Medical WWYD?

[Tinijocaro]

A month ago I was having symptoms of an appendicitis attack. Had a ct scan done and my appenidix was fine.

They did find I had some small fibroids of no concern, and a small spot on my lung. I've never had a ct scan before. My gen doc wants me to go for a repeat chest ct scan. I'm thinking-ok I'll do it.

I went to my rheumotologist that week and mentioned that I was going to go for a repeat ct scan for the spot on my lungs. I'm on a medication that can cause cancer if used a long time, although I've only been on it for less than a year.

Rheumotologist said that a ct scan 100 times the radiation of an x-ray and that you should have them very sparingly, especially since I'm only 50. She did not recommend me going for the second catscan. She said that many. many people have a spot on their lung that just happen to be found while scanning a different part of the body, same as my fibroid. I am having no trouble or symptoms with my lungs or uterine area.

Two contrasting opinions from two medical professionals.

WWYD?

 

[JustineMarie]

A month ago I was having symptoms of an appendicitis attack. Had a ct scan done and my appenidix was fine.

They did find I had some small fibroids of no concern, and a small spot on my lung. I've never had a ct scan before. My gen doc wants me to go for a repeat chest ct scan. I'm thinking-ok I'll do it.

I went to my rheumotologist that week and mentioned that I was going to go for a repeat ct scan for the spot on my lungs. I'm on a medication that can cause cancer if used a long time, although I've only been on it for less than a year.

Rheumotologist said that a ct scan 100 times the radiation of an x-ray and that you should have them very sparingly, especially since I'm only 50. She did not recommend me going for the second catscan. She said that many. many people have a spot on their lung that just happen to be found while scanning a different part of the body, same as my fibroid. I am having no trouble or symptoms with my lungs or uterine area.

Two contrasting opinions from two medical professionals.

WWYD?

I'd get the CT scan.

 

[Pea-n-Me]

When do they want you to repeat it? Now? A month from now? Six months from now?

How does the rheumatologist suggest you monitor the spot? Surely he or she doesn't think it's something you should ignore?

And fibroids (and other gyn issues that can't always be seen on CT scan) can cause pain in that area.

 

[Tinijocaro]

Rheumy said that they would take a scan of the lung area, then need another one in 6 months so that would be THREE scans in less than a year. I'm concerned about that much radiation causing cancer, I'm concerned that I already HAVE cancer and am afraid to ignore it.

At this point I'm only concerned with the lung spot. They can take my uterus if the fibroids grow and start causing me problems!

Does anyone else think this is a difficult decision or is it me?

 

[toystory1130]

I think your correct in being concerned. It would be a hard decision for me as well, is there any other type of scan they can do to look at this spot that would not be so harmful?

 

[TipsyTraveler]

Is the rheumatologist's line of thinking that since you already have an image of the spot (caught on abdominal scan), then it's okay to wait six months for a recheck? No need to do an additional CT now because they've already captured an image of it? I could sorta kinda understand that.

What is your regular doctor's reason for wanting another scan now? To get a clearer image? To have a full view of your lungs to make sure there are no others?

Personally, paranoia would get the best of me and radiation be damned... I'd want to know exactly what's happening inside my body. I'd get the scan.

 

[Pea-n-Me]

I would work with my primary care doctor on it, since that is the doctor overseeing ALL of my care. And I would consider a pulmonary consult.

 

[TipsyTraveler]

I would work with my primary care doctor on it, since that is the doctor overseeing ALL of my care. And I would consider a pulmonary consult.

Yeah, do that.

The more I think about it, the more I think you should do the additional scan. You don't really have a baseline to compare to with the current partial-lung view. If you go for a recheck in six months and they see another spot, you'll have no idea if it was already there, how fast whatever's going on is progressing, etc., unless you have a solid starting point.

 

[Pea-n-Me]

Hopefully these will be helpful, without being too scary.

http://www.nlm.nih.gov/medlineplus/ency/article/000071.htm

http://www.foxnews.com/health/2012/07/27/lung-spots-less-dangerous-than-patients-think/

 

[TipsyTraveler]

Thanks for posting those links, Pea-n-Me.

I hope my posts didn't scare you, OP. I believe in being cautious but there's no reason to freak out just yet. (Easier said than done, I know. I always jump to the worst case scenarios in my mind when it comes to health issues.) The spot could very well be nothing. I had a coworker who had known about a nodule in her lung for more than ten years. It just sat there, doing nothing, bothering nobody, and occasionally she and her doctors would take a peek at it to make sure it was still minding it's own business.

 

[phorsenuf]

I have 4 nodules in my lungs as well as a mass that for the last few years have been hanging out doing nothing. They monitor them to make sure they do not grow. If I have not received a CT scan for a different reason within the year, then I have one done to check on them. I usually have 2-3 CT scans a year done on various parts of the body. Have they given my cancer,, or increased my chances? Who knows, but the reasons for having them done outweigh the possibility that they could.

 

[PlutoPony]

My suggestion would be to consult a Thoracic Surgeon rather than a Pulmonologist. They see spots on the lungs all the time and make determinations on whether further investigation is needed like another CT, biopsy, or even surgery. It's likely a pulmonologist would refer you to a Thoracic to get a more definitive diagnosis. We have worked with both and for something this the Thoracic really had more experience, as it's not likely to be a lung function issue. And it may well be nothing.

While I understand the Rheumotologist's point, it sounds like they think you should do nothing to investigate further at this point? That surprises me given how many more options you have if you were to have something going on with the lump and it was discovered now vs 6 months from now.

 

[Pea-n-Me]

My suggestion would be to consult a Thoracic Surgeon rather than a Pulmonologist. They see spots on the lungs all the time and make determinations on whether further investigation is needed like another CT, biopsy, or even surgery. It's likely a pulmonologist would refer you to a Thoracic to get a more definitive diagnosis. We have worked with both and for something this the Thoracic really had more experience, as it's not likely to be a lung function issue. And it may well be nothing.

I would see what my primary care recommends, but it could really go either way. A pulmonologist may take a medical approach, and that would be my preference. Some times it's a matter of who can see you first.

http://my.clevelandclinic.org/servi...-thoracic-surgeon-lung-cancer-awareness-month

Laney26: I had a chest x-ray and it said suspicious left upper lobe density. They want me to see a doctor - what type of doctor should I see? What could that mean?

Daniel_Raymond,_MD: You need to have a CT scan, the result of which can be reviewed by your primary care doctor and then you can be referred to the appropriate specialist. Alternatively, you could see a Pulmonologist or Thoracic Surgeon who can review the CT scan with you and discuss options for future management.

 

[CanBeGrumpy]

The latest issue of Consumer Reports has an article on CT scans that might help you. Also, if I were you I would be questioning the use of a CT scan for investigating appendicitis symptoms. An ultrasound might have been all that was needed. I hope you can find a good resolution to this. It is a hard decision.

 

[The Mystery Machine]

Get the scan pronto.

 

[KBoopaloo]

Was your original CT primarily an abdominal CT and now they want to do a chest CT to get a better look at the lung? If that is the case, I would definitely get the extra scan. If they are just repeating the exact same scan, I would likely consult a pulmonary or thoracic specialist first but would stilly probably get the 2nd scan.

My mom has had CTs of both her abdomen and her chest for years for a variety of reasons and while I know that parts of the chest can often be seen in the abdominal scan and parts of the abdomen can often be seen in a chest scan, it may be that they are looking to get a better angle on whatever it is they saw - which may very well be nothing. As my mom's thoracic surgeon said (when an abdominal spot was found on her chest CT!) "very often when we go looking for something, we find it" when it comes to medical scans.

As for worrying about having to get another follow up CT in 6 months, that is likely where I'd see if I could spread out the scans - get this repeat one now, get an opinion from a thoracic specialist and go from there. If the specialist wants to take a watch and wait approach, maybe see if you can spread out the time between this CT and the follow up.

 

[gottaluvPluto]

I have two nodules in my lungs that we watched for a couple of years. I no longer get them checked out because they have not grown at all. I have a pulmonary doctor that I love. He was able to give me more information than my primary doctor about my nodules. I suggest you see a pulmonary specialist and have him look at your scans.

 

[Pea-n-Me]

These things are known as "incidental findings", i.e. they happen to show up when looking at or for something else, and it's true, many of us are probably walking around with all kinds of things we're unaware of. I sometimes dread having scans for that reason.

I agree, I would probably wait to see a lung specialist in the next several weeks and take it from there. They may have a particular scan they want to use as opposed to a regular CT scan.

 

[frostedpink]

I would definitely get a repeat CT scan of the chest. What if there are more spots? I'm not trying to scare you, but a current cancer is much more scary that exposing yourself to radiation that could possibly contribute to a cancer years down the road.

From what I've read, cancer from radiation doesn't happen overnight. It can develop years (like 10 years) down the road. Sometimes the benefits of the CT scan outweigh that risk.

 

[LilyWDW]

Considering my mom passed from lung cancer, I would be getting the CT scan. You don't mess around with the possibility of cancer. Especially since waiting could make things much worst.