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Contrast or no contrast

nattyay
Posts: 12
Joined: Apr 2010

After my left radical nephrectomy in February 2009, my Urologist was adamant that my CT scans be without contrast. Initially they were concerned that my other kidney may have been diseased, but it is a healthy working kidney (thank goodness). Even after this confirmation, CT scans were ordered without contrast.

This year, I switched insurance companies. My new doctor is ordering my CT with contrast. I've explained that past CT scans have been without contrast. She then discussed the matter with a nephrologist who confirmed that this was standard operating procedure. Keep in mind that medical records were not adequately transferred over, and I had to verbally provide my medical history to the new insurance company. She said if I had concerns to speak with the radiologist. I talked to the radiology department who indicated that they would use Bisipaque, which they indicate is a less-stress dose IV contrast. Who is right and who is wrong. If I need contrast why hasn't it been used the last three times?

JackieP125's picture
JackieP125
Posts: 55
Joined: Jan 2012

I have had 2 CT Scans and both were with Contrast and IV Dye. I understand that this stuff lights up the tumors and that is why it is important. I don't know why you didn't need it before but I believe everyone here does the Contrast. This stuff is awful!!! But very necessary according to my Oncologist.

icemantoo's picture
icemantoo
Posts: 1452
Joined: Jan 2010

There is no right or wrong answer. Contrast of course can give clearer pictures and a more accurate diagnosis. Contrast however can adversley effect your Kidneys and usually if not always the doctor requests certain blood tests before or as a condition to contrast, The blood tests are bun and creatine. The better question for your doctor would be, why do you think I should have contrast and vice versa. Based upon your medical history there may be more than 1 answer to your question.

Icemantoo

love4life
Posts: 33
Joined: May 2010

My mom had her kidney removed in 2009. Since then she has had her scans with contrast. Before each test she goes in 2 hours early for iv's to hydrate her remaining kidney and then receives another iv for 2 hours after the test to flush the kidney. Maybe you could ask your doctor about doing something like that if you want to make sure your remaining kidney is protected.

donna_lee's picture
donna_lee
Posts: 388
Joined: Feb 2009

The only non-contrast CT I have had was the diagnostic one in April 2006. Since that time, I've had nearly 20, all with pre and post hydration, all with iodine contrast dye, and acetylcyst oral the day prior to and morning of the test.
The dye helps define the outline of whatever may be there, the acetylcyst is a mucous thinner, and the extra pre/post is to provide additional fluids to help the remaining kidney flush out the dye. Oh, and don't forget the the 2 (two) containers of Barium Sulfate to drink, starting one hour before the time of the test. Even with flavored "BS", the last few swallows are gagged down. This is for the gastro-intestinal system illumination. So during that post hydration, it really becomes "BS" and it rapidly passes through.
I think I dread the CTs worse than getting the results.

But as stated by others, ask your Dr.
donna_lee

Minnesota Girl's picture
Minnesota Girl
Posts: 115
Joined: Jul 2011

I've had two follow-up CTs, both with contrast. They always check my kidney function that day and I get a lower than normal dose. I haven't done the pre and post hydration that others mentioned.

I know from experience, though, that it is the contrast that makes the tumor glow. I had a non-contrast CT about 2 1/2 years before my diagnosis. Once the tumor was known, the radiologist was able to look back at the older non-contrast CT and see the shadow of the tumor. If I had contrast on the earlier CT, my cancer would have been found 2 1/2 years earlier. Luckily, I was still diagnosed pretty early.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

That's about as convincing an argument as I've ever heard for having contrast unless there's a very strong reason for not doing so. It's lucky they still caught yours early and one has to wonder how many cases there are which don't enjoy the same good outcome.

jhsu's picture
jhsu
Posts: 78
Joined: Sep 2009

I’m wondering, if a nodule lodges in right next to a main vessel which one has a better possibility to see it in the scan?

Jon

foxhd's picture
foxhd
Posts: 1855
Joined: Oct 2011

My schedule seems alittle intense compared to everyone else. Since november, I get a ct scan every 6 weeks! I need to drink a bout a liter of contrast and then get an IV contrast moments before my scan. Fortunately my GFR has remained over 60. Now if all these scans don't kill me. And so far, it is possible that this schedule will continue as long as I am in treatment.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

I'm in much the same boat as you Fox, except for about 12 week intervals, probably indefinitely, and having a scan without the dye, then IV infusion while on the deck and then further scan. (The most unpleasant experience I've had in this whole game was the dx scan - drink plenty, wait a bit, drink quarts more, wait for ever - not being allowed to urinate all the while - then clamber painfully, while nearly bursting, onto the table, holding it in for dear life (which it might have been if I'd let it all out and had to wait for a future date to do it all again) then a seemingly endless wait, scans, then contrast in, more scans, shouting into the intercom 'I'm desperate, I can't hang on!' and being told 'Only another 20 seconds'. They cleared the way for me to roll off the table and dash to the toilet, door open ready --- OOOOOH! After that the subsequent surgery was an anticlimax!
I reckon you and I get special treatment because we 'contrast' with other patients - the radiologists must really like us and get a sort of warm feeling whenever we visit!

alice124's picture
alice124
Posts: 860
Joined: Mar 2012

John has had four CT scans--all with IV contrast. He's asked to drink two pints of water, but the contrast is delivered via IV. That has not varied.

ourfriendjohn's picture
ourfriendjohn
Posts: 72
Joined: Jun 2012

I am curious if anyone else is having MRI's for their follow-up imaging instead of CT scans. I have had one set of images since my Sept 2011 radical nephrectomy (17.5cm 2b,n0,m0 sarcomatoid) and the doctor ordered abdominal and pelvis MRI's w/o & w iv contrast instead of CT scans for that. Preliminary blood tests had shown borderline (high) creatine levels A chest x-ray was also performed. He has also ordered MRI's and the chest x-ray for the next set of images scheduled in about four months. Being very frugal I pushed for CT scans instead. He says he is concerned about the increased radiation exposure that I would be exposed to with the CT scan and the potential effect of the required contrast material to my remaining kidney. Do any of you have similar experiences or information on CT scans versus MRI's?

John

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Jon and John - there is a medical physicist, Susan Poteat, on the Acor KIDNEY_ONC list who can, and tirelessly does, give authoritative answers on questions about medical imaging. She can tell you the respective merits, hazards and contraindications for these technologies.

(John, its excreted creatinine they measure, not creatine.)

The latest CT scanners emit much less radiation and the risks are probably well justified for the crucial information they can reveal.

ourfriendjohn's picture
ourfriendjohn
Posts: 72
Joined: Jun 2012

I appreciate the reference to Susan Poteat. I have seen the you and Iceman's referrals to the Acor KIDNEY_ONC list in the past. I still have so much to learn. Thanks for being there for us newbies.

John

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

John, I hope you found Susan's reply helpful.

ourfriendjohn's picture
ourfriendjohn
Posts: 72
Joined: Jun 2012

Yes, her responses were very helpful. As it turns out that we both have ties to Atlanta and North Carolina and she was able to give me some referrals for RCC specialists in Atlanta. I appreciate you referring me to her. The ACOR list is a bit more technical than CSN but appears to be a great resource.

Limelife50's picture
Limelife50
Posts: 409
Joined: Nov 2011

Hey listen up just to let every one know once there is damage to your kidneys from the contrast for the most part it is irreversible so what i have decided to do is to go with a half dose

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

That sounds like a pretty standard protocol Alice - anyway it's the same as the administration I'm subject to, except that the first one I had, for initial dx, involved drinking more and lengthy waits. I guess that next time I have one I'll enquire why the first one had to be so excruciating.

donna_lee's picture
donna_lee
Posts: 388
Joined: Feb 2009

I yr after first DX and surgery, the difference between a 9 mo and 12 mo CT showed a node that had not been present earlier. It was attached to the Inferiour Vena Cava and the Duodenum, positive on biopsy, and surgically removed.
Another year later, very similar story, this time posterior or behind the bifurcation of the aorta in the lower pelvis (where it splits to go down each leg.) It was too difficult to access for biopsy, but lit up on a PET scan. More surgery. So now the incision scar runs from my bikini line to my right armpit. Oh well, bikinis aren't my thing anyway.

By the way, got my test results today. More nodules in the thyroid. Some had shrunk, and others were present, and some had grown. The rest of me, left kidney, urinary bladder, right half of liver and spleen hadn't changed much. Next step is see an ENT, since the non-cancersous thyroid nodules seem to be causing pressure along the clavicle, i.e., seat/shoulder belt, and especially after the ultrasound last week. I feel like I'me being choked.
And in another 3 months, its back for a CT...with dye. I have a couple of friends in the support group who can't have dye for lung or other tests because they're allergic to it-makes them go into anaphalaxis.

Hey-you been watching the Olympic Trials? Since Eugene is only a couple of hours drive, the track stuff has been great to follow. I went to school with Steve Prefontaine's sisters. It was great to see Ashton Eaton break world record in the Pentathlon. His fiance, Briane Thiesen is representing Canada in the Heptathlon. And they both graduated from U of ORegon.

PS-those of us with metal in us can't have MRI's -it gets hot and starts moving to the on/off rotation of the magnet. I have a mending plate & screws holding ribs together where they had to separate them to access the liver ( and you can imagine what I said the Dr. did to me in that surgery!!!); and then 6 months later the orthopaedists put my ankle back together with 2-2" screws on the tibia and a plate and 6 screws on the fibula.

Have a great July 4.
donna_lee

foxhd's picture
foxhd
Posts: 1855
Joined: Oct 2011

Donna lee, sounds like an average day in your life.... I'm also looking forward to the Olympics. Have a good holiday also!

alice124's picture
alice124
Posts: 860
Joined: Mar 2012

Hi Donna Lee,

I hope you get a quick appointment. That pressure on the clavicle sounds terrible.

It is fun watching the Olympic trials, particularly if they are being held near your home base. Michael Phelps is almost a neighbor of ours, only a mile or so down the street in a high dollar waterfront condo. He's spotted on occasion at our local Safeway, and he's shown up at the golf club where John belongs. John says golf is not his sport and I actually got the feeling from John that Michael and his band of friends were a little irreverant when it came to golf. That doesn't earn you merit badges in my house. I was surprised to see John actually watching the trials; guess Michael has been somewhat forgiven.

Hope you had a great 4th. I haven't been able to get into this site lately. Server has been down more than it's been up.
________________________________
Fox - if you are reading this, waiting anxiously for your scan results. How are you feeling?

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

You've probably noticed, Alice, that ACOR has also had some problems lately. Have many servers been knocked out recently in the US (maybe due to adverse climatic conditions)? Like you, I've been finding CSN down for extended periods over the last day or so.

I'm about to write to the CSN team again to enquire how they're progressing in addressing our issues and suggestions. However, I won't be doing so tonight because I'm too bushed.

I played the Carnoustie Championship Course this morning and was going into the Club for a coffee with my pal when I was greeted (at about the spot where the laddie is holding the Olympic Torch in my pic) by a bunch of members saying 'so glad you made it - you're on the tee in 10 minutes on the Burnside Course'. I've been away in London and Edinburgh lately and didn't know I'd been picked for an inter-club seniors match. I had to swallow a quick cappucino and head out again. Fortunately I finished off our game with a birdie 2 on the 16th hole for a 3 & 2 win and our Club whitewashed the visiting team 6-0 so I wasn't in bad odour for nearly missing the fixture!

However, it wasn't exactly model self-care: around 10 mile walk, sunburnt, dehydrated, missed lunch and finished the day in the Club with curry, fries and rice and a pint or two of Guinness. Still, tired but happy!

I'll write CSN but the weekend priority is feet up and watch Serena notch up another triumph at Wimbledon and then, on Sunday, with luck, see our local boy, Andy Murray, beat Roger Federer for the Mens' title. Are you and John into tennis? And now, the Olympics almost upon us in my home town. I'm so glad I survived into this great year of sport, in addition to all the other, more important, things that make life worth living (as detailed in the excellent posting by Maria Doherty on ACOR!).

icemantoo's picture
icemantoo
Posts: 1452
Joined: Jan 2010

I had an MRI without contrast yesterday on my knee (after a bad fall) as ordered by an Orthepedic surgeon. I suspect that it was without contrast because of my Kidney history, I will follow up with that question on Monday. Isn't it nice to talk about something medical other than the kidney fo a change. I guess that will happen more and more as we get older. I will be 69 next week.

Icemantoo

Machelle03's picture
Machelle03
Posts: 27
Joined: Jul 2012

My husband Pat has had contrast with all of his CT scans. We make sure he drinks plenty of water beforehand and the bloodwork has shown thus far that his kidney is healthy, praise God. If you can have the contast I would say do it. We all need to make sure the doctors can see all they can. My thoughts and prayers are with you.

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