Claustrophobia, joint pain and an MRI

Ask Dr. Keith Roach M.D UDiTo Kdil E©aidn MUD)

Claustrophobia, joint pain and an MRI

DEAR DR. ROACH: About three years ago, I experienced pain in my knee. The doctor told me I needed an MRI. I have claustrophobia and was given a pill to take an hour before the procedure. I think that was Xanax, but I'm not sure. I took it and walked into the facility like a drunken sailor, with help from my husband. When I was put in the machine, I went to sleep and then woke when the MRI was over. In another year or so, the knee hurt more and another MRI was prescribed. I was given a tranquilizer for my claustrophobia but refused anything to put me to sleep. As a result, before the procedure was finished, I was screaming in pain because my knee refuses to be immobile for more than a couple of minutes. No one heard me or responded to my screams, and I felt like I was being tortured. I had a titanium knee replacement done two years ago but have been having different kinds of pain off and on. I am seeing a new doctor and am sure an MRI will be prescribed. What do I do? I cannot tolerate that torture again. Please help. -C.C.

ANSWER: Claustrophobia during an MRI scan is a common problem. If an MRI really must be done, then one approach to the problem is sedation. Alprazolam (Xanax) is a very short-acting sedative that it sounds like worked pretty well for you. Unfortunately, getting the dose exactly right isn't always easy, and if the dose isn't strong enough, it isn't helpful, while too much can (rarely) affect breathing. Another approach is an open MRI, which most people with claustrophobia can tolerate.

You have a second issue, which is pain with prolonged immobility. Sedatives aren't painkillers, but if you are asleep, as it sounds like you were the first time, the test may be over before you get into trouble. A short-acting painkiller for the procedure might help this, but I would see if you could get the same dose of Xanax you got the first time.

DEAR DR. ROACH: My son is healthy and 51 years of age. He had chickenpox as a young child. My concern is if he should get the shingles vaccination now or wait until he is older. I have heard that the vaccine wears off as you get older, and I wonder if he should wait until he is older and hope he does not get the shingles in the meantime. -L.C.P.

ANSWER: The current recommendation is to get the shingles vaccine at age 60, being the best compromise between reducing risk of shingles as quickly as possible and making sure it lasts long enough to provide benefit when it's most necessary: as we get older. People with or without a history of chickenpox or shingles should get the vaccine unless there is a reason not to give it.

A new subunit vaccine has completed a phase 3 trial, and the results are very encouraging. It seems to be more effective and longer-lasting than the current vaccine. Hopefully additional data will confirm this and it can be approved for use.

*** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cor nell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.