LIVE: Brains and biostats

I’m just past halfway on a medical journey that is scientifically so fascinating, so incredible, but so wrapped up in my own phobia that I may just faint trying to write about it.

About 1% of the population has an aneurysm that they’re not aware of – that’s 1 in 100. They can be there from birth, or form at any point - unrelated to our lifestyles – and may never affect us. But not everyone is so lucky. When an aneurysm ruptures, it’s death or a severe stroke. 

Cartoon character Sterling Archer’s three biggest fears are alligators, crocodiles and brain aneurysms. The latter because they can happen anywhere at anytime.

The neurologist explained that they mark out your risk in five-year blocks. I’m unlikely to have a severe stroke in the next five years, but as I’m so young, I’ve lots of five-year blocks left in my life, making a stroke a near certainty somewhere in my future.

I’ve always wanted an MRI on my brain. They’re so cool: magnetic resonance imaging. I work in science, with a deep interest in atomic physics and quantum mechanics: the areas so important to the scans we get from fancy machines where the operators hide behind glazed windows or lead walls.

An MRI works on the atomic level. The massive magnet causes hydrogen atoms in the body to align with the magnetic field. There are a lot of hydrogen atoms – at least two for every molecule of water. So we’re talking billions. A pulse of radio waves applied to the area being imaged cause the hydrogen to spin in a different direction. When the pulse is switched off, the atoms return to their previous alignment, emitting energy as they do so. This energy is picked up by the machine and turned into the images we see.

Awesome! Well, my big nerdy brain thinks so. 

Images:

MRI of my brain.

CT scan of the skull base showing the stent and the tube that put it there. 

CT scan of the skull showing the veins, arteries and aneurysm, using a dye sent up through the same tube.

When my GP suggested a brain scan as part of an investigation into my tinnitus (a ringing in the ears I’ve had for nearly a decade and am finally looking into), I was very excited. I would experience the atomic physics in action!

My intelligence is my most important feature. Just to me though as it makes me insufferable on most occasions to most people. Why do I insist on correcting people all the time? My NIDA teacher never appreciated me updating her that ‘power posing’ doesn’t actually increase testosterone, as the one small study that showed this has never been replicated and is now debunked. So, not intelligence so much but a deep well of knowledge and curiosity for everything.

The MRI detected no signs of tinnitus, but it did detect an ‘incidental’ aneurysm. Incidental means there were no symptoms. It was not affecting my life in any way. Not yet. No one commented on how well-endowed my lobes might be.

My aneurysm is 2mm: tiny. But new research on a large dataset out of China shifted the accepted convention that rupture risk is related to size. Instead, the neurologist said, it is the shape that determines the risk. So I’d have to undergo a procedure to assess the shape. 

Image: Recovering from the aneurysm repair surgery (the surgery that comes after the cerebral angiogram).

The procedure is a ‘cerebral angiogram’. My private health insurance doesn’t cover me, but Medicare does. I don’t look it up, I don’t go searching for information on what that will entail. All I know is I need some blood tests and to turn up to the hospital, fasted, at 8am in a few weeks’ time. 

This is when the phobia becomes relevant. There’s something about any mention of the circulatory system that sends me week and light-headed. A deep realisation of the human body’s vulnerability and fragility that renders me unable to function normally. The band the nurse puts on my arm to take blood ignites a voice in my head panicking that my arm will fall off. I can’t feel my own pulse without immediately shaking me hands and head to get some sense back into myself. 

It's not needles, it’s that I’m convinced this fluid of life is somehow temporary, so easily removed, and the tubes that hold them so delicate. To have this flow be measured or interrupted for a moment is dangerous. It’s not rational thinking, but no phobia is.

Thinking I was just going to get a dye into my veins from a small needle, I get to the hospital. They insert a cannula. I’m very pleased with my bravery, though I feel weak about the fact that there is an entry point to one of my veins. The theatre room is bigger and more elaborate than I expected. I hold out my cannula for some dye, but they ignore it and ask me to hold a bar with my other hand, upturned wrist exposed, while they tape my head to the bed.

The tube goes through my artery. Conscious I feel it move through my elbow. It’s very uncomfortable. When the dye comes through, I feel the warmth in small patches of my brain.  There’s a flash, strange circular shapes and lightning bolts appear behind my eyes. The process is repeated for different sections of my brain. Sometimes it's not warmth but thudding pain, or a sharp crackling inside my ear.

How incredible that such a thing is possible. They’re taking Xrays of the blood vessels in my brain. They’re injecting an iodine-based liquid into my brain. The iodine atoms absorb the x-rays, like the calcium in bones do, making them show up as opaque in the image. How the hell can they direct which part of my brain it goes into at any moment?

Before he removes the tube, he says that the arterial walls tend to grip the tube. This only seems to happen in young women, for some unknown reason, so this bit will hurt. I’m tempted to reply, “isn’t that true for all medical procedures?”

It’s a 45minute procedure and two hours of assessment as they make sure my hand isn’t going to fall off from an incorrectly sealed artery. Aural migraines set in – no pain, just a loss of vision. They continue on and off (mostly on) for three days. Apparently something else young women are more likely to experience.

A month later I hear the results. My arm still hurts, particularly around the elbow. The clot is a high-risk shape. Of course it is. He recommends they put a stent in within the next six months. This will repair it. 

I have toured Australia performing my quantum comedies. This year is the year of quantum, but I was not going to be able to take them to our wonderful Fringe festivals, not until I had the aneurysm sorted - which happened the week before we recorded this episode!

Looking back at photos of me during the Melbourne International Comedy Festival and my goodness, I don't look well. But, or medical capabilities are amazing, our health care great, and I'm repaired. An intense journey where I met amazing, talented people, and pushed at my phobias.