Believe it or not, (and I am certain she will disagree with this) my wife’s spinal tap was harder on me than it was on her.

After all her other diagnostic tests were done – Magnetic Resonance Images (MRI), Visual Evoked Reponse (VER), electromyograms (EMG), blood work (CBC, etc.), electroencephalograms (EEG) – the lumbar puncture (SPINAL TAP) was saved for last. It’s the one test that actually answers the question, “is this Multiple Sclerosis (MS)?”

The way I understand it, spinal fluid is removed and sent to a lab which uses electroflouresis and looks for oligoclonal bands – don’t worry, I don’t understand it either. If the oligoclonal bands are present in the results, then they, along with the other test results, make it official: it’s MS. (According to Wikipedia, “Approximately 79%-90% of all patients with multiple sclerosis have permanently observable oligoclonal bands“.

Drawing the spinal fluid is a fairly simple, uncomplicated procedure for the doctor and patient. Perhaps, not so much for the husband/caregiver, though.

I didn’t see it all because of where I was standing when it started, but it looked like a very professionally organized medical procedure. My wife sat sideways on an examining table with a nurse beside her at the table’s end. The neurologist stood behind her with a shiny tray of medical instruments.

My wife’s feet were placed on a round, stainless steel stool in front of her beside the examining table. The stool was adjusted to just the right height for her comfort. (Up front, I want to add there was no stool or seating of any kind for the husband/caregiver). I stood in front of her for moral support and to help her remain still.

A little local anesthetic was administered at the spinal tap site. After a few moments of the neurologist asking, “Can you feel it now? Can you feel it now?”, he was ready to begin.

Knowing that medical procedures have caused me to feel a little faint in the past, I focused my attention on my beautiful wife’s face. She, however, wasn’t really in the mood for deep eye-gazing and so I was pretty much to myself. But I did my job well. I kept her still and provided continuous support.

A few minutes into the procedure my wife, doing as instructed, reported to her doctor, “I can feel that. It’s like a little pressure.”

For the first time, I looked over her shoulder at the neurologist. In response to her report that she could feel something, he reached to his shiny collection of goodies. He chose a syringe with a needle and then he did the oddest thing. He tilted sideways a bit.

I looked to the nurse and she was leaning the same way! And the walls, too!

It hit me. I was fainting!

Quickly, I searched for a place to sit. And right in front of me was the stool for my wife’s feet. Perfect!

Then that little part of my brain that often has the last rational thought before it all goes black, screamed into my dark fog, “No! She can’t be moved!”

Searching around the leaning room in slow motion I saw so many things: the tilting neurologist was focused on my wife’s back, the tilted nurse was focused on the neurologist, my leaning wife was looking at me with big eyes and raised eyebrows (she suspected what was coming), the bright surgical lights were dimming, to the left was a doorway. I fell through it and, as it opened, I saw my landing place in the dark: a surgical chair! I crashed!

Fortunately, the room I crashed was empty and no procedures were in progress!

I leaned back in the chair like I were at the dentist’s. The darkness began subsiding. Slowly, I began gathering my senses and noticed a stack of surgical towels and a sink beside the chair. Grabbing a handful of the towels, I plunged them into the cool running water and covered my face waiting for the nausea to pass and clarity of thought to return.

As soon as I felt like sitting up I began pulling the towels from my head. Immediately, a nurse walked into the room through the other door.

She stopped when she saw me. I was not expected. I tried to grin without looking goofy as water dripped down my head and onto my shirt.

“Can I help you sir?”

“No, I think I’m ready to go back in for more,” I replied. Her eyes widened as she backed out of the door.

I walked softly back into the room where my wife, the neurologist and his nurse were still at it. My head pounded. Sheepishly, I stood in front of my wife. Seeing my pale face and wet hair, she knew her suspicion had been true.

“I almost fainted,” I explained softly.

“I know,” she replied.

“How are you doing?”

“He’s almost through”, she offered calmly, continuing to sit still on the examining table.

“That’s good. I’m here for you, Baby”, I offered.

“I know you are.”

Caregiver’s Tip: When forced to observe medical procedures that may cause you to faint, make certain you have an appropriate landing place before the procedure begins.

So much can be discovered with a little light. As a caregiver, you’ve probably seen a doctor slip the top edge of a Magnetic Resonance Imaging (MRI) image into the clip on a light box. The MRI results I’ve seen look like large photographic negatives. If you remember the old x-ray pictures, you’ll have the right idea.

The light box, usually mounted on the wall of the examination room, illuminates the MRI by shining an even field of light through it. At home, without a light box, when I want to look at one of my wife’s MRI images, I hold it up to the light and do my best. All I know about what I’m looking for is that the white spots are probably not good.

Guess what I found online. An illuminating article is available on “The Radiology Assistant” website.

Frederik Barkhof of The MR Center for MS Research, of the Radiology Department of the ‘Vrije Universiteit’ Medical Center in Amsterdam has provided a review of his presentation for a Neuroradiology teaching course for the Dutch Radiology Society. Barkof’s presentation was adapted for “The Radiology Assistant” by Robin Smithuis, general radiologist in the Rijnland Hospital, Leiderdorp, the Netherlands. It is fascinating stuff!

Barkhof’s presentation focuses on the role of MRI in the diagnosis of Multiple Sclerosis. The information available at http://www.radiologyassistant.nl/en/4556dea65db62 is excellent and filled with examples which explain actual MRI images.

If you’ve ever wondered what those white spots on an MRI of the brain mean in the diagnosis of Multiple Sclerosis, explore the article on “The Radiology Assistant”. While it may not help with the specific details of the MRI’s you have an opportunity to see, the article does provide a broad background for MS caregivers and encourages an appreciation for what radiologists and neurologists look for and see when they look at an MRI.

Caregiver Tip: Learn as much as you feel comfortable learning about the medical issues related to multiple sclerosis. The more you understand multiple sclerosis, the more comfortable you’ll feel asking important questions and the more confident you’ll feel in your role as caregiver.