Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#33 Brain MRI: What Could Possibly Go Wrong?
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Summary:
What happens when you need a brain MRI—but the results leave you with more questions than answers? In this episode, I take you through my personal journey of facing unexpected MRI findings, the emotional and medical challenges that followed, and the valuable lessons I learned along the way. If you've ever dealt with medical uncertainty, this episode is for you.
Key Topics & Takeaways:
- The Decision to Get an MRI – Why my persistent vertigo symptoms led me to pursue brain imaging.
- The MRI Experience – What to expect, including the impact of claustrophobia and tips for managing anxiety during the scan.
- The Immediate Shock of Results – Understanding what “chronic microhemorrhage” means and how I navigated the initial fear.
- Seeking Answers – The process of finding a neurologist quickly versus waiting for a super-specialist.
- The Power of Medical Conversations – How reviewing my MRI images in detail helped clarify what was truly concerning (and what wasn’t).
- Lessons for Everyone – How to approach unexpected medical findings, manage anxiety, and make informed decisions about your health.
- Practical Next Steps – From tracking symptoms to preparing questions for doctors, how to take control of your health journey.
🔹 Take Action:
- If you've ever faced an unexpected medical result, take a step back, ask the right questions, and seek out the right specialists.
- Interested in the six pillars of longevity and wellness? Download my free eBook "How to Live Long and Well" at DrBobbyLiveLongAndWell.com.
Getting a brain MRI. What could go wrong? I needed the scan, but it showed abnormalities that were worrisome and I was left with uncertainty and fear. I learned several lessons from my life, and perhaps yours, perhaps yours. Hi, I'm Dr Bobby Du Bois and welcome. To Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and figure that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome everyone to episode 33, brain MRI. What Could Go Wrong could go wrong? Well, in past episodes like number 12, to test or not to test we talked about screening, where you might get one of those hundreds of blood tests or a total body MRI scan, and the goal there was to try to find if there is any disease really really early before you get symptoms and to try to intervene Now. This sounded good and I talked about it in the podcast, but there are problems with false positives, where a test is abnormal, and that may lead to a lot of anxiety, further testing and even complications. Now I have my own story to tell and share and I think there's some lessons for me, and I think maybe some lessons for you, from what I experienced. So let's begin with my story. Now. This is not about a screening MRI scan. This was not something that I was like. Well, maybe I should just do this to see what might be there.
Speaker 1:I woke up a couple months ago and the room was spinning. Now, I wasn't lightheaded, it was truly spinning and as I would get out of bed for about 30 seconds, everything would just be spinning in circles and then it would go away. But I had kind of a low-grade headache, almost like a hangover, during the course of the day. Now, when this comes on suddenly like this, the most likely cause it's what's called benign paroxysmal positional vertigo. It's a long name, but basically it has something to do with what's going on in your inner ear and there are little crystals in there and sometimes they get into the wrong place and that can cause the problem and it usually resolves in a few days or perhaps a few weeks. Well, several months went on and it was still there and I was like this isn't normal. This doesn't seem like the benign positional vertigo. I wonder if there's something more I should be aware of.
Speaker 1:So I went to my primary care doctor and he and I thought that getting an MRI scan made some sense. Now, as I titled this, what could go wrong with an MRI scan? Well, as I walked in there, the technician said well, do you have any metal in your body, like a foreign object or an artificial joint or a pacemaker? And I had this image that if I had one of these things with the magnet in the MRI scan and it's a huge, powerful magnet all these things could come flying out of somebody's body, which, of course, would be rather dangerous. And what I learned was no, I don't have any metal in my body. But if I did something like that, they aren't going to come flying out of your body, but they could get dislodged a little bit, and that wouldn't be ideal. And so, of course, you want to tell people at the MRI scan place about it. Well, I live in Austin and everybody and his brother has a tattoo, and they ask you about tattoos because I guess some of the tattoo paint may have some metal in it. And no, the tattoos are not going to come flying out of your body. Again, that was the image I was thinking, but the tattoos and some of the metal can distort the image, and so it's very important to tell folks about that before you go into the scanner.
Speaker 1:Well, back to my story. That was just a little bit of a detour. So I went and did the MRI scan and doing the study was pretty uneventful. Now they talk about what are called open MRI scans, and this means that you know the head of the scanner and the foot of the scanner are open, but when you're actually doing it, you're in a tube. Even though the tube isn't closed at one or the other end, you're in a tube, and for some people it can cause some claustrophobia or feeling uncomfortable. Now, as we learned in episode five about mind-body harmony and meditation and breath work, that's what I did. I closed my eyes while I was in the scanner and it took 15-20 minutes. I closed my eyes while I was in the scanner and it took 15-20 minutes and was able to meditate, and if I had any anxiety about being in this narrow tube, the breathing and the meditation helped me a lot. So if you ever need to do an MRI scan, and this is something you're a little uneasy about. Maybe try some breath work or meditation. Okay, so the results Now.
Speaker 1:What was remarkable is that when you leave the MRI scanner area, the technician says, well, this has to be reviewed by the radiologist and you'll get results in the next one to two days. And it turns out, at least in Texas. I don't know if this is absolutely true everywhere, but once the radiologist has completed the report, in the old days they would send the report to your doctor who ordered the test. The doctor would review that and then it would be released to you, the patient. But now, apparently, the laws are at least here that they have to release the results to me at the same time as they release it to the referring doctor. So before I got to my car, I looked at my email and, lo and behold, there was the report, which was unbelievable that I got it within probably 10 or 15 minutes. This is all now electronic, so presumably they sent the MRI scan to some remote location where the radiologist was just sitting and available, read the report and within 10 or 15 minutes I had it, which is quite remarkable.
Speaker 1:Okay, so the good news is that when I read the scan results, there was no evidence of a tumor. There was also no evidence that might explain the vertigo. And here's the kicker. They wrote on the report the following chronic microhemorrhage in the left frontal lobe, white matter. Now, obviously there's a lot of gobbledygook here and you probably don't necessarily need to worry about what exactly it said. But chronic microhemorrhage. It said but chronic micro hemorrhage. Now, that can't be good. As I was reading this, I'm saying this can't be a normal thing and I'm not sure I'm happy about hearing I have a chronic micro hemorrhage in the front part of my brain. And this also brought to memory my brother-in-law who at a young age, had frontal lobe dementia, which was quite devastating on the family, and so this brought to mind could this lead to something like that? All right, so now I'm thinking about this as I'm driving home in my car.
Speaker 1:Of course, as soon as I get home I have to start doing my scientific homework. What is chronic micro hemorrhage? What does this mean? And I found review articles and I found primary studies and reached out quickly to my primary care doctor and again, he didn't know definitive answers about this either. So what did I do and this may be a lesson for you.
Speaker 1:I started a list of questions because I knew, ultimately, I was going to have to see a neurologist, and so this was the beginning of getting ready for that visit. First question what does it mean? What does it mean to have chronic micro hemorrhage? Secondly, what causes it? And I learned that it could be high blood pressure, and I have high blood pressure, which has been treated well, but maybe that caused it. And then there's something that worried me more and it's called amyloid angiopathy. Now when you hear the word amyloid, you think maybe Alzheimer's disease. So now I'm worried that potentially this puts me at significant risk for Alzheimer's disease at a young age.
Speaker 1:Now, all of these specific questions are not ones that are probably going to apply to you, or hopefully won't apply to you, but the process of asking these questions, and I'm just giving you these as examples as to what you might do if something like this arises. So, as I was reading about amyloid angiopathy, which is basically a blood vessel problem due to the amyloid, I was asking questions does it increase my risk of dementia? The answer is yes, several-fold increase, it appears. How common is finding something like this at my age, finding something like this at my age? And if there are chronic micro hemorrhages, how do I reduce getting more of them, because clearly more of them can't be good? I was on low-dose aspirin related to my cardiac risk, and should I stop the low-dose aspirin? All right? So these were some of the questions that I was starting to wrestle with Now over the next number of days.
Speaker 1:There was an emotional impact. So I'm very healthy. I follow the six pillars. Of course I talk about them with you. So of course I have to follow them. And you realize, well, look, bad luck happens even when you're healthy or appear healthy, and even when you're doing all the preventive care work that you can do. So maybe this is something that was my bad luck.
Speaker 1:And then I began to sort of reflect on well, I'm not going to die tomorrow from this, but it could mean that dementia strikes in some number of years in the future not 20 or 30 years, but maybe over the next three, five, seven, nine years. And what if I only have those number of good years left? Am I approaching life how I would like to? And I basically felt, yes, the life I have, running the exotic animal ranch and the bed and breakfast and then, of course, working with you, my audience, with the podcast and with coaching. Yes, I think I am living my life like I would like to. I love my wife, I love my family, I appreciate them. So that part I felt pretty good. But then I was like things like, well, you know, I've saved money over the years. If I had a more limited number of future years, would I do anything different? And my wife and I have been talking about going to Europe and I'm like, yeah, we're definitely going business class. There's no reason to not at this point in our lives. Whether I'm destined to have dementia in the near term or not, let's make that decision, all right.
Speaker 1:So these were the questions that I had queued up. This is some of the emotional impact that I was facing. What do I do next? Well, clearly, the next step was to see a specialist, in this case a neurologist. So this is something that many of you will face, which is in many, many cities increasingly, to see a specialist can take a long time. Increasingly, to see a specialist can take a long time. It can take months to get to see the specialist you really, really want to.
Speaker 1:So I had a discussion with my primary care doctor. Do I wait for the special neurologist at the academic center who might be the most expert at this issue of chronic micro hemorrhage, or do I find a neurologist that's more available? Maybe not on the you know 10 best neurologists list in the United States, but I was thinking, you know, this has got to be a relatively common question that comes up, and any good neurologist should be able to help me at least take things the next step. So we chose, my primary care doctor and I, to go to a neurologist who had availability quickly for me, and I was able to schedule to see him within a week, which was really quite remarkable. On Tuesday I had the MRI scan and, as I said, 15 minutes later I had the results and then within a week, I would get to see a neurologist who could help me begin to understand what the journey was ahead of me.
Speaker 1:Now, if you've listened to episode 20, do you like your doctor? I walk through a whole series of things about how you judge your relationship with your doctor and ways that you might make it better. By all means, listen to episode 20 if you haven't, or if you'd like to refresh your memory. And so there were a whole lot of things I was thinking about as I was going to visit the neurologist and, as it turned out, he checked off many of the boxes of things that are very important. He saw me on time, he took time in the exam room, he answered questions. When there were some follow-up questions, I could email through the portal and he had referrals that made sense.
Speaker 1:Well, what did I learn Well? Well, what did I learn? Well, the good news is I am a physician, so it was very, very helpful to walk through the MRI scan together in detail, because what I got from the radiology department was just a written report, didn't really give me a detailed sense of what was there. So we walked through each slice of my brain, slicing it top to bottom, side to side and every other which way, and it turned out there was a little micro hemorrhage in the location where they talked about. It was very small. And then there was a thing in another part of the brain that might have been a micro hemorrhage or could have just been a blood vessel that we were looking at. So the first lesson that came out of this is that looking at the scan was way more illuminating with my doctor. Of course I wouldn't be able to understand the scan myself than the report. And in hindsight that report should have been more precise about how many micro hemorrhages were there.
Speaker 1:Was this something they commonly see in doing thousands of these MRI scans? That all ideally could have been included in the report. And since these reports go to the patient right away, even more important, obviously the radiologist has to be cautious about what it means. But there's a few things they could have said that would have just clarified things a lot. So in talking to the neurologist I said look, this is my scan. Is this something you see commonly as folks age?
Speaker 1:And he said it's really not uncommon, doesn't mean it's normal, but what he saw did not worry him. He said, look, this kind of thing does pop up. And he said there's no indication that this little micro hemorrhage puts me at great risk of dementia. And and this was the good news because you know, as I've talked about, when you do a screening test and again this wasn't a screening test you want to reassure yourself that there's no evidence of early disease. So I took this as an opportunity to say well, I got the scan and obviously I got this abnormality we're not happy about. But let's take a look at the brain more generally. And what do you think of the brain? And he said look, it looks great. There's no evidence of thinning or shrinkage or all the things that you think about when you look at an older person's brain as indicators that maybe there's early dementia. And none of that was there. So that was very reassuring.
Speaker 1:And then we got into a discussion about the level of blood pressure that would be ideal to reduce our risk of stroke. And he said well, if you keep it under 135 over 85, that's really good. But I said well, my understanding of the literature is that if you can get it down below 120, that's even better. And he said yeah, you're right, that's true. But for most people, if you try to lower the blood pressure that low people will get dizzy. So although statistically that's what you want to do, for most people, as they get older, their brain needs a higher blood pressure to keep all the blood flowing in the brain.
Speaker 1:Now, for me, getting below 120 doesn't cause symptoms. Of course, if it drops below 90, I do start to feel a little dizzy. So that made me feel good that I guess my brain was doing well, that it could tolerate a somewhat lower blood pressure. So I walked into my neurology visit with a lot of fear, a lot of concern about what this means and my future, and for me I was very fortunate that I left the neurology office feeling even better about my brain than before, because it was clear I didn't have a brain tumor and not likely to get one in the next year or two because these are often slow growing and that the brain looked good and healthy and no early signs that maybe something's going on All right. So now I'm left with the most likely diagnosis that I in fact have that benign positional vertigo, even though usually it's gone within days, weeks or up to a month. Yes, after two months I did have continuing symptoms, but the good news is actually, between the two months and three months it finally did pretty much go away.
Speaker 1:But you have to ask yourself the question. I asked myself the question, but I don't want the vertigo to come back. What's the likelihood it will, and this is true for all sorts of illnesses. You want to know is it going to come back? Well, there's about a 25% rate of reoccurrence in the next year. So of course I asked the question can I reduce that risk?
Speaker 1:So went to the literature and it appears from some studies that vitamin D can reduce the risk. Oh, great, so let's take vitamin D supplements. But and this is why it's so important not to get carried away with studies without reading them more carefully the only time vitamin D helped for these vertigo patients was if your vitamin D level was already low. Well, that kind of makes sense. If it's low, maybe treating it could make it better. Well, in my case, my vitamin D level is just fine, so there's no reason for me to take vitamin D, and some reasons we can talk about it at next podcast, about why you don't necessarily just want to take vitamin D, especially at higher doses, for no reason.
Speaker 1:And it turns out, if you have this vertigo problem, there's some really good physical therapy they can do. Basically, it has to do with lying you down and turning your head in certain positions, and the vertigo can be resolved within one session, maybe two sessions, but generally you can really do a good job by doing that, and so, even though I don't know how to prevent it, I now know if one of these episodes pops up, I'm going back to the physical therapist. Now this is a special physical therapist that focuses on balance and dizziness, that I know what to do for the future. And here's something that I didn't realize is possible. Maybe I don't, you know, I have a referral to the physical therapist and those are good for a year, but I'm like, well, what if I get this episode again 18 months from now? And what the physical therapist said to me is what you can do on a yearly basis is ask your doctor just to put in a referral, even though you don't need it, and that referral will be good for the next year. So if anything happens, I don't have to reach out to my primary care doctor, wait for them to make the referral, the referral, get to the physical therapy place. It can be like a standing order and it will always be available to me. So if you have recurrent episodes of back pain or something else, this could be something you just keep in place so you're ready if a problem occurs.
Speaker 1:All right, let's sum things up. This was an episode I wanted to share with you because there were lessons learned, lessons learned by me and maybe lessons that would be helpful for you. First lesson even a test that you need, in this case the MRI scan, which was clearly indicated after several months of symptoms not going away. Even a test that's needed can send you down an anxiety-ridden rabbit hole, because it may come up with something that doesn't explain what's going on but could lead to worry.
Speaker 1:Second lesson when choosing for me when to see the neurologist and whether to go to the super super specialist or somebody who is more available, sometimes quick answers beats the super super specialist answer. So waiting six months would have led to a lot of anxiety, a lot of uneasiness, and in the end I would have learned from the super specialists that, yeah, it's not something to worry about. So for me, getting that answer within a week was really important. Now, I could have always seen a second neurologist from a tertiary care center after that. So for me and this is something to keep in mind maybe you just want to find somebody that's relatively available and then see how that goes, and if you still have uncertainties, by all means then go to the next tier of specialist. But for me that quick approach, which gave me an excellent set of answers, really was wonderful, rather than waiting six months.
Speaker 1:So I hope you don't get a worrisome diagnosis as we age. Probably we will at some point, but perhaps my journey might be helpful for you and give you some ideas about how you might address it. Let me know your story if something like this has happened, and maybe I can share that with our listeners and help all of us. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobbilivelongandwellcom. That's Dr. As in D-R Bobby livelongandwellcom.