followup question to your reposnse on pain and bone cancer fear

Thank you very much for answering Dr. Juing, as I feel like a complete basket case the past few weeks.

If I could please ask you one last question. Would a chest x ray and then an abdominal ct scan with contrast take a good look at the chest bones ribs and thoracic/lumbar spine to pretty much rule out cancer as the cause of my mid chest and back pain?  I am so worried about bone cancer. I know and accept that the CT scan looks at all of the organs like lungs spleen liver etc. and rules out cancer which is a relief but I am worried about the bones/spine. My doctor says the ct is through in this regard and I shouldnt worry about bone cancer. He also says that my calcium and PTH would likely be markedly elevated with bone cancer. Those blood tests were normal. Lastly he told me that primary bone cancer in that area at my age is very rare and it would usually be mestatized from the lungs or liver in the area I am complaining about. My lungs and liver were fine on the ct scan sao he says I should stop worrying.

My psychiatrist who I had seen for years left my area a year ago and is returning at the end of June. My doctor is referring me to him as soon as he is back and says I need my meds reviewed  and maybe try some new ones, like effexor as you had mentioned as well as being able to talk about my problem with cbt. My anxiety and depression are bad and have a hypochondria type effect when I get bad pain that doesn't go away I think cancer and become highly anxious and depressed. I was also wondering if a pain management clinic might help with nerve blocks to the middle of my back.

Thanks again so much for responding to my last question and I would be much appreciative if you could answer this last question so I can try to slowly relax until I am able to see my psychiatrist at the end of June.

[J T Junig, MD PhD]

Yes, those tests (the CT studies) are very good at looking at the bony spine and ribs, for abnormal growths and masses.  And anything that grows in a bone will erode into the bone, causing changes in the alk phos and calcium levels that will be quite sensitive.

I want to share a story about a patient of mine-- she was recently having chest pain during anxiety attacks and wanted a cath to rule out a heart attack.  The hospital did a stress test and said that a cath was not needed, but she didn't take that advice, and instead went to a different hospital that was 'hungrier' for business.  They said 'sure, we will do a cath... can't be too sure!'.  During the cath, the end of the catheter was pressed against the wall of the coronary artery so that when the dye was injected it dissected the vessel.  Four hours later she left the cath lab, after having a heart attack during the procedure, and ending up with two stents to open the vessels damaged by the procedure!  The diagnosis, by the way, was that her coronaries were completely healthy-- before the cath they were, anyway.

A bone scan is pretty safe, but it does involve getting an injection of a radioactive substance, and there are always rare cases where the patient has an anaphylactic reaction to the material, or any one of a hundred other things can go wrong.  Doctors learn to decide when the risks of a test are balanced by the risks of NOT having a test-- that is part of their training and experience.  

Try your best to let go and trust the care of the doctors you are seeing.  Hard to do, the way health care has become... but still the best medicine.

[Mark2929]

to clarify I had a chest and abdominal and pelvic ct with contrast

[Mark2929]

My doctor the other day re-tested my ALP and it went down slightly to 139 and he also had the isoenzymes test re-done and it showed the ALP elevation was to the liver not bone, so my PTH, Calcium and Alk Phos(Bone) are normal and he says these would be markedly abnormal if I had bone cancer.

Hopefully you will have a chance to let me know how well the chest and abdominal CT with contrast scan look at the spine and bone. My doctor says they are very good at detecting bone abnormalities, so I don't need a bone scan.  Thanks again Dr. Juing and I will look at your web site and CBT suggestion in the next few days.

[Mark2929]

Thank you for the response Dr. Junig. I saw my doctor earlier this week and he agreed to do the bone scan, which I had yesterday, so far without any tracer side effects and I have been drinking lots of water to expel the tracer. I will have the results this coming Tuesday, however the radiologist talked to me for a brief moment after the scan and said that nothing jumped out at him and he thinks it will be fine, which is a relief. The anxiety and stress of worrying and waiting for the results has been immense and exacted an awful toll on me in the past 5 weeks. My appetite is almost non existent, I have lost about 12 pounds and have had allot of trouble sleeping.  

My family doctor has set aside 30 minutes for me to discuss my back and chest pain and stress/anxiety medical worries this coming Tuesday, which is very nice of him as he is a very busy family doctor who usually gives patients an average of about 5-10 min per visit.

My doctor feels that most all of the tests are done and the last likely test we may do is a spinal mri, as most of the pain is now in my mid-back and it is quite intense at times. Lying down with heat and tylenol  provides some relief. The great news he says is that it is not cancer or my heart causing my pain,  which I have worried about so much.

I had a spinal mri about 5-6 years ago, which showed some early minor issues with a couple of disks and also a narrowing of the facet joints and some mild scoliosis. He says its possible that I may have a partially slipped disk impacting some nerves causing my pain and if it is he will have it treated with either surgery or nerve block injections. At the very least he wants to rule that out as a source of pain. I do recall sneezing at an awkward angle about 6 weeks ago and had a tremendous waive of pain that lasted a minute and went away. The pain started a few days later and my doctor says I may have even torn a muscle somewhere. In any event if the MRI shows no nerve/disk impairment then he says my pain is likely due to my fibromyalgia, Chronic fatigue anxiety, depression and IBS and the fact I fixate and worry so much about pain and my health. Being in Canada on a public health care system I will have to wait about 4 months for the MRI and I am hoping in the interim the pain dies down.

My previous psychiatrist I saw for many years is returning to my area & I am booked for June 23rd, then every week or two, which will help. He does not however do CBT, which you had mentioned.

Do you have information you can send me on what services/prices you offer and about the webcam aspect etc. I am in the Toronto area.  I have a decent computer with high speed internet and would have to buy a webcam & microphone.  Can you please provide some detail on your cbt and psychotherapy services and how they might benefit me?

Lastly, other than the Spinal MRI my doctor is ordering,  I was wondering if you have any other test or chest/back pain therapy suggestions?  Presently I am using Tylenol 500mg 1x per day or Advil 400 mg x1 per day and am using a heating pad, which at times provides some but not total relief of pain. I have just started some chiropractic and massage therapy once a week.  The pain often, but not always worsens with most activities, usually sharp and very dull in the mid back and chest area and is really negatively impacting my quality of life.

Thanks again.