Read on Twitter
Our research on #IBD #PTSD I discussed at #CCCongress21 continues. We still see alarming % of patients w a lot of symptoms. While I don't have PTSD from my 18 years w it, I do want to share a single incident 17 years ago that was traumatic to highlight a point. Pull up a chair 
Once upon a time, there was a medical test called an enteroclysis used to identify small bowel Crohn's disease. Similar to the small bowel follow through (SBFT), except the barium in this test is injected into the small bowel via placement of a nasogastric (NG) tube...
Our 26 year old heroine sits on an exam table, expecting the SBFT but notices right away the tubes on a metal tray and knows what's next. Her 
rate immediately quickens, breathing more rapid. She has a horrible gag reflex and her 
races about what to do...
rate immediately quickens, breathing more rapid. She has a horrible gag reflex and her races about what to do...
The nice radiologist enters the room, ready to start. The patient tells the MD about how this isn't going to work, the gag reflex is too strong, she won't be able to swallow the tube easily. There is a slight pressure to her voice but it's not obvious what's going on inside....
The MD smiles and says it won't be that bad, that she will use a numbing spray to stop the gag reflex. The patient laughs nervously and says she doesn't really think the spray will help, no REALLY the gag reflex is strong. She stops short of fleeing the room...
A pit settled into her stomach, she doesn't say any more and the test proceeds. The "numbing" spray is applied, its bitter taste making her mouth water more. Then the tube is started down her throat, except not up her nose but her mouth. She is told repeatedly to swallow...
The gagging starts almost immediately. With the extra saliva, she chokes even more. The MD continues to say "come on, swallow!" as she tries her best. Someone gets a towel to catch the drool streaming down her face along with the tears freely flowing from both eyes....
In what feels like an eternity, the tube is finally down. The MD says "you weren't kidding about that reflex!" And the patient gives a weak smile. They guide her to the table. Every time she moves she gags, they tell her to keep her chin to her chest...
For some reason, the barium travels through her digestive tract very fast and the radiologist notices on the x-rays this is happening and asks her if she needs to go to the bathroom. YES please, she tries to say without gagging. Thinking this would mean getting up to actually....
go to the bathroom. Instead, a male technician enters the room. She is laying on her stomach still and he says "I'm going to place this bag to collect the barium" and she is immediately confused. Bag? When she feels the tube (?) placed in her rectum it becomes clear she....
won't be going to the bathroom. Now, with a tube down her throat and a tube out her ass, she begins to laugh to herself but it's not really a laugh because she's having a fun time. She disassociates and sees herself from above, laying on the table....
Being a graduate student in clinical psychology she knows what's happening so she doesn't become afraid. This continues until the test is done and she can sit up (first gotta remove the butt tube!) and the tech pulls the NG tube out with more gagging...
She is told the test is done and she can go. The embarrassment she feels is monumental, between the gagging and the butt bag. She quickly goes back to the changing room and vows never to have another test like that again....
Fast forward 14 years, our heroine is being worked up for Eosinophilic Esophagitis, which she has had symptoms of for the past 7 years. Never mentioned it to her IBD doctor because she is afraid of an upper endoscopy (EGD) but agrees to it because of MAC sedation....
Her doctor would like to do an esophageal manometry. She knows exactly what this test is and refuses citing the experience with the enteroclysis. This goes on for almost 2 years before she agrees when she is able to get the manometry probe placed under sedation...
Even today, she can play the movie in her head of that day. It doesn't cause flashbacks or nightmares, she isn't on edge day after day. But she did defer medical care for several years, choosing to live with EoE symptoms over the possibility of having another traumatic event...
This is a single incident and by objective measure not really that bad. It wasn't an emergency surgery, she didn't have uncontrolled pain or the loss of part of her body. Yet there the memory sits, probably never going away.
This is how medical trauma goes down.
This is how medical trauma goes down.
Twitter CME credit:
What are some mistakes that the medical team made during this procedure that may have contributed to the trauma?
What could have been done differently to get the test done while mitigating the intense emotions going on?
What are some mistakes that the medical team made during this procedure that may have contributed to the trauma?
What could have been done differently to get the test done while mitigating the intense emotions going on?
Thanks for coming to my TED talk.
