MR Enterography

En•ter•og•ra•phy

noun

A treatise upon, or description of, the intestines; enterology.

Well folks, I went in for my first MR enterography today to take a better look at my small intestines. I've been having an unreasonable amount of digestive trouble lately and my gastroenterologist wanted to get a look at the entire gastrointestinal tract. All I knew going into the procedure was that it would involve the use of magnetic resonance imaging (MRI) and that I would have to drink barium sulfate so that my intestines would be more visible on the imaging. Now, let me tell you what really happened. 

I go to the University of Washington's Digestive Disease Center to see my gastroenterologist, Dr. Timothy Zisman; a physician whom all other doctors should aspire to emulate. He is clearly smart, funny, forthright, compassionate, and persevering. He apologizes when he doesn't have an answer for me, but promises not to give up. He is not abrupt, callous, condescending, or detached. It is obvious he went into Medicine to help people, and works hard everyday to bring comfort to his patients. After conducting an endoscopy and colonoscopy earlier this month, Dr. Zisman could not find anything that would explain the symptoms that I have been experiencing, thus, his next step was to order a MR Enterography.

The radiology department at the University of Washington called me last week to schedule my procedure.  I showed up at 1:00pm today and the registration desk gave me a funny look and said "Welcome! You're quite early, though..... but wait. Your check-in time is listed as 1:00pm. I will double-check with the back." The receptionist made a phone call, I was a hour and fifteen minutes early. Joy. They did kindly validate my parking for the day and offer a free coffee pass to the espresso bar. I left the second floor dungeon and killed time in the medical center's lobby. 

At 2:15pm I returned to the registration desk greeted, warmly, by miss Bonnie Anderson. This woman is a champion of hospital hospitality; I hold her in the highest regard by the way she treated me. Bonnie was warm, apologetic, understanding, funny, complimentary, helpful, and sweeter than sugar. After check-in  another sweet nurse took me back to a room to get changed. I would get a sexy hospital gown and pants, complete with two huge gaps in the crotch. Hey, at least I got pants, right?  

I put my things away and was shown to a little room with three walls and a curtain as the fourth, open to the hallway. There was an oversized, faux-leather-wrapped arm chair with one bottle of barium sulfate waiting on each side. Under each bottle was a hospital issued towel and bendy straw (good call on the bendy straw, UW). I had 45 minutes to consume 900 mL of "berry-flavored" barium sulfate; I was not allowed to chug it, just sip slowly. "Savor it," joked one male nurse. Ha! I must admit that throughout my entire experience today, the service I received from all of the hospital staff was better than a 5-star hotel. They treated me like a princess, a sick princess. 

When I was just half way through my first bottle of barium, a female nurse sat down next to me and said eagerly, "Are you the one I get to start an IV on?!" I looked at her, straw hovering on my lips, with a look in my eyes that colored her stupid and said firmly, "No." She looked a little shocked, "Oh.... Well.... Let me go check!" Sweetnursenumbertwo smiled and walked away. Silly woman, I'm getting an MRI, why would I need an IV, I thought to myself. I relaxed back in my seat, sipped my berry mocktail, and joked with the technicians as they passed, "How's your cocktail?" one tech joked. "Delicious, do you want some? I've got two bottles!" I jested. Another ten minutes must have passed and sweetnursenumbertwo hadn't returned, I was home free, I didn't need an IV. All I had to do then was finish my strong smelling, moderately poor tasting thick beverages and have fun with the staff members until my scans; I even enlisted one technician, who we'll call Tosh, as my body guard. It was all fun and games until sweetnursenumbertwo pushed a cart full of alcohol pads and IV starts in my direction. Gulp, uh oh. I was not prepared for this. Luckily, I'd been drinking a lot of water this week so I wouldn't be hypovolemic.  Sweetnursenumbertwo smiled as she approached, "Morgan? I didn't think I was wrong; when I see someone drinking the barium cocktail, I know they'll be needing an IV to go along with it for vascular contrast." I tried to force a genuine smile in return, "Sorry I turned you away, I didn't know a MRI would ever require an IV for an imaging study; I thought that was just CT scans." "Nope," she said, "we have to have a line in so that we can inject contrast and glucagon into your vascular system; it gives us a better picture." Huh, well, you learn something new everyday. You'll be okay. You'll be okay. You'll be okay. This will all be over soon, I chanted in my head. I chewed on my straw nervously as sweetnursenumbertwo asked which arm is best. "Right. Never left," I answered. I hesitated, then asked, "Hey, do you have a butterfly IV start you can use? Those work best for my infantile veins." She looked a little confused, and then went through the drawers of her cart and found a butterfly start. No way! I didn't know they had butterfly IV starts, all this time I'd been senselessly suffering. She held up the beautiful needle and attached tubing with it's cute little yellow "wings", "Okay, so we do have a butterfly start, but I'm not very experienced at using them; however, I can see if Kirby can do it." 'Not experienced?' Lady, back away from my veins with that needle. "Yes, please! That would be great. The more experienced the better!" Shortly thereafter I was greeted by Nurse Kirby, the IV ninja, as I call him. He found that the veins at my elbow hide behind my nerves, so he gave my right hand a few flicks and then stuck me. I didn't even feel it. "Oh no," he said, "I'm sorry, but I think I got it on the first try." Relief. Best IV start ever! Looks like this will be smooth sailing after all! 

I got my bodyguard, Tosh, to open the second bottle of berry mocktail for me and sipped away as he told me funny imaging stories from patients past. I had 200 mL to go before I'd finished my liquid chalk, when technician Kevin took a seat next to my throne, "So we are just about ready for you, a nurse will be over shortly to give you the intramuscular shot..." I stopped him there, "Shot?" What shot? Why is everything a surprise today? I was not given any details of this procedure, should have done my homework.  "Yeah, it is a shot of glucagon to slow the movement of your intestines so we can get better quality photos." Oh, joy. 

Within minutes a cheery, auburn-haired nurse drifted over witha long needled syringe. "Okay, Morgan, you have a couple choices, thigh or hip?" Butt, always go with the butt. "Hip!" I stood up, dropped my hospital pants and just moved my lace panty strap to maintain some dignity. Within seconds, it was over and done with; such a small gaged needle that I didn't even feel a thing. Getting my pants back on with one hand was interesting, though. Don't tell my mom, but I used my teeth to tie them. Sorry, mom. 

That was it, I was ready, the MRI room was visible from my royal armchair. Sweetnursenumberone came to take me to the room, "We are going to the 'mobile' MRI unit... you'll want to wrap that blanket around you, we have a long walk and are going outside." But, but, but... there's one RIGHT THERE! I want that one! The nurse was taking me out of the comfort zone I'd established with the staff in the main radiology department. You'll be okay. You'll be okay. You'll be okay.  

As we walked through the stark hospital hallways, we had to hug the wall for a team to pass with a patient in a bed with way too much equipment attached to be healthy. It was an elderly man. He had been intubated and I could see the discomfort in his face, eyes squeezed shut, hands gripping his blankets. Wow, there's some perspective for you. I could be in worse. I'm just in for a routine, inconvenient procedure. 

The technician who would be conducting my actual MRI had a unique first name, Boo Boo, seriously. She was a twenty-something thin asian woman with her hair pulled back by multiple small rubber ties. I worried she wouldn't be as careful and attentive as Kirby had been with my IV. I was wrong, Boo Boo was very meticulous, careful and calming. I worried that my IV would get caught while moving through the small cylinder, but don't worry, it didn't. Boo Boo attached a breathing sensor to my diaphragm, a square padded coil to my abdomen, and then strapped it all together like twine around a stuffed chicken breast. Most would feel very uncomfortable being so confined, but I was as comfy as a baby swaddled in a warm blanket. Ear plugs were inserted to protect my hearing and then oversized headphones playing country music on top of that. Bliss. I was ready for a nap. 

It was approximately a 25 minute scan, during which I had to take 20 or so deep breaths in and out and then hold my breath for about 10-15 seconds. This proved to be a challenge with my ailing lungs; I thought I was going to suffocate, by choice. I didn't want to mess up the scan; I had done so much in preparation, I would tolerate almost anything to finish. Little did I anticipate what I would have to tolerate to finish. Fifteen minutes in I started to feel stabbing pains in my groin and pelvic region. Oh no, oh no no no. Is this supposed to happen? Or is this just my endometriosis acting up? Stab. Cringe. Gasp. Yeppp, that's the endo alright. Great timing. I gasped during one of my breathless pictures, ouch!! The stabbing pain was getting worse and more frequent, and I couldn't even curl into the fetal position like I normally would. I just had to take the pain. Tears streamed down my cheeks. You'll be okay. You'll be okay. You'll be okay.

Boo boo paused the imaging to add the final glucagon and contrast to my IV from the extension a nurse had placed. "Okay, Morgan, it will go slowly, and I can stop it if anything feels uncomfortable you just squeeze the alarm. Here we go." It felt like she pushed shards of fiery glass into my veins; I yelped. Squeeze squeeze squeeze, BEEP! BEEP! BEEP! The alarm sounded. She stopped. Between my groin, pelvis, and veins, a steady stream of tears fell from my cheeks. I could tell Boo Boo felt bad. You have to finish, Morgan, just finish. Boo Boo administered the contrast manually, it only burned a little, it was tolerable. We finished the last 5 minutes of the scan with 10 more breath holds. Victory! I was proud. I made it. Done. 

Tosh took me back to my royal throne and removed my IV and gave me a hot pack for my hand. A thick cloud of fatigue loomed over my head. Work is going to be roooough tonight. While in the changing room, I began to feel nauseated. Maybe I'm just hungry. I slowly made my way back to my car, it was as I fell into the driver's seat that I didn't know how I'd make it home. My intestines were cramping, my stomach felt inflamed, the nausea had worsened, and my pelvis was still being attacked by ninja stars. You'll be okay. You'll be okay. You'll be okay. I cancelled my work for the evening and just set my sights on getting home; mission: bed. 

Traffic. Was. Terrible. 

GPS estimated a 60 minute commute. SIXTY?! I will explode. I tried to avoid the freeway, but I ended up on back roads in the ghetto that weren't moving and my sick-induced road rage would probably get me shot. I found my way to the freeway and messaged my dad, "ARE YOU AT THE OFFICE?" He was. Thank God! "Leave the door unlocked - I'm coming and I'm sick." I broke more traffic laws than I can count on one hand (sorry, Mom) to get there. Never have I run so fast in flip flops to get to a bathroom. At least I made it this time. 

My dad's office offered temporary relief. Still, hours after the whole ordeal my intestines are still gassy and cramping, I am feverish and swollen head to toe, and my pelvis has yet to let up on the civil war. 

This was not the day I had expected, but I survived. 

I wish that I had been more educated on what to expect today so that could have arrived more prepared. To my audience: always get the facts. Know what you're getting into, and plan for the worst. 

I am SO thankful for the amazing group at UW that took care of me today, but I would happily never drink barium or get an IV ever again. 

Just another day in the life. Thank you for reading my story. 

- M

I'm sick, and you expect me to exercise?

mo·ti·va·tion

noun

the reason or reasons one has for acting or behaving in a particular way 

A friend of mine reached out to me and asked how I stay so motivated to exercise despite all of my health ailments.  The truth of the matter is that I'm not always motivated, I don't always want to go or even feel compelled to go workout. I just go anyways. 

Everyone struggles with finding the motivation to get a workout in, sick or healthy; I would like to believe it's both easier and harder to find that motivation when you're chronically ill. On the one hand, if you've just laid up in bed for days on end and you're finally feeling like a functioning human being again, you want to take advantage of all of the things you physically couldn't do for the past several days; namely, exercise. On the other hand, when you've been laid up for days on end, you've got a lot to catch up on, and if exercise isn't at the top of your priority list then forget it, you're not going to do it.

Like time and money, our energy is a currency, and we only get so much (even less if you're chronically ill). How we spend it is directly proportional to our priorities in life. Some of these priorities are more a necessity than a choice: basic hygiene, the human need for social interaction, financial stability (an income), and nourishment. If your body is working hard just to keep itself running, your energy will be nearly drained once you've achieved all of your necessary "to-do's." Beyond mere survival there is not much room for extracurricular activity so, we must choose wisely. There are easy choices like, sitting around watching TV, going out to share a meal with friends/family, or cleaning your house, etc. These are the type of activities that, when devoid of them, make you feel deprived; whereas, for the sedentary life, if you go without exercise, you don't feel like you're missing out. It is all about our priorities and constantly reminding ourselves of them so that we don't forget what they are. Trust me, it's easy to let your priorities slide, and it takes effort to maintain what you once decided was truly important to you.

Here are some of the ways I talk myself into working out when I don't "feel" like it:

1. Promise yourself you can skip tomorrow if you commit to today. I am the queen of procrastination when it comes to quitting.... "Nah, I'll just quit tomorrow..." "Next time, I'll quit next time."

2. I can't skip the workout I need the most; it's always the one I don't want to do. For me, my abs have been weak ever since my last abdominal laparoscopy. I wasn't allowed to directly workout my abs for months afterward, and by the time I was able to, they were back at square one. My motivation to strengthen them had waned, and I never looked forward to my ab exercises [correction: I still don't, but I do them, because I need to].

3. Have a plan. If you're like me, making plans is hard, because you're at the mercy of what your body will allow you to do. That was a big deterrent  for me for a long time. I knew I wouldn't be able to follow a program, so why should I make one?! I soon learned that without a plan, there was no urgency to workout, no reason, nothing to "check off." Have a plan. Stick to it as best you can.

4. Feeling tired? Just say you'll workout for "10 minutes" [or any arbitrarily low number], odds are that your body will be energized by the exercise and you'll be more likely to finish what you had originally intended to do. I use this one ALL the time, works like a charm.

5. Find a mirror, strip down and look are your nude self, are you satisfied? Do you look strong enough? Fit enough? If yes, then you can stay home.

6. Troll youtube. When I am not feeling motivated I turn to youtube to watch videos of other athletes; I am inspired by their level of fitness to at least try to take one step closer to achieving the physical feats that they have.

7. "If I workout today, I haven't used up another rest day." Especially when you've just been "resting" for days on end, your muscles should be fresh for a good workout!

8. Just go have fun. Don't feel like doing the workout you have planned but don't want to melt into the couch in shame? Then do something that's fun, whether that means going to the gym and trying all of the weird machines or exercises you've been wanting to but haven't incorporated into your routine OR grabbing your roller blades and cruising around a lake. Don't forget, it doesn't matter how slow you're going, you're still lapping everyone on the couch.

9. Reward yourself. Not with food. I have to earn my TV time: One minute of physical activity equates to one minute of TV time. But I can't take out TV credit, this is fitness, not America; our health does not accept IOU's.

10. Why don't you want to work out? Is it because I haven't prioritized my goals? If my health isn't a priority, I may as well cancel my gym membership and save some money that I can now spend on Twinkies. ;-)

11. You will feel better when you're done. It will suck on your way to your workout, and will probably even suck during it, too, but dinner always tastes better after a good workout! Woody Allen said it best "80% of success is showing up."

12. Lower your standards. Not every workout you do has to be your best one; it's okay to just go in and do the sets and reps you had planned to do and not be amazing. When I do this, it's motivating to do that workout even better the next time.

13. Look at photos that inspire you to action. I am most inspired by old photos of myself when I was feeling really fit, and if I'm not there now, seeing the picture makes me want to get back to that place, or better, as I remember how great it felt!

14. Get some new tunes. Theres nothing like updating your workout playlist that makes you want to go use it!

15. Make an appointment. If you are really struggling with all of the above, invest your hard earned money in a personal trainer and make an appointment that you have to show up for. As a personal trainer myself, I know that a majority of the time, my clients are only workout that day because they had an appointment with me, and that's okay. I show them a good workout, and hopefully, a good time. I try to make health and fitness fun, so that it's not a drag; I know the exercises my clients love and those they hate, and if they are having a particularly bad day, I do the exercises they enjoy, it can turn their entire day around!

Most of the workouts I didn't want to do ended up being my best. 

I invite you to leave a comment of what motivates you to workout when you don't want to as well! :) 

Until next time. 

M