Life as a research subject
by David Nilles
I write about NDSU research every day, and now I am about to take my understanding of what that means to a whole new level. I'm about to transition from observer to research subject.
And. Here. We. Go.
Max Pagel looks up from his computer as I gently knock on the door and stick my head in. He's in an athletic training room deep within Bentson-Bunker Fieldhouse, and though I've spent many years on campus, I had trouble navigating the basement maze. I'm late for my appointment.
He reassures me I'm in the right place.
The study is about the effects of caffeine ingestion on muscle cramping, which requires people who are capable of consuming caffeine and have muscles to cramp. This means I need to agree to a few dietary restrictions and the prospect of "some discomfort from electrical stimulation."I'm willing to try most anything once. And since I'm the only writer on the team young enough to fit the study's age requirements, I'd feel guilty saying no.
Pagel stands up from his computer. He is tall and has short-cropped brown hair with a beard to match. He is fit and lanky, the build, I presume, of a former athlete. He certainly looks the part, wearing a hooded sweatshirt and khakis.
He hands me a questionnaire. I answer standard questions about heart, mental and blood-borne diseases, family history and my current health. I get weighed, so no luck if I fibbed about my body mass index. Next, he asks me to remove my right shoe and sock and motions for me to sit on the green athletic training table near the room's entrance. I'm thankful for the morning slot so a complete stranger doesn't have to inspect my foot after a day in dress shoes.
Pagel begins firmly tracing his thumbs along the top and side of my foot. I am momentarily self-conscious. But he works with athletes every day, I tell myself. Some sock fuzz is likely the least of his concerns. He is searching for my flexor hallucis brevis, the muscle responsible for flexing my big toe. Somewhere midfoot he finds it and reaches for a permanent marker. With a ruler, he meticulously measures down the side of my foot and adds two dots to my sole to mark the proper location for sensors that will measure my leg and foot muscles.
Pagel doesn't freely offer up much information, but he answers any questions fully and quickly. It's a trend he keeps throughout the study. Rather than pepper him with questions, I take mental notes and let him work.
I notice a computer on a mobile cart nearby. The cart's lower shelf holds what I later discover is an electrical muscle stimulator. I don't think much of it at the time. It's just another piece of equipment in the windowless room. It might appear more threatening if I knew it would be responsible for sending electrical impulses into my foot. But, for now, it's a silver box covered in an assortment of knobs and switches. Sometimes naivety isn't a bad thing.
Pagel asks me to roll up my pant leg so he can pinpoint a final spot just below my right kneecap. He uses a disposable razor to shave a small patch of skin. It's the first of several times I wonder what my aged colleagues are doing. He lightly brushes around each dot, and another inside my right ankle, with fine sandpaper. I expect a sting when Pagel cleans the areas with isopropyl alcohol, but none comes. Each of his movements is purposeful. He doesn't waste any motion. He's efficient.
Pagel needs to be meticulous with these steps, and he is. He attaches four disposable patches to which sensors are clipped. Each location must be accurate for each research subject. The sensors are connected via wires to a sending unit the size of a cigarette lighter, which, in turn, feeds into the computer. The entire mechanism is responsible for spitting out data on my muscle movements.
I know that researchers, including some at NDSU, already have studied the impact of pickle juice and potassium on muscle cramping, which makes me wonder how Pagel settled on his research hypothesis. He tells about a football game he attended as an undergraduate athletic training student at Minnesota State University Mankato. Four players repeatedly left the game with leg cramps. A trainer discovered all four of them had consumed caffeine-laden energy drinks prior to the game. Pagel didn't think caffeine was the problem, and his study will go a long way toward helping prove or disprove his hypothesis.
As Pagel talks, he locates an arterial pulse on the inside of my ankle. It lies next to the nerve that directs signals to my big toe. I learn this from Pagel. I've never given my foot's function much thought.
Today's goal is to tell my nerve to tell my toe to flex. To accomplish this, Pagel places an electrode on my ankle over the nerve. When he hits a button on the muscle stimulator, the electrode sends a single electric pulse into my foot. It's a bit of a shock, literally.
Pagel spends several minutes looking for the correct spot to place the electrode. It's important to his study to get as accurate of information as possible. We find the right spot with my feedback. He straps the electrode in place with an athletic bandage.
We begin baseline testing. Pagel asks me to flex my toe four times. As I do, we both watch the computer screen. The software program traces and records my movements with a sine wave. The oscillation produces data Pagel will use to support his findings.
I realize my presence isn't the important part. It's the data I can provide.
To extract that data, Pagel will send electrical pulses of increasing intensity, measured in hertz, through my foot. If my foot doesn't cramp, I rest for 60 seconds before a higher intensity pulse.
Pagel clicks a mouse. A second later a quick burst of eight electrical pulses surges through my foot. Each pulse briefly flexes my big toe downward. The effect of all eight pulses feels like a foot cramp, which is the ultimate goal.
Aside from the pulses, I feel nothing and my foot relaxes.
After the first 60-second rest, Pagel increases the intensity and sends another set of pulses through my foot. We repeat the process several times. Pagel reminds me to fight the urge to flex my foot, which is difficult when it wants to cramp.
I find myself trying to remember what combination of hertz and volts causes electrocution. I'm not concerned for my safety, as Pagel regularly checks on my welfare. It's just the type of thought that crosses my mind each time a relative stranger straps electrodes to my leg after I've signed an informed consent release form.
Pagel asks me how I'm doing. "OK,"I lie.
Pagel turns the stimulator to 12 and clicks the mouse. He notices it before I feel it, but my big toe is stuck pointing downward. "Do you feel that?"he asks, glancing at my foot, then the computer and then me. I fight the urge to flex my foot, which by now is locked in a full-blown spasm. It feels like a charley horse, and once it takes hold, focused mainly in the ball of my foot, I desperately want to stomp, shake or massage my foot - anything but hold still.
Pagel makes sure he has adequate readings. He then slowly releases the cramp by pushing up on my toe. It's a relief. We have our baseline and I'm done for the day.
The next day I receive an email from Pagel. I briefly wonder if he's booting me from the study because I wasn't tough enough. No such luck. It's a list of caffeinated foods and beverages to avoid. I must abstain from caffeine for the rest of the study. A dull headache reminds me that I should be cutting back anyway.
I return to the lab. Another test subject is lying on the table. I quietly take a seat while Pagel continues with him. "We're going to 14. Are you ready?"
The subject, Grant, nods that he is. "And, here. We. Go."
Grant is holding the rolled-up towel. I feel a little better about myself.
During a 60-second rest period, Pagel walks across the room. He tells me to close my eyes and hold out my hand. I comply. I'm not sure what to expect, but I presume it involves taking a pill. I know I will receive three during the study. Each contains varying levels of caffeine, ranging from none to the equivalent of three 16-ounce cans of energy drink.
It is a pill. I swallow it with a plastic beaker full of water.
Meanwhile, Pagel finishes up with Grant, who cramps at 24 hertz. I wonder if I look that comfortable. I'll find out soon.
After Grant leaves, I remove my shoe and sock and take his place on the table.
No sandpaper this time, just a little alcohol prior to sticking on the sensors. Pagel easily finds the nerve in my heel. Both of us know what he's looking for.
The only change in today's routine is a 30-minute wait for the pill to take effect. I lie on the table with my eyes closed. I can't nap, so I ask Pagel more about his hypothesis.
It takes 22 hertz to cramp my foot. It's a new personal best, although I wonder if it supports Pagel's hypothesis. I later find out the pill was a placebo. It shouldn't have differed much from my baseline number.
The remaining two tests follow the same pattern. I take a pill, rest for 30 minutes and begin the electrical impulses. In essence, they are routine.
And then my role in Pagel's study is complete. I go to Pagel's office one last time to collect my research-subject compensation. This time I don't knock and startle two students. One is lying on her side on the training table. Another research study already is underway.
Pagel tells me he has been surprised by some of the results. His gut feeling is they won't completely support his hypothesis. Then it is my turn to be surprised. Pagel tells me my foot was hardest to cramp.