Other Side Of The Coin

MedScanMan said:

Hi David
First of all let me say that you really did get a great scan. You had non Ionic Contrast (Omnipaque....best stuff), probably made you warm down below for about 15 second and maybe a little warm in the throat but no nausea. Years ago everybody got nauseous. The technologist not only did a venous and an arterial phase (meaning they were able to measure delayed iv contrast images, but he had the scanner reformat the axial images into a coronal view. That’s like stacking all the images on top of each other to get a complete view of your body from front to back. As far as the oral contrast, it does say that before the non contrast films you drank Gastrografin. This contrast takes the place of Barium.....tastes very bitter and for an Abdomen and Pelvis you would have had to drink two glasses.....then sit for a while and then a final glass before lying down. If you don't remember drinking that stuff (and you would, believe me), then the radiologist made a mistake in his reading. I'm glad they found your pelvis images. I told you they were in a computer somewhere. Hope you're having a good week-end.

Jeff

MedScanMan said:

Oral Contrast/Water
Good morning.....Normally whenever you have IV contrast you'll be asked to drink water for a good 24 hours so as to be well hydrated and your veins will be easier to stick. As far as Water being used in place of Gastrografin or Barium.....The very hi speed (New scanners) are so fast that even without oral contrast very little is missed in the GI track. The oral contrast is only meant to show stomach, small bowel, large bowel, and recto/sigmoid. When contrast shows in the rectum then the Radiologist feels the exam was complete. Some people are called back for a delayed scan of the lower pelvis if no contrast reached the area. As for water as contrast.....there is a Dr. who knows more about CT scanning than anybody in the country. He's at Hopkins and his name is Dr. Elliott Fishman. I do all my continuing education with him He travels with a lecture team all over the country and does full week-end seminars. Radiologists and Technologists getting their education credits together. I go for my CEU's and the Doctors get their CME's all at the same time. Below is what he says about Water Contrast in place of the others. Also you might find of interest the web site CTisUs.com. It’s his teaching site from Hopkins. There is so much you can see there. Every disease…..every way to scan them……movies to watch. It’s truly amazing. Read below. It may help.

Jeff

Recent advances in computed tomographic (CT) technology and three-dimensional (3D) imaging software have sparked renewed interest in using CT to evaluate gastric disease. Multidetector row CT scanners allow thinner collimation, which improves the visualization of subtle tumors as well as the quality of the 3D data sets. When water is used as an oral contrast agent, subtle disease is easier to visualize, especially when a rapid contrast material bolus is intravenously administered. Adenocarcinoma is the most common gastric malignancy and typically appears as focal or segmental wall thickening or a discrete mass. Gastric lymphoma can have a CT appearance similar to that of adenocarcinoma. Both gastric adenocarcinoma and lymphoma may be associated with adenopathy. Gastrointestinal stromal tumors (GISTs) tend to appear as well-defined masses that arise from the gastric wall and may be exophytic when large. GISTs are usually not associated with significant adenopathy. In addition to gastric malignancies, CT can also help detect inflammatory conditions of the stomach, including gastritis and peptic ulcer disease. CT angiography is especially helpful for depicting the gastric vasculature, which may be affected by a variety of disease conditions.

MedScanMan said:

A Tough One
OK....I won't refer back to the other thread you mentioned. The best I can do is tell you what the job is of each physician. (in my opinion). Radiologists are a breed of their own. If you've made up your mind to be a doctor, you have a couple of decisions to make after you graduate from Med School. Internship can be anything, but most of all it will tell you if deep down you're a "person". If the answer is yes because you enjoy speaking to, helping and getting close to patients and their families, then you have many choices. If during your internship you find yourself feeling holier than thou, flying above all the patients that want a simple moment of your time but you're too "good" to give that moment......if you find that you can't go on unless you begin anger management classes so as to bring you back to earth.....then Radiology should be your residency. These people (and I use the term loosely) should never expose themselves to patients and family. They need to come to work.....lock themselves in their room.....put the headset on and begin dictating. Actually the locks on these doors should be on the outside and they should have to knock a few times to be let out......for lunch.....etc.
As far as I know, all Urologists are trained in general surgery during their urology residency. I never knew a urologist that did not do his own Nephrectomy’s. Sometimes assisted by another general surgeon in case there were other unknown problems but they all spend at least one day a week in the OR.
Nephrologists are kidney disease specialists. Renal Hypertension, elevated BUN and Creatinine levels and dozens of other renal problems other than the many forms of kidney cancer including RCC. I know some Nephrologists that like to do their own renal biopsy work. They might not trust the Radiologist or their patients might ask them to do it as to not be exposed to another stranger.
Until my RCC I never had exposure to a Urology Oncology department. The hospital I worked in was a little over 500 beds and specialized in open heart. We had four ICU's. One for cardiac, one for surgical, one for renal (usually end stage dialysis) and one called CVICU. That was the busiest. Post open heart. Ten beds in each unit but CVICU was always filled. When introduced to the Urology Oncology Department at the Miami VA facility this healthcare worker found himself in unfamiliar territory. It had a staff of about twenty people. Doctors from the University of Miami spent two days a week there. The two hospitals practically shared the same parking lot. These very special urologists are in a category all unto itself. This is where you want to be if you're in our position. They're the most up to date on the newest procedures. They do fellowships at other teaching facilities and then return with new techniques. I've never seen anything like it. The attending had three 5th year residents with him at all times and they continuously bounced things off of one another. I felt very secure in their hands. I believe, and many on this board might disagree with me, but the Urology Oncology Department is where we as RCC patients belong. Even post op, because I knew all the doctors in the department I didn't care who came to see me during the day. And.....unlike most places where doctors turn things over to PA's I never saw one.

Hoped this helped a little. Just my opinion.
Jeff

MedScanMan said:

Maybe
Next Friday I'll try and come up with something. But if you want something funny, it won't be about Radiologists.

Jeff

MedScanMan said:

CT/MRI
Hi David,
I never thought I'd see this thread again. I read over what I had written to introduce myself here back in August.......and I'm thinking about the state I was in back then. Thinking of my own situation, I sort of blame myself for my cancers. Having two unrelated cancers pop up at the same time (RCC and Bladder) brings me back to college in the 70's in a three year Radiologic Technology program and how much radiation protection was stressed. Actually during my one year internship at a local hospital here in Broward County Florida, we were scored on that. Over the years I seemed to let it go. I fell into the mindset of "if you can't see it, it can't hurt you". Very bad thinking on my part.....asking an assistant to push certain buttons for my while I covered myself with lead aprons and lead neck protectors just to make a nervous patient more comfortable, at the beginning doing thousands of early morning portable chest x-rays and not fully leading up and not standing back far enough as well as quick shots in the emergency room of gunshot wounds and things moving at a pace so fast when I yelled XRAY....everybody ran ten feet away and sometimes I never even grabbed my lead apron. I never registered a significant amount of radiation on my monitor but the "Compton" or scattered radiation is everywhere for a few milliseconds. I truly believe I gave myself these two cancers. That said.....when being exposed to radiation you need to balance the exposure on one hand and the importance of the information on the other. In a world where ionizing radiation had no effect on human tissue, I would always have a CT scan as follow up imaging for RCC. Today's 64 slice scanners are so fast, you're in and out in minutes. Also most facilities do sagittal and coronal reconstruction of the original images. The amount of information the doctor gets is now overwhelming. Even when I was working, people would ask me, "what's better....a Cat Scan or an MRI"? There is no answer to that. Each has its place. Nothing comes close to MRI scanning when it comes to the Brain, Lower back, shoulders, knees, and imaging of the carotids, circle of willis and other brain angiography. You don't even need contrast to get beautiful images of the carotid arteries as in MRI we actually use your own blood flow in a sequence called "time of flight" to leave no doubt in a surgeons mind if surgery is needed. If you were never diagnosed with any adenopathy, lymph node involvement and you're just getting these follow up scans to make sure another RCC doesn't show its nasty head, then I think alternation each year would be fine. Either way, you're going to do what your new doctor wants you to do. You have some input here, but he or she is going to have their way of doing things. As far as the cost goes, I'm guessing you have insurance so the fact that MRI'S get billed at a higher dollar amount, that shouldn't matter to you. If you're paying out of pocket for all this you can always get a cash price at small diagnostic centers simply by walking in with a prescription. An MRI that in a hospital would be billed out at maybe $4,000.00 would be billed from a diagnostic center at about $1300.00. If you walk in off the street and tell any of these centers that you want a cash price for an MRI of the abdomen (attention Kidneys) you might get the entire test done for 5 or 6 hundred. These places love cash. The variance in pricing is disgusting, I know.... but it is what it is. They talk about waste fraud and abuse in the system.......the Governor of my state Rick Scott, ran a company that had to pay 1.1 Billion dollars in Medicare Fraud.....He took the 5th amendment more than 75 times and the loons in my state made him Governor a year later. Go figure. The great thing for everybody......and so many on this board as I read every day (even this morning somebody posted "because of financial difficulties they had not had follow up testing") well in only 13 months everybody will be allowed to purchase healthcare. Other than my six years in the military, I've spent my entire life in this field and I tell you, anybody who thinks that healthcare in the United States should be a "for profit" system is either evil or never knew anybody who was truly ill and without coverage through no fault of their own. Now that I've lost half of my friends on the board, let me wish you well with your new doctor. Let's hope that he or she realizes that you're the type of person who wants to be involved in his care.....and that you're treated that way.
Regards,Jeff

MedScanMan said:

So Much Here
Hi,
Let me try and explain a few things. Some of this is out of my league, but let's do some of the easy stuff first. The last thing you typed was your curiosity as to why your Mom's sugar went sky high during the PET/CT scan. If she had just a PET scan it would have been done in the nuclear medicine department. Just like bone scans, thyroid uptake scans, even stress tests done on the treadmill. The radionuclide is the injection used for the PET scan. These radioisotopes are different for each test. This is not my field but I know they use caesium 137, iodine 123 and 131, Gallium and the one everybody recognizes is Thallium as in Thallium Stress Test. In Positron Emission or PET the injection is fludeoxyglucose, and it comes under many names. So that word right there should make you understand why her sugar went up. The main ingredient in the PET scanning procedure comes from sugar. I believe the half life of this isotope is short and the body gets back to normal pretty quickly.
I don't know the results of her pathology report but I would guess if her original surgery involved lymph nodes then the increase in nodules in the lungs would be the RCC spreading. For me this would be a guess and there are so many people on this board more informed than I am when it comes to metastatic disease coming from RCC. They've been through it, and my knowledge of pathology comes directly from my reading here.
As for the two masses in the post surgery renal fossa.....if they're going away they might have been some sort of inflammatory process. Maybe two hematomas. I can't think of anything else that would go away on its own. The doctors may have been wrong on that call months ago.
If she has a mass on her duodenum (in case you don't know.....that's the very first part of the stomach) and mediastinal lymph node activity, there very well may be another primary site here. I look forward to you typing the Impression at the very bottom of her New PET/CT scan. That should pretty much answer all the questions, especially since the Radiologist has a previous exam to compare it to. Best of luck to you.
Jeff

MedScanMan said:

Not Colon Ca
It would not be colon cancer. I know it's difficult if you've never been exposed to human anatomy but this is easy for you. The digestive system begins with the esophagus (that's right after you swallow, that leads to the stomach, then on to the small bowel (intestine)through the ileocecal valve and then to the colon or Large intestine. That's the colon.... from there to the rectum. When people have a colon cancer it can be in the ascending colon, transverse colon, descending colon or the recto/sigmoid. The duodenum is at the other end. Stop letting your head twirl trying to understand "Radiologist Speak"..................it will make you nuts. You're going to have the results of a new PET/CT in a few days and your questions will be answered. Good or bad, you're going to know everything.

Jeff