They refused to use contrast!

[CtResident]

I'm not sure what to make of this situation.

I had my t-spine. They didn't use contrast. So I told them that the nurse told me it would be with and without. They said no, that the protocols for what the dr. requested didn't require the use of contrast, that it would not give any more information than the MRI without it.

Really? Is that true? Then why offer it at all, in any circumstance? Hmmm?

I saw on the paper that it mentioned hyperreflexia & fatigue. (This was a different paper than my bloodwork paper.)

I was under the impression that hyperreflXIA was different than hyperrefleXES?

Could that be the problem?

I feel mentally drained by this. BUT, you know me, gotta find the humor in it!

They gave me a CD, and it is labeled Dorsal Spine.

What am I, a fish?

Yeah, I do feel like I'm flailing around here.

Suzanne

[CtResident]

So, um, ahem, (shuffling feet)......

I was looking at that radiology assistant website we love, and IT SAYS:


MS Spinal cord Protocol

"Gadolinium is not necessary when only the spinal cord is examined.
Contrary to the brain there will only rarely be enhancement in the cord.
Only when other diagnoses are considered (e.g. sarcoid) Gd is necessary.
The most diagnostic sequence is the conventional SE PDW, because this is the most sensitive technique.
FLAIR should NOT be used in the spinal cord and will only demonstrate 10% of the lesions."

So maybe I made Much Ado about NOTHING??

If I could have one wish, it would be for consistency!

Suzanne

[smittygirl]

Suz,

In my office there would absolutely be a note AND a verbal given to the doc about what happened.  However, I have witnessed secretary's, med tech's and even nurses who just don't care or claim they are too busy.  It is shameful what goes on in some offices, sorry if I came on too strong, it just infuriates me at the lack of caring and work ethic in some of these doctors offices.  If you can, write your doctor a quick note and mail it, all mail is opened by a secretary and given to the doctor for review and then placed in your chart.  Also don't be afraid to call them again if more than a week goes by and you haven't heard from them, the squeaky wheel.....!   Hang in there!

Smitty

[CtResident]

I don't know how long it will take for the report; I was told they'd call me.

Suzanne

[CtResident]

I agree with you.....but am caught between a rock and a hard place. I did call the pcp's office and tell her that when Dr. C gets the report, and he sees that they didn't do what he asked, I don't want him to be surprised or upset about it.

Aren't nurses (PA's?) supposed to write down a note in the file if the patient calls? So will this be in my file? I want him to know that I am aware of this, and if he isn't, come June, I will fill him in!!!

Suzanne

[CtResident]

Ahh, the wonders of zoom. I think the clue might be this. On the requisition sheet it says Dorsal Pain.

What? Maybe the pcp isn't mentioning ruling out MS until he feels he can say it with certainty?

Dorsal Pain. Hmph!!!

More like gluteus maximus pain.

HA!

Suzanne

[smittygirl]

If the doctor wrote w/without contrast then THAT is what should have been done, it is never up to the tech, the radiologist or anyone else but the doctor.  The tech is there to perform the test, the radiologist is there to read it, period.  As I have mentioned before I work for a large medical group, I was to have an MRI of T & C spine as well as sacroiliac joints.  I have AS ( Ankoylosing Spondylitis)   The tech said she thought I really didn't "need" the sacroiliac done and it was a very uncomfortable test for me to go thru.  I was livid.  Long story short that tech lost her job because she didn't follow Dr's orders.  You have to be your own advocate, do let anyone push you around.  I am in full agreement with Monotreme's response to you.

[mokibear]

Geez girl, I too am sorry for today. I am in agreement with everyone else in that I don't understand how they don't have to follow the doctor's orders. I would definitely look into this further.

Thinking of you
Hugs
Moki

[wingnut19]

Hey Suz!

I'm sorry about how your experience went today....My goodness, why can't people just follow simple directions?  I wonder why they did that?!?!?  Very Strange...

I just had a question for you......I don't know how it works in the US, but how soon will the 'written' report take to be completed, do you know?  I was just wondering because it's for certain it won't take until June!

Keep your chin up, kiddo....
Tammy

[CtResident]

The Yale dr. suggested I have the t-spine MRI..........but she suggested it be done locally. So I dropped off a letter to my pcp outlining what the Yale dr. had said (no MS, have t-spine LOCALLY,see a neuro LOCALLY, take iron for low ferritin). I no longer see the Yale dr. as she seemed quite ready to dismiss me, a very condescending woman.

I asked my pcp in the letter should I do this stuff before I see the new neuro, or let the new neuro decide what he would want to do? (I do not have a new neuro yet.)

The pcp's nurse mailed me the paper for the bloodwork, then called me last week about the t-spine appt, and she specifically said with and without contrast. I remember because I was keyed in on that kind of phrase. I even asked the tech what the strength of the machine is (1.5 T).

So, today, they did what they felt was "protocol", and said that's what the supervisor said. So they did mention that a supervisor had made that decision.

I did call my pcp, but I don't know where to go from here!! Wait, I just remembered: I saw a few signs about surveys on how good the service was. Maybe if I get one of those in the mail, there will be a contact number on it? But usually they're from out of state.

Maybe I will contact the insurance company??

Suzanne

[Nerve_Wrecked]

If I recall, it was the Yale doc (or someone other than your PCP) who ordered the MRI with and without contrast right?

I'd call them, and ask what the protocal is, in this situation. I'd ask them why the techs could/would take it upon themselves to make their own requisition (basically, that's what they did, by eliminating  the contrast), and  what can be done about it now.

Christine
(un-dx)

[CtResident]

I know, I was kind of surprised. They don't know what we discussed, what the plan for my treatment is......I don't know what else to do.

I am hoping that whatever was flagged on the MRI today will be something of significance and in June (!!) when I see the pcp, we'll know what to do.

:-(

Suzanne

[monotreme]

Wow, Suzanne.  That is not the case here in DE or in PA.  They do what the doctor orders.  The radiologists do not intervene and take away contrast if it is ordered.

I am still not sure that is good medicine.  I mean, the radiologist does not know you or your symptoms, etc.  I still think it was very bad judgement.  

Sorry you had the experience.
Elaine

[CtResident]

I just called the pcp. The nurse said the radiologist can decide what to do, and that contrast is used in instances such as abdomen or kidneys.

I can call the opthamologist on my own, no referral needed.

I moved my next appt. from July 18th up to June 9th.

They will call me with results before then, I don't need to wait until June.

Now back to learning how to make red arrows on MRI images.

Suzanne

[monotreme]

Suzanne,
   The radiologist needs to do what is ordered on the form from the doctor.  If it says with and without contrast, then I believe you could demand a repeat MRI at no cost to your insurance.  Or you could call the insurance company and tell them that the doctor did not follow the order and you want a new study.  Then the center who did the test today may not get paid...too bad!!

   In any case, you need to contact the radiologist in charge TODAY and get the name of the person.  You should request that the test that was ordered should be done.  Even if a spine MRI is just looking at the discs, then contrast is used.  the spine is hard to visualize.

  So to get your money's worth, you need to get the error in judgement corrected immediately.

  Good Luck.  Remember, this is just something I would do, and my opinion only!!
Elaine

[CtResident]

My followup with the pcp is for July--- BUT, that was set up before I went to Yale. I have since dropped of a note to him explaining what the Yale dr. wanted, and how she wanted it done locally. I have cancelled any further appts. with her.

After today's bloodwork and t-spine were done, I will call and ask for a newer appt., since I also want to get my eyes looked at. I will also see if he can refer me to a local neuro. There are some in a group who work with MS folks, but not specifically MS neuros. The one at Yale was a big disappointment to me.

I don't know when I'll have the report, I am hoping by the end of this week.

Suzanne

[Want to feel well!!!]

WTF???  Why didn't they do both if both were ordered?  Talk about frustrating.

Do you know how long before the report is done?  Do you have an appointment with your GP this week or soon?  I know you want to get your hands on the report.

Hun, I hope this will lead to your answer...and like ASAP.

Wanna
  

[CtResident]

As a matter of fact, all paperwork ordered, and with my signature, is ON the CD. I zoomed in and YES, there is the request for with and without contrast.

Suzanne

[CtResident]

This CD was different than my first one (different place),  had to figure out how to see the images, then post them here.

I HAVE something! What, I do not know!

HELP!

Thank you VERY much, I appreciate it enormously.

Suzanne

[Myhope360]

As I understand with the contrast new active inflammation will show brighter than the old lesions.  The lesions on my brain MRI didn't enhance with the contrast.  It was only a brief consolation for me.  The fact that I have 13 LESIONS is bad no matter what.

Thank you

[Heather3418]

Contrast dye will highlight lesions even when they are "not active."  I hate those words "not active."  MS is ALWAYS active.  What it all really means is that if your lesions are going through changes and you are in an active flair up, this will show the radiologist exactly what is going on with those particular lesions.  It's the brightness of the contrast dye itself, that shows the radiologist if you are in an "active" flair.  But even old lesions will show up just a little bit brighter with the contrast dye and even BRIGHTER if you are in an active flair up.  Does this make any sense?  I confuse myself.

Have a great day...

Heather

[Myhope360]

I thought contrast was used to detect active inflammation.  If demyelinating disease is suspected I don't see why contrast wouldn't be used.  Contrast was used for the 3 MRI I had, c spine, t spine and brain.  Without contrast I think only old lesions are detected.  The mention of the fish made me laugh.  Thank you for making me laugh, I too was feeling frustrated today.

[Heather3418]

If it is any concellation to you, my spinal lesion showed up before the contrast and showed up after the contrast.  I was NOT in an active flair up.  But the spinal lesion showed up as an old scar.  Thankfully it did not enhance and showed no changes.  But here we are 13 years from diagnosis and that same spinal lesion is still there after all these years.  I would trust that this is one lesion that is truly scarred and the damage to that area is permanent.

Heather  

[Want to feel well!!!]

Did you make a copy of the doctor's order?  Did you see "with and without" on the order?  And, what was it the MS specialist at Yale wanted you to get?

Sorry you are feeling frustrated, and I completely understand.

Hopefully Heather can shed some light on it.

Wanna

[Heather3418]

Can you go to your profile and post any pictures from your spinal MRI, so I can see what they look like?

Heather