MRIs and a connection to tackling some of life’s obstacles

In this blog post, I’ll weave one of my typical stories that will begin with my enthusiasm and excitement for MRIs, again with a series of numbered citations for those interested in further reading.  The timing of this post is connected to me recently having my 13^th MRI, on Friday September 13, 2024, where my enthusiasm overflowed for a few reasons.  In this post I will explain my excitement about MRIs, link back to a challenging MRI experience, then will use my own approach to handling that challenge and subsequent ones to build on the ways we can all approach life’s obstacles and challenges and include some references along the way.  In talking about challenges, I might touch on topics that make you consider the obstacles or challenges in your own life, so please, take care while reading.  If it sounds interesting though, please read on!

My first MRI took place on October 13^th 2022, nine months after my initial appointments with family doctor, psychiatrist and neurologist in January 2022; I WAS EXCITED!  My interest in medical imaging began in high school.  For a school project, I visited our local hospital to learn and report on the technologies in use there in the early 1990s.  In University, I added a Physics minor to my Biochemistry major and knew both the underlying physics and application of theory that went into creating these amazing machines.  I had a workable understanding of how MRI scanners work: a STRONG magnetic field lines up protons in hydrogen nuclei along the common axis of the MRI scanner bore, then specifically tuned radio frequency pulses deflect the protons’ magnetic vectors such that the protons in different tissues and micro-environments resonate differently and receiver coils in the scanner detect that resonance at different frequencies, while measuring the time it takes for the magnetic vector of those deflected protons to relax back to the aligned axis (the T1 relaxation time) and for the axial spin to relax back (the T2 relaxation time). ⁽¹⁾

A commonly used 1.5 Tesla scanner has a magnetic field strength of about 15,000 Gauss (roughly 30,000 times the strength of the Earth’s ~0.5 Gauss field) which already is impressive to me.  When I think about the controls needed to maintain the primary magnetic field then manipulate the X/Y/Z gradient coils, shim coils and radiofrequency coils, computing power required to produce each tissue-focused pulse sequences, and the sheer computing power needed to collect data for relaxation times measured in milliseconds (thousands of a second) then to compile and analyze that data so that the imaging calculations can produce the typical ‘slice’ images we’re familiar with.  In these two paragraphs, I’ve covered and added bold text to the magnetic, resonance and imaging components that give an MRI its name.  It still fascinates me that we’re able to use physics and engineering to get these unique images of our bodies with non-invasive techniques that use safer radio frequencies instead of more energetic x-rays ⁽²⁾, and to ‘tune’ the pulse sequences in ways that can distinguish between tissue types and highlight areas of concern.  My fascination about the technology was why my 10/13/2022 scan was a thrill for me.

Obstacle 1: Panic

Early in this blog, I shared how that story progressed.  The 10/13/2022 scan led to my November 1^st ~12-hour craniotomy and partial right temporal lobectomy.  My second MRI was on Nov 2, 2022, within 12 hours of waking up from that surgery, so it’s easy to imagine that I didn’t enter the MRI bore in the same general state that I did for the first scan several weeks prior.  While in the narrow bore of the MRI, surrounded by the loud noises of this fascinating machine, I realized that my left foot was paralyzed and couldn’t quite tell even whether my left foot was still there or not.  I PANICKED, and squeezed the bulb in my hand to end the scan and bring the technician into the room to get me out of the bore.  I knew that my MRI experience was now changed and soon started thinking more about what my next MRI experience would be like, suspecting that I had now learned to associate an MRI with panic.

To prepare for my next MRI, I began by searching YouTube for videos with MRI sounds so I could see
how I felt while listening to them.  I found the “MRI Scan Sounds Explained…” video by MRIPETCTSOURCE (https://youtu.be/Pxw2ZpGp5AM?si=FoSEC5OuQh-4DET9) to be very helpful, and quickly learned that just hearing the sounds at a low volume left me feeling uneasy.  I began my own home-grown model of Cognitive Behavioural Therapy (CBT) ⁽³⁾ by listening repeatedly and learning the different sequence sounds and what they do.  I was soon able to recognize the startup pre-scan sequence, the 3-plane localizer / Scout scan, Fast Spin Echo (FSE), Diffusion Weighted Imaging (DWI), Fluid Attenuated Inversion Recovery (FLAIR), and the T1 vs T2 versions of each.  I knew that the T2-FLAIR images were the most useful for highlighting my brain cancer, so I studied this sequence with greater attention.  As I grew more comfortable with hearing these sounds, I moved to high quality headphones at louder volumes, then finally decided to simulate the experience of being in the MRI bore by listening to the loud volume sounds through headphones while tucked beneath our coffee table covered in a blanket.  This now explains the image that opened this blog post!  By training myself to get excited about hearing the T2 FLAIR sequence, even while in a confined space, I nearly eliminated the panic that had set in on November 2^nd.  By my third scan on December 23^rd, I felt confident, and spoke to the MRI technician about my hesitation.  Before we started the scan, I asked them to announce when the T2 FLAIR was coming up, then focused on identifying each scan sequence as it came up.  I turned that scan back into a fun experience and was comforted when the familiar sound of the T2 FLAIR followed the technician’s announcement that we were ready.  I considered this to be a success in being able to get through the obstacle, by re-training my internal reactions such that I had a much better experience.  It minimized the size of the obstacle to the point that it was nearly absent and let me get through it with barely any consequence.

Before I go further in explaining how I’ve used similar approaches, I want to point out that in each of these, I used earbuds / headphones as my chosen technique, and I did so on my own – without guidance from a professional – but not without stopping to carefully assess and consider the chance of unintended consequences or harm.  I considered my approach to be low risk, as I could at any point stop the audio or take out the earbuds / remove the headphones.  I’ll soon speak more about why I’m not suggesting everyone should try their own ‘at-home CBT handy-project’, rather I’m sharing as some ideas about how we can prepare for how we face obstacles ahead of us.

For my foot, I knew I needed more help, so I chose a professionally-guided approach with physiotherapy and exercise.  I benefited from instructions from my physiotherapist on useful stretches and use of Transcutaneous Electrical Nerve Stimulation (TENS) ⁽⁴⁾ and Neuromuscular and Muscular Electrical Stimulation (NMES) ⁽⁵⁾, so today I can move my foot and walk normally, though with generalized numbness and limited sense of feeling.  With the support of a professional, I was able to work through this small obstacle and to reduce it to the point that it doesn’t impact my usual day-to-day.

Obstacle 2: Language

Early in my recovery, I faced several obstacles from my newly renovated brain.  I began referring to it / me as ‘Stu 2.0’, which soon merged from ‘Stu two.0’ to ‘S_two.0’ or ‘Stu.0’, where I quickly learned that I had near-zero real-time memory and was unable to remember any events from a day, which was made worse by anything that added vibration to the fluid that remained in my resection site, such that vibration from travel would nearly assure that I wouldn’t remember anything from a given day.  I found myself much more ‘on edge’ or ‘jumpy’, which with my care team we later suggested was because of local brain structure renovations in Stu.0 where the surgery left my amygdala intact but renovated its surroundings.  The amygdala is located at the underside of the temporal lobe from where it regulates our ‘fight or flight’ response that links to emotional reactivity and associative learning and other cognitive processes. ⁽⁶⁾

By writing a daily journal and studying it later, I was able to begin remembering by retraining Stu.0 for a new way of memory consolidation through focused and purpose-built personal distributed learning ⁽⁷⁾.

While Stu.0’s ability to hear was not, my ability to detect and understand language was, particularly when language was coming from my right side and in environments with other background noise.  This was easy to understand by reviewing that the temporal lobe is responsible for: memory, learning, controlling emotions, speech, and language. ⁽⁸⁾  As my right ear captured sounds coming in from my right side, the nerves that travel from the ear to the right temporal lobe encountered a vastly changed structure, hence my difficulty in identifying language to my right, and some of the other memory and emotional impacts I was experiencing.  My solution for this inspired by my successful MRI training, so I started listening to podcasts with ONLY a right earbud in place, and even better done with background noise and noise suppression turned OFF.  When I struggled, I’d go back and listen again, or just switch to a podcast that I didn’t care about so much, leaving me feel comfortable if I missed any points.  While retraining my brain to better detect language to my right, I was careful to sit so that my friends and groups of people were to my left, giving me a better chance of noticing when they were speaking and being able to recognize what they were saying.

I’m now back to being able to detect language in my surroundings, such that I don’t need to pay much attention to where conversation would originate in my environment.  I consider this to be a success in navigating around my language obstacle, by re-training Stu.0 in recognizing voices, likely by creating new neural pathways that successfully navigated around the resected portion of my right temporal lobe.

My latest obstacle: Music

I’ve been doing remarkably well as I approach my two-year ‘cranioversary’ but have noticed new internal experiential changes that that I’ve only been recently able to connect to some external stimulus, and I’m better able now to understand that music has become a negative trigger for me.  My newest obstacle comes in the form of strong unease in some environments featuring music in the background.  My response has ranged from panic to terror, which I see as an explanation for why I’ve not yet been able to make a strong link to exactly what it is that is causing this new response, but it seems to be linked to a group of musical phrases and cadences, specific notes, or tempo.  With the temporal lobe’s “[involvement] in short-term memory, speech, musical rhythm and some degree of smell recognition” ⁽⁹⁾, it’s possible that this is an example of behavioural plasticity arising from neuromodulation ⁽¹⁰⁾, or more easily stated, a ‘fun new trick’ my brain has learned for certain musical rhythms.

This is something that I want to solve, so I’m back to my now familiar trick of using earbuds and headphones to try to retrain my brain around its new behaviour.  I’m finding songs that trigger my panic / terror response more strongly and am listening to them first at low volume then increasing the volume and moving to the richer sound of better-quality headphones.  Again, I see this as a low risk home-baked CBT approach where I can easily turn the volume down or stop if I feel overwhelmed.  It’s my caution / disclaimer to ‘not try this at home’ for other obstacles, but one that for me I have hope will be able to help me enjoy music again.

Connecting the puzzle and reintroducing hope

In telling this story, I connect it back to the obstacles we ALL face in our own lives.  We each travel with obstacles and fears that don’t show on the surface and where I hope we can show compassion to others as we all face our own day-to-day. 

I’ve linked a few small ideas about getting through our obstacles by finding ways to minimize them and making them easier to face or getting around them by taking different routes or retraining ourselves for new ways of approaching things.  The way I’m describing it is fuzzy, but I hope I’ve given you some food for thought here.  When we identify the challenges ahead of us, we can take our own approaches to get through or around them, AND we can engage the help of professionals who have strong tools to assist us, or our friends and networks who can be there to support us as we face our obstacles in hope of a better tomorrow.

With that, I hope you take care of yourself as you face your own challenges, show compassion for yourself to allow space to try as many attempts as you need to succeed – sometimes referred to as the Frequent Attempts In Learning approach – and for others because we never know what challenges others are facing.  I wish you well, and please wish me luck in my next ‘navigating around’ project!

A small update, a few days later...

After spending some time listening to different songs and trying to re-teach my brain  around its new behaviour, I started noticing some specific tonal qualities in songs that triggered a reaction, along with what seemed to be a tempo-driven effect.  If a song kept 'hitting back' with a particular tonal quality at a specific rhythm, it caught my attention, so I started gathering data.  I tracked each song's tempo (in Beats Per Minute / BPM) and categorized for the presence or absence of particular tonal qualities I noticed.  I plotted the tonal quality against the songs' speeds to group songs by these qualities, then added in my score for the scale of my response, creating a bubble plot to help me better understand where to focus.  This could be referred to as a Patient Reported Outcome Measure (PROM) as a type of Real World Evidence (RWE).  With an n=1 data set, it's useful for me but not that useful in that it can't be extrapolated to help others.  Regardless, this graph now gives me some clues about the qualities in a song that trigger me, and allow me to better focus my re-training on songs that have those qualities that trigger a stronger response.  For now, I'll focus on songs with tonal qualities I assigned as '3' or '4', and in the BPM range that seems to demand my brain's attention.

Works Cited

1. How does it work?: Magnetic resonance imaging. Berger, Abi. 7328, 2002, BMJ, Vol. 324, pp. 35-35.  https://ncbi.nlm.nih.gov/pmc/articles/pmc1121941

2. Elert, Glenn. Electromagnetic Spectrum, The Physics Hypertextbook. hypertextbook.com. [Online] [Cited: 19 9 2024.] http://physics.info/em-spectrum/.

3. Strengths-based cognitive-behavioural therapy: a four-step model to build resilience. Padesky, Christine A. and Mooney, Kathleen A. 4, 2012, Clinical Psychology & Psychotherapy, Vol. 19, pp. 283-290. https://onlinelibrary.wiley.com/doi/full/10.1002/cpp.1795

4. Cleveland Clinic. Transcutaneous Electrical Nerve Stimulation (TENS). Cleveland Clinic. [Online] 25 09 2023. https://my.clevelandclinic.org/health/treatments/15840-transcutaneous-electrical-nerve-stimulation-tens.

5. Physiopedia. Neuromuscular and Muscular Electrical Stimulation (NMES). Physiopedia. [Online] [Cited: 19 09 2024.] https://www.physio-pedia.com/Neuromuscular_and_Muscular_Electrical_Stimulation_(NMES).

6. The amygdala and emotion. Gallagher, Michela and Chiba, Andrea A. 2, 1996, Current Opinion in Neurobiology, Vol. 6, pp. 221-227.  https://ncbi.nlm.nih.gov/pubmed/8725964 

7. Distributed learning enhances relational memory consolidation. Litman, Leib and Davachi, Lila. 9, 2008, Learning & Memory, Vol. 15, pp. 711-716.  http://learnmem.cshlp.org/content/15/9/711.full.html

8. The Brain Tumour Charity. The human brain. The Brain Tumour Charity. [Online] 2024. [Cited: 19 September 2024.] https://www.thebraintumourcharity.org/brain-tumour-diagnosis-treatment/how-brain-tumours-are-diagnosed/brain-tumour-biology/the-human-brain/#h-temporal-lobe-nbsp.

9. Johns Hopkins Medicine. Brain Anatomy and How the Brain Works. hopkinsmedicine.org. [Online] [Cited: 19 09 2024.] https://www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-of-the-brain.

10. Cellular mechanisms of neuromodulation in a small neural network. Harris-Warrick, Ronald M. 2011, The Biomedical & Life Sciences Collection.  https://hstalks.com/t/1959/cellular-mechanisms-of-neuromodulation-in-a-small-