Yuck- Neurologist visit

[Aggie_Ama]

I finally got into the neurologist yesterday. He found no reason to be interested in the weight loss vs. tremor returning thing. I find it frustrating that is seems related but all the MDs are like "interesting" and then move on. UGH! Other than that I love my doc but seriously why does no one think anything of the switch on my tremor flipping with weight loss? :rolleyes:

He did not put my back on Mysoline which made me happy. Something about a drug with a long half life that breaks down to phenobarbital really gives me the creeps. Plus I had to take super high estrogen BC which cannot be good for you. Otherwise I had no complaints about Mysoline but phenabarbitol is a bit scary. So we are trying Inderol which is cool since I can take it as needed. May not be cool if it makes me pass out, we will see when it is filled this afternoon.

The crappy thing is I asked why neurologists and my GP keep asking if I have had scans. My doctor said honestly he doesn't know why he never sent me probably because the docs at Baylor didn't so good, lets do it to "dot the i's and cross the t's". So I ask a question and wind up getting sent for a MRI which he thinks will change nothing. I don't know why but I am totally weirded out by the MRI. I tried to get DH to take me (whenever it is) but he said "it is no big deal and I don't know if I can get off". Ugh, I know it is no big deal but I don't want to wait alone. :o

On a side note, my blood pressure was high yesterday 141/92. They used some kind of new thingy that goes on your wrist and looks like a polar HR monitor. I wonder how good that is to use on someone who cannot stop shaking in their wrists? Anyway my BP is usually much lower like 110/60 so I am not thinking too much of it and the doctor didn't even notice it was high on the chart. Besides inderol will lower BP so it is all good I guess.

I wonder why I feel like I have more questions today than answers? At least the bright side is since we switched meds I am on a 3 month visit window instead of 12 month like I once was.

[Eden]

I just watched an inservice at work (I work at a children's hospital) about blood pressure. The guy giving it was of the opinion that the wrist style bp monitors are pretty useless... Anyway, unless you get consistently high readings (at least 3, I think) then you shouldn't have to worry.

[coyote]

I have never had an MRI, only been witness to one....I agree, they do seem scary. If you can not find someone to go with then, let us know when you are going so that we can keep you in our thoughts. Maybe with so many of us 'with you' atleast in though it might not be as scary.

Neuro stuff can be such a pian *ss to figure out. Hopefully you get some good solid answers soon.

[bmccasland]

I've had two MRI's back to back - head and then IAC's (inner auditory canals)back when my migraines were getting pretty bad. I thought they'd do both at the same time, run the head, get the extra cuts of the IAC's when they got there, and then continue on with the rest of the head. Nope. Two separate exams. Anyway, the MRI wasn't scary at all, and I fell asleep. The tech informed me he new I was asleep when I started snoring. Gee thanks.

So try to relax, it isn't bad at all.

[SadieKate]

Amanda, how much of you are they scanning? Are they using any contrast medium? How long do they expect it to take? What kind of machine?

There is no reason to be concerned unless you are claustrophobic or have had reactions to a contrast medium like Gadolinium (assuming they are even giving you any).

The first MRI I had was of my head only and was done in a open MRI - a big flat disk over my head and I could see the room. You are not enclosed. I am mildly claustrophobic but needed no medication. No problems.

The most recent one was two series of my head and then all the way down to my lumbar region. Two frickin' hours in a tube up to my hips. Xanax is WONDERFUL but you must have someone to drive you home. They will not allow you to drive yourself home if you've been given any medication to deal with the claustrophobia.

And if you think you need Xanax, you need to tell them ahead of time and arrive early.

There is no reason to be scared but you should find out the answers to the questions at the top.

One other note: I can't handle ear plugs but they'll try to make you use them as the magnets are very loud. Since my head is always immobilized, I have them put lots of padding against my ears. That with the Xanax and I'm in another world.

Oh yeah. The tech also put a tissue over my eyes and somehow that fakes you into not thinking about that tube just inches away. I'm becoming quite the expert in patience, relaxation and noise management with these.:rolleyes:

[Aggie_Ama]

Eden- Thanks I wasn't too concerned in fact I couldn't see how using one of those was good for someone with a tremor. My BP is always good and yesterday my appointment was late, the receptionist misplaced my new insurance card when she was scanning it and I didn't want to be at a neuro again. So it was no shock to have high BP.

Coyote- Thanks you're very sweet. I am still waiting for the imaging center to call me to set it up.

Beth- I am good at sleeping anywhere so maybe I can have your luck. I did that during an EEG, the most magical test ever since the encourage you to sleep and conduct it in a dim room.

Sadie- The sheet just says "Routine MRI". I don't think they are doing on contrast dye but at least now I know what to ask the schedulers thank you so much for that. I am not claustraphobic per se but I do get panic attacks if I am not in control of my situation. So the first one you described would be okay but in a tube would probably mean a panic attack.

[Crankin]

I had 3 closed MRIs last year; head and neck, lumbar, and upper spine. I am mildly claustrophobic, but you could still see out part way. I just did deep breathing. I did have Gandolin with the head and neck and was quite concerned because I AM allergic to IV contrast dye they use with CT scans. But I had no problems with the MRI.
I can get panicky, too in these situations, but I was determined not to take drugs for this. I went by myself and it was fine.
Robyn

[snapdragen]

2 closed MRI's in the last year. I kept my eyes closed the whole time, and counted. The tech would tell me how long the scan would last, and I'd start counting :rolleyes:

[Cataboo]

Aggie_Ama,

This could be completely out of left field since I really don't know any of your medical history - I do remember you mentioning the tremor & weight loss before but can't really remember the details.

But there are cases with fat soluble drugs that the drugs are stored in your fat deposits - and when you lose weight, those drugs are then released back into your system. that can play havoc with some random drug tests, btw.

So if you were on any sort of drug in the past - possibly when you lose weight, it's getting released back into your system and causes the tremors.

[Aggie_Ama]

Catriona- I read that but I think it is more to do with the cycle of tremors. I tried the Inderol tonight so I guess we shall see how it goes. I hope it works since 60 pills were only $4.52!

My DH is cruising for a bruisin on the MRI I swear. He basically told me I was being a drama queen about it and it was no big deal and why on earth would I even consider asking about Xanax. Grrrr. My mom volunteered to drive me if it is an enclosed and I go the Xanax route, she knows I am a drama queen but thinks if I am going to be all worked up about it I might as well check on what type it and if I want Xanax then okay. My husband knows I get all panicky if I feel trapped and he has only had his knee MRI'd like he knows anything. Stupid boy.

[Possegal]

I barely handled the MRI on my knee and I freaked out when I had an OPEN MRI on my shoulder - that was embarrassing! Nothing wrong with being a little freaked out by the containment in the tube. Better living through pharmacology! (and the fact that I'm a pharmacologist has nothing to do with that! :) ).

[Zen]

I can no longer count how many MRI's I've had.
I was freaked out at first, now i fall asleep.

Take a washcloth with you, see if you can run it under hot water right before the procedure, fold it up and put it over your eyes.

If you wear a sports bra, t-shirt and plain cycling tights (no metal zippers) you don't have to wear any fashionable gowns.

[SadieKate]

Act-u-ally . . . . I was told at my last MRI that they don't like to do that (let you wear your own clothes) because some fabric creates an artifact in the image, particular knits like in sports bras. So the tech let me slide this time but she said never again (with a smiley stinky eye :p).

This office didn't know me and was most impressed though that I showed up with nothing with metal. I was kind of surprised that they were surprised. If you have one, you should know the routine.

[Zen]

I've never heard that :confused:

[SadieKate]

I hadn't either but why risk it. I'm on a PPO instead of an HMO for the first time in years. Having just paid 20% of the bill for a two series MRI from my head to my kidneys, I don't want to have to do it again because of my sports bra. :eek: :eek:

So got the report today: MS lesions unchanged, vertebral bodies look great (no osteoporosis??), confirmation of my self-diagnosed lipoma, and several small renal cystic structures of 1 cm in right kidney requiring follow-up ultra-sound. Oh crap. And what is a "central disc osteophyte complex at the C4-5 level?" I've got some research to do during my insomnia until that ultrasound.

[snapdragen]

And what is a "central disc osteophyte complex at the C4-5 level?" I've got some research to do during my insomnia until that ultrasound.

Hello! Bone spurs in your neck. Welcome to my world.....:eek:. From what I understand, developing these is common. I just happened to grow lots of them in jumbo size. :D

[SadieKate]

Fabulous. I knew you were my role model in many ways.

The report also says "minimally indents the anterior thecal sac. No central canal narrowing."

[snapdragen]

Fabulous. I knew you were my role model in many ways.

Wanna borrow my collar.......:rolleyes:

[SadieKate]

Ah, just like a big sister . . . . :p

[Dogmama]

My DH is cruising for a bruisin on the MRI I swear. He basically told me I was being a drama queen about it and it was no big deal and why on earth would I even consider asking about Xanax.


Tell him to stuff it. They put me completely out for MRI's. I'm claustrophobic & I last about 2 seconds in that machine. And I hate drama.

OTOH, I have a friend who is a construction supervisor. He loves MRI's. He says the racket in the machine makes him think he's at a construction site.

[Tuckervill]

Ama, your husband crossed into the realm of non-supportive with that one. It doesn't matter how HE feels about it. It matters how YOU feel, and he should take those feeling seriously. If he can't, then leave him home, but I wouldn't let him get away without knowing he crossed the line (if he was mine).

I'm sure it will be tense for you, but you will get through it.

Karen

[Aggie_Ama]

Ama, your husband crossed into the realm of non-supportive with that one. It doesn't matter how HE feels about it. It matters how YOU feel, and he should take those feeling seriously. If he can't, then leave him home, but I wouldn't let him get away without knowing he crossed the line (if he was mine).


Oh he knows. First of all I told him I had a right to be a drama queen and gave him my more than two cents on why I could be scared and didn't appreciate him thinking less of me for it. Second I told him my mother would accompany me because she thinks taking Xanax to avoid a panic attack is perfectly reasonable because I tend to be a little over excited about things even though she herself wouldn't need it. She is cool as a cucumber, Dad would need Xanax. :rolleyes: I think he was a little hurt that I put my foot down with him taking me after I asked him to do it but it was all good after that. Still waiting on the imaging center to schedule it, I hate waiting. The doctor told me to call if they don't be this afternoon.

Xanax doesn't do much to me, just makes me mellow. It is a weird state since I am usually a worry wart, I am rarely calm. My former doctor thought I was so high strung that my tremors would be cured with xanax or valium but it didn't work.

On another note the Inderol did not work last night but I am still giving it a chance. It didn't make me sleepy, light headed or anything. I have a mild tremor this morning, so I will take one. Hopefully I won't spend the rest of the day at work feeling dumb. My doctor thinks I am older than last time I had it (true by 5 years) so maybe I will not have side effects like I did before. I guess older people generally tolerate it better?

[OakLeaf]

Aw, Amanda, I'm sorry your H is giving you so much grief. :( Hope the techs treat you sympathetically and that you get through your MRI without too much anxiety.

And SK... bummer you too.

Big hugs to everyone.

[Aggie_Ama]

Aw, Amanda, I'm sorry your H is giving you so much grief. :( Hope the techs treat you sympathetically and that you get through your MRI without too much anxiety.



Aww thanks. I am used to him. I am a drama queen and he just doesn't get it, heck half the time I don't get me. After 11 years together I just roll with it and rant a bit when he annoys me. I am sure I will report back that the MRI was nothing and I was being a big ol' baby about it.

[SadieKate]

Xanax doesn't do much to me, just makes me mellow. It is a weird state since I am usually a worry wart, I am rarely calm. That's really all they want it to do since it's an anti-anxiety med. They prefer you didn't fall asleep as you might involuntarily move and sometimes they will talk to you to tell you the next steps. Like snap said, "This series will take x minutes." Or they may ask if you're warm enough or need a pillow under your knees or whatever. They keep blankets in a warmer that can make it quite cozy.

Give your DH a slap upside the head from all of us, m'kay? :p You're right that it isn't just the stress of the MRI but also the entire quandary about why you're getting the MRI.

Hang tough. You'll get through it fine.

[Aggie_Ama]

Since I am impatiently waiting, I wonder what it means that my doctor checked off scan head with and without brain? Maybe I can look that up. It sounds like I get to do two scans. Off to google and see what I can find.

[Aggie_Ama]

Okay I got the answer, yes to contrast. Yes it is enclosed. It will take about 40-60 minutes Friday afternoon. No one seems to be able to take me so I might have to go drug free. What I am more terrified of is getting my first IV. The first one I ever saw put in was an absolutely horrible experience when DH had his appendectomy. I don't think women scream as shrilly during child birth and 7 years later the incident is still haunting me. DH has IVs every 8 weeks and thinks no big deal. They usually have trouble finding my veins to draw blood so IVs sound horrible. I am getting all worked up just thinking about it. And when I had my wisdom teeth pulled I told them novacaine only since they weren't compacted and I would not have an IV unless they were cutting. At least I can get it over with and be done. My doctor thinks this is a one and done thing on a MRI since I just have a tremor. Ugh, I have made myself sick. I think it is time for some deep breathing at lunch, I am such a baby.

[bmccasland]

Aggie-Ama - calm, think calm. Deeeeeep breath in, slooowwwllyy let it out. Breathe in....... out....... in ...... out...

is there any chance you could drop by the MRI dept just to see the silly thing? Maybe if you saw the machine you wouldn't be quite so nervous.

I admit when I was having the CT and then the MRI for my migraine issues - to rule out anything "organic" I was terrified (Organic = tumor). I remember my Mom sent me flowers to cheer me up. But the tech folks were great. After my MRI, the tech told me that he didn't see anything unusual - and that he wasn't supposed to tell me, but thought I'd like to know, and I'd be hearing from my doc in a couple of days. In my head I heard Arnie S's voice - "it's not a tumor".

It's OK to be scared, your feelings are valid. But try to slow down just a bit, and maybe it won't feel quite so scary. Cup of camomile tea with honey? A cuppa tea cures all evil frights, right?

Got to admit - i like the "with and without brain" part. :p If I only had a brain!

[Aggie_Ama]

Thanks Beth. My mom gave me a swift kick in the butt via phone at lunch. It is now the IV really bugging me, the machine is just weird. DH told me he has probably had 25 IVs since that one in 2001 and that is the only one he ever recalls hurting. Besides this test will put the rest so many doubts I have had, like why they keep asking me if I had one but never sent me for one. I think a nice run, followed by a warm bubble bath and later tea will bring me back to earth this evening. I am such a drama queen I swear. :o

[emily_in_nc]

Hi Amanda,

IVs are not fun but are nothing to get too worked up about. I have problems giving blood normally (small veins in my inner elbow area), but they have no problems finding a nice fat vein in my hand to stick an IV in. Yeah, it stings a bit for sure, but it's not worth losing sleep over. Believe me, I am a pain wimp, have to have sedation for dental work, etc., so if I can handle an unmedicated IV, I guarantee that you can. Just grit your teeth and don't watch!

Best of luck with all of this....

[Fredwina]

I've also got deep viens I usually wind up getting poked in both arms :rolleyes:.I had to have a blood draw when I still had my arm in the splint from my accident and almost rescheduled it.
Yes, if they can 't do the elbow, they'll stick you in the hand. hurts, but I've been told I have a high pain tolerance

[Deborajen]

Aggie Ama, boy can I relate. I just had my first MRI done yesterday morning. It was of the brain, with and without contrast. I can tell you the machine was noisy and it looked like something from a sci-fi flick. The tech took lots of steps to make me comfortable - put a big pad under the back of my legs, covered me with a nice, warm blanket, gave me ear plugs (which were a BIG help), put pads on each side of my head, etc. Being slid under the magnet was a little intimidating, but I could still see all around the room. It didn't seem like that tight of a squeeze once I was there. I just closed my eyes for most of the test, and it didn't end up being that bad. When she gave me the injection for the contrast, I couldn't see the needle and it was over pretty quickly. I didn't get an IV - just a shot - ?

I came out of the room feeling like I'd listened to a bunch of rock music. I'm glad it's over, but if I had to go through it again I'd be able to handle it.

You'll do fine - and you're not a drama queen! I survived - I'm here - no needle pain - you'll do the same. In other words, just "git 'er done."

Deb

[Dogmama]

Thanks Beth. My mom gave me a swift kick in the butt via phone at lunch. It is now the IV really bugging me, :o

Be sure that you are well hydrated before your test. That will help with the IV insertion.

[Aggie_Ama]

After all that I am cancelling it for now. My insurance does not cover until I meet my deductible meaning the test is $600 out of pocket. Since my neuro said it was more to "dot the i's and cross the t's" than needed I am going to wait. I have to see him again 1/19 and I will discuss with him what the test will help us with and why they do them for tremors in the first place. The imaging company requires you pay up front, if they would bill us that would be okay but right now my husband and I have chosen to let me see the neuro again before having the MRI. I will likely have it done after 1/19 to give my doctor some insight but not tomorrow.

I need to up my inderol, it is just not enough at 20 mg. :(

[coyote]

Be sure that you are well hydrated before your test. That will help with the IV insertion.

+1 on that. Drink a lot of water the night before....like a gallon if you can. If you are the least bit dehydrated your viens are harder to find.

I got that tip the first time I tried to donate blood while living in the desert.

[OakLeaf]

+2 - only time they've ever had trouble finding a vein on me is when I needed the IV because of dehydration. That was no fun.


Edit - missed your last post, Aggie. That stinks :( Can you schedule it for the first week of the year, and have it done through a hospital where they would bill you? That way you wouldn't be "wasting" your 2008 deductible, but the results would still be ready for your neuro appointment on the 19th.

[Aggie_Ama]

I am going to ask my neuro if there is another imaging center to use since it is stupid this one knows it is a hefty fee and want you to pay up front. My insurance renews in July, so our deductibles actually carry over. I really want to discuss the test with my neuro since I went 4.5 years without one. I would like to know what we might learn and go from there. I will probably be on a 3 month schedule with the neurologist until we get my meds in check since it went into remission and then came back. We are trying completely new medicine and I have constant leg tremors now which was not the case in 2004.

I have to call my doctor to adjust the dose of my meds, I will ask them to see if there is another center. Edited: There is but they are going to see if he is okay with me waiting until after the next appointment. I think the one they use will take 1/2 up front instead of the full amount but $300 at Christmas is more than I can really swing this year. I know the imaging center has bills to pay but it is really a lot of money for us "to do the i's and cross the t's". :(

[Tuckervill]

I see you've canceled, but the IV...here's a tip. If you have any doubts about the person who is doing it, ask for a phlebotomist. I've been in a situation where the person didn't know what they were really doing, and I had to be stuck at least 4 times and and they still didn't get it! They finally called in a phlebotomist (which is the person in the hospital who just does blood draws) and I didn't even feel the darn thing!

Since then, they only get one chance with me, and then they have to swallow their pride and call someone who is better at it!

It really doesn't hurt that much, and it's only a very short time that it hurts. Once it's in, it doesn't hurt. I take a really deep cleansing breath and I don't look, either.

Karen

[Aggie_Ama]

I talked to my co-workers and we have two plans, even the higher ($$$) plan has this issue so at least that is good to know. I only went to the cheaper this year. And my deductible does reset in January even though insurance renews in July. I might as well wait until after the first of the year to get this done and have much of my $1k deductible met for 2009. Insurance can really be a pain. The doctor's office will also give me a list of other offices to do it, maybe one will bill me for it or let me up front pay less.

[snapdragen]

Check to see if your insurance plan has a preferred imaging provider -- that might help with the cost too.

[Miranda]

Hun, I'm sorry you're having to get back in the tube of doom. It is a test that shows a lot of stuff that no other does.

I have been in there serveral times with my neuro junk and other stuff. I am claustrophobia. I need sedation and a driver, though last time I did make it without. Even though the claustrophobia is technically an imagined fear, it causes me emotional upset. Which emotional upset is one of my asthma triggers. Not being able to breath due to an asthma attack, and being stuck in the tube, gets to be a real problem. I think the brain is the worst. They clamp that awful cage over your face in addition the the tube.

For me... eyes closed, washcloth over my eyes, the tech wraps me up in a blanket tight, no music--talk to me instead... asthma meds before, happy drugs. Plus, I go scope the place out before the test. If I don't like the faciltiy, I shop another one. See the room. Meet the tech. "Hello... I'm Miranda and I think I may die on your watch, can we make a plan for that not to happen? I know you don't want to use your cpr skills...". It's amazing how nice people can be when you ask them "right" :o. Actually, I have my own techs memorized by name now and check when they are working. How high maintenance drama is that?:rolleyes:

On the DH, well, I'm married to his brother and then some. I've had my 80yr half-blind mother take me before, kids screaming in the parking lot w/g-ma, and drive us all home with me laid out on drugs. Sounds safe, eh? Actually, my other thought at times was to employ an aid from a home health agency as a driver. Or take a taxi. I know that sounds a bit cold, but really you just need reliable wheels at a minimum. I know such services exists. Maybe the docs office, or MRI center might have a tip?

Mom in her age and wisdom says, where there's a will, there's a way... women are very resourceful creatures. Spirits of positive wishes will be with you from your cyber sisters when the test time comes.

EDIT: IVs... did you know there is also a topical numbing cream they can apply before the stick to take care of the pain of the needle? If you are getting sedated and have to be there ahead of test time anyways is no big deal. Just check ahead to make sure they have it on hand. It's like a thick white skin lotion. Btw, the lab I used to work at did some major university sports teams... the football linebackers were the ones that always fainted the hardest at the sight of a needle.

[Duck on Wheels]

I learned this from one of my PhD students' field notes (She was observing doctors' meetings at a neurology dept.): MRIs are pretty much a standard test nowadays for anything neurological. When they can't figure something out, they tend to say "Hmm. Have we done an MRI yet?" The MRI shows lots of interesting stuff. The results look like an x-ray, but where an x-ray mostly shows bone vs. soft tissue, the MRI differentiates between all kinds of tissues with varying densities and water content. So an MRI can differentiate between bone, muscle, nerves, veins, and so on. That makes it like a "shotgun" exam -- it "hits" just about anything in front of it. Tumor, yes, but also stuff as banal as a pinched nerve or a bruise. Depending, of course, on how close together they take the images, which are like "slices" that they can then patch together for a 3D-view. Close together they're more likely to catch even teensy stuff, further apart and they might miss that pinched nerve.

They can also retune the whole machine to show physiochemical processes, like lactic acid accumulating as you work a muscle. But that does take re-setting the machine, so it's either the tissue differentiation view or the physiochemical view in any given exam.

The magnet is noisy, kind of like a car backfiring. The machine is also kinda clanky as it revs up. But with ear plugs, and maybe some Xanax, the noise shouldn't be a problem. The machine looks like a big tube with a gurney that slides through it. You lie on the gurney, as comfey as they can make it (but it is narrow and confining, so they can never get it to the level of a 5* hotel bed). They slide the gurney stepwise through the machine, taking image after image "slice" by "slice" (metaphorically, of course. there are no sharp edges to this thing, so no actual slicing). Then they slide you out and it's over. Each image can take a few seconds, and they don't want you to move, so they tell you when to expect the noisy bits that you have to lie still for and when you have a wriggle break.

The physics of it all are pretty fascinating too. I'm sure there are actual physicists on the board who can tell me I've got this wrong, but I think it has to do with hydrogen atoms, the way they spin and the way the line up all parallel to one another under the influence of certain combinations of magnetism and radio waves. Somehow, the machine can tell whether they're lined up or relaxed and whether they're spinning one direction or another. It can also tell how long it takes them to line up and relax as the radio waves (or is it the magnet?) are switched on and off, and the difference in these times has to do with the density of the tissue. So where an x-ray machine is sending radioactive particles through you at a film, the MRI is only using magnetic and radio frequency waves. In other words, it's safer than the more familiar (and therefore less scary?) x-ray machine.

[Aggie_Ama]

Duck- THe science behind it is fascinating. I am going to have it done after the first of the year I reckon. Then it counts for my 2009 deductible and if something crappy happens and we end up in the ER or hospital we can write it off. I hope not but having it done this year still wouldn't get me anywhere near write off level. ;)

[Mistie]

I have had an MRI of my head. My mother was diagnosed with MS about 10 years ago. I started to have numbness in my right hand (along the pinkie finger). Doc thought it best to do an MRI which would be a baseline if nothing was there. Negative for lesions and the numbness was actually due to a ganglion cyst that was growing on a tendon. Ask for a washcloth as the lights can be strange. There will be a loud banging noise all around you. It bangs at points as the machine goes around your body. It lasted 10-15 minutes, maybe? I can't remember how long. No moving during the process though. It wasn't scary, just weird.

[alleyoop]

Amanda, I am so sorry you are going through this. I just read this thread! If you are having the test in Jan, I might be able to help with the transportation. Just email me! If it is a MWF morning, I should be able to help! I live next to your work, so I am SURE we can figure something out! Please, don't hesitate to ask. After 2 c-sections and an appendectomy this last spring, I have the self-advocate thing down pat!

-Heather