#nerve conduction study

On Monday, I have my MRI. As tests go, it’s fairly mundane; the most prevalent complaint is that you are required to stay still for a long time inside of a loud, clunky machine.

The MRI is to be conducted both with and without contrast. This means they will need to insert an IV catheter at some point, and inject a special fluid that the scanner can detect.

I’ve had my blood drawn plenty of times. I had an IV last time I was in the ER. (It was certainly annoying; but no more painful than the aforementioned blood draws.) However, my mind continues to gravitate towards - and get stuck on - this step.

I think perhaps it’s because I’m coming to realize that what rattles me most is the perception that I am no longer in control of a medical situation. The more steps required in a given appointment, the more likely the providers will have an efficient operation going, the more likely they are to maintain a pace faster than I am comfortable with.

Last week I had my nerve conduction study / electromyograph performed.

The nerve conduction study was first. I had a very nice technician; a young man named William. He listened to me earnestly when I explained my anxiousness; and did exactly what I asked: took his time, explained everything, and was honest with me about any discomfort I might experience.

Prior to the test, I had been instructed to wear clothing that would leave my arms and legs easily accessible (e.g. t-shirt and shorts, weather permitting). I settled for a sleeveless shirt and skirt that could easily be hiked up as necessary.

Apparently I chose poorly, as William provided a blanket which which I could cover up and prevent my thighs from flashing immodestly. We actually had a really nice conversation about it; where he explained that this was de facto policy for female patients, and I noted that I wasn’t opposed, merely surprised... Because my experience to date had, of course, been so different.

The test primarily consisted of William applying electrical shocks in various places; and measuring the corresponding signals reaching the ends of my extremities. He described this process as “More annoying than painful”, and that’s an assessment that (barring a few full-power shocks) I agreed with.

(To his credit, William had himself been shocked many times as part of his training; and was both sympathetic and informative as a result.)

After an hour of this, William subbed out and the neurologist subbed in; tasked with performing the electromyograph.

At the end of my ER visit, I was referred to the Neurology department; and forewarned that they would most likely want to order this test and that they were sorry it was so uncomfortable. I had similar conversations with my own provider, and the nurse practitioner I saw at Neurology.

The entire time I was thinking to myself: “How bad could it be”? The information I could find online explained that the test was conducted by inserting a needle into various muscles; although not particularly fun, this was no worse than my usual intramuscular injection regimen. Likewise, I undergo electrolysis every two weeks - surely that was the high bar for outpatient-induced pain?

Ah, well.

The neurologist very kindly ensured that I was prepared and had forewarning, and then inserted the needle in the muscle between my thumb and forefinger. I determined later that the needle was conical in design; which made for a less traumatic wound, but also perhaps more discomfort on insertion. Regardless, it was bearable.

I was not prepared for the next step: the neurologist had to move the needle about; not unlike swinging a television antenna around the room in search of better reception. This had me gritting my teeth. On top of that, I then had to flex the very muscle the needle was in; to take more readings.

This process took what felt like a couple of minutes; and once done, he proceeded to measure a muscle in my forearm, and then my bicep. After that it was the front of my shin, the calf muscle, and my upper thigh.

Again, he was very concerned with my well-being; but also rightly discerned that I was more interested in getting the test over than taking a break - so we powered through. Thankfully, as no issues were found on the left side, it was not necessary to proceed to the right.

I burst into tears as soon as I was outside. I can recall only one other time when a medical provider induced such pain that I was white-knuckling the surface of the exam table: after I inadvertently cut my finger open as a young teen; and the attending doctor had to examine the wound (and by extension, manipulate it while his assistants sprayed saline and whoever knows what else in there).

I didn’t think it affected me that badly; but I had to do my shot yesterday, and it was so hard. My hands were trembling, and on my first attempt, the needle barely even pierced the surface of the skin - I was that afraid of how much it could hurt.

Tomorrow I see my therapist. Our last appointment was, unfortunately, cancelled; so it’s been a while. We’ve been working on all the pent-up misery associated with my pre-immigration medical. That’s another subject swirling around in my head; and likely the root of a good portion of what I’m dealing with at present.

I was railroaded; moved through a medical assembly line like a non-person. Every time I feel as if there’s even a slight possibility that might be happening again, it all starts to come back - fear; the belief that I can no longer protect myself; that I am a target of contempt.

That brings me full circle; back to my upcoming MRI. There are several possible outcomes to this test: the best outcome, of course, would be that nothing of note is found. (This would suggest that the majority of my symptoms to date were caused by inflammation of my neural and nervous tissue; and as the inflammation naturally abides, so too will the symptoms.)

Another possibility is that I might have suffered a rare complication in which one’s own immune system attacks the nervous system. This is slightly more concerning, as one of the defining characteristics is permanent lesions of the white matter of the brain.

There is a third and final possibility: that the virus triggered a minor stroke. Such a thing would be unusual for a person of my age; as with so many other rare phenomena however, COVID has demonstrated exceptionally rare complications are surprisingly common once you are dealing with a virus that thinks little of the blood-brain barrier.

As you can imagine, two of the outcomes are terrifying in terms of their lifelong implications.

I’ll have my answer after Monday. For now, I’ll go back to ruing the godforsaken system of wealth transfer this country mockingly refers to as ‘health insurance’; knowing that I could have most likely had my results in hand much sooner if it wasn’t so absolutely vital to consult a third party on whether or not it was actually medically necessary to treat me.

02:35 AM.