Are you ready for the real kicker?
On this twenty-first day of December, I agreed to have a needle shoved into my spinal column during the dreaded lumbar puncture...also known as a spinal tap.
I had my first spinal tap on February 19th, of 2011. My father - the former Navy fighter pilot - describes the event as being, "hellish." The experience was touched on in a reflective diary entry here. What I don't mention in that post is that the doctor was so inept or tired that she stopped midway through inserting the needle, after realizing that she didn't administer enough local anesthetic. With the nurses supposedly shaking their heads at the whole situation, the doctor started the procedure all over again. I'm a pretty tough cookie but, I couldn't get out of bed for about two weeks afterwards.
I think it goes without saying that I was none too thrilled about the prospect of having a needle inserted between my L4 and L5 vertebrae for a second time...on the day that the world was supposed to end.
THE WORLD DID NOT END!!!
The only issue with the tap was my own anxiety. I had managed to stay cool and collected all morning but, the trauma of the first tap had finally gotten to me. My mother looked on in horror as I sat trembling and shaking like a drenched fawn in a cold nor'easter. I was terrified, which - in retrospect - was silly as the procedure itself was less of an event than finding a good vein usually is for me.
So, for those who don't know the details of a lumbar puncture, I shall explain in layman's terms. I'll also have some advice for surviving a spinal tap interspersed throughout:
- HYDRATION: This fellow is on almost every one of my lists. Being properly hydrated prior to any procedure or test will make things infinitely easier for the patient. Make sure you drink at least 64 fluid ounces of water the day before the tap and have plenty of water the day of, as well.
- RESTROOM: Now that you've had all of this water, you will indubitably need to use the facilities at some point. And you don't want that urge to come while you have a needle in your back.
- RELAX take it easy!...(MIKA, anyone?): Use your neuro's prep time to relax and decompress. Practice some deep breaths and think happy thoughts. Marshmallows and penguins. Rainbows.
William Hung.Whale song. Thai food. Relax your jaw, neck, shoulder and back muscles and focus on your breathing.
- POSITIONING: Your neurologist will put you in one of two positions for the procedure: ¹curled up in the fetal position on one of your sides, or ²sitting with your feet planted firmly on the ground or a stool, with your head and shoulders curled forward and down.
- PREPARATION: After finding the best two vertebrae to go between, your neurologist will clean the area with tincture of iodine (WARNING: this stuff can be chilly!)
- PAINKILLERS: This is when your neurologist will give you a dose of local anesthetic (usually lidocaine) to numb you up before he or she begins the procedure. It can be given with a normal syringe or with a sort of pressurized auto-injector. This will probably sting for about 10 seconds or so, but will then begin to do its job. Take this extra time to chillax some more.
- PINCH and PRESSURE!: This is when things really start to happen. The neurologist takes a spinal needle and inserts it through the skin and between two of the lumbar vertebrae until it reaches what is called the dura:
- The dura is the part of the central nervous system surrounding the brain and spinal chord that contains the cerebrospinal fluid. The spinal fluid will be tested for oligoclonal bands that are indicative of multiple sclerosis.
- If the anesthetic was done properly, you hopefully won't feel a pinch. But you will feel pressure, the severity of which can vary depending on needle size. This is not a pleasant or familiar feeling. It doesn't last long, though. Stay calm and breathe through the sensation.
- WAIT: This is the easy part. Don't move, just think happy thoughts and wait as your neurologist collects drops of your spinal fluid in vials.
- POST-PROCEDURE: You're finished! The needle will be removed, you'll be bandaged up and the neurologist will have you lying supine (on your back) for a while.
- PLANKING - kind of: About ⅓ of patients experience a post spinal headache in the first few days following the procedure. Your neuro will tell you to stay supine for at least 24 hours, getting up only to use the bathroom and eat meals. This may be plenty of time for you to avoid the spinal headache but, you could need more. Listen to your body.
- CAFFEINE: Another way to avoid the headache is to ingest caffeine after the tap. Have some nice caffeinated green tea or coffee or treat yourself to a bit of dark chocolate.
- HYDRATION: Once again, fluids are your friends! You've just lost fluid through the spinal tap, so drinking more water will help keep things from getting too dehydrated in the ol' noggin.
- SLEEP: This is not the time to "turn it up to eleven," in the words of This is Spinal Tap's Nigel Tufnel. Your body will need some nice quiet rest after this. Take it easy, put on your eye mask and sleep for as long as you can!
Thanks for reading; I hope this has been helpful! What is your advice / experience with spinal taps?
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Here is my favorite YouTube demonstration of a lumbar puncture for anyone who is interested:
I wish everyone a Happy, Healthy New Year!