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Avatar universal

is further testing really necessary?

I went to the gynecologist about 2 weeks ago. My pap came up abnormal so they called me to come in for a cervical culture and did a urine catheter. Those tests came up "abnormal cells" My doctor ordered blood work and an IVP (but couldn't have it done because I am allergic to iodine) so then she ordered a renal ultrasound which I am having done tomorrow morning. When I asked what exactly they were looking for, the nurse said, " just want to be thorough... better safe than sorry." The blood work showed all normal except for a low anion gap (5.3) and low SGOT/AST (12) . I have had no symptoms that I know of.... just went in for my annual exam. Any hint on what they may be looking for would be GREATLY appreciated. I am thinking about just not having anymore tests done as I can't not afford to have anything done that is not absolutely necessary. Thanks for the input!

17 Responses
Avatar universal
a low anion gap is rare. and when it is low that means that your body is not releasing enough bicarbonates to balance out the pH in your system. sometimes this can come from vitamin deficiencies especially if youre on a starvation diet or something like that.this can sometimes signal a problem with the liver, heart or kidneys. also, a low sgot/ast of 12 also signals somethin wrong with the kidneys. your sgot/ast should be up around 20 or 30 so 12 is pretty low. when it is that low is does signal that something is wrong with the kidneys. so all signs point to the kidneys in this case. i would definatly be tested further because kidney failure is not something you want to risk just because the tests are expensive. many places have payment plans or if you fit into a certain bracket will take care of the whole expense. good luck with your test tomorrow. if you have any more questions just ask.
Avatar universal
Thank you so much for your reply!  I will definately keep my appointment for tomorrow morning.  Any idea what to expect in a renal ultrasound?  I am assuming it is basically the same as a pregnancy ultrasound except of the kidneys.  The waiting is DEFINATELY the hardest part!!  When I called to schedule the IVP and told the hospital that I was allergic to iodine they stated that I would have to be premedicated for 3 days first.  My doctor decided that I should get the renal ultrasound instead... now I am wondering if it is because she did not want me to wait or if it was just easier to have the ultrasound instead of the 3 days of medication.  Is one test better than the other?  
By the way.. one of the reasons that I was considering (not considering now :-)   not having further tests was because I had no other symptoms.  
Once again I really appreciate your input!
Avatar universal
the only difference is the kind of rays used. x-rays obviously....use x rays lol. ultrasounds use sound waves to see whats going on. the problem with any of those tests is that you can see something but not necessarily what it is. theyre not necessarily looking for a mass. they could be looking for stones, changes in the walls of your kidneys...lots of things. they are both just gateways to seeing if this is just a fluke. if either test came up with something you would see a specialist.

i would say its not because of the 3 days thing since it took 2 weeks to get an ultrasound scheduled anyways. all doctors have their own opinions and they all treat differently. if something seems suspicious theyll probably send you to a urologist. do you drink very much alcohol or have you perhaps hurt your back lately? your ast levels can be thrown off from an injury and sometimes, if you drink more alcohol than you should *wink* then that does a number on your kidneys and liver which also corrospond to your ast levels.

let me know what they say. usually the technician will be able to say whether they see something suspicious or not. and if they dont then ask. you deserve to know.
Avatar universal
I got the ultrasound within two days after my doctor received my blood work and had sent the orders to the hospital.  I am going in about an hour.  I VERY rarely drink (probably had 3 drinks in the past year... before that it was probably 3 years since I had any type of alcohol.)  I do not recall hurting my back in any way.
I will let you know what the technician said.  Hopefully I don't have to wait until the doctor calls me.  By the way.... this is all being done through my gynecologist, should I be giving my family doctor the results also?
Thanks again,
Christy
Avatar universal
you should really share your results with all your doctors. there could be a medication that he wants you on for whatever reason and if he doesnt know about any kidney problems he might not think about the possible side effects if theyre not terribly obvious. so yes i would, definately. good luck.
Avatar universal
What I don't understand is why the didn't tell you what all of the extra tests are for.   It's bad enough having an abnormal pap let alone tests that you aren't given a reason for.  It's time to ask.
Avatar universal
i think sometimes doctors think "well i dont want to freak them out and make them think the worst" so they just dont say anything. because they know a lot of people will sit at home worrying like crazy when it could be absolutely nothing. but at the same time, i would want to hear all the possibilities first off to prepare myself. because if they say "its probably nothing" and it turns out to be cancer then how do you react? if they tell me "it could be cancer" a week before hand im a lot better prepared and have already done research etc.... it just depends. there is always that what if and doctors know how bad people freak out when its unnecessary stress.
Avatar universal
Well... I am back from the ultrasound.  The tech said that she didn't see anything unusual.  Whew!  So.... now I have to try to figure out what next.  I have an appt. with my gynocologist on Tuesday so hopefully she says everything is okay and I can just drop it.  But... what would make my pap test show "abnormal cells" and either my cervical culture or my urine catheter show "abnormal" and then my anion gap and SGOT/AST to show low, but my ultrasound to be normal???
I totally agree that the doctors should always let us know more that they usually do.  I like to pray for the best but prepare for the worst.  I think it is always best to know the best case senario vs. the worst case.  
I guess I should have been more pushy when I asked what they were looking for.  I guess that initially I just figured they would let me know if I needed to worry.  But after thinking about it, I decided that I wanted to know regardless!  lol
Anyway I really appreciate all the input and please let me know what you think about everything I know so far and what ya'll might do at this point.
Thanks!!!
Christy
Avatar universal
pap smears can be abnormal from a lot of things. having sex recently, inflammation, infection (yeast or STD) etc.... tons of things can throw the test off. one of the others that seems to be becoming an epidemic lately is HPV. are you sexually active? if so, with how many people? have they ever been tested? the worst thing about HPV is that so many women think "i dont have any warts" and that that clears them of having HPV. In many women, and most men, it can stay in your system with absolutely no symptoms. it can go away on its own or it can give you cervical cancer. there are so many different strains that its hard to give just one symptom or treatment. in your blood tests did she test you for HPV? also, did she give you a class when she told you your test was abnormal? it goes from class 1 to 5. 1 being normal and 5 being cancer. all of this can run together, believe it or not. if you have an infection anywhere in your body that lowers your defenses and your body becomes wore out. your body being worn down can be the reason that you have an anion gap and also the reason your pap was abnormal. the biggest thing to remember is, you know your own body. you know when you feel normal and when you dont. if you feel no symptoms and your ultrasound came back normal then maybe youre just kinda sick or have a yeast infection. dont let a doctor tell you that its all in your head or vise versa, give you symptoms you dont have and try to dignose you with something thats not there. they tend to forget that everyone is different. my normal body temp is 87.6 not 89.7. so to most people 90 degrees isnt a fever, but for me it is. get what im saying?

i would try some vitamins or changing of your diet to be more balanced etc... go back in a month or so and check again. but make sure you dont have sex, ****** or anything else that could throw off the test like i mentioned earlier.
Avatar universal
I have been married for almost 18 years.  Not something I really like to share but... my husband did have an affair almost three years ago.  At that time we were both tested for everything and even went back 6 months later and were retested.  Both time all results came back showing that neither of us had any STD.  Could something be just now showing up even though it didn't show up in either of the previous tests?  
I don't recall her saying anything about a class.  I have a copy of the lab results from the blood work, what would I be looking for to see if she tested for HPV?  One page shows: Procedure-- CBC there are 15 things listed all appearing to be within the normal range.  Second page shows: Procedure -- TSH there is only one thing listed... TSH 2.62 uIU/ml .  Third page- Complete Metabolic Panel  18 things listed all appearing to be within normal range except the low anion gap and low SGOT/AST.  Fourth page - Lipid Profile - 4 things listed all appearing to be within normal range.
Avatar universal
if she knows you have been married that long and already tested negative she probably didnt test for it. you might just have a yeast infection or something. especially if you were tested for everything. the general rule is 6 months for something to show up. so if you went back 6 mo later and got tested again id say youre safe on the STDs.

TSH is just a test to see if you have hyper-/hypothyroidism. but your TSH is directly in the middle actually. 0.5-5.0 is a good range.

well you got me stumped lol. if everything came back normal this may have been a fluke. i would just see how long your doctor wants you to wait before having that stuff checked again. maybe a month or 2. if its balanced out then nothing to worry about. if it has been getting worse then obviously more tests need to be done. but like i said earlier. everyones body is different. plus, most drugs/tests that are done medically are tested on white men. not women. so just because you dont fit in the range of a healthy white male does not mean youre unhealthy. like i said earlier, you know your body better than anyone else. youre gonna know if something is wrong. and if you dont feel in youre gut that you need something else checked then i would relax. just maybe get blood tests every few months to make sure nothing is happening. good luck.
Avatar universal
Thank you so much for all of your input!!!  You have been tremendously kind and helpful.  I will let you know how everything turns out Tuesday.
Thanks again!
Christy
Avatar universal
Back from the doctor..... more tests!!  Results came back.... Urine, presumed voided: Rare atypical urothelial cells.  Inconclusive.  Comment:  This urine specimen demonstrates a rare cluster of small atypical urothelial cells.  Benign squamous epithelial cells are also identified.  The differential diagnosis includes a low-grade urothelial neoplasm.  However, a reactive process, including infection, instrumentation, and stones, cannot be excluded.  Close clinical correlation and follow-up is recommended.
She is sending me to an urologist Wednesday and she is doing a Cryo of cervix in four weeks (due to the abnormal cells found during my pap smear).
When I asked her if any of this could be due to an STD she said "no, all that came back good.  I was hoping it would be an infection, but there is no infection."
I was determined not to leave with any questions, but when I asked what the results meant she said something about tumors and better to catch it before it advances and I kind of blanked!  So now I am not sure if she thinks I have cancer and is sending me to urologist to be sure or what is going on.  I told my husband that he is going with me from now on, cause I seem to be getting easily confused! lol!  I am usually a pretty strong and independent person... not sure why I am being like this!
OH... the renal ultrasound seems okay to me as I am reading it... the impression says: No significant abnormalities are appreciated (I personally appreciate that are no abnormalities :-)   My husband seems to think I am weird though.. it says that my left kidney measure 12.3 cm and my right kidney measures 8.3 cm.  lol
Christy
Avatar universal
I am reading about the Cryosurgery of the cervix and thinking that I do not want to have that done.  What happens if I don't?  How do I know if this is absolutely necessary?
Avatar universal
abnormal pap smears can be very very bad. did you ever ask about the class thing i told you about? from 1-4? the difference in size is sometimes an indication of something in your kidneys but thats good that everything looked ok. still doesnt explain the results. thats probably why she wants more tests. thank god that your doctor is going this far.

i have had ruptured ovarian cysts and uterine polyps for a couple years now. i have gone to 3 separate doctors, 1 family and 2 obgyn. i tell them im having rapid weight gain, acne, pms symptoms, horrible pain, breakthrough bleeding for 10 days straight with normal periods before and after. for an entire month i didnt bleed for 5 of the 30 days. they did an ultra sound and found a polyp. then they did a hysterosonogram and said it wasnt a polyp or it ruptured because its lower in my uterus. and thats it. still bleeding, still weight gain, still acne, still high testosterone but they said "well your test came back ok" so theyre done. this is the 3rd doctor to do one test, not find something and give up. even though it doesnt take care of any of my symptoms. seriously....be thankful your doctor actually gives a **** cause im starting to lose faith in the whole system. i just have this feeling that im going to end up in the hospital on my death bed and then theyll figure out that this whole time its been some crazy disease but no one cared to test me further. if your doctor wants another test i would do it. you can never be careful enough. also considering diapers, tampons, pads and many other things made from treated cotton have toxins in them that go into your body and never leave. and these toxins are carcinigens. and if it comes back normal you just play process of elimination. there is a saying in medicine that when you hear hoofbeats think horses not zebras. well it sounds like you and i are zebras. so just keep searching until you find answers. a doctor isnt going to have you do unnecessary tests. if anything theyll write something off to not have to do a test. so if your doctor recommends it i would do it.
Avatar universal
I was so shocked when she mentioned possible tumors that I kind of blanked and forgot all the questions that I was going to ask!  I am now writing them down as I think of them.  I am definately following through on all of the tests that she has ordered.  Not looking forward to the cryosurgery but will do it anyway!  Just aggravating having to wait for more tests and not know anything right this moment.
I am so sorry to hear about all of your difficulties, I will definately say a prayer for you.  How long have you been dealing with all of this?  You mention that you have had a problem with weight gain and acne.... I have had a weight problem for years and even though I have been exercising and watching what I eat I have not been able to lose (I was able to lose in the past doing this but not this time for some reason).  I mentioned this to the doctor after she weighed me yesterday and she prescribed me Adipex so hopefully that helps.  I have also been having a problem with acne the past 6 months or so.  I am 38 and have never had a problem with that before.  Funny that you mention those two things because I would not have associated them with the other things that are going on.  
I am grateful that I have a thorough doctor and pray that you find one also!!
Christy
Avatar universal
it has been happening for about 4 years. yeah im 20 and totally past the whole puberty stage and have never had more than a zit or 2 at a time. now theyre all over no matter how much i wash my face. my boyfriend agreed to walk 2 miles a day with me to help me lose weight. he lost 5 lbs i lost 1. and one day i counted my calorie intake to see what it averages out to and its like 1500 per day which is about 700 less than my recommended for my height and stature.

i have never heard of adipex, what is that? i called yesterday and it turns out they had looked at my results a while ago....just never called me. so i set up an appt for next tues to talk about an IUD or something with no release of hormones. all of my symptoms point to poly cystic vary syndrome. i told the nurse how aggravating it is to do one test, have it ok and think that thats it. i was like "that does not take care of me bleeding for 25 days or gaining weight for no reason or having pains that bring me to tears" and i told her i was extremely mad that after 2 years of ultra sounds and tests people still wont listen to me. My first visit was august 20th and I still havent gotten my blood results back. grrr.... stupid network in united healthcare making me go to specific people.

if this doesnt go over well im going to find a new one even if i have to drive 20 miles. whats very annoying is that i have shelled out 100 bucks for nothing in the past 2 months. and i cant have a preliminary interview with the doctor to see if they will be the same way. so im jsut paying 25 dollars every visit and they wont put 2 visits on 1 thing so that i only pay 1 copay. they dont seem to understand (or care) that im a broke college student.

good luck with all your tests and i hope you find something out. because if stuff like that goes untreated it can worsen almost instantly it seems like. and the horrible thing is that some cancers grow amazingly slow. and others can appear and kill within a year or even less. its good that the pap showed that. makes you feel for all those women out there with no insurance and diseases floating in their bodies that they dont know about from people protesting planned parenthoods and clinics to shut them down. we should be thankful that we have resources to do these tests in the first place.
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