Ho Ho Flippin' Ho

I received an early Christmas present from the US Healthcare System.  As I opened the box it came in, I discovered another box.  Inside that was---wait for it---yet another box.  I continued to drill down in my Cardboard Russian Nesting Doll until I found the last box.  Inside was---nothing.  

Some context is required to see the gallows humor in all of it.  It all started with my Urologist, who wanted an MRI of my prostate due to an explosive growth in my PSA from somewhere in the 3.0 range to 8.98.  Since I take finasteride, a drug designed to shrink the prostate over time, the true PSA is actually double the 8.98, or 17.96.  The technical term for that reading is "HOLY SHIT!"

Possessing a whiz-bang pacemaker that is capable of allowing MRIs, I began the process of getting one.  And that's when the boxes began to multiply.  First off, my Urology practice has a relationship with a hospital that doesn't have a relationship with Medtronic, the manufacturer of my pacemaker.  Medtronic has to be present when I have an MRI so it can put the pacemaker into a standby mode.  No Medtronic person, no MRI.

So, my Urology team contacts the Medical University of South Carolina (MUSC).  Well regarded, with  plenty of MRI machines and a relationship with Medtronic.  The only sticking point (so I thought) was that they are in Charleston, a 2.5 hour drive from scenic Mullins, SC.  No fuss, I thought.  I drive 2.5 hours to Durham all the time.  Sign me up.

The next Box came from MUSC, and out of Left Field.  "Did you know that your pacemaker unit and the lead that goes into your heart come from different manufacturers?  And did you know that because of that we can't give you an MRI?  Sorry, no MRI soup for you."

A cursory examination of Medtronic's website reveals that, according to Medtronic, their leads and pacemaker MUST be used in tandem to allow MRIs.  Boston Scientific, the manufacturer of the leads, says the exact same thing about their pacemaker/lead combination.

My response was pretty much what you'd expect.  Starts with something on the line of "WHAT?  I mean, WHAT THE ACTUAL FUCK?  WHY?"  Moves on to "GIVE ME HEADS ON PIKES!  WHAT WERE THEY THINKING AT DUKE?  WHY??"

Marjorie fires off a nastygram to my electrophysiologist at Duke.  Much more polite than the above, but still a bit strained.  Concurrently, I started thinking about finding a World-Class Ambulance Chaser to sue the living daylights out of Duke, my EP, and everyone else who got within 15 feet of me during the pacemaker procedure in August.  

My EP responds.  "Technically it's an off-label scan, but we do them all the time.  The risk is low."

When a doctor begins a conversation with "technically" it marks the moment when the doctor speaks but his/her attorney's words come out.  Eagle-eyed readers will remember that very description from the first blog entry in this project.  But this doctor knows, right?  

Employing the old Russian proverb "Trust, but verify", I call Boston Scientific.  Ask the question about mix-and-match.  The next Box opens.  "Well, teaching hospitals have been at the front of combining leads and pacemakers from different manufacturers.  We don't recommend it, but an independent study was commissioned and the results indicate there is barely any risk differential.  

The nice lady at BS (an unfortunate acronym, but let's go with it) told me about Magnasafe, the study that documents these procedures.  Good thing I scrolled down at Google, because the first Magnasafe that comes up  is a safe.  Magnasafe.org was more what I was looking for.  Hurray.

Opening up the Magnasafe Box yielded just what the nice lady at BS said it would--that mix-and-match was acceptable for non-thoracic MRIs.  Santa has delivered!  Let the wassail flow like water!

But the Magnasafe Box came with a string attached.  The study indeed said it was OK to match non-common manufacturers.  BUT--it was specifically measuring MRI machines with 1.5 Tesla (a designation that indicates the relative strength of the magnetic field generated by the machine).  My urologist wants an image that is 3.0 Tesla, because it offers better imaging of the prostate.  

There is no (zero) mention of 3.0 Tesla in the Magnasafe study.  They weren't studying that.  They may  at some point in the indeterminate future. Just not now.  Back to "No MRI for you, bub" unless I want to be a pioneer in the world of Magnetic Resonance Imaging.  Nope.  As they say in Gay Paree, "Pas moi".  

My EP probably doesn't know about the shortcomings of the Magnasafe study because it hasn't come across her radar.  The MUSC people probably knew about the Magnasafe study but also knew that 3.0 Tesla isn't on the table for mix-and-match.  Recall the wassail.  Santa replaced the candy canes with coal.  

Ho Ho Flippin' Ho...