Radiation, Tests, and Specialists: How Much Is Too Much?

[Jemima]

I've had a bad year as far as illnesses go. So far in 2011 I've had a lung infection and something or other in the lower esophagus. So far, I've had a chest X-ray, a CT chest scan with dye, and an upper GI with Barium swallow.

I saw a specialist for the lung infection and he thought it was either pneumonia or an atypical form of TB because it responded to antibiotics rather dramatically, but neither he nor my personal doctor (who voted for walking pneumonia) knows for sure despite the tests. The Lung Guy wants me to go back and have another CT chest scan without the dye, supposedly to make sure the cavity in my lung is healing, and I also have to get a mammogram for my annual physical. I'm supposed to see a gastroenterologist, even though the bulge in my esophagus turned out to be a muscle spasm, and he may want more tests involving radiation.

I'm beginning to think this is far too much exposure and I'm sure that at least some of the specialist referrals and tests are a CYA move on the doctors' parts. I scheduled the second CT chest scan, but I'm not sure I want to go through with it right now, especially since I disliked the lung doctor so much that I canceled the follow-up appointment and am tentatively planning on seeing a different specialist.

The lung infection is over. I feel very good and rarely cough. I've had spasms in my esophagus for years which have gradually gotten better. I'm beginning to feel like I've been in the hospital anyway with all the different doctors and tests - all I need is for one of them to call at 3:00 AM and ask if I'm sleeping well - and now that I'm back to work and have no sick or vacation time left, scheduling all of this stuff on my flex days off is dicey. I'm beginning to think that most doctors have absolutely no regard for a patient's time.

Any experiences or opinions to share?

[JaneV2.0]

I think 90% of today's medical expenses are a waste of money--we've taken "worried well" to a stratospheric level--but hey! it keeps the medical-industrial complex in business. rrrrr OK, that may be hyperbolic, but that's my slant on it. I'm in queue for a new book called Overdiagnosed (Welch, Schwarts, and Woloshin), written by one of the rare doctors who agrees with me. I say if you emerged unscathed from "treatment," you should consider yourself lucky. Lots of people don't.

[CathyA]

I think its great that you are questioning this Jemima! I rarely go to docs anymore because I know it will be tons of unpleasant tests and lots of radiation. I've had probably 6-8 ct scans to my head/sinuses. Makes me think my poor memory is because of all that radiation.

If you don't like your lung doc, then find another. There is a huge variation in doctors' abilities and personalities.
I have fibromyalgia, which led me to have tons of tests over the years. Nothing ever showed, so I just accept many of the symptoms, and only go to the doc when it seems life threatening. I did finally find a great Internal Medicine doc who trusts his own clinical assessment and doesn't feel the need to trust tests all the time. I think lots of docs have lost that ability.
Another thing I've learned is that I don't have to go through with anything the doc says I have to. If a doc gets defensive because you don't want alot of radiation.....then find another one.
Jemima......may I ask your age? Are you on any meds? I'm finding that there are lots of possible ways to treat problems, without needing tons of tests or docs.
I too have esophogeal spasms, but usually know what causes them and how to avoid them.
I say listen to your inner voice that's telling you this is all too much. You can always decide differently in the future if you're feeling really bad.
Good luck!

[Jemima]

Jemima......may I ask your age? Are you on any meds? I'm finding that there are lots of possible ways to treat problems, without needing tons of tests or docs.
I too have esophogeal spasms, but usually know what causes them and how to avoid them.
I say listen to your inner voice that's telling you this is all too much. You can always decide differently in the future if you're feeling really bad.
Good luck!

I'm 65 years old, Cathy, and I take Pristiq (an antidepressant), Dynacirc (blood pressure), Evista (osteoporosis), and Lipitor. I was given a new antibiotic (something called a Z Pack, azithromycin I think) for the lung infection, which cleared up dramatically within two days of the first dose. The esophageal spasm was discovered by accident in the CT chest scan, not because of any symptoms. Dr. Doom, the lung doc, had me convinced it was cancer and I was a wreck waiting for the GI test results, which went astray between the hospital and my regular doctor's office and arrived a week later than expected. I haven't scheduled the gastroenterologist yet, and I'm ambivalent about going through with the CT chest scan.

Thanks for the book suggestion, Jane. I started reading the first pages on Amazon and definitely want to get a copy very soon.

[reader99]

Let me add a book recommendation: "Potatoes Not Prozac" by Kathleen Desmaisons, Ph.D. It's not as lame as the title might suggest. Using her eating plan - which is very doable, ordinary grocery store food - I have reduced and gone off anti-depressants (and feel so much better without the side effects), and for the first time in ages FEEL LIKE exercising, not as a Should but as a Want to. I'll give blood this week and find out if my cholesterol level has changed.

Re Lipitor, pls google 'lipitor and coq10' for cautions.

I hesitate to influence anyone to ignore medical advice, in case that might be a mistake; OTOH I feel so much better since I started googling for lifestyle changes instead of trusting doctors.

[CathyA]

Jemima........I've been thinking about this, and I find it very strange that they say they saw an esophageal spasm, and you didn't feel it. I get them, and they are extremely painful. Is it possible it is a hiatal hernia? (although that could possibly have alot of GERD symptoms.) Oh....I just read your post again and it sounds like you've had painful (?) esophageal spasms in the past. I think you need an upper endoscopy. That would show exactly what's going on in there. It just doesn't make sense to me that a pulmonologist is diagnosing your esophagus. Upper endoscopies are not difficult, since you're pretty much asleep. I definitely think you need to see a GI doc, but you don't have to do any test you don't want to. This "muscle spasm" on your CT just isn't making sense to me.
Be sure to take your ct scan/report with you to the GI doc. And make sure you know he's a good one, before you go (if you can).

Upper endoscopies don't use any radiation, which is nice.

[Jemima]

The only thing I can figure out from the Upper GI/Barium test and my personal doctor's comments is that they couldn't find anything wrong and assumed it was a spasm. I do occasionally have painful hiccups, but none during the test. I've also experienced a feeling of food "sticking" when I'm eating, but usually only something very dry (like white meat chicken or garlic bread) or something I haven't chewed very well, and those experiences have dwindled over the past several years. My doctor thought the esophageal distension was due to scarring from acid reflux. I'm just plain confused and I think I might ask the hospital or my doctor for a copy of the report. They did find a small hiatal hernia, but I also seem to remember that I was asked only to strip from the waist up for the CT chest scan and I wonder if my esophagus "distension" was the waistband button on my jeans.

I agree with you, Cathy, about the lung doctor poking his nose into another specialty. I canceled my appontment with the lung doctor and don't intend to go back, although I'm tempted to have the follow-up CT chest scan - wearing pants with a plastic button.

[CathyA]

I'm 61 and have intermittent esophageal problems. Sometimes I think I'll probably die from choking on chicken! For some reason, chicken is the worst for me. I believe we still have some hormonal fluctuations, even in menopause, which cause problems. Losing our estrogen definitely has an effect on our muscles.........of which the esophagus is a large one. I even developed sleep apnea during perimenopause......probably because of the weaking muscles. I would also wonder about some of the side-effects of your meds.
Definitely get the radiologist's report. They know how to read xrays better than the MDs most of the time.

So are your symptoms from the lung problem all gone now?

There is something called Barrett's esophagus. It can come from long-term untreated GERD. Its a precursor to cancer. The good thing about an upper endoscopy is that it will show any changes in your lower esophagus. If you have the chance to have one of those, I would do it.
I also think hiatal hernias are under estimated. I really think I have a sliding one, although most docs really downplay them. If I lean over alot, I start getting irregular heartbeats, and I'm sure its from the hiatal hernia.

That bulge they saw on your lower esophagus could have been your hiatal hernia. (part of your stomach poking through the opening in the diaphragm).
At any rate......I hope you're feeling better!

[Jemima]

Thanks for the good wishes, Cathy.

My lung problem was gone before the five-day antibiotic prescription was used up, and it's been nearly two months since I first went to the doctor for it. No more problems to date.

Anyway, I'm going to have to give this situation a lot more thought and get my hands on the Upper GI report before I decide what to do. Dr. Doom is definitely out of the picture, though.

[Jemima]

Let me add a book recommendation: "Potatoes Not Prozac" by Kathleen Desmaisons, Ph.D. It's not as lame as the title might suggest. Using her eating plan - which is very doable, ordinary grocery store food - I have reduced and gone off anti-depressants (and feel so much better without the side effects), and for the first time in ages FEEL LIKE exercising, not as a Should but as a Want to. I'll give blood this week and find out if my cholesterol level has changed.

Re Lipitor, pls google 'lipitor and coq10' for cautions.

I hesitate to influence anyone to ignore medical advice, in case that might be a mistake; OTOH I feel so much better since I started googling for lifestyle changes instead of trusting doctors.

Thanks for the book lead, reader. I think my depression has a genetic component (both parents suffered a severe depression in early adulthood and my maternal grandfather drank himself to death), so I'd be hesitant to try a special diet instead of medication, but it's an interesting book. Nutrition fascinates me.

I'm aware of the side effects of Lipitor and am ambivalent about continuing to take it. I'm considering trying half a pill between my currently scheduled blood test and the next one. My cholestrol is down to 134 and that scares me. Since I started taking it way back when, I've switched to an almost-vegetarian diet and avoid transfats like the plague they are, and I think that's caused quite a drop in cholestrol all by itself.

[CathyA]

Sounds like a good plan Jemima! Let us know how it goes.