vitamin Retailer called Coenzyme Q10 "one of the most important dietary supplements of the new millennium." There’s little question that Coenzyme Q10 is an important source of revenue for vitamin sellers. There are, however, big questions about whether this supplement is important for your health. Virtually every cell in your body uses this vitamin-like substance. It helps transfer the energy stored in food into ATP, the body’s energy molecule. It helps protect and stabilize cell membranes and it is a powerful antioxidant. Heart disease can reduce levels of Coenzyme Q10. Does taking it prevent or fight heart disease?

Some studies say yes. In mostly small trials, use of the supplement appeared to lessen chest pain (angina), lower blood pressure, and improve the symptoms of heart failure. Other studies, though, showed that Coenzyme Q10 had little effect in these situations. Some preliminary research suggests that the statin family of cholesterol-lowering drugs interferes with the body’s ability to make Coenzyme Q10. Yet a study published three years ago in the American Heart Journal showed that two commonly used statins, pravastatin (Pravachol) and atorvastatin (Lipitor), had no effect on Coenzyme Q10 levels.

A report on Science magazine two years ago showed how little we really know about Coenzyme Q10 in the diet. Roundworms fed a diet without any Coenzyme Q10 lived 60 percent longer than those with normal amounts in their food. We’re certainly not roundworms. But the results suggest that you might not want to load on this supplement until we know more about it. Coenzyme Q10 seems to be safe. Side effects are uncommon and minor, such as an upset stomach, nausea, diarrhea, and itching or rash. But it may increase the risk of bleeding or blood clots. If so, it could pose a problem for anyone taking aspirin, clopidogrel (Plavix), or a blood thinner such as warfarin (Coumadin) or heparin.

The best advice I could give you right now about Coenzyme Q10 is caveat emptor – let the buyer beware. It seems to be safe, but there’s no good evidence that it improves heart health. US national guidelines on the use of statins and the treatment of congestive heart failure recommend against Coenzyme Q10. If you choose to use it, take it as an insurance, not as a substitute for proven strategies.

Empty Nest Syndrome

Our youngest child is leaving us this school year to go to college and live in Manila. My husband and I are apprehensive. Most of our married lives had been spent on child-related activities. I guess we’re afraid about that approaching void in our lives. What can we do?

R.A. Calapan, Mindoro

Both men and women can experience a transition in their lives when the kids grow up and leave home. This period is sometimes referred to as the empty nest syndrome. Some researchers consider the event more significant for women because it can involve the loss of major parts of a mother’s traditional role. Some women though, look forward to the empty nest, seeing it as a release from parental duties – a time for personal growth. Others do not. "Perhaps, it has been commonly misunderstood that the empty nest largely is a negative experience," says Jeffrey D. Rome, MD, a Mayo Clinic psychiatrist. "But the medical literature and a common-sense approach suggest that this time offers an opportunity to do other things in life, free from the responsibilities of child raising." Still, some women see the emptying of their nest as traumatic. Women who are overprotective mothers, whose identities center on motherhood and who don’t gradually expand their interests over the years may feel lost, aimless or even severely depressed when the last child departs.

For most parents however, the empty nest period has a slight and temporary effect on psychological well-being. It usually has no effect on physical health. "You’re likely to feel the effects of the change immediately," explains Dr. Rome. "But you can begin to fill the nest with other activities and people. Down the road, six months to a year, the impact is less." Life is filled with transitional experiences you can deal best with change by anticipating the future and by examining your own ways of reacting to change. Then take some planning steps to adapt. "Make sure social, recreational and occupational opportunities are available to compensate for your empty nest," suggests Dr. Rome. "Don’t wait until the children leave home to develop outside interests. As infants grow to be teenagers, parenting responsibilities change and can afford you the opportunity to do some of those things you put on hold when the kids were in diapers." Despite misconceptions about the empty nest, it’s not necessarily a period with lasting negative impact. And reacting emotionally to it at first, with some degree of loss or distress, is a natural and healthy reaction to this set of circumstances.

With time, let the freedom from childcare lead you to new directions. Take time to read, travel, go back to school or pay new attention to your health and fitness. Research suggests that the departure of the children can in fact improve a marriage. The empty nest allows you to anticipate new phases to share with your grown children – their career successes or the birth of a new generation. Cope with your empty nest by seeing it as a time for self-expression and personal growth. Enjoy it as yet another normal part of growing up as a person.