Happy MS Awareness Month!
March has always been a special month for me. First, my birthday is the 8th. Second, I share my birthday with International Women’s Day (and the birthday of Monkees drummer Micky Dolenz!). And a few months ago, I realized that March is National MS Education & Awareness Month. Plus, MS Week is March 3-9!
That said, I’ll try hard to blog a bit more and tell even more of my story. Explain the types of tests I’ve had in the last four years, talk about my experiences stumbling (sometimes literally) through life, and spread awareness about the complexity of diagnosing, treating and dealing with the disease.
Rather than bore you with another chronological timeline, though, I’m going to write about whatever pops in my head. And today? It’s the spinal tap.
I don’t mean the rock mockumentary that came out a year before I was born. I’m talking about the actual lumbar puncture, where a needle is inserted between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid (CSF). That’s the fluid that surrounds your brain and spinal cord to protect them from injury. This test can help diagnose brain/spinal cord disorders, including multiple sclerosis.
Sounds like a fun time, no? Here’s what happens…
1. You are asked to lie on your side with your legs pulled up to your chest and your neck slightly bent forward (aka the fetal position).
2. The doctor then feels around your back to locate the space where the needle needs to be inserted. Once the area is identified, it is sterilized and then lidocaine (a numbing medication) is injected to numb the area completely.
3. The needle is then inserted into the lower back, either between the third and fourth lumbar or fourth and fifth lumbar level. I was told at the time that being in the fetal position allows the vertebral spaces to open more widely to make needle passage easier. I was also told that, while it wouldn’t hurt, I might feel pressure. And, honestly, I felt a ton of pressure. TMI, I know, but it almost feels like you have to poop…but that pressure is in your back. It’s the craziest sensation, and it’s not comfortable. Never mind that I have a needle inserted into my back. But this procedure happened while I was admitted for a weekend at a teaching hospital, where several other residents (all male) watched the roughly 20-minute procedure as my backside was out for everyone to see. I had underwear on but still…embarrassing.
4. Back to the procedure: The fluid drips at its own slow-as-a-snail pace into a series of three or four vials that are then sent to the lab for evaluation.
5. Accordning to the National MS Society, “The CSF of people with MS usually contains elevated levels of IgG antibodies, as well as a specific group of proteins called oligoclonal bands. Occasionally there are also certain proteins that are the breakdown products of myelin.”
Feeling squeamish yet?
How about this….I’ve had TWO spinal taps. And the second one, which was done as an outpatient service, was even more uncomfortable.
I was in a small room with two female doctors, which put me at ease. The uncomfortable part was that the resident was having trouble positioning the needle, which increased the pressure and made my feet tingle constantly. It also made the procedure last longer than usual.
However, the one good thing I can tell you is that I didn’t get a spinal headache. And I hear those can be excruciating. I was asked to lie as flat as I could for about 20 minutes right after the procedure, to recline on my way home and to lie flat again as soon as I got home for a couple of hours.
In the end, neither spinal tap led to a diagnosis for me. But that doesn’t mean they haven’t been helpful for others. The National MS Society says that some 5 to 10 percent of patients with MS never show these CSF abnormalities. I guess I’m the minority, but it’s helpful to know that the test can be beneficial for so many others…not to mention those with other disorders and infections.