Okay, long story. I'll skip the details of why he needs this. Just does, and it's vital.

He has always had anxiety, been claustrophobic, and sometimes had panic attacks. Over the years, he has found methods to deal with this effectively. Meditation techniques, that sort of thing.

In the last few months, he started taking a 0.5 mg Klonopin now and then. At most maybe 2-3 times a week.

This MRI has him worried. Not so much because of the idea of anxiety or claustrophobia -- he knows he'll be able to get out of the tube if necessary. He is mainly concerned about the side effect of his anxiety, which is for his salivary glands to stop entirely to the point where his tongue sticks to the roof of his mouth and he starts to choke.

He's talked by phone with the people at the facility, who have assured him he'll be able to get out of the tube if needed and that he'll be able to take sips of water in between when they take the MRI shots. But he's worried about the choking hitting him and not being able to do or say anything while he's in the MRI tube.

We are going to stop at a sporting goods store on the way and see if we can find any kind of the reserviors for water back packs or even the outdoor showers -- if we can find one without any metal, maybe they'll let him run the plastic tubing inside the MRI? So long as he knows he'll be able to get a sip of water if he needs it, he thinks he'll be okay.

Anyway...back to my Klonopin Q: I've been trying to reassure him that he should be able to safely take more than his usual 0.5 pill before he does this. (The people at the facility of course say to bring your anti-anxiety meds with you and that you will be able to take it before the procedure starts.)

I looked Klonopin up at Rxlist.com -- sounds like you can take a lot. I occasionally take two of my own 0.5 mg with no problem.

Does anyone have an idea how many he should be able to safely take? Without the usual titration?

Thanks for any info. And my apologies for the length of this post.

They won't want him having a camelback running into the MRI, with or without metal.

He may want to use some of the OTC dry mouth aids, or ask his dentist or PCP for just enough saliva enhancing meds to get thru the day.

It is also possible to stimulate saliva briefly by pressing on or massaging the salivary glands (on the outer angle of the jaw).

good luck,

a.m.

i took 1mg ok klonopin before my MRI and was fine on it (though that was my rx'd dosage, but 1mg is a safe dose.)

also, they continually talk to you in the MRI and there's a microphone in there, so if you just stop answering them they will pull you out to make sure you are ok.

he should also make sure to let them know he is claustrophobic.

also, there is something called an "open MRI" if he has time to shop around for facilities that use the open machine and not the closed one.

Thanks, Penny!

Thanks for the Klonopin info!

Yeah, I've tried to reassure him about the microphone. The people at the facility have as well. He's been completely up front about his problems and concerns. But at this point, there is no getting through about the water issue. He just has to know he'll be able to have access immediately.

I have a feeling that the fear of the MRI is actually much worse than what he'll experience. I'm sure that once he gets there, they will do everything they can to put him at ease.

I've had several MRIs. This is his first. Fortunately I've been okay with them, and when I needed to I could use relaxation/meditation techniques to get though.

Being curious, I've asked the techs how they handle people with problems. I've always been impressed by their answers...very sensitive. They say that dealing with people's anxieties is probably the major part of their job.

Unfortunately, this facility is the only one in the area that has what he needs, so no open MRI. He has prostate cancer. This MRI has spectroscopy as well as what I think they call a rectal coil(?). Gives much better image of this particular cancer. Still in the investigational stage (though its value is already well-proven), so he is taking part in a study.

Thanks again.
revlow

PS - I think 1 mg is safe, too. Good to get your confirmation. Think if he takes this he'll be in good shape.

Of course I'll be driving afterwards.

Couple suggestions:

If he has worked with meditation, have him practice up prior to the MRI. Like a couple times a day for 10 minutes. I was a little nervous once I got in there (have panic issues myself) and I just closed my eyes and "left" my body. It worked well for me. If you as his advocate focus more on this, and less on the "what if's?" then that in itself may relax him.

You are also doing the best thing for anxiety. You are answering all the "what ifs". Now focus on other parts you can control. Remember panic and anxiety are fear of losing control. What would work best for him in preperation?

I had mine done in a hospital - they have those cups with plastic straws. Maybe having one in the room would help. Ask ahead of time.

You might try .75 mgs of Klonopin. I always suggest half pill doses. People always go from one, right to two. What about one and a half? Not that two would be harmful. The thing with Klonopin is this: If you need it, you barely notice it. If you don't, you fall asleep. Or I do anyway. Falling asleep wouldn't be bad either.

Anyway - I would try and do the leg work and make him comfortable with what he can do to prepare. Then focus on those things rather than this one huge issue.

My husband has anxiety too. So I have done this a time or two myself. Good luck. If he can calm himself - it'll be cake! I was in there for over 30 minutes, it felt like 5.

Breeze

Edit to add: I asked Albert about the advice I had given you. He said for *him* he likes that I know all the details and he can ask me if he wants to. He is part of each process.

He also said that during one of his radiation treatments, a nurse gave him a rolled up towel to hold. She told not to squeeze it, or pull it, just hold it. He said it made a huge difference! He said too in an MRI, you don't have anything to do with your hands. I suppose this might help. Don't know if this is something that would work for your friend, but thought I would mention it.

Thanks, Breeze! All good advice.

I strongly suspect when we get there his fear will diminish, and that his own skills to mitigate stress will kick in. Hell, he even used to teach classes in dealing with fears and phobias! Even worked with an airline to teach classes in getting over fear of flying (one of his own biggies in the past).

But with this experience, I am witnessing his vulerability surface to these past bugaboos. (His really being disabled by his phobias happened before I knew him.) And this recent spate of doctors and tests is the 1st medical thing he has had to deal with since his tonsillectomy at age 7! So, he's due.

He also is dealing with all the details, asking all the questions, being as informed as he can possibly be. He's been doing well so far throughout this crisis. Biopsy, no problem. Ultrasound, no problem.

MRI...fears bubble up.

But I do think once we get there he'll do okay.

I'll pass along all of your suggestions. Like your husband and the towel, you never know what will help.

Also, Breeze...how is your husband doing? Still all clear? PSA still good?

Best,
revlow

I've had several MRIs, and the thing that always stressed me out the most about them is that they tell you not to move a muscle or it can screw up the pictures. So I lay there trying to hold as still as possible, which of course leads to my nose itching and my eyes blinking like mad. >.<

The MRI clinic that I go to gives me a little "panic button" thing which I hold in my hand. If ever I feel panicked or uncomfortable, I just have to push the button, and out I come. It sort of looks like the little buttons they give the contestants on Jeopardy. I've never needed to use it, but just having it is a nice security. Earplugs are a must too.

I think that feeling like I'm choking would be very unpleasant, but I wonder how long it would take to really choke. I'm sure that there is time to get your roomie out of the tube before any damage would be done. So is the fear of actual choking to death what he's worried about or is it perhaps the fear of being embarassed should he have to be removed from the MRI? Both are of course valid and deserving of atttention, but it might be helpful to know what the real fear is in order to deal with it.

All really good points.

That's exactly it. In his case, with his non-functioning saliva glands, it's the not having access to water that scares him. Don't know if possible, but we're going to see if they'll allow a non-metal water container outside the MRI with a long plastic hose, to be threaded into it. Who knows? Might be possible. Worth a try and we'll come prepared in case they'll go for it.

I'll let him know about the panic button. Would be just the ticket in this situation, if they have it.

Oh, AM...somehow I'd missed your post. Poo. That's too bad about the camelback. Bummer.

He's already tried OTC stuff without success. (So did I back in the day when I was on old AD's with sever anticholinergic effects.) I didn't know about prescription meds for this. Unfortunately, probably too late unless he can get ahold of PCP early Monday morning. Do you have any names of these meds?

I'll tell him about the massaging trick.


Even though I do fine in MRIs, that's always the part that drives me nuts -- the itchy nose! That's when inwardly saying a mantra and other relaxation stuff helped.

In his case, I think it's the fear of actual choking. He doesn't embarrass easily. He's really open about all this, the phobias, anxiety, etc. Plus he's a boisterous type.

Mentioned the idea of guided imagery, rehearsal, etc. With his background, he immediately latched on to the idea, so hopefully he'll be doing some of this. I think once we get into the Big City tomorrow evening (staying overnight in nice hotel), he'll also start to relax.

Thanks to all of you for your wonderful help and suggestions! As always, you've been great!
revlow

Did some research. Found saliva-inducing drugs pilocarpine (Salagen) and cevimeline (Evoxac). Are there any others I should know about?

Salagen is probably out of the question. The instructions say to take with a full glass of water, and the MRI prep is to have very little water that morning. Don't see these instructions for Evoxac though.

Thanks for your help!

revlow:

Well sounds like things are well in hand. Like I said and he knows - anxiety is fear of loss of control. So the more things he believes are in his control, the better he'll do. I like that panic button thing. Mine was an open MRI, but I'm tall and when I slid in there I my nose came within inches of the top of part of the machine.



Thank you for asking. His last PSA was about 6 weeks ago and it was 1.2 (maybe lower - he had a bunch in a row) I think. That was down from one taken just a couple weeks previously. We feel, for now, we're in the clear and may be forever. But since the tumor came back once, we have to be vigilant. That reminds me.......

Breeze

Doubling the dose before the procedure is not a bad idea. I can vary my dose between 4 and 8mg per day as I feel appropriate, depending on my anxiety situation. For example when doing something that has been anxiety provoking in the past, like being in church, i'll pop and extra klonopin an hour before i have to go. It works for me. I'm on a fairly high dose too, and haven't experienced any withdrawal effects from playing with my dosages.

Tom

First, thanks to all!

Here's what happened...

The day before the MRI, we left to go to the Big City. It was a Sunday, so no getting ahold of usual doc. Before leaving, roomie called hospital in our little town and talked with the ER doc. She said she wouldn't be comfortable rxing a saliva-inducing drug due to the SEs, even for a 1-day use. However, she did give some suggestions. One, to use artificial tears right before the procedure; some will drain into the mouth and could help a bit. The other was to use lemon drops; sour induces saliva.

On our way into the Big City, we stopped at a sporting goods store and roomie did buy a camelbak water bag. I seriously doubted this would be of use.

Also, his thought was to "build-up" the Klonopin in his system. So, he took one Sunday afternoon, another Sunday evening, and one I guess about 1 hour before the MRI. (I don't have a clue whether this "build-up" idea has any scientific merit, but hey...even if it doesn't, he *believed* it did.)

So, we go to the university for the MRI. The first tech we dealt with was okay, but sort of a butthead too. Absolutely nixed the idea of using the camelbak.

However, the two women who prepped roomie were great! One of them even said "what a great idea!" They checked to see if there were any metal parts that would be a problem. There were none. So they positioned it on the pillow behind his head. Roomie also had purchased an extension tube for the camelbak, and it was used; definitely good thinking on his part. So holding the water tube next to his mouth, and the panic button in his other hand, he was in good shape.

The other thing that was cool was they let me stay in the room with him. Of course, they took my medical record and put me in scrubs. This was reassuring to roomie. I pulled my chair right up to the opening, side closest to where his head was positioned. His head was in the tube but he could look upward and see me.

Most of the time during the "shoots" (or whatever they are called) the thing was too loud for him to hear me, but there were a couple of these when the cadence was such that he could hear me count off every few minutes for him. This included the 17 minute long spectroscopy. It was a big help to him.

So it actually ended up being a great experience. The women were so wonderful and helpful. Anything that was doable to help him feel comfortable was okay by them. We were blown away, totally impressed.

And in the long run, this ended up being a good rehearsal for some of his treatment options -- like some of the forms of radiation where you are encloed, if that ends up being the best choice for his particular cancer. He now knows he can get through it.

Afterwards, we had a great lunch at an outdoor cafe.

He won't know any results till he sees the docs next week.

Again, thanks to everyone for your help.

revlow:

Sounds like all went well. I think it helped that he was able to do the things that helped him feel in control. That is the key to anxiety. I guess I should read up on your thread because I haven't a clue where you guys are in all this. I am guessing that you're still in the testing stages and trying to determine his best option. I wish him (and you) all the best.

And a quick word just for you. I have been a caretaker now for my husband for 15 years. He's MI along with the prostate cancer that pops in and out of our lives from time to time. What little I know of you, I see that you feel better doing research and compiling all you can on these subjects so you can make the best informed decision. I couldn't agree more. People don't realize that doctors aren't gods ( I just wrote "dogs" lol) by any stretch. We really really need to be our own advocates, and carry a spare along for insurance. (Your roomie being his own advocate, you being the indispensable spare) But let me just say this:

Please take care of yourself through all this. I found myself so wrapped up in his care, that I did some real damage to myself over the years. My anxiety disorder popped up, I hurt my back, and I had to learn how to let go. It's not an easy task. And you are a good person to go through this with him.

But each day (and you may do this already) you need to take time out just for you. Meditate, walk, read a funky novel, listen to music - something. Everyone said this to me and I blew it off thinking I could handle any and all that came my way. Well there's a wall out there. And I hit it doing 90 mph last fall. I mean that figuratively, not literally.

I know you have a lot of outside interests, and hope you still have a dog around to keep you sane. But just remember. You are no good to him unless you are healthy too.

My little words of wisdom for the day. I'll be following your journey more closely now.

take care.

Breeze

Exactly. I think when medical professionals are sensitive to this, they help out immensely. When they aren't, well, they are assholes.

Thanks. Yup, this MRI was the last of the tests.

I couldn't agree more.

Thanks for your words of wisdom for the day. I need to remind myself of this.

Heya revlow,

Well, I (as usual) missed the most interesting days on CB.



Glad things went well

--ncc--